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+Present your answer without any extraneous information.,What is optimal foraging theory when compared to automotive theft?,"See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/257885522 Prey selection among Los Angeles car thieves Article in Crime Science · December 2013 DOI: 10.1186/2193-7680-2-3 CITATIONS 14 READS 183 1 author: P. Jeffrey Brantingham University of California, Los Angeles 159 PUBLICATIONS 8,448 CITATIONS SEE PROFILE All content following this page was uploaded by P. Jeffrey Brantingham on 17 April 2020. The user has requested enhancement of the downloaded file. R E S EAR CH Open Access Prey selection among Los Angeles car thieves P Jeffrey Brantingham Abstract More than 63,000 cars were reported stolen in Los Angeles in 2003–04. However, the distribution of thefts across car types is very uneven. Some cars types such as the Honda Civic were stolen at much higher frequencies than the majority of car types. Charnov’s classic prey selection model suggests that such uneven targeting should be related to variations in the environmental abundance, expected payoffs, and handling costs associated with different car types. Street-based surveys in Los Angeles suggest that differences in abundance explain the majority of thefts. Cars stolen despite being rare may reflect offender preference based on differential payoffs, probably in some non-monetary currency such as prestige or excitement. Differential handling costs play a more ambiguous role in target selection, but may underlie thieves’ decisions to ignore some cars common in the environment. The unspecialized nature of car theft in Los Angeles suggests that the behavioral and cognitive capacities needed to be a successful car thief are generic. The evolved capacity to solve foraging problems in boundedly-rational ways, mixed with small amounts of trial-and-error and/or social learning, are sufficient to produce experts from inexperienced thieves. Keywords: Crime; Environmental criminology; Behavioral ecology; Optimal foraging; Bounded-rationality; Social learning Background The rational choice theory of crime holds that offenders engage in crime because they stand to receive significant short-term benefits with little attendant risk and small associated costs (Cornish and Clarke 1986, 1987). Presented with a suitable target or victim, unguarded by an effective security measure, the reasoning offender generally capitalizes on that opportunity (Felson and Clarke 1998; Freeman 1996). Beyond implying a common-sense relationship between benefits and costs, however, rational choice theory does not immediately identify what makes any given victim or target suitable. A conceptual framework introduced by Clarke (1999) suggests that property targets are suitable when they are concealable, removable, available, valuable, enjoyable and disposable, capturing several of the dimensions of costs and benefits that are important in offender decision making. While useful, the so-called CRAVED approach also leaves much unspecified about the relative importance of relationships among the different dimensions of target suitability. Here I turn to theory arising outside of criminology to provide a formal framework in which understand the relationships between target characteristics and offender target selection. Specifically, I use Charnov’s (1976) prey selection model to evaluate offender choice to steal different car types. The prey selection model postulates that a forager will ignore a particular prey type upon encounter if the expected return from a future prey encounter is greater. Preference in Charnov’s model is defined in terms of the relative abundance of different prey types and their respective handling costs and payoffs upon consumption. Intuitively, prey that are easy to handle or have high payoffs may be preferred but rarely taken, if they are rarely encountered. Prey that are hard to handle or have low payoffs may still be taken, if more profitable prey are rarely encountered. Here the predictions of Charnov’s prey selection model are rejected based on findings that unique car types are stolen almost exclusively in response to their environmental availability. Only occasionally are cars targeted because they have higher perceived payoffs. Overall, Los Angeles car thieves operate primarily as unspecialized foragers. Correspondence: branting@ucla.edu Department of Anthropology, University of California, Los Angeles, 341 Haines Hall, UCLA, Box 951553, Los Angeles, CA 90095-1553, USA © 2013 Brantingham; licensee Springer. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Brantingham Crime Science 2013, 2:3 http://www.crimesciencejournal.com/content/2/1/3 Optimal foraging theory and crime Foraging theory is the branch of ecology that seeks to understand how animal behavior facilitates the encounter, acquisition and processing of resources necessary to survival (Stephens and Krebs 1986). The foraging challenges facing an animal are substantial. Essential resources are rarely located in the same location as the animal needing them, necessitating behaviors that either carry the animal to the resources, or position the animal to intercept resources that move. Many resource types possess defenses that aim to thwart acquisition, even after a forager has encountered them. Animals therefore need behavioral strategies designed discriminate among resource types and defeat their defenses once they have decided to acquire them. Finally, even after a resource as been encountered and acquired, it may contain a mixture of useable and unusable constituents. Behaviors may play a key role in sorting and separating these constituents. Only after jumping these foraging hurdles may an animal benefit from the resource. Recognize, however, that the behaviors deployed to facilitate encounter, acquisition and processing of a resources are not cost free. Optimal foraging theory therefore posits that evolution and/or learning has shaped animal behavior to maximize the average or long-term return rate from essential resources, net the costs of encounter, acquisition and processing. Here I cast car theft as a foraging problem and test the proposition that the specific car types stolen represent behaviors consistent with optimal foraging theory. Three conditions must be met to consider car theft as an optimal foraging problem (see also Bernasco 2009; Felson 2006; Johnson et al. 2009). First, car theft should satisfy a need that is perceived by the offender to be essential. Car thieves report a range of motivations for stealing cars including financial motives such as theftfor-export or an immediate need for cash, mundane or routine motives such as transportation, and recreational motives such as a search for excitement, prestige or status (Copes 2003; Dhami 2008; Kellett and Gross 2006; Lantsman 2013; Light et al. 1993). With the exception of theft-for-transport, car theft is not remarkable in motivation compared with other crimes (Wright et al. 2006; Wright and Decker 1994). However, car theft may be a comparably low risk alternative to satisfy these needs (Copes and Tewksbury 2011). Between 2003 and 2006, ~12.9% of reported car thefts in the US were cleared by arrests, while robberies over the same period were cleared at a rate twice as high ~25.8% (Federal Bureau of Investigation 2003–2006). The vast majority of car thefts therefore entail no negative consequences, at least over the short term (Freeman 1999). The benefits may therefore be substantial. Payoffs to car theft might be calculated in a cash currency, if cars and/or their parts are being fenced (Clarke 1999; Tremblay et al. 2001). Payoffs might also be calculated in non-cash commodities such as barter value in drugs (Stevenson and Forsythe 1998) or prestige and excitement—an essential resource for joy riding teenagers (Copes 2003; Jacobs et al. 2003; Kellett and Gross 2006). Second, car thieves must also have behavioral alternatives to deploy during foraging and these alternatives must result in different payoff outcomes. Ethnographic evidence indicates that car theft involves choices between alternative search strategies, tools and techniques for gaining entry and ‘hot wiring’ targeted vehicles, and strategies for escape and disposal of stolen vehicles (Copes and Cherbonneau 2006; Copes and Tewksbury 2011; Farrell et al. 2011; Langworthy and Lebeau 1992; Lantsman 2013; Light et al. 1993; Lu 2003). Whether these different behavioral alternatives lead to real differences in payoffs is an open question. The observation that different car types are stolen to satisfy different needs may imply differential payoffs (Clarke 1999). However, the extent to which alternative behavioral strategies drive these payoffs, as required by optimal foraging theory, is unknown. Finally, there must be a mechanism by which car thieves select among the alternative behaviors, yielding near-optimal strategies for locating, stealing and disposing of cars. Simple trial-and-error and/or social learning in the context of co-offending appear to play this role (Akers 2008; Reiss and Farrington 1991). Juvenile car thieves often start as passengers, observing the actions of their more experienced friends (Light et al. 1993). Such learning mechanisms seem capable quickly producing effective cognitive scripts that car thieves can adhere to during commission of a crime (Tremblay et al. 2001). The prey selection model The foraging problem confronted by car thieves is similar in many ways to prey selection, a classical problem in behavioral ecology studied by Charnov (1976) and others (see Krebs et al. 1977; Stephens and Krebs 1986). Given sequential encounters with prey types, each having different expected returns and handling costs, which types should be pursued and captured? Let ei, hi and λi be the expected payoff, handling cost and local density of a prey of type i. Prey types i = 1, 2, … N are ranked in descending order of the ratio of payoff to handling cost ei/hi. The prey classification algorithm says that prey types i = 1, 2, … j should be pursued and captured upon encounter, but prey type j + 1 should be ignored if its payoff to handling cost ratio is below the mean for all higher ranked prey: Brantingham Crime Science 2013, 2:3 Page 2 of 11 http://www.crimesciencejournal.com/content/2/1/3 X j i¼1 λiei 1 þX j i¼1 λihi > ejþ1 hjþ1 ð1Þ In other words, if the expected return from future prey encounters is higher than would be gained by taking the current target, then it is better to wait. The prey choice model makes two distinctive predictions. First, prey types are either always taken upon encounter, or always ignored. This is the so-called “zero–one” rule in reference to the analytical result that an attack on prey type i will occur with probability qi = 0, or qi = 1, and nothing in between (Stephens and Krebs 1986). Second, whether or not a prey type is taken is dependent only on the encounter rate with higherranked prey, not its own encounter rate. Note that the term λi appears only on the left-hand side in Equation (1). The implication is that only changes in the encounter rate with higher ranked prey items will impact the decision to attack a lower ranked prey item once it has been encountered. Thus, if a higher ranked prey type becomes very scarce, a lower ranked prey type may be added to the diet. However, if a lower ranked prey type suddenly becomes very common, it will not necessarily be added to the diet without a concomitant change in the rate of encounter with higher ranked types. Empirical evidence from both animal (Hughes and Dunkin 1984; Prugh 2005; but see Pyke 1984) and human foragers (Hames and Vickers 1982; Smith 1991) suggests that the prey classification algorithm provides insights into prey selection behavior across a diverse range of taxa and foraging contexts. Car theft may be considered a special case of prey selection if car types vary in expected payoffs, handling costs and/or local abundance and offenders are attentive to these differences. As discussed in the Methods section, the available data on payoffs and handling times do not allow for a fine-grained test of either the zero–one rule, or the hypothesis that changes in the encounter rate with higher-ranked car types impact the inclusion of lower ranked car types in an offender’s ‘diet’. A strict reading of the prey choice model also suggests that car theft may not perfectly conform to all of its assumptions (see for comparison Smith 1991). The prey choice model assumes that: (1) foragers are long-term rate maximizers, meaning that average results of stealing cars over long time periods, rather than short-term gains, are optimized by different foraging strategies; (2) searching for and handling of targeted vehicles are mutually exclusive; (3) encounters with vehicles follow a Poisson process, meaning that two cars cannot be encountered simultaneously and each encounter is statistically independent of all others; (4) the payoff to stealing cars ei, the handling costs hi, and encounter rates λi are environmentally fixed in time and space; and (5) that the foraging car thief has perfect information about ei, hi and λi. Assumptions 1, 2, 3 and 5 may be reasonable for car theft. The notion that criminal behavioral strategies might be shaped by learning to produce long-term average rate maximization (Assumption 1) seems far fetched at first (but see Tremblay and Morselli 2000). Criminal offenders tend to be present-oriented (Gottfredson and Hirschi 1990; Nagin and Paternoster 1994) and therefore appear little concerned with the long-term costs and benefits of crime (Wilson and Abrahamse 1992). However, the question at hand is not whether crime pays relative to non-crime alternatives, but rather whether stealing one car type is more profitable in the long run than stealing an alternative car type. It is conceivable that offenders adopt strategies that maximize the longterm or average payoffs from car theft by making discriminating choices about which cars to steal. It is also reasonable to suppose that simultaneous search for cars to steal and the physical act stealing a car are mutually exclusive activities (Assumption 2). This is made more complicated by co-offending, which is quite common for younger car thieves (Light et al. 1993), if some in an offending party search nearby targets while others are breaking into a given car. It is unknown whether encounters with cars to steal follow a Poisson process (Assumption 3). Ultimately, this is an empirical question for which data need to be collected. Conceptually, however, a motivated car thief walking down a linear street segment encounters cars sequentially and independently. Whether such conditions hold in a parking lot may depend on situational factors such as the layout of and available observation points in the lot. The prey choice model is not obviated under these circumstances (Stephens and Krebs 1986: 38–45), but additional costs associated with discriminating between simultaneously encountered car types must be taken into account. Perhaps the greatest challenge comes from strictly assuming that the key parameters of prey selection remain fixed in time and space (Assumption 4) (Suresh and Tewksbury 2013). At intermediate time scales (months to years), the payoffs to stealing different car types certainly change with turnover in the composition of cars on the street. Early and late model years may differ significantly in both perceived or actual value as well as handling costs, for example, following the introduction of RFID keys for ignition systems (Farrell et al. 2011). Similarly, there may be short-term (hourly-daily) fluctuations in environmental abundance of cars parked in locations where they might be stolen. Nevertheless, it is reasonable to assume that car thieves have relatively Brantingham Crime Science 2013, 2:3 Page 3 of 11 http://www.crimesciencejournal.com/content/2/1/3 accurate knowledge of the encounter rates, payoffs and handling costs associated with different cars, or learn them very quickly when conditions change (Assumption 5) (Akers 2008; Light et al. 1993). Given the above limitations, I test a conservative null hypothesis in place of the two detailed predictions made by the prey selection model: H0. If every car yields the same payoff and all are equally difficult to steal (i. e., ei/hi = ej/hj ∀ i, j), then differences in theft rates arise only from differences in relative abundances of car types λi. In other words, if all cars rank equally in the ratio of payoffs to handling costs, then all cars are part of the ‘diet’ and should be taken immediately upon encounter. Cars encountered more frequently will appear in the diet more often and, in fact, will be stolen at a frequency proportional to λi. One should therefore expect a strong correlation between relative abundances and theft rates if the null hypothesis is true. Failure to reject the null hypothesis implies that car thieves are unspecialized foragers and take only what is presented to them by the environment. Rejection of the null hypothesis, for all or even some car types, may constitute evidence that differential payoffs and/or handling costs enter into car thieves’ situational foraging decisions. Under these circumstances we can evaluate the role that payoffs and/or handling costs may play in driving target choice. Methods Car types are defined as unique make-models or, where necessary, make-model-years. For example, 1992 and 2002 Honda Civics may be different car types, from the point of view of the offender, because they have different perceived payoffs and may also differ in how easy they are to break into and ‘hot wire’ (Farrell et al. 2011). An initial database of car make-model-years was assembled using a popular car shopping and research website, www.edmonds.com. A student assistant was then trained to quickly and accurately identify car types in pilot surveys of a university campus parking structures. Street-based surveys were conducted in three Los Angeles zip codes (90034, 90045 and 90291) during two excursions in October-December 2004 and OctoberDecember 2005. The three survey locations had the highest volume of car thefts in 2003 among zip codes on the Los Angeles West Side. Surveys involved walking between one and three contiguous blocks, first up one side and then down the other. Surveys on the exact same block segments were conducted at two-hour intervals between 6AM and 6PM. The most dramatic change in density of cars parked on the street occurred between 6AM and 8AM. I therefore assume that the mix of car types seen at 6AM represents the overnight diversity. Only vehicles in publically accessible street locations were recorded. The observed relative frequency of each car type i is used as a measure of encounter rate λi. Expected value on the illegal market is used as a proxy for the payoffs ei associated with stealing different car types (Copes 2003; Matsueda et al. 1992). I do not assume that all car thieves seek cash. Rather, illegal market value is a generic currency that is expected to be positively correlated with non-monetary payoffs. For example, a ‘hot car’ is not only more likely to demand more money in an illegal market context, but it is also expected to have a higher payoff in excitement and prestige for the teenage car thief. Illegal market value is calculated as ei = f ∑ ipivi, where pi is the proportion of cars of a given make-model-year stolen, vi is the legal market value of the car at the time of theft as determined from the Kelley Blue Book (DeBacker 2003), and f is the fraction of the legal market value realized on the illegal market. I assume that f = 0.1, but choice of a different constant does not impact the results. I use break-in times as a proxy for overall handling costs hi. The UK-based “What Car?” Security Supertest (Secured by Design 2000, 2003) conducted attack testing of new cars marketed in the UK. The tests evaluated the ability of new vehicles to withstand attacks by trained locksmiths using the non-destructive entry techniques commonly deployed by car thieves. The tests included 123 unique make-models and measured the time, in seconds, needed to gain entry to each vehicle. A car was considered to pass the test if it was not possible to gain entry within two minutes. Break-in time represents only one of the handling costs associated with car theft. I assume, however, that the handling costs at different critical points in the theft process are positively correlated. For example, if a car is easy to enter, it is also more likely to be easy to ‘hot wire’, less likely to have a geo-location device installed and be easier to chop. Evaluation of the relationships between car theft, environmental abundances, payoffs and handling costs is conducted using non-parametric statistics that are robust to ordinal scale data and non-normal distribution characteristics (Conover 1998). Theft frequencies and environmental abundances are compared using Kendall’s τ, a generalized correlation coefficient that measures the similarity of ranked order lists. Kendall’s τ b allows for rank order ties. Illegal market values and break-in times among common and rare cares are non-normally distributed. Medians therefore provide the most robust measure of central tendency and the non-parametric Mann–Whitney U the most appropriate corresponding statistical test. Differences in distribution shape are computed using the non-parametric Kolmogorov-Smirnov D. Brantingham Crime Science 2013, 2:3 Page 4 of 11 http://www.crimesciencejournal.com/content/2/1/3 Results Between 1 Jan 2003 and 31 December 2004, 63,528 vehicles were reported stolen within the City of Los Angeles (Federal Bureau of Investigation 2003–2006). In zip codes 90034, 90045 and 90291, located on the West Side of Los Angeles and representing ~3.5% of the land area of the City, a total of 2,251 cars were stolen during the same period, or ~3.5% of all thefts. These cars are divided into 271 unique make-model types. The Honda Civic and Accord, Toyota Camry and Corolla, and Nissan Sentra together comprise ~25% of the total thefts and 87 car types are represented by single thefts (Figure 1A, Table 1). To test whether the observed bias in thefts towards some car types is driven by environmental abundance, I conducted surveys of main artery and residential streets (see Methods). A total of 1,825 cars were observed and these were classified into 262 unique make-model types. As with reported thefts, the cars available on the streets are dominated by a few types (Figure 1B). Seventy seven types identified in the survey are singletons. The distribution is qualitatively similar to rank species abundance curves in ecology, which show environments numerically dominated by a few species, but most of the richness is accumulated through species with small numbers of individuals Hubbell (2001). Here I focus on the top 25 most commonly stolen cars. These car types account for 53% of the total observed volume of stolen cars (N = 1198) and the bulk of the variation in theft frequency. A comparison of theft and density rank order frequencies shows a significant positive relationship (Kendall’s τ b = 0.491, p < 0.001) (Figure 2). Thirteen of the top 25 most stolen cars are also in the top 25 for abundance (Table 1). In general, the most common cars on the street are also the most stolen. The positive relationship between abundance and theft is particularly strong among the top nine most stolen cars (Kendall’s τ b = 0.611, p = 0.022). Honda Civics are the most abundant cars and the most frequently stolen. For the top nine cars it is difficult to reject the null hypothesis that environmental abundance is driving the targeting of these vehicles for theft. Note, however, that approximately one half (N = 12) of the top 25 most stolen cars are not in the top 25 for abundance. Several of these are significant outliers (Table 1). For example, the Chrysler 300M is ranked 14, with 33 thefts in 2003–04, but was observed only 0 20 40 60 80 100 120 140 160 180 1 10 19 28 37 46 55 64 73 82 91 100 109 118 127 136 145 154 163 172 181 190 199 208 217 226 235 244 253 262 271 Number of Thefts Theft Rank Honda Civic Toyota Camry Honda Accord Jeep Grand Cherokee Ferrari 360 N = 2,251 A 0 20 40 60 80 100 120 140 Number of Cars Honda Civic Honda Accord Toyota Corolla Chevy Cavalier Porsche Carerra N = 1,825 B Figure 1 Rank order plots of make-model car types stolen and observed in street-based surveys in three Los Angeles zip codes. (A) Cars stolen in zip codes 90034, 90045 and 90291 between Jan 1, 2003 and December 31, 2004 are numerically dominated by a few car types. (B) The rank order abundance of car types in the same zip codes, observed in street surveys conducted in 2004 and 2005, reveals the structure of car theft opportunities. Brantingham Crime Science 2013, 2:3 Page 5 of 11 http://www.crimesciencejournal.com/content/2/1/3 once in the 1,825 cars identified in street surveys (survey rank = 224). Similarly, the Pontiac Grand AM was ranked 10, with 44 thefts, but was observed only four times in the same surveys (survey rank = 110.5). It may be that thieves targeted these rare cars based on specialized evaluation of the expected payoffs, handling costs, or both, made at the time of encounter. Taking into account car make, model and year, I calculated the expected illegal market value for each car stolen in 2003 as 10% of the Kelley Blue Book value at the time of theft (see Methods) (DeBacker 2003; Stevenson and Forsythe 1998; Tremblay et al. 2001). Illegal market value is used as broad proxy for both monetary and non-monetary payoffs. Figure 3 shows that the distribution of expected illegal market values for the outliers is significantly different from that associated with environmentally common cars (Mann–Whitney U = 8562, Wilcoxon = 73542, Z = −11.327, p < .001). Among the environmentally common cars, the median expected illegal market value is $740 (min = $293, max = $2,916). Among the environmentally rare cars, the median is twice as large at $1,515 (min = $210, max $4,493). These data suggest that the outliers within the sample of stolen cars may be targeted because they offer a higher expected payoff. It is also possible that ease-of-theft is responsible for the observed outliers (Farrell et al. 2011; Light et al. 1993; Wiles and Costello 2000). The UK-based “WhatCar?” Security Supertest (Secured by Design 2000, 2003), evaluated the ability of a range of new vehicles to withstand attacks using non-destructive entry techniques (see Methods). Break-in time is used as a proxy for handling costs at all stages of the theft process. The aggregated results from 2000 and 2003, excluding those cars that passed the test, show a weak, but significant relationship between break-in times and Table 1 The top 25 most stolen car types in 2003–2004 and their environmental densities in Los Angeles zip codes 90034, 90045 and 90291 Make-model Theft N Survey N Recovery N Theft p Survey p Recovery p Theft rank Survey rank HONDA CIVIC 155 128 110 0.069 0.070 0.710 1 1 TOYOTA CAMRY 151 59 118 0.067 0.032 0.781 2 4 HONDA ACCORD 109 94 81 0.048 0.052 0.743 3 2 TOYOTA COROLLA 68 86 47 0.030 0.047 0.691 4 3 NISSAN SENTRA 60 33 45 0.027 0.018 0.750 5 9 ACURA INTEGRA 52 21 28 0.023 0.012 0.538 6 14 FORD MUSTANG 50 20 41 0.022 0.011 0.820 7 16 FORD EXPLORER 49 57 35 0.022 0.031 0.714 8 5 FORD TAURUS 46 28 36 0.020 0.015 0.783 9 11 PONTIAC GRAND AM/PRIX 43 4 38 0.019 0.002 0.884 10 110.5 NISSAN ALTIMA 35 42 27 0.016 0.023 0.771 11 7 CHEVY IMPALA 34 6 26 0.015 0.003 0.765 12.5 79.5 DODGE STRATUS 34 5 30 0.015 0.003 0.882 12.5 93.5 CHRYSLER 300M 33 1 31 0.015 0.001 0.939 14 224 CHEVY BLAZER 32 15 24 0.014 0.008 0.750 15 25 CHRYSLER PT CRUISER 31 8 26 0.014 0.004 0.839 16 58 DODGE CARAVAN 28 8 18 0.012 0.004 0.643 17.5 58 DODGE INTREPID 28 9 23 0.012 0.005 0.821 17.5 49.5 JEEP CHEROKEE 27 34 16 0.012 0.019 0.593 19 8 LINCOLN TOWN CAR 24 4 22 0.011 0.002 0.917 20 110.5 DODGE NEON 23 2 19 0.010 0.001 0.826 21.5 165.5 FORD FOCUS 23 7 20 0.010 0.004 0.870 21.5 68.5 CHRYSLER SEBRING 21 3 15 0.009 0.002 0.714 24 132.5 FORD EXPEDITION 21 12 13 0.009 0.007 0.619 24 32.5 JEEP GRAND CHEROKEE 21 20 14 0.009 0.011 0.667 24 16 Note: Theft and recovery proportions are calculated with respect to all 2,251 cars stolen. Survey proportions are calculated with respect to the 1,825 unique car types identified in street-based surveys. Environmental densities were measured in two survey periods October-December 2004 and October-December 2005. Brantingham Crime Science 2013, 2:3 Page 6 of 11 http://www.crimesciencejournal.com/content/2/1/3 market price in US Dollars (r 2 = .258, p < .001) (Figure 4A). The median break-in time for all vehicle types successfully attacked was 29 seconds and the minimum time was two seconds. Twenty three cars (~19%) have break-in times under 15 seconds. Vehicle make-models are not equivalent between the UK and US markets, despite similar names, and comparable data are not available from US contexts. It is not possible therefore to map break-in times from the Security Supertests directly to car types stolen in the US Number of Thefts 100 80 60 40 20 0 Illegal Market Value in $ 0 1,000 2,000 3,000 4,000 5,000 100 80 60 40 20 0 A B Figure 3 Frequency histograms of the estimated illegal market values show much lower expected payoffs may be attributed to the top nine most stolen cars (A), where density is expected to the major determinant of theft, compared with the outliers (B), where environmental density is not implicated. 0 5 10 15 20 25 0 50 100 150 200 250 Theft Rank Survey Rank Chrysler300M Dodge Neon Chevy Impala Pontriac Grand Prix/Am Dodge Stratus Chrysler Sebring Lincoln Town Car Ford Focus Chrysler PT Cruiser Dodge Caravan Dodge Intrepid Figure 2 A scatter plot of abundance rank order against theft rank order shows a strong positive relationship between car availability and theft risk. Eleven car-types are stolen much more frequently than their environmental abundance would suggest. Line represents a hypothetical 1:1 relationship between rank abundance and rank theft. Brantingham Crime Science 2013, 2:3 Page 7 of 11 http://www.crimesciencejournal.com/content/2/1/3 using the UK data. However, some indication of handling costs may be gained by examining patterns within manufactures. Seven of the cars stolen in disproportion to their environmental density were manufactured by Daimler-Chrysler, three by Ford and two by GM (Table 1). Of the 123 cars tested in the Security Supertests, 44 were vehicles by these manufacturers. Eleven (25%) successfully withstood attacks lasting two minutes, compared with 24 of the remaining 79 car types (44%). The data may suggest that Daimler-Chrysler, GM and Ford vehicles are more broadly susceptible to attack. However, a range of break-in times characterize the vehicles that did not pass the test (Table 2). Low and high-mid market cars sold under the Chrysler brand (e.g., Neon, Grand Voyager) have minimum break-in times of between four and six seconds, while one low-market GM car sold under the Vauxhall brand had a brake-in time of two seconds. Midmarket GM cars, also sold under the Vauxhall brand, had a mean break-in time of 81 seconds. The aggregate results do not indicate that cars made by DaimlerChrysler, Ford or GM are disproportionately easier for car thieves to handle. Indeed, cars marketed by other manufacturers show a significant skew towards shorter break-in times and, by implication, lower handling costs for thieves (Kolmogorov-Smirnov Z = 1.349, p = 0.053) (Figure 4B,C). Discussion and conclusion It is difficult to reject the null hypothesis that environmental abundance is the primary determinant of what cars are targeted for theft. There is a particularly strong relationship between abundance and theft rank for the top-nine most stolen cars. In the CRAVED conceptual framework put forward by Clarke (1999), availability would seem to outweigh other dimensions that might influence theft choice. In the instances where cars are targeted despite being rare, payoff differences may play some role. Car recovery rates provide one measure of the importance of non-monetary, or possibly limited monetary payoffs to car theft (Clarke and Harris 1992). There is little systematic difference in the rate of recovery across car types (Table 1), suggesting that none of the top 25 most stolen cars are disproportionately landing in fully-body chop shops or being stolen for export. The payoffs here seem to be primarily non-monetary. Furthermore, among the outliers that are stolen despite being rare, it appears that the newest model years are targeted. For example, eight of 12 Chrysler 300s and seven of 13 Chrysler Sebrings stolen during 2003 were 2004 model years, which became available only in the last five months of the year. The implication is that these cars, though rare, were targeted precisely because they were perceived to be ‘hot rides’ (Wiles and Costello 2000). That some cars are more valuable or enjoyable can override their low availability, but this occurs infrequently. It is less apparent that lower handling costs biased thieves’ decisions to target environmentally rare cars, although ethnographic work suggests that handling costs are often a significant concern (Clarke 1999; Light et al. 1993; Wiles and Costello 2000). Recent research suggests that the potential for encountering opposition from car owners is a major concern (Copes and Tewksbury 2011), but it is uncertain how the probability of opposition might relate to car type. Direct handling costs may have played a role in driving Los Angeles car thieves to A BC Figure 4 Break-in times for UK make-models measured by the “WhatCar?” Security Supertest in 2000 and 2003. (A) Scatter plot of break-in time versus US market price implies only a weak relationship between payoffs and handling costs. Frequency histograms of the break-in times for (B) GM-, Daimler-Chrysler- and Ford-group cars and (C) all other car types. Brantingham Crime Science 2013, 2:3 Page 8 of 11 http://www.crimesciencejournal.com/content/2/1/3 ignore certain environmentally common cars. Seven make-model types including the Volkswagen Jetta, Toyota RAV4 and Nissan Xterra ranked within the top 25 for abundance, but were rarely or never stolen (Table 3). An average of 57% of the vehicles sold by the corresponding manufactures in the UK passed the Security Supertests. This is compared only 25% of Daimler-Chrysler, GM and Ford cars representative of the environmentally rare group. The implication is that these cars may be ignored because they are more resistant to attack. Detailed attack analyses of cars from the US market could help resolve the exact role of handling costs in the differential targeting of some cars. In spite of the narrow role that differential payoffs and handling costs appear to play the choice of which cars to steal, one must be careful to not fall prey to the ecological fallacy. Ethnographic evidence points to a degree of specialization among car thieves, with distinctions among those engaged in opportunistic theft and those in organized crime, and among younger and older offenders. Such specializations are not directly visible in aggregate car theft data. It is possible that the population of Los Angeles car thieves consists of several different types each with their preferred prey. The observed frequency of stolen car types might therefore represent a mixture of fixed, independent strategies, some rare and Table 3 Environmentally abundant cars of low theft rank in zip codes 90034, 90045 and 90291 and the aggregated 2000 and 2003 “WhatCar?” Security Supertest results for cars from the corresponding manufacturers Make-model Theft N Survey N Theft rank Survey rank N tested Passing p Models failing Mean (s) σ (s) Min (s) Max (s) Volkswagen Jetta 9 56 63 6 6 0.50 Lupo 1.4S, Polo Gti, Golf 1.6SE 32 16.09 19 50 Toyota RAV4 5 19 91 18 8 0.63 Yaris Verso, Corolla, Avensis 46.33 15.50 31 46 Lexus ES 15 229 25 3 0.67 IS 111 Nissan Xterra 2 16 164 21 5 0.80 Micra 1.3 SE 14 Volvo S Class 17 229 19.5 3 0.67 XC90 70 Subaru Outback 2 15 164 25 3 0.00 Impreza, Impreza Turbo, Legacy 22.67 24.79 5 51 Table 2 Break-in times in seconds for Daimler-Chrysler, Ford and GM brands sold in the UK tested in the “WhatCar?” Security Supertest in 2000 and 2003 Manufacturer Make-model Market N Mean (seconds) σ (seconds) Min (seconds) Max (seconds) Daimler-Chysler Chrysler Neon Low 1 4 Daimler-Chysler Mercedes A Class Mid 1 30 Daimler-Chysler Chrysler Grand Voyager High-mid 1 6 Daimler-Chysler Mercedes C, E Class High 2 70 7.07 65 75 Ford Fiesta, Focus Ghia Estate, Ka 3, Mazda 626 Sport Low 4 40.75 15.9 23 60 Ford Focus TDi Ghia, Ka, Streetka, Landrover Freelander, Mazda MPV, Mazda Premacy Mid 6 33.83 17.08 19 65 Ford Focus, Land Rover Discovery, Mazda 6 High-mid 3 43 13.45 28 54 Ford Mondeo, Jaguar XKR, Range Rover 4.0 HSE, Volvo XC90 High 4 69 21.76 40 93 GM Vauxall Agilla, Astra Low 2 12 13.44 2 21 GM Vauxall Corsa, Frontera, Meriva, Zafira Mid 4 81 40.04 21 108 GM Saab 93, Saab 95, Vauxall Astra High-mid 3 45.67 10.69 39 58 GM Cadillac Seville STS, Vauxall Vectra High 2 58 74.95 5 111 Total Daimler-Chrysler, GM, Ford 33 46.88 30.68 2 111 Other Car types 55 32.22 29.36 2 115 Brantingham Crime Science 2013, 2:3 Page 9 of 11 http://www.crimesciencejournal.com/content/2/1/3 some common, not variation in the behavior of offenders in general. The converse is also potentially true. There is a danger of falling prey to an ethnographic fallacy that confounds our ability to infer aggregate characteristics from ethnographically rich data collected at an individual scale. To wit, given interviews with tens of car thieves about their offending preferences, can we reliably infer the population characteristics of the many thousands of individuals likely responsible for the 63,000 cars stolen in Los Angeles in 2003-2004? There is no easy way to resolve the ecological or ethnographic fallacy. I suspect, however, that the unspecialized foragers responding primarily to environmental abundances greatly outnumber the specialists, making the latter practically invisible in aggregate data. The results described here are important for understanding the broader causes of criminal behavior and may suggest novel approaches to crime prevention based on formal ecological models (see also Bernasco 2009; Brantingham et al. 2012; Felson 2006). The unspecialized nature of car theft in Los Angeles implies that the behavioral and cognitive capacities needed to be a successful thief are generic. Indeed, humans are well-equipped to become effective foragers for criminal opportunities given an evolved psychology to solve foraging problems in boundedly-rational ways (Hutchinson et al. 2007), combined with small amounts of individual trial-and-error or social learning (Akers 2008; Boyd and Richerson 1985). Indeed, the co-offending that characterizes the early careers (<20 years old) of most offenders, including car thieves, is ideally suited to the transmission of the simple skills sufficient to produce experts from inexperienced thieves (Reiss and Farrington 1991). That auto theft in Los Angeles is driven primarily by environmental structure provides further evidence that the greatest gains in crime prevention are to be had in altering the structure of criminal opportunity (Brantingham and Brantingham 1981; Farrell et al. 2011; Felson and Clarke 1998). How environmental alterations impact situational foraging behaviors and longer-term population trajectories are well-studied within ecology (Henle et al. 2004; Kerr et al. 2007), suggesting a way forward for formal crime ecology. Competing interests The author declares that he has no competing interests. Acknowledgements This work was supported in part by grants NSF-FRG DMS-0968309, ONR N000141010221, ARO-MURI W911NF-11-1-0332, and AFOSR-MURI FA9550-10-1-0569, and by the UCLA Faculty Senate. I am indebted to the Los Angeles Police Department for providing the data analyzed here. Thank you to David Bell from Secured by Design and Silas Borden for assistance with the street-based surveys. Received: 29 November 2012 Accepted: 29 April 2013 Published: 3 July 2013 References Akers, R (2008). Social learning and social structure: A general theory of crime and deviance. Boston: Northeastern University Press. Bernasco, W. (2009). Foraging strategies of homo criminalis: lessons from behavioral ecology. Crime Patterns and Analysis, 2(1), 5–16. Boyd, R, & Richerson, PJ (1985). Culture and the Evolutionary Process. Chicago: University of Chicago Press. Brantingham, PJ, & Brantingham, PL (1981). Environmental Criminology. Beverly Hills: Sage. Brantingham, PJ, Tita, GE, Short, MB, & Reid, SE. (2012). The ecology of gang territorial boundaries. Criminology, 50(3), 851–885. Charnov, EL. (1976). Optimal foraging - attack strategy of a mantid. American Naturalist, 110(971), 141–151. Clarke, RV. (1999). Hot Products: Understanding, Anticipating and Reducing Demand for Stolen Goods (Police Research Series, Paper 112.). London: Home Office. Clarke, RV, & Harris, PM (1992). Auto Theft and its Prevention. In M Tonry (Ed.), Crime and Justice: A Review of Research (Vol. 16, pp. 1–54). Chicago: University of Chicago Press. Conover, WJ. (1998). Practical Nonparametric Statistics. Hoboken: Wiley. Copes, H. (2003). Streetlife and the rewards of auto theft. Deviant Behavior, 24(4), 309–332. Copes, H, & Cherbonneau, M. (2006). The key to auto theft - Emerging methods of auto theft from the offenders' perspective. British Journal of Criminology, 46(5), 917–934. Copes, H, & Tewksbury, R. (2011). Criminal experience and perceptions of risk: what auto thieves fear when stealing cars. Journal of Crime and Justice, 34(1), 62–79. Cornish, DB, & Clarke, RV (1986). Introduction. In DB Cornish & RV Clarke (Eds.), The Reasoning Criminal: Rational Choice Perspectives on Criminal Offending. New York: Springer-Verlag. Cornish, DB, & Clarke, RV. (1987). Understanding crime displacement: An application of rational choice theory. Criminology, 25(4), 933–947. DeBacker, P (Ed.). (2003). Kelley Blue Book Used Car Guide Consumer Edition 1988–2002. Irvine, CA: Kelly Blue Book. Dhami, MK. (2008). Youth auto theft: a survey of a general population of canadian youth. Canadian Journal of Criminology and Criminal Justice, 50(2), 187–209. Farrell, G, Tseloni, A, & Tilley, N. (2011). The effectiveness of vehicle security devices and their role in the crime drop. Criminology and Criminal Justice, 11(1), 21–35. Federal Bureau of Investigation (2003–2006). Crime in the United States, Uniform Crime Reports. http://www.fbi.gov/ucr/ucr.htm. Felson, M (2006). Crime and Nature. Thousand Oaks: Sage. Felson, M, & Clarke, RV (1998). Opportunity Makes the Thief: Practical Theory for Crime Prevention (Police Research Series Paper 98). London: Home Office Policing and Reducing Crime Unit. Freeman, RB. (1996). Why do so many young american men commit crimes and what might we do about it? The Journal of Economic Perspectives, 10(1), 25–42. Freeman, RB. (1999). The economics of crime. Handbook of Labor Economics, 3, 3529–3571. Gottfredson, MR, & Hirschi, T (1990). A General Theory of Crime. Stanford: Stanford University Press. Hames, RB, & Vickers, WT. (1982). Optimal diet breadth theory as a model to explain variability in Amazonian hunting. American Ethnologist, 9(2), 358–378. Henle, K, Davies, KF, Kleyer, M, Margules, C, & Settele, J. (2004). Predictors of species sensitivity to fragmentation. Biodiversity and Conservation, 13(1), 207–251. Hubbell, SP (2001). The Unified Neutral Theory of Biodiversity and Biogeography. Princeton: Princeton University Press. Hughes, RN, & Dunkin, SD. (1984). Behavioral components of prey selection by Dogwhelks, Nucella-Lapillus (L), feeding on Mussels, Mytilus-Edulis-L, in the Laboratory. Journal of Experimental Marine Biology and Ecology, 77(1–2), 45–68. Hutchinson, JMC, Wilke, A, & Todd, PM. (2007). Patch leaving in humans: can a generalist adapt its rules to dispersal of items across patches? Animal Behavior, 75, 1331–1349. Jacobs, BA, Topalli, V, & Wright, R. (2003). Carjacking, streetlife and offender motivation. British Journal of Criminology, 43(4), 673–688. Johnson, SD, Summers, L, & Pease, K. (2009). Offender as forager? a direct test of the boost account of victimization. Journal of Quantitative Criminology, 25(2), 181–200. Brantingham Crime Science 2013, 2:3 Page 10 of 11 http://www.crimesciencejournal.com/content/2/1/3 Kellett, S, & Gross, H. (2006). Addicted to joyriding? An exploration of young offenders' accounts of their car crime. Psychology Crime & Law, 12(1), 39–59. Kerr, JT, Kharouba, HM, & Currie, DJ. (2007). The macroecological contribution to global change solutions. Science, 316(5831), 1581–1584. Krebs, JR, Erichsen, JT, Webber, MI, & Charnov, EL. (1977). Optimal prey selection in great tit (parus-major). Animal Behaviour, 25(FEB), 30–38. Langworthy, RH, & Lebeau, JL. (1992). The spatial-distribution of sting targets. Journal of Criminal Justice, 20(6), 541–551. Lantsman, L. (2013). “Moveable currency”: the role of seaports in export oriented vehicle theft. Crime, Law and Social Change, 59(2), 157–184. Light, R, Nee, C, & Ingham, H (1993). Car Theft: The Offender's Perspective (Home Office Rresearch Study No. 30). London: Home Office. Lu, YM. (2003). Getting away with the stolen vehicle: an investigation of journeyafter-crime. The Professional Geographer, 55(4), 422–433. Matsueda, RL, Piliavin, I, Gartner, R, & Polakowski, M. (1992). The prestige of criminal and conventional occupations: a subcultural model of criminal activity. American Sociological Review, 57(6), 752–770. Nagin, DS, & Paternoster, R. (1994). Personal capital and social control: the detterence implications of a theory of individual differences in criminal offending. Criminology, 32(4), 581–606. Prugh, LR. (2005). Coyote prey selection and community stability during a decline in food supply. Oikos, 110(2), 253–264. Pyke, GH. (1984). Optimal foraging theory - a critical-review. Annual Review of Ecology and Systematics, 15, 523–575. Reiss, AJ, & Farrington, DP. (1991). Advancing knowledge about co-offending: results from a prospective longitudinal survey of London males. The Journal of Criminal Law and Criminology, 82(2), 360–395. Secured by Design (2000, 2003). The ""WhatCar?"" Security Supertests were conducted in 2000 and 2003. The attack tests are described online at http://www.whatcar.co.uk/news-special-report.aspx?NA=204498. Smith, EA (1991). Inujjuamiut Foraging Strategies: Evolutionary Ecology of an Arctic Hunting Economy. New York: Aldine de Gruyter. Stephens, DW, & Krebs, JR (1986). Foraging Theory. In. Princeton: Princeton University Press. Stevenson, RJ, & Forsythe, LMV (1998). The Stolen Goods Market in New South Wales. Sydney: New South Wales Bureau of Crime Statistics and Research. Suresh, G, & Tewksbury, R. (2999). Locations of motor vehicle theft and recovery. American Journal of Criminal Justice, 1–16. Tremblay, P, & Morselli, C. (2000). Patterns in criminal achievement: Wilson and Abrahamse revisited. Criminology, 38(2), 633–659. Tremblay, P, Talon, B, & Hurley, D. (2001). Body switching and related adaptations in the resale of stolen vehicles. Script elaborations and aggregate crime learning curves. British Journal of Criminology, 41(4), 561–579. Wiles, P, & Costello, A (2000). The 'Road to Nowhere': The Evidence for Travelling Criminals (Report 207). London: Home Office. Wilson, JQ, & Abrahamse, A. (1992). Does crime pay? Justice Quarterly, 9, 359–377. Wright, R, Brookman, F, & Bennett, T. (2006). The foreground dynamics of street robbery in Britain. British Journal of Criminology, 46(1), 1–15. Wright, RT, & Decker, SH (1994). Burglars on the Job: Streetlife and Residential Breakins. Boston: Northeastern University Press. doi:10.1186/2193-7680-2-3 Cite this article as: Brantingham: Prey selection among Los Angeles car thieves. Crime Science 2013 2:3. Submit your manuscript to a journal and benefi t from: 7 Convenient online submission 7 Rigorous peer review 7 Immediate publication on acceptance 7 Open access: articles freely available online 7 High visibility within the fi eld 7 Retaining the copyright to your article Submit your next manuscript at 7 springeropen.com Brantingham Crime Science 2013, 2:3 Page 11 of 11 http://www.crimesciencejournal.com/content/2/1/3 View publication stats","Present your answer without any extraneous information. What is optimal foraging theory when compared to automotive theft? See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/257885522 Prey selection among Los Angeles car thieves Article in Crime Science · December 2013 DOI: 10.1186/2193-7680-2-3 CITATIONS 14 READS 183 1 author: P. Jeffrey Brantingham University of California, Los Angeles 159 PUBLICATIONS 8,448 CITATIONS SEE PROFILE All content following this page was uploaded by P. Jeffrey Brantingham on 17 April 2020. The user has requested enhancement of the downloaded file. R E S EAR CH Open Access Prey selection among Los Angeles car thieves P Jeffrey Brantingham Abstract More than 63,000 cars were reported stolen in Los Angeles in 2003–04. However, the distribution of thefts across car types is very uneven. Some cars types such as the Honda Civic were stolen at much higher frequencies than the majority of car types. Charnov’s classic prey selection model suggests that such uneven targeting should be related to variations in the environmental abundance, expected payoffs, and handling costs associated with different car types. Street-based surveys in Los Angeles suggest that differences in abundance explain the majority of thefts. Cars stolen despite being rare may reflect offender preference based on differential payoffs, probably in some non-monetary currency such as prestige or excitement. Differential handling costs play a more ambiguous role in target selection, but may underlie thieves’ decisions to ignore some cars common in the environment. The unspecialized nature of car theft in Los Angeles suggests that the behavioral and cognitive capacities needed to be a successful car thief are generic. The evolved capacity to solve foraging problems in boundedly-rational ways, mixed with small amounts of trial-and-error and/or social learning, are sufficient to produce experts from inexperienced thieves. Keywords: Crime; Environmental criminology; Behavioral ecology; Optimal foraging; Bounded-rationality; Social learning Background The rational choice theory of crime holds that offenders engage in crime because they stand to receive significant short-term benefits with little attendant risk and small associated costs (Cornish and Clarke 1986, 1987). Presented with a suitable target or victim, unguarded by an effective security measure, the reasoning offender generally capitalizes on that opportunity (Felson and Clarke 1998; Freeman 1996). Beyond implying a common-sense relationship between benefits and costs, however, rational choice theory does not immediately identify what makes any given victim or target suitable. A conceptual framework introduced by Clarke (1999) suggests that property targets are suitable when they are concealable, removable, available, valuable, enjoyable and disposable, capturing several of the dimensions of costs and benefits that are important in offender decision making. While useful, the so-called CRAVED approach also leaves much unspecified about the relative importance of relationships among the different dimensions of target suitability. Here I turn to theory arising outside of criminology to provide a formal framework in which understand the relationships between target characteristics and offender target selection. Specifically, I use Charnov’s (1976) prey selection model to evaluate offender choice to steal different car types. The prey selection model postulates that a forager will ignore a particular prey type upon encounter if the expected return from a future prey encounter is greater. Preference in Charnov’s model is defined in terms of the relative abundance of different prey types and their respective handling costs and payoffs upon consumption. Intuitively, prey that are easy to handle or have high payoffs may be preferred but rarely taken, if they are rarely encountered. Prey that are hard to handle or have low payoffs may still be taken, if more profitable prey are rarely encountered. Here the predictions of Charnov’s prey selection model are rejected based on findings that unique car types are stolen almost exclusively in response to their environmental availability. Only occasionally are cars targeted because they have higher perceived payoffs. Overall, Los Angeles car thieves operate primarily as unspecialized foragers. Correspondence: branting@ucla.edu Department of Anthropology, University of California, Los Angeles, 341 Haines Hall, UCLA, Box 951553, Los Angeles, CA 90095-1553, USA © 2013 Brantingham; licensee Springer. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Brantingham Crime Science 2013, 2:3 http://www.crimesciencejournal.com/content/2/1/3 Optimal foraging theory and crime Foraging theory is the branch of ecology that seeks to understand how animal behavior facilitates the encounter, acquisition and processing of resources necessary to survival (Stephens and Krebs 1986). The foraging challenges facing an animal are substantial. Essential resources are rarely located in the same location as the animal needing them, necessitating behaviors that either carry the animal to the resources, or position the animal to intercept resources that move. Many resource types possess defenses that aim to thwart acquisition, even after a forager has encountered them. Animals therefore need behavioral strategies designed discriminate among resource types and defeat their defenses once they have decided to acquire them. Finally, even after a resource as been encountered and acquired, it may contain a mixture of useable and unusable constituents. Behaviors may play a key role in sorting and separating these constituents. Only after jumping these foraging hurdles may an animal benefit from the resource. Recognize, however, that the behaviors deployed to facilitate encounter, acquisition and processing of a resources are not cost free. Optimal foraging theory therefore posits that evolution and/or learning has shaped animal behavior to maximize the average or long-term return rate from essential resources, net the costs of encounter, acquisition and processing. Here I cast car theft as a foraging problem and test the proposition that the specific car types stolen represent behaviors consistent with optimal foraging theory. Three conditions must be met to consider car theft as an optimal foraging problem (see also Bernasco 2009; Felson 2006; Johnson et al. 2009). First, car theft should satisfy a need that is perceived by the offender to be essential. Car thieves report a range of motivations for stealing cars including financial motives such as theftfor-export or an immediate need for cash, mundane or routine motives such as transportation, and recreational motives such as a search for excitement, prestige or status (Copes 2003; Dhami 2008; Kellett and Gross 2006; Lantsman 2013; Light et al. 1993). With the exception of theft-for-transport, car theft is not remarkable in motivation compared with other crimes (Wright et al. 2006; Wright and Decker 1994). However, car theft may be a comparably low risk alternative to satisfy these needs (Copes and Tewksbury 2011). Between 2003 and 2006, ~12.9% of reported car thefts in the US were cleared by arrests, while robberies over the same period were cleared at a rate twice as high ~25.8% (Federal Bureau of Investigation 2003–2006). The vast majority of car thefts therefore entail no negative consequences, at least over the short term (Freeman 1999). The benefits may therefore be substantial. Payoffs to car theft might be calculated in a cash currency, if cars and/or their parts are being fenced (Clarke 1999; Tremblay et al. 2001). Payoffs might also be calculated in non-cash commodities such as barter value in drugs (Stevenson and Forsythe 1998) or prestige and excitement—an essential resource for joy riding teenagers (Copes 2003; Jacobs et al. 2003; Kellett and Gross 2006). Second, car thieves must also have behavioral alternatives to deploy during foraging and these alternatives must result in different payoff outcomes. Ethnographic evidence indicates that car theft involves choices between alternative search strategies, tools and techniques for gaining entry and ‘hot wiring’ targeted vehicles, and strategies for escape and disposal of stolen vehicles (Copes and Cherbonneau 2006; Copes and Tewksbury 2011; Farrell et al. 2011; Langworthy and Lebeau 1992; Lantsman 2013; Light et al. 1993; Lu 2003). Whether these different behavioral alternatives lead to real differences in payoffs is an open question. The observation that different car types are stolen to satisfy different needs may imply differential payoffs (Clarke 1999). However, the extent to which alternative behavioral strategies drive these payoffs, as required by optimal foraging theory, is unknown. Finally, there must be a mechanism by which car thieves select among the alternative behaviors, yielding near-optimal strategies for locating, stealing and disposing of cars. Simple trial-and-error and/or social learning in the context of co-offending appear to play this role (Akers 2008; Reiss and Farrington 1991). Juvenile car thieves often start as passengers, observing the actions of their more experienced friends (Light et al. 1993). Such learning mechanisms seem capable quickly producing effective cognitive scripts that car thieves can adhere to during commission of a crime (Tremblay et al. 2001). The prey selection model The foraging problem confronted by car thieves is similar in many ways to prey selection, a classical problem in behavioral ecology studied by Charnov (1976) and others (see Krebs et al. 1977; Stephens and Krebs 1986). Given sequential encounters with prey types, each having different expected returns and handling costs, which types should be pursued and captured? Let ei, hi and λi be the expected payoff, handling cost and local density of a prey of type i. Prey types i = 1, 2, … N are ranked in descending order of the ratio of payoff to handling cost ei/hi. The prey classification algorithm says that prey types i = 1, 2, … j should be pursued and captured upon encounter, but prey type j + 1 should be ignored if its payoff to handling cost ratio is below the mean for all higher ranked prey: Brantingham Crime Science 2013, 2:3 Page 2 of 11 http://www.crimesciencejournal.com/content/2/1/3 X j i¼1 λiei 1 þX j i¼1 λihi > ejþ1 hjþ1 ð1Þ In other words, if the expected return from future prey encounters is higher than would be gained by taking the current target, then it is better to wait. The prey choice model makes two distinctive predictions. First, prey types are either always taken upon encounter, or always ignored. This is the so-called “zero–one” rule in reference to the analytical result that an attack on prey type i will occur with probability qi = 0, or qi = 1, and nothing in between (Stephens and Krebs 1986). Second, whether or not a prey type is taken is dependent only on the encounter rate with higherranked prey, not its own encounter rate. Note that the term λi appears only on the left-hand side in Equation (1). The implication is that only changes in the encounter rate with higher ranked prey items will impact the decision to attack a lower ranked prey item once it has been encountered. Thus, if a higher ranked prey type becomes very scarce, a lower ranked prey type may be added to the diet. However, if a lower ranked prey type suddenly becomes very common, it will not necessarily be added to the diet without a concomitant change in the rate of encounter with higher ranked types. Empirical evidence from both animal (Hughes and Dunkin 1984; Prugh 2005; but see Pyke 1984) and human foragers (Hames and Vickers 1982; Smith 1991) suggests that the prey classification algorithm provides insights into prey selection behavior across a diverse range of taxa and foraging contexts. Car theft may be considered a special case of prey selection if car types vary in expected payoffs, handling costs and/or local abundance and offenders are attentive to these differences. As discussed in the Methods section, the available data on payoffs and handling times do not allow for a fine-grained test of either the zero–one rule, or the hypothesis that changes in the encounter rate with higher-ranked car types impact the inclusion of lower ranked car types in an offender’s ‘diet’. A strict reading of the prey choice model also suggests that car theft may not perfectly conform to all of its assumptions (see for comparison Smith 1991). The prey choice model assumes that: (1) foragers are long-term rate maximizers, meaning that average results of stealing cars over long time periods, rather than short-term gains, are optimized by different foraging strategies; (2) searching for and handling of targeted vehicles are mutually exclusive; (3) encounters with vehicles follow a Poisson process, meaning that two cars cannot be encountered simultaneously and each encounter is statistically independent of all others; (4) the payoff to stealing cars ei, the handling costs hi, and encounter rates λi are environmentally fixed in time and space; and (5) that the foraging car thief has perfect information about ei, hi and λi. Assumptions 1, 2, 3 and 5 may be reasonable for car theft. The notion that criminal behavioral strategies might be shaped by learning to produce long-term average rate maximization (Assumption 1) seems far fetched at first (but see Tremblay and Morselli 2000). Criminal offenders tend to be present-oriented (Gottfredson and Hirschi 1990; Nagin and Paternoster 1994) and therefore appear little concerned with the long-term costs and benefits of crime (Wilson and Abrahamse 1992). However, the question at hand is not whether crime pays relative to non-crime alternatives, but rather whether stealing one car type is more profitable in the long run than stealing an alternative car type. It is conceivable that offenders adopt strategies that maximize the longterm or average payoffs from car theft by making discriminating choices about which cars to steal. It is also reasonable to suppose that simultaneous search for cars to steal and the physical act stealing a car are mutually exclusive activities (Assumption 2). This is made more complicated by co-offending, which is quite common for younger car thieves (Light et al. 1993), if some in an offending party search nearby targets while others are breaking into a given car. It is unknown whether encounters with cars to steal follow a Poisson process (Assumption 3). Ultimately, this is an empirical question for which data need to be collected. Conceptually, however, a motivated car thief walking down a linear street segment encounters cars sequentially and independently. Whether such conditions hold in a parking lot may depend on situational factors such as the layout of and available observation points in the lot. The prey choice model is not obviated under these circumstances (Stephens and Krebs 1986: 38–45), but additional costs associated with discriminating between simultaneously encountered car types must be taken into account. Perhaps the greatest challenge comes from strictly assuming that the key parameters of prey selection remain fixed in time and space (Assumption 4) (Suresh and Tewksbury 2013). At intermediate time scales (months to years), the payoffs to stealing different car types certainly change with turnover in the composition of cars on the street. Early and late model years may differ significantly in both perceived or actual value as well as handling costs, for example, following the introduction of RFID keys for ignition systems (Farrell et al. 2011). Similarly, there may be short-term (hourly-daily) fluctuations in environmental abundance of cars parked in locations where they might be stolen. Nevertheless, it is reasonable to assume that car thieves have relatively Brantingham Crime Science 2013, 2:3 Page 3 of 11 http://www.crimesciencejournal.com/content/2/1/3 accurate knowledge of the encounter rates, payoffs and handling costs associated with different cars, or learn them very quickly when conditions change (Assumption 5) (Akers 2008; Light et al. 1993). Given the above limitations, I test a conservative null hypothesis in place of the two detailed predictions made by the prey selection model: H0. If every car yields the same payoff and all are equally difficult to steal (i. e., ei/hi = ej/hj ∀ i, j), then differences in theft rates arise only from differences in relative abundances of car types λi. In other words, if all cars rank equally in the ratio of payoffs to handling costs, then all cars are part of the ‘diet’ and should be taken immediately upon encounter. Cars encountered more frequently will appear in the diet more often and, in fact, will be stolen at a frequency proportional to λi. One should therefore expect a strong correlation between relative abundances and theft rates if the null hypothesis is true. Failure to reject the null hypothesis implies that car thieves are unspecialized foragers and take only what is presented to them by the environment. Rejection of the null hypothesis, for all or even some car types, may constitute evidence that differential payoffs and/or handling costs enter into car thieves’ situational foraging decisions. Under these circumstances we can evaluate the role that payoffs and/or handling costs may play in driving target choice. Methods Car types are defined as unique make-models or, where necessary, make-model-years. For example, 1992 and 2002 Honda Civics may be different car types, from the point of view of the offender, because they have different perceived payoffs and may also differ in how easy they are to break into and ‘hot wire’ (Farrell et al. 2011). An initial database of car make-model-years was assembled using a popular car shopping and research website, www.edmonds.com. A student assistant was then trained to quickly and accurately identify car types in pilot surveys of a university campus parking structures. Street-based surveys were conducted in three Los Angeles zip codes (90034, 90045 and 90291) during two excursions in October-December 2004 and OctoberDecember 2005. The three survey locations had the highest volume of car thefts in 2003 among zip codes on the Los Angeles West Side. Surveys involved walking between one and three contiguous blocks, first up one side and then down the other. Surveys on the exact same block segments were conducted at two-hour intervals between 6AM and 6PM. The most dramatic change in density of cars parked on the street occurred between 6AM and 8AM. I therefore assume that the mix of car types seen at 6AM represents the overnight diversity. Only vehicles in publically accessible street locations were recorded. The observed relative frequency of each car type i is used as a measure of encounter rate λi. Expected value on the illegal market is used as a proxy for the payoffs ei associated with stealing different car types (Copes 2003; Matsueda et al. 1992). I do not assume that all car thieves seek cash. Rather, illegal market value is a generic currency that is expected to be positively correlated with non-monetary payoffs. For example, a ‘hot car’ is not only more likely to demand more money in an illegal market context, but it is also expected to have a higher payoff in excitement and prestige for the teenage car thief. Illegal market value is calculated as ei = f ∑ ipivi, where pi is the proportion of cars of a given make-model-year stolen, vi is the legal market value of the car at the time of theft as determined from the Kelley Blue Book (DeBacker 2003), and f is the fraction of the legal market value realized on the illegal market. I assume that f = 0.1, but choice of a different constant does not impact the results. I use break-in times as a proxy for overall handling costs hi. The UK-based “What Car?” Security Supertest (Secured by Design 2000, 2003) conducted attack testing of new cars marketed in the UK. The tests evaluated the ability of new vehicles to withstand attacks by trained locksmiths using the non-destructive entry techniques commonly deployed by car thieves. The tests included 123 unique make-models and measured the time, in seconds, needed to gain entry to each vehicle. A car was considered to pass the test if it was not possible to gain entry within two minutes. Break-in time represents only one of the handling costs associated with car theft. I assume, however, that the handling costs at different critical points in the theft process are positively correlated. For example, if a car is easy to enter, it is also more likely to be easy to ‘hot wire’, less likely to have a geo-location device installed and be easier to chop. Evaluation of the relationships between car theft, environmental abundances, payoffs and handling costs is conducted using non-parametric statistics that are robust to ordinal scale data and non-normal distribution characteristics (Conover 1998). Theft frequencies and environmental abundances are compared using Kendall’s τ, a generalized correlation coefficient that measures the similarity of ranked order lists. Kendall’s τ b allows for rank order ties. Illegal market values and break-in times among common and rare cares are non-normally distributed. Medians therefore provide the most robust measure of central tendency and the non-parametric Mann–Whitney U the most appropriate corresponding statistical test. Differences in distribution shape are computed using the non-parametric Kolmogorov-Smirnov D. Brantingham Crime Science 2013, 2:3 Page 4 of 11 http://www.crimesciencejournal.com/content/2/1/3 Results Between 1 Jan 2003 and 31 December 2004, 63,528 vehicles were reported stolen within the City of Los Angeles (Federal Bureau of Investigation 2003–2006). In zip codes 90034, 90045 and 90291, located on the West Side of Los Angeles and representing ~3.5% of the land area of the City, a total of 2,251 cars were stolen during the same period, or ~3.5% of all thefts. These cars are divided into 271 unique make-model types. The Honda Civic and Accord, Toyota Camry and Corolla, and Nissan Sentra together comprise ~25% of the total thefts and 87 car types are represented by single thefts (Figure 1A, Table 1). To test whether the observed bias in thefts towards some car types is driven by environmental abundance, I conducted surveys of main artery and residential streets (see Methods). A total of 1,825 cars were observed and these were classified into 262 unique make-model types. As with reported thefts, the cars available on the streets are dominated by a few types (Figure 1B). Seventy seven types identified in the survey are singletons. The distribution is qualitatively similar to rank species abundance curves in ecology, which show environments numerically dominated by a few species, but most of the richness is accumulated through species with small numbers of individuals Hubbell (2001). Here I focus on the top 25 most commonly stolen cars. These car types account for 53% of the total observed volume of stolen cars (N = 1198) and the bulk of the variation in theft frequency. A comparison of theft and density rank order frequencies shows a significant positive relationship (Kendall’s τ b = 0.491, p < 0.001) (Figure 2). Thirteen of the top 25 most stolen cars are also in the top 25 for abundance (Table 1). In general, the most common cars on the street are also the most stolen. The positive relationship between abundance and theft is particularly strong among the top nine most stolen cars (Kendall’s τ b = 0.611, p = 0.022). Honda Civics are the most abundant cars and the most frequently stolen. For the top nine cars it is difficult to reject the null hypothesis that environmental abundance is driving the targeting of these vehicles for theft. Note, however, that approximately one half (N = 12) of the top 25 most stolen cars are not in the top 25 for abundance. Several of these are significant outliers (Table 1). For example, the Chrysler 300M is ranked 14, with 33 thefts in 2003–04, but was observed only 0 20 40 60 80 100 120 140 160 180 1 10 19 28 37 46 55 64 73 82 91 100 109 118 127 136 145 154 163 172 181 190 199 208 217 226 235 244 253 262 271 Number of Thefts Theft Rank Honda Civic Toyota Camry Honda Accord Jeep Grand Cherokee Ferrari 360 N = 2,251 A 0 20 40 60 80 100 120 140 Number of Cars Honda Civic Honda Accord Toyota Corolla Chevy Cavalier Porsche Carerra N = 1,825 B Figure 1 Rank order plots of make-model car types stolen and observed in street-based surveys in three Los Angeles zip codes. (A) Cars stolen in zip codes 90034, 90045 and 90291 between Jan 1, 2003 and December 31, 2004 are numerically dominated by a few car types. (B) The rank order abundance of car types in the same zip codes, observed in street surveys conducted in 2004 and 2005, reveals the structure of car theft opportunities. Brantingham Crime Science 2013, 2:3 Page 5 of 11 http://www.crimesciencejournal.com/content/2/1/3 once in the 1,825 cars identified in street surveys (survey rank = 224). Similarly, the Pontiac Grand AM was ranked 10, with 44 thefts, but was observed only four times in the same surveys (survey rank = 110.5). It may be that thieves targeted these rare cars based on specialized evaluation of the expected payoffs, handling costs, or both, made at the time of encounter. Taking into account car make, model and year, I calculated the expected illegal market value for each car stolen in 2003 as 10% of the Kelley Blue Book value at the time of theft (see Methods) (DeBacker 2003; Stevenson and Forsythe 1998; Tremblay et al. 2001). Illegal market value is used as broad proxy for both monetary and non-monetary payoffs. Figure 3 shows that the distribution of expected illegal market values for the outliers is significantly different from that associated with environmentally common cars (Mann–Whitney U = 8562, Wilcoxon = 73542, Z = −11.327, p < .001). Among the environmentally common cars, the median expected illegal market value is $740 (min = $293, max = $2,916). Among the environmentally rare cars, the median is twice as large at $1,515 (min = $210, max $4,493). These data suggest that the outliers within the sample of stolen cars may be targeted because they offer a higher expected payoff. It is also possible that ease-of-theft is responsible for the observed outliers (Farrell et al. 2011; Light et al. 1993; Wiles and Costello 2000). The UK-based “WhatCar?” Security Supertest (Secured by Design 2000, 2003), evaluated the ability of a range of new vehicles to withstand attacks using non-destructive entry techniques (see Methods). Break-in time is used as a proxy for handling costs at all stages of the theft process. The aggregated results from 2000 and 2003, excluding those cars that passed the test, show a weak, but significant relationship between break-in times and Table 1 The top 25 most stolen car types in 2003–2004 and their environmental densities in Los Angeles zip codes 90034, 90045 and 90291 Make-model Theft N Survey N Recovery N Theft p Survey p Recovery p Theft rank Survey rank HONDA CIVIC 155 128 110 0.069 0.070 0.710 1 1 TOYOTA CAMRY 151 59 118 0.067 0.032 0.781 2 4 HONDA ACCORD 109 94 81 0.048 0.052 0.743 3 2 TOYOTA COROLLA 68 86 47 0.030 0.047 0.691 4 3 NISSAN SENTRA 60 33 45 0.027 0.018 0.750 5 9 ACURA INTEGRA 52 21 28 0.023 0.012 0.538 6 14 FORD MUSTANG 50 20 41 0.022 0.011 0.820 7 16 FORD EXPLORER 49 57 35 0.022 0.031 0.714 8 5 FORD TAURUS 46 28 36 0.020 0.015 0.783 9 11 PONTIAC GRAND AM/PRIX 43 4 38 0.019 0.002 0.884 10 110.5 NISSAN ALTIMA 35 42 27 0.016 0.023 0.771 11 7 CHEVY IMPALA 34 6 26 0.015 0.003 0.765 12.5 79.5 DODGE STRATUS 34 5 30 0.015 0.003 0.882 12.5 93.5 CHRYSLER 300M 33 1 31 0.015 0.001 0.939 14 224 CHEVY BLAZER 32 15 24 0.014 0.008 0.750 15 25 CHRYSLER PT CRUISER 31 8 26 0.014 0.004 0.839 16 58 DODGE CARAVAN 28 8 18 0.012 0.004 0.643 17.5 58 DODGE INTREPID 28 9 23 0.012 0.005 0.821 17.5 49.5 JEEP CHEROKEE 27 34 16 0.012 0.019 0.593 19 8 LINCOLN TOWN CAR 24 4 22 0.011 0.002 0.917 20 110.5 DODGE NEON 23 2 19 0.010 0.001 0.826 21.5 165.5 FORD FOCUS 23 7 20 0.010 0.004 0.870 21.5 68.5 CHRYSLER SEBRING 21 3 15 0.009 0.002 0.714 24 132.5 FORD EXPEDITION 21 12 13 0.009 0.007 0.619 24 32.5 JEEP GRAND CHEROKEE 21 20 14 0.009 0.011 0.667 24 16 Note: Theft and recovery proportions are calculated with respect to all 2,251 cars stolen. Survey proportions are calculated with respect to the 1,825 unique car types identified in street-based surveys. Environmental densities were measured in two survey periods October-December 2004 and October-December 2005. Brantingham Crime Science 2013, 2:3 Page 6 of 11 http://www.crimesciencejournal.com/content/2/1/3 market price in US Dollars (r 2 = .258, p < .001) (Figure 4A). The median break-in time for all vehicle types successfully attacked was 29 seconds and the minimum time was two seconds. Twenty three cars (~19%) have break-in times under 15 seconds. Vehicle make-models are not equivalent between the UK and US markets, despite similar names, and comparable data are not available from US contexts. It is not possible therefore to map break-in times from the Security Supertests directly to car types stolen in the US Number of Thefts 100 80 60 40 20 0 Illegal Market Value in $ 0 1,000 2,000 3,000 4,000 5,000 100 80 60 40 20 0 A B Figure 3 Frequency histograms of the estimated illegal market values show much lower expected payoffs may be attributed to the top nine most stolen cars (A), where density is expected to the major determinant of theft, compared with the outliers (B), where environmental density is not implicated. 0 5 10 15 20 25 0 50 100 150 200 250 Theft Rank Survey Rank Chrysler300M Dodge Neon Chevy Impala Pontriac Grand Prix/Am Dodge Stratus Chrysler Sebring Lincoln Town Car Ford Focus Chrysler PT Cruiser Dodge Caravan Dodge Intrepid Figure 2 A scatter plot of abundance rank order against theft rank order shows a strong positive relationship between car availability and theft risk. Eleven car-types are stolen much more frequently than their environmental abundance would suggest. Line represents a hypothetical 1:1 relationship between rank abundance and rank theft. Brantingham Crime Science 2013, 2:3 Page 7 of 11 http://www.crimesciencejournal.com/content/2/1/3 using the UK data. However, some indication of handling costs may be gained by examining patterns within manufactures. Seven of the cars stolen in disproportion to their environmental density were manufactured by Daimler-Chrysler, three by Ford and two by GM (Table 1). Of the 123 cars tested in the Security Supertests, 44 were vehicles by these manufacturers. Eleven (25%) successfully withstood attacks lasting two minutes, compared with 24 of the remaining 79 car types (44%). The data may suggest that Daimler-Chrysler, GM and Ford vehicles are more broadly susceptible to attack. However, a range of break-in times characterize the vehicles that did not pass the test (Table 2). Low and high-mid market cars sold under the Chrysler brand (e.g., Neon, Grand Voyager) have minimum break-in times of between four and six seconds, while one low-market GM car sold under the Vauxhall brand had a brake-in time of two seconds. Midmarket GM cars, also sold under the Vauxhall brand, had a mean break-in time of 81 seconds. The aggregate results do not indicate that cars made by DaimlerChrysler, Ford or GM are disproportionately easier for car thieves to handle. Indeed, cars marketed by other manufacturers show a significant skew towards shorter break-in times and, by implication, lower handling costs for thieves (Kolmogorov-Smirnov Z = 1.349, p = 0.053) (Figure 4B,C). Discussion and conclusion It is difficult to reject the null hypothesis that environmental abundance is the primary determinant of what cars are targeted for theft. There is a particularly strong relationship between abundance and theft rank for the top-nine most stolen cars. In the CRAVED conceptual framework put forward by Clarke (1999), availability would seem to outweigh other dimensions that might influence theft choice. In the instances where cars are targeted despite being rare, payoff differences may play some role. Car recovery rates provide one measure of the importance of non-monetary, or possibly limited monetary payoffs to car theft (Clarke and Harris 1992). There is little systematic difference in the rate of recovery across car types (Table 1), suggesting that none of the top 25 most stolen cars are disproportionately landing in fully-body chop shops or being stolen for export. The payoffs here seem to be primarily non-monetary. Furthermore, among the outliers that are stolen despite being rare, it appears that the newest model years are targeted. For example, eight of 12 Chrysler 300s and seven of 13 Chrysler Sebrings stolen during 2003 were 2004 model years, which became available only in the last five months of the year. The implication is that these cars, though rare, were targeted precisely because they were perceived to be ‘hot rides’ (Wiles and Costello 2000). That some cars are more valuable or enjoyable can override their low availability, but this occurs infrequently. It is less apparent that lower handling costs biased thieves’ decisions to target environmentally rare cars, although ethnographic work suggests that handling costs are often a significant concern (Clarke 1999; Light et al. 1993; Wiles and Costello 2000). Recent research suggests that the potential for encountering opposition from car owners is a major concern (Copes and Tewksbury 2011), but it is uncertain how the probability of opposition might relate to car type. Direct handling costs may have played a role in driving Los Angeles car thieves to A BC Figure 4 Break-in times for UK make-models measured by the “WhatCar?” Security Supertest in 2000 and 2003. (A) Scatter plot of break-in time versus US market price implies only a weak relationship between payoffs and handling costs. Frequency histograms of the break-in times for (B) GM-, Daimler-Chrysler- and Ford-group cars and (C) all other car types. Brantingham Crime Science 2013, 2:3 Page 8 of 11 http://www.crimesciencejournal.com/content/2/1/3 ignore certain environmentally common cars. Seven make-model types including the Volkswagen Jetta, Toyota RAV4 and Nissan Xterra ranked within the top 25 for abundance, but were rarely or never stolen (Table 3). An average of 57% of the vehicles sold by the corresponding manufactures in the UK passed the Security Supertests. This is compared only 25% of Daimler-Chrysler, GM and Ford cars representative of the environmentally rare group. The implication is that these cars may be ignored because they are more resistant to attack. Detailed attack analyses of cars from the US market could help resolve the exact role of handling costs in the differential targeting of some cars. In spite of the narrow role that differential payoffs and handling costs appear to play the choice of which cars to steal, one must be careful to not fall prey to the ecological fallacy. Ethnographic evidence points to a degree of specialization among car thieves, with distinctions among those engaged in opportunistic theft and those in organized crime, and among younger and older offenders. Such specializations are not directly visible in aggregate car theft data. It is possible that the population of Los Angeles car thieves consists of several different types each with their preferred prey. The observed frequency of stolen car types might therefore represent a mixture of fixed, independent strategies, some rare and Table 3 Environmentally abundant cars of low theft rank in zip codes 90034, 90045 and 90291 and the aggregated 2000 and 2003 “WhatCar?” Security Supertest results for cars from the corresponding manufacturers Make-model Theft N Survey N Theft rank Survey rank N tested Passing p Models failing Mean (s) σ (s) Min (s) Max (s) Volkswagen Jetta 9 56 63 6 6 0.50 Lupo 1.4S, Polo Gti, Golf 1.6SE 32 16.09 19 50 Toyota RAV4 5 19 91 18 8 0.63 Yaris Verso, Corolla, Avensis 46.33 15.50 31 46 Lexus ES 15 229 25 3 0.67 IS 111 Nissan Xterra 2 16 164 21 5 0.80 Micra 1.3 SE 14 Volvo S Class 17 229 19.5 3 0.67 XC90 70 Subaru Outback 2 15 164 25 3 0.00 Impreza, Impreza Turbo, Legacy 22.67 24.79 5 51 Table 2 Break-in times in seconds for Daimler-Chrysler, Ford and GM brands sold in the UK tested in the “WhatCar?” Security Supertest in 2000 and 2003 Manufacturer Make-model Market N Mean (seconds) σ (seconds) Min (seconds) Max (seconds) Daimler-Chysler Chrysler Neon Low 1 4 Daimler-Chysler Mercedes A Class Mid 1 30 Daimler-Chysler Chrysler Grand Voyager High-mid 1 6 Daimler-Chysler Mercedes C, E Class High 2 70 7.07 65 75 Ford Fiesta, Focus Ghia Estate, Ka 3, Mazda 626 Sport Low 4 40.75 15.9 23 60 Ford Focus TDi Ghia, Ka, Streetka, Landrover Freelander, Mazda MPV, Mazda Premacy Mid 6 33.83 17.08 19 65 Ford Focus, Land Rover Discovery, Mazda 6 High-mid 3 43 13.45 28 54 Ford Mondeo, Jaguar XKR, Range Rover 4.0 HSE, Volvo XC90 High 4 69 21.76 40 93 GM Vauxall Agilla, Astra Low 2 12 13.44 2 21 GM Vauxall Corsa, Frontera, Meriva, Zafira Mid 4 81 40.04 21 108 GM Saab 93, Saab 95, Vauxall Astra High-mid 3 45.67 10.69 39 58 GM Cadillac Seville STS, Vauxall Vectra High 2 58 74.95 5 111 Total Daimler-Chrysler, GM, Ford 33 46.88 30.68 2 111 Other Car types 55 32.22 29.36 2 115 Brantingham Crime Science 2013, 2:3 Page 9 of 11 http://www.crimesciencejournal.com/content/2/1/3 some common, not variation in the behavior of offenders in general. The converse is also potentially true. There is a danger of falling prey to an ethnographic fallacy that confounds our ability to infer aggregate characteristics from ethnographically rich data collected at an individual scale. To wit, given interviews with tens of car thieves about their offending preferences, can we reliably infer the population characteristics of the many thousands of individuals likely responsible for the 63,000 cars stolen in Los Angeles in 2003-2004? There is no easy way to resolve the ecological or ethnographic fallacy. I suspect, however, that the unspecialized foragers responding primarily to environmental abundances greatly outnumber the specialists, making the latter practically invisible in aggregate data. The results described here are important for understanding the broader causes of criminal behavior and may suggest novel approaches to crime prevention based on formal ecological models (see also Bernasco 2009; Brantingham et al. 2012; Felson 2006). The unspecialized nature of car theft in Los Angeles implies that the behavioral and cognitive capacities needed to be a successful thief are generic. Indeed, humans are well-equipped to become effective foragers for criminal opportunities given an evolved psychology to solve foraging problems in boundedly-rational ways (Hutchinson et al. 2007), combined with small amounts of individual trial-and-error or social learning (Akers 2008; Boyd and Richerson 1985). Indeed, the co-offending that characterizes the early careers (<20 years old) of most offenders, including car thieves, is ideally suited to the transmission of the simple skills sufficient to produce experts from inexperienced thieves (Reiss and Farrington 1991). That auto theft in Los Angeles is driven primarily by environmental structure provides further evidence that the greatest gains in crime prevention are to be had in altering the structure of criminal opportunity (Brantingham and Brantingham 1981; Farrell et al. 2011; Felson and Clarke 1998). How environmental alterations impact situational foraging behaviors and longer-term population trajectories are well-studied within ecology (Henle et al. 2004; Kerr et al. 2007), suggesting a way forward for formal crime ecology. Competing interests The author declares that he has no competing interests. Acknowledgements This work was supported in part by grants NSF-FRG DMS-0968309, ONR N000141010221, ARO-MURI W911NF-11-1-0332, and AFOSR-MURI FA9550-10-1-0569, and by the UCLA Faculty Senate. I am indebted to the Los Angeles Police Department for providing the data analyzed here. Thank you to David Bell from Secured by Design and Silas Borden for assistance with the street-based surveys. Received: 29 November 2012 Accepted: 29 April 2013 Published: 3 July 2013 References Akers, R (2008). Social learning and social structure: A general theory of crime and deviance. Boston: Northeastern University Press. Bernasco, W. (2009). Foraging strategies of homo criminalis: lessons from behavioral ecology. Crime Patterns and Analysis, 2(1), 5–16. Boyd, R, & Richerson, PJ (1985). Culture and the Evolutionary Process. Chicago: University of Chicago Press. Brantingham, PJ, & Brantingham, PL (1981). Environmental Criminology. Beverly Hills: Sage. Brantingham, PJ, Tita, GE, Short, MB, & Reid, SE. (2012). The ecology of gang territorial boundaries. Criminology, 50(3), 851–885. Charnov, EL. (1976). Optimal foraging - attack strategy of a mantid. American Naturalist, 110(971), 141–151. Clarke, RV. (1999). Hot Products: Understanding, Anticipating and Reducing Demand for Stolen Goods (Police Research Series, Paper 112.). London: Home Office. Clarke, RV, & Harris, PM (1992). Auto Theft and its Prevention. In M Tonry (Ed.), Crime and Justice: A Review of Research (Vol. 16, pp. 1–54). Chicago: University of Chicago Press. Conover, WJ. (1998). Practical Nonparametric Statistics. Hoboken: Wiley. Copes, H. (2003). Streetlife and the rewards of auto theft. Deviant Behavior, 24(4), 309–332. Copes, H, & Cherbonneau, M. (2006). The key to auto theft - Emerging methods of auto theft from the offenders' perspective. British Journal of Criminology, 46(5), 917–934. Copes, H, & Tewksbury, R. (2011). Criminal experience and perceptions of risk: what auto thieves fear when stealing cars. Journal of Crime and Justice, 34(1), 62–79. Cornish, DB, & Clarke, RV (1986). Introduction. In DB Cornish & RV Clarke (Eds.), The Reasoning Criminal: Rational Choice Perspectives on Criminal Offending. New York: Springer-Verlag. Cornish, DB, & Clarke, RV. (1987). Understanding crime displacement: An application of rational choice theory. Criminology, 25(4), 933–947. DeBacker, P (Ed.). (2003). Kelley Blue Book Used Car Guide Consumer Edition 1988–2002. Irvine, CA: Kelly Blue Book. Dhami, MK. (2008). Youth auto theft: a survey of a general population of canadian youth. Canadian Journal of Criminology and Criminal Justice, 50(2), 187–209. Farrell, G, Tseloni, A, & Tilley, N. (2011). The effectiveness of vehicle security devices and their role in the crime drop. Criminology and Criminal Justice, 11(1), 21–35. Federal Bureau of Investigation (2003–2006). Crime in the United States, Uniform Crime Reports. http://www.fbi.gov/ucr/ucr.htm. Felson, M (2006). Crime and Nature. Thousand Oaks: Sage. Felson, M, & Clarke, RV (1998). Opportunity Makes the Thief: Practical Theory for Crime Prevention (Police Research Series Paper 98). London: Home Office Policing and Reducing Crime Unit. Freeman, RB. (1996). Why do so many young american men commit crimes and what might we do about it? The Journal of Economic Perspectives, 10(1), 25–42. Freeman, RB. (1999). The economics of crime. Handbook of Labor Economics, 3, 3529–3571. Gottfredson, MR, & Hirschi, T (1990). A General Theory of Crime. Stanford: Stanford University Press. Hames, RB, & Vickers, WT. (1982). Optimal diet breadth theory as a model to explain variability in Amazonian hunting. American Ethnologist, 9(2), 358–378. Henle, K, Davies, KF, Kleyer, M, Margules, C, & Settele, J. (2004). Predictors of species sensitivity to fragmentation. Biodiversity and Conservation, 13(1), 207–251. Hubbell, SP (2001). The Unified Neutral Theory of Biodiversity and Biogeography. Princeton: Princeton University Press. Hughes, RN, & Dunkin, SD. (1984). Behavioral components of prey selection by Dogwhelks, Nucella-Lapillus (L), feeding on Mussels, Mytilus-Edulis-L, in the Laboratory. Journal of Experimental Marine Biology and Ecology, 77(1–2), 45–68. Hutchinson, JMC, Wilke, A, & Todd, PM. (2007). Patch leaving in humans: can a generalist adapt its rules to dispersal of items across patches? Animal Behavior, 75, 1331–1349. Jacobs, BA, Topalli, V, & Wright, R. (2003). Carjacking, streetlife and offender motivation. British Journal of Criminology, 43(4), 673–688. Johnson, SD, Summers, L, & Pease, K. (2009). Offender as forager? a direct test of the boost account of victimization. Journal of Quantitative Criminology, 25(2), 181–200. Brantingham Crime Science 2013, 2:3 Page 10 of 11 http://www.crimesciencejournal.com/content/2/1/3 Kellett, S, & Gross, H. (2006). Addicted to joyriding? An exploration of young offenders' accounts of their car crime. Psychology Crime & Law, 12(1), 39–59. Kerr, JT, Kharouba, HM, & Currie, DJ. (2007). The macroecological contribution to global change solutions. Science, 316(5831), 1581–1584. Krebs, JR, Erichsen, JT, Webber, MI, & Charnov, EL. (1977). Optimal prey selection in great tit (parus-major). Animal Behaviour, 25(FEB), 30–38. Langworthy, RH, & Lebeau, JL. (1992). The spatial-distribution of sting targets. Journal of Criminal Justice, 20(6), 541–551. Lantsman, L. (2013). “Moveable currency”: the role of seaports in export oriented vehicle theft. Crime, Law and Social Change, 59(2), 157–184. Light, R, Nee, C, & Ingham, H (1993). Car Theft: The Offender's Perspective (Home Office Rresearch Study No. 30). London: Home Office. Lu, YM. (2003). Getting away with the stolen vehicle: an investigation of journeyafter-crime. The Professional Geographer, 55(4), 422–433. Matsueda, RL, Piliavin, I, Gartner, R, & Polakowski, M. (1992). The prestige of criminal and conventional occupations: a subcultural model of criminal activity. American Sociological Review, 57(6), 752–770. Nagin, DS, & Paternoster, R. (1994). Personal capital and social control: the detterence implications of a theory of individual differences in criminal offending. Criminology, 32(4), 581–606. Prugh, LR. (2005). Coyote prey selection and community stability during a decline in food supply. Oikos, 110(2), 253–264. Pyke, GH. (1984). Optimal foraging theory - a critical-review. Annual Review of Ecology and Systematics, 15, 523–575. Reiss, AJ, & Farrington, DP. (1991). Advancing knowledge about co-offending: results from a prospective longitudinal survey of London males. The Journal of Criminal Law and Criminology, 82(2), 360–395. Secured by Design (2000, 2003). The ""WhatCar?"" Security Supertests were conducted in 2000 and 2003. The attack tests are described online at http://www.whatcar.co.uk/news-special-report.aspx?NA=204498. Smith, EA (1991). Inujjuamiut Foraging Strategies: Evolutionary Ecology of an Arctic Hunting Economy. New York: Aldine de Gruyter. Stephens, DW, & Krebs, JR (1986). Foraging Theory. In. Princeton: Princeton University Press. Stevenson, RJ, & Forsythe, LMV (1998). The Stolen Goods Market in New South Wales. Sydney: New South Wales Bureau of Crime Statistics and Research. Suresh, G, & Tewksbury, R. (2999). Locations of motor vehicle theft and recovery. American Journal of Criminal Justice, 1–16. Tremblay, P, & Morselli, C. (2000). Patterns in criminal achievement: Wilson and Abrahamse revisited. Criminology, 38(2), 633–659. Tremblay, P, Talon, B, & Hurley, D. (2001). Body switching and related adaptations in the resale of stolen vehicles. Script elaborations and aggregate crime learning curves. British Journal of Criminology, 41(4), 561–579. Wiles, P, & Costello, A (2000). The 'Road to Nowhere': The Evidence for Travelling Criminals (Report 207). London: Home Office. Wilson, JQ, & Abrahamse, A. (1992). Does crime pay? Justice Quarterly, 9, 359–377. Wright, R, Brookman, F, & Bennett, T. (2006). The foreground dynamics of street robbery in Britain. British Journal of Criminology, 46(1), 1–15. Wright, RT, & Decker, SH (1994). Burglars on the Job: Streetlife and Residential Breakins. Boston: Northeastern University Press. doi:10.1186/2193-7680-2-3 Cite this article as: Brantingham: Prey selection among Los Angeles car thieves. Crime Science 2013 2:3. 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+See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/257885522 Prey selection among Los Angeles car thieves Article in Crime Science · December 2013 DOI: 10.1186/2193-7680-2-3 CITATIONS 14 READS 183 1 author: P. Jeffrey Brantingham University of California, Los Angeles 159 PUBLICATIONS 8,448 CITATIONS SEE PROFILE All content following this page was uploaded by P. Jeffrey Brantingham on 17 April 2020. The user has requested enhancement of the downloaded file. R E S EAR CH Open Access Prey selection among Los Angeles car thieves P Jeffrey Brantingham Abstract More than 63,000 cars were reported stolen in Los Angeles in 2003–04. However, the distribution of thefts across car types is very uneven. Some cars types such as the Honda Civic were stolen at much higher frequencies than the majority of car types. Charnov’s classic prey selection model suggests that such uneven targeting should be related to variations in the environmental abundance, expected payoffs, and handling costs associated with different car types. Street-based surveys in Los Angeles suggest that differences in abundance explain the majority of thefts. Cars stolen despite being rare may reflect offender preference based on differential payoffs, probably in some non-monetary currency such as prestige or excitement. Differential handling costs play a more ambiguous role in target selection, but may underlie thieves’ decisions to ignore some cars common in the environment. The unspecialized nature of car theft in Los Angeles suggests that the behavioral and cognitive capacities needed to be a successful car thief are generic. The evolved capacity to solve foraging problems in boundedly-rational ways, mixed with small amounts of trial-and-error and/or social learning, are sufficient to produce experts from inexperienced thieves. Keywords: Crime; Environmental criminology; Behavioral ecology; Optimal foraging; Bounded-rationality; Social learning Background The rational choice theory of crime holds that offenders engage in crime because they stand to receive significant short-term benefits with little attendant risk and small associated costs (Cornish and Clarke 1986, 1987). Presented with a suitable target or victim, unguarded by an effective security measure, the reasoning offender generally capitalizes on that opportunity (Felson and Clarke 1998; Freeman 1996). Beyond implying a common-sense relationship between benefits and costs, however, rational choice theory does not immediately identify what makes any given victim or target suitable. A conceptual framework introduced by Clarke (1999) suggests that property targets are suitable when they are concealable, removable, available, valuable, enjoyable and disposable, capturing several of the dimensions of costs and benefits that are important in offender decision making. While useful, the so-called CRAVED approach also leaves much unspecified about the relative importance of relationships among the different dimensions of target suitability. Here I turn to theory arising outside of criminology to provide a formal framework in which understand the relationships between target characteristics and offender target selection. Specifically, I use Charnov’s (1976) prey selection model to evaluate offender choice to steal different car types. The prey selection model postulates that a forager will ignore a particular prey type upon encounter if the expected return from a future prey encounter is greater. Preference in Charnov’s model is defined in terms of the relative abundance of different prey types and their respective handling costs and payoffs upon consumption. Intuitively, prey that are easy to handle or have high payoffs may be preferred but rarely taken, if they are rarely encountered. Prey that are hard to handle or have low payoffs may still be taken, if more profitable prey are rarely encountered. Here the predictions of Charnov’s prey selection model are rejected based on findings that unique car types are stolen almost exclusively in response to their environmental availability. Only occasionally are cars targeted because they have higher perceived payoffs. Overall, Los Angeles car thieves operate primarily as unspecialized foragers. Correspondence: branting@ucla.edu Department of Anthropology, University of California, Los Angeles, 341 Haines Hall, UCLA, Box 951553, Los Angeles, CA 90095-1553, USA © 2013 Brantingham; licensee Springer. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Brantingham Crime Science 2013, 2:3 http://www.crimesciencejournal.com/content/2/1/3 Optimal foraging theory and crime Foraging theory is the branch of ecology that seeks to understand how animal behavior facilitates the encounter, acquisition and processing of resources necessary to survival (Stephens and Krebs 1986). The foraging challenges facing an animal are substantial. Essential resources are rarely located in the same location as the animal needing them, necessitating behaviors that either carry the animal to the resources, or position the animal to intercept resources that move. Many resource types possess defenses that aim to thwart acquisition, even after a forager has encountered them. Animals therefore need behavioral strategies designed discriminate among resource types and defeat their defenses once they have decided to acquire them. Finally, even after a resource as been encountered and acquired, it may contain a mixture of useable and unusable constituents. Behaviors may play a key role in sorting and separating these constituents. Only after jumping these foraging hurdles may an animal benefit from the resource. Recognize, however, that the behaviors deployed to facilitate encounter, acquisition and processing of a resources are not cost free. Optimal foraging theory therefore posits that evolution and/or learning has shaped animal behavior to maximize the average or long-term return rate from essential resources, net the costs of encounter, acquisition and processing. Here I cast car theft as a foraging problem and test the proposition that the specific car types stolen represent behaviors consistent with optimal foraging theory. Three conditions must be met to consider car theft as an optimal foraging problem (see also Bernasco 2009; Felson 2006; Johnson et al. 2009). First, car theft should satisfy a need that is perceived by the offender to be essential. Car thieves report a range of motivations for stealing cars including financial motives such as theftfor-export or an immediate need for cash, mundane or routine motives such as transportation, and recreational motives such as a search for excitement, prestige or status (Copes 2003; Dhami 2008; Kellett and Gross 2006; Lantsman 2013; Light et al. 1993). With the exception of theft-for-transport, car theft is not remarkable in motivation compared with other crimes (Wright et al. 2006; Wright and Decker 1994). However, car theft may be a comparably low risk alternative to satisfy these needs (Copes and Tewksbury 2011). Between 2003 and 2006, ~12.9% of reported car thefts in the US were cleared by arrests, while robberies over the same period were cleared at a rate twice as high ~25.8% (Federal Bureau of Investigation 2003–2006). The vast majority of car thefts therefore entail no negative consequences, at least over the short term (Freeman 1999). The benefits may therefore be substantial. Payoffs to car theft might be calculated in a cash currency, if cars and/or their parts are being fenced (Clarke 1999; Tremblay et al. 2001). Payoffs might also be calculated in non-cash commodities such as barter value in drugs (Stevenson and Forsythe 1998) or prestige and excitement—an essential resource for joy riding teenagers (Copes 2003; Jacobs et al. 2003; Kellett and Gross 2006). Second, car thieves must also have behavioral alternatives to deploy during foraging and these alternatives must result in different payoff outcomes. Ethnographic evidence indicates that car theft involves choices between alternative search strategies, tools and techniques for gaining entry and ‘hot wiring’ targeted vehicles, and strategies for escape and disposal of stolen vehicles (Copes and Cherbonneau 2006; Copes and Tewksbury 2011; Farrell et al. 2011; Langworthy and Lebeau 1992; Lantsman 2013; Light et al. 1993; Lu 2003). Whether these different behavioral alternatives lead to real differences in payoffs is an open question. The observation that different car types are stolen to satisfy different needs may imply differential payoffs (Clarke 1999). However, the extent to which alternative behavioral strategies drive these payoffs, as required by optimal foraging theory, is unknown. Finally, there must be a mechanism by which car thieves select among the alternative behaviors, yielding near-optimal strategies for locating, stealing and disposing of cars. Simple trial-and-error and/or social learning in the context of co-offending appear to play this role (Akers 2008; Reiss and Farrington 1991). Juvenile car thieves often start as passengers, observing the actions of their more experienced friends (Light et al. 1993). Such learning mechanisms seem capable quickly producing effective cognitive scripts that car thieves can adhere to during commission of a crime (Tremblay et al. 2001). The prey selection model The foraging problem confronted by car thieves is similar in many ways to prey selection, a classical problem in behavioral ecology studied by Charnov (1976) and others (see Krebs et al. 1977; Stephens and Krebs 1986). Given sequential encounters with prey types, each having different expected returns and handling costs, which types should be pursued and captured? Let ei, hi and λi be the expected payoff, handling cost and local density of a prey of type i. Prey types i = 1, 2, … N are ranked in descending order of the ratio of payoff to handling cost ei/hi. The prey classification algorithm says that prey types i = 1, 2, … j should be pursued and captured upon encounter, but prey type j + 1 should be ignored if its payoff to handling cost ratio is below the mean for all higher ranked prey: Brantingham Crime Science 2013, 2:3 Page 2 of 11 http://www.crimesciencejournal.com/content/2/1/3 X j i¼1 λiei 1 þX j i¼1 λihi > ejþ1 hjþ1 ð1Þ In other words, if the expected return from future prey encounters is higher than would be gained by taking the current target, then it is better to wait. The prey choice model makes two distinctive predictions. First, prey types are either always taken upon encounter, or always ignored. This is the so-called “zero–one” rule in reference to the analytical result that an attack on prey type i will occur with probability qi = 0, or qi = 1, and nothing in between (Stephens and Krebs 1986). Second, whether or not a prey type is taken is dependent only on the encounter rate with higherranked prey, not its own encounter rate. Note that the term λi appears only on the left-hand side in Equation (1). The implication is that only changes in the encounter rate with higher ranked prey items will impact the decision to attack a lower ranked prey item once it has been encountered. Thus, if a higher ranked prey type becomes very scarce, a lower ranked prey type may be added to the diet. However, if a lower ranked prey type suddenly becomes very common, it will not necessarily be added to the diet without a concomitant change in the rate of encounter with higher ranked types. Empirical evidence from both animal (Hughes and Dunkin 1984; Prugh 2005; but see Pyke 1984) and human foragers (Hames and Vickers 1982; Smith 1991) suggests that the prey classification algorithm provides insights into prey selection behavior across a diverse range of taxa and foraging contexts. Car theft may be considered a special case of prey selection if car types vary in expected payoffs, handling costs and/or local abundance and offenders are attentive to these differences. As discussed in the Methods section, the available data on payoffs and handling times do not allow for a fine-grained test of either the zero–one rule, or the hypothesis that changes in the encounter rate with higher-ranked car types impact the inclusion of lower ranked car types in an offender’s ‘diet’. A strict reading of the prey choice model also suggests that car theft may not perfectly conform to all of its assumptions (see for comparison Smith 1991). The prey choice model assumes that: (1) foragers are long-term rate maximizers, meaning that average results of stealing cars over long time periods, rather than short-term gains, are optimized by different foraging strategies; (2) searching for and handling of targeted vehicles are mutually exclusive; (3) encounters with vehicles follow a Poisson process, meaning that two cars cannot be encountered simultaneously and each encounter is statistically independent of all others; (4) the payoff to stealing cars ei, the handling costs hi, and encounter rates λi are environmentally fixed in time and space; and (5) that the foraging car thief has perfect information about ei, hi and λi. Assumptions 1, 2, 3 and 5 may be reasonable for car theft. The notion that criminal behavioral strategies might be shaped by learning to produce long-term average rate maximization (Assumption 1) seems far fetched at first (but see Tremblay and Morselli 2000). Criminal offenders tend to be present-oriented (Gottfredson and Hirschi 1990; Nagin and Paternoster 1994) and therefore appear little concerned with the long-term costs and benefits of crime (Wilson and Abrahamse 1992). However, the question at hand is not whether crime pays relative to non-crime alternatives, but rather whether stealing one car type is more profitable in the long run than stealing an alternative car type. It is conceivable that offenders adopt strategies that maximize the longterm or average payoffs from car theft by making discriminating choices about which cars to steal. It is also reasonable to suppose that simultaneous search for cars to steal and the physical act stealing a car are mutually exclusive activities (Assumption 2). This is made more complicated by co-offending, which is quite common for younger car thieves (Light et al. 1993), if some in an offending party search nearby targets while others are breaking into a given car. It is unknown whether encounters with cars to steal follow a Poisson process (Assumption 3). Ultimately, this is an empirical question for which data need to be collected. Conceptually, however, a motivated car thief walking down a linear street segment encounters cars sequentially and independently. Whether such conditions hold in a parking lot may depend on situational factors such as the layout of and available observation points in the lot. The prey choice model is not obviated under these circumstances (Stephens and Krebs 1986: 38–45), but additional costs associated with discriminating between simultaneously encountered car types must be taken into account. Perhaps the greatest challenge comes from strictly assuming that the key parameters of prey selection remain fixed in time and space (Assumption 4) (Suresh and Tewksbury 2013). At intermediate time scales (months to years), the payoffs to stealing different car types certainly change with turnover in the composition of cars on the street. Early and late model years may differ significantly in both perceived or actual value as well as handling costs, for example, following the introduction of RFID keys for ignition systems (Farrell et al. 2011). Similarly, there may be short-term (hourly-daily) fluctuations in environmental abundance of cars parked in locations where they might be stolen. Nevertheless, it is reasonable to assume that car thieves have relatively Brantingham Crime Science 2013, 2:3 Page 3 of 11 http://www.crimesciencejournal.com/content/2/1/3 accurate knowledge of the encounter rates, payoffs and handling costs associated with different cars, or learn them very quickly when conditions change (Assumption 5) (Akers 2008; Light et al. 1993). Given the above limitations, I test a conservative null hypothesis in place of the two detailed predictions made by the prey selection model: H0. If every car yields the same payoff and all are equally difficult to steal (i. e., ei/hi = ej/hj ∀ i, j), then differences in theft rates arise only from differences in relative abundances of car types λi. In other words, if all cars rank equally in the ratio of payoffs to handling costs, then all cars are part of the ‘diet’ and should be taken immediately upon encounter. Cars encountered more frequently will appear in the diet more often and, in fact, will be stolen at a frequency proportional to λi. One should therefore expect a strong correlation between relative abundances and theft rates if the null hypothesis is true. Failure to reject the null hypothesis implies that car thieves are unspecialized foragers and take only what is presented to them by the environment. Rejection of the null hypothesis, for all or even some car types, may constitute evidence that differential payoffs and/or handling costs enter into car thieves’ situational foraging decisions. Under these circumstances we can evaluate the role that payoffs and/or handling costs may play in driving target choice. Methods Car types are defined as unique make-models or, where necessary, make-model-years. For example, 1992 and 2002 Honda Civics may be different car types, from the point of view of the offender, because they have different perceived payoffs and may also differ in how easy they are to break into and ‘hot wire’ (Farrell et al. 2011). An initial database of car make-model-years was assembled using a popular car shopping and research website, www.edmonds.com. A student assistant was then trained to quickly and accurately identify car types in pilot surveys of a university campus parking structures. Street-based surveys were conducted in three Los Angeles zip codes (90034, 90045 and 90291) during two excursions in October-December 2004 and OctoberDecember 2005. The three survey locations had the highest volume of car thefts in 2003 among zip codes on the Los Angeles West Side. Surveys involved walking between one and three contiguous blocks, first up one side and then down the other. Surveys on the exact same block segments were conducted at two-hour intervals between 6AM and 6PM. The most dramatic change in density of cars parked on the street occurred between 6AM and 8AM. I therefore assume that the mix of car types seen at 6AM represents the overnight diversity. Only vehicles in publically accessible street locations were recorded. The observed relative frequency of each car type i is used as a measure of encounter rate λi. Expected value on the illegal market is used as a proxy for the payoffs ei associated with stealing different car types (Copes 2003; Matsueda et al. 1992). I do not assume that all car thieves seek cash. Rather, illegal market value is a generic currency that is expected to be positively correlated with non-monetary payoffs. For example, a ‘hot car’ is not only more likely to demand more money in an illegal market context, but it is also expected to have a higher payoff in excitement and prestige for the teenage car thief. Illegal market value is calculated as ei = f ∑ ipivi, where pi is the proportion of cars of a given make-model-year stolen, vi is the legal market value of the car at the time of theft as determined from the Kelley Blue Book (DeBacker 2003), and f is the fraction of the legal market value realized on the illegal market. I assume that f = 0.1, but choice of a different constant does not impact the results. I use break-in times as a proxy for overall handling costs hi. The UK-based “What Car?” Security Supertest (Secured by Design 2000, 2003) conducted attack testing of new cars marketed in the UK. The tests evaluated the ability of new vehicles to withstand attacks by trained locksmiths using the non-destructive entry techniques commonly deployed by car thieves. The tests included 123 unique make-models and measured the time, in seconds, needed to gain entry to each vehicle. A car was considered to pass the test if it was not possible to gain entry within two minutes. Break-in time represents only one of the handling costs associated with car theft. I assume, however, that the handling costs at different critical points in the theft process are positively correlated. For example, if a car is easy to enter, it is also more likely to be easy to ‘hot wire’, less likely to have a geo-location device installed and be easier to chop. Evaluation of the relationships between car theft, environmental abundances, payoffs and handling costs is conducted using non-parametric statistics that are robust to ordinal scale data and non-normal distribution characteristics (Conover 1998). Theft frequencies and environmental abundances are compared using Kendall’s τ, a generalized correlation coefficient that measures the similarity of ranked order lists. Kendall’s τ b allows for rank order ties. Illegal market values and break-in times among common and rare cares are non-normally distributed. Medians therefore provide the most robust measure of central tendency and the non-parametric Mann–Whitney U the most appropriate corresponding statistical test. Differences in distribution shape are computed using the non-parametric Kolmogorov-Smirnov D. Brantingham Crime Science 2013, 2:3 Page 4 of 11 http://www.crimesciencejournal.com/content/2/1/3 Results Between 1 Jan 2003 and 31 December 2004, 63,528 vehicles were reported stolen within the City of Los Angeles (Federal Bureau of Investigation 2003–2006). In zip codes 90034, 90045 and 90291, located on the West Side of Los Angeles and representing ~3.5% of the land area of the City, a total of 2,251 cars were stolen during the same period, or ~3.5% of all thefts. These cars are divided into 271 unique make-model types. The Honda Civic and Accord, Toyota Camry and Corolla, and Nissan Sentra together comprise ~25% of the total thefts and 87 car types are represented by single thefts (Figure 1A, Table 1). To test whether the observed bias in thefts towards some car types is driven by environmental abundance, I conducted surveys of main artery and residential streets (see Methods). A total of 1,825 cars were observed and these were classified into 262 unique make-model types. As with reported thefts, the cars available on the streets are dominated by a few types (Figure 1B). Seventy seven types identified in the survey are singletons. The distribution is qualitatively similar to rank species abundance curves in ecology, which show environments numerically dominated by a few species, but most of the richness is accumulated through species with small numbers of individuals Hubbell (2001). Here I focus on the top 25 most commonly stolen cars. These car types account for 53% of the total observed volume of stolen cars (N = 1198) and the bulk of the variation in theft frequency. A comparison of theft and density rank order frequencies shows a significant positive relationship (Kendall’s τ b = 0.491, p < 0.001) (Figure 2). Thirteen of the top 25 most stolen cars are also in the top 25 for abundance (Table 1). In general, the most common cars on the street are also the most stolen. The positive relationship between abundance and theft is particularly strong among the top nine most stolen cars (Kendall’s τ b = 0.611, p = 0.022). Honda Civics are the most abundant cars and the most frequently stolen. For the top nine cars it is difficult to reject the null hypothesis that environmental abundance is driving the targeting of these vehicles for theft. Note, however, that approximately one half (N = 12) of the top 25 most stolen cars are not in the top 25 for abundance. Several of these are significant outliers (Table 1). For example, the Chrysler 300M is ranked 14, with 33 thefts in 2003–04, but was observed only 0 20 40 60 80 100 120 140 160 180 1 10 19 28 37 46 55 64 73 82 91 100 109 118 127 136 145 154 163 172 181 190 199 208 217 226 235 244 253 262 271 Number of Thefts Theft Rank Honda Civic Toyota Camry Honda Accord Jeep Grand Cherokee Ferrari 360 N = 2,251 A 0 20 40 60 80 100 120 140 Number of Cars Honda Civic Honda Accord Toyota Corolla Chevy Cavalier Porsche Carerra N = 1,825 B Figure 1 Rank order plots of make-model car types stolen and observed in street-based surveys in three Los Angeles zip codes. (A) Cars stolen in zip codes 90034, 90045 and 90291 between Jan 1, 2003 and December 31, 2004 are numerically dominated by a few car types. (B) The rank order abundance of car types in the same zip codes, observed in street surveys conducted in 2004 and 2005, reveals the structure of car theft opportunities. Brantingham Crime Science 2013, 2:3 Page 5 of 11 http://www.crimesciencejournal.com/content/2/1/3 once in the 1,825 cars identified in street surveys (survey rank = 224). Similarly, the Pontiac Grand AM was ranked 10, with 44 thefts, but was observed only four times in the same surveys (survey rank = 110.5). It may be that thieves targeted these rare cars based on specialized evaluation of the expected payoffs, handling costs, or both, made at the time of encounter. Taking into account car make, model and year, I calculated the expected illegal market value for each car stolen in 2003 as 10% of the Kelley Blue Book value at the time of theft (see Methods) (DeBacker 2003; Stevenson and Forsythe 1998; Tremblay et al. 2001). Illegal market value is used as broad proxy for both monetary and non-monetary payoffs. Figure 3 shows that the distribution of expected illegal market values for the outliers is significantly different from that associated with environmentally common cars (Mann–Whitney U = 8562, Wilcoxon = 73542, Z = −11.327, p < .001). Among the environmentally common cars, the median expected illegal market value is $740 (min = $293, max = $2,916). Among the environmentally rare cars, the median is twice as large at $1,515 (min = $210, max $4,493). These data suggest that the outliers within the sample of stolen cars may be targeted because they offer a higher expected payoff. It is also possible that ease-of-theft is responsible for the observed outliers (Farrell et al. 2011; Light et al. 1993; Wiles and Costello 2000). The UK-based “WhatCar?” Security Supertest (Secured by Design 2000, 2003), evaluated the ability of a range of new vehicles to withstand attacks using non-destructive entry techniques (see Methods). Break-in time is used as a proxy for handling costs at all stages of the theft process. The aggregated results from 2000 and 2003, excluding those cars that passed the test, show a weak, but significant relationship between break-in times and Table 1 The top 25 most stolen car types in 2003–2004 and their environmental densities in Los Angeles zip codes 90034, 90045 and 90291 Make-model Theft N Survey N Recovery N Theft p Survey p Recovery p Theft rank Survey rank HONDA CIVIC 155 128 110 0.069 0.070 0.710 1 1 TOYOTA CAMRY 151 59 118 0.067 0.032 0.781 2 4 HONDA ACCORD 109 94 81 0.048 0.052 0.743 3 2 TOYOTA COROLLA 68 86 47 0.030 0.047 0.691 4 3 NISSAN SENTRA 60 33 45 0.027 0.018 0.750 5 9 ACURA INTEGRA 52 21 28 0.023 0.012 0.538 6 14 FORD MUSTANG 50 20 41 0.022 0.011 0.820 7 16 FORD EXPLORER 49 57 35 0.022 0.031 0.714 8 5 FORD TAURUS 46 28 36 0.020 0.015 0.783 9 11 PONTIAC GRAND AM/PRIX 43 4 38 0.019 0.002 0.884 10 110.5 NISSAN ALTIMA 35 42 27 0.016 0.023 0.771 11 7 CHEVY IMPALA 34 6 26 0.015 0.003 0.765 12.5 79.5 DODGE STRATUS 34 5 30 0.015 0.003 0.882 12.5 93.5 CHRYSLER 300M 33 1 31 0.015 0.001 0.939 14 224 CHEVY BLAZER 32 15 24 0.014 0.008 0.750 15 25 CHRYSLER PT CRUISER 31 8 26 0.014 0.004 0.839 16 58 DODGE CARAVAN 28 8 18 0.012 0.004 0.643 17.5 58 DODGE INTREPID 28 9 23 0.012 0.005 0.821 17.5 49.5 JEEP CHEROKEE 27 34 16 0.012 0.019 0.593 19 8 LINCOLN TOWN CAR 24 4 22 0.011 0.002 0.917 20 110.5 DODGE NEON 23 2 19 0.010 0.001 0.826 21.5 165.5 FORD FOCUS 23 7 20 0.010 0.004 0.870 21.5 68.5 CHRYSLER SEBRING 21 3 15 0.009 0.002 0.714 24 132.5 FORD EXPEDITION 21 12 13 0.009 0.007 0.619 24 32.5 JEEP GRAND CHEROKEE 21 20 14 0.009 0.011 0.667 24 16 Note: Theft and recovery proportions are calculated with respect to all 2,251 cars stolen. Survey proportions are calculated with respect to the 1,825 unique car types identified in street-based surveys. Environmental densities were measured in two survey periods October-December 2004 and October-December 2005. Brantingham Crime Science 2013, 2:3 Page 6 of 11 http://www.crimesciencejournal.com/content/2/1/3 market price in US Dollars (r 2 = .258, p < .001) (Figure 4A). The median break-in time for all vehicle types successfully attacked was 29 seconds and the minimum time was two seconds. Twenty three cars (~19%) have break-in times under 15 seconds. Vehicle make-models are not equivalent between the UK and US markets, despite similar names, and comparable data are not available from US contexts. It is not possible therefore to map break-in times from the Security Supertests directly to car types stolen in the US Number of Thefts 100 80 60 40 20 0 Illegal Market Value in $ 0 1,000 2,000 3,000 4,000 5,000 100 80 60 40 20 0 A B Figure 3 Frequency histograms of the estimated illegal market values show much lower expected payoffs may be attributed to the top nine most stolen cars (A), where density is expected to the major determinant of theft, compared with the outliers (B), where environmental density is not implicated. 0 5 10 15 20 25 0 50 100 150 200 250 Theft Rank Survey Rank Chrysler300M Dodge Neon Chevy Impala Pontriac Grand Prix/Am Dodge Stratus Chrysler Sebring Lincoln Town Car Ford Focus Chrysler PT Cruiser Dodge Caravan Dodge Intrepid Figure 2 A scatter plot of abundance rank order against theft rank order shows a strong positive relationship between car availability and theft risk. Eleven car-types are stolen much more frequently than their environmental abundance would suggest. Line represents a hypothetical 1:1 relationship between rank abundance and rank theft. Brantingham Crime Science 2013, 2:3 Page 7 of 11 http://www.crimesciencejournal.com/content/2/1/3 using the UK data. However, some indication of handling costs may be gained by examining patterns within manufactures. Seven of the cars stolen in disproportion to their environmental density were manufactured by Daimler-Chrysler, three by Ford and two by GM (Table 1). Of the 123 cars tested in the Security Supertests, 44 were vehicles by these manufacturers. Eleven (25%) successfully withstood attacks lasting two minutes, compared with 24 of the remaining 79 car types (44%). The data may suggest that Daimler-Chrysler, GM and Ford vehicles are more broadly susceptible to attack. However, a range of break-in times characterize the vehicles that did not pass the test (Table 2). Low and high-mid market cars sold under the Chrysler brand (e.g., Neon, Grand Voyager) have minimum break-in times of between four and six seconds, while one low-market GM car sold under the Vauxhall brand had a brake-in time of two seconds. Midmarket GM cars, also sold under the Vauxhall brand, had a mean break-in time of 81 seconds. The aggregate results do not indicate that cars made by DaimlerChrysler, Ford or GM are disproportionately easier for car thieves to handle. Indeed, cars marketed by other manufacturers show a significant skew towards shorter break-in times and, by implication, lower handling costs for thieves (Kolmogorov-Smirnov Z = 1.349, p = 0.053) (Figure 4B,C). Discussion and conclusion It is difficult to reject the null hypothesis that environmental abundance is the primary determinant of what cars are targeted for theft. There is a particularly strong relationship between abundance and theft rank for the top-nine most stolen cars. In the CRAVED conceptual framework put forward by Clarke (1999), availability would seem to outweigh other dimensions that might influence theft choice. In the instances where cars are targeted despite being rare, payoff differences may play some role. Car recovery rates provide one measure of the importance of non-monetary, or possibly limited monetary payoffs to car theft (Clarke and Harris 1992). There is little systematic difference in the rate of recovery across car types (Table 1), suggesting that none of the top 25 most stolen cars are disproportionately landing in fully-body chop shops or being stolen for export. The payoffs here seem to be primarily non-monetary. Furthermore, among the outliers that are stolen despite being rare, it appears that the newest model years are targeted. For example, eight of 12 Chrysler 300s and seven of 13 Chrysler Sebrings stolen during 2003 were 2004 model years, which became available only in the last five months of the year. The implication is that these cars, though rare, were targeted precisely because they were perceived to be ‘hot rides’ (Wiles and Costello 2000). That some cars are more valuable or enjoyable can override their low availability, but this occurs infrequently. It is less apparent that lower handling costs biased thieves’ decisions to target environmentally rare cars, although ethnographic work suggests that handling costs are often a significant concern (Clarke 1999; Light et al. 1993; Wiles and Costello 2000). Recent research suggests that the potential for encountering opposition from car owners is a major concern (Copes and Tewksbury 2011), but it is uncertain how the probability of opposition might relate to car type. Direct handling costs may have played a role in driving Los Angeles car thieves to A BC Figure 4 Break-in times for UK make-models measured by the “WhatCar?” Security Supertest in 2000 and 2003. (A) Scatter plot of break-in time versus US market price implies only a weak relationship between payoffs and handling costs. Frequency histograms of the break-in times for (B) GM-, Daimler-Chrysler- and Ford-group cars and (C) all other car types. Brantingham Crime Science 2013, 2:3 Page 8 of 11 http://www.crimesciencejournal.com/content/2/1/3 ignore certain environmentally common cars. Seven make-model types including the Volkswagen Jetta, Toyota RAV4 and Nissan Xterra ranked within the top 25 for abundance, but were rarely or never stolen (Table 3). An average of 57% of the vehicles sold by the corresponding manufactures in the UK passed the Security Supertests. This is compared only 25% of Daimler-Chrysler, GM and Ford cars representative of the environmentally rare group. The implication is that these cars may be ignored because they are more resistant to attack. Detailed attack analyses of cars from the US market could help resolve the exact role of handling costs in the differential targeting of some cars. In spite of the narrow role that differential payoffs and handling costs appear to play the choice of which cars to steal, one must be careful to not fall prey to the ecological fallacy. Ethnographic evidence points to a degree of specialization among car thieves, with distinctions among those engaged in opportunistic theft and those in organized crime, and among younger and older offenders. Such specializations are not directly visible in aggregate car theft data. It is possible that the population of Los Angeles car thieves consists of several different types each with their preferred prey. The observed frequency of stolen car types might therefore represent a mixture of fixed, independent strategies, some rare and Table 3 Environmentally abundant cars of low theft rank in zip codes 90034, 90045 and 90291 and the aggregated 2000 and 2003 “WhatCar?” Security Supertest results for cars from the corresponding manufacturers Make-model Theft N Survey N Theft rank Survey rank N tested Passing p Models failing Mean (s) σ (s) Min (s) Max (s) Volkswagen Jetta 9 56 63 6 6 0.50 Lupo 1.4S, Polo Gti, Golf 1.6SE 32 16.09 19 50 Toyota RAV4 5 19 91 18 8 0.63 Yaris Verso, Corolla, Avensis 46.33 15.50 31 46 Lexus ES 15 229 25 3 0.67 IS 111 Nissan Xterra 2 16 164 21 5 0.80 Micra 1.3 SE 14 Volvo S Class 17 229 19.5 3 0.67 XC90 70 Subaru Outback 2 15 164 25 3 0.00 Impreza, Impreza Turbo, Legacy 22.67 24.79 5 51 Table 2 Break-in times in seconds for Daimler-Chrysler, Ford and GM brands sold in the UK tested in the “WhatCar?” Security Supertest in 2000 and 2003 Manufacturer Make-model Market N Mean (seconds) σ (seconds) Min (seconds) Max (seconds) Daimler-Chysler Chrysler Neon Low 1 4 Daimler-Chysler Mercedes A Class Mid 1 30 Daimler-Chysler Chrysler Grand Voyager High-mid 1 6 Daimler-Chysler Mercedes C, E Class High 2 70 7.07 65 75 Ford Fiesta, Focus Ghia Estate, Ka 3, Mazda 626 Sport Low 4 40.75 15.9 23 60 Ford Focus TDi Ghia, Ka, Streetka, Landrover Freelander, Mazda MPV, Mazda Premacy Mid 6 33.83 17.08 19 65 Ford Focus, Land Rover Discovery, Mazda 6 High-mid 3 43 13.45 28 54 Ford Mondeo, Jaguar XKR, Range Rover 4.0 HSE, Volvo XC90 High 4 69 21.76 40 93 GM Vauxall Agilla, Astra Low 2 12 13.44 2 21 GM Vauxall Corsa, Frontera, Meriva, Zafira Mid 4 81 40.04 21 108 GM Saab 93, Saab 95, Vauxall Astra High-mid 3 45.67 10.69 39 58 GM Cadillac Seville STS, Vauxall Vectra High 2 58 74.95 5 111 Total Daimler-Chrysler, GM, Ford 33 46.88 30.68 2 111 Other Car types 55 32.22 29.36 2 115 Brantingham Crime Science 2013, 2:3 Page 9 of 11 http://www.crimesciencejournal.com/content/2/1/3 some common, not variation in the behavior of offenders in general. The converse is also potentially true. There is a danger of falling prey to an ethnographic fallacy that confounds our ability to infer aggregate characteristics from ethnographically rich data collected at an individual scale. To wit, given interviews with tens of car thieves about their offending preferences, can we reliably infer the population characteristics of the many thousands of individuals likely responsible for the 63,000 cars stolen in Los Angeles in 2003-2004? There is no easy way to resolve the ecological or ethnographic fallacy. I suspect, however, that the unspecialized foragers responding primarily to environmental abundances greatly outnumber the specialists, making the latter practically invisible in aggregate data. The results described here are important for understanding the broader causes of criminal behavior and may suggest novel approaches to crime prevention based on formal ecological models (see also Bernasco 2009; Brantingham et al. 2012; Felson 2006). The unspecialized nature of car theft in Los Angeles implies that the behavioral and cognitive capacities needed to be a successful thief are generic. Indeed, humans are well-equipped to become effective foragers for criminal opportunities given an evolved psychology to solve foraging problems in boundedly-rational ways (Hutchinson et al. 2007), combined with small amounts of individual trial-and-error or social learning (Akers 2008; Boyd and Richerson 1985). Indeed, the co-offending that characterizes the early careers (<20 years old) of most offenders, including car thieves, is ideally suited to the transmission of the simple skills sufficient to produce experts from inexperienced thieves (Reiss and Farrington 1991). That auto theft in Los Angeles is driven primarily by environmental structure provides further evidence that the greatest gains in crime prevention are to be had in altering the structure of criminal opportunity (Brantingham and Brantingham 1981; Farrell et al. 2011; Felson and Clarke 1998). How environmental alterations impact situational foraging behaviors and longer-term population trajectories are well-studied within ecology (Henle et al. 2004; Kerr et al. 2007), suggesting a way forward for formal crime ecology. Competing interests The author declares that he has no competing interests. Acknowledgements This work was supported in part by grants NSF-FRG DMS-0968309, ONR N000141010221, ARO-MURI W911NF-11-1-0332, and AFOSR-MURI FA9550-10-1-0569, and by the UCLA Faculty Senate. I am indebted to the Los Angeles Police Department for providing the data analyzed here. Thank you to David Bell from Secured by Design and Silas Borden for assistance with the street-based surveys. Received: 29 November 2012 Accepted: 29 April 2013 Published: 3 July 2013 References Akers, R (2008). Social learning and social structure: A general theory of crime and deviance. Boston: Northeastern University Press. Bernasco, W. (2009). Foraging strategies of homo criminalis: lessons from behavioral ecology. Crime Patterns and Analysis, 2(1), 5–16. Boyd, R, & Richerson, PJ (1985). Culture and the Evolutionary Process. Chicago: University of Chicago Press. Brantingham, PJ, & Brantingham, PL (1981). Environmental Criminology. Beverly Hills: Sage. Brantingham, PJ, Tita, GE, Short, MB, & Reid, SE. (2012). The ecology of gang territorial boundaries. Criminology, 50(3), 851–885. Charnov, EL. (1976). Optimal foraging - attack strategy of a mantid. American Naturalist, 110(971), 141–151. Clarke, RV. (1999). Hot Products: Understanding, Anticipating and Reducing Demand for Stolen Goods (Police Research Series, Paper 112.). London: Home Office. Clarke, RV, & Harris, PM (1992). Auto Theft and its Prevention. In M Tonry (Ed.), Crime and Justice: A Review of Research (Vol. 16, pp. 1–54). Chicago: University of Chicago Press. Conover, WJ. (1998). Practical Nonparametric Statistics. Hoboken: Wiley. Copes, H. (2003). Streetlife and the rewards of auto theft. Deviant Behavior, 24(4), 309–332. Copes, H, & Cherbonneau, M. (2006). The key to auto theft - Emerging methods of auto theft from the offenders' perspective. British Journal of Criminology, 46(5), 917–934. Copes, H, & Tewksbury, R. (2011). Criminal experience and perceptions of risk: what auto thieves fear when stealing cars. Journal of Crime and Justice, 34(1), 62–79. Cornish, DB, & Clarke, RV (1986). Introduction. In DB Cornish & RV Clarke (Eds.), The Reasoning Criminal: Rational Choice Perspectives on Criminal Offending. New York: Springer-Verlag. Cornish, DB, & Clarke, RV. (1987). Understanding crime displacement: An application of rational choice theory. Criminology, 25(4), 933–947. DeBacker, P (Ed.). (2003). Kelley Blue Book Used Car Guide Consumer Edition 1988–2002. Irvine, CA: Kelly Blue Book. Dhami, MK. (2008). Youth auto theft: a survey of a general population of canadian youth. Canadian Journal of Criminology and Criminal Justice, 50(2), 187–209. Farrell, G, Tseloni, A, & Tilley, N. (2011). The effectiveness of vehicle security devices and their role in the crime drop. Criminology and Criminal Justice, 11(1), 21–35. Federal Bureau of Investigation (2003–2006). Crime in the United States, Uniform Crime Reports. http://www.fbi.gov/ucr/ucr.htm. Felson, M (2006). Crime and Nature. Thousand Oaks: Sage. Felson, M, & Clarke, RV (1998). Opportunity Makes the Thief: Practical Theory for Crime Prevention (Police Research Series Paper 98). London: Home Office Policing and Reducing Crime Unit. Freeman, RB. (1996). Why do so many young american men commit crimes and what might we do about it? The Journal of Economic Perspectives, 10(1), 25–42. Freeman, RB. (1999). The economics of crime. Handbook of Labor Economics, 3, 3529–3571. Gottfredson, MR, & Hirschi, T (1990). A General Theory of Crime. Stanford: Stanford University Press. Hames, RB, & Vickers, WT. (1982). Optimal diet breadth theory as a model to explain variability in Amazonian hunting. American Ethnologist, 9(2), 358–378. Henle, K, Davies, KF, Kleyer, M, Margules, C, & Settele, J. (2004). Predictors of species sensitivity to fragmentation. Biodiversity and Conservation, 13(1), 207–251. Hubbell, SP (2001). The Unified Neutral Theory of Biodiversity and Biogeography. Princeton: Princeton University Press. Hughes, RN, & Dunkin, SD. (1984). Behavioral components of prey selection by Dogwhelks, Nucella-Lapillus (L), feeding on Mussels, Mytilus-Edulis-L, in the Laboratory. Journal of Experimental Marine Biology and Ecology, 77(1–2), 45–68. Hutchinson, JMC, Wilke, A, & Todd, PM. (2007). Patch leaving in humans: can a generalist adapt its rules to dispersal of items across patches? Animal Behavior, 75, 1331–1349. Jacobs, BA, Topalli, V, & Wright, R. (2003). Carjacking, streetlife and offender motivation. British Journal of Criminology, 43(4), 673–688. Johnson, SD, Summers, L, & Pease, K. (2009). Offender as forager? a direct test of the boost account of victimization. Journal of Quantitative Criminology, 25(2), 181–200. Brantingham Crime Science 2013, 2:3 Page 10 of 11 http://www.crimesciencejournal.com/content/2/1/3 Kellett, S, & Gross, H. (2006). Addicted to joyriding? An exploration of young offenders' accounts of their car crime. Psychology Crime & Law, 12(1), 39–59. Kerr, JT, Kharouba, HM, & Currie, DJ. (2007). The macroecological contribution to global change solutions. Science, 316(5831), 1581–1584. Krebs, JR, Erichsen, JT, Webber, MI, & Charnov, EL. (1977). Optimal prey selection in great tit (parus-major). Animal Behaviour, 25(FEB), 30–38. Langworthy, RH, & Lebeau, JL. (1992). The spatial-distribution of sting targets. Journal of Criminal Justice, 20(6), 541–551. Lantsman, L. (2013). “Moveable currency”: the role of seaports in export oriented vehicle theft. Crime, Law and Social Change, 59(2), 157–184. Light, R, Nee, C, & Ingham, H (1993). Car Theft: The Offender's Perspective (Home Office Rresearch Study No. 30). London: Home Office. Lu, YM. (2003). Getting away with the stolen vehicle: an investigation of journeyafter-crime. The Professional Geographer, 55(4), 422–433. Matsueda, RL, Piliavin, I, Gartner, R, & Polakowski, M. (1992). The prestige of criminal and conventional occupations: a subcultural model of criminal activity. American Sociological Review, 57(6), 752–770. Nagin, DS, & Paternoster, R. (1994). Personal capital and social control: the detterence implications of a theory of individual differences in criminal offending. Criminology, 32(4), 581–606. Prugh, LR. (2005). Coyote prey selection and community stability during a decline in food supply. Oikos, 110(2), 253–264. Pyke, GH. (1984). Optimal foraging theory - a critical-review. Annual Review of Ecology and Systematics, 15, 523–575. Reiss, AJ, & Farrington, DP. (1991). Advancing knowledge about co-offending: results from a prospective longitudinal survey of London males. The Journal of Criminal Law and Criminology, 82(2), 360–395. Secured by Design (2000, 2003). The ""WhatCar?"" Security Supertests were conducted in 2000 and 2003. The attack tests are described online at http://www.whatcar.co.uk/news-special-report.aspx?NA=204498. Smith, EA (1991). Inujjuamiut Foraging Strategies: Evolutionary Ecology of an Arctic Hunting Economy. New York: Aldine de Gruyter. Stephens, DW, & Krebs, JR (1986). Foraging Theory. In. Princeton: Princeton University Press. Stevenson, RJ, & Forsythe, LMV (1998). The Stolen Goods Market in New South Wales. Sydney: New South Wales Bureau of Crime Statistics and Research. Suresh, G, & Tewksbury, R. (2999). Locations of motor vehicle theft and recovery. American Journal of Criminal Justice, 1–16. Tremblay, P, & Morselli, C. (2000). Patterns in criminal achievement: Wilson and Abrahamse revisited. Criminology, 38(2), 633–659. Tremblay, P, Talon, B, & Hurley, D. (2001). Body switching and related adaptations in the resale of stolen vehicles. Script elaborations and aggregate crime learning curves. British Journal of Criminology, 41(4), 561–579. Wiles, P, & Costello, A (2000). The 'Road to Nowhere': The Evidence for Travelling Criminals (Report 207). London: Home Office. Wilson, JQ, & Abrahamse, A. (1992). Does crime pay? Justice Quarterly, 9, 359–377. Wright, R, Brookman, F, & Bennett, T. (2006). The foreground dynamics of street robbery in Britain. British Journal of Criminology, 46(1), 1–15. Wright, RT, & Decker, SH (1994). Burglars on the Job: Streetlife and Residential Breakins. Boston: Northeastern University Press. doi:10.1186/2193-7680-2-3 Cite this article as: Brantingham: Prey selection among Los Angeles car thieves. Crime Science 2013 2:3. Submit your manuscript to a journal and benefi t from: 7 Convenient online submission 7 Rigorous peer review 7 Immediate publication on acceptance 7 Open access: articles freely available online 7 High visibility within the fi eld 7 Retaining the copyright to your article Submit your next manuscript at 7 springeropen.com Brantingham Crime Science 2013, 2:3 Page 11 of 11 http://www.crimesciencejournal.com/content/2/1/3 View publication stats
+
+USER:
+What is optimal foraging theory when compared to automotive theft?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",True,7,10,7671,,25
+[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.,I think Bitcoin is very interesting and want to buy some cryptocurrency but I have no idea of the best time. I live in CA and get paid at the first of the month. What is my best strategy?,"What is the Best Time to Buy Cryptocurrency? It’s traded 24 hours a day, 7 days a week by investors located all around the world. Cryptocurrency is a volatile market that can offer opportunities to make - or lose - significant sums of money What is the Best Time to Buy Cryptocurrency? There are many methods that equity investors use to decide when to execute a trade in the stock markets, but the same rules and trading patterns don’t always apply to cryptocurrency. It’s true that cryptocurrency buyers can make purchases within certain windows to get the best possible price. Still, the volatility of the cryptocurrency market makes it very difficult to identify reliable patterns and choose positions accordingly. Unlike other assets, trading cryptocurrency has very low barriers to entry with tokens with a range of values. Rising inflation has also caused many to invest as a way to increase ancillary income. The allure of potentially turning a small investment into millions has also led others to try their luck with digital assets. Lastly, the constant hype around cryptocurrencies has caused even some crypto skeptics to look more closely out of FOMO (the Fear Of Missing Out). Buying cryptocurrency requires individuals to use a crypto wallet that can interact with the blockchain that tracks cryptocurrencies. The easiest way to do this is through an online cryptocurrency exchange platform. There are many to choose from, but exchange fees can vary widely. Make sure to take all fees into account before you buy cryptocurrency. Additionally, the transaction costs to record your transaction to the distributed ledger that is the blockchain can also vary due to the demand on computing power, energy, or volume of transactions that can impact your bottom line. However, with the volatility in trading cryptocurrency, those who want to start investing in cryptocurrency often wonder when is the best time to buy cryptocurrency? Key Highlights Many investors, some less experienced than others, are buying cryptocurrencies due to the hype, “fear-of-missing-out,” and low barrier to entry. Choosing the right positions can make or break an investment strategy, and the volatility of cryptocurrency makes it difficult to identify patterns and investment triggers. There are certain times that are better for trading cryptocurrency than others, but ultimately the best time to buy crypto is when the buyer is feeling confident in their strategy and financially ready to make a move. Best Time of the Day to Buy Cryptocurrency One of the perks of trading cryptocurrency is that you can buy it whenever you want. But many investors buy and sell cryptocurrencies during the same hours that the New York Stock Exchange (“NYSE”) is open. But since you can buy and sell crypto at all hours of the day, you’ll need to know which hours are better for buying cryptocurrency. Through analyzing months of data, you’ll begin to notice daily trends. Paying attention to cryptocurrencies with higher market capitalizations like Bitcoin, Ether, and Solana can also help newer investors determine better times of day to trade since cryptocurrency prices tend to rise and fall together. Experts say the best time of day to buy cryptocurrency is early in the morning before the NYSE opens since values tend to rise as the day goes on. Be sure to pay attention to slight daily fluctuations across different cryptocurrencies since trends will vary from coin to coin. Best Time of the Week to Buy Cryptocurrency Now that you’re getting used to setting your alarm bright and early to watch cryptocurrency trends, you may begin to notice longer patterns from week to week. Prices are lower when the market is less busy. Although you can trade cryptocurrencies at any time of day, the market is more active during typical work hours and less active early in the morning, at night, and on the weekends. Generally, cryptocurrency prices start low on Monday and rise throughout the week. When the weekend hits, prices tend to drop until market activity begins the following Monday. Since prices are likely to be at their lowest point following a weekend of low trading activity, Monday is the best time of the week to buy cryptocurrency. Best Time of the Month to Buy Cryptocurrency Pricing trends carry on as weeks turn into months, and new trading patterns emerge that raise and lower the price of various cryptocurrencies over time. Since crypto trends are constantly in flux, deciding the best time of the month to buy cryptocurrency will require patience as you get to know the pricing trends of your favorite coins. For now, the best time to buy cryptocurrency is toward the end of the month. Cryptocurrency prices tend to rise in the first weeks of the month before they collapse and continue to trend downward through the end of the month. It’s worth reiterating again that cryptocurrencies are notorious for their volatility, which means patterns and trends that are true one month can vary widely the next. It takes time and diligence to learn how to follow cryptocurrency values and market fluctuations. How to Time the Cryptocurrency Market Here’s a quick recap to help you learn how to time the cryptocurrency market and get the best possible prices: Cryptocurrencies are most active during the work week, with prices starting low on Monday morning and steadily rising until they drop over the weekend. Pay attention to stock market trading hours as they have an effect on cryptocurrency trading, even though you can buy and sell cryptocurrencies 24/7. Be aware of your risk tolerance by forecasting your cash flow and watching cryptocurrency market trends. The Best Time to Buy Cryptocurrency It can be difficult to time the cryptocurrency market due to its volatile nature, but there are times that are better for buying cryptocurrencies than others. Just as with any other investment, cryptocurrency buyers should be aware of their risk tolerance and market conditions. But some trading strategies that work well on the stock exchange may not translate into profits for cryptocurrency trades. The best time to buy cryptocurrency is whenever you’re ready to start investing. Don’t put more into your investment than you are willing to lose, and keep in mind the rule of dollar-cost averaging. Once you’ve decided on a position, use this guide to decide when the best time to enter the cryptocurrency market is for you.","[question] I think Bitcoin is very interesting and want to buy some cryptocurrency but I have no idea of the best time. I live in CA and get paid at the first of the month. What is my best strategy? ===================== [text] What is the Best Time to Buy Cryptocurrency? It’s traded 24 hours a day, 7 days a week by investors located all around the world. Cryptocurrency is a volatile market that can offer opportunities to make - or lose - significant sums of money What is the Best Time to Buy Cryptocurrency? There are many methods that equity investors use to decide when to execute a trade in the stock markets, but the same rules and trading patterns don’t always apply to cryptocurrency. It’s true that cryptocurrency buyers can make purchases within certain windows to get the best possible price. Still, the volatility of the cryptocurrency market makes it very difficult to identify reliable patterns and choose positions accordingly. Unlike other assets, trading cryptocurrency has very low barriers to entry with tokens with a range of values. Rising inflation has also caused many to invest as a way to increase ancillary income. The allure of potentially turning a small investment into millions has also led others to try their luck with digital assets. Lastly, the constant hype around cryptocurrencies has caused even some crypto skeptics to look more closely out of FOMO (the Fear Of Missing Out). Buying cryptocurrency requires individuals to use a crypto wallet that can interact with the blockchain that tracks cryptocurrencies. The easiest way to do this is through an online cryptocurrency exchange platform. There are many to choose from, but exchange fees can vary widely. Make sure to take all fees into account before you buy cryptocurrency. Additionally, the transaction costs to record your transaction to the distributed ledger that is the blockchain can also vary due to the demand on computing power, energy, or volume of transactions that can impact your bottom line. However, with the volatility in trading cryptocurrency, those who want to start investing in cryptocurrency often wonder when is the best time to buy cryptocurrency? Key Highlights Many investors, some less experienced than others, are buying cryptocurrencies due to the hype, “fear-of-missing-out,” and low barrier to entry. Choosing the right positions can make or break an investment strategy, and the volatility of cryptocurrency makes it difficult to identify patterns and investment triggers. There are certain times that are better for trading cryptocurrency than others, but ultimately the best time to buy crypto is when the buyer is feeling confident in their strategy and financially ready to make a move. Best Time of the Day to Buy Cryptocurrency One of the perks of trading cryptocurrency is that you can buy it whenever you want. But many investors buy and sell cryptocurrencies during the same hours that the New York Stock Exchange (“NYSE”) is open. But since you can buy and sell crypto at all hours of the day, you’ll need to know which hours are better for buying cryptocurrency. Through analyzing months of data, you’ll begin to notice daily trends. Paying attention to cryptocurrencies with higher market capitalizations like Bitcoin, Ether, and Solana can also help newer investors determine better times of day to trade since cryptocurrency prices tend to rise and fall together. Experts say the best time of day to buy cryptocurrency is early in the morning before the NYSE opens since values tend to rise as the day goes on. Be sure to pay attention to slight daily fluctuations across different cryptocurrencies since trends will vary from coin to coin. Best Time of the Week to Buy Cryptocurrency Now that you’re getting used to setting your alarm bright and early to watch cryptocurrency trends, you may begin to notice longer patterns from week to week. Prices are lower when the market is less busy. Although you can trade cryptocurrencies at any time of day, the market is more active during typical work hours and less active early in the morning, at night, and on the weekends. Generally, cryptocurrency prices start low on Monday and rise throughout the week. When the weekend hits, prices tend to drop until market activity begins the following Monday. Since prices are likely to be at their lowest point following a weekend of low trading activity, Monday is the best time of the week to buy cryptocurrency. Best Time of the Month to Buy Cryptocurrency Pricing trends carry on as weeks turn into months, and new trading patterns emerge that raise and lower the price of various cryptocurrencies over time. Since crypto trends are constantly in flux, deciding the best time of the month to buy cryptocurrency will require patience as you get to know the pricing trends of your favorite coins. For now, the best time to buy cryptocurrency is toward the end of the month. Cryptocurrency prices tend to rise in the first weeks of the month before they collapse and continue to trend downward through the end of the month. It’s worth reiterating again that cryptocurrencies are notorious for their volatility, which means patterns and trends that are true one month can vary widely the next. It takes time and diligence to learn how to follow cryptocurrency values and market fluctuations. How to Time the Cryptocurrency Market Here’s a quick recap to help you learn how to time the cryptocurrency market and get the best possible prices: Cryptocurrencies are most active during the work week, with prices starting low on Monday morning and steadily rising until they drop over the weekend. Pay attention to stock market trading hours as they have an effect on cryptocurrency trading, even though you can buy and sell cryptocurrencies 24/7. Be aware of your risk tolerance by forecasting your cash flow and watching cryptocurrency market trends. The Best Time to Buy Cryptocurrency It can be difficult to time the cryptocurrency market due to its volatile nature, but there are times that are better for buying cryptocurrencies than others. Just as with any other investment, cryptocurrency buyers should be aware of their risk tolerance and market conditions. But some trading strategies that work well on the stock exchange may not translate into profits for cryptocurrency trades. The best time to buy cryptocurrency is whenever you’re ready to start investing. Don’t put more into your investment than you are willing to lose, and keep in mind the rule of dollar-cost averaging. Once you’ve decided on a position, use this guide to decide when the best time to enter the cryptocurrency market is for you. https://corporatefinanceinstitute.com/resources/cryptocurrency/best-time-to-buy-cryptocurrency/#:~:text=Prices%20are%20lower%20when%20the,and%20rise%20throughout%20the%20week. ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.","[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
+
+EVIDENCE:
+What is the Best Time to Buy Cryptocurrency? It’s traded 24 hours a day, 7 days a week by investors located all around the world. Cryptocurrency is a volatile market that can offer opportunities to make - or lose - significant sums of money What is the Best Time to Buy Cryptocurrency? There are many methods that equity investors use to decide when to execute a trade in the stock markets, but the same rules and trading patterns don’t always apply to cryptocurrency. It’s true that cryptocurrency buyers can make purchases within certain windows to get the best possible price. Still, the volatility of the cryptocurrency market makes it very difficult to identify reliable patterns and choose positions accordingly. Unlike other assets, trading cryptocurrency has very low barriers to entry with tokens with a range of values. Rising inflation has also caused many to invest as a way to increase ancillary income. The allure of potentially turning a small investment into millions has also led others to try their luck with digital assets. Lastly, the constant hype around cryptocurrencies has caused even some crypto skeptics to look more closely out of FOMO (the Fear Of Missing Out). Buying cryptocurrency requires individuals to use a crypto wallet that can interact with the blockchain that tracks cryptocurrencies. The easiest way to do this is through an online cryptocurrency exchange platform. There are many to choose from, but exchange fees can vary widely. Make sure to take all fees into account before you buy cryptocurrency. Additionally, the transaction costs to record your transaction to the distributed ledger that is the blockchain can also vary due to the demand on computing power, energy, or volume of transactions that can impact your bottom line. However, with the volatility in trading cryptocurrency, those who want to start investing in cryptocurrency often wonder when is the best time to buy cryptocurrency? Key Highlights Many investors, some less experienced than others, are buying cryptocurrencies due to the hype, “fear-of-missing-out,” and low barrier to entry. Choosing the right positions can make or break an investment strategy, and the volatility of cryptocurrency makes it difficult to identify patterns and investment triggers. There are certain times that are better for trading cryptocurrency than others, but ultimately the best time to buy crypto is when the buyer is feeling confident in their strategy and financially ready to make a move. Best Time of the Day to Buy Cryptocurrency One of the perks of trading cryptocurrency is that you can buy it whenever you want. But many investors buy and sell cryptocurrencies during the same hours that the New York Stock Exchange (“NYSE”) is open. But since you can buy and sell crypto at all hours of the day, you’ll need to know which hours are better for buying cryptocurrency. Through analyzing months of data, you’ll begin to notice daily trends. Paying attention to cryptocurrencies with higher market capitalizations like Bitcoin, Ether, and Solana can also help newer investors determine better times of day to trade since cryptocurrency prices tend to rise and fall together. Experts say the best time of day to buy cryptocurrency is early in the morning before the NYSE opens since values tend to rise as the day goes on. Be sure to pay attention to slight daily fluctuations across different cryptocurrencies since trends will vary from coin to coin. Best Time of the Week to Buy Cryptocurrency Now that you’re getting used to setting your alarm bright and early to watch cryptocurrency trends, you may begin to notice longer patterns from week to week. Prices are lower when the market is less busy. Although you can trade cryptocurrencies at any time of day, the market is more active during typical work hours and less active early in the morning, at night, and on the weekends. Generally, cryptocurrency prices start low on Monday and rise throughout the week. When the weekend hits, prices tend to drop until market activity begins the following Monday. Since prices are likely to be at their lowest point following a weekend of low trading activity, Monday is the best time of the week to buy cryptocurrency. Best Time of the Month to Buy Cryptocurrency Pricing trends carry on as weeks turn into months, and new trading patterns emerge that raise and lower the price of various cryptocurrencies over time. Since crypto trends are constantly in flux, deciding the best time of the month to buy cryptocurrency will require patience as you get to know the pricing trends of your favorite coins. For now, the best time to buy cryptocurrency is toward the end of the month. Cryptocurrency prices tend to rise in the first weeks of the month before they collapse and continue to trend downward through the end of the month. It’s worth reiterating again that cryptocurrencies are notorious for their volatility, which means patterns and trends that are true one month can vary widely the next. It takes time and diligence to learn how to follow cryptocurrency values and market fluctuations. How to Time the Cryptocurrency Market Here’s a quick recap to help you learn how to time the cryptocurrency market and get the best possible prices: Cryptocurrencies are most active during the work week, with prices starting low on Monday morning and steadily rising until they drop over the weekend. Pay attention to stock market trading hours as they have an effect on cryptocurrency trading, even though you can buy and sell cryptocurrencies 24/7. Be aware of your risk tolerance by forecasting your cash flow and watching cryptocurrency market trends. The Best Time to Buy Cryptocurrency It can be difficult to time the cryptocurrency market due to its volatile nature, but there are times that are better for buying cryptocurrencies than others. Just as with any other investment, cryptocurrency buyers should be aware of their risk tolerance and market conditions. But some trading strategies that work well on the stock exchange may not translate into profits for cryptocurrency trades. The best time to buy cryptocurrency is whenever you’re ready to start investing. Don’t put more into your investment than you are willing to lose, and keep in mind the rule of dollar-cost averaging. Once you’ve decided on a position, use this guide to decide when the best time to enter the cryptocurrency market is for you.
+
+USER:
+I think Bitcoin is very interesting and want to buy some cryptocurrency but I have no idea of the best time. I live in CA and get paid at the first of the month. What is my best strategy?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,28,39,1055,,232
+"Provide responses in clear, concise and simple manner. The target audience has no knowledge of the subject and are not experts. You response should only rely on the provided context.",In what ways is Biden trying to improve the life of the average American?,"Biden Portrays Next Phase of Economic Agenda as Middle-Class Lifeline The president used his State of the Union speech to pitch tax increases for the rich, along with plans to cut costs and protect consumers. President Biden used his State of the Union speech on Thursday to remind Americans of his efforts to steer the nation’s economy out of a pandemic recession, and to lay the groundwork for a second term focused on making the economy more equitable by raising taxes on companies and the wealthy while taking steps to reduce costs for the middle class. Mr. Biden offered a blitz of policies squarely targeting the middle class, including efforts to make housing more affordable for first-time home buyers. The president used his speech to try and differentiate his economic proposals with those supported by Republicans, including former President Donald J. Trump. Those proposals have largely centered on cutting taxes, rolling back the Biden administration’s investments in clean energy and gutting the Internal Revenue Service. Many of Mr. Biden’s policy proposals would require acts of Congress and hinge on Democrats winning control of the House and the Senate. However, the president also unveiled plans to direct federal agencies to use their powers to reduce costs for big-ticket items like housing at a time when the lingering effects of inflation continue to weigh on economic sentiment. From taxes and housing to inflation and consumer protection, Mr. Biden had his eye on pocketbook issues. Raising Taxes on the Rich Many of the tax cuts that Mr. Trump signed into law in 2017 are set to expire next year, making tax policy among the most critical issues on the ballot this year. On Thursday night, Mr. Biden built upon many of the tax proposals that he has been promoting for the last three years, calling for big corporations and the wealthiest Americans to pay more. He proposed raising a new corporate minimum tax to 21 percent from 15 percent and proposed a new 25 percent minimum tax rate for billionaires, which he said would raise $500 billion over a decade. Criticizing the cost of the 2017 tax cuts, Mr. Biden asked, “Do you really think the wealthy and big corporations need another $2 trillion in tax breaks?” Help for the Housing Market High interest rates have made housing unaffordable for many Americans, and Mr. Biden called for a mix of measures to help ease those costs. That included tax credits and mortgage assistance for first-time home buyers and new incentives to encourage the construction and renovation of affordable housing. Mr. Biden called on Congress to make certain first-time buyers eligible for a $10,000 credit, along with making some “first generation” home buyers eligible for up to $25,000 toward a down payment. The president also unveiled new grants and incentives to encourage the construction of affordable housing. He also said the Consumer Financial Protection Bureau would be pursuing new rules to address “anticompetitive” closing costs that lenders impose on buyers and sellers, and called for more scrutiny of landlords who collude to raise rents and sneak hidden fees into rental agreements. Our politics reporters. Times journalists are not allowed to endorse or campaign for candidates or political causes. That includes participating in rallies and donating money to a candidate or cause. Learn more about our process. Protecting Consumers From “Shrinkflation” There is only so much that a president can do to tame rapid inflation, but Mr. Biden used his remarks to lean into his favorite new boogeyman: shrinkflation. “Same size bag, put fewer chips in it,” Mr. Biden said. He called on lawmakers to pass legislation to put an end to the corporate practice of reducing the size of products without reducing their price tag. The president also touted his efforts to cut credit card late charges and “junk” fees and to eliminate surprise fees for online ticket sales, and he claimed to be saving Americans billions of dollars from various forms of price gouging. Building and Buying American One of the mysteries that consume Mr. Biden’s advisers is why he does not get sufficient credit for the major pieces of legislation that have been enacted during the last three years. The president blitzed through those accomplishments, reminding his audience of the construction of new roads and bridges and investments in the development of microchips and clean energy manufacturing. Veering off script, Mr. Biden ribbed Republicans for voting against some of those policies while reaping the benefits of the investments in their states. Tackling China As president, Mr. Biden has prioritized stabilizing America’s economic relationship with China while also trying to reduce the United States’ reliance on Chinese products. Mr. Biden took aim at Mr. Trump, saying that while the former president portrayed himself as tough on China, the Biden administration’s policies were having a bigger impact on shrinking the bilateral trade deficit and powering U.S. economic growth. The president added that his administration had been pushing back against China’s unfair trade practices and keeping exports of sensitive American technology away from the Chinese military. He said that Republicans who claim that the U.S. is falling behind China were wrong. “America is rising,” Mr. Biden said. “We have the best economy in the world.”","Provide responses in clear, concise and simple manner. The target audience has no knowledge of the subject and are not experts. You response should only rely on the provided context. In what ways is Biden trying to improve the life of the average American? Biden Portrays Next Phase of Economic Agenda as Middle-Class Lifeline The president used his State of the Union speech to pitch tax increases for the rich, along with plans to cut costs and protect consumers. President Biden used his State of the Union speech on Thursday to remind Americans of his efforts to steer the nation’s economy out of a pandemic recession, and to lay the groundwork for a second term focused on making the economy more equitable by raising taxes on companies and the wealthy while taking steps to reduce costs for the middle class. Mr. Biden offered a blitz of policies squarely targeting the middle class, including efforts to make housing more affordable for first-time home buyers. The president used his speech to try and differentiate his economic proposals with those supported by Republicans, including former President Donald J. Trump. Those proposals have largely centered on cutting taxes, rolling back the Biden administration’s investments in clean energy and gutting the Internal Revenue Service. Many of Mr. Biden’s policy proposals would require acts of Congress and hinge on Democrats winning control of the House and the Senate. However, the president also unveiled plans to direct federal agencies to use their powers to reduce costs for big-ticket items like housing at a time when the lingering effects of inflation continue to weigh on economic sentiment. From taxes and housing to inflation and consumer protection, Mr. Biden had his eye on pocketbook issues. Raising Taxes on the Rich Many of the tax cuts that Mr. Trump signed into law in 2017 are set to expire next year, making tax policy among the most critical issues on the ballot this year. On Thursday night, Mr. Biden built upon many of the tax proposals that he has been promoting for the last three years, calling for big corporations and the wealthiest Americans to pay more. He proposed raising a new corporate minimum tax to 21 percent from 15 percent and proposed a new 25 percent minimum tax rate for billionaires, which he said would raise $500 billion over a decade. Criticizing the cost of the 2017 tax cuts, Mr. Biden asked, “Do you really think the wealthy and big corporations need another $2 trillion in tax breaks?” Help for the Housing Market High interest rates have made housing unaffordable for many Americans, and Mr. Biden called for a mix of measures to help ease those costs. That included tax credits and mortgage assistance for first-time home buyers and new incentives to encourage the construction and renovation of affordable housing. Mr. Biden called on Congress to make certain first-time buyers eligible for a $10,000 credit, along with making some “first generation” home buyers eligible for up to $25,000 toward a down payment. The president also unveiled new grants and incentives to encourage the construction of affordable housing. He also said the Consumer Financial Protection Bureau would be pursuing new rules to address “anticompetitive” closing costs that lenders impose on buyers and sellers, and called for more scrutiny of landlords who collude to raise rents and sneak hidden fees into rental agreements. Our politics reporters. Times journalists are not allowed to endorse or campaign for candidates or political causes. That includes participating in rallies and donating money to a candidate or cause. Learn more about our process. Protecting Consumers From “Shrinkflation” There is only so much that a president can do to tame rapid inflation, but Mr. Biden used his remarks to lean into his favorite new boogeyman: shrinkflation. “Same size bag, put fewer chips in it,” Mr. Biden said. He called on lawmakers to pass legislation to put an end to the corporate practice of reducing the size of products without reducing their price tag. The president also touted his efforts to cut credit card late charges and “junk” fees and to eliminate surprise fees for online ticket sales, and he claimed to be saving Americans billions of dollars from various forms of price gouging. Building and Buying American One of the mysteries that consume Mr. Biden’s advisers is why he does not get sufficient credit for the major pieces of legislation that have been enacted during the last three years. The president blitzed through those accomplishments, reminding his audience of the construction of new roads and bridges and investments in the development of microchips and clean energy manufacturing. Veering off script, Mr. Biden ribbed Republicans for voting against some of those policies while reaping the benefits of the investments in their states. Tackling China As president, Mr. Biden has prioritized stabilizing America’s economic relationship with China while also trying to reduce the United States’ reliance on Chinese products. Mr. Biden took aim at Mr. Trump, saying that while the former president portrayed himself as tough on China, the Biden administration’s policies were having a bigger impact on shrinking the bilateral trade deficit and powering U.S. economic growth. The president added that his administration had been pushing back against China’s unfair trade practices and keeping exports of sensitive American technology away from the Chinese military. He said that Republicans who claim that the U.S. is falling behind China were wrong. “America is rising,” Mr. Biden said. “We have the best economy in the world.”","Provide responses in clear, concise and simple manner. The target audience has no knowledge of the subject and are not experts. You response should only rely on the provided context.
+
+EVIDENCE:
+Biden Portrays Next Phase of Economic Agenda as Middle-Class Lifeline The president used his State of the Union speech to pitch tax increases for the rich, along with plans to cut costs and protect consumers. President Biden used his State of the Union speech on Thursday to remind Americans of his efforts to steer the nation’s economy out of a pandemic recession, and to lay the groundwork for a second term focused on making the economy more equitable by raising taxes on companies and the wealthy while taking steps to reduce costs for the middle class. Mr. Biden offered a blitz of policies squarely targeting the middle class, including efforts to make housing more affordable for first-time home buyers. The president used his speech to try and differentiate his economic proposals with those supported by Republicans, including former President Donald J. Trump. Those proposals have largely centered on cutting taxes, rolling back the Biden administration’s investments in clean energy and gutting the Internal Revenue Service. Many of Mr. Biden’s policy proposals would require acts of Congress and hinge on Democrats winning control of the House and the Senate. However, the president also unveiled plans to direct federal agencies to use their powers to reduce costs for big-ticket items like housing at a time when the lingering effects of inflation continue to weigh on economic sentiment. From taxes and housing to inflation and consumer protection, Mr. Biden had his eye on pocketbook issues. Raising Taxes on the Rich Many of the tax cuts that Mr. Trump signed into law in 2017 are set to expire next year, making tax policy among the most critical issues on the ballot this year. On Thursday night, Mr. Biden built upon many of the tax proposals that he has been promoting for the last three years, calling for big corporations and the wealthiest Americans to pay more. He proposed raising a new corporate minimum tax to 21 percent from 15 percent and proposed a new 25 percent minimum tax rate for billionaires, which he said would raise $500 billion over a decade. Criticizing the cost of the 2017 tax cuts, Mr. Biden asked, “Do you really think the wealthy and big corporations need another $2 trillion in tax breaks?” Help for the Housing Market High interest rates have made housing unaffordable for many Americans, and Mr. Biden called for a mix of measures to help ease those costs. That included tax credits and mortgage assistance for first-time home buyers and new incentives to encourage the construction and renovation of affordable housing. Mr. Biden called on Congress to make certain first-time buyers eligible for a $10,000 credit, along with making some “first generation” home buyers eligible for up to $25,000 toward a down payment. The president also unveiled new grants and incentives to encourage the construction of affordable housing. He also said the Consumer Financial Protection Bureau would be pursuing new rules to address “anticompetitive” closing costs that lenders impose on buyers and sellers, and called for more scrutiny of landlords who collude to raise rents and sneak hidden fees into rental agreements. Our politics reporters. Times journalists are not allowed to endorse or campaign for candidates or political causes. That includes participating in rallies and donating money to a candidate or cause. Learn more about our process. Protecting Consumers From “Shrinkflation” There is only so much that a president can do to tame rapid inflation, but Mr. Biden used his remarks to lean into his favorite new boogeyman: shrinkflation. “Same size bag, put fewer chips in it,” Mr. Biden said. He called on lawmakers to pass legislation to put an end to the corporate practice of reducing the size of products without reducing their price tag. The president also touted his efforts to cut credit card late charges and “junk” fees and to eliminate surprise fees for online ticket sales, and he claimed to be saving Americans billions of dollars from various forms of price gouging. Building and Buying American One of the mysteries that consume Mr. Biden’s advisers is why he does not get sufficient credit for the major pieces of legislation that have been enacted during the last three years. The president blitzed through those accomplishments, reminding his audience of the construction of new roads and bridges and investments in the development of microchips and clean energy manufacturing. Veering off script, Mr. Biden ribbed Republicans for voting against some of those policies while reaping the benefits of the investments in their states. Tackling China As president, Mr. Biden has prioritized stabilizing America’s economic relationship with China while also trying to reduce the United States’ reliance on Chinese products. Mr. Biden took aim at Mr. Trump, saying that while the former president portrayed himself as tough on China, the Biden administration’s policies were having a bigger impact on shrinking the bilateral trade deficit and powering U.S. economic growth. The president added that his administration had been pushing back against China’s unfair trade practices and keeping exports of sensitive American technology away from the Chinese military. He said that Republicans who claim that the U.S. is falling behind China were wrong. “America is rising,” Mr. Biden said. “We have the best economy in the world.”
+
+USER:
+In what ways is Biden trying to improve the life of the average American?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,30,14,870,,531
+"Answers must only be provided from the text below. Sentences must be 9 words or less, no words longer than 8 characters.",how should kids operate the fridge freezer?,"instructions • Warnings and Important Safety Instructions in this manual do not cover all possible conditions and situations that may occur. It is your responsibility to use common sense, caution, and care when installing, maintaining, and operating your appliance. • Because these following operating instructions cover various models, the characteristics of your refrigerator may differ slightly from those described in this manual and not all warning signs may be applicable. If you have any questions or concerns, contact your nearest service center or find help and information online at www.samsung.com. • R-600a or R-134a is used as a refrigerant. Check the compressor label on the rear of the appliance or the rating label inside the fridge to see which refrigerant is used for your appliance. When this product contains flammable gas (Refrigerant R-600a), contact your local authority in regard to safe disposal of this product. • In order to avoid the creation of a flammable gas-air mixture if a leak in the refrigerating circuit occurs, the size of the room in which the appliance may be sited depends on the amount of refrigerant used. Safety information Untitled-1 4 2022-03-25 6:06:25 English 5 Safety information • Never start up an appliance showing any signs of damage. If in doubt, consult your dealer. The room must be 1 m3 in size for every 8 g of R-600a refrigerant inside the appliance. The amount of refrigerant in your particular appliance is shown on the identification plate inside the appliance. • Refrigerant squirting out of the pipes could ignite or cause an eye injury. When refrigerant leaks from the pipe, avoid any naked flames and move anything flammable away from the product and ventilate the room immediately. - Failing to do so may result in fire or explosion. • To avoid contamination of food, please respect the following instructions: - Opening the door for long periods can cause a significant increase of the temperature in the compartments of the appliance. - Clean regularly surfaces that can come in contact with food and accessible drainage systems. - Clean water tanks if they have not been used for 48 h; flush the water system connected to a water supply if water has not been drawn for 5 days. - Store raw meat and fish in suitable containers in the refrigerator, so that it is not in contact with or drip onto other food. - Two-star frozen-food compartments are suitable for storing pre-frozen food, storing or making icecream and making ice cubes. - One-, two- and three-star compartments are not suitable for the freezing of fresh food. Untitled-1 5 2022-03-25 6:06:25 Safety information 6 English Safety information - If the refrigerating appliance is left empty for long periods, switch off, defrost, clean, dry, and leave the door open to prevent mould developing within the appliance. Important safety symbols and precautions: Please follow all safety instructions in this manual. This manual uses the following safety symbols. WARNING Hazards or unsafe practices that may result in severe personal injury, property damage, and/or death. CAUTION Hazards or unsafe practices that may result in severe personal injury and/or property damage. NOTE Useful information that helps users understand or benefit from the refrigerator. These warning signs are here to prevent injury to you and others. Please follow them carefully. After reading this section, keep it in a safe place for future reference. Untitled-1 6 2022-03-25 6:06:25 English 7 Safety information Important safety precautions Warning; Risk of fire / flammable materials WARNING • When positioning the appliance, ensure the supply cord is not trapped or damaged. • Do not locate multiple portable socket-outlets or portable power supplies at the rear of the appliance. • Fill with potable water only. • Connect to potable water supply only. • Keep ventilation openings, in the appliance enclosure or in the built-in structure, clear of obstruction. • Do not use mechanical devices or any other means to accelerate the defrosting process, other than those recommended by the manufacturer. • Do not damage the refrigerant circuit. • Do not use electrical appliances inside the food storage compartments of the appliance, unless they are of the type recommended by the manufacturer. • This appliance is not intended for use by persons (including children) with reduced physical, sensory, or mental capabilities, or those who lack experience and knowledge, unless they have been given supervision or instruction concerning the use of the appliance by a person responsible for their safety","Answers must only be provided from the text below. Sentences must be 9 words or less, no words longer than 8 characters. how should kids operate the fridge freezer? instructions • Warnings and Important Safety Instructions in this manual do not cover all possible conditions and situations that may occur. It is your responsibility to use common sense, caution, and care when installing, maintaining, and operating your appliance. • Because these following operating instructions cover various models, the characteristics of your refrigerator may differ slightly from those described in this manual and not all warning signs may be applicable. If you have any questions or concerns, contact your nearest service center or find help and information online at www.samsung.com. • R-600a or R-134a is used as a refrigerant. Check the compressor label on the rear of the appliance or the rating label inside the fridge to see which refrigerant is used for your appliance. When this product contains flammable gas (Refrigerant R-600a), contact your local authority in regard to safe disposal of this product. • In order to avoid the creation of a flammable gas-air mixture if a leak in the refrigerating circuit occurs, the size of the room in which the appliance may be sited depends on the amount of refrigerant used. Safety information Untitled-1 4 2022-03-25 6:06:25 English 5 Safety information • Never start up an appliance showing any signs of damage. If in doubt, consult your dealer. The room must be 1 m3 in size for every 8 g of R-600a refrigerant inside the appliance. The amount of refrigerant in your particular appliance is shown on the identification plate inside the appliance. • Refrigerant squirting out of the pipes could ignite or cause an eye injury. When refrigerant leaks from the pipe, avoid any naked flames and move anything flammable away from the product and ventilate the room immediately. - Failing to do so may result in fire or explosion. • To avoid contamination of food, please respect the following instructions: - Opening the door for long periods can cause a significant increase of the temperature in the compartments of the appliance. - Clean regularly surfaces that can come in contact with food and accessible drainage systems. - Clean water tanks if they have not been used for 48 h; flush the water system connected to a water supply if water has not been drawn for 5 days. - Store raw meat and fish in suitable containers in the refrigerator, so that it is not in contact with or drip onto other food. - Two-star frozen-food compartments are suitable for storing pre-frozen food, storing or making icecream and making ice cubes. - One-, two- and three-star compartments are not suitable for the freezing of fresh food. Untitled-1 5 2022-03-25 6:06:25 Safety information 6 English Safety information - If the refrigerating appliance is left empty for long periods, switch off, defrost, clean, dry, and leave the door open to prevent mould developing within the appliance. Important safety symbols and precautions: Please follow all safety instructions in this manual. This manual uses the following safety symbols. WARNING Hazards or unsafe practices that may result in severe personal injury, property damage, and/or death. CAUTION Hazards or unsafe practices that may result in severe personal injury and/or property damage. NOTE Useful information that helps users understand or benefit from the refrigerator. These warning signs are here to prevent injury to you and others. Please follow them carefully. After reading this section, keep it in a safe place for future reference. Untitled-1 6 2022-03-25 6:06:25 English 7 Safety information Important safety precautions Warning; Risk of fire / flammable materials WARNING • When positioning the appliance, ensure the supply cord is not trapped or damaged. • Do not locate multiple portable socket-outlets or portable power supplies at the rear of the appliance. • Fill with potable water only. • Connect to potable water supply only. • Keep ventilation openings, in the appliance enclosure or in the built-in structure, clear of obstruction. • Do not use mechanical devices or any other means to accelerate the defrosting process, other than those recommended by the manufacturer. • Do not damage the refrigerant circuit. • Do not use electrical appliances inside the food storage compartments of the appliance, unless they are of the type recommended by the manufacturer. • This appliance is not intended for use by persons (including children) with reduced physical, sensory, or mental capabilities, or those who lack experience and knowledge, unless they have been given supervision or instruction concerning the use of the appliance by a person responsible for their safety","Answers must only be provided from the text below. Sentences must be 9 words or less, no words longer than 8 characters.
+
+EVIDENCE:
+instructions • Warnings and Important Safety Instructions in this manual do not cover all possible conditions and situations that may occur. It is your responsibility to use common sense, caution, and care when installing, maintaining, and operating your appliance. • Because these following operating instructions cover various models, the characteristics of your refrigerator may differ slightly from those described in this manual and not all warning signs may be applicable. If you have any questions or concerns, contact your nearest service center or find help and information online at www.samsung.com. • R-600a or R-134a is used as a refrigerant. Check the compressor label on the rear of the appliance or the rating label inside the fridge to see which refrigerant is used for your appliance. When this product contains flammable gas (Refrigerant R-600a), contact your local authority in regard to safe disposal of this product. • In order to avoid the creation of a flammable gas-air mixture if a leak in the refrigerating circuit occurs, the size of the room in which the appliance may be sited depends on the amount of refrigerant used. Safety information Untitled-1 4 2022-03-25 6:06:25 English 5 Safety information • Never start up an appliance showing any signs of damage. If in doubt, consult your dealer. The room must be 1 m3 in size for every 8 g of R-600a refrigerant inside the appliance. The amount of refrigerant in your particular appliance is shown on the identification plate inside the appliance. • Refrigerant squirting out of the pipes could ignite or cause an eye injury. When refrigerant leaks from the pipe, avoid any naked flames and move anything flammable away from the product and ventilate the room immediately. - Failing to do so may result in fire or explosion. • To avoid contamination of food, please respect the following instructions: - Opening the door for long periods can cause a significant increase of the temperature in the compartments of the appliance. - Clean regularly surfaces that can come in contact with food and accessible drainage systems. - Clean water tanks if they have not been used for 48 h; flush the water system connected to a water supply if water has not been drawn for 5 days. - Store raw meat and fish in suitable containers in the refrigerator, so that it is not in contact with or drip onto other food. - Two-star frozen-food compartments are suitable for storing pre-frozen food, storing or making icecream and making ice cubes. - One-, two- and three-star compartments are not suitable for the freezing of fresh food. Untitled-1 5 2022-03-25 6:06:25 Safety information 6 English Safety information - If the refrigerating appliance is left empty for long periods, switch off, defrost, clean, dry, and leave the door open to prevent mould developing within the appliance. Important safety symbols and precautions: Please follow all safety instructions in this manual. This manual uses the following safety symbols. WARNING Hazards or unsafe practices that may result in severe personal injury, property damage, and/or death. CAUTION Hazards or unsafe practices that may result in severe personal injury and/or property damage. NOTE Useful information that helps users understand or benefit from the refrigerator. These warning signs are here to prevent injury to you and others. Please follow them carefully. After reading this section, keep it in a safe place for future reference. Untitled-1 6 2022-03-25 6:06:25 English 7 Safety information Important safety precautions Warning; Risk of fire / flammable materials WARNING • When positioning the appliance, ensure the supply cord is not trapped or damaged. • Do not locate multiple portable socket-outlets or portable power supplies at the rear of the appliance. • Fill with potable water only. • Connect to potable water supply only. • Keep ventilation openings, in the appliance enclosure or in the built-in structure, clear of obstruction. • Do not use mechanical devices or any other means to accelerate the defrosting process, other than those recommended by the manufacturer. • Do not damage the refrigerant circuit. • Do not use electrical appliances inside the food storage compartments of the appliance, unless they are of the type recommended by the manufacturer. • This appliance is not intended for use by persons (including children) with reduced physical, sensory, or mental capabilities, or those who lack experience and knowledge, unless they have been given supervision or instruction concerning the use of the appliance by a person responsible for their safety
+
+USER:
+how should kids operate the fridge freezer?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,22,7,739,,250
+Only use information from the text provided. Do not use any external resources or prior knowledge to answer questions.,List the things people thought would happen in the future according to this article from 1995.,"The Internet? Bah! Hype alert: Why cyberspace isn't, and will never be, nirvana By NEWSWEEK From the magazine issue dated Feb 27, 1995 After two decades online, I'm perplexed. It's not that I haven't had a gas of a good time on the Internet. I've met great people and even caught a hacker or two. But today, I'm uneasy about this most trendy and oversold community. Visionaries see a future of telecommuting workers, interactive libraries and multimedia classrooms. They speak of electronic town meetings and virtual communities. Commerce and business will shift from offices and malls to networks and modems. And the freedom of digital networks will make government more democratic. Baloney. Do our computer pundits lack all common sense? The truth in no online database will replace your daily newspaper, no CD-ROM can take the place of a competent teacher and no computer network will change the way government works. Consider today's online world. The Usenet, a worldwide bulletin board, allows anyone to post messages across the nation. Your word gets out, leapfrogging editors and publishers. Every voice can be heard cheaply and instantly. The result? Every voice is heard. The cacophany more closely resembles citizens band radio, complete with handles, harrasment, and anonymous threats. When most everyone shouts, few listen. How about electronic publishing? Try reading a book on disc. At best, it's an unpleasant chore: the myopic glow of a clunky computer replaces the friendly pages of a book. And you can't tote that laptop to the beach. Yet Nicholas Negroponte, director of the MIT Media Lab, predicts that we'll soon buy books and newspapers straight over the Intenet. Uh, sure. What the Internet hucksters won't tell you is tht the Internet is one big ocean of unedited data, without any pretense of completeness. Lacking editors, reviewers or critics, the Internet has become a wasteland of unfiltered data. You don't know what to ignore and what's worth reading. Logged onto the World Wide Web, I hunt for the date of the Battle of Trafalgar. Hundreds of files show up, and it takes 15 minutes to unravel them—one's a biography written by an eighth grader, the second is a computer game that doesn't work and the third is an image of a London monument. None answers my question, and my search is periodically interrupted by messages like, ""Too many connectios, try again later."" Won't the Internet be useful in governing? Internet addicts clamor for government reports. But when Andy Spano ran for county executive in Westchester County, N.Y., he put every press release and position paper onto a bulletin board. In that affluent county, with plenty of computer companies, how many voters logged in? Fewer than 30. Not a good omen. Point and click: Then there are those pushing computers into schools. We're told that multimedia will make schoolwork easy and fun. Students will happily learn from animated characters while taught by expertly tailored software.Who needs teachers when you've got computer-aided education? Bah. These expensive toys are difficult to use in classrooms and require extensive teacher training. Sure, kids love videogames—but think of your own experience: can you recall even one educational filmstrip of decades past? I'll bet you remember the two or three great teachers who made a difference in your life. Then there's cyberbusiness. We're promised instant catalog shopping—just point and click for great deals. We'll order airline tickets over the network, make restaurant reservations and negotiate sales contracts. Stores will become obselete. So how come my local mall does more business in an afternoon than the entire Internet handles in a month? Even if there were a trustworthy way to send money over the Internet—which there isn't—the network is missing a most essential ingredient of capitalism: salespeople. What's missing from this electronic wonderland? Human contact. Discount the fawning techno-burble about virtual communities. Computers and networks isolate us from one another. A network chat line is a limp substitute for meeting friends over coffee. No interactive multimedia display comes close to the excitement of a live concert. And who'd prefer cybersex to the real thing? While the Internet beckons brightly, seductively flashing an icon of knowledge-as-power, this nonplace lures us to surrender our time on earth. A poor substitute it is, this virtual reality where frustration is legion and where—in the holy names of Education and Progress—important aspects of human interactions are relentlessly devalued.","Context Block: The Internet? Bah! Hype alert: Why cyberspace isn't, and will never be, nirvana By NEWSWEEK From the magazine issue dated Feb 27, 1995 After two decades online, I'm perplexed. It's not that I haven't had a gas of a good time on the Internet. I've met great people and even caught a hacker or two. But today, I'm uneasy about this most trendy and oversold community. Visionaries see a future of telecommuting workers, interactive libraries and multimedia classrooms. They speak of electronic town meetings and virtual communities. Commerce and business will shift from offices and malls to networks and modems. And the freedom of digital networks will make government more democratic. Baloney. Do our computer pundits lack all common sense? The truth in no online database will replace your daily newspaper, no CD-ROM can take the place of a competent teacher and no computer network will change the way government works. Consider today's online world. The Usenet, a worldwide bulletin board, allows anyone to post messages across the nation. Your word gets out, leapfrogging editors and publishers. Every voice can be heard cheaply and instantly. The result? Every voice is heard. The cacophany more closely resembles citizens band radio, complete with handles, harrasment, and anonymous threats. When most everyone shouts, few listen. How about electronic publishing? Try reading a book on disc. At best, it's an unpleasant chore: the myopic glow of a clunky computer replaces the friendly pages of a book. And you can't tote that laptop to the beach. Yet Nicholas Negroponte, director of the MIT Media Lab, predicts that we'll soon buy books and newspapers straight over the Intenet. Uh, sure. What the Internet hucksters won't tell you is tht the Internet is one big ocean of unedited data, without any pretense of completeness. Lacking editors, reviewers or critics, the Internet has become a wasteland of unfiltered data. You don't know what to ignore and what's worth reading. Logged onto the World Wide Web, I hunt for the date of the Battle of Trafalgar. Hundreds of files show up, and it takes 15 minutes to unravel them—one's a biography written by an eighth grader, the second is a computer game that doesn't work and the third is an image of a London monument. None answers my question, and my search is periodically interrupted by messages like, ""Too many connectios, try again later."" Won't the Internet be useful in governing? Internet addicts clamor for government reports. But when Andy Spano ran for county executive in Westchester County, N.Y., he put every press release and position paper onto a bulletin board. In that affluent county, with plenty of computer companies, how many voters logged in? Fewer than 30. Not a good omen. Point and click: Then there are those pushing computers into schools. We're told that multimedia will make schoolwork easy and fun. Students will happily learn from animated characters while taught by expertly tailored software.Who needs teachers when you've got computer-aided education? Bah. These expensive toys are difficult to use in classrooms and require extensive teacher training. Sure, kids love videogames—but think of your own experience: can you recall even one educational filmstrip of decades past? I'll bet you remember the two or three great teachers who made a difference in your life. Then there's cyberbusiness. We're promised instant catalog shopping—just point and click for great deals. We'll order airline tickets over the network, make restaurant reservations and negotiate sales contracts. Stores will become obselete. So how come my local mall does more business in an afternoon than the entire Internet handles in a month? Even if there were a trustworthy way to send money over the Internet—which there isn't—the network is missing a most essential ingredient of capitalism: salespeople. What's missing from this electronic wonderland? Human contact. Discount the fawning techno-burble about virtual communities. Computers and networks isolate us from one another. A network chat line is a limp substitute for meeting friends over coffee. No interactive multimedia display comes close to the excitement of a live concert. And who'd prefer cybersex to the real thing? While the Internet beckons brightly, seductively flashing an icon of knowledge-as-power, this nonplace lures us to surrender our time on earth. A poor substitute it is, this virtual reality where frustration is legion and where—in the holy names of Education and Progress—important aspects of human interactions are relentlessly devalued. Question: List the things people thought would happen in the future according to this article from 1995. System Instruction: Only use information from the text provided. Do not use any external resources or prior knowledge to answer questions.","Only use information from the text provided. Do not use any external resources or prior knowledge to answer questions.
+
+EVIDENCE:
+The Internet? Bah! Hype alert: Why cyberspace isn't, and will never be, nirvana By NEWSWEEK From the magazine issue dated Feb 27, 1995 After two decades online, I'm perplexed. It's not that I haven't had a gas of a good time on the Internet. I've met great people and even caught a hacker or two. But today, I'm uneasy about this most trendy and oversold community. Visionaries see a future of telecommuting workers, interactive libraries and multimedia classrooms. They speak of electronic town meetings and virtual communities. Commerce and business will shift from offices and malls to networks and modems. And the freedom of digital networks will make government more democratic. Baloney. Do our computer pundits lack all common sense? The truth in no online database will replace your daily newspaper, no CD-ROM can take the place of a competent teacher and no computer network will change the way government works. Consider today's online world. The Usenet, a worldwide bulletin board, allows anyone to post messages across the nation. Your word gets out, leapfrogging editors and publishers. Every voice can be heard cheaply and instantly. The result? Every voice is heard. The cacophany more closely resembles citizens band radio, complete with handles, harrasment, and anonymous threats. When most everyone shouts, few listen. How about electronic publishing? Try reading a book on disc. At best, it's an unpleasant chore: the myopic glow of a clunky computer replaces the friendly pages of a book. And you can't tote that laptop to the beach. Yet Nicholas Negroponte, director of the MIT Media Lab, predicts that we'll soon buy books and newspapers straight over the Intenet. Uh, sure. What the Internet hucksters won't tell you is tht the Internet is one big ocean of unedited data, without any pretense of completeness. Lacking editors, reviewers or critics, the Internet has become a wasteland of unfiltered data. You don't know what to ignore and what's worth reading. Logged onto the World Wide Web, I hunt for the date of the Battle of Trafalgar. Hundreds of files show up, and it takes 15 minutes to unravel them—one's a biography written by an eighth grader, the second is a computer game that doesn't work and the third is an image of a London monument. None answers my question, and my search is periodically interrupted by messages like, ""Too many connectios, try again later."" Won't the Internet be useful in governing? Internet addicts clamor for government reports. But when Andy Spano ran for county executive in Westchester County, N.Y., he put every press release and position paper onto a bulletin board. In that affluent county, with plenty of computer companies, how many voters logged in? Fewer than 30. Not a good omen. Point and click: Then there are those pushing computers into schools. We're told that multimedia will make schoolwork easy and fun. Students will happily learn from animated characters while taught by expertly tailored software.Who needs teachers when you've got computer-aided education? Bah. These expensive toys are difficult to use in classrooms and require extensive teacher training. Sure, kids love videogames—but think of your own experience: can you recall even one educational filmstrip of decades past? I'll bet you remember the two or three great teachers who made a difference in your life. Then there's cyberbusiness. We're promised instant catalog shopping—just point and click for great deals. We'll order airline tickets over the network, make restaurant reservations and negotiate sales contracts. Stores will become obselete. So how come my local mall does more business in an afternoon than the entire Internet handles in a month? Even if there were a trustworthy way to send money over the Internet—which there isn't—the network is missing a most essential ingredient of capitalism: salespeople. What's missing from this electronic wonderland? Human contact. Discount the fawning techno-burble about virtual communities. Computers and networks isolate us from one another. A network chat line is a limp substitute for meeting friends over coffee. No interactive multimedia display comes close to the excitement of a live concert. And who'd prefer cybersex to the real thing? While the Internet beckons brightly, seductively flashing an icon of knowledge-as-power, this nonplace lures us to surrender our time on earth. A poor substitute it is, this virtual reality where frustration is legion and where—in the holy names of Education and Progress—important aspects of human interactions are relentlessly devalued.
+
+USER:
+List the things people thought would happen in the future according to this article from 1995.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,19,16,728,,715
+"The response should be accurate and concise, with little added conversational elements or tone. If you cannot provide the answer to the request based on the context given, make sure to simply state, ""The information is not available at this time.""",What impact does the FDA expect the nonprescription availability of Opill to have on unintended pregnancies?,"3/10/24, 10:58 AM FDA Approves First Nonprescription Daily Oral Contraceptive | FDA FDA NEWS RELEASE FDA Approves First Nonprescription Daily Oral Contraceptive For Immediate Release: July 13, 2023 Espanol (https:/Awww.fda.gov/news-events/press-announcements/la-fda-aprueba-el-primer-anticonceptivo-oral-diario-sin-receta) Today, the U.S. Food and Drug Administration approved Opill (norgestrel) tablet for nonprescription use to prevent pregnancy— the first daily oral contraceptive approved for use in the U.S. without a prescription. Approval of this progestin-only oral contraceptive pill provides an option for consumers to purchase oral contraceptive medicine without a prescription at drug stores, convenience stores and grocery stores, as well as online. The timeline for availability and price of this nonprescription product is determined by the manufacturer. Other approved formulations and dosages of other oral contraceptives will remain available by prescription only. “Today’s approval marks the first time a nonprescription daily oral contraceptive will be an available option for millions of people in the United States,” said Patrizia Cavazzoni, M.D., director of the FDA’s Center for Drug Evaluation and Research. “When used as directed, daily oral contraception is safe and is expected to be more effective than currently available nonprescription contraceptive methods in preventing unintended pregnancy.” Nonprescription availability of Opill may reduce barriers to access by allowing individuals to obtain an oral contraceptive without the need to first see a health care provider. Almost half of the 6.1 million pregnancies in the U.S. each year are unintended. Unintended pregnancies have been linked to negative maternal and perinatal outcomes, including reduced likelihood of receiving early prenatal care and increased risk of preterm delivery, with associated adverse neonatal, developmental and child health outcomes. Availability of nonprescription Opill may help reduce the number of unintended pregnancies and their potential negative impacts. The contraceptive efficacy of norgestrel was established with the original approval for prescription use in 1973. ription-nonprescription-rx-ote-switches) to switch norgestrel from a prescription to an over-the- counter product. For approval of a product for use in the nonprescription setting, the FDA requires that the applicant demonstrate (https://www.accessdata.fda.gov/drugsatfda_docs/nda/2023/0170310rigisogiSumR.pdf) that the product can be used by consumers safely and effectively, relying only on the nonprescription drug labeling without any assistance from a health care professional. Studies showed that consumer understanding of information on the Opill Drug Facts label was high overall and that a high proportion of consumers understood the label instructions, supporting their ability to properly use the drug when it is available as an over-the-counter product. When properly used, Opill is safe and effective. https:/Awww.fda.gov/news-events/press-announcements/fda-approves-first-nonprescription-daily-oral-contraceptive 3/10/24, 10:58 AM FDA Approves First Nonprescription Daily Oral Contraceptive | FDA Opill should be taken at the same time every day; adherence to daily use at the same time of day is important for the effectiveness of Opill. Using medications that interact with Opill can result in decreased efficacy of Opill or the other medication, or both, potentially resulting in unintended pregnancy. The most common side effects of Opill include irregular bleeding, headaches, dizziness, nausea, increased appetite, abdominal pain, cramps or bloating. Opill should not be used by those who have or have ever had breast cancer. Consumers who have any other form of cancer should ask a doctor before use. Opill also should not be used together with another hormonal birth control product such as another oral contraceptive tablet, a vaginal ring, a contraceptive patch, a contraceptive implant, a contraceptive injection or an IUD (intra-uterine device). Use of Opill may be associated with changes in vaginal bleeding patterns, such as irregular spotting and prolonged bleeding. Consumers should inform a health care provider if they develop repeated vaginal bleeding after sex, or prolonged episodes of bleeding or amenorrhea (absence of menstrual period). Individuals who miss two periods (or have missed a single period and have missed doses of Opill) or suspect they may be pregnant should take a pregnancy test. Consumers should discontinue Opill if pregnancy is confirmed. Opill is not for use as emergency contraception and does not prevent pregnancy after unprotected sex. Oral contraceptives do not protect against transmission of HIV, AIDS and other sexually transmitted diseases such as chlamydia, genital herpes, genital warts, gonorrhea, hepatitis B and syphilis. Condoms should be used to prevent sexually transmitted diseases. The FDA granted the approval to Laboratoire HRA Pharma, recently acquired by Perrigo Company ple. Related Information * Drugs@FDA: Opill (http://www.accessdata.fda.gov/scripts/cder/daf/index.cfm? event=overview.process&varAppINo=017031), * Decisional Memo (https://www.accessdata.fda.gov/drugsatfda_docs/nda/2023/0170310rigisog1SumR.pdf) © Opill (0.075mg Oral Norgestrel Tablet) Information (http://www.fda.gov/drugs/postmarket-drug-safety- information-patients-and-providers/opill-oo75mg-oral-norgestrel-tablet-information), HEF The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products. Inquiries Media: Jeremy Kahn (mailto: Jeremy. kahn@fda.hhs.gov) & (301) 796-8671 https:/Awww.fda.gov/news-events/press-announcements/fda-approves-first-nonprescription-daily-oral-contraceptive 3/10/24, 10:58 AM FDA Approves First Nonprescription Daily Oral Contraceptive | FDA Consumer: &. 888-INFO-FDA Was this helpful? @ More Press Announcements (/news-events/newsroom/press-announcements) https://Awww.fda.gov/news-events/press-announcements/fda-approves-first-nonprescription-daily-oral-contraceptive 3/3","The response should be accurate and concise, with little added conversational elements or tone. If you cannot provide the answer to the request based on the context given, make sure to simply state, ""The information is not available at this time."" What impact does the FDA expect the nonprescription availability of Opill to have on unintended pregnancies? 3/10/24, 10:58 AM FDA Approves First Nonprescription Daily Oral Contraceptive | FDA FDA NEWS RELEASE FDA Approves First Nonprescription Daily Oral Contraceptive For Immediate Release: July 13, 2023 Espanol (https:/Awww.fda.gov/news-events/press-announcements/la-fda-aprueba-el-primer-anticonceptivo-oral-diario-sin-receta) Today, the U.S. Food and Drug Administration approved Opill (norgestrel) tablet for nonprescription use to prevent pregnancy— the first daily oral contraceptive approved for use in the U.S. without a prescription. Approval of this progestin-only oral contraceptive pill provides an option for consumers to purchase oral contraceptive medicine without a prescription at drug stores, convenience stores and grocery stores, as well as online. The timeline for availability and price of this nonprescription product is determined by the manufacturer. Other approved formulations and dosages of other oral contraceptives will remain available by prescription only. “Today’s approval marks the first time a nonprescription daily oral contraceptive will be an available option for millions of people in the United States,” said Patrizia Cavazzoni, M.D., director of the FDA’s Center for Drug Evaluation and Research. “When used as directed, daily oral contraception is safe and is expected to be more effective than currently available nonprescription contraceptive methods in preventing unintended pregnancy.” Nonprescription availability of Opill may reduce barriers to access by allowing individuals to obtain an oral contraceptive without the need to first see a health care provider. Almost half of the 6.1 million pregnancies in the U.S. each year are unintended. Unintended pregnancies have been linked to negative maternal and perinatal outcomes, including reduced likelihood of receiving early prenatal care and increased risk of preterm delivery, with associated adverse neonatal, developmental and child health outcomes. Availability of nonprescription Opill may help reduce the number of unintended pregnancies and their potential negative impacts. The contraceptive efficacy of norgestrel was established with the original approval for prescription use in 1973. ription-nonprescription-rx-ote-switches) to switch norgestrel from a prescription to an over-the- counter product. For approval of a product for use in the nonprescription setting, the FDA requires that the applicant demonstrate (https://www.accessdata.fda.gov/drugsatfda_docs/nda/2023/0170310rigisogiSumR.pdf) that the product can be used by consumers safely and effectively, relying only on the nonprescription drug labeling without any assistance from a health care professional. Studies showed that consumer understanding of information on the Opill Drug Facts label was high overall and that a high proportion of consumers understood the label instructions, supporting their ability to properly use the drug when it is available as an over-the-counter product. When properly used, Opill is safe and effective. https:/Awww.fda.gov/news-events/press-announcements/fda-approves-first-nonprescription-daily-oral-contraceptive 3/10/24, 10:58 AM FDA Approves First Nonprescription Daily Oral Contraceptive | FDA Opill should be taken at the same time every day; adherence to daily use at the same time of day is important for the effectiveness of Opill. Using medications that interact with Opill can result in decreased efficacy of Opill or the other medication, or both, potentially resulting in unintended pregnancy. The most common side effects of Opill include irregular bleeding, headaches, dizziness, nausea, increased appetite, abdominal pain, cramps or bloating. Opill should not be used by those who have or have ever had breast cancer. Consumers who have any other form of cancer should ask a doctor before use. Opill also should not be used together with another hormonal birth control product such as another oral contraceptive tablet, a vaginal ring, a contraceptive patch, a contraceptive implant, a contraceptive injection or an IUD (intra-uterine device). Use of Opill may be associated with changes in vaginal bleeding patterns, such as irregular spotting and prolonged bleeding. Consumers should inform a health care provider if they develop repeated vaginal bleeding after sex, or prolonged episodes of bleeding or amenorrhea (absence of menstrual period). Individuals who miss two periods (or have missed a single period and have missed doses of Opill) or suspect they may be pregnant should take a pregnancy test. Consumers should discontinue Opill if pregnancy is confirmed. Opill is not for use as emergency contraception and does not prevent pregnancy after unprotected sex. Oral contraceptives do not protect against transmission of HIV, AIDS and other sexually transmitted diseases such as chlamydia, genital herpes, genital warts, gonorrhea, hepatitis B and syphilis. Condoms should be used to prevent sexually transmitted diseases. The FDA granted the approval to Laboratoire HRA Pharma, recently acquired by Perrigo Company ple. Related Information * Drugs@FDA: Opill (http://www.accessdata.fda.gov/scripts/cder/daf/index.cfm? event=overview.process&varAppINo=017031), * Decisional Memo (https://www.accessdata.fda.gov/drugsatfda_docs/nda/2023/0170310rigisog1SumR.pdf) © Opill (0.075mg Oral Norgestrel Tablet) Information (http://www.fda.gov/drugs/postmarket-drug-safety- information-patients-and-providers/opill-oo75mg-oral-norgestrel-tablet-information), HEF The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products. Inquiries Media: Jeremy Kahn (mailto: Jeremy. kahn@fda.hhs.gov) & (301) 796-8671 https:/Awww.fda.gov/news-events/press-announcements/fda-approves-first-nonprescription-daily-oral-contraceptive 3/10/24, 10:58 AM FDA Approves First Nonprescription Daily Oral Contraceptive | FDA Consumer: &. 888-INFO-FDA Was this helpful? @ More Press Announcements (/news-events/newsroom/press-announcements) https://Awww.fda.gov/news-events/press-announcements/fda-approves-first-nonprescription-daily-oral-contraceptive 3/3","The response should be accurate and concise, with little added conversational elements or tone. If you cannot provide the answer to the request based on the context given, make sure to simply state, ""The information is not available at this time.""
+
+EVIDENCE:
+3/10/24, 10:58 AM FDA Approves First Nonprescription Daily Oral Contraceptive | FDA FDA NEWS RELEASE FDA Approves First Nonprescription Daily Oral Contraceptive For Immediate Release: July 13, 2023 Espanol (https:/Awww.fda.gov/news-events/press-announcements/la-fda-aprueba-el-primer-anticonceptivo-oral-diario-sin-receta) Today, the U.S. Food and Drug Administration approved Opill (norgestrel) tablet for nonprescription use to prevent pregnancy— the first daily oral contraceptive approved for use in the U.S. without a prescription. Approval of this progestin-only oral contraceptive pill provides an option for consumers to purchase oral contraceptive medicine without a prescription at drug stores, convenience stores and grocery stores, as well as online. The timeline for availability and price of this nonprescription product is determined by the manufacturer. Other approved formulations and dosages of other oral contraceptives will remain available by prescription only. “Today’s approval marks the first time a nonprescription daily oral contraceptive will be an available option for millions of people in the United States,” said Patrizia Cavazzoni, M.D., director of the FDA’s Center for Drug Evaluation and Research. “When used as directed, daily oral contraception is safe and is expected to be more effective than currently available nonprescription contraceptive methods in preventing unintended pregnancy.” Nonprescription availability of Opill may reduce barriers to access by allowing individuals to obtain an oral contraceptive without the need to first see a health care provider. Almost half of the 6.1 million pregnancies in the U.S. each year are unintended. Unintended pregnancies have been linked to negative maternal and perinatal outcomes, including reduced likelihood of receiving early prenatal care and increased risk of preterm delivery, with associated adverse neonatal, developmental and child health outcomes. Availability of nonprescription Opill may help reduce the number of unintended pregnancies and their potential negative impacts. The contraceptive efficacy of norgestrel was established with the original approval for prescription use in 1973. ription-nonprescription-rx-ote-switches) to switch norgestrel from a prescription to an over-the- counter product. For approval of a product for use in the nonprescription setting, the FDA requires that the applicant demonstrate (https://www.accessdata.fda.gov/drugsatfda_docs/nda/2023/0170310rigisogiSumR.pdf) that the product can be used by consumers safely and effectively, relying only on the nonprescription drug labeling without any assistance from a health care professional. Studies showed that consumer understanding of information on the Opill Drug Facts label was high overall and that a high proportion of consumers understood the label instructions, supporting their ability to properly use the drug when it is available as an over-the-counter product. When properly used, Opill is safe and effective. https:/Awww.fda.gov/news-events/press-announcements/fda-approves-first-nonprescription-daily-oral-contraceptive 3/10/24, 10:58 AM FDA Approves First Nonprescription Daily Oral Contraceptive | FDA Opill should be taken at the same time every day; adherence to daily use at the same time of day is important for the effectiveness of Opill. Using medications that interact with Opill can result in decreased efficacy of Opill or the other medication, or both, potentially resulting in unintended pregnancy. The most common side effects of Opill include irregular bleeding, headaches, dizziness, nausea, increased appetite, abdominal pain, cramps or bloating. Opill should not be used by those who have or have ever had breast cancer. Consumers who have any other form of cancer should ask a doctor before use. Opill also should not be used together with another hormonal birth control product such as another oral contraceptive tablet, a vaginal ring, a contraceptive patch, a contraceptive implant, a contraceptive injection or an IUD (intra-uterine device). Use of Opill may be associated with changes in vaginal bleeding patterns, such as irregular spotting and prolonged bleeding. Consumers should inform a health care provider if they develop repeated vaginal bleeding after sex, or prolonged episodes of bleeding or amenorrhea (absence of menstrual period). Individuals who miss two periods (or have missed a single period and have missed doses of Opill) or suspect they may be pregnant should take a pregnancy test. Consumers should discontinue Opill if pregnancy is confirmed. Opill is not for use as emergency contraception and does not prevent pregnancy after unprotected sex. Oral contraceptives do not protect against transmission of HIV, AIDS and other sexually transmitted diseases such as chlamydia, genital herpes, genital warts, gonorrhea, hepatitis B and syphilis. Condoms should be used to prevent sexually transmitted diseases. The FDA granted the approval to Laboratoire HRA Pharma, recently acquired by Perrigo Company ple. Related Information * Drugs@FDA: Opill (http://www.accessdata.fda.gov/scripts/cder/daf/index.cfm? event=overview.process&varAppINo=017031), * Decisional Memo (https://www.accessdata.fda.gov/drugsatfda_docs/nda/2023/0170310rigisog1SumR.pdf) © Opill (0.075mg Oral Norgestrel Tablet) Information (http://www.fda.gov/drugs/postmarket-drug-safety- information-patients-and-providers/opill-oo75mg-oral-norgestrel-tablet-information), HEF The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products. Inquiries Media: Jeremy Kahn (mailto: Jeremy. kahn@fda.hhs.gov) & (301) 796-8671 https:/Awww.fda.gov/news-events/press-announcements/fda-approves-first-nonprescription-daily-oral-contraceptive 3/10/24, 10:58 AM FDA Approves First Nonprescription Daily Oral Contraceptive | FDA Consumer: &. 888-INFO-FDA Was this helpful? @ More Press Announcements (/news-events/newsroom/press-announcements) https://Awww.fda.gov/news-events/press-announcements/fda-approves-first-nonprescription-daily-oral-contraceptive 3/3
+
+USER:
+What impact does the FDA expect the nonprescription availability of Opill to have on unintended pregnancies?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",True,41,16,826,,660
+All information in your response must come from the provided text. Do not use any outside information.,What are the leading arguments around private equity firms trying to increase revenue and reduce costs in healthcare?,"A 2021 report from the Medicare Payment Advisory Commission (MedPAC) found that private equity investments in health care substantially expanded in the preceding 20 years, particularly with respect to acquisitions of health care providers, including hospitals, physician groups, and nursing homes. While the overall significance of these investments to the health care sector is disputed, they have attracted regulatory, legislative, and academic interest, particularly in the midst of ongoing conversations about health care quality and costs. Scrutiny often focuses on the structure and incentives of private equity investment in health care. Private equity funds typically aim to acquire portfolio companies, increase their value, and exit from these investments, generally in a defined time frame. The structure of private equity can involve an array of corporate entities, which may generally shield fund managers and investors from liability. Regulators have expressed concern that these institutional features may give private equity firms an “undue focus on short-term profits and aggressive cost-cutting” that creates unique risks relative to other market participants, with impacts on patient care and competition. For example, MedPAC’s report details ongoing debates regarding the effects of private equity efforts to increase profitability in health care investments by increasing revenue while reducing costs. On the other hand, private equity representatives and other stakeholders argue that such efforts can improve both efficiency and patient care, and that private equity has been scapegoated for broader issues in the health care system. In December 2023, the Biden Administration announced that federal agencies, including the Department of Justice (DOJ), the Department of Health and Human Services (HHS), and the Federal Trade Commission (FTC), would take increased actions to lower health care costs, increase quality, and protect consumers. As part of this effort, the agencies released a Request for Information (RFI) soliciting public comments on the effects of private equity investments on patients and health care workers. The agencies argued that “[a]cademic research and agency experience in enforcement actions” have demonstrated that “patients, health care workers, and others may suffer negative consequences” as a result of these investments in the health care sector. Although there is limited federal law that directly addresses private equity ownership in health care, private equity firms and funds have recently faced claims alongside their portfolio companies in the health care sector under federal laws concerning both fraudulent and anticompetitive behavior. Legal commentators have noted the increased legal risk such trends create for private equity investors, whose involvement in managing portfolio businesses may support alleged knowledge of wrongdoing. This Legal Sidebar explores recent regulatory and enforcement activities involving private equity investments in health care under federal antitrust law and the False Claims Act, including efforts to hold private equity firms and funds directly liable alongside portfolio companies. The term private equity is often used to refer to a variety of investments that typically pool private funds from specific, qualified investors for a set period of time and use them to purchase controlling interests in operating businesses, known as portfolio companies. Private equity funds are generally structured as limited partnerships; the general partners manage the fund’s investments, and limited partners are those that invest in the fund but are not directly involved in its operation. A private equity firm may serve as the general partner for multiple funds, each with their own limited partners and portfolio companies. The qualified investors who invest as limited partners include pension plans, other private funds, foreign institutional investors, insurance companies, and high-net-worth individuals. Investments in portfolio companies could take the form of leveraged buyouts. For more information on the private equity industry generally, including its structure, size, and common terminology, see CRS Report R47053, Private Equity and Capital Markets Policy, by Eva Su. The typical structure of a private equity fund will thus involve several separate entities, all of which are distinct from the portfolio companies controlled by the fund. Portfolio companies may themselves consist of a collection of separate legal entities, including corporations and limited liability companies (LLCs). Under general principles of corporate law, the shareholders of a corporation and the members of an LLC are ordinarily not liable for the entity’s obligations. Instead, they risk only the amount they have invested in the business. These principles do not always shield owners from liability. In some rare circumstances, the corporate entity may be disregarded and liability imposed upon the company’s owners for corporate conduct, a process called piercing the corporate veil. Owners of a company may also be held directly liable for their own conduct, separate from the company’s conduct or liability.","All information in your response must come from the provided text. Do not use any outside information. A 2021 report from the Medicare Payment Advisory Commission (MedPAC) found that private equity investments in health care substantially expanded in the preceding 20 years, particularly with respect to acquisitions of health care providers, including hospitals, physician groups, and nursing homes. While the overall significance of these investments to the health care sector is disputed, they have attracted regulatory, legislative, and academic interest, particularly in the midst of ongoing conversations about health care quality and costs. Scrutiny often focuses on the structure and incentives of private equity investment in health care. Private equity funds typically aim to acquire portfolio companies, increase their value, and exit from these investments, generally in a defined time frame. The structure of private equity can involve an array of corporate entities, which may generally shield fund managers and investors from liability. Regulators have expressed concern that these institutional features may give private equity firms an “undue focus on short-term profits and aggressive cost-cutting” that creates unique risks relative to other market participants, with impacts on patient care and competition. For example, MedPAC’s report details ongoing debates regarding the effects of private equity efforts to increase profitability in health care investments by increasing revenue while reducing costs. On the other hand, private equity representatives and other stakeholders argue that such efforts can improve both efficiency and patient care, and that private equity has been scapegoated for broader issues in the health care system. In December 2023, the Biden Administration announced that federal agencies, including the Department of Justice (DOJ), the Department of Health and Human Services (HHS), and the Federal Trade Commission (FTC), would take increased actions to lower health care costs, increase quality, and protect consumers. As part of this effort, the agencies released a Request for Information (RFI) soliciting public comments on the effects of private equity investments on patients and health care workers. The agencies argued that “[a]cademic research and agency experience in enforcement actions” have demonstrated that “patients, health care workers, and others may suffer negative consequences” as a result of these investments in the health care sector. Although there is limited federal law that directly addresses private equity ownership in health care, private equity firms and funds have recently faced claims alongside their portfolio companies in the health care sector under federal laws concerning both fraudulent and anticompetitive behavior. Legal commentators have noted the increased legal risk such trends create for private equity investors, whose involvement in managing portfolio businesses may support alleged knowledge of wrongdoing. This Legal Sidebar explores recent regulatory and enforcement activities involving private equity investments in health care under federal antitrust law and the False Claims Act, including efforts to hold private equity firms and funds directly liable alongside portfolio companies. The term private equity is often used to refer to a variety of investments that typically pool private funds from specific, qualified investors for a set period of time and use them to purchase controlling interests in operating businesses, known as portfolio companies. Private equity funds are generally structured as limited partnerships; the general partners manage the fund’s investments, and limited partners are those that invest in the fund but are not directly involved in its operation. A private equity firm may serve as the general partner for multiple funds, each with their own limited partners and portfolio companies. The qualified investors who invest as limited partners include pension plans, other private funds, foreign institutional investors, insurance companies, and high-net-worth individuals. Investments in portfolio companies could take the form of leveraged buyouts. For more information on the private equity industry generally, including its structure, size, and common terminology, see CRS Report R47053, Private Equity and Capital Markets Policy, by Eva Su. The typical structure of a private equity fund will thus involve several separate entities, all of which are distinct from the portfolio companies controlled by the fund. Portfolio companies may themselves consist of a collection of separate legal entities, including corporations and limited liability companies (LLCs). Under general principles of corporate law, the shareholders of a corporation and the members of an LLC are ordinarily not liable for the entity’s obligations. Instead, they risk only the amount they have invested in the business. These principles do not always shield owners from liability. In some rare circumstances, the corporate entity may be disregarded and liability imposed upon the company’s owners for corporate conduct, a process called piercing the corporate veil. Owners of a company may also be held directly liable for their own conduct, separate from the company’s conduct or liability. What are the leading arguments around private equity firms trying to increase revenue and reduce costs in healthcare?","All information in your response must come from the provided text. Do not use any outside information.
+
+EVIDENCE:
+A 2021 report from the Medicare Payment Advisory Commission (MedPAC) found that private equity investments in health care substantially expanded in the preceding 20 years, particularly with respect to acquisitions of health care providers, including hospitals, physician groups, and nursing homes. While the overall significance of these investments to the health care sector is disputed, they have attracted regulatory, legislative, and academic interest, particularly in the midst of ongoing conversations about health care quality and costs. Scrutiny often focuses on the structure and incentives of private equity investment in health care. Private equity funds typically aim to acquire portfolio companies, increase their value, and exit from these investments, generally in a defined time frame. The structure of private equity can involve an array of corporate entities, which may generally shield fund managers and investors from liability. Regulators have expressed concern that these institutional features may give private equity firms an “undue focus on short-term profits and aggressive cost-cutting” that creates unique risks relative to other market participants, with impacts on patient care and competition. For example, MedPAC’s report details ongoing debates regarding the effects of private equity efforts to increase profitability in health care investments by increasing revenue while reducing costs. On the other hand, private equity representatives and other stakeholders argue that such efforts can improve both efficiency and patient care, and that private equity has been scapegoated for broader issues in the health care system. In December 2023, the Biden Administration announced that federal agencies, including the Department of Justice (DOJ), the Department of Health and Human Services (HHS), and the Federal Trade Commission (FTC), would take increased actions to lower health care costs, increase quality, and protect consumers. As part of this effort, the agencies released a Request for Information (RFI) soliciting public comments on the effects of private equity investments on patients and health care workers. The agencies argued that “[a]cademic research and agency experience in enforcement actions” have demonstrated that “patients, health care workers, and others may suffer negative consequences” as a result of these investments in the health care sector. Although there is limited federal law that directly addresses private equity ownership in health care, private equity firms and funds have recently faced claims alongside their portfolio companies in the health care sector under federal laws concerning both fraudulent and anticompetitive behavior. Legal commentators have noted the increased legal risk such trends create for private equity investors, whose involvement in managing portfolio businesses may support alleged knowledge of wrongdoing. This Legal Sidebar explores recent regulatory and enforcement activities involving private equity investments in health care under federal antitrust law and the False Claims Act, including efforts to hold private equity firms and funds directly liable alongside portfolio companies. The term private equity is often used to refer to a variety of investments that typically pool private funds from specific, qualified investors for a set period of time and use them to purchase controlling interests in operating businesses, known as portfolio companies. Private equity funds are generally structured as limited partnerships; the general partners manage the fund’s investments, and limited partners are those that invest in the fund but are not directly involved in its operation. A private equity firm may serve as the general partner for multiple funds, each with their own limited partners and portfolio companies. The qualified investors who invest as limited partners include pension plans, other private funds, foreign institutional investors, insurance companies, and high-net-worth individuals. Investments in portfolio companies could take the form of leveraged buyouts. For more information on the private equity industry generally, including its structure, size, and common terminology, see CRS Report R47053, Private Equity and Capital Markets Policy, by Eva Su. The typical structure of a private equity fund will thus involve several separate entities, all of which are distinct from the portfolio companies controlled by the fund. Portfolio companies may themselves consist of a collection of separate legal entities, including corporations and limited liability companies (LLCs). Under general principles of corporate law, the shareholders of a corporation and the members of an LLC are ordinarily not liable for the entity’s obligations. Instead, they risk only the amount they have invested in the business. These principles do not always shield owners from liability. In some rare circumstances, the corporate entity may be disregarded and liability imposed upon the company’s owners for corporate conduct, a process called piercing the corporate veil. Owners of a company may also be held directly liable for their own conduct, separate from the company’s conduct or liability.
+
+USER:
+What are the leading arguments around private equity firms trying to increase revenue and reduce costs in healthcare?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,17,18,755,,51
+"Answer prompts only using the information provided by the context sources associated with the prompt. If the user asks for medical advice, inform the user that you are unable to provide medical advice as an AI model, and direct them to the proper sources to get medical advice from. If the user asks for medical information, provide a medical disclaimer to the user before answering the prompt.",What should I know about treatments for Scarlet Fever?,"Scarlet Fever This leaflet offers more information about Scarlet Fever. If you have any further questions or concerns, please speak to the staff member in charge of your child’s care. What is Scarlet Fever? Scarlet Fever is a bacterial infection that affects children. It is caused by the streptococcus bacteria which are found in our throats and on our skin. Scarlet Fever is easily treated with antibiotics. If antibiotic treatment is started early, the chance of children developing complications is rare. What are the signs and symptoms? • Sore throat • Flushed cheeks • Red, swollen tongue • Fever • Typical red, rough (sandpaper) rash appears a couple of days after the sore throat. The rash often starts on the chest and stomach before spreading to the rest of the body. Does my child need any tests to confirm the diagnosis? The doctor will usually be able to diagnose scarlet fever by seeing the typical rash and hearing what symptoms your child has. A swab from your child’s throat may be taken. This will be sent to the laboratory to see if the streptococcus bacteria grow. Your doctor may start treatment while waiting for the result of this swab. What treatments are available? Scarlet fever is easily treated with antibiotics. Liquid penicillin is often used to treat children. These must be taken for seven days, even though most people get better after four to five days. Your child will still be infectious for 24 hours after antibiotic treatment has started and they shouldn't attend nursery or school during this period. What happens if I do not get treatment? Without antibiotic treatment, your child will be infectious for one to two weeks after they became unwell. Rare, but serious complications (rheumatic fever, pneumonia and sepsis) are more likely to occur if antibiotics are not taken. Is there anything I can do to help my child? • Encourage them to drink a lot • Give paracetamol for fever if your child is upset • Use calamine lotion to soothe itchy skin. How to prevent spread? • Encourage coughing and sneezing into tissues and wash hands after sneezing and coughing • Keep children off school for 24 hours after starting antibiotics (or two weeks if antibiotics are not used) • Avoid sharing bed linen, towels, clothes, drinks with people with scarlet fever. For more information leaflets on conditions, procedures, treatments and services offered at our hospitals, please visit www.stgeorges.nhs.uk Additional services Patient Advice and Liaison Service (PALS) PALS can offer you on-the-spot advice and information when you have comments or concerns about our services or the care you have received. You can visit the PALS office between 9.30am and 4.30pm, Monday to Friday in the main corridor between Grosvenor and Lanesborough wings (near the lift foyer). Tel: 020 8725 2453 Email: pals@stgeorges.nhs.uk NHS Choices NHS Choices provides online information and guidance on all aspects of health and healthcare, to help you make decisions about your health. Web: www.nhs.uk NHS 111 You can call 111 when you need medical help fast but it’s not a 999 emergency. NHS 111 is available 24 hours a day, 365 days a year. Calls are free from landlines and mobile phones. Tel: 111 AccessAble You can download accessibility guides for all our services by searching ‘St George’s Hospital’ on the AccessAble website (www.accessable.co.uk). The guides are designed to ensure everyone – including those with accessibility needs – can access our hospital and community sites with confidence.","System Instructions: Answer prompts only using the information provided by the context sources associated with the prompt. If the user asks for medical advice, inform the user that you are unable to provide medical advice as an AI model, and direct them to the proper sources to get medical advice from. If the user asks for medical information, provide a medical disclaimer to the user before answering the prompt. Question: What should I know about treatments for Scarlet Fever? Context Block: Scarlet Fever This leaflet offers more information about Scarlet Fever. If you have any further questions or concerns, please speak to the staff member in charge of your child’s care. What is Scarlet Fever? Scarlet Fever is a bacterial infection that affects children. It is caused by the streptococcus bacteria which are found in our throats and on our skin. Scarlet Fever is easily treated with antibiotics. If antibiotic treatment is started early, the chance of children developing complications is rare. What are the signs and symptoms? • Sore throat • Flushed cheeks • Red, swollen tongue • Fever • Typical red, rough (sandpaper) rash appears a couple of days after the sore throat. The rash often starts on the chest and stomach before spreading to the rest of the body. Does my child need any tests to confirm the diagnosis? The doctor will usually be able to diagnose scarlet fever by seeing the typical rash and hearing what symptoms your child has. A swab from your child’s throat may be taken. This will be sent to the laboratory to see if the streptococcus bacteria grow. Your doctor may start treatment while waiting for the result of this swab. What treatments are available? Scarlet fever is easily treated with antibiotics. Liquid penicillin is often used to treat children. These must be taken for seven days, even though most people get better after four to five days. Your child will still be infectious for 24 hours after antibiotic treatment has started and they shouldn't attend nursery or school during this period. What happens if I do not get treatment? Without antibiotic treatment, your child will be infectious for one to two weeks after they became unwell. Rare, but serious complications (rheumatic fever, pneumonia and sepsis) are more likely to occur if antibiotics are not taken. Is there anything I can do to help my child? • Encourage them to drink a lot • Give paracetamol for fever if your child is upset • Use calamine lotion to soothe itchy skin. How to prevent spread? • Encourage coughing and sneezing into tissues and wash hands after sneezing and coughing • Keep children off school for 24 hours after starting antibiotics (or two weeks if antibiotics are not used) • Avoid sharing bed linen, towels, clothes, drinks with people with scarlet fever. For more information leaflets on conditions, procedures, treatments and services offered at our hospitals, please visit www.stgeorges.nhs.uk Additional services Patient Advice and Liaison Service (PALS) PALS can offer you on-the-spot advice and information when you have comments or concerns about our services or the care you have received. You can visit the PALS office between 9.30am and 4.30pm, Monday to Friday in the main corridor between Grosvenor and Lanesborough wings (near the lift foyer). Tel: 020 8725 2453 Email: pals@stgeorges.nhs.uk NHS Choices NHS Choices provides online information and guidance on all aspects of health and healthcare, to help you make decisions about your health. Web: www.nhs.uk NHS 111 You can call 111 when you need medical help fast but it’s not a 999 emergency. NHS 111 is available 24 hours a day, 365 days a year. Calls are free from landlines and mobile phones. Tel: 111 AccessAble You can download accessibility guides for all our services by searching ‘St George’s Hospital’ on the AccessAble website (www.accessable.co.uk). The guides are designed to ensure everyone – including those with accessibility needs – can access our hospital and community sites with confidence.","Answer prompts only using the information provided by the context sources associated with the prompt. If the user asks for medical advice, inform the user that you are unable to provide medical advice as an AI model, and direct them to the proper sources to get medical advice from. If the user asks for medical information, provide a medical disclaimer to the user before answering the prompt.
+
+EVIDENCE:
+Scarlet Fever This leaflet offers more information about Scarlet Fever. If you have any further questions or concerns, please speak to the staff member in charge of your child’s care. What is Scarlet Fever? Scarlet Fever is a bacterial infection that affects children. It is caused by the streptococcus bacteria which are found in our throats and on our skin. Scarlet Fever is easily treated with antibiotics. If antibiotic treatment is started early, the chance of children developing complications is rare. What are the signs and symptoms? • Sore throat • Flushed cheeks • Red, swollen tongue • Fever • Typical red, rough (sandpaper) rash appears a couple of days after the sore throat. The rash often starts on the chest and stomach before spreading to the rest of the body. Does my child need any tests to confirm the diagnosis? The doctor will usually be able to diagnose scarlet fever by seeing the typical rash and hearing what symptoms your child has. A swab from your child’s throat may be taken. This will be sent to the laboratory to see if the streptococcus bacteria grow. Your doctor may start treatment while waiting for the result of this swab. What treatments are available? Scarlet fever is easily treated with antibiotics. Liquid penicillin is often used to treat children. These must be taken for seven days, even though most people get better after four to five days. Your child will still be infectious for 24 hours after antibiotic treatment has started and they shouldn't attend nursery or school during this period. What happens if I do not get treatment? Without antibiotic treatment, your child will be infectious for one to two weeks after they became unwell. Rare, but serious complications (rheumatic fever, pneumonia and sepsis) are more likely to occur if antibiotics are not taken. Is there anything I can do to help my child? • Encourage them to drink a lot • Give paracetamol for fever if your child is upset • Use calamine lotion to soothe itchy skin. How to prevent spread? • Encourage coughing and sneezing into tissues and wash hands after sneezing and coughing • Keep children off school for 24 hours after starting antibiotics (or two weeks if antibiotics are not used) • Avoid sharing bed linen, towels, clothes, drinks with people with scarlet fever. For more information leaflets on conditions, procedures, treatments and services offered at our hospitals, please visit www.stgeorges.nhs.uk Additional services Patient Advice and Liaison Service (PALS) PALS can offer you on-the-spot advice and information when you have comments or concerns about our services or the care you have received. You can visit the PALS office between 9.30am and 4.30pm, Monday to Friday in the main corridor between Grosvenor and Lanesborough wings (near the lift foyer). Tel: 020 8725 2453 Email: pals@stgeorges.nhs.uk NHS Choices NHS Choices provides online information and guidance on all aspects of health and healthcare, to help you make decisions about your health. Web: www.nhs.uk NHS 111 You can call 111 when you need medical help fast but it’s not a 999 emergency. NHS 111 is available 24 hours a day, 365 days a year. Calls are free from landlines and mobile phones. Tel: 111 AccessAble You can download accessibility guides for all our services by searching ‘St George’s Hospital’ on the AccessAble website (www.accessable.co.uk). The guides are designed to ensure everyone – including those with accessibility needs – can access our hospital and community sites with confidence.
+
+USER:
+What should I know about treatments for Scarlet Fever?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,67,9,578,,7
+You will answer the prompt question using only information from the document provided in the prompt.,Summarize the research that has been done on the health benefits of black tea regarding the Corona virus.,"Liu et al.,(2005) showed that the theaflavin derivatives had more potent anti-HIV-1 activity than catechin derivatives. These tea polyphenols could inhibit HIV-1 entry into target cells by blocking HIV-1 envelope glycoprotein-mediated membrane fusion. The fusion inhibitory activity of the tea polyphenols was correlated with their ability to block the formation of the gp41 six- helix bundle, a fusion-active core conformation. Computer-aided molecular docking analyses indicate that these tea polyphenols, theaflavin-3,3′-digallate (TF3) as an example, may bind to the highly conserved hydrophobic pocket on the surface of the central trimeric coiled coil formed by the N-terminal heptad repeats of gp41. These results indicate that tea, especially black tea, may be used as a source of anti-HIV agents and theaflavin derivatives may be applied as lead compounds for developing HIV-1 entry inhibitors targeting gp41. EGCG present in green tea has been shown to inhibit Herpes simplex virus type-1 (HSV-1) (Oleviera, 2008; Issack et al., 2008) by possibly binding to the glycoproteins on the envelope of the virus, thereby preventing viral entry into the host cell. The increased stability of theaflavins compared to EGCG at neutral pH could make these black tea compounds a more feasible option for the design of an antiviral therapeutic agent than EGCG (Su et al, 2003). Black Tea Extract Black Tea: Antiviral Activity & Boosting Immunity | 7 consisting primarily of theaflavins is not cytotoxic and can reduce or block the production of infectious HSV-1 virions in cultured A549 and Vero cells, thus inhibiting the infectivity of the virus by interfering in the attachment, penetration and viral DNA replication of HSV-1 particles (Cantatore et al.,2013). The anti-influenza virus and anti-inflammatory activities of theaflavin derivatives have been reported by Zu at. el.,(2012). The theaflavins fraction (TF80%, with a purity of 80%) and three theaflavin (TF) derivatives from black tea have been found to exhibit potent inhibitory effects against influenza virus in vitro. The authors have used assays for neuraminidase (NA) activity, hemagglutination (HA) inhibition, a real-time quantitative PCR (qPCR) for gene expression of hemagglutinin (HA) and a cytopathic effect (CPE) reduction assay for studying the activity of TFs. The results showed that the TFs exerted significant inhibitory effects on the NA of three different subtypes of influenza virus strains and also on HA through two major mechanisms. The TF derivatives might have a direct effect on viral particle infectivity affecting replication of the viral HA gene during early stage of infection. In addition, TFs decreased the expression level of the inflammatory cytokine IL-6 during viral infection, expression of which may result in serious tissue injury and apoptosis. Thus, the results indicated that TF derivatives are potential compounds with anti-influenza viral replication and anti-inflammatory properties. A study of antiviral activity of theaflavins (extracted from black tea) against Hepatitis C virus (HCV) using human hepatoma Huh-7 cells showed significant decrease of infectivity of the virus in the presence of each of the three theaflavins, with a clear dose-dependent inhibitory effect. The antiviral activity of the theaflavins was confirmed by quantification of viral RNA. TF3 was found to be more active and the HCV pseudotyped virions confirmed their activity on HCV entry and demonstrated their pan-genotypic action by directly acting on the virus particle and inhibited cell-to-cell spread. Further, TFs in combination with Sofosbuvir and Daclatasvir which are FDA approved drugs for HCV, enhanced the antiviral activity of both drugs (additive effect) demonstrating that it could be used in combination with direct acting antivirals (DAA) used in hepatitis C therapy. Thus, theaflavins, that are present in high quantity in black tea, hold promise for therapeutic use against HCV infection and also as neutraceutical as it inhibit cell-to-cell entry of the virus (Chowdhury, et al., 2018). In a study reported by Clark et al. (1998) it was demonstrated that theaflavins extracted from black tea were able to neutralize bovine coronavirus and rotavirus infections. The crude black tea extract and the various fractions of theaflavins extracted from black tea were tested individually and in combination for antirotaviral activity. The combination of theaflavin fractions (TF1 + TF2a + TF2b + TF3) was more active than the sum of the activities of these four fractions individually, indicating synergism amongst the TF components. The results of this study showed that theaflavin and theaflavin gallate derivatives have inactivation activity (in vitro) against both rotavirus and coronavirus. The crude black tea extract was also able to neutralize the coronavirus. In view of the current pandemic created by the novel corona virus COVID-19, lot of efforts are on globally to develop suitable vaccine and to relook the existing drugs and molecules for effectiveness against the causative agent SARS-CoV-2 (Tang et al., 2020). Coronaviruses are enveloped positive-stranded RNA viruses that replicate in the cytoplasm (Belouzard et al. 2012). To deliver their nucleocapsid into the host cell they rely on the fusion of their envelope with the host cell membrane. The spike glycoprotein (S) mediates virus entry and is a primary determinant of cell tropism and pathogenesis. The RNA dependent RNA polymerase (RdRp) is known to be an important enzyme that catalyzes the replication of RNA from RNA templates. Black Tea: Antiviral Activity & Boosting Immunity | 8 In a recent study published in the Journal of Medical Virology, 83 compounds used in Chinese medicine system were screened for their potential efficacy against SARS-CoV-2 by assessing their binding efficiency onto this RNA dependent RNA polymerase (RdRp) of the COVID-19 virus (Lung et. al., 2020). The authors have generated three dimensional model structures of RdRp of SARS-CoV-2 (2019 Pandemic), SARS-CoV (2002 epidemic) and MERS-CoV (2012 epidemic) using Modeller UCSF Chimera (https://www.cgl.ucsf.edu/chimera/) and SWISS-MODEL (https:// swissmodel. expasy.org/) to test the efficacy of the compounds. This virtual screening in this bioinformatics study revealed that out of the 83 compounds screened, theaflavin was the best compound on the basis of idock score (prediction of binding affinity), hydrophobic interactions and additional hydrogen bonds between theaflavin and amino acid near the active site of RdRp. This was further confirmed by lower binding energy when it docks the catalytic pocket of SARS-CoV-2 RdRp. These finding suggested that theaflavins could be used as a lead compound for developing a SARS-CoV-2 inhibitor that targets the RdRp. Theaflavins are present in black tea and the highest theaflavin contents are present in the black teas of Assam. Though further in vivo, animal and clinical trials would be required to carry forward this research finding, it is quite interesting to note that an earlier study from Taiwan has in fact convincingly demonstrated the inhibition of SARS-CoV 3C-like protease activity by Theaflavin-3,3’-digallate (TF3) published in the journal Evidence based Complementary and Alternative Medicine (Chen et.al.,2005). The authors have reported that the extracts from Puer and Black tea were more potent than the green or oolong tea extracts in their inhibitory activities against a chymotrypsin-like (3CLPro) protease. In this study 3CL protease was a target and the virus of interest was SARS- CoV (2002 epidemic). This study also used docking approach to screen out the best inhibitory compounds using a natural product library consisting of 720 compounds. Two compounds, tannic acid and TF2b (Theaflavin 3-gallate) were found to be active against 3CL Protease. Since many other related to tannic acid and TF2b are also present in various kinds of teas, the authors further examined the inhibition of activity by various tea extracts and several well known pure ingredients present in teas. The water extracts of TF2b (theaflavin-3-gallate), TF3 (theaflavin diggallate) and tannic acid were found to be the best effective 3CLPro inhibitors with inhibitory concentration (IC50) of less than 10 μM. The results from this study showed that Puer and Black tea extracts were more potent than the green or oolong tea extracts in inhibitory activities against 3C-like protease (3CLPro) of severe acute respiratory syndrome coronavirus (SARS-CoV), notably the active constituents viz. Theaflavin-3-gallate (TF2b) theaflavin-3,3’-digallate (TF3) and tannic acid were effective 3CLPro inhibitors.","System Prompt: You will answer the prompt question using only information from the document provided in the prompt. Question: Summarize the research that has been done on the health benefits of black tea regarding the Corona virus. Context Block: Liu et al.,(2005) showed that the theaflavin derivatives had more potent anti-HIV-1 activity than catechin derivatives. These tea polyphenols could inhibit HIV-1 entry into target cells by blocking HIV-1 envelope glycoprotein-mediated membrane fusion. The fusion inhibitory activity of the tea polyphenols was correlated with their ability to block the formation of the gp41 six- helix bundle, a fusion-active core conformation. Computer-aided molecular docking analyses indicate that these tea polyphenols, theaflavin-3,3′-digallate (TF3) as an example, may bind to the highly conserved hydrophobic pocket on the surface of the central trimeric coiled coil formed by the N-terminal heptad repeats of gp41. These results indicate that tea, especially black tea, may be used as a source of anti-HIV agents and theaflavin derivatives may be applied as lead compounds for developing HIV-1 entry inhibitors targeting gp41. EGCG present in green tea has been shown to inhibit Herpes simplex virus type-1 (HSV-1) (Oleviera, 2008; Issack et al., 2008) by possibly binding to the glycoproteins on the envelope of the virus, thereby preventing viral entry into the host cell. The increased stability of theaflavins compared to EGCG at neutral pH could make these black tea compounds a more feasible option for the design of an antiviral therapeutic agent than EGCG (Su et al, 2003). Black Tea Extract Black Tea: Antiviral Activity & Boosting Immunity | 7 consisting primarily of theaflavins is not cytotoxic and can reduce or block the production of infectious HSV-1 virions in cultured A549 and Vero cells, thus inhibiting the infectivity of the virus by interfering in the attachment, penetration and viral DNA replication of HSV-1 particles (Cantatore et al.,2013). The anti-influenza virus and anti-inflammatory activities of theaflavin derivatives have been reported by Zu at. el.,(2012). The theaflavins fraction (TF80%, with a purity of 80%) and three theaflavin (TF) derivatives from black tea have been found to exhibit potent inhibitory effects against influenza virus in vitro. The authors have used assays for neuraminidase (NA) activity, hemagglutination (HA) inhibition, a real-time quantitative PCR (qPCR) for gene expression of hemagglutinin (HA) and a cytopathic effect (CPE) reduction assay for studying the activity of TFs. The results showed that the TFs exerted significant inhibitory effects on the NA of three different subtypes of influenza virus strains and also on HA through two major mechanisms. The TF derivatives might have a direct effect on viral particle infectivity affecting replication of the viral HA gene during early stage of infection. In addition, TFs decreased the expression level of the inflammatory cytokine IL-6 during viral infection, expression of which may result in serious tissue injury and apoptosis. Thus, the results indicated that TF derivatives are potential compounds with anti-influenza viral replication and anti-inflammatory properties. A study of antiviral activity of theaflavins (extracted from black tea) against Hepatitis C virus (HCV) using human hepatoma Huh-7 cells showed significant decrease of infectivity of the virus in the presence of each of the three theaflavins, with a clear dose-dependent inhibitory effect. The antiviral activity of the theaflavins was confirmed by quantification of viral RNA. TF3 was found to be more active and the HCV pseudotyped virions confirmed their activity on HCV entry and demonstrated their pan-genotypic action by directly acting on the virus particle and inhibited cell-to-cell spread. Further, TFs in combination with Sofosbuvir and Daclatasvir which are FDA approved drugs for HCV, enhanced the antiviral activity of both drugs (additive effect) demonstrating that it could be used in combination with direct acting antivirals (DAA) used in hepatitis C therapy. Thus, theaflavins, that are present in high quantity in black tea, hold promise for therapeutic use against HCV infection and also as neutraceutical as it inhibit cell-to-cell entry of the virus (Chowdhury, et al., 2018). In a study reported by Clark et al. (1998) it was demonstrated that theaflavins extracted from black tea were able to neutralize bovine coronavirus and rotavirus infections. The crude black tea extract and the various fractions of theaflavins extracted from black tea were tested individually and in combination for antirotaviral activity. The combination of theaflavin fractions (TF1 + TF2a + TF2b + TF3) was more active than the sum of the activities of these four fractions individually, indicating synergism amongst the TF components. The results of this study showed that theaflavin and theaflavin gallate derivatives have inactivation activity (in vitro) against both rotavirus and coronavirus. The crude black tea extract was also able to neutralize the coronavirus. In view of the current pandemic created by the novel corona virus COVID-19, lot of efforts are on globally to develop suitable vaccine and to relook the existing drugs and molecules for effectiveness against the causative agent SARS-CoV-2 (Tang et al., 2020). Coronaviruses are enveloped positive-stranded RNA viruses that replicate in the cytoplasm (Belouzard et al. 2012). To deliver their nucleocapsid into the host cell they rely on the fusion of their envelope with the host cell membrane. The spike glycoprotein (S) mediates virus entry and is a primary determinant of cell tropism and pathogenesis. The RNA dependent RNA polymerase (RdRp) is known to be an important enzyme that catalyzes the replication of RNA from RNA templates. Black Tea: Antiviral Activity & Boosting Immunity | 8 In a recent study published in the Journal of Medical Virology, 83 compounds used in Chinese medicine system were screened for their potential efficacy against SARS-CoV-2 by assessing their binding efficiency onto this RNA dependent RNA polymerase (RdRp) of the COVID-19 virus (Lung et. al., 2020). The authors have generated three dimensional model structures of RdRp of SARS-CoV-2 (2019 Pandemic), SARS-CoV (2002 epidemic) and MERS-CoV (2012 epidemic) using Modeller UCSF Chimera (https://www.cgl.ucsf.edu/chimera/) and SWISS-MODEL (https:// swissmodel. expasy.org/) to test the efficacy of the compounds. This virtual screening in this bioinformatics study revealed that out of the 83 compounds screened, theaflavin was the best compound on the basis of idock score (prediction of binding affinity), hydrophobic interactions and additional hydrogen bonds between theaflavin and amino acid near the active site of RdRp. This was further confirmed by lower binding energy when it docks the catalytic pocket of SARS-CoV-2 RdRp. These finding suggested that theaflavins could be used as a lead compound for developing a SARS-CoV-2 inhibitor that targets the RdRp. Theaflavins are present in black tea and the highest theaflavin contents are present in the black teas of Assam. Though further in vivo, animal and clinical trials would be required to carry forward this research finding, it is quite interesting to note that an earlier study from Taiwan has in fact convincingly demonstrated the inhibition of SARS-CoV 3C-like protease activity by Theaflavin-3,3’-digallate (TF3) published in the journal Evidence based Complementary and Alternative Medicine (Chen et.al.,2005). The authors have reported that the extracts from Puer and Black tea were more potent than the green or oolong tea extracts in their inhibitory activities against a chymotrypsin-like (3CLPro) protease. In this study 3CL protease was a target and the virus of interest was SARS- CoV (2002 epidemic). This study also used docking approach to screen out the best inhibitory compounds using a natural product library consisting of 720 compounds. Two compounds, tannic acid and TF2b (Theaflavin 3-gallate) were found to be active against 3CL Protease. Since many other related to tannic acid and TF2b are also present in various kinds of teas, the authors further examined the inhibition of activity by various tea extracts and several well known pure ingredients present in teas. The water extracts of TF2b (theaflavin-3-gallate), TF3 (theaflavin diggallate) and tannic acid were found to be the best effective 3CLPro inhibitors with inhibitory concentration (IC50) of less than 10 μM. The results from this study showed that Puer and Black tea extracts were more potent than the green or oolong tea extracts in inhibitory activities against 3C-like protease (3CLPro) of severe acute respiratory syndrome coronavirus (SARS-CoV), notably the active constituents viz. Theaflavin-3-gallate (TF2b) theaflavin-3,3’-digallate (TF3) and tannic acid were effective 3CLPro inhibitors.","You will answer the prompt question using only information from the document provided in the prompt.
+
+EVIDENCE:
+Liu et al.,(2005) showed that the theaflavin derivatives had more potent anti-HIV-1 activity than catechin derivatives. These tea polyphenols could inhibit HIV-1 entry into target cells by blocking HIV-1 envelope glycoprotein-mediated membrane fusion. The fusion inhibitory activity of the tea polyphenols was correlated with their ability to block the formation of the gp41 six- helix bundle, a fusion-active core conformation. Computer-aided molecular docking analyses indicate that these tea polyphenols, theaflavin-3,3′-digallate (TF3) as an example, may bind to the highly conserved hydrophobic pocket on the surface of the central trimeric coiled coil formed by the N-terminal heptad repeats of gp41. These results indicate that tea, especially black tea, may be used as a source of anti-HIV agents and theaflavin derivatives may be applied as lead compounds for developing HIV-1 entry inhibitors targeting gp41. EGCG present in green tea has been shown to inhibit Herpes simplex virus type-1 (HSV-1) (Oleviera, 2008; Issack et al., 2008) by possibly binding to the glycoproteins on the envelope of the virus, thereby preventing viral entry into the host cell. The increased stability of theaflavins compared to EGCG at neutral pH could make these black tea compounds a more feasible option for the design of an antiviral therapeutic agent than EGCG (Su et al, 2003). Black Tea Extract Black Tea: Antiviral Activity & Boosting Immunity | 7 consisting primarily of theaflavins is not cytotoxic and can reduce or block the production of infectious HSV-1 virions in cultured A549 and Vero cells, thus inhibiting the infectivity of the virus by interfering in the attachment, penetration and viral DNA replication of HSV-1 particles (Cantatore et al.,2013). The anti-influenza virus and anti-inflammatory activities of theaflavin derivatives have been reported by Zu at. el.,(2012). The theaflavins fraction (TF80%, with a purity of 80%) and three theaflavin (TF) derivatives from black tea have been found to exhibit potent inhibitory effects against influenza virus in vitro. The authors have used assays for neuraminidase (NA) activity, hemagglutination (HA) inhibition, a real-time quantitative PCR (qPCR) for gene expression of hemagglutinin (HA) and a cytopathic effect (CPE) reduction assay for studying the activity of TFs. The results showed that the TFs exerted significant inhibitory effects on the NA of three different subtypes of influenza virus strains and also on HA through two major mechanisms. The TF derivatives might have a direct effect on viral particle infectivity affecting replication of the viral HA gene during early stage of infection. In addition, TFs decreased the expression level of the inflammatory cytokine IL-6 during viral infection, expression of which may result in serious tissue injury and apoptosis. Thus, the results indicated that TF derivatives are potential compounds with anti-influenza viral replication and anti-inflammatory properties. A study of antiviral activity of theaflavins (extracted from black tea) against Hepatitis C virus (HCV) using human hepatoma Huh-7 cells showed significant decrease of infectivity of the virus in the presence of each of the three theaflavins, with a clear dose-dependent inhibitory effect. The antiviral activity of the theaflavins was confirmed by quantification of viral RNA. TF3 was found to be more active and the HCV pseudotyped virions confirmed their activity on HCV entry and demonstrated their pan-genotypic action by directly acting on the virus particle and inhibited cell-to-cell spread. Further, TFs in combination with Sofosbuvir and Daclatasvir which are FDA approved drugs for HCV, enhanced the antiviral activity of both drugs (additive effect) demonstrating that it could be used in combination with direct acting antivirals (DAA) used in hepatitis C therapy. Thus, theaflavins, that are present in high quantity in black tea, hold promise for therapeutic use against HCV infection and also as neutraceutical as it inhibit cell-to-cell entry of the virus (Chowdhury, et al., 2018). In a study reported by Clark et al. (1998) it was demonstrated that theaflavins extracted from black tea were able to neutralize bovine coronavirus and rotavirus infections. The crude black tea extract and the various fractions of theaflavins extracted from black tea were tested individually and in combination for antirotaviral activity. The combination of theaflavin fractions (TF1 + TF2a + TF2b + TF3) was more active than the sum of the activities of these four fractions individually, indicating synergism amongst the TF components. The results of this study showed that theaflavin and theaflavin gallate derivatives have inactivation activity (in vitro) against both rotavirus and coronavirus. The crude black tea extract was also able to neutralize the coronavirus. In view of the current pandemic created by the novel corona virus COVID-19, lot of efforts are on globally to develop suitable vaccine and to relook the existing drugs and molecules for effectiveness against the causative agent SARS-CoV-2 (Tang et al., 2020). Coronaviruses are enveloped positive-stranded RNA viruses that replicate in the cytoplasm (Belouzard et al. 2012). To deliver their nucleocapsid into the host cell they rely on the fusion of their envelope with the host cell membrane. The spike glycoprotein (S) mediates virus entry and is a primary determinant of cell tropism and pathogenesis. The RNA dependent RNA polymerase (RdRp) is known to be an important enzyme that catalyzes the replication of RNA from RNA templates. Black Tea: Antiviral Activity & Boosting Immunity | 8 In a recent study published in the Journal of Medical Virology, 83 compounds used in Chinese medicine system were screened for their potential efficacy against SARS-CoV-2 by assessing their binding efficiency onto this RNA dependent RNA polymerase (RdRp) of the COVID-19 virus (Lung et. al., 2020). The authors have generated three dimensional model structures of RdRp of SARS-CoV-2 (2019 Pandemic), SARS-CoV (2002 epidemic) and MERS-CoV (2012 epidemic) using Modeller UCSF Chimera (https://www.cgl.ucsf.edu/chimera/) and SWISS-MODEL (https:// swissmodel. expasy.org/) to test the efficacy of the compounds. This virtual screening in this bioinformatics study revealed that out of the 83 compounds screened, theaflavin was the best compound on the basis of idock score (prediction of binding affinity), hydrophobic interactions and additional hydrogen bonds between theaflavin and amino acid near the active site of RdRp. This was further confirmed by lower binding energy when it docks the catalytic pocket of SARS-CoV-2 RdRp. These finding suggested that theaflavins could be used as a lead compound for developing a SARS-CoV-2 inhibitor that targets the RdRp. Theaflavins are present in black tea and the highest theaflavin contents are present in the black teas of Assam. Though further in vivo, animal and clinical trials would be required to carry forward this research finding, it is quite interesting to note that an earlier study from Taiwan has in fact convincingly demonstrated the inhibition of SARS-CoV 3C-like protease activity by Theaflavin-3,3’-digallate (TF3) published in the journal Evidence based Complementary and Alternative Medicine (Chen et.al.,2005). The authors have reported that the extracts from Puer and Black tea were more potent than the green or oolong tea extracts in their inhibitory activities against a chymotrypsin-like (3CLPro) protease. In this study 3CL protease was a target and the virus of interest was SARS- CoV (2002 epidemic). This study also used docking approach to screen out the best inhibitory compounds using a natural product library consisting of 720 compounds. Two compounds, tannic acid and TF2b (Theaflavin 3-gallate) were found to be active against 3CL Protease. Since many other related to tannic acid and TF2b are also present in various kinds of teas, the authors further examined the inhibition of activity by various tea extracts and several well known pure ingredients present in teas. The water extracts of TF2b (theaflavin-3-gallate), TF3 (theaflavin diggallate) and tannic acid were found to be the best effective 3CLPro inhibitors with inhibitory concentration (IC50) of less than 10 μM. The results from this study showed that Puer and Black tea extracts were more potent than the green or oolong tea extracts in inhibitory activities against 3C-like protease (3CLPro) of severe acute respiratory syndrome coronavirus (SARS-CoV), notably the active constituents viz. Theaflavin-3-gallate (TF2b) theaflavin-3,3’-digallate (TF3) and tannic acid were effective 3CLPro inhibitors.
+
+USER:
+Summarize the research that has been done on the health benefits of black tea regarding the Corona virus.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",True,16,18,1307,,120
+Refer only to the provided context document when answering the question.,List all the types of bonds only using information from the provided document.,"𝐒𝐭𝐨𝐜𝐤𝐬 𝐚𝐧𝐝 𝐁𝐨𝐧𝐝𝐬 𝐂𝐨𝐦𝐩𝐚𝐫𝐢𝐬𝐨𝐧 Large companies and other entities use bonds as a form of debt borrowing or financing. Unlike loans, bonds are more transferrable and divisible by the lenders, allowing for multiple investors, which is appropriate when financing needs are very substantial. Bearing similarities to the concept of a first mortgage and a second mortgage, there are senior bonds and subordinated bonds; the senior bonds take precedence over the subordinated bonds in terms of payment priority, and therefore are safer for the lender or investor. Equity, on the other hand, represents a share of ownership in a for-profit corporation. It is what is “left over” from revenue brought in after all expenses (operating expenses, taxes, interest) have been paid. Because equity holders are entitled to what is “left over,” this means they are the investor class exposed to the greatest risk, but are also entitled to the greatest reward. A corporation’s capital structure is typically comprised of one or more forms of debt and one or more forms of equity. According to the chart below, there is an order of precedence governing how money flows in an entity from one class of investors to another. Because debt or bond holders have a senior claim relative to equity holders, business profits first go towards senior debt payments, then to any subordinate class of debt, and then to any preferred class of equity. From there, all remaining profits flow to common equity as a return on investment to be distributed to the owners of common equity. Pending the direction and approval of the company’s board of directors, this distribution can come in the form of a dividend (or stock buyback), reinvested into the company, or most likely a combination of both. If business prospects are extremely good, a common equity shareholder may receive a theoretically uncapped return on their investment. Over the long run, the return on equity of successful and stable corporations exceeds the cost of debt sufficiently enough to compensate investors for the additional risk they are taking. The source of the additional risk is the priority of payments when business conditions are weaker. If there is an economic cycle of weaker revenues, a business might find itself barely able to service its debt financing. In this case, it is unlikely any residual profits will be available to common shareholders for distribution; these circumstances may last for years and many require the business to resort to costly compromises to ensure its debt payments are met. Meanwhile, the senior debt holders can take comfort in the fact the return on their investment is of highest priority and will only be compromised as a last resort. This creates what can be referred to as a more open system of outcomes for stocks and a more closed system of outcomes for bonds; this feature will be expanded upon in greater detail later. These nuances in the capital structure may seem like semantics to some, but as was stated in the introduction, it is an essential component of developing a true understanding of investment options and has great implications on risk and return characteristics. Stock and Bond Investment Opportunities In terms of the number of different investments investors are able to choose from, there are overwhelmingly more bond opportunities than stock opportunities. This may come as a surprise to some as market media attention is overwhelmingly slanted towards stock investing instead of bond investing. Investment products are: • Not a Deposit • Not FDIC Insured • Not Insured by any Federal Government Agency • Not Guaranteed by the Bank • May Go Down in Value In fact, there are 68 times more bond issuances than there are publicly owned stocks. If a person only includes the stocks actively traded on an exchange, there would be 277 times more bond issuances. Yet in terms of the amount of capital invested in each market, there is only 54% more invested in bonds than there is invested in equities. Similar to how the vast amount of market media attention is fixated on the relatively few amount of actively traded stocks, the amount of investment dollars chasing those actively traded stocks is disproportionately large compared to the amount of capital invested in the vast universe of bonds. Within the overemphasis on stocks, there is yet more of a disproportionate emphasis placed on the largest companies; of the aggregate investment in all of the 15,000 publicly traded corporations, 70% of that capital is concentrated in the 500 largest corporations. Put another way, 70% of the money is invested in 3% of the companies; these are the companies receiving the lion’s share of market media attention! In investing, when all of the attention and capital is placed in one area, it is unlikely there are undiscovered opportunities in that area. In fact, numerous studies have shown there is no outperformance potential when investing in the largest U.S. corporations. However, studies have consistently indicated outperformance potential is available investing in small U.S. corporations, various bond sectors, and in certain international investments. Different Types of Stocks Stock market opportunities are often segmented different ways. The three most prominent forms of categorization are market capitalization size, value or growth, and industry classification. The capitalization size of a company is measured by the market value of all outstanding shares of a company’s equity. Companies’ market capitalization is categorized between large cap, medium cap, and small cap. Companies are considered to be large cap when their market capitalization exceeds $10 billion. Companies between $2 billion and $10 billion market cap are considered mid cap companies. Those companies with less than $2 billion market cap are considered small cap companies. The next series of categorization is between value and growth and is often determined by the price of a company’s equity in relation to its earnings, its future earnings prospects, and the amount of profits the corporations retain versus what is returned to shareholders. All else unchanged, the lower the company’s price relative to earnings (measured by the Price to Earnings (P/E) ratio, or other relative value measurements) the more likely it is to be classified as a value company instead of a growth company; Investment products are: • Not a Deposit • Not FDIC Insured • Not Insured by any Federal Government Agency • Not Guaranteed by the Bank • May Go Down in Value value companies tend to have a low stock price due to unfavorable growth or future earnings prospects. Growth companies tend to have very favorable earnings growth forecasts causing their equity prices to be much higher relative to the company’s current earnings. When categorizing equity mutual funds or ETFs, the Equity Style Box is a conventional way to categorize the predominant types of companies a fund is primarily invested in. The Equity Style a fund pursues may not provide an investor the capability to predict future returns, but it helps to understand the types of companies a fund is invested in and to compare the actual investment activities to the fund’s mandated objectives. The final categorization of stocks is the industry classifications; these are subsections of the equity investment market and are often referred to as equity subsectors. The predominant subsectors are: energy, materials, industrials, consumer goods (basic staples), consumer discretionary, health care, utilities, financials, and technology. This series of classifications is especially useful because an industry’s trends, opportunities, and risks bear a heavy influence on the future prospects of the earnings and stock price of companies within that industry. In fact, a key focal point in corporate investment analysis is to perform an industry analysis. As an industry is beneficially or negatively exposed to an economic cycle, the corresponding beneficial or negative implications are likely to be shared across the vast majority of companies in the industry. By categorizing between equity subsectors, an investor may be better able to develop informed expectations of how their equity portfolio will perform in a given economic cycle. Different Types of Bonds Three general categorizations of bonds are issuer type, maturity length, and credit strength. When discussing stocks, the discussion always pertained to shares of corporations. For-profit corporations are only one of many kinds of bond issuers. The overarching categorizations of bond issuers are: U.S. Treasury and other federal agencies, mortgage- related bonds, corporate bonds, asset-backed bonds, and municipal bonds. Within mortgage-related, asset- backed, and municipal bonds, there is a multitude of meaningfully different issuer types. For example: in municipal bonds, there are: cities, states, counties, toll roads, school districts, business and residential real estate developments, event centers, hospitals, prisons, sewer systems, tobacco bonds, etc. The type of issuer and its repayment source carry strong implications on a bond’s credit strength, its perceived risk, and ultimately the return opportunities for investors. The maturity length of a bond and whether it can be prepaid in advance of the maturity date has important implications on the long term returns on bond investing. All else unchanged, a bond with a longer maturity typically has a higher return and is considered to be a higher risk.2 Basic Bond Valuation and Maturity Trade-offs If a person owns a $100 bond that earns 5% return each year for 5 years in a world where the market expects 5% return, the market value on the bond would be $100. However, if the market instead expected a 4% return, what would the 2However, in the context of a portfolio of stocks and bonds, having longer maturity bonds while having greater individual risk can actually lower portfolio risk due to their historic negative correlation to stocks. market value be? In that case, the bond owner would benefit by an extra 1% per year over 5 years equating to a 5% aggregate benefit; ignoring compounding and preciseness, the market value on that bond would be 5% higher, or $105. For a 10 year bond instead of a 5 year bond, the differences in interest rates would have twice the magnitude of impact.","<context> ================== 𝐒𝐭𝐨𝐜𝐤𝐬 𝐚𝐧𝐝 𝐁𝐨𝐧𝐝𝐬 𝐂𝐨𝐦𝐩𝐚𝐫𝐢𝐬𝐨𝐧 Large companies and other entities use bonds as a form of debt borrowing or financing. Unlike loans, bonds are more transferrable and divisible by the lenders, allowing for multiple investors, which is appropriate when financing needs are very substantial. Bearing similarities to the concept of a first mortgage and a second mortgage, there are senior bonds and subordinated bonds; the senior bonds take precedence over the subordinated bonds in terms of payment priority, and therefore are safer for the lender or investor. Equity, on the other hand, represents a share of ownership in a for-profit corporation. It is what is “left over” from revenue brought in after all expenses (operating expenses, taxes, interest) have been paid. Because equity holders are entitled to what is “left over,” this means they are the investor class exposed to the greatest risk, but are also entitled to the greatest reward. A corporation’s capital structure is typically comprised of one or more forms of debt and one or more forms of equity. According to the chart below, there is an order of precedence governing how money flows in an entity from one class of investors to another. Because debt or bond holders have a senior claim relative to equity holders, business profits first go towards senior debt payments, then to any subordinate class of debt, and then to any preferred class of equity. From there, all remaining profits flow to common equity as a return on investment to be distributed to the owners of common equity. Pending the direction and approval of the company’s board of directors, this distribution can come in the form of a dividend (or stock buyback), reinvested into the company, or most likely a combination of both. If business prospects are extremely good, a common equity shareholder may receive a theoretically uncapped return on their investment. Over the long run, the return on equity of successful and stable corporations exceeds the cost of debt sufficiently enough to compensate investors for the additional risk they are taking. The source of the additional risk is the priority of payments when business conditions are weaker. If there is an economic cycle of weaker revenues, a business might find itself barely able to service its debt financing. In this case, it is unlikely any residual profits will be available to common shareholders for distribution; these circumstances may last for years and many require the business to resort to costly compromises to ensure its debt payments are met. Meanwhile, the senior debt holders can take comfort in the fact the return on their investment is of highest priority and will only be compromised as a last resort. This creates what can be referred to as a more open system of outcomes for stocks and a more closed system of outcomes for bonds; this feature will be expanded upon in greater detail later. These nuances in the capital structure may seem like semantics to some, but as was stated in the introduction, it is an essential component of developing a true understanding of investment options and has great implications on risk and return characteristics. Stock and Bond Investment Opportunities In terms of the number of different investments investors are able to choose from, there are overwhelmingly more bond opportunities than stock opportunities. This may come as a surprise to some as market media attention is overwhelmingly slanted towards stock investing instead of bond investing. Investment products are: • Not a Deposit • Not FDIC Insured • Not Insured by any Federal Government Agency • Not Guaranteed by the Bank • May Go Down in Value In fact, there are 68 times more bond issuances than there are publicly owned stocks. If a person only includes the stocks actively traded on an exchange, there would be 277 times more bond issuances. Yet in terms of the amount of capital invested in each market, there is only 54% more invested in bonds than there is invested in equities. Similar to how the vast amount of market media attention is fixated on the relatively few amount of actively traded stocks, the amount of investment dollars chasing those actively traded stocks is disproportionately large compared to the amount of capital invested in the vast universe of bonds. Within the overemphasis on stocks, there is yet more of a disproportionate emphasis placed on the largest companies; of the aggregate investment in all of the 15,000 publicly traded corporations, 70% of that capital is concentrated in the 500 largest corporations. Put another way, 70% of the money is invested in 3% of the companies; these are the companies receiving the lion’s share of market media attention! In investing, when all of the attention and capital is placed in one area, it is unlikely there are undiscovered opportunities in that area. In fact, numerous studies have shown there is no outperformance potential when investing in the largest U.S. corporations. However, studies have consistently indicated outperformance potential is available investing in small U.S. corporations, various bond sectors, and in certain international investments. Different Types of Stocks Stock market opportunities are often segmented different ways. The three most prominent forms of categorization are market capitalization size, value or growth, and industry classification. The capitalization size of a company is measured by the market value of all outstanding shares of a company’s equity. Companies’ market capitalization is categorized between large cap, medium cap, and small cap. Companies are considered to be large cap when their market capitalization exceeds $10 billion. Companies between $2 billion and $10 billion market cap are considered mid cap companies. Those companies with less than $2 billion market cap are considered small cap companies. The next series of categorization is between value and growth and is often determined by the price of a company’s equity in relation to its earnings, its future earnings prospects, and the amount of profits the corporations retain versus what is returned to shareholders. All else unchanged, the lower the company’s price relative to earnings (measured by the Price to Earnings (P/E) ratio, or other relative value measurements) the more likely it is to be classified as a value company instead of a growth company; Investment products are: • Not a Deposit • Not FDIC Insured • Not Insured by any Federal Government Agency • Not Guaranteed by the Bank • May Go Down in Value value companies tend to have a low stock price due to unfavorable growth or future earnings prospects. Growth companies tend to have very favorable earnings growth forecasts causing their equity prices to be much higher relative to the company’s current earnings. When categorizing equity mutual funds or ETFs, the Equity Style Box is a conventional way to categorize the predominant types of companies a fund is primarily invested in. The Equity Style a fund pursues may not provide an investor the capability to predict future returns, but it helps to understand the types of companies a fund is invested in and to compare the actual investment activities to the fund’s mandated objectives. The final categorization of stocks is the industry classifications; these are subsections of the equity investment market and are often referred to as equity subsectors. The predominant subsectors are: energy, materials, industrials, consumer goods (basic staples), consumer discretionary, health care, utilities, financials, and technology. This series of classifications is especially useful because an industry’s trends, opportunities, and risks bear a heavy influence on the future prospects of the earnings and stock price of companies within that industry. In fact, a key focal point in corporate investment analysis is to perform an industry analysis. As an industry is beneficially or negatively exposed to an economic cycle, the corresponding beneficial or negative implications are likely to be shared across the vast majority of companies in the industry. By categorizing between equity subsectors, an investor may be better able to develop informed expectations of how their equity portfolio will perform in a given economic cycle. Different Types of Bonds Three general categorizations of bonds are issuer type, maturity length, and credit strength. When discussing stocks, the discussion always pertained to shares of corporations. For-profit corporations are only one of many kinds of bond issuers. The overarching categorizations of bond issuers are: U.S. Treasury and other federal agencies, mortgage- related bonds, corporate bonds, asset-backed bonds, and municipal bonds. Within mortgage-related, asset- backed, and municipal bonds, there is a multitude of meaningfully different issuer types. For example: in municipal bonds, there are: cities, states, counties, toll roads, school districts, business and residential real estate developments, event centers, hospitals, prisons, sewer systems, tobacco bonds, etc. The type of issuer and its repayment source carry strong implications on a bond’s credit strength, its perceived risk, and ultimately the return opportunities for investors. The maturity length of a bond and whether it can be prepaid in advance of the maturity date has important implications on the long term returns on bond investing. All else unchanged, a bond with a longer maturity typically has a higher return and is considered to be a higher risk.2 Basic Bond Valuation and Maturity Trade-offs If a person owns a $100 bond that earns 5% return each year for 5 years in a world where the market expects 5% return, the market value on the bond would be $100. However, if the market instead expected a 4% return, what would the 2However, in the context of a portfolio of stocks and bonds, having longer maturity bonds while having greater individual risk can actually lower portfolio risk due to their historic negative correlation to stocks. market value be? In that case, the bond owner would benefit by an extra 1% per year over 5 years equating to a 5% aggregate benefit; ignoring compounding and preciseness, the market value on that bond would be 5% higher, or $105. For a 10 year bond instead of a 5 year bond, the differences in interest rates would have twice the magnitude of impact. <question> ================== List all the types of bonds only using information from the provided document. <instruction> ================== Refer only to the provided context document when answering the question.","Refer only to the provided context document when answering the question.
+
+EVIDENCE:
+𝐒𝐭𝐨𝐜𝐤𝐬 𝐚𝐧𝐝 𝐁𝐨𝐧𝐝𝐬 𝐂𝐨𝐦𝐩𝐚𝐫𝐢𝐬𝐨𝐧 Large companies and other entities use bonds as a form of debt borrowing or financing. Unlike loans, bonds are more transferrable and divisible by the lenders, allowing for multiple investors, which is appropriate when financing needs are very substantial. Bearing similarities to the concept of a first mortgage and a second mortgage, there are senior bonds and subordinated bonds; the senior bonds take precedence over the subordinated bonds in terms of payment priority, and therefore are safer for the lender or investor. Equity, on the other hand, represents a share of ownership in a for-profit corporation. It is what is “left over” from revenue brought in after all expenses (operating expenses, taxes, interest) have been paid. Because equity holders are entitled to what is “left over,” this means they are the investor class exposed to the greatest risk, but are also entitled to the greatest reward. A corporation’s capital structure is typically comprised of one or more forms of debt and one or more forms of equity. According to the chart below, there is an order of precedence governing how money flows in an entity from one class of investors to another. Because debt or bond holders have a senior claim relative to equity holders, business profits first go towards senior debt payments, then to any subordinate class of debt, and then to any preferred class of equity. From there, all remaining profits flow to common equity as a return on investment to be distributed to the owners of common equity. Pending the direction and approval of the company’s board of directors, this distribution can come in the form of a dividend (or stock buyback), reinvested into the company, or most likely a combination of both. If business prospects are extremely good, a common equity shareholder may receive a theoretically uncapped return on their investment. Over the long run, the return on equity of successful and stable corporations exceeds the cost of debt sufficiently enough to compensate investors for the additional risk they are taking. The source of the additional risk is the priority of payments when business conditions are weaker. If there is an economic cycle of weaker revenues, a business might find itself barely able to service its debt financing. In this case, it is unlikely any residual profits will be available to common shareholders for distribution; these circumstances may last for years and many require the business to resort to costly compromises to ensure its debt payments are met. Meanwhile, the senior debt holders can take comfort in the fact the return on their investment is of highest priority and will only be compromised as a last resort. This creates what can be referred to as a more open system of outcomes for stocks and a more closed system of outcomes for bonds; this feature will be expanded upon in greater detail later. These nuances in the capital structure may seem like semantics to some, but as was stated in the introduction, it is an essential component of developing a true understanding of investment options and has great implications on risk and return characteristics. Stock and Bond Investment Opportunities In terms of the number of different investments investors are able to choose from, there are overwhelmingly more bond opportunities than stock opportunities. This may come as a surprise to some as market media attention is overwhelmingly slanted towards stock investing instead of bond investing. Investment products are: • Not a Deposit • Not FDIC Insured • Not Insured by any Federal Government Agency • Not Guaranteed by the Bank • May Go Down in Value In fact, there are 68 times more bond issuances than there are publicly owned stocks. If a person only includes the stocks actively traded on an exchange, there would be 277 times more bond issuances. Yet in terms of the amount of capital invested in each market, there is only 54% more invested in bonds than there is invested in equities. Similar to how the vast amount of market media attention is fixated on the relatively few amount of actively traded stocks, the amount of investment dollars chasing those actively traded stocks is disproportionately large compared to the amount of capital invested in the vast universe of bonds. Within the overemphasis on stocks, there is yet more of a disproportionate emphasis placed on the largest companies; of the aggregate investment in all of the 15,000 publicly traded corporations, 70% of that capital is concentrated in the 500 largest corporations. Put another way, 70% of the money is invested in 3% of the companies; these are the companies receiving the lion’s share of market media attention! In investing, when all of the attention and capital is placed in one area, it is unlikely there are undiscovered opportunities in that area. In fact, numerous studies have shown there is no outperformance potential when investing in the largest U.S. corporations. However, studies have consistently indicated outperformance potential is available investing in small U.S. corporations, various bond sectors, and in certain international investments. Different Types of Stocks Stock market opportunities are often segmented different ways. The three most prominent forms of categorization are market capitalization size, value or growth, and industry classification. The capitalization size of a company is measured by the market value of all outstanding shares of a company’s equity. Companies’ market capitalization is categorized between large cap, medium cap, and small cap. Companies are considered to be large cap when their market capitalization exceeds $10 billion. Companies between $2 billion and $10 billion market cap are considered mid cap companies. Those companies with less than $2 billion market cap are considered small cap companies. The next series of categorization is between value and growth and is often determined by the price of a company’s equity in relation to its earnings, its future earnings prospects, and the amount of profits the corporations retain versus what is returned to shareholders. All else unchanged, the lower the company’s price relative to earnings (measured by the Price to Earnings (P/E) ratio, or other relative value measurements) the more likely it is to be classified as a value company instead of a growth company; Investment products are: • Not a Deposit • Not FDIC Insured • Not Insured by any Federal Government Agency • Not Guaranteed by the Bank • May Go Down in Value value companies tend to have a low stock price due to unfavorable growth or future earnings prospects. Growth companies tend to have very favorable earnings growth forecasts causing their equity prices to be much higher relative to the company’s current earnings. When categorizing equity mutual funds or ETFs, the Equity Style Box is a conventional way to categorize the predominant types of companies a fund is primarily invested in. The Equity Style a fund pursues may not provide an investor the capability to predict future returns, but it helps to understand the types of companies a fund is invested in and to compare the actual investment activities to the fund’s mandated objectives. The final categorization of stocks is the industry classifications; these are subsections of the equity investment market and are often referred to as equity subsectors. The predominant subsectors are: energy, materials, industrials, consumer goods (basic staples), consumer discretionary, health care, utilities, financials, and technology. This series of classifications is especially useful because an industry’s trends, opportunities, and risks bear a heavy influence on the future prospects of the earnings and stock price of companies within that industry. In fact, a key focal point in corporate investment analysis is to perform an industry analysis. As an industry is beneficially or negatively exposed to an economic cycle, the corresponding beneficial or negative implications are likely to be shared across the vast majority of companies in the industry. By categorizing between equity subsectors, an investor may be better able to develop informed expectations of how their equity portfolio will perform in a given economic cycle. Different Types of Bonds Three general categorizations of bonds are issuer type, maturity length, and credit strength. When discussing stocks, the discussion always pertained to shares of corporations. For-profit corporations are only one of many kinds of bond issuers. The overarching categorizations of bond issuers are: U.S. Treasury and other federal agencies, mortgage- related bonds, corporate bonds, asset-backed bonds, and municipal bonds. Within mortgage-related, asset- backed, and municipal bonds, there is a multitude of meaningfully different issuer types. For example: in municipal bonds, there are: cities, states, counties, toll roads, school districts, business and residential real estate developments, event centers, hospitals, prisons, sewer systems, tobacco bonds, etc. The type of issuer and its repayment source carry strong implications on a bond’s credit strength, its perceived risk, and ultimately the return opportunities for investors. The maturity length of a bond and whether it can be prepaid in advance of the maturity date has important implications on the long term returns on bond investing. All else unchanged, a bond with a longer maturity typically has a higher return and is considered to be a higher risk.2 Basic Bond Valuation and Maturity Trade-offs If a person owns a $100 bond that earns 5% return each year for 5 years in a world where the market expects 5% return, the market value on the bond would be $100. However, if the market instead expected a 4% return, what would the 2However, in the context of a portfolio of stocks and bonds, having longer maturity bonds while having greater individual risk can actually lower portfolio risk due to their historic negative correlation to stocks. market value be? In that case, the bond owner would benefit by an extra 1% per year over 5 years equating to a 5% aggregate benefit; ignoring compounding and preciseness, the market value on that bond would be 5% higher, or $105. For a 10 year bond instead of a 5 year bond, the differences in interest rates would have twice the magnitude of impact.
+
+USER:
+List all the types of bonds only using information from the provided document.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,11,13,1659,,152
+This task requires you to answer questions based only on the information provided in the prompt. Give your answer in bullet points.,Briefly summarize the IRS's efforts to create a DF system. Include only the important facts.,"Individuals may satisfy their income tax obligations by filing a paper return or filing an electronic one (efiling). To e-file, a taxpayer must use software preapproved by the Internal Revenue Service (IRS). Most individual returns are e-filed. For the 2022 tax year (through December 29, 2023), the IRS received 162 million returns, 93% of which (150 million) had been e-filed. Professional preparers submitted 57% of the e-filed returns and self-preparing individuals the other 43%. Historically, the IRS has provided taxpayers with several options for free e-filing, but those options did not include e-filing directly with the IRS through a secure portal on its website, an option known as Direct File (DF). As a result of several recent developments, a DF option is now available as a pilot program during the 2024 filing season. This Insight describes how the pilot DF system came to be and how it is intended to work. Emergence of An IRS Direct-File Option The IRS’s efforts to create a DF system go back to the early 2000s. The initial attempt was a response to a 2001 directive from the Office of Management and Budget to expand e-filing as part of an effort to increase the range of online federal government services. In 2002, concerned about the cost of developing and maintaining a DF system and facing opposition in Congress to such an initiative, the IRS formed a partnership with a number of commercial tax preparation firms to provide free tax preparation and e-filing to lower-income taxpayers through a program known as Free File. Under the agreement establishing the program, member companies were to provide free e-filing to eligible taxpayers through their online platforms, and in return, the IRS would refrain from developing its own DF system. This restriction lasted from 2003 until 2019, when it was dropped from the memorandum of understanding governing the Free File program. There were several reasons for this decision. Historic usage rates for the program had ranged from 3% to 4% of eligible taxpayers. The IRS invested little in promoting and policing the program. Some media reports in 2019 revealed that some member companies had been diverting Free File-eligible taxpayers to the companies’ paid filing services. Interest in the IRS providing a DF service seems to have grown since 2019. The Inflation Reduction Act (IRA, P.L. 117-169) provided the IRS with $15 million to create a direct e-file task force and deliver two reports to Congress by May 16, 2023. The task force was to prepare one report, and an “independent third party” chosen by the IRS was to prepare a second report.","This task requires you to answer questions based only on the information provided in the prompt. Give your answer in bullet points. Briefly summarize the IRS's efforts to create a DF system. Include only the important facts. Individuals may satisfy their income tax obligations by filing a paper return or filing an electronic one (efiling). To e-file, a taxpayer must use software preapproved by the Internal Revenue Service (IRS). Most individual returns are e-filed. For the 2022 tax year (through December 29, 2023), the IRS received 162 million returns, 93% of which (150 million) had been e-filed. Professional preparers submitted 57% of the e-filed returns and self-preparing individuals the other 43%. Historically, the IRS has provided taxpayers with several options for free e-filing, but those options did not include e-filing directly with the IRS through a secure portal on its website, an option known as Direct File (DF). As a result of several recent developments, a DF option is now available as a pilot program during the 2024 filing season. This Insight describes how the pilot DF system came to be and how it is intended to work. Emergence of An IRS Direct-File Option The IRS’s efforts to create a DF system go back to the early 2000s. The initial attempt was a response to a 2001 directive from the Office of Management and Budget to expand e-filing as part of an effort to increase the range of online federal government services. In 2002, concerned about the cost of developing and maintaining a DF system and facing opposition in Congress to such an initiative, the IRS formed a partnership with a number of commercial tax preparation firms to provide free tax preparation and e-filing to lower-income taxpayers through a program known as Free File. Under the agreement establishing the program, member companies were to provide free e-filing to eligible taxpayers through their online platforms, and in return, the IRS would refrain from developing its own DF system. This restriction lasted from 2003 until 2019, when it was dropped from the memorandum of understanding governing the Free File program. There were several reasons for this decision. Historic usage rates for the program had ranged from 3% to 4% of eligible taxpayers. The IRS invested little in promoting and policing the program. Some media reports in 2019 revealed that some member companies had been diverting Free File-eligible taxpayers to the companies’ paid filing services. Interest in the IRS providing a DF service seems to have grown since 2019. The Inflation Reduction Act (IRA, P.L. 117-169) provided the IRS with $15 million to create a direct e-file task force and deliver two reports to Congress by May 16, 2023. The task force was to prepare one report, and an “independent third party” chosen by the IRS was to prepare a second report.","This task requires you to answer questions based only on the information provided in the prompt. Give your answer in bullet points.
+
+EVIDENCE:
+Individuals may satisfy their income tax obligations by filing a paper return or filing an electronic one (efiling). To e-file, a taxpayer must use software preapproved by the Internal Revenue Service (IRS). Most individual returns are e-filed. For the 2022 tax year (through December 29, 2023), the IRS received 162 million returns, 93% of which (150 million) had been e-filed. Professional preparers submitted 57% of the e-filed returns and self-preparing individuals the other 43%. Historically, the IRS has provided taxpayers with several options for free e-filing, but those options did not include e-filing directly with the IRS through a secure portal on its website, an option known as Direct File (DF). As a result of several recent developments, a DF option is now available as a pilot program during the 2024 filing season. This Insight describes how the pilot DF system came to be and how it is intended to work. Emergence of An IRS Direct-File Option The IRS’s efforts to create a DF system go back to the early 2000s. The initial attempt was a response to a 2001 directive from the Office of Management and Budget to expand e-filing as part of an effort to increase the range of online federal government services. In 2002, concerned about the cost of developing and maintaining a DF system and facing opposition in Congress to such an initiative, the IRS formed a partnership with a number of commercial tax preparation firms to provide free tax preparation and e-filing to lower-income taxpayers through a program known as Free File. Under the agreement establishing the program, member companies were to provide free e-filing to eligible taxpayers through their online platforms, and in return, the IRS would refrain from developing its own DF system. This restriction lasted from 2003 until 2019, when it was dropped from the memorandum of understanding governing the Free File program. There were several reasons for this decision. Historic usage rates for the program had ranged from 3% to 4% of eligible taxpayers. The IRS invested little in promoting and policing the program. Some media reports in 2019 revealed that some member companies had been diverting Free File-eligible taxpayers to the companies’ paid filing services. Interest in the IRS providing a DF service seems to have grown since 2019. The Inflation Reduction Act (IRA, P.L. 117-169) provided the IRS with $15 million to create a direct e-file task force and deliver two reports to Congress by May 16, 2023. The task force was to prepare one report, and an “independent third party” chosen by the IRS was to prepare a second report.
+
+USER:
+Briefly summarize the IRS's efforts to create a DF system. Include only the important facts.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,22,15,432,,302
+Answer only using information from the provided text. You are not allowed to use any external resources or prior knowledge. Limit the response to 200 words.,Explain the gender unique challenges of women with autism.,"Individuals with Autism Spectrum Disorder (ASD) face an assortment of social, emotional, and mental challenges. Typically, individuals with ASD have different and unexpected communication styles, difficulty recognizing others’ social cues, discomfort when making eye contact, delayed speech and unusual speech styles, and a preference for narrow or extreme groups of interests (Lai, Lombardo, Baron-Cohen, & Simon, 2014). Notable strengths can include an ability to focus on details, a perseverance for completing tasks, and an aptitude in following rules or instructions. While little is understood about the origins of autism, there is evidence to suggest atypical brain development and organization that may be related to genetic and environmental factors (Chaste & Leboyer, 2012). The U.S. Centers for Disease Control and Prevention (2018) reported that in 2014 one out of every fifty-nine individuals was identified with ASD, in contrast to the 1:150 ratio in the year 2000. More recently, research has revealed an even higher uptick, reflecting occurrences as high as one in 40 individuals having ASD (Kogan et al., 2018). Since 2006, when ASD screening became recommended, the familiarity and acceptance of the disorder has grown, leading to a spike in diagnoses in recent years (Wright, 2017). Although ASD has numerous subtypes, many studies depict how females with ASD are characteristically different than their male counterparts across the spectrum. Females with ASD have not only demonstrated a different set of mannerisms, but also face a variety of unique challenges. Females are often under-recognized on the spectrum and are three to four times less likely to be diagnosed with autism than males (Loomes et al., 2017). Males, on the other hand, not only dominate the autism spectrum in numbers, but also in the amount of research done on ASD. This brings into question whether males are more likely to develop ASD or if there is a diagnostic gender bias causing females to be underdiagnosed (Gould & Ashton-Smith, 2011). In this paper, I will evaluate the literature that examines the specific, gender-unique challenges that females with ASD experience. I will be discussing the underdiagnosis of females with ASD, the higher risk of sexual abuse for females with ASD, and the frequent development of secondary mental health concerns in females with ASD. Females with Autism are Underdiagnosed Females with ASD often go undiagnosed or receive a late diagnosis (Mandic-Maravic et al., 2015). An accurate and early diagnosis for individuals with ASD is essential to optimize their social and emotional development (Milner, McIntosh, Colvert, & Happé, 2019). Baldwin and Costley (2016) found that females who did not receive a diagnosis until the age of 18 or older were far more likely to struggle later in life because of the lack of necessary assistance and treatment they could have received in their adolescent years. In this section, I will discuss two common explanations as to why females may be underdiagnosed: camouflaging and differences in presentation than males. Camouflaging Females with ASD are able to camouflage their autistic traits better than males with ASD (Lai et al. 2011). Camouflaging is defined as presenting and behaving oneself as neurotypical in order to fit into society (Milner et al., 2019; Schuck, Flores, & Fung, 2019). Mimicking behaviors, communicating nonverbally, reducing strange behaviors around others, and preparing small talk or “scripts” beforehand are ways females attempt to camouflage (Hull et al., 2017). In one study, women and girls reported to successfully hide their autistic traits by learning stock phrases or studying the appropriate amount of time they needed to maintain eye contact in order to appear normal in conversation (Lai et al., 2019). In another study, some females with autism reported that they camouflage in order to connect with friends, go on dates, get out of the spotlight, get a job, or simply be seen as neurotypical (Hull et al., 2017). Researchers presented a questionnaire to individuals with ASD and found that 89.2% of males with ASD and 90.9% of females with ASD attempt to camouflage their autism in order to fit in (Cassidy, Bradley, Shaw, & Baron-Cohen, 2018). Though both females and males try to hide autistic traits, females attained much higher scores, indicating that they are more adept at camouflaging and do so in more situations than males (Lai et al., 2011). Differences in presentation from males Autistic traits manifest differently between males and females with ASD, which subsequently causes false negative results in females being evaluated","System instruction: Answer only using information from the provided text. You are not allowed to use any external resources or prior knowledge. Limit the response to 200 words. Context: Individuals with Autism Spectrum Disorder (ASD) face an assortment of social, emotional, and mental challenges. Typically, individuals with ASD have different and unexpected communication styles, difficulty recognizing others’ social cues, discomfort when making eye contact, delayed speech and unusual speech styles, and a preference for narrow or extreme groups of interests (Lai, Lombardo, Baron-Cohen, & Simon, 2014). Notable strengths can include an ability to focus on details, a perseverance for completing tasks, and an aptitude in following rules or instructions. While little is understood about the origins of autism, there is evidence to suggest atypical brain development and organization that may be related to genetic and environmental factors (Chaste & Leboyer, 2012). The U.S. Centers for Disease Control and Prevention (2018) reported that in 2014 one out of every fifty-nine individuals was identified with ASD, in contrast to the 1:150 ratio in the year 2000. More recently, research has revealed an even higher uptick, reflecting occurrences as high as one in 40 individuals having ASD (Kogan et al., 2018). Since 2006, when ASD screening became recommended, the familiarity and acceptance of the disorder has grown, leading to a spike in diagnoses in recent years (Wright, 2017). Although ASD has numerous subtypes, many studies depict how females with ASD are characteristically different than their male counterparts across the spectrum. Females with ASD have not only demonstrated a different set of mannerisms, but also face a variety of unique challenges. Females are often under-recognized on the spectrum and are three to four times less likely to be diagnosed with autism than males (Loomes et al., 2017). Males, on the other hand, not only dominate the autism spectrum in numbers, but also in the amount of research done on ASD. This brings into question whether males are more likely to develop ASD or if there is a diagnostic gender bias causing females to be underdiagnosed (Gould & Ashton-Smith, 2011). In this paper, I will evaluate the literature that examines the specific, gender-unique challenges that females with ASD experience. I will be discussing the underdiagnosis of females with ASD, the higher risk of sexual abuse for females with ASD, and the frequent development of secondary mental health concerns in females with ASD. Females with Autism are Underdiagnosed Females with ASD often go undiagnosed or receive a late diagnosis (Mandic-Maravic et al., 2015). An accurate and early diagnosis for individuals with ASD is essential to optimize their social and emotional development (Milner, McIntosh, Colvert, & Happé, 2019). Baldwin and Costley (2016) found that females who did not receive a diagnosis until the age of 18 or older were far more likely to struggle later in life because of the lack of necessary assistance and treatment they could have received in their adolescent years. In this section, I will discuss two common explanations as to why females may be underdiagnosed: camouflaging and differences in presentation than males. Camouflaging Females with ASD are able to camouflage their autistic traits better than males with ASD (Lai et al. 2011). Camouflaging is defined as presenting and behaving oneself as neurotypical in order to fit into society (Milner et al., 2019; Schuck, Flores, & Fung, 2019). Mimicking behaviors, communicating nonverbally, reducing strange behaviors around others, and preparing small talk or “scripts” beforehand are ways females attempt to camouflage (Hull et al., 2017). In one study, women and girls reported to successfully hide their autistic traits by learning stock phrases or studying the appropriate amount of time they needed to maintain eye contact in order to appear normal in conversation (Lai et al., 2019). In another study, some females with autism reported that they camouflage in order to connect with friends, go on dates, get out of the spotlight, get a job, or simply be seen as neurotypical (Hull et al., 2017). Researchers presented a questionnaire to individuals with ASD and found that 89.2% of males with ASD and 90.9% of females with ASD attempt to camouflage their autism in order to fit in (Cassidy, Bradley, Shaw, & Baron-Cohen, 2018). Though both females and males try to hide autistic traits, females attained much higher scores, indicating that they are more adept at camouflaging and do so in more situations than males (Lai et al., 2011). Differences in presentation from males Autistic traits manifest differently between males and females with ASD, which subsequently causes false negative results in females being evaluated Question: Explain the gender unique challenges of women with autism.","Answer only using information from the provided text. You are not allowed to use any external resources or prior knowledge. Limit the response to 200 words.
+
+EVIDENCE:
+Individuals with Autism Spectrum Disorder (ASD) face an assortment of social, emotional, and mental challenges. Typically, individuals with ASD have different and unexpected communication styles, difficulty recognizing others’ social cues, discomfort when making eye contact, delayed speech and unusual speech styles, and a preference for narrow or extreme groups of interests (Lai, Lombardo, Baron-Cohen, & Simon, 2014). Notable strengths can include an ability to focus on details, a perseverance for completing tasks, and an aptitude in following rules or instructions. While little is understood about the origins of autism, there is evidence to suggest atypical brain development and organization that may be related to genetic and environmental factors (Chaste & Leboyer, 2012). The U.S. Centers for Disease Control and Prevention (2018) reported that in 2014 one out of every fifty-nine individuals was identified with ASD, in contrast to the 1:150 ratio in the year 2000. More recently, research has revealed an even higher uptick, reflecting occurrences as high as one in 40 individuals having ASD (Kogan et al., 2018). Since 2006, when ASD screening became recommended, the familiarity and acceptance of the disorder has grown, leading to a spike in diagnoses in recent years (Wright, 2017). Although ASD has numerous subtypes, many studies depict how females with ASD are characteristically different than their male counterparts across the spectrum. Females with ASD have not only demonstrated a different set of mannerisms, but also face a variety of unique challenges. Females are often under-recognized on the spectrum and are three to four times less likely to be diagnosed with autism than males (Loomes et al., 2017). Males, on the other hand, not only dominate the autism spectrum in numbers, but also in the amount of research done on ASD. This brings into question whether males are more likely to develop ASD or if there is a diagnostic gender bias causing females to be underdiagnosed (Gould & Ashton-Smith, 2011). In this paper, I will evaluate the literature that examines the specific, gender-unique challenges that females with ASD experience. I will be discussing the underdiagnosis of females with ASD, the higher risk of sexual abuse for females with ASD, and the frequent development of secondary mental health concerns in females with ASD. Females with Autism are Underdiagnosed Females with ASD often go undiagnosed or receive a late diagnosis (Mandic-Maravic et al., 2015). An accurate and early diagnosis for individuals with ASD is essential to optimize their social and emotional development (Milner, McIntosh, Colvert, & Happé, 2019). Baldwin and Costley (2016) found that females who did not receive a diagnosis until the age of 18 or older were far more likely to struggle later in life because of the lack of necessary assistance and treatment they could have received in their adolescent years. In this section, I will discuss two common explanations as to why females may be underdiagnosed: camouflaging and differences in presentation than males. Camouflaging Females with ASD are able to camouflage their autistic traits better than males with ASD (Lai et al. 2011). Camouflaging is defined as presenting and behaving oneself as neurotypical in order to fit into society (Milner et al., 2019; Schuck, Flores, & Fung, 2019). Mimicking behaviors, communicating nonverbally, reducing strange behaviors around others, and preparing small talk or “scripts” beforehand are ways females attempt to camouflage (Hull et al., 2017). In one study, women and girls reported to successfully hide their autistic traits by learning stock phrases or studying the appropriate amount of time they needed to maintain eye contact in order to appear normal in conversation (Lai et al., 2019). In another study, some females with autism reported that they camouflage in order to connect with friends, go on dates, get out of the spotlight, get a job, or simply be seen as neurotypical (Hull et al., 2017). Researchers presented a questionnaire to individuals with ASD and found that 89.2% of males with ASD and 90.9% of females with ASD attempt to camouflage their autism in order to fit in (Cassidy, Bradley, Shaw, & Baron-Cohen, 2018). Though both females and males try to hide autistic traits, females attained much higher scores, indicating that they are more adept at camouflaging and do so in more situations than males (Lai et al., 2011). Differences in presentation from males Autistic traits manifest differently between males and females with ASD, which subsequently causes false negative results in females being evaluated
+
+USER:
+Explain the gender unique challenges of women with autism.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,26,9,729,,470
+Don't include any information from other sources.,Make a table listing all of the acronyms and initialisms used in this text and what they mean.,"Restless Legs Syndrome Restless legs syndrome (RLS) causes an unpleasant prickling or tingling in the legs, especially in the calves, that is relieved by moving or massaging them. People who have RLS feel a need to stretch or move their legs to get rid of the uncomfortable or painful feelings. As a result, it may be difficult to fall asleep and stay asleep. One or both legs may be affected. Some people also feel the sensations in their arms. These sensations also can occur when lying down or sitting for long periods of time, such as while at a desk, riding in a car, or watching a movie. Many people who have RLS also have brief limb movements during sleep, often with abrupt onset, occurring every 5–90 seconds. This condition, known as periodic limb movements in sleep (PLMS), can repeatedly awaken people who have RLS, reducing their total sleep time and interrupting their sleep. Some people have PLMS but have no abnormal sensations in their legs while awake. RLS affects 5–15 percent of Americans, and its prevalence increases with age. RLS occurs more often in women than men. One study found that RLS accounted for one-third of the insomnia seen in patients older than age 60. Children also can have RLS. In children, the condition may be associated with symptoms of attention-deficit hyperactivity disorder. However, it’s not fully known how the disorders are related. Sometimes “growing pains” can be mistaken for RLS. RLS is often inherited. Pregnancy, kidney failure, and anemia related to iron or vitamin deficiency can trigger or worsen RLS symptoms. Researchers suspect that these conditions cause an iron deficiency that results in a lack of dopamine, which is used by the brain to control physical sensation and limb movements. Doctors usually can diagnose RLS by patients’ symptoms and a telltale worsening of symptoms at night or while at rest. Some doctors may order a blood test to check ferretin levels (ferretin is a form of iron). Doctors also may ask people who have RLS to spend a night in a sleep laboratory, where they are monitored to rule out other sleep disorders and to document the excessive limb movements. RLS is treatable but not always curable. Dramatic improvements are seen quickly when patients are given dopamine-like drugs or iron supplements. Alternatively, people who have milder cases may be treated successfully with sedatives or behavioral strategies. These Common Sleep Disorders 48 Your Guide to Healthy Sleep n strategies include stretching, taking a hot bath, or massaging the legs before bedtime. Avoiding caffeinated beverages also can help reduce symptoms, and certain medications (e.g., some antidepressants, particularly selective serotonin reuptake inhibitors) may cause RLS. If iron or vitamin deficiency underlies RLS, symptoms may improve with prescribed iron, vitamin B12, or folate supplements. Some people may require anticonvulsant medications to control the creeping and crawling sensations in their limbs. Others who have severe symptoms that are associated with another medical disorder or that do not respond to normal treatments may need to be treated with pain relievers. Narcolepsy Narcolepsy’s main symptom is extreme and overwhelming daytime sleepiness, even after adequate nighttime sleep. In addition, nighttime sleep may be fragmented by frequent awakenings. People who have narcolepsy often fall asleep at inappropriate times and places. Although TV sitcoms occasionally feature these individuals to generate a few laughs, narcolepsy is no laughing matter. People who have narcolepsy experience daytime “sleep attacks” that last from seconds to more than one-half hour, can occur without warning, and may cause injury. These embarrassing sleep spells also can make it difficult to work and to maintain normal personal or social relationships. With narcolepsy, the usually sharp distinctions between being asleep and awake are blurred. Also, people who have narcolepsy tend to fall directly into dream-filled REM sleep, rather than enter REM sleep gradually after passing through the non-REM sleep stages first. In addition to overwhelming daytime sleepiness, narcolepsy has three other commonly associated symptoms, but these may not occur in all people: Sudden muscle weakness (cataplexy). This weakness is similar to the paralysis that normally occurs during REM sleep, but it lasts a few seconds to minutes while an individual is awake. Cataplexy tends to be triggered by sudden emotional reactions, such as anger, surprise, fear, or laughter. The weakness may show up as limpness at the neck, buckling of the knees, or sagging facial muscles affecting speech, or it may cause a complete body collapse. 49 Common Sleep Disorders At first, I was misdiagnosed with chronic fatigue syndrome, because I was in my forties and narcolepsy symptoms usually start during the teen years. Because I didn’t have any of the symptoms of chronic fatigue syndrome other than sleepiness, I went to a neurologist for help. He noticed the cataplexy (muscle weakness) right away, and then I was officially diagnosed with narcolepsy and then later on with borderline sleep apnea. “Even though there is no cure for narcolepsy, you can feel like you have control if you manage it well. “When you have narcolepsy, you live your life differently. But with a good plan and supportive friends and family, it all turns out OK. SZE-PING “ ” 50 Your Guide to Healthy Sleep n n Sleep paralysis. People who have narcolepsy may experience a temporary inability to talk or move when falling asleep or waking up, as if they were glued to their beds. Vivid dreams. These dreams can occur when people who have narcolepsy first fall asleep or wake up. The dreams are so lifelike that they can be confused with reality. Experts estimate that as many as 350,000 Americans have narcolepsy, but fewer than 50,000 are diagnosed. The disorder may be as widespread as Parkinson’s disease or multiple sclerosis, and more prevalent than cystic fibrosis, but it is less well known. Narcolepsy is often mistaken for depression, epilepsy, or the side effects of medicines. Narcolepsy can be difficult to diagnose in people who have only the symptom of excessive daytime sleepiness. It is usually diagnosed during an overnight sleep recording (PSG) that is followed by an MSLT. (See “How Are Sleep Disorders Diagnosed?” on page 44.) Both tests reveal symptoms of narcolepsy—the tendency to fall asleep rapidly and enter REM sleep early, even during brief naps. Narcolepsy can develop at any age, but the symptoms tend to appear first during adolescence or early adulthood. About 1 of every 10 people who have narcolepsy has a close family member who has the disorder, suggesting that one can inherit a tendency to develop narcolepsy. Studies suggest that a substance in the brain called hypocretin plays a key role in narcolepsy. Most people who have narcolepsy lack hypocretin, which promotes wakefulness. Scientists believe that an autoimmune reaction—perhaps triggered by disease, viral illness, or brain injury— specifically destroys the hypocretin-generating cells in the brains of people who have narcolepsy. 51 Eventually, researchers may develop a treatment for narcolepsy that restores hypocretin to normal levels. In the meantime, most people who have narcolepsy find some to all of their symptoms relieved by various drug treatments. For example, central nervous system stimulants can reduce daytime sleepiness. Antidepressants and other drugs that suppress REM sleep can prevent muscle weakness, sleep paralysis, and vivid dreaming. Doctors also usually recommend that people who have narcolepsy take short naps (10–15 minutes) two or three times a day, if possible, to help control excessive daytime sleepiness.","Make a table listing all of the acronyms and initialisms used in this text and what they mean. Don't include any information from other sources. Restless Legs Syndrome Restless legs syndrome (RLS) causes an unpleasant prickling or tingling in the legs, especially in the calves, that is relieved by moving or massaging them. People who have RLS feel a need to stretch or move their legs to get rid of the uncomfortable or painful feelings. As a result, it may be difficult to fall asleep and stay asleep. One or both legs may be affected. Some people also feel the sensations in their arms. These sensations also can occur when lying down or sitting for long periods of time, such as while at a desk, riding in a car, or watching a movie. Many people who have RLS also have brief limb movements during sleep, often with abrupt onset, occurring every 5–90 seconds. This condition, known as periodic limb movements in sleep (PLMS), can repeatedly awaken people who have RLS, reducing their total sleep time and interrupting their sleep. Some people have PLMS but have no abnormal sensations in their legs while awake. RLS affects 5–15 percent of Americans, and its prevalence increases with age. RLS occurs more often in women than men. One study found that RLS accounted for one-third of the insomnia seen in patients older than age 60. Children also can have RLS. In children, the condition may be associated with symptoms of attention-deficit hyperactivity disorder. However, it’s not fully known how the disorders are related. Sometimes “growing pains” can be mistaken for RLS. RLS is often inherited. Pregnancy, kidney failure, and anemia related to iron or vitamin deficiency can trigger or worsen RLS symptoms. Researchers suspect that these conditions cause an iron deficiency that results in a lack of dopamine, which is used by the brain to control physical sensation and limb movements. Doctors usually can diagnose RLS by patients’ symptoms and a telltale worsening of symptoms at night or while at rest. Some doctors may order a blood test to check ferretin levels (ferretin is a form of iron). Doctors also may ask people who have RLS to spend a night in a sleep laboratory, where they are monitored to rule out other sleep disorders and to document the excessive limb movements. RLS is treatable but not always curable. Dramatic improvements are seen quickly when patients are given dopamine-like drugs or iron supplements. Alternatively, people who have milder cases may be treated successfully with sedatives or behavioral strategies. These Common Sleep Disorders 48 Your Guide to Healthy Sleep n strategies include stretching, taking a hot bath, or massaging the legs before bedtime. Avoiding caffeinated beverages also can help reduce symptoms, and certain medications (e.g., some antidepressants, particularly selective serotonin reuptake inhibitors) may cause RLS. If iron or vitamin deficiency underlies RLS, symptoms may improve with prescribed iron, vitamin B12, or folate supplements. Some people may require anticonvulsant medications to control the creeping and crawling sensations in their limbs. Others who have severe symptoms that are associated with another medical disorder or that do not respond to normal treatments may need to be treated with pain relievers. Narcolepsy Narcolepsy’s main symptom is extreme and overwhelming daytime sleepiness, even after adequate nighttime sleep. In addition, nighttime sleep may be fragmented by frequent awakenings. People who have narcolepsy often fall asleep at inappropriate times and places. Although TV sitcoms occasionally feature these individuals to generate a few laughs, narcolepsy is no laughing matter. People who have narcolepsy experience daytime “sleep attacks” that last from seconds to more than one-half hour, can occur without warning, and may cause injury. These embarrassing sleep spells also can make it difficult to work and to maintain normal personal or social relationships. With narcolepsy, the usually sharp distinctions between being asleep and awake are blurred. Also, people who have narcolepsy tend to fall directly into dream-filled REM sleep, rather than enter REM sleep gradually after passing through the non-REM sleep stages first. In addition to overwhelming daytime sleepiness, narcolepsy has three other commonly associated symptoms, but these may not occur in all people: Sudden muscle weakness (cataplexy). This weakness is similar to the paralysis that normally occurs during REM sleep, but it lasts a few seconds to minutes while an individual is awake. Cataplexy tends to be triggered by sudden emotional reactions, such as anger, surprise, fear, or laughter. The weakness may show up as limpness at the neck, buckling of the knees, or sagging facial muscles affecting speech, or it may cause a complete body collapse. 49 Common Sleep Disorders At first, I was misdiagnosed with chronic fatigue syndrome, because I was in my forties and narcolepsy symptoms usually start during the teen years. Because I didn’t have any of the symptoms of chronic fatigue syndrome other than sleepiness, I went to a neurologist for help. He noticed the cataplexy (muscle weakness) right away, and then I was officially diagnosed with narcolepsy and then later on with borderline sleep apnea. “Even though there is no cure for narcolepsy, you can feel like you have control if you manage it well. “When you have narcolepsy, you live your life differently. But with a good plan and supportive friends and family, it all turns out OK. SZE-PING “ ” 50 Your Guide to Healthy Sleep n n Sleep paralysis. People who have narcolepsy may experience a temporary inability to talk or move when falling asleep or waking up, as if they were glued to their beds. Vivid dreams. These dreams can occur when people who have narcolepsy first fall asleep or wake up. The dreams are so lifelike that they can be confused with reality. Experts estimate that as many as 350,000 Americans have narcolepsy, but fewer than 50,000 are diagnosed. The disorder may be as widespread as Parkinson’s disease or multiple sclerosis, and more prevalent than cystic fibrosis, but it is less well known. Narcolepsy is often mistaken for depression, epilepsy, or the side effects of medicines. Narcolepsy can be difficult to diagnose in people who have only the symptom of excessive daytime sleepiness. It is usually diagnosed during an overnight sleep recording (PSG) that is followed by an MSLT. (See “How Are Sleep Disorders Diagnosed?” on page 44.) Both tests reveal symptoms of narcolepsy—the tendency to fall asleep rapidly and enter REM sleep early, even during brief naps. Narcolepsy can develop at any age, but the symptoms tend to appear first during adolescence or early adulthood. About 1 of every 10 people who have narcolepsy has a close family member who has the disorder, suggesting that one can inherit a tendency to develop narcolepsy. Studies suggest that a substance in the brain called hypocretin plays a key role in narcolepsy. Most people who have narcolepsy lack hypocretin, which promotes wakefulness. Scientists believe that an autoimmune reaction—perhaps triggered by disease, viral illness, or brain injury— specifically destroys the hypocretin-generating cells in the brains of people who have narcolepsy. 51 Eventually, researchers may develop a treatment for narcolepsy that restores hypocretin to normal levels. In the meantime, most people who have narcolepsy find some to all of their symptoms relieved by various drug treatments. For example, central nervous system stimulants can reduce daytime sleepiness. Antidepressants and other drugs that suppress REM sleep can prevent muscle weakness, sleep paralysis, and vivid dreaming. Doctors also usually recommend that people who have narcolepsy take short naps (10–15 minutes) two or three times a day, if possible, to help control excessive daytime sleepiness. Parasomnias (Abnormal Arousals) In some people, the walking, talking, and other body functions normally suppressed during sleep occur during certain sleep stages. Alternatively, the paralysis or vivid images usually experienced during dreaming may persist after awakening. These occurrences are collectively known as parasomnias and include confusional arousals (a mixed state of being both asleep and awake), sleep talking, sleep walking, night terrors, sleep paralysis, and REM sleep behavior disorder (acting out dreams). Most of these disorders— such as confusional arousals, sleep walking, and night terrors—are more common in children, who tend to outgrow them once they become adults. People who are sleep-deprived also may experience some of these disorders, including sleep walking and sleep paralysis. Sleep paralysis also commonly occurs in people who have narcolepsy. Certain medications or neurological disorders appear to lead to other parasomnias, such as REM sleep behavior disorder, and these parasomnias tend to occur more in elderly people. If you or a family member has persistent episodes of sleep paralysis, sleep walking, or acting out of dreams, talk with your doctor. Taking measures to assure the safety of children and other family members who have partial arousals from sleep is very important.","Don't include any information from other sources.
+
+EVIDENCE:
+Restless Legs Syndrome Restless legs syndrome (RLS) causes an unpleasant prickling or tingling in the legs, especially in the calves, that is relieved by moving or massaging them. People who have RLS feel a need to stretch or move their legs to get rid of the uncomfortable or painful feelings. As a result, it may be difficult to fall asleep and stay asleep. One or both legs may be affected. Some people also feel the sensations in their arms. These sensations also can occur when lying down or sitting for long periods of time, such as while at a desk, riding in a car, or watching a movie. Many people who have RLS also have brief limb movements during sleep, often with abrupt onset, occurring every 5–90 seconds. This condition, known as periodic limb movements in sleep (PLMS), can repeatedly awaken people who have RLS, reducing their total sleep time and interrupting their sleep. Some people have PLMS but have no abnormal sensations in their legs while awake. RLS affects 5–15 percent of Americans, and its prevalence increases with age. RLS occurs more often in women than men. One study found that RLS accounted for one-third of the insomnia seen in patients older than age 60. Children also can have RLS. In children, the condition may be associated with symptoms of attention-deficit hyperactivity disorder. However, it’s not fully known how the disorders are related. Sometimes “growing pains” can be mistaken for RLS. RLS is often inherited. Pregnancy, kidney failure, and anemia related to iron or vitamin deficiency can trigger or worsen RLS symptoms. Researchers suspect that these conditions cause an iron deficiency that results in a lack of dopamine, which is used by the brain to control physical sensation and limb movements. Doctors usually can diagnose RLS by patients’ symptoms and a telltale worsening of symptoms at night or while at rest. Some doctors may order a blood test to check ferretin levels (ferretin is a form of iron). Doctors also may ask people who have RLS to spend a night in a sleep laboratory, where they are monitored to rule out other sleep disorders and to document the excessive limb movements. RLS is treatable but not always curable. Dramatic improvements are seen quickly when patients are given dopamine-like drugs or iron supplements. Alternatively, people who have milder cases may be treated successfully with sedatives or behavioral strategies. These Common Sleep Disorders 48 Your Guide to Healthy Sleep n strategies include stretching, taking a hot bath, or massaging the legs before bedtime. Avoiding caffeinated beverages also can help reduce symptoms, and certain medications (e.g., some antidepressants, particularly selective serotonin reuptake inhibitors) may cause RLS. If iron or vitamin deficiency underlies RLS, symptoms may improve with prescribed iron, vitamin B12, or folate supplements. Some people may require anticonvulsant medications to control the creeping and crawling sensations in their limbs. Others who have severe symptoms that are associated with another medical disorder or that do not respond to normal treatments may need to be treated with pain relievers. Narcolepsy Narcolepsy’s main symptom is extreme and overwhelming daytime sleepiness, even after adequate nighttime sleep. In addition, nighttime sleep may be fragmented by frequent awakenings. People who have narcolepsy often fall asleep at inappropriate times and places. Although TV sitcoms occasionally feature these individuals to generate a few laughs, narcolepsy is no laughing matter. People who have narcolepsy experience daytime “sleep attacks” that last from seconds to more than one-half hour, can occur without warning, and may cause injury. These embarrassing sleep spells also can make it difficult to work and to maintain normal personal or social relationships. With narcolepsy, the usually sharp distinctions between being asleep and awake are blurred. Also, people who have narcolepsy tend to fall directly into dream-filled REM sleep, rather than enter REM sleep gradually after passing through the non-REM sleep stages first. In addition to overwhelming daytime sleepiness, narcolepsy has three other commonly associated symptoms, but these may not occur in all people: Sudden muscle weakness (cataplexy). This weakness is similar to the paralysis that normally occurs during REM sleep, but it lasts a few seconds to minutes while an individual is awake. Cataplexy tends to be triggered by sudden emotional reactions, such as anger, surprise, fear, or laughter. The weakness may show up as limpness at the neck, buckling of the knees, or sagging facial muscles affecting speech, or it may cause a complete body collapse. 49 Common Sleep Disorders At first, I was misdiagnosed with chronic fatigue syndrome, because I was in my forties and narcolepsy symptoms usually start during the teen years. Because I didn’t have any of the symptoms of chronic fatigue syndrome other than sleepiness, I went to a neurologist for help. He noticed the cataplexy (muscle weakness) right away, and then I was officially diagnosed with narcolepsy and then later on with borderline sleep apnea. “Even though there is no cure for narcolepsy, you can feel like you have control if you manage it well. “When you have narcolepsy, you live your life differently. But with a good plan and supportive friends and family, it all turns out OK. SZE-PING “ ” 50 Your Guide to Healthy Sleep n n Sleep paralysis. People who have narcolepsy may experience a temporary inability to talk or move when falling asleep or waking up, as if they were glued to their beds. Vivid dreams. These dreams can occur when people who have narcolepsy first fall asleep or wake up. The dreams are so lifelike that they can be confused with reality. Experts estimate that as many as 350,000 Americans have narcolepsy, but fewer than 50,000 are diagnosed. The disorder may be as widespread as Parkinson’s disease or multiple sclerosis, and more prevalent than cystic fibrosis, but it is less well known. Narcolepsy is often mistaken for depression, epilepsy, or the side effects of medicines. Narcolepsy can be difficult to diagnose in people who have only the symptom of excessive daytime sleepiness. It is usually diagnosed during an overnight sleep recording (PSG) that is followed by an MSLT. (See “How Are Sleep Disorders Diagnosed?” on page 44.) Both tests reveal symptoms of narcolepsy—the tendency to fall asleep rapidly and enter REM sleep early, even during brief naps. Narcolepsy can develop at any age, but the symptoms tend to appear first during adolescence or early adulthood. About 1 of every 10 people who have narcolepsy has a close family member who has the disorder, suggesting that one can inherit a tendency to develop narcolepsy. Studies suggest that a substance in the brain called hypocretin plays a key role in narcolepsy. Most people who have narcolepsy lack hypocretin, which promotes wakefulness. Scientists believe that an autoimmune reaction—perhaps triggered by disease, viral illness, or brain injury— specifically destroys the hypocretin-generating cells in the brains of people who have narcolepsy. 51 Eventually, researchers may develop a treatment for narcolepsy that restores hypocretin to normal levels. In the meantime, most people who have narcolepsy find some to all of their symptoms relieved by various drug treatments. For example, central nervous system stimulants can reduce daytime sleepiness. Antidepressants and other drugs that suppress REM sleep can prevent muscle weakness, sleep paralysis, and vivid dreaming. Doctors also usually recommend that people who have narcolepsy take short naps (10–15 minutes) two or three times a day, if possible, to help control excessive daytime sleepiness.
+
+USER:
+Make a table listing all of the acronyms and initialisms used in this text and what they mean.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,7,18,1230,,193
+Refer only to the provided text and do not use any outside information.,What motivated congress to approve two competing bills?,"House-passed H.R. 8070 H.R. 8070, known as the Servicemember Quality of Life Improvement and National Defense Authorization Act for Fiscal Year 2025, would authorize $883.7 billion, as requested, according to the accompanying committee report, H.Rept. 118-529. Together with amounts for certain defense-related programs not within the legislation’s purview or requiring additional authorization, the discretionary budget authority implication of the bill would total $895.2 billion—consistent with the defense discretionary spending cap for FY2025 established in the Fiscal Responsibility Act of 2023 (P.L. 118-5). During an April 30, 2024, hearing on the FY2025 DOD budget request, Representative Mike Rogers, chair of the House Armed Services Committee (HASC), described the department’s request as inadequate to restore deterrence. “But this is the hand dealt to us by the Fiscal Responsibility Act that we all have responsibility for enacting,” he said. “As we move to mark up the FY2025 NDAA, we will play that hand that was dealt to us.” In preparation for House consideration of the legislation, Representative Barbara Lee submitted an amendment that would have reduced the amount authorized by the bill by $100 billion, excluding accounts related to the Defense Health Program, military personnel, and pay and benefits. The amendment was not considered for floor debate. A bipartisan amendment adopted as Section 1005 of the bill would reduce funding for a military department or defense agency by 0.5% upon failure to submit financial statements or achieve an independent audit opinion. While the overall level of funding authorizations in H.R. 8070 would match the President’s request, amounts authorized for certain types of accounts would differ from the request. For example, in terms of DOD titles, the legislation would authorize $3.8 billion (2.1%) more than requested for military personnel (MILPERS) appropriations, largely to support a 19.5% pay raise for certain junior enlisted service members and an expanded housing allowance benefit as part of a package of “quality of life” initiatives. The legislation would authorize $2.8 billion (1.7%) less than requested for procurement Congressional Research Service 3 appropriations, including the Shipbuilding and Conversion, Navy account—with no funding authorized for the Navy to procure the seventh Constellation-class (FFG) frigate, a type of small surface combatant. In a Statement of Administration Policy on H.R. 8070, the Biden Administration “strongly” opposed changing the basic pay schedule before the completion of the Fourteenth Quadrennial Review of Military Compensation (QRMC) and expressed disappointment at the level of shipbuilding funding, among other areas of disagreement. SASC-reported S. 4638 S. 4638 would authorize $908.4 billion, $25.1 billion more than requested for DOD to “accelerate equipment recapitalization, increase military construction, address the highest-priority unfunded requirements of the military services and combatant commanders, decrease the Department’s facility maintenance backlog, and strengthen the defense industrial base.” During debate of the bill in a closed session, the Senate Armed Services Committee (SASC) voted 16-9 on a motion “to include a provision that would increase the topline by $25.0 billion.” Senator Roger Wicker, Ranking Member of SASC, filed the motion following the release of a plan calling for a “generational investment” in the U.S. military—with proposed funding increases of $55 billion in FY2025 and additional amounts to reach 5% of Gross Domestic Product in the future—to prevent conflict, recapitalize U.S. military equipment, and safeguard national security innovation. Senator Jack Reed, chair of SASC, said he voted against reporting the bill to the Senate because it included “a funding increase that cannot be appropriated without breaking lawful spending caps and causing unintended harm to our military. I appreciate the need for greater defense spending to ensure our national security, but I cannot support this approach.” S. 4638 would authorize $25.1 billion more funding than requested for DOD, across each appropriation title, with $10.0 billion more than requested for procurement accounts; $2.9 billion more for research, development, test, and evaluation (RDT&E) accounts; and $3.1 billion more for military construction (MILCON) accounts.","Refer only to the provided text and do not use any outside information. What motivated congress to approve two competing bills? House-passed H.R. 8070 H.R. 8070, known as the Servicemember Quality of Life Improvement and National Defense Authorization Act for Fiscal Year 2025, would authorize $883.7 billion, as requested, according to the accompanying committee report, H.Rept. 118-529. Together with amounts for certain defense-related programs not within the legislation’s purview or requiring additional authorization, the discretionary budget authority implication of the bill would total $895.2 billion—consistent with the defense discretionary spending cap for FY2025 established in the Fiscal Responsibility Act of 2023 (P.L. 118-5). During an April 30, 2024, hearing on the FY2025 DOD budget request, Representative Mike Rogers, chair of the House Armed Services Committee (HASC), described the department’s request as inadequate to restore deterrence. “But this is the hand dealt to us by the Fiscal Responsibility Act that we all have responsibility for enacting,” he said. “As we move to mark up the FY2025 NDAA, we will play that hand that was dealt to us.” In preparation for House consideration of the legislation, Representative Barbara Lee submitted an amendment that would have reduced the amount authorized by the bill by $100 billion, excluding accounts related to the Defense Health Program, military personnel, and pay and benefits. The amendment was not considered for floor debate. A bipartisan amendment adopted as Section 1005 of the bill would reduce funding for a military department or defense agency by 0.5% upon failure to submit financial statements or achieve an independent audit opinion. While the overall level of funding authorizations in H.R. 8070 would match the President’s request, amounts authorized for certain types of accounts would differ from the request. For example, in terms of DOD titles, the legislation would authorize $3.8 billion (2.1%) more than requested for military personnel (MILPERS) appropriations, largely to support a 19.5% pay raise for certain junior enlisted servicemembers and an expanded housing allowance benefit as part of a package of “quality of life” initiatives. The legislation would authorize $2.8 billion (1.7%) less than requested for procurement Congressional Research Service 3 appropriations, including the Shipbuilding and Conversion, Navy account—with no funding authorized for the Navy to procure the seventh Constellation-class (FFG) frigate, a type of small surface combatant. In a Statement of Administration Policy on H.R. 8070, the Biden Administration “strongly” opposed changing the basic pay schedule before the completion of the Fourteenth Quadrennial Review of Military Compensation (QRMC) and expressed disappointment at the level of shipbuilding funding, among other areas of disagreement. SASC-reported S. 4638 S. 4638 would authorize $908.4 billion, $25.1 billion more than requested for DOD to “accelerate equipment recapitalization, increase military construction, address the highest-priority unfunded requirements of the military services and combatant commanders, decrease the Department’s facility maintenance backlog, and strengthen the defense industrial base.” During debate of the bill in a closed session, the Senate Armed Services Committee (SASC) voted 16-9 on a motion “to include a provision that would increase the topline by $25.0 billion.” Senator Roger Wicker, Ranking Member of SASC, filed the motion following the release of a plan calling for a “generational investment” in the U.S. military—with proposed funding increases of $55 billion in FY2025 and additional amounts to reach 5% of Gross Domestic Product in the future—to prevent conflict, recapitalize U.S. military equipment, and safeguard national security innovation. Senator Jack Reed, chair of SASC, said he voted against reporting the bill to the Senate because it included “a funding increase that cannot be appropriated without breaking lawful spending caps and causing unintended harm to our military. I appreciate the need for greater defense spending to ensure our national security, but I cannot support this approach.” S. 4638 would authorize $25.1 billion more funding than requested for DOD, across each appropriation title, with $10.0 billion more than requested for procurement accounts; $2.9 billion more for research, development, test, and evaluation (RDT&E) accounts; and $3.1 billion more for military construction (MILCON) accounts.","Refer only to the provided text and do not use any outside information.
+
+EVIDENCE:
+House-passed H.R. 8070 H.R. 8070, known as the Servicemember Quality of Life Improvement and National Defense Authorization Act for Fiscal Year 2025, would authorize $883.7 billion, as requested, according to the accompanying committee report, H.Rept. 118-529. Together with amounts for certain defense-related programs not within the legislation’s purview or requiring additional authorization, the discretionary budget authority implication of the bill would total $895.2 billion—consistent with the defense discretionary spending cap for FY2025 established in the Fiscal Responsibility Act of 2023 (P.L. 118-5). During an April 30, 2024, hearing on the FY2025 DOD budget request, Representative Mike Rogers, chair of the House Armed Services Committee (HASC), described the department’s request as inadequate to restore deterrence. “But this is the hand dealt to us by the Fiscal Responsibility Act that we all have responsibility for enacting,” he said. “As we move to mark up the FY2025 NDAA, we will play that hand that was dealt to us.” In preparation for House consideration of the legislation, Representative Barbara Lee submitted an amendment that would have reduced the amount authorized by the bill by $100 billion, excluding accounts related to the Defense Health Program, military personnel, and pay and benefits. The amendment was not considered for floor debate. A bipartisan amendment adopted as Section 1005 of the bill would reduce funding for a military department or defense agency by 0.5% upon failure to submit financial statements or achieve an independent audit opinion. While the overall level of funding authorizations in H.R. 8070 would match the President’s request, amounts authorized for certain types of accounts would differ from the request. For example, in terms of DOD titles, the legislation would authorize $3.8 billion (2.1%) more than requested for military personnel (MILPERS) appropriations, largely to support a 19.5% pay raise for certain junior enlisted service members and an expanded housing allowance benefit as part of a package of “quality of life” initiatives. The legislation would authorize $2.8 billion (1.7%) less than requested for procurement Congressional Research Service 3 appropriations, including the Shipbuilding and Conversion, Navy account—with no funding authorized for the Navy to procure the seventh Constellation-class (FFG) frigate, a type of small surface combatant. In a Statement of Administration Policy on H.R. 8070, the Biden Administration “strongly” opposed changing the basic pay schedule before the completion of the Fourteenth Quadrennial Review of Military Compensation (QRMC) and expressed disappointment at the level of shipbuilding funding, among other areas of disagreement. SASC-reported S. 4638 S. 4638 would authorize $908.4 billion, $25.1 billion more than requested for DOD to “accelerate equipment recapitalization, increase military construction, address the highest-priority unfunded requirements of the military services and combatant commanders, decrease the Department’s facility maintenance backlog, and strengthen the defense industrial base.” During debate of the bill in a closed session, the Senate Armed Services Committee (SASC) voted 16-9 on a motion “to include a provision that would increase the topline by $25.0 billion.” Senator Roger Wicker, Ranking Member of SASC, filed the motion following the release of a plan calling for a “generational investment” in the U.S. military—with proposed funding increases of $55 billion in FY2025 and additional amounts to reach 5% of Gross Domestic Product in the future—to prevent conflict, recapitalize U.S. military equipment, and safeguard national security innovation. Senator Jack Reed, chair of SASC, said he voted against reporting the bill to the Senate because it included “a funding increase that cannot be appropriated without breaking lawful spending caps and causing unintended harm to our military. I appreciate the need for greater defense spending to ensure our national security, but I cannot support this approach.” S. 4638 would authorize $25.1 billion more funding than requested for DOD, across each appropriation title, with $10.0 billion more than requested for procurement accounts; $2.9 billion more for research, development, test, and evaluation (RDT&E) accounts; and $3.1 billion more for military construction (MILCON) accounts.
+
+USER:
+What motivated congress to approve two competing bills?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,13,8,642,,66
+For this task you are not allowed to use any external knowledge or information to respond. Only use the information provided in the prompt.,What are the listed audio and video products that health care providers are and are not allowed to use for telehealth?,"Application of HIPAA Requirements to Health Care Providers During the COVID-19 Emergency Although health care providers must typically comply with HIPAA’s requirements, HHS has said it will use its enforcement discretion to provide temporary relief in response to the COVID-19 pandemic. As detailed in this Report, federal agencies enjoy discretion in deciding whether to bring enforcement actions, and courts generally decline to review such decisions. Given this discretion, the HHS OCR has announced that during the COVID-19 public health emergency it is “exercising its enforcement discretion” not to enforce the HIPAA rules against health care providers providing telehealth services in good faith. In its notice of enforcement discretion, OCR explained that health care providers may use “non-public facing audio or video communications products” such as “Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, Zoom, or Skype” without the risk that OCR will seek a penalty for HIPAA Congressional Research Service 4 LSB10490· VERSION 1 · NEW non-compliance. OCR encourages providers to notify patients of the potential privacy risks of these platforms, and also to enable all privacy modes and encryption where available. OCR noted, however, that health care providers who seek “additional privacy protections” should provide such services through technology vendors that are HIPAA compliant and will enter into business associate contracts. It identified several vendors—such as Skype for Business, Zoom for Healthcare, and Google G Suite Hangouts Meet—who have represented that they are HIPAA compliant and willing to enter into business associate contracts, although OCR disclaimed that it was validating any of the vendors’ HIPAA compliance. OCR said, however, that health care providers should not use public-facing services such as “Facebook Live, Twitch, TikTok,” and similar “public-facing” applications, and it further explained in a separate publication that use of these services could be evidence of “bad faith” subject to enforcement. OCR’s notice of enforcement discretion does not have an expiration date, and OCR has said that it will notify the public when it no longer applies. DOJ, unlike OCR, has not declared that it will refrain from exercising its criminal enforcement authority during the COVID-19 emergency. Consequently, individuals may still be liable for “knowingly” obtaining or disclosing PHI in violation of HIPAA’s requirements. However, while OCR did not address criminal liability in its notice of enforcement discretion, it might choose not to refer cases to DOJ for criminal prosecution that involve a health care provider relying in good faith on OCR’s notice of enforcement discretion.","For this task you are not allowed to use any external knowledge or information to respond. Only use the information provided in the prompt. What are the listed audio and video products that health care providers are and are not allowed to use for telehealth? Application of HIPAA Requirements to Health Care Providers During the COVID-19 Emergency Although health care providers must typically comply with HIPAA’s requirements, HHS has said it will use its enforcement discretion to provide temporary relief in response to the COVID-19 pandemic. As detailed in this Report, federal agencies enjoy discretion in deciding whether to bring enforcement actions, and courts generally decline to review such decisions. Given this discretion, the HHS OCR has announced that during the COVID-19 public health emergency it is “exercising its enforcement discretion” not to enforce the HIPAA rules against health care providers providing telehealth services in good faith. In its notice of enforcement discretion, OCR explained that health care providers may use “non-public facing audio or video communications products” such as “Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, Zoom, or Skype” without the risk that OCR will seek a penalty for HIPAA Congressional Research Service 4 LSB10490· VERSION 1 · NEW non-compliance. OCR encourages providers to notify patients of the potential privacy risks of these platforms, and also to enable all privacy modes and encryption where available. OCR noted, however, that health care providers who seek “additional privacy protections” should provide such services through technology vendors that are HIPAA compliant and will enter into business associate contracts. It identified several vendors—such as Skype for Business, Zoom for Healthcare, and Google G Suite Hangouts Meet—who have represented that they are HIPAA compliant and willing to enter into business associate contracts, although OCR disclaimed that it was validating any of the vendors’ HIPAA compliance. OCR said, however, that health care providers should not use public-facing services such as “Facebook Live, Twitch, TikTok,” and similar “public-facing” applications, and it further explained in a separate publication that use of these services could be evidence of “bad faith” subject to enforcement. OCR’s notice of enforcement discretion does not have an expiration date, and OCR has said that it will notify the public when it no longer applies. DOJ, unlike OCR, has not declared that it will refrain from exercising its criminal enforcement authority during the COVID-19 emergency. Consequently, individuals may still be liable for “knowingly” obtaining or disclosing PHI in violation of HIPAA’s requirements. However, while OCR did not address criminal liability in its notice of enforcement discretion, it might choose not to refer cases to DOJ for criminal prosecution that involve a health care provider relying in good faith on OCR’s notice of enforcement discretion.","For this task you are not allowed to use any external knowledge or information to respond. Only use the information provided in the prompt.
+
+EVIDENCE:
+Application of HIPAA Requirements to Health Care Providers During the COVID-19 Emergency Although health care providers must typically comply with HIPAA’s requirements, HHS has said it will use its enforcement discretion to provide temporary relief in response to the COVID-19 pandemic. As detailed in this Report, federal agencies enjoy discretion in deciding whether to bring enforcement actions, and courts generally decline to review such decisions. Given this discretion, the HHS OCR has announced that during the COVID-19 public health emergency it is “exercising its enforcement discretion” not to enforce the HIPAA rules against health care providers providing telehealth services in good faith. In its notice of enforcement discretion, OCR explained that health care providers may use “non-public facing audio or video communications products” such as “Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, Zoom, or Skype” without the risk that OCR will seek a penalty for HIPAA Congressional Research Service 4 LSB10490· VERSION 1 · NEW non-compliance. OCR encourages providers to notify patients of the potential privacy risks of these platforms, and also to enable all privacy modes and encryption where available. OCR noted, however, that health care providers who seek “additional privacy protections” should provide such services through technology vendors that are HIPAA compliant and will enter into business associate contracts. It identified several vendors—such as Skype for Business, Zoom for Healthcare, and Google G Suite Hangouts Meet—who have represented that they are HIPAA compliant and willing to enter into business associate contracts, although OCR disclaimed that it was validating any of the vendors’ HIPAA compliance. OCR said, however, that health care providers should not use public-facing services such as “Facebook Live, Twitch, TikTok,” and similar “public-facing” applications, and it further explained in a separate publication that use of these services could be evidence of “bad faith” subject to enforcement. OCR’s notice of enforcement discretion does not have an expiration date, and OCR has said that it will notify the public when it no longer applies. DOJ, unlike OCR, has not declared that it will refrain from exercising its criminal enforcement authority during the COVID-19 emergency. Consequently, individuals may still be liable for “knowingly” obtaining or disclosing PHI in violation of HIPAA’s requirements. However, while OCR did not address criminal liability in its notice of enforcement discretion, it might choose not to refer cases to DOJ for criminal prosecution that involve a health care provider relying in good faith on OCR’s notice of enforcement discretion.
+
+USER:
+What are the listed audio and video products that health care providers are and are not allowed to use for telehealth?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,24,21,407,,393
+"You may not reference any other resources or find the answer to the prompt from any other resources beyond the provided text. If the answer is not given in the text, you must clearly state that. You may not assume or allude to potential meanings of the answers if the text does not explicitly state the answer. Do not expand upon the meanings of the answer if the text does not.",What advantages do offline vs online retailers have?,"Due to savings in inventory costs, online retailing has a big advantage in selling less popular items (the long tail) and in removing geographic barriers to purchase. Brynjolfsson et al. (2003) estimated that the significantly increased assortment of books available online increased consumer welfare by $700 million to a billion dollars in 2000. In comparing the online sales of a clothing retailer with the catalog sales of the same item, Brynjolfsson et al. (2009) showed that online sales of niche items were less sensitive to competition from offline stores than from catalog sales because the online sales were skewed toward niche items. Brynjolfsson et al. (2011) showed that online sales of niche items increased with recommendations and search tools, indicating that these tools lowered search costs, making it easier for consumers to locate them. In sum, because of the ability to handle more extensive inventories and provide search tools that facilitate locating niche items, online retailing has a comparative advantage in selling less popular items, translating into substantial benefits for consumers. As noted above, online sellers have an advantage in facilitating a search for information on digital attributes (including price). In contrast, offline sellers have an advantage in providing information on non- digital attributes and providing faster delivery. This leads to the possibility that consumers will search among both online and offline retailers.","You may not reference any other resources or find the answer to the prompt from any other resources beyond the provided text. If the answer is not given in the text, you must clearly state that. You may not assume or allude to potential meanings of the answers if the text does not explicitly state the answer. Do not expand upon the meanings of the answer if the text does not. What advantages do offline vs online retailers have? Due to savings in inventory costs, online retailing has a big advantage in selling less popular items (the long tail) and in removing geographic barriers to purchase. Brynjolfsson et al. (2003) estimated that the significantly increased assortment of books available online increased consumer welfare by $700 million to a billion dollars in 2000. In comparing the online sales of a clothing retailer with the catalog sales of the same item, Brynjolfsson et al. (2009) showed that online sales of niche items were less sensitive to competition from offline stores than from catalog sales because the online sales were skewed toward niche items. Brynjolfsson et al. (2011) showed that online sales of niche items increased with recommendations and search tools, indicating that these tools lowered search costs, making it easier for consumers to locate them. In sum, because of the ability to handle more extensive inventories and provide search tools that facilitate locating niche items, online retailing has a comparative advantage in selling less popular items, translating into substantial benefits for consumers. As noted above, online sellers have an advantage in facilitating a search for information on digital attributes (including price). In contrast, offline sellers have an advantage in providing information on non- digital attributes and providing faster delivery. This leads to the possibility that consumers will search among both online and offline retailers.","You may not reference any other resources or find the answer to the prompt from any other resources beyond the provided text. If the answer is not given in the text, you must clearly state that. You may not assume or allude to potential meanings of the answers if the text does not explicitly state the answer. Do not expand upon the meanings of the answer if the text does not.
+
+EVIDENCE:
+Due to savings in inventory costs, online retailing has a big advantage in selling less popular items (the long tail) and in removing geographic barriers to purchase. Brynjolfsson et al. (2003) estimated that the significantly increased assortment of books available online increased consumer welfare by $700 million to a billion dollars in 2000. In comparing the online sales of a clothing retailer with the catalog sales of the same item, Brynjolfsson et al. (2009) showed that online sales of niche items were less sensitive to competition from offline stores than from catalog sales because the online sales were skewed toward niche items. Brynjolfsson et al. (2011) showed that online sales of niche items increased with recommendations and search tools, indicating that these tools lowered search costs, making it easier for consumers to locate them. In sum, because of the ability to handle more extensive inventories and provide search tools that facilitate locating niche items, online retailing has a comparative advantage in selling less popular items, translating into substantial benefits for consumers. As noted above, online sellers have an advantage in facilitating a search for information on digital attributes (including price). In contrast, offline sellers have an advantage in providing information on non- digital attributes and providing faster delivery. This leads to the possibility that consumers will search among both online and offline retailers.
+
+USER:
+What advantages do offline vs online retailers have?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,71,8,223,,143
+"<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> [user request] <TEXT> [context document]","I am writing a report about vaccines in the context of the Covid-19 pandemic. I am a PhD student and my focus is on the molecular aspects of vaccines. Can you give me a list of the different types of vaccines and their characteristics? Keep it brief, I don't want the response to exceed 300 words. I also want to know how Toll-like receptors are related to vaccines.","In late 2019, a novel beta coronavirus emerged in Wuhan, China, and rapidly spread worldwide. The Coronavirus disease 2019 (COVID-19) has a high potential of a pandemic due to its high contagious rate with high mortality globally (Sharma et al. 2020; Su et al. 2020; Wibawa 2021). Therefore, substantial efforts are needed to develop effective vaccines or therapies against the disease (Su et al. 2020). Symptoms of COVID-19 disease vary, including mild flu-like symptoms, pneumonia, acute respiratory distress syndrome (ARDS), and fatal outcome. Patients with cancer, diabetes, cardiovascular diseases, older adults, and even genetically predisposed individuals are at highest risk of COVID-19 severity (Sharma et al. 2020; Su et al. 2020; Wibawa 2021; Vakil et al. 2022). As per the World Health Organization (WHO) recommendations, wearing masks, using antiviral drugs, social distancing, and adherence to vaccination procedures are crucial behaviors to control of COVID-19 pandemic around the world (Sharma et al. 2020). The scientific effort towards development of efficient vaccines against invasive pathogens dates back many years since long (Deb et al. 2020; Zhang et al. 2020; Wibawa 2021). These vaccine platforms have also been designed against pathogenic bacteria (Farhani et al. 2019; Jafari and Mahmoodi 2021). In this regard, developing an efficient, protective, and safe vaccine is considered as a pivotal preventive approach to hinder the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread (Moore and Klasse 2020). Therefore, different pharmaceutical companies and research teams worldwide competed to present a safe and efficient vaccine against the COVID-19 for international community use. These efforts have developed other vaccine platforms to enter preclinical and clinical trials and some of them have been approved (Chen et al. 2021), including traditional vaccines such as live or inactivated, subunit, and nucleic acid-based vaccines as next-generation vaccines (Moore and Klasse 2020). Based on the scientific evidence, live-attenuated vaccines stimulate the innate, cellular, and humoral immune responses by inducing Toll-like Receptors (TLRs) with long-term immunity and may develop hypersensitivity. The main drawback of these vaccines is their costly safety and efficacy assessments. Inactivated viral vaccines poorly provoke cellular immune responses which mitigate their efficacy. In April 2020, an inactivated COVID-19 vaccine was manufactured by Sinovac and Wuhan Institute of Biological Products (Sinopharm) (Moore and Klasse 2020; Su et al. 2020). Subunit vaccines are safe, with some defects including low immunogenicity, booster or adjuvant requirement, and high cost (Koirala et al. 2020; Su et al. 2020). Nucleic acid-based vaccines have been developed based on sequence information. They include DNA or mRNA sequences of antigens that strongly stimulate cellular and humoral immune responses in various doses. Due to their advantages, such as fast production, and the earliest COVID-19 vaccines in clinical trials, a noticeable advantage of DNA-based vaccines is their stability in various storage conditions (Silveira et al. 2020; van Riel and de Wit 2020). RNA-based vaccines received more attention from pharmaceutical companies like Pfizer/Biontech and Moderna. In contrast to DNA vaccines, they stimulate effective humoral immune response as TLR ligand without adjuvant, and its sequence is modified to preclude mRNA degradation (Moore and Klasse 2020; van Riel and de Wit 2020; Soiza et al. 2021).","<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> I am writing a report about vaccines in the context of the Covid-19 pandemic. I am a PhD student and my focus is on the molecular aspects of vaccines. Can you give me a list of the different types of vaccines and their characteristics? Keep it brief, I don't want the response to exceed 300 words. I also want to know how Toll-like receptors are related to vaccines. <TEXT> In late 2019, a novel beta coronavirus emerged in Wuhan, China, and rapidly spread worldwide. The Coronavirus disease 2019 (COVID-19) has a high potential of a pandemic due to its high contagious rate with high mortality globally (Sharma et al. 2020; Su et al. 2020; Wibawa 2021). Therefore, substantial efforts are needed to develop effective vaccines or therapies against the disease (Su et al. 2020). Symptoms of COVID-19 disease vary, including mild flu-like symptoms, pneumonia, acute respiratory distress syndrome (ARDS), and fatal outcome. Patients with cancer, diabetes, cardiovascular diseases, older adults, and even genetically predisposed individuals are at highest risk of COVID-19 severity (Sharma et al. 2020; Su et al. 2020; Wibawa 2021; Vakil et al. 2022). As per the World Health Organization (WHO) recommendations, wearing masks, using antiviral drugs, social distancing, and adherence to vaccination procedures are crucial behaviors to control of COVID-19 pandemic around the world (Sharma et al. 2020). The scientific effort towards development of efficient vaccines against invasive pathogens dates back many years since long (Deb et al. 2020; Zhang et al. 2020; Wibawa 2021). These vaccine platforms have also been designed against pathogenic bacteria (Farhani et al. 2019; Jafari and Mahmoodi 2021). In this regard, developing an efficient, protective, and safe vaccine is considered as a pivotal preventive approach to hinder the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread (Moore and Klasse 2020). Therefore, different pharmaceutical companies and research teams worldwide competed to present a safe and efficient vaccine against the COVID-19 for international community use. These efforts have developed other vaccine platforms to enter preclinical and clinical trials and some of them have been approved (Chen et al. 2021), including traditional vaccines such as live or inactivated, subunit, and nucleic acid-based vaccines as next-generation vaccines (Moore and Klasse 2020). Based on the scientific evidence, live-attenuated vaccines stimulate the innate, cellular, and humoral immune responses by inducing Toll-like Receptors (TLRs) with long-term immunity and may develop hypersensitivity. The main drawback of these vaccines is their costly safety and efficacy assessments. Inactivated viral vaccines poorly provoke cellular immune responses which mitigate their efficacy. In April 2020, an inactivated COVID-19 vaccine was manufactured by Sinovac and Wuhan Institute of Biological Products (Sinopharm) (Moore and Klasse 2020; Su et al. 2020). Subunit vaccines are safe, with some defects including low immunogenicity, booster or adjuvant requirement, and high cost (Koirala et al. 2020; Su et al. 2020). Nucleic acid-based vaccines have been developed based on sequence information. They include DNA or mRNA sequences of antigens that strongly stimulate cellular and humoral immune responses in various doses. Due to their advantages, such as fast production, and the earliest COVID-19 vaccines in clinical trials, a noticeable advantage of DNA-based vaccines is their stability in various storage conditions (Silveira et al. 2020; van Riel and de Wit 2020). RNA-based vaccines received more attention from pharmaceutical companies like Pfizer/Biontech and Moderna. In contrast to DNA vaccines, they stimulate effective humoral immune response as TLR ligand without adjuvant, and its sequence is modified to preclude mRNA degradation (Moore and Klasse 2020; van Riel and de Wit 2020; Soiza et al. 2021). https://link.springer.com/article/10.1007/s00203-023-03480-5","<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> [user request] <TEXT> [context document]
+
+EVIDENCE:
+In late 2019, a novel beta coronavirus emerged in Wuhan, China, and rapidly spread worldwide. The Coronavirus disease 2019 (COVID-19) has a high potential of a pandemic due to its high contagious rate with high mortality globally (Sharma et al. 2020; Su et al. 2020; Wibawa 2021). Therefore, substantial efforts are needed to develop effective vaccines or therapies against the disease (Su et al. 2020). Symptoms of COVID-19 disease vary, including mild flu-like symptoms, pneumonia, acute respiratory distress syndrome (ARDS), and fatal outcome. Patients with cancer, diabetes, cardiovascular diseases, older adults, and even genetically predisposed individuals are at highest risk of COVID-19 severity (Sharma et al. 2020; Su et al. 2020; Wibawa 2021; Vakil et al. 2022). As per the World Health Organization (WHO) recommendations, wearing masks, using antiviral drugs, social distancing, and adherence to vaccination procedures are crucial behaviors to control of COVID-19 pandemic around the world (Sharma et al. 2020). The scientific effort towards development of efficient vaccines against invasive pathogens dates back many years since long (Deb et al. 2020; Zhang et al. 2020; Wibawa 2021). These vaccine platforms have also been designed against pathogenic bacteria (Farhani et al. 2019; Jafari and Mahmoodi 2021). In this regard, developing an efficient, protective, and safe vaccine is considered as a pivotal preventive approach to hinder the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread (Moore and Klasse 2020). Therefore, different pharmaceutical companies and research teams worldwide competed to present a safe and efficient vaccine against the COVID-19 for international community use. These efforts have developed other vaccine platforms to enter preclinical and clinical trials and some of them have been approved (Chen et al. 2021), including traditional vaccines such as live or inactivated, subunit, and nucleic acid-based vaccines as next-generation vaccines (Moore and Klasse 2020). Based on the scientific evidence, live-attenuated vaccines stimulate the innate, cellular, and humoral immune responses by inducing Toll-like Receptors (TLRs) with long-term immunity and may develop hypersensitivity. The main drawback of these vaccines is their costly safety and efficacy assessments. Inactivated viral vaccines poorly provoke cellular immune responses which mitigate their efficacy. In April 2020, an inactivated COVID-19 vaccine was manufactured by Sinovac and Wuhan Institute of Biological Products (Sinopharm) (Moore and Klasse 2020; Su et al. 2020). Subunit vaccines are safe, with some defects including low immunogenicity, booster or adjuvant requirement, and high cost (Koirala et al. 2020; Su et al. 2020). Nucleic acid-based vaccines have been developed based on sequence information. They include DNA or mRNA sequences of antigens that strongly stimulate cellular and humoral immune responses in various doses. Due to their advantages, such as fast production, and the earliest COVID-19 vaccines in clinical trials, a noticeable advantage of DNA-based vaccines is their stability in various storage conditions (Silveira et al. 2020; van Riel and de Wit 2020). RNA-based vaccines received more attention from pharmaceutical companies like Pfizer/Biontech and Moderna. In contrast to DNA vaccines, they stimulate effective humoral immune response as TLR ligand without adjuvant, and its sequence is modified to preclude mRNA degradation (Moore and Klasse 2020; van Riel and de Wit 2020; Soiza et al. 2021).
+
+USER:
+I am writing a report about vaccines in the context of the Covid-19 pandemic. I am a PhD student and my focus is on the molecular aspects of vaccines. Can you give me a list of the different types of vaccines and their characteristics? Keep it brief, I don't want the response to exceed 300 words. I also want to know how Toll-like receptors are related to vaccines.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,20,68,518,,36
+Use only the information provided to answer. Do not use outside sources or internal knowledge. Use bullet point format in chronological order.,Please list the dates and their significance.,"The Court of Arbitration for Sport (CAS) has issued the operative part of its decision in the appeal arbitration procedures CAS 2023/A/10025 Simona Halep v. International Tennis Integrity Agency (ITIA) and CAS 2023/A/10227 International Tennis Integrity Agency (ITIA) v. Simona Halep: The appeal procedures before the CAS concerned two separate charges: 1. a charge which arose from a prohibited substance (Roxadustat) being detected in a urine sample collected from Simona Halep on 29 August 2022 during the US Open; and 2. a charge that Ms Halep’s Athlete Biological Passport (ABP), in particular a blood sample given by Ms Halep on 22 September 2022, established use of a prohibited substance and/or prohibited method. In its decision dated 22 September 2023, the International Tennis Federation (ITF) Independent Tribunal found Ms Halep guilty of both Anti-doping Rule Violations (ADRV) and imposed a four-year period of ineligibility on her. In the appeal filed by Simona Halep at the CAS against the first instance Decision, Ms Halep requested that the sanction be reduced and be no longer than the period of the provisional suspension already served. In its separate appeal, the ITIA requested that the CAS sanction Ms Halep’s ADRVs together as one single violation based on the violation that carried the most severe sanction, and the imposition of a period of ineligibility of between four and six years. The CAS appeal arbitration proceedings involved intensive pre-hearing processes and a three-day hearing which took place on 7-9 February 2024 in Lausanne, Switzerland. The CAS Panel heard from many lay and expert witnesses, most of whom were present in person at the hearing. The CAS Panel has unanimously determined that the four-year period of ineligibility imposed by the ITF Independent Tribunal is to be reduced to a period of ineligibility of nine (9) months starting on 7 October 2022, which period expired on 6 July 2023. As that period expired before the appeal procedures were even lodged with the CAS, the CAS Panel has determined it appropriate to issue the operative part of the Arbitral Award as soon as practicable, together with a comprehensive media release. The CAS Panel has also ordered the disqualification of all competitive results achieved by Ms. Halep from 29 August 2022 (the date of her positive sample) to 7 October 2022, including forfeiture of any medals, titles, ranking points and prize money. Therefore, the appeal filed by the ITIA is dismissed and the appeal filed by Simona Halep is partially upheld (her request to backdate the start of the suspension on 29 August 2022 is dismissed). Roxadustat charge According to Articles 2.1 and 2.2 of the Tennis Anti-Doping Programme (“TADP”), it is each player’s personal duty to ensure that no prohibited substance enters their body and players are responsible for any prohibited substances found to be present in their samples. In this matter, a prohibited substance (i.e. Roxadustat) was found to be present in a sample collected from Ms. Halep on 29 August 2022 during the US Open. Ms. Halep did not contest liability in that she accepted that, by reasons of the presence of Roxadustat in her sample, she had committed anti-doping rule violations under Articles 2.1 and 2.2 of the TADP. However, she objected to the intentional nature of the infraction and argued that the positive test was the result of contamination. Having carefully considered all the evidence put before it, the CAS Panel determined that Ms. Halep had established, on the balance of probabilities, that the Roxadustat entered her body through the consumption of a contaminated supplement which she had used in the days shortly before 29 August 2022 and that the Roxadustat, as detected in her sample, came from that contaminated product. As a result, the CAS Panel determined that Ms. Halep had also established, on the balance of probabilities, that her anti-doping rule violations were not intentional. Although the CAS Panel found that Ms. Halep did bear some level of fault or negligence for her violations, as she did not exercise sufficient care when using the Keto MCT supplement, it concluded that she bore no significant fault or negligence. Athlete Biological Passport (ABP) charge With respect to the charge concerning Ms. Halep’s ABP, the ITIA bore the onus of establishing (to the standard of comfortable satisfaction) that Ms. Halep had used a prohibited substance and/or prohibited method. It primarily relied on a blood sample given by Ms. Halep on 22 September 2022, the results of which it alleged demonstrated the anti-doping rule violation under Article 2.2 of the TADP. Contrary to the reasoning of the first instance tribunal, the CAS Panel determined that it was appropriate in the circumstances to consider the results of a private blood sample given by Ms. Halep on 9 September 2022 in the context of a surgery which occurred shortly thereafter. Those results, and Ms. Halep’s public statements that she did not intend to compete for the remainder of the 2022 calendar year, impacted the plausibility of the doping scenarios relied upon by the ITF Independent Tribunal. Having regard to the evidence as a whole, the CAS Panel was not comfortably satisfied that an anti-doping rule violation under Article 2.2. of the TADP had occurred. It therefore dismissed that charge. The CAS Panel has issued the following decision: 1. The appeal filed by Simona Halep on 28 September 2023 against the decision issued on 22 September 2023 by the ITF Independent Tribunal is admissible and is partially upheld. 2. The appeal filed by the International Tennis Integrity Agency (ITIA) on 14 December 2023 against the decision issued on 22 September 2023 by the ITF Independent Tribunal is admissible and is dismissed. 3. The decision issued on 22 September 2023 by the ITF Independent Tribunal is set aside. 4. Simona Halep is found to have committed Anti-Doping Rule Violations under Articles 2.1 (presence) and 2.2 (use) of the Tennis Anti-Doping Programme 2022 as a result of the presence of a Prohibited Substance (Roxadustat) in her urine sample collected In-Competition on 29 August 2022. 5. Simona Halep is sanctioned with a period of Ineligibility of nine (9) months, commencing on 7 October 2022. 6. Credit is given to Simona Halep for her provisional suspension served since 7 October 2022. 7. All results obtained by Simona Halep in competitions taking place in the period 29 August 2022 to 7 October 2022 are disqualified, with all resulting consequences, including forfeiture of any medals, titles, ranking points and prize money. 8. The award is pronounced without costs, except for the Court Office fees of CHF 1,000 (one thousand Swiss francs) paid by each of Simona Halep in respect of her appeal and the International Tennis Integrity Agency (ITIA) in respect of its appeal, which is retained by the CAS. 9. The International Tennis Integrity Agency (ITIA) is ordered to pay Simona Halep an amount of CHF 20,000 (twenty thousand Swiss francs) as a contribution towards her legal fees and other expenses incurred in connection with these arbitration proceedings. The reasoned award will be notified to the parties in due course. It will be published by CAS unless the parties request confidentiality.","The Court of Arbitration for Sport (CAS) has issued the operative part of its decision in the appeal arbitration procedures CAS 2023/A/10025 Simona Halep v. International Tennis Integrity Agency (ITIA) and CAS 2023/A/10227 International Tennis Integrity Agency (ITIA) v. Simona Halep: The appeal procedures before the CAS concerned two separate charges: 1. a charge which arose from a prohibited substance (Roxadustat) being detected in a urine sample collected from Simona Halep on 29 August 2022 during the US Open; and 2. a charge that Ms Halep’s Athlete Biological Passport (ABP), in particular a blood sample given by Ms Halep on 22 September 2022, established use of a prohibited substance and/or prohibited method. In its decision dated 22 September 2023, the International Tennis Federation (ITF) Independent Tribunal found Ms Halep guilty of both Anti-doping Rule Violations (ADRV) and imposed a four-year period of ineligibility on her. In the appeal filed by Simona Halep at the CAS against the first instance Decision, Ms Halep requested that the sanction be reduced and be no longer than the period of the provisional suspension already served. In its separate appeal, the ITIA requested that the CAS sanction Ms Halep’s ADRVs together as one single violation based on the violation that carried the most severe sanction, and the imposition of a period of ineligibility of between four and six years. The CAS appeal arbitration proceedings involved intensive pre-hearing processes and a three-day hearing which took place on 7-9 February 2024 in Lausanne, Switzerland. The CAS Panel heard from many lay and expert witnesses, most of whom were present in person at the hearing. The CAS Panel has unanimously determined that the four-year period of ineligibility imposed by the ITF Independent Tribunal is to be reduced to a period of ineligibility of nine (9) months starting on 7 October 2022, which period expired on 6 July 2023. As that period expired before the appeal procedures were even lodged with the CAS, the CAS Panel has determined it appropriate to issue the operative part of the Arbitral Award as soon as practicable, together with a comprehensive media release. The CAS Panel has also ordered the disqualification of all competitive results achieved by Ms. Halep from 29 August 2022 (the date of her positive sample) to 7 October 2022, including forfeiture of any medals, titles, ranking points and prize money. Therefore, the appeal filed by the ITIA is dismissed and the appeal filed by Simona Halep is partially upheld (her request to backdate the start of the suspension on 29 August 2022 is dismissed). Roxadustat charge According to Articles 2.1 and 2.2 of the Tennis Anti-Doping Programme (“TADP”), it is each player’s personal duty to ensure that no prohibited substance enters their body and players are responsible for any prohibited substances found to be present in their samples. In this matter, a prohibited substance (i.e. Roxadustat) was found to be present in a sample collected from Ms. Halep on 29 August 2022 during the US Open. Ms. Halep did not contest liability in that she accepted that, by reasons of the presence of Roxadustat in her sample, she had committed anti-doping rule violations under Articles 2.1 and 2.2 of the TADP. However, she objected to the intentional nature of the infraction and argued that the positive test was the result of contamination. Having carefully considered all the evidence put before it, the CAS Panel determined that Ms. Halep had established, on the balance of probabilities, that the Roxadustat entered her body through the consumption of a contaminated supplement which she had used in the days shortly before 29 August 2022 and that the Roxadustat, as detected in her sample, came from that contaminated product. As a result, the CAS Panel determined that Ms. Halep had also established, on the balance of probabilities, that her anti-doping rule violations were not intentional. Although the CAS Panel found that Ms. Halep did bear some level of fault or negligence for her violations, as she did not exercise sufficient care when using the Keto MCT supplement, it concluded that she bore no significant fault or negligence. Athlete Biological Passport (ABP) charge With respect to the charge concerning Ms. Halep’s ABP, the ITIA bore the onus of establishing (to the standard of comfortable satisfaction) that Ms. Halep had used a prohibited substance and/or prohibited method. It primarily relied on a blood sample given by Ms. Halep on 22 September 2022, the results of which it alleged demonstrated the anti-doping rule violation under Article 2.2 of the TADP. Contrary to the reasoning of the first instance tribunal, the CAS Panel determined that it was appropriate in the circumstances to consider the results of a private blood sample given by Ms. Halep on 9 September 2022 in the context of a surgery which occurred shortly thereafter. Those results, and Ms. Halep’s public statements that she did not intend to compete for the remainder of the 2022 calendar year, impacted the plausibility of the doping scenarios relied upon by the ITF Independent Tribunal. Having regard to the evidence as a whole, the CAS Panel was not comfortably satisfied that an anti-doping rule violation under Article 2.2. of the TADP had occurred. It therefore dismissed that charge. The CAS Panel has issued the following decision: 1. The appeal filed by Simona Halep on 28 September 2023 against the decision issued on 22 September 2023 by the ITF Independent Tribunal is admissible and is partially upheld. 2. The appeal filed by the International Tennis Integrity Agency (ITIA) on 14 December 2023 against the decision issued on 22 September 2023 by the ITF Independent Tribunal is admissible and is dismissed. 3. The decision issued on 22 September 2023 by the ITF Independent Tribunal is set aside. 4. Simona Halep is found to have committed Anti-Doping Rule Violations under Articles 2.1 (presence) and 2.2 (use) of the Tennis Anti-Doping Programme 2022 as a result of the presence of a Prohibited Substance (Roxadustat) in her urine sample collected In-Competition on 29 August 2022. 5. Simona Halep is sanctioned with a period of Ineligibility of nine (9) months, commencing on 7 October 2022. 6. Credit is given to Simona Halep for her provisional suspension served since 7 October 2022. 7. All results obtained by Simona Halep in competitions taking place in the period 29 August 2022 to 7 October 2022 are disqualified, with all resulting consequences, including forfeiture of any medals, titles, ranking points and prize money. 8. The award is pronounced without costs, except for the Court Office fees of CHF 1,000 (one thousand Swiss francs) paid by each of Simona Halep in respect of her appeal and the International Tennis Integrity Agency (ITIA) in respect of its appeal, which is retained by the CAS. 9. The International Tennis Integrity Agency (ITIA) is ordered to pay Simona Halep an amount of CHF 20,000 (twenty thousand Swiss francs) as a contribution towards her legal fees and other expenses incurred in connection with these arbitration proceedings. The reasoned award will be notified to the parties in due course. It will be published by CAS unless the parties request confidentiality. Please list the dates and their significance. Use only the information provided to answer. Do not use outside sources or internal knowledge. Use bullet point format in chronological order.","Use only the information provided to answer. Do not use outside sources or internal knowledge. Use bullet point format in chronological order.
+
+EVIDENCE:
+The Court of Arbitration for Sport (CAS) has issued the operative part of its decision in the appeal arbitration procedures CAS 2023/A/10025 Simona Halep v. International Tennis Integrity Agency (ITIA) and CAS 2023/A/10227 International Tennis Integrity Agency (ITIA) v. Simona Halep: The appeal procedures before the CAS concerned two separate charges: 1. a charge which arose from a prohibited substance (Roxadustat) being detected in a urine sample collected from Simona Halep on 29 August 2022 during the US Open; and 2. a charge that Ms Halep’s Athlete Biological Passport (ABP), in particular a blood sample given by Ms Halep on 22 September 2022, established use of a prohibited substance and/or prohibited method. In its decision dated 22 September 2023, the International Tennis Federation (ITF) Independent Tribunal found Ms Halep guilty of both Anti-doping Rule Violations (ADRV) and imposed a four-year period of ineligibility on her. In the appeal filed by Simona Halep at the CAS against the first instance Decision, Ms Halep requested that the sanction be reduced and be no longer than the period of the provisional suspension already served. In its separate appeal, the ITIA requested that the CAS sanction Ms Halep’s ADRVs together as one single violation based on the violation that carried the most severe sanction, and the imposition of a period of ineligibility of between four and six years. The CAS appeal arbitration proceedings involved intensive pre-hearing processes and a three-day hearing which took place on 7-9 February 2024 in Lausanne, Switzerland. The CAS Panel heard from many lay and expert witnesses, most of whom were present in person at the hearing. The CAS Panel has unanimously determined that the four-year period of ineligibility imposed by the ITF Independent Tribunal is to be reduced to a period of ineligibility of nine (9) months starting on 7 October 2022, which period expired on 6 July 2023. As that period expired before the appeal procedures were even lodged with the CAS, the CAS Panel has determined it appropriate to issue the operative part of the Arbitral Award as soon as practicable, together with a comprehensive media release. The CAS Panel has also ordered the disqualification of all competitive results achieved by Ms. Halep from 29 August 2022 (the date of her positive sample) to 7 October 2022, including forfeiture of any medals, titles, ranking points and prize money. Therefore, the appeal filed by the ITIA is dismissed and the appeal filed by Simona Halep is partially upheld (her request to backdate the start of the suspension on 29 August 2022 is dismissed). Roxadustat charge According to Articles 2.1 and 2.2 of the Tennis Anti-Doping Programme (“TADP”), it is each player’s personal duty to ensure that no prohibited substance enters their body and players are responsible for any prohibited substances found to be present in their samples. In this matter, a prohibited substance (i.e. Roxadustat) was found to be present in a sample collected from Ms. Halep on 29 August 2022 during the US Open. Ms. Halep did not contest liability in that she accepted that, by reasons of the presence of Roxadustat in her sample, she had committed anti-doping rule violations under Articles 2.1 and 2.2 of the TADP. However, she objected to the intentional nature of the infraction and argued that the positive test was the result of contamination. Having carefully considered all the evidence put before it, the CAS Panel determined that Ms. Halep had established, on the balance of probabilities, that the Roxadustat entered her body through the consumption of a contaminated supplement which she had used in the days shortly before 29 August 2022 and that the Roxadustat, as detected in her sample, came from that contaminated product. As a result, the CAS Panel determined that Ms. Halep had also established, on the balance of probabilities, that her anti-doping rule violations were not intentional. Although the CAS Panel found that Ms. Halep did bear some level of fault or negligence for her violations, as she did not exercise sufficient care when using the Keto MCT supplement, it concluded that she bore no significant fault or negligence. Athlete Biological Passport (ABP) charge With respect to the charge concerning Ms. Halep’s ABP, the ITIA bore the onus of establishing (to the standard of comfortable satisfaction) that Ms. Halep had used a prohibited substance and/or prohibited method. It primarily relied on a blood sample given by Ms. Halep on 22 September 2022, the results of which it alleged demonstrated the anti-doping rule violation under Article 2.2 of the TADP. Contrary to the reasoning of the first instance tribunal, the CAS Panel determined that it was appropriate in the circumstances to consider the results of a private blood sample given by Ms. Halep on 9 September 2022 in the context of a surgery which occurred shortly thereafter. Those results, and Ms. Halep’s public statements that she did not intend to compete for the remainder of the 2022 calendar year, impacted the plausibility of the doping scenarios relied upon by the ITF Independent Tribunal. Having regard to the evidence as a whole, the CAS Panel was not comfortably satisfied that an anti-doping rule violation under Article 2.2. of the TADP had occurred. It therefore dismissed that charge. The CAS Panel has issued the following decision: 1. The appeal filed by Simona Halep on 28 September 2023 against the decision issued on 22 September 2023 by the ITF Independent Tribunal is admissible and is partially upheld. 2. The appeal filed by the International Tennis Integrity Agency (ITIA) on 14 December 2023 against the decision issued on 22 September 2023 by the ITF Independent Tribunal is admissible and is dismissed. 3. The decision issued on 22 September 2023 by the ITF Independent Tribunal is set aside. 4. Simona Halep is found to have committed Anti-Doping Rule Violations under Articles 2.1 (presence) and 2.2 (use) of the Tennis Anti-Doping Programme 2022 as a result of the presence of a Prohibited Substance (Roxadustat) in her urine sample collected In-Competition on 29 August 2022. 5. Simona Halep is sanctioned with a period of Ineligibility of nine (9) months, commencing on 7 October 2022. 6. Credit is given to Simona Halep for her provisional suspension served since 7 October 2022. 7. All results obtained by Simona Halep in competitions taking place in the period 29 August 2022 to 7 October 2022 are disqualified, with all resulting consequences, including forfeiture of any medals, titles, ranking points and prize money. 8. The award is pronounced without costs, except for the Court Office fees of CHF 1,000 (one thousand Swiss francs) paid by each of Simona Halep in respect of her appeal and the International Tennis Integrity Agency (ITIA) in respect of its appeal, which is retained by the CAS. 9. The International Tennis Integrity Agency (ITIA) is ordered to pay Simona Halep an amount of CHF 20,000 (twenty thousand Swiss francs) as a contribution towards her legal fees and other expenses incurred in connection with these arbitration proceedings. The reasoned award will be notified to the parties in due course. It will be published by CAS unless the parties request confidentiality.
+
+USER:
+Please list the dates and their significance.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,22,7,1185,,206
+You are given a reference document. You must only use information found in the reference document to answer the question asked.,What is the case for it not being a smart financial decision to participate in Cyber Monday based on the given information?,"Is It A Smart Financial Decision To Participate In Cyber Monday? True Tamplin Contributor Cyber Monday is around the corner, promising big online discounts and deals. With its attractive offers and hidden risks, it’s important to understand how Cyber Monday affects your shopping habits and financial health before deciding whether to take part in this major online event. Benefits Of Cyber Monday Potential Savings And Discounts Retailers compete to attract customers during Cyber Monday, resulting in some of the lowest prices of the year on a wide range of products. These discounts aren’t limited to overstock or outdated items; often, they include the latest electronics, fashion, and more. The key here is the scale and breadth of these discounts, which can apply to both luxury and everyday items, making it a prime opportunity for you to make significant savings on high-ticket items or stock up on essentials. Convenience And Ease Of Shopping In today’s fast-paced world, the ability to shop from anywhere is a significant advantage. This ease of access not only saves time but also reduces the physical and mental stress associated with holiday shopping. Cyber Monday also simplifies comparing prices across different websites, reading reviews, and making informed choices without the pressure of in-store sales tactics. Additionally, the online platform allows for a more personalized shopping experience, with algorithms suggesting products that align with your interests and past shopping behavior. Cyber Monday is known for exclusive deals that are not available at other times of the year. These can include not only price reductions but also bundle deals, where additional products are included at a lower combined cost. These deals can be particularly appealing for acquiring high-demand items like electronics, designer brands, or new releases, which are rarely discounted at other times. Finding Unique Or Hard-To-Find Items Unlike physical stores, which have limited shelf space and tend to stock only the most popular items, online retailers can offer a more diverse range of products. During Cyber Monday, with its expanded focus on sales, even niche retailers and small businesses participate, offering unique or handcrafted items that aren’t available in mainstream stores. This aspect of Cyber Monday can be particularly appealing to those looking for specialty items, collector’s items, or bespoke products. Drawbacks Of Cyber Monday Risk Of Overspending The lure of great deals can sometimes lead to impulsive buying decisions. Consumers often buy items they don’t need, swayed by the perceived value of the discounts. This risk is heightened during Cyber Monday due to the aggressive marketing tactics employed by retailers, leveraging the scarcity and time-limited nature of deals. The psychological impact of seeing a countdown timer or a limited stock alert can override rational decision-making, leading to purchases that might not align with your needs or financial capacity. This can result in financial strain, buyer’s remorse, and unnecessary items, negating the very benefits you sought to gain from the sale. Scams And Fraudulent Websites The high volume of online traffic make Cyber Monday a ripe target for scammers. These fraudulent activities can range from creating entirely fake shopping sites that mimic legitimate ones, to more subtle scams, such as selling counterfeit or substandard products. The risk extends to cybersecurity threats, such as phishing attempts designed to steal personal and financial information. You might end up losing money, compromise your data, or receive inferior products, turning what should have been a savvy shopping experience into a costly mistake. Potential Delays Due to the sheer volume of transactions, the risk of delays in shipping and the possibility of popular items being back-ordered are significant. This can be particularly frustrating when purchasing gifts for the holidays, as items may not arrive in time. The frustration is compounded when customer service lines are overwhelmed, leaving you with little recourse but to wait. If you require immediate product availability, relying on Cyber Monday purchases can be a gamble. Technological Issues Websites crashing or slowing down during high-traffic periods can be a major deterrent, with pages taking too long to load or transactions failing to process. In the worst-case scenario, you might lose out on a deal due to a website crash just as you were about to complete a purchase. This can also raise security concerns, as interrupted transactions might expose your financial details or lead to double-charging. Factors To Consider In Decision-Making Financial Situation And Budget Before diving into Cyber Monday deals, assess your finances. It’s essential to set a budget and stick to it, ensuring that any purchases made are within your means and don’t lead to financial strain. It involves scrutinizing your financial health and setting a budget specifically for Cyber Monday shopping. A well-planned budget should account for not only the cost of the items but also any additional expenses, such as shipping or potential return fees. Shopping Needs And Preferences Are the items you’re interested in likely to be on sale? Does the convenience of online shopping appeal to you? For instance, if you are in the market for high-tech gadgets or specific fashion brands, Cyber Monday might offer the best deals. However, for items that don’t typically see significant discounts, it might not be as beneficial. This assessment also includes considering your shopping habits – whether you enjoy the thrill of finding deals in a time-sensitive environment or prefer a more relaxed, thoughtful shopping experience. Research And Price Comparison Price comparison is crucial, as some deals advertised for Cyber Monday might not be as exclusive or advantageous as they seem. Retailers often inflate original prices to make discounts appear more significant. Additionally, the same product might be available at a lower price at a different time or from a different retailer. Thorough research ensures that the decision to buy is based on the best available information, leading to more satisfactory and value-for-money purchases. Alternative Shopping Occasions Consider other sales events throughout the year, such as Black Friday, post-holiday sales, or even random flash sales. Each of these occasions has its own set of advantages. For example, Black Friday might offer better deals for in-store shopping, while post-holiday sales could be ideal for non-seasonal items. By comparing Cyber Monday with these alternatives, you can determine the best time to purchase the items you need, potentially finding better deals or a shopping experience more suited to your preferences. Final Thoughts Whether or not to participate in Cyber Monday depends on your individual circumstances. If you’re a savvy shopper who knows what you want, can stick to a budget, and are comfortable navigating online platforms, Cyber Monday can be a fruitful shopping experience. If not, there are always other times to shop. Keep an eye out for deals throughout the year, and remember that patience can often lead to better savings without the rush and pressure of a single day event. Happy shopping! Or not. Follow me on Twitter or LinkedIn. Check out my website or some of my other work here.","You are given a reference document. You must only use information found in the reference document to answer the question asked. What is the case for it not being a smart financial decision to participate in Cyber Monday based on the given information? Is It A Smart Financial Decision To Participate In Cyber Monday? True Tamplin Contributor Cyber Monday is around the corner, promising big online discounts and deals. With its attractive offers and hidden risks, it’s important to understand how Cyber Monday affects your shopping habits and financial health before deciding whether to take part in this major online event. Benefits Of Cyber Monday Potential Savings And Discounts Retailers compete to attract customers during Cyber Monday, resulting in some of the lowest prices of the year on a wide range of products. These discounts aren’t limited to overstock or outdated items; often, they include the latest electronics, fashion, and more. The key here is the scale and breadth of these discounts, which can apply to both luxury and everyday items, making it a prime opportunity for you to make significant savings on high-ticket items or stock up on essentials. Convenience And Ease Of Shopping In today’s fast-paced world, the ability to shop from anywhere is a significant advantage. This ease of access not only saves time but also reduces the physical and mental stress associated with holiday shopping. Cyber Monday also simplifies comparing prices across different websites, reading reviews, and making informed choices without the pressure of in-store sales tactics. Additionally, the online platform allows for a more personalized shopping experience, with algorithms suggesting products that align with your interests and past shopping behavior. Cyber Monday is known for exclusive deals that are not available at other times of the year. These can include not only price reductions but also bundle deals, where additional products are included at a lower combined cost. These deals can be particularly appealing for acquiring high-demand items like electronics, designer brands, or new releases, which are rarely discounted at other times. Finding Unique Or Hard-To-Find Items Unlike physical stores, which have limited shelf space and tend to stock only the most popular items, online retailers can offer a more diverse range of products. During Cyber Monday, with its expanded focus on sales, even niche retailers and small businesses participate, offering unique or handcrafted items that aren’t available in mainstream stores. This aspect of Cyber Monday can be particularly appealing to those looking for specialty items, collector’s items, or bespoke products. Drawbacks Of Cyber Monday Risk Of Overspending The lure of great deals can sometimes lead to impulsive buying decisions. Consumers often buy items they don’t need, swayed by the perceived value of the discounts. This risk is heightened during Cyber Monday due to the aggressive marketing tactics employed by retailers, leveraging the scarcity and time-limited nature of deals. The psychological impact of seeing a countdown timer or a limited stock alert can override rational decision-making, leading to purchases that might not align with your needs or financial capacity. This can result in financial strain, buyer’s remorse, and unnecessary items, negating the very benefits you sought to gain from the sale. Scams And Fraudulent Websites The high volume of online traffic make Cyber Monday a ripe target for scammers. These fraudulent activities can range from creating entirely fake shopping sites that mimic legitimate ones, to more subtle scams, such as selling counterfeit or substandard products. The risk extends to cybersecurity threats, such as phishing attempts designed to steal personal and financial information. You might end up losing money, compromise your data, or receive inferior products, turning what should have been a savvy shopping experience into a costly mistake. Potential Delays Due to the sheer volume of transactions, the risk of delays in shipping and the possibility of popular items being back-ordered are significant. This can be particularly frustrating when purchasing gifts for the holidays, as items may not arrive in time. The frustration is compounded when customer service lines are overwhelmed, leaving you with little recourse but to wait. If you require immediate product availability, relying on Cyber Monday purchases can be a gamble. Technological Issues Websites crashing or slowing down during high-traffic periods can be a major deterrent, with pages taking too long to load or transactions failing to process. In the worst-case scenario, you might lose out on a deal due to a website crash just as you were about to complete a purchase. This can also raise security concerns, as interrupted transactions might expose your financial details or lead to double-charging. Factors To Consider In Decision-Making Financial Situation And Budget Before diving into Cyber Monday deals, assess your finances. It’s essential to set a budget and stick to it, ensuring that any purchases made are within your means and don’t lead to financial strain. It involves scrutinizing your financial health and setting a budget specifically for Cyber Monday shopping. A well-planned budget should account for not only the cost of the items but also any additional expenses, such as shipping or potential return fees. Shopping Needs And Preferences Are the items you’re interested in likely to be on sale? Does the convenience of online shopping appeal to you? For instance, if you are in the market for high-tech gadgets or specific fashion brands, Cyber Monday might offer the best deals. However, for items that don’t typically see significant discounts, it might not be as beneficial. This assessment also includes considering your shopping habits – whether you enjoy the thrill of finding deals in a time-sensitive environment or prefer a more relaxed, thoughtful shopping experience. Research And Price Comparison Price comparison is crucial, as some deals advertised for Cyber Monday might not be as exclusive or advantageous as they seem. Retailers often inflate original prices to make discounts appear more significant. Additionally, the same product might be available at a lower price at a different time or from a different retailer. Thorough research ensures that the decision to buy is based on the best available information, leading to more satisfactory and value-for-money purchases. Alternative Shopping Occasions Consider other sales events throughout the year, such as Black Friday, post-holiday sales, or even random flash sales. Each of these occasions has its own set of advantages. For example, Black Friday might offer better deals for in-store shopping, while post-holiday sales could be ideal for non-seasonal items. By comparing Cyber Monday with these alternatives, you can determine the best time to purchase the items you need, potentially finding better deals or a shopping experience more suited to your preferences. Final Thoughts Whether or not to participate in Cyber Monday depends on your individual circumstances. If you’re a savvy shopper who knows what you want, can stick to a budget, and are comfortable navigating online platforms, Cyber Monday can be a fruitful shopping experience. If not, there are always other times to shop. Keep an eye out for deals throughout the year, and remember that patience can often lead to better savings without the rush and pressure of a single day event. Happy shopping! Or not. Follow me on Twitter or LinkedIn. Check out my website or some of my other work here.","You are given a reference document. You must only use information found in the reference document to answer the question asked.
+
+EVIDENCE:
+Is It A Smart Financial Decision To Participate In Cyber Monday? True Tamplin Contributor Cyber Monday is around the corner, promising big online discounts and deals. With its attractive offers and hidden risks, it’s important to understand how Cyber Monday affects your shopping habits and financial health before deciding whether to take part in this major online event. Benefits Of Cyber Monday Potential Savings And Discounts Retailers compete to attract customers during Cyber Monday, resulting in some of the lowest prices of the year on a wide range of products. These discounts aren’t limited to overstock or outdated items; often, they include the latest electronics, fashion, and more. The key here is the scale and breadth of these discounts, which can apply to both luxury and everyday items, making it a prime opportunity for you to make significant savings on high-ticket items or stock up on essentials. Convenience And Ease Of Shopping In today’s fast-paced world, the ability to shop from anywhere is a significant advantage. This ease of access not only saves time but also reduces the physical and mental stress associated with holiday shopping. Cyber Monday also simplifies comparing prices across different websites, reading reviews, and making informed choices without the pressure of in-store sales tactics. Additionally, the online platform allows for a more personalized shopping experience, with algorithms suggesting products that align with your interests and past shopping behavior. Cyber Monday is known for exclusive deals that are not available at other times of the year. These can include not only price reductions but also bundle deals, where additional products are included at a lower combined cost. These deals can be particularly appealing for acquiring high-demand items like electronics, designer brands, or new releases, which are rarely discounted at other times. Finding Unique Or Hard-To-Find Items Unlike physical stores, which have limited shelf space and tend to stock only the most popular items, online retailers can offer a more diverse range of products. During Cyber Monday, with its expanded focus on sales, even niche retailers and small businesses participate, offering unique or handcrafted items that aren’t available in mainstream stores. This aspect of Cyber Monday can be particularly appealing to those looking for specialty items, collector’s items, or bespoke products. Drawbacks Of Cyber Monday Risk Of Overspending The lure of great deals can sometimes lead to impulsive buying decisions. Consumers often buy items they don’t need, swayed by the perceived value of the discounts. This risk is heightened during Cyber Monday due to the aggressive marketing tactics employed by retailers, leveraging the scarcity and time-limited nature of deals. The psychological impact of seeing a countdown timer or a limited stock alert can override rational decision-making, leading to purchases that might not align with your needs or financial capacity. This can result in financial strain, buyer’s remorse, and unnecessary items, negating the very benefits you sought to gain from the sale. Scams And Fraudulent Websites The high volume of online traffic make Cyber Monday a ripe target for scammers. These fraudulent activities can range from creating entirely fake shopping sites that mimic legitimate ones, to more subtle scams, such as selling counterfeit or substandard products. The risk extends to cybersecurity threats, such as phishing attempts designed to steal personal and financial information. You might end up losing money, compromise your data, or receive inferior products, turning what should have been a savvy shopping experience into a costly mistake. Potential Delays Due to the sheer volume of transactions, the risk of delays in shipping and the possibility of popular items being back-ordered are significant. This can be particularly frustrating when purchasing gifts for the holidays, as items may not arrive in time. The frustration is compounded when customer service lines are overwhelmed, leaving you with little recourse but to wait. If you require immediate product availability, relying on Cyber Monday purchases can be a gamble. Technological Issues Websites crashing or slowing down during high-traffic periods can be a major deterrent, with pages taking too long to load or transactions failing to process. In the worst-case scenario, you might lose out on a deal due to a website crash just as you were about to complete a purchase. This can also raise security concerns, as interrupted transactions might expose your financial details or lead to double-charging. Factors To Consider In Decision-Making Financial Situation And Budget Before diving into Cyber Monday deals, assess your finances. It’s essential to set a budget and stick to it, ensuring that any purchases made are within your means and don’t lead to financial strain. It involves scrutinizing your financial health and setting a budget specifically for Cyber Monday shopping. A well-planned budget should account for not only the cost of the items but also any additional expenses, such as shipping or potential return fees. Shopping Needs And Preferences Are the items you’re interested in likely to be on sale? Does the convenience of online shopping appeal to you? For instance, if you are in the market for high-tech gadgets or specific fashion brands, Cyber Monday might offer the best deals. However, for items that don’t typically see significant discounts, it might not be as beneficial. This assessment also includes considering your shopping habits – whether you enjoy the thrill of finding deals in a time-sensitive environment or prefer a more relaxed, thoughtful shopping experience. Research And Price Comparison Price comparison is crucial, as some deals advertised for Cyber Monday might not be as exclusive or advantageous as they seem. Retailers often inflate original prices to make discounts appear more significant. Additionally, the same product might be available at a lower price at a different time or from a different retailer. Thorough research ensures that the decision to buy is based on the best available information, leading to more satisfactory and value-for-money purchases. Alternative Shopping Occasions Consider other sales events throughout the year, such as Black Friday, post-holiday sales, or even random flash sales. Each of these occasions has its own set of advantages. For example, Black Friday might offer better deals for in-store shopping, while post-holiday sales could be ideal for non-seasonal items. By comparing Cyber Monday with these alternatives, you can determine the best time to purchase the items you need, potentially finding better deals or a shopping experience more suited to your preferences. Final Thoughts Whether or not to participate in Cyber Monday depends on your individual circumstances. If you’re a savvy shopper who knows what you want, can stick to a budget, and are comfortable navigating online platforms, Cyber Monday can be a fruitful shopping experience. If not, there are always other times to shop. Keep an eye out for deals throughout the year, and remember that patience can often lead to better savings without the rush and pressure of a single day event. Happy shopping! Or not. Follow me on Twitter or LinkedIn. Check out my website or some of my other work here.
+
+USER:
+What is the case for it not being a smart financial decision to participate in Cyber Monday based on the given information?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,21,22,1153,,83
+system instruction: [This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. Present your answer in headed sections with an explanation for each section. Each explanation should be in bullet points with exactly three bullet points.],question: [which famous economists are mentioned?],"Free market economies: o Also known as laissez-faire economies, where governments leave markets to their own devices, so the market forces of supply and demand allocate scarce resources. o Economic decisions are taken by private individuals and firms, and private individuals own everything. There is no government intervention. o In reality, governments usually intervene by implementing laws and public services, such as property rights and national defence. o Adam Smith and Friedrich Hayek were famous free market economists. Adam Smith’s famous theory of the invisible hand of the market can be applied to free market economies and the price mechanism, which describes how prices are determined by the ‘spending votes’ of consumers and businesses. Smith recognised some of the issues with monopoly power that could arise from a free market, however. Hayek argued that government intervention makes the market worse. For example, shortly after the 1930s crash, he argued that the Fed caused the crash by keeping interest rates low, and encouraging investments which were not economically worthwhile: ‘malinvestments’. o What to produce: determined by what the consumer prefers o How to produce it: producers seek profits o For whom to produce it: whoever has the greatest purchasing power in the economy, and is therefore able to buy the good o Advantages: o Firms are likely to be efficient because they have to provide goods and services demanded by consumers. They are also likely to lower their average costs and make better use of scarce resources. Therefore, overall output of the economy increases. o The bureaucracy from government intervention is avoided. o Some economists might argue the freedom gained from having a free economy leads to more personal freedom. o Disadvantages: o The free market ignores inequality, and tends to benefit those who hold most of the wealth. There are no social security payments for those on low incomes. www.pmt.education o There could be monopolies, which could exploit the market by charging higher prices. o There could be the overconsumption of demerit goods, which have large negative externalities, such as tobacco. o Public goods are not provided in a free market, such as national defence. Merit goods, such as education, are underprovided. Command economy: o This is where the government allocates all of the scarce resources in an economy to where they think there is a greater need. It is also referred to as central planning. o Karl Marx saw the free market as unstable. He saw profits created in the free market as coming from the exploitation of labour, and by not paying workers to cover the value of their work. He argued for the “common ownership of the means of production”. o What to produce: determined by what the government prefers o How to produce it: governments and their employees o For whom to produce it: who the government prefers o Advantages: o It might be easier to coordinate resources in times of crises, such as wars. o The government can compensate for market failure, by reallocating resources. They might ensure everyone can access basic necessities. o Inequality in society could be reduced, and society might maximise welfare rather than profit. o The abuse of monopoly power could be prevented. o Disadvantages: o Governments fail, as do markets, and they may not be fully informed for what to produce. o They may not necessarily meet consumer preferences. o It limits democracy and personal freedom. Mixed economy: o This has features of both command and free economies and is the most common economic system today. There are different balances between command and free economies in reality, though. The UK is generally www.pmt.education considered quite central, whilst the US is slightly more free (although the government spends around 35% of GDP) and Cuba is more centrally planned. o The market is controlled by both the government and the forces of supply and demand. o Governments often provide public goods such as street lights, roads and the police, and merit goods, such as healthcare and education. o What to produce: determined by both consumer and government preferences o How to produce it: determined by producers making profits and the government o For whom to produce it: both who the government prefers and the purchasing power of private individuals.","system instruction: [This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. Present your answer in headed sections with an explanation for each section. Each explanation should be in bullet points with exactly three bullet points.] question: [which famous economists are mentioned?] context block: [Free market economies: o Also known as laissez-faire economies, where governments leave markets to their own devices, so the market forces of supply and demand allocate scarce resources. o Economic decisions are taken by private individuals and firms, and private individuals own everything. There is no government intervention. o In reality, governments usually intervene by implementing laws and public services, such as property rights and national defence. o Adam Smith and Friedrich Hayek were famous free market economists. Adam Smith’s famous theory of the invisible hand of the market can be applied to free market economies and the price mechanism, which describes how prices are determined by the ‘spending votes’ of consumers and businesses. Smith recognised some of the issues with monopoly power that could arise from a free market, however. Hayek argued that government intervention makes the market worse. For example, shortly after the 1930s crash, he argued that the Fed caused the crash by keeping interest rates low, and encouraging investments which were not economically worthwhile: ‘malinvestments’. o What to produce: determined by what the consumer prefers o How to produce it: producers seek profits o For whom to produce it: whoever has the greatest purchasing power in the economy, and is therefore able to buy the good o Advantages: o Firms are likely to be efficient because they have to provide goods and services demanded by consumers. They are also likely to lower their average costs and make better use of scarce resources. Therefore, overall output of the economy increases. o The bureaucracy from government intervention is avoided. o Some economists might argue the freedom gained from having a free economy leads to more personal freedom. o Disadvantages: o The free market ignores inequality, and tends to benefit those who hold most of the wealth. There are no social security payments for those on low incomes. www.pmt.education o There could be monopolies, which could exploit the market by charging higher prices. o There could be the overconsumption of demerit goods, which have large negative externalities, such as tobacco. o Public goods are not provided in a free market, such as national defence. Merit goods, such as education, are underprovided. Command economy: o This is where the government allocates all of the scarce resources in an economy to where they think there is a greater need. It is also referred to as central planning. o Karl Marx saw the free market as unstable. He saw profits created in the free market as coming from the exploitation of labour, and by not paying workers to cover the value of their work. He argued for the “common ownership of the means of production”. o What to produce: determined by what the government prefers o How to produce it: governments and their employees o For whom to produce it: who the government prefers o Advantages: o It might be easier to coordinate resources in times of crises, such as wars. o The government can compensate for market failure, by reallocating resources. They might ensure everyone can access basic necessities. o Inequality in society could be reduced, and society might maximise welfare rather than profit. o The abuse of monopoly power could be prevented. o Disadvantages: o Governments fail, as do markets, and they may not be fully informed for what to produce. o They may not necessarily meet consumer preferences. o It limits democracy and personal freedom. Mixed economy: o This has features of both command and free economies and is the most common economic system today. There are different balances between command and free economies in reality, though. The UK is generally www.pmt.education considered quite central, whilst the US is slightly more free (although the government spends around 35% of GDP) and Cuba is more centrally planned. o The market is controlled by both the government and the forces of supply and demand. o Governments often provide public goods such as street lights, roads and the police, and merit goods, such as healthcare and education. o What to produce: determined by both consumer and government preferences o How to produce it: determined by producers making profits and the government o For whom to produce it: both who the government prefers and the purchasing power of private individuals.]","system instruction: [This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. Present your answer in headed sections with an explanation for each section. Each explanation should be in bullet points with exactly three bullet points.]
+
+EVIDENCE:
+Free market economies: o Also known as laissez-faire economies, where governments leave markets to their own devices, so the market forces of supply and demand allocate scarce resources. o Economic decisions are taken by private individuals and firms, and private individuals own everything. There is no government intervention. o In reality, governments usually intervene by implementing laws and public services, such as property rights and national defence. o Adam Smith and Friedrich Hayek were famous free market economists. Adam Smith’s famous theory of the invisible hand of the market can be applied to free market economies and the price mechanism, which describes how prices are determined by the ‘spending votes’ of consumers and businesses. Smith recognised some of the issues with monopoly power that could arise from a free market, however. Hayek argued that government intervention makes the market worse. For example, shortly after the 1930s crash, he argued that the Fed caused the crash by keeping interest rates low, and encouraging investments which were not economically worthwhile: ‘malinvestments’. o What to produce: determined by what the consumer prefers o How to produce it: producers seek profits o For whom to produce it: whoever has the greatest purchasing power in the economy, and is therefore able to buy the good o Advantages: o Firms are likely to be efficient because they have to provide goods and services demanded by consumers. They are also likely to lower their average costs and make better use of scarce resources. Therefore, overall output of the economy increases. o The bureaucracy from government intervention is avoided. o Some economists might argue the freedom gained from having a free economy leads to more personal freedom. o Disadvantages: o The free market ignores inequality, and tends to benefit those who hold most of the wealth. There are no social security payments for those on low incomes. www.pmt.education o There could be monopolies, which could exploit the market by charging higher prices. o There could be the overconsumption of demerit goods, which have large negative externalities, such as tobacco. o Public goods are not provided in a free market, such as national defence. Merit goods, such as education, are underprovided. Command economy: o This is where the government allocates all of the scarce resources in an economy to where they think there is a greater need. It is also referred to as central planning. o Karl Marx saw the free market as unstable. He saw profits created in the free market as coming from the exploitation of labour, and by not paying workers to cover the value of their work. He argued for the “common ownership of the means of production”. o What to produce: determined by what the government prefers o How to produce it: governments and their employees o For whom to produce it: who the government prefers o Advantages: o It might be easier to coordinate resources in times of crises, such as wars. o The government can compensate for market failure, by reallocating resources. They might ensure everyone can access basic necessities. o Inequality in society could be reduced, and society might maximise welfare rather than profit. o The abuse of monopoly power could be prevented. o Disadvantages: o Governments fail, as do markets, and they may not be fully informed for what to produce. o They may not necessarily meet consumer preferences. o It limits democracy and personal freedom. Mixed economy: o This has features of both command and free economies and is the most common economic system today. There are different balances between command and free economies in reality, though. The UK is generally www.pmt.education considered quite central, whilst the US is slightly more free (although the government spends around 35% of GDP) and Cuba is more centrally planned. o The market is controlled by both the government and the forces of supply and demand. o Governments often provide public goods such as street lights, roads and the police, and merit goods, such as healthcare and education. o What to produce: determined by both consumer and government preferences o How to produce it: determined by producers making profits and the government o For whom to produce it: both who the government prefers and the purchasing power of private individuals.
+
+USER:
+question: [which famous economists are mentioned?]
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,54,6,707,,774
+Only use information in the text here when responding.,treatments for types of arthritis?,"Types of Arthritis • Peripheral Arthritis. Peripheral arthritis usually affects the large joints of the arms and legs, including the elbows, wrists, knees, and ankles. The discomfort may be “migratory,” moving from one joint to another. If left untreated, the pain may last from a few days to several weeks. Peripheral arthritis tends to be more common among people who have ulcerative colitis or Crohn’s disease of the colon. The level of inflammation in the joints generally mirrors the extent of inflammation in the colon. Although no specific test can make an absolute diagnosis, various diagnostic methods—including analysis of joint fluid, blood tests, and X-rays—are used to rule out other causes of joint pain. Fortunately, IBD-related peripheral arthritis usually does not cause any lasting damage and treatment of the underlying IBD typically results in improvement in the joint discomfort. • Axial Arthritis. Also known as spondylitis or spondyloarthropathy, axial arthritis produces pain and stiffness in the lower spine and sacroiliac joints (at the bottom of the back). Interestingly, and especially in young people, these symptoms may come on months or even years before the symptoms of IBD appear. Unlike peripheral arthritis, axial arthritis may cause permanent damage if the bones of the vertebral column fuse together—thereby creating decreased range of motion in the back. In some cases, a restriction in rib motion may make it difficult for people to take deep breaths. Active spondylitis generally subsides by age 40. Therapy for people with axial arthritis often includes the use of biologic therapies. Non-medical therapies are geared toward improving range of motion in the back. Stretching exercises are recommended, as is the application of moist heat to the back. Treatment of the underlying IBD is helpful, but generally less effective than in patients with peripheral arthritis. • Ankylosing Spondylitis. A more severe form of spinal arthritis, ankylosing spondylitis (AS) is a rare complication, affecting between 2% and 3% of people with IBD. It is seen more often in Crohn’s disease than in ulcerative colitis. In addition to causing arthritis of the spine and sacroiliac joints, ankylosing spondylitis can cause inflammation of the eyes, lungs, and heart valves. The cause of AS is not known, but most affected individuals share a common genetic marker. In some cases, the disease occurs in genetically susceptible people after exposure to bowel or urinary tract infections. Occasionally, AS foretells the development of IBD. AS typically strikes people under the age of 30, mainly adolescents and young adult males, appearing first as a dramatic loss of flexibility in the lower spine. Rehabilitation therapy is essential to help maintain joint flexibility. But even with optimal therapy, some people will develop a stiff or “ankylosed” spine. Symptoms of AS may continue to worsen even after surgical removal of the colon. It is important to see a rheumatologist when this disease is suspected, as biologic treatments often help reduce complications and joint damage. Diagnosis It is not always easy to determine if the arthritis is linked to the intestinal condition. In general, the arthritis that complicates IBD is not as severe as rheumatoid arthritis. The joints do not ordinarily undergo destructive changes, and joint involvement is not symmetric (affecting the same joints on both sides of the body). Except for ankylosing spondylitis, arthritis associated with IBD usually improves as intestinal symptoms improve. Treatment In the general population, people with peripheral arthritis may use nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and swelling of the joints. However, as a rule, these medications—which include aspirin and ibuprofen—are not a good option for everyone with IBD because they can irritate the intestinal lining and increase the inflammation. (It should be noted, though, that some people with IBD can tolerate NSAIDs and find these medications helpful in relieving symptoms of arthritis. It is important to discuss medication usage with your doctor.) Corticosteroids also may be used to treat the arthritis symptoms as well as IBD. In most cases, doctors manage the symptoms of peripheral arthritis by controlling the inflammation within the colon. Only axial arthritis seems not to improve as the intestinal inflammation resolves. Once inflammation has decreased, possibly after a course of a medication such as prednisone or sulfasalazine (or other 5-aminosalicylates), joint pain generally disappears. Because they take months to work, the immunomodulators azathioprine and/or 6-mercaptopurine are not used specifically to control joint inflammation. However, the immunomodulator methotrexate can be an effective treatment for IBD-associated joint pain. Similarly, the newer biologic agents such as infliximab (Remicade®), adalimumab (Humira®), and certolizumab (Cimzia®) have all been shown to be very effective in reducing joint inflammation and swelling. Infliximab and adalimumab have even shown good results as a primary treatment for ankylosing spondylitis, preventing joint damage and destruction. In addition to medication, doctors may recommend resting the affected joint, occasional use of moist heat, or range of motion exercises, as demonstrated by a physical therapist.","treatments for types of arthritis? Only use information in the text here when responding. Types of Arthritis • Peripheral Arthritis. Peripheral arthritis usually affects the large joints of the arms and legs, including the elbows, wrists, knees, and ankles. The discomfort may be “migratory,” moving from one joint to another. If left untreated, the pain may last from a few days to several weeks. Peripheral arthritis tends to be more common among people who have ulcerative colitis or Crohn’s disease of the colon. The level of inflammation in the joints generally mirrors the extent of inflammation in the colon. Although no specific test can make an absolute diagnosis, various diagnostic methods—including analysis of joint fluid, blood tests, and X-rays—are used to rule out other causes of joint pain. Fortunately, IBD-related peripheral arthritis usually does not cause any lasting damage and treatment of the underlying IBD typically results in improvement in the joint discomfort. • Axial Arthritis. Also known as spondylitis or spondyloarthropathy, axial arthritis produces pain and stiffness in the lower spine and sacroiliac joints (at the bottom of the back). Interestingly, and especially in young people, these symptoms may come on months or even years before the symptoms of IBD appear. Unlike peripheral arthritis, axial arthritis may cause permanent damage if the bones of the vertebral column fuse together—thereby creating decreased range of motion in the back. In some cases, a restriction in rib motion may make it difficult for people to take deep breaths. Active spondylitis generally subsides by age 40. Therapy for people with axial arthritis often includes the use of biologic therapies. Non-medical therapies are geared toward improving range of motion in the back. Stretching exercises are recommended, as is the application of moist heat to the back. Treatment of the underlying IBD is helpful, but generally less effective than in patients with peripheral arthritis. • Ankylosing Spondylitis. A more severe form of spinal arthritis, ankylosing spondylitis (AS) is a rare complication, affecting between 2% and 3% of people with IBD. It is seen more often in Crohn’s disease than in ulcerative colitis. In addition to causing arthritis of the spine and sacroiliac joints, ankylosing spondylitis can cause inflammation of the eyes, lungs, and heart valves. The cause of AS is not known, but most affected individuals share a common genetic marker. In some cases, the disease occurs in genetically susceptible people after exposure to bowel or urinary tract infections. Occasionally, AS foretells the development of IBD. AS typically strikes people under the age of 30, mainly adolescents and young adult males, appearing first as a dramatic loss of flexibility in the lower spine. Rehabilitation therapy is essential to help maintain joint flexibility. But even with optimal therapy, some people will develop a stiff or “ankylosed” spine. Symptoms of AS may continue to worsen even after surgical removal of the colon. It is important to see a rheumatologist when this disease is suspected, as biologic treatments often help reduce complications and joint damage. Diagnosis It is not always easy to determine if the arthritis is linked to the intestinal condition. In general, the arthritis that complicates IBD is not as severe as rheumatoid arthritis. The joints do not ordinarily undergo destructive changes, and joint involvement is not symmetric (affecting the same joints on both sides of the body). Except for ankylosing spondylitis, arthritis associated with IBD usually improves as intestinal symptoms improve. Treatment In the general population, people with peripheral arthritis may use nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and swelling of the joints. However, as a rule, these medications—which include aspirin and ibuprofen—are not a good option for everyone with IBD because they can irritate the intestinal lining and increase the inflammation. (It should be noted, though, that some people with IBD can tolerate NSAIDs and find these medications helpful in relieving symptoms of arthritis. It is important to discuss medication usage with your doctor.) Corticosteroids also may be used to treat the arthritis symptoms as well as IBD. In most cases, doctors manage the symptoms of peripheral arthritis by controlling the inflammation within the colon. Only axial arthritis seems not to improve as the intestinal inflammation resolves. Once inflammation has decreased, possibly after a course of a medication such as prednisone or sulfasalazine (or other 5-aminosalicylates), joint pain generally disappears. Because they take months to work, the immunomodulators azathioprine and/or 6-mercaptopurine are not used specifically to control joint inflammation. However, the immunomodulator methotrexate can be an effective treatment for IBD-associated joint pain. Similarly, the newer biologic agents such as infliximab (Remicade®), adalimumab (Humira®), and certolizumab (Cimzia®) have all been shown to be very effective in reducing joint inflammation and swelling. Infliximab and adalimumab have even shown good results as a primary treatment for ankylosing spondylitis, preventing joint damage and destruction. In addition to medication, doctors may recommend resting the affected joint, occasional use of moist heat, or range of motion exercises, as demonstrated by a physical therapist.","Only use information in the text here when responding.
+
+EVIDENCE:
+Types of Arthritis • Peripheral Arthritis. Peripheral arthritis usually affects the large joints of the arms and legs, including the elbows, wrists, knees, and ankles. The discomfort may be “migratory,” moving from one joint to another. If left untreated, the pain may last from a few days to several weeks. Peripheral arthritis tends to be more common among people who have ulcerative colitis or Crohn’s disease of the colon. The level of inflammation in the joints generally mirrors the extent of inflammation in the colon. Although no specific test can make an absolute diagnosis, various diagnostic methods—including analysis of joint fluid, blood tests, and X-rays—are used to rule out other causes of joint pain. Fortunately, IBD-related peripheral arthritis usually does not cause any lasting damage and treatment of the underlying IBD typically results in improvement in the joint discomfort. • Axial Arthritis. Also known as spondylitis or spondyloarthropathy, axial arthritis produces pain and stiffness in the lower spine and sacroiliac joints (at the bottom of the back). Interestingly, and especially in young people, these symptoms may come on months or even years before the symptoms of IBD appear. Unlike peripheral arthritis, axial arthritis may cause permanent damage if the bones of the vertebral column fuse together—thereby creating decreased range of motion in the back. In some cases, a restriction in rib motion may make it difficult for people to take deep breaths. Active spondylitis generally subsides by age 40. Therapy for people with axial arthritis often includes the use of biologic therapies. Non-medical therapies are geared toward improving range of motion in the back. Stretching exercises are recommended, as is the application of moist heat to the back. Treatment of the underlying IBD is helpful, but generally less effective than in patients with peripheral arthritis. • Ankylosing Spondylitis. A more severe form of spinal arthritis, ankylosing spondylitis (AS) is a rare complication, affecting between 2% and 3% of people with IBD. It is seen more often in Crohn’s disease than in ulcerative colitis. In addition to causing arthritis of the spine and sacroiliac joints, ankylosing spondylitis can cause inflammation of the eyes, lungs, and heart valves. The cause of AS is not known, but most affected individuals share a common genetic marker. In some cases, the disease occurs in genetically susceptible people after exposure to bowel or urinary tract infections. Occasionally, AS foretells the development of IBD. AS typically strikes people under the age of 30, mainly adolescents and young adult males, appearing first as a dramatic loss of flexibility in the lower spine. Rehabilitation therapy is essential to help maintain joint flexibility. But even with optimal therapy, some people will develop a stiff or “ankylosed” spine. Symptoms of AS may continue to worsen even after surgical removal of the colon. It is important to see a rheumatologist when this disease is suspected, as biologic treatments often help reduce complications and joint damage. Diagnosis It is not always easy to determine if the arthritis is linked to the intestinal condition. In general, the arthritis that complicates IBD is not as severe as rheumatoid arthritis. The joints do not ordinarily undergo destructive changes, and joint involvement is not symmetric (affecting the same joints on both sides of the body). Except for ankylosing spondylitis, arthritis associated with IBD usually improves as intestinal symptoms improve. Treatment In the general population, people with peripheral arthritis may use nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and swelling of the joints. However, as a rule, these medications—which include aspirin and ibuprofen—are not a good option for everyone with IBD because they can irritate the intestinal lining and increase the inflammation. (It should be noted, though, that some people with IBD can tolerate NSAIDs and find these medications helpful in relieving symptoms of arthritis. It is important to discuss medication usage with your doctor.) Corticosteroids also may be used to treat the arthritis symptoms as well as IBD. In most cases, doctors manage the symptoms of peripheral arthritis by controlling the inflammation within the colon. Only axial arthritis seems not to improve as the intestinal inflammation resolves. Once inflammation has decreased, possibly after a course of a medication such as prednisone or sulfasalazine (or other 5-aminosalicylates), joint pain generally disappears. Because they take months to work, the immunomodulators azathioprine and/or 6-mercaptopurine are not used specifically to control joint inflammation. However, the immunomodulator methotrexate can be an effective treatment for IBD-associated joint pain. Similarly, the newer biologic agents such as infliximab (Remicade®), adalimumab (Humira®), and certolizumab (Cimzia®) have all been shown to be very effective in reducing joint inflammation and swelling. Infliximab and adalimumab have even shown good results as a primary treatment for ankylosing spondylitis, preventing joint damage and destruction. In addition to medication, doctors may recommend resting the affected joint, occasional use of moist heat, or range of motion exercises, as demonstrated by a physical therapist.
+
+USER:
+treatments for types of arthritis?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,9,5,810,,61
+You can only respond with the information in the context block. Please give your response in a simple tone that could be shared with a non-legal audience and easily understood.,Please summarize the determinations made in the text provided and explain the consequences of the rulings made.,"In the United States Court of Federal Claims No. 13-821 (Filed: 2 January 2024) *************************************** INGHAM REG’L MEDICAL CENTER, * n/k/a MCLAREN GREATER LANSING, * et al., * * Plaintiffs, * * v. * * THE UNITED STATES, * * Defendant. * * Plaintiffs are six hospitals purporting to represent a class of approximately 1,610 hospitals across the United States in a suit requesting, among other things, the Court interpret what the Federal Circuit has deemed an “extremely strange” contract.1 This contract arose when hospitals complained the government underpaid reimbursements for Department of Defense Military Health System, TRICARE, outpatient services rendered between 2003 and 2009. In 2011, after completion of a data analysis, the government voluntarily entered a discretionary payment process contract with plaintiffs and offered net adjusted payments. In November 2022, after nine years of litigation and one Federal Circuit appeal, the Court granted in part and denied in part the government’s Motion for Summary Judgment. As the only surviving breach of contract claims concern the government’s duty to extract, analyze, and adjust line items from its 1 9 June 2022 Oral Arg. Tr. at 161:7–13, ECF No. 259 (“THE COURT: So the Federal Circuit panel, when the case was argued, characterized this agreement as extremely strange. [THE GOVERNMENT]: That is accurate. It is extremely strange. THE COURT: It is extremely strange? [THE GOVERNMENT]: It is.”). Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 1 of 23 - 2 - database, the Court required the parties to file a joint status report regarding the effect of summary judgment on plaintiffs’ Renewed Motion to Certify a Class Action. Following a status conference, plaintiffs filed a discovery motion related to class certification. For the following reasons, the Court grants-in-part and denies-in-part plaintiffs’ Motion. I. Background A. Factual and Procedural History2 TRICARE is a “military health care system” which “provides medical and dental care for current and former members of the military and their dependents.” Ingham Reg’l Med. Ctr. v. United States, 874 F.3d 1341, 1342 (Fed. Cir. 2017). TRICARE Management Activity (TMA), a “field office in the Defense Department [(DoD)],” managed the TRICARE system.3 N. Mich. Hosps., Inc. v. Health Net Fed. Servs., LLC, 344 F. App’x 731, 734 (3d Cir. 2009). In 2001, Congress amended the TRICARE statute to require DoD to follow Medicare rules when reimbursing outside healthcare providers. Ingham Reg’l Med. Ctr., 874 F.3d at 1343 (citing 10 U.S.C. § 1079(j)(2) (2002)). To facilitate transition to Medicare rules, in 2005, DoD issued a Final Rule which specified “[f]or most outpatient services, hospitals would receive payments ‘based on the TRICARE-allowable cost method in effect for professional providers or the [Civilian Health and Medical Program of the Uniformed Services] (CHAMPUS) Maximum Allowable Charge (CMAC).’” Id. (quoting TRICARE; Sub-Acute Care Program; Uniform Skilled Nursing Facility Benefit; Home Health Care Benefit; Adopting Medicare Payment Methods for Skilled Nursing Facilities and Home Health Care Providers, 70 Fed. Reg. 61368, 61371 (Oct. 24, 2005) (codified as amended at 32 C.F.R. § 199)). The TRICARE-allowable cost method “applied until 2009, when TRICARE introduced a new payment system for hospital outpatient services that was similar to the Medicare [Outpatient Prospective Payment System (OPPS)].” Id. In response to hospital complaints of payment issues, TRICARE hired Kennell and Associates, a consulting firm, to “undertake a study [(‘Kennell study’)] of the accuracy of its payments to the hospitals.” Ingham Reg’l Med. Ctr., 874 F.3d at 1343–44. The Kennell study “compared CMAC payments to the payments that would have been made using Medicare payment principles, and determined that DoD ‘(1) underpaid hospitals for outpatient radiology but, (2) correctly paid hospitals for all other outpatient services.’” Id. at 1344 (emphasis omitted) (citation omitted). From the Kennell study findings, “DoD created a discretionary payment process [(DPP)],” and, on 25 April 2011, DoD notified hospitals by letter of the process for them to “request a review of their TRICARE reimbursements (the ‘Letter’)” and “published a document titled ‘NOTICE TO HOSPITALS OF POTENTIAL ADJUSTMENT TO PAST PAYMENTS FOR OUTPATIENT RADIOLOGY SERVICES’ (the ‘Notice’)” on the TRICARE website. Id.; App. to Def.’s MSJ at A3–A9, ECF No. 203-1. The Notice described a nine-step methodology to “govern the review of payments for hospital outpatient radiology services and [the] payment 2 The factual and procedural history in this Order contains only those facts pertinent to plaintiffs’ Motion for Discovery, ECF No. 269. 3 The Defense Health Agency now manages activities previously managed by TMA. Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 2 of 23 - 3 - of any discretionary net adjustments” by which hospitals could “request an analysis of their claims data for possible discretionary adjustment.” App. to Def.’s MSJ at A7. On 21 October 2013, plaintiffs brought this action claiming the government underpaid them for certain outpatient medical services they provided between 1 August 2003 and 1 May 2009. See Ingham Reg’l Med. Ctr. v United States, 126 Fed. Cl. 1, 9 (2016), aff’d in part, rev’d in part, 874 F.3d 1341 (Fed. Cir. 2017). Plaintiffs allege the approximately six years of underpayment breached two contracts and violated various statutory and regulatory provisions. Id. Plaintiffs estimate several thousand hospitals submitted requests for discretionary payment, including the six named plaintiffs in this case. See id. at 16. Plaintiffs therefore seek to represent a class of as many as 1,610 similarly situated hospitals. See Pls.’ Mem. in Supp. of Mot. to Certify at 1, ECF No. 77; see also Mot. to Certify, ECF No. 76. On 11 February 2020, during the parties’ second discovery period, plaintiffs requested from the government “[a]ny and all data concerning hospital outpatient services claims and TRICARE reimbursement for hospital outpatient services claims during the relevant time period . . . .” See App. to Pls.’ Disc. Mot. at 23, ECF No. 269; Gov’t’s Disc. Resp. at 11, ECF No. 270. The government rejected this request for records from “thousands of hospitals . . . that are not [named] plaintiffs” on 16 March 2020 and instead only “produce[d] the data requested for the six plaintiffs in this lawsuit.” App. to Pls.’ Disc. Mot. at 29. Plaintiffs filed a motion to clarify the case schedule or, in the alternative, to compel discovery of “data and documents relating to the [g]overnment’s calculation of payments under the [DPP] for all putative class members, not just the named [p]laintiffs” on 31 July 2020, the last day of discovery. See Pls.’ Mot. to Compel (“Pl.’s MTC”) at 2, ECF No. 161 (emphasis added). In response, the government stated, “[t]here is no basis for the Court to . . . compel extraneous discovery of hospitals that are not now in this lawsuit.” Def.’s Resp. to Pl.’s MTC (“Def.’s MTC Resp.”) at 2, ECF No. 166. During a status conference on 13 October 2020, the parties agreed to table plaintiffs’ discovery request and associated Motion to Compel pending resolution of the government’s then-pending Motion for Reconsideration, ECF No. 150, and any additional potentially dispositive motions. See 13 Oct. 2020 Tr. (“SC Tr.”) at 27:13–28:9, ECF No. 178 (“THE COURT: . . . So to state differently, then, [plaintiffs agree] to stay consideration of this particular [discovery] issue until class certification is decided? [PLAINTIFFS:] Yes, that would be fine. THE COURT: . . . [W]ould the [g]overnment agree with that? [THE GOVERNMENT:] Yes, [y]our [h]onor . . . [but] the [g]overnment still intends to file a motion for summary judgment. . . . THE COURT: Okay. So on the [g]overnment’s motion for summary judgment . . . that should probably not be filed until at least after the motion for reconsideration is resolved? [THE GOVERNMENT:] That’s correct.”). On 5 June 2020, plaintiffs filed a renewed motion to certify a class and appoint class counsel (“Pls.’ Class Cert.”), ECF No. 146, which the parties fully briefed. See Def.’s Class Cert. Resp., ECF No. 207; Pls.’ Class Cert. Reply, EF No. 226. On 26 August 2021, the government filed a motion for summary judgment (“Def.’s MSJ”), ECF No. 203. Plaintiffs filed an opposition to the government’s motion for summary judgment on 4 February 2022 (“Pls.’ MSJ Resp.”), ECF No. 225, and on 11 March 2022, the government filed a reply (“Def.’s MSJ Reply”), ECF No. 234. Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 3 of 23 - 4 - “The Court [granted] the government’s [M]otion for [S]ummary [J]udgment as to plaintiffs’ hospital-data duty and mutual mistake of fact claims but [denied] the government’s [M]otion as to plaintiffs’ TMA-data duty and alternate zip code claims[,] . . . [and stayed] the evidentiary motions” on 28 November 2022. Ingham Reg’l Med. Ctr. v. United States, 163 Fed. Cl. 384, 428 (2022). The Court, deeming the government’s settlement arrangements with plaintiffs to be contracts (the “DPP Contracts”), specifically found “the DPP Contract[s] only obligated TMA to use its data, not the hospitals’ data,” leaving the government’s data as the only set relevant to this case. Id. at 427. The Court held the government’s (1) “failure to extract thirteen line items [meeting all qualifications for extraction] for Integris Baptist and Integris Bass Baptist”; and (2) failure to adjust “five . . . line items [for Integris Baptist] during the DPP because of an alternate zip code” constituted breach of the DPP Contracts. Id. at 409–10, 412. “Based on the summary judgment holding . . . the Court [found it needed] further information regarding how plaintiffs in this post-summary judgment smaller class would meet the requirements for class certification.” Id. “The Court accordingly decline[d] to rule on plaintiffs’ class certification motion . . . [a]s the only surviving claims are breach of contract for failure to follow the DPP in a few limited circumstances, [and] the parties did not adequately brief the narrower proposed class of plaintiffs arising under the remaining claims.” Id. The Court ordered the parties to file “a joint status report [(JSR)] providing the parties’ views on class certification for the smaller class of plaintiffs affected by the government’s breach of contract for failure to follow the DPP in limited circumstances and on whether further briefing is necessary.” Id. On 28 December 2022, the parties filed a JSR providing their opposing positions on whether plaintiffs can request further discovery related to class certification: “plaintiffs expressly reserve, and do not waive, any rights that they may currently have, or may have in the future, with respect to additional class certification fact or expert discovery”; and “the [g]overnment opposes any further fact or expert discovery in connection with plaintiffs’ amended/supplemental motion for class certification, and, in agreeing to the foregoing briefing schedule, is not agreeing to any further fact or expert discovery in this case.” 28 Dec. 2022 JSR at 2, ECF No. 262. Plaintiffs then filed a motion requesting leave to conduct further discovery and submit a supplemental expert report on 21 March 2023 (“plaintiffs’ Discovery Motion”). Pls.’ Disc. Mot., ECF No. 269. The government filed a response on 21 April 2023. Gov’t’s Disc. Resp. Plaintiffs filed a reply on 9 May 2023. Pls.’ Disc. Reply, ECF No. 271. The Court held oral argument on 19 July 2023. See 5 June 2023 Order, ECF No. 272; 19 July 2023 Oral Arg. Tr. (“Tr.”), ECF No. 276. On 31 August 2023, following oral argument on plaintiffs’ Discovery Motion, the government filed an unopposed motion to stay the case for the government to complete a “second look at the records [analyzed] . . . in the July 2019 expert report of Kennell . . . that were the subject of one of the Court’s liability rulings on summary judgment.” Def.’s Mot. to Stay at 1, ECF No. 277. The Court granted this Motion on the same day. Order, ECF No. 278. On 25 October 2023, the parties filed a JSR, ECF No. 284, in which the government addressed its findings4 and “proposed [a] way forward” in this case. 25 Oct. 2023 JSR at 2. In 4 In the 25 October 2023 JSR, the government explained twelve of the thirteen line items the government failed to extract for Integris Baptist and Integris Bass Baptist, see Ingham Reg’l Med. Ctr. v. United States, 163 Fed. Cl. 384, 412 (2022), were missed due to a “now-known” error in which “a very small set of patients comprised of military spouses . . . under age 65” were overlooked because they “receive Medicare Part A” but not Medicare Part B, Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 4 of 23 - 5 - response to the government’s data analysis, plaintiffs noted in the JSR “the [g]overnment’s update makes clear that [additional g]overnment data is required to evaluate which hospitals were affected by the [g]overnment’s breach of the DPP.” Id. at 16. Plaintiffs then likewise “[p]roposed [n]ext [s]teps” in this case, beginning with resolution of their Discovery Motion. Id. at 18. On 19 December 2023, the Court held a telephonic status conference to understand the technical aspects of plaintiffs’ discovery requests as they relate to the DPP process and algorithm. See Scheduling Order, ECF No. 285. B. Discovery Requests at Issue Plaintiffs seek leave to perform additional discovery stemming from the Court’s summary judgment holding “TMA [breached its duty] . . . to extract, analyze, and adjust radiology data from its database” by failing to (1) adjust “five . . . line items [for Integris Baptist] during the DPP because of an alternate zip code” and (2) “extract . . . thirteen line items [meeting the criteria for extraction] for Integris Baptist and Integris Bass Baptist.” Ingham Reg’l Med. Ctr., 163 Fed. Cl. at 409–10, 412. Plaintiffs’ sought-after discovery includes a request for “the same data for the [putative] class hospitals” as plaintiffs currently “have [for the] six named [p]laintiffs,” Tr. at 50:14–19, to assist plaintiffs in identifying “line items in [TMA’s radiology data] . . . that met the [DPP C]ontract criteria but were excluded from the adjustment . . . .” Gov’t’s Disc. Resp. at 15. In all, plaintiffs “seek leave to (1) depose a [g]overnment corporate designee, (2) serve document requests, and (3) thereafter serve a supplemental expert report on the relevant class issues.” Pls.’ Disc. Mot. at 2. Plaintiffs further detail the purpose of each request: First, [p]laintiffs seek leave to depose a [g]overnment corporate designee to identify the various data sources in the [g]overnment’s possession from the relevant time period. Second, [p]laintiffs seek leave to serve . . . document requests to obtain critical data related to each Potential Class member hospital. Third, once the above discovery is completed, [p]laintiffs seek leave to serve a supplemental expert report that applies the DPP methodology to the relevant claims data to identify the Final Class. Id. at 6–7 (footnote omitted) (citations omitted). The second request, mirroring plaintiffs’ February 2020 request for “[a]ny and all data concerning hospital outpatient service claims and TRICARE reimbursement for hospital outpatient services claims during the relevant time period,” App. to Pl.’s Disc. Mot. at 23, comprises “(1) all information Kennell used in the DPP calculations for each Potential Class member hospital, as well as the underlying calculations[;] and (2) all hospital outpatient claims meaning the “outpatient services that these individuals receive are paid for . . . by TRICARE.” 25 Oct. JSR at 4, ECF No. 284. As a result of this Medicare arrangement, line items for this group of patients were not extracted as the individuals were mistakenly deemed Medicare, rather than TRICARE, recipients for procedures within the scope of the DPP. Id. The cause of the thirteenth unextracted line item remains unclear. Id. at 5. Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 5 of 23 - 6 - data available for each of the Potential Class member hospitals during the relevant time period.” Pl.’s Disc. Mot. at 8–9. This request includes: (1) CMAC rate files “needed to apply the DPP methodology”; (2) “[d]ata on hospital outpatient radiology services claim line items for each Potential Class member hospital”; (3) “[d]ata concerning hospital outpatient services claim line items for each Potential Class member hospital” to verify the radiology files are complete; and (4) “TRICARE Encounter Data (‘TED’) records and Health Care Service Records (‘HCSR’).” Id. at 9–10. II. Applicable Law This court’s application of the Rules of the United States Court of Federal Claims (“RCFC”) is guided by case law interpreting the Federal Rules of Civil Procedure (FRCP). See RCFC rules committee’s note to 2002 revision (“[I]nterpretation of the court’s rules will be guided by case law and the Advisory Committee Notes that accompany the Federal Rules of Civil Procedure.”). Regarding the scope of discovery, the rules of this court provide: [P]arties may obtain discovery regarding any nonprivileged matter that is relevant to any party’s claim or defense and proportional to the needs of the case, considering the importance of the issues at stake in the action, the amount in controversy, the parties’ relative access to relevant information, the parties’ resources, the importance of the discovery in resolving the issues, and whether the burden or expense of the proposed discovery outweighs its likely benefit. RCFC 26(b)(1). “Questions of the scope and conduct of discovery are . . . committed to the discretion of the trial court.” Florsheim Shoe Co., Div. of Interco, Inc. v. United States, 744 F.2d 787, 797 (Fed. Cir. 1984). The Court of Federal Claims generally “afford[s] a liberal treatment to the rules of discovery.” Securiforce Int’l Am., LLC v. United States, 127 Fed. Cl. 386, 400 (2016), aff’d in part and vacated in part on other grounds, 879 F.3d 1354 (Fed. Cir. 2018), cert. denied, 139 S. Ct. 478 (2018) (mem.). “[T]he [C]ourt must be careful not to deprive a party of discovery that is reasonably necessary to afford a fair opportunity to develop and prepare the case.” Heat & Control, Inc. v. Hester Indus., Inc., 785 F.2d 1017, 1024 (Fed. Cir. 1986) (quoting FED. R. CIV. P. 26(b)(1) advisory committee’s note to 1983 amendment). Further, “[a] trial court ‘has wide discretion in setting the limits of discovery.’” Schism v. United States, 316 F.3d 1259, 1300 (Fed. Cir. 2002) (quoting Moore v. Armour Pharm. Co., 927 F.2d 1194, 1197 (11th Cir. 1991)). This court has previously found such “discretion [extends to] . . . deciding whether to grant a motion to . . . reopen discovery.” Croman Corp. v. United States, 94 Fed. Cl. 157, 160 (2010) (citing Te-Moak Bands of W. Shoshone Indians of Nev. v. United States, 948 F.2d 1258, 1260 (Fed. Cir. 1991)); see also Wordtech Sys., Inc. v. Integrated Networks Sols., Inc., 609 F.3d 1308, 1322–23 (Fed. Cir. 2010) (citing Coleman v. Quaker Oats Co., 232 F.3d 1271, 1294 (9th Cir. 2000)) (applying Ninth Circuit law in determining trial court did not abuse its discretion in refusing to reopen discovery). Notwithstanding, modification of a court-imposed schedule, including a discovery schedule, may be done “only for good cause and with the judge’s consent.” RCFC 16(b)(4). In Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 6 of 23 - 7 - High Point Design, the Federal Circuit applied Second Circuit law5 when discussing the good cause standard of FRCP 16(b)(4) for amending a case schedule. “When assessing whether good cause has been shown, ‘the primary consideration is whether the moving party can demonstrate diligence.’” High Point Design LLC v. Buyers Direct, Inc., 730 F.3d 1301, 1319 (Fed. Cir. 2013) (quoting Kassner v. 2nd Ave. Delicatessen, Inc., 496 F.3d 229, 244 (2d Cir. 2007)); see also Adv. Software Design Corp. v. Fiserv, Inc., 641 F.3d 1368, 1381 (Fed. Cir. 2011) (“Under the good cause standard, the threshold inquiry is whether the movant has been diligent.” (citing Sherman v. Winco Fireworks, Inc., 532 F.3d 709, 717 (8th Cir. 2008))). This “requires a showing that even with the exercise of due diligence the moving party could not meet the order’s timetable.” Slip Track Sys., Inc. v. Metal-Lite, Inc., 304 F.3d 1256, 1270 (Fed. Cir. 2002) (applying Ninth Circuit law in finding defendant’s attempt to amend the pleadings first required modification of the scheduling order under FRCP 16(b)(4)). Trial courts may also consider “other relevant factors including, in particular, whether allowing the amendment . . . will prejudice [the opposing party].” High Point Design, 730 F.3d at 1319 (quoting Kassner, 496 F.3d at 244); 6A WRIGHT ET AL., FEDERAL PRACTICE AND PROCEDURE § 1522.2 (3d ed. 1998) (“What constitutes good cause sufficient to justify the modification of a scheduling order necessarily varies with the circumstances of each case.”). Prejudice related to the reopening of discovery may involve the delay of proceedings. Wordtech Sys., 609 F.3d at 1322 (“[A] need to reopen discovery and therefore delay the proceedings supports a district court’s finding of prejudice from a delayed motion to amend the complaint.” (quoting Lockheed Martin Corp. v. Network Sols., Inc., 194 F.3d 980, 986 (9th Cir. 1999))). III. Parties’ Arguments Plaintiffs contend “good cause exists for [p]laintiffs to conduct . . . additional limited discovery,” Pls.’ Disc. Mot. at 7–8 (citing Geneva Pharms. Tech. Corp. v. Barr Lab’ys, Inc., Nos. 98 Civ. 861, 99 Civ. 3687, 2005 WL 2132438, at *5 (S.D.N.Y. Sept. 6, 2005)), largely mirroring their “live and pending request for discovery [from February 2020] that[ ha]s been tabled” since October 2020, Tr. at 37:16–17; see SC Tr. at 27:13–23. Specifically, plaintiffs argue, “[t]he Court’s ruling on the [g]overnment’s Summary Judgment Motion is a material event that has fundamentally altered the scope of this case.” Pl.’s Disc. Mot. at 7–8 (citing Ingham Reg’l Med. Ctr. v. United States, 163 Fed. Cl. 384, 428 (2022) (“[T]he parties did not adequately brief the narrower proposed class of plaintiffs arising under the remaining claims.”)). Plaintiffs state the requested “discovery will allow them to provide the Court with the information required for the determination of the Final Class, and that this will greatly assist the Court with its ruling on class certification.” Id. at 10. At oral argument, the government acknowledged “[p]laintiffs[’] [2020] request [for] all class hospital data” concerned much of the same information plaintiffs are “asking for now.” Tr. at 103:7–17. The government, however, maintains “plaintiffs’ motion to reopen fact and expert discovery should be denied.” Gov’t’s Disc. Resp. at 17. Specifically, the government argues plaintiffs “filed this case, moved for class certification twice, and proceeded through two full rounds of fact and expert discovery, based upon . . . [p]laintiffs’ view of the law.” Id. at 16. The 5 RCFC 16(b)(4) is identical to the corresponding Rule 16(b)(4) of the Federal Rules of Civil Procedure. Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 7 of 23 - 8 - government therefore argues plaintiffs should not be permitted to “reopen fact and expert discovery” simply because “on summary judgment,” the “legal theories that animated plaintiffs’ [previous] discovery and expert reports have been shown . . . to be . . . wrong.” Id. at 16–17. The government argues “[a] party’s realization that it elected to pursue the wrong litigation strategy is not good cause for amending a schedule,” so plaintiffs have failed to show good cause to reopen discovery as they request. Gov’t’s Disc. Resp. at 17 (quoting Sys. Fuels, Inc. v. United States, 111 Fed. Cl. 381, 383 (2013)). Alluding to the standard for reopening discovery, the government argues “no actions by plaintiffs . . . even remotely approximate the showing of diligence required under RCFC 16 . . . .” Id. at 35. The government also argues plaintiffs’ requests “overwhelming[ly] and incurabl[y] prejudice . . . the [g]overnment.” Id. at 38. IV. Whether Good Cause Exists to Reopen Discovery As noted supra Section III, plaintiffs contend “good cause exists for [p]laintiffs to conduct . . . additional limited discovery,” Pls.’ Disc. Mot. at 7–8 (citing Geneva Pharms. Tech. Corp. v. Barr Lab’ys, Inc., Nos. 98 Civ. 861, 99 Civ. 3687, 2005 WL 2132438, at *5 (S.D.N.Y. Sept. 6, 2005)), largely mirroring their “live and pending request for discovery [from February 2020] that[ ha]s been tabled” since October 2020, when the parties agreed to first proceed with the government’s Motion for Reconsideration and Motion for Summary Judgment. Tr. at 37:16– 17; see SC Tr. at 27:13–23. Plaintiffs believe the requested “discovery will allow them to provide the Court with the information required for the determination of the Final Class, and that this will greatly assist the Court with its ruling on class certification.” Pl.’s Disc. Mot. at 10. In contrast, the government asserts plaintiffs have, in two previous rounds of discovery and in their summary judgment briefing, chosen to pursue a litigation strategy based on a class damages model relying on hospital and government data and cannot now justify reopening discovery because they need to change tactics following the Court’s summary judgment ruling limiting the scope of this case to the government’s data. See Gov’t’s Disc. Resp. at 22–23. Specifically, the government contends plaintiffs have neither made the required showing of diligence during past discovery periods to justify modifying the Court’s discovery schedule nor adequately refuted the government’s claim this discovery is prejudicial. See Gov’t’s Disc. Resp. at 28, 35. “A trial court ‘has wide discretion in setting the limits of discovery.’” Schism v. United States, 316 F.3d 1259, 1300 (Fed. Cir. 2002) (quoting Moore v. Armour Pharm. Co., 927 F.2d 1194, 1197 (11th Cir. 1991)). This court has previously found such “discretion [is applicable] in deciding whether to grant a motion to . . . reopen discovery.” Croman Corp. v. United States, 94 Fed. Cl. 157, 160 (2010) (citing Te-Moak Bands of W. Shoshone Indians of Nev. v. United States, 948 F.2d 1258, 1260 (Fed. Cir. 1991)). RCFC 16(b)(4) permits modification of a court-imposed schedule, such as to re-open discovery, “only for good cause and with the judge’s consent.”6 Good cause “requires a showing that even with the exercise of due diligence the moving party could not meet the order’s timetable.” Slip Track Sys., Inc. v. Metal-Lite, Inc., 304 F.3d 1256, 1270 (Fed. Cir. 2002) (applying Ninth Circuit law in finding defendant’s attempt to amend the 6 At oral argument, the parties agreed plaintiffs are requesting the Court reopen discovery, meaning this good cause standard applies. Tr. 99:14–19: “[PLAINTIFFS:] I think, as between [supplementation and reopening], th[ese requests] probably fit[] better in the reopening category as between those two . . . . THE COURT: So . . . the standard for reopening is good cause? [PLAINTIFFS:] Yes. THE COURT: [The government], [do] you agree? [THE GOVERNMENT:] I agree.” Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 8 of 23 - 9 - pleadings first required modification of the scheduling order under FRCP 16(b)(4)). Likewise, in determining whether good cause exists to reopen discovery, a trial court may consider “other relevant factors including, in particular, whether allowing the amendment . . . will prejudice [the opposing party].” High Point Design LLC v. Buyers Direct, Inc., 730 F.3d 1301, 1319 (Fed. Cir. 2013) (quoting Kassner v. 2nd Ave. Delicatessen, Inc., 496 F.3d 229, 244 (2d Cir. 2007)). The Court accordingly must determine whether good cause exists to reopen discovery as requested by plaintiffs by analyzing plaintiffs’ diligence and whether the requested discovery prejudices the government. The Court begins with plaintiffs’ document requests. A. Document Requests Plaintiffs request the government turn over “critical data related to each Potential Class member hospital” and argue “denying ‘precertification discovery where it is necessary to determine the existence of a class is an abuse of discretion.’” Pls.’ Disc. Mot. at 6–7; Pls.’ Disc. Reply at 2 (quoting Perez v. Safelite Grp. Inc., 553 F. App’x 667, 669 (9th Cir. 2014)). These document requests specifically target “(1) all information Kennell used in the DPP calculations for each Potential Class member hospital, as well as the underlying calculations, and (2) all hospital outpatient claims data available for each of the Potential Class member hospitals during the relevant time period.” Pls.’ Disc. Mot. at 8–9. Plaintiffs’ goal is to acquire all “radiology line item[]” data and other information necessary to “apply the DPP methodology” to all of the putative class members’ claims data from the DPP period. Id. at 9. Plaintiffs contend “good cause exists” for the Court to reopen discovery with respect to these documents because the “Court’s ruling on the [g]overnment’s Summary Judgment Motion is a material event that . . . fundamentally altered the scope of this case.” Id. at 8. Namely, plaintiffs’ “damages are now limited to those claims involving errors in the [g]overnment’s data,” so plaintiffs allege this data, which “by its very nature [is] exclusively in [the government’s] possession,” is necessary “to identify the class members.” Pls.’ Disc. Reply at 3; see Ingham Reg’l Med. Ctr. v. United States, 163 Fed. Cl. 384, 427–29 (2022). Further, plaintiffs believe reopening discovery for this request is appropriate because in February 2020, during discovery, plaintiffs served a request for production on the government for the same “data concerning hospital outpatient services, claims, and . . . reimbursement for all class hospitals.” Tr. at 41:5–11. Plaintiffs likewise moved to compel this discovery in July 2020. Pls.’ Disc. Reply at 4 (“Plaintiffs also later moved for an order to conduct class discovery or for the [g]overnment to alternatively produce documents for all hospitals.”). Plaintiffs argue tabling this request and motion at the end of October 2020 while the case “proceeded with reconsideration, summary judgment, and other procedural” items did not do away with their “live and pending request for [this] discovery.” Tr. at 41:16–17, 37:14– 25, 128:5–6. With respect to prejudice, plaintiffs clarify their requests “will not prejudice the” government primarily because “the benefit to this case from the discovery would significantly outweigh any burden,” Pls.’ Disc. Reply at 8–9 (first citing Davita HealthCare Partners, Inc. v. United States, 125 Fed. Cl. 394, 402 n.6 (2016); and then citing Kennedy Heights Apartments Ltd. I v. United States, 2005 WL 6112633, at *4 (Fed. Cl. Apr. 26, 2005)), as this discovery will “assist the court with its ruling on class certification.” Pls.’ Disc. Mot. at 9–10. Further, plaintiffs contend any prejudice could be cured at trial by cross-examination of plaintiffs’ expert, who will use this data in a future supplemental report. Pls.’ Disc. Reply at 10 (citing Panasonic Commc’ns Corp. of Am. v. United States, 108 Fed. Cl. 412, 416 (2013)). Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 9 of 23 - 10 - The government argues good cause does not exist to reopen discovery as requested by plaintiffs. With respect to diligence, the government first asserts plaintiffs’ 31 July 2020 Motion regarding class discovery was not diligent because it was filed on the last day of the discovery period. Gov’t’s Disc. Resp. at 33–34. Next, the government argues “[p]laintiffs make no claim that it was impossible during two separate discovery periods for them to have served on the [g]overnment . . . the proposed discovery requests . . . because it obviously was not.” Id. at 28 (citation omitted). Rather, per the government, “plaintiffs disregarded, rather than responding to, evidence, analysis, and law that was inconsistent with their theories of the case, even when the [g]overnment brought such issues to the fore.” Id. at 30. The government argues “plaintiffs ignored these issues at their peril throughout the entire second period of fact and expert discovery that followed, and that means that they were not diligent under the law” and are not now entitled to discovery to assist them in changing their theory of the case. Id. at 31–32. Concerning prejudice, the government argues “plaintiffs are proposing fact discovery on a scale never before undertaken in this case, a new expert report for the [g]overnment to then respond to, more expert depositions, and, no doubt, additional Daubert and class-related motions practice, resulting in substantial delay in bringing this matter to resolution.” Id. at 36 (footnote omitted). “Permitting plaintiffs to now evade a long overdue reckoning, and attempt to moot [the government’s motions to exclude plaintiffs’ expert reports], in addition to being completely contrary to law, [according to the government,] deprives the [g]overnment of its day in court for what should be an imminent resolution of this matter.” Id. 1. Diligence A finding of diligence sufficient to modify a case schedule “requires a showing that even with the exercise of due diligence the moving party could not meet the order’s timetable.” Slip Track Sys., Inc., 304 F.3d at 1270 (applying Ninth Circuit law in finding defendant’s attempt to amend the pleadings first required modification of the scheduling order under FRCP 16(b)(4)). On 11 February 2020, at the very early stages of the “re-opened period of fact discovery,” plaintiffs “served the [g]overnment with additional document requests,” including a request for “[a]ny and all data concerning hospital outpatient services claims and TRICARE reimbursement for hospital outpatient services claims during the relevant time period . . . .” Gov’t’s Disc. Resp. at 11 (citations omitted); see also App. to Pls.’ Disc. Mot. at 23. At the time, the government “objected to this request” and only “produce[d] the data requested for the six [named] plaintiffs.” Id. at 11–12 (citations omitted). Over the next several months, the parties continued with fact and expert discovery, during which time the Court “established a schedule for briefing on class certification and summary judgment.” Id. at 13 (citing Order at 2, ECF No. 143). On 31 July 2020, “the date . . . both fact and expert discovery closed, plaintiffs filed a motion . . . [to] compel[] the [g]overnment to produce documents for all hospitals, rather than for just the six representative plaintiffs.” Id. at 14. Plaintiffs therefore requested the data at issue in this document request at least twice before the instant Motion—once on 11 February 2020 and again on 31 July 2020. Tr. at 81:10–11 (“[PLAINTIFFS:] [W]e did ask for all of those things that [the government is] talking about [before we t]abled the issues . . . .”). They thus argue they “meet [the] diligence [standard] here because [they] asked for” this information “a long time ago” and continued to believe it “was a live and open issue.” Tr. at 128:5–6; Tr. at 104:25–105:9 (“[PLAINTIFFS:] We served the discovery request in the discovery period. We got objections from the [g]overnment. We conferred several times with [the government] about this to figure Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 10 of 23 - 11 - out what we are doing here . . . . We then had the conference with the Court because we had filed our motion [to compel] and the [g]overnment fought to arrange things in the way they arranged. So we walked away from that believing this [discovery] was a live and open issue.”); see 28 Dec. 2022 JSR at 2. The government’s first diligence argument, as noted supra Section IV.A, is plaintiffs filed their Motion to Compel on the final day of discovery and thus did not diligently pursue this request. Gov’t’s Disc. Resp. at 33–34; Tr. at 84:21–23 (“[THE GOVERNMENT:] [Plaintiffs] did nothing between March and July. There was no agreement to table during that four-month period. And then in July, they filed a motion [to compel.]”). Despite the already pending 11 February 2020 “request for all class hospital data,” the government contends plaintiffs “should have filed more motions to compel” earlier in the discovery period. Tr. at 85:4–10; Tr. at 107:2– 5 (“[PLAINTIFFS:] [The government is saying] we raised [these discovery issues] too long ago and didn’t come back often enough.”). To the extent the government alleges “filing a motion to compel on the very last day of discovery is . . . untimely, not diligent,” however, the government overlooks the significance of plaintiffs’ timely February 2020 request. See Gov’t’s Disc. Resp. at 34. Plaintiffs did not first make this request the day discovery closed; they asked the government to produce these documents early in the discovery period. Pls.’ Disc. Mot. at 4–5. Plaintiffs then “conferred several times with” the government and waited to see whether the government’s production would be sufficiently responsive to their February 2020 request despite the government’s objection. Tr. at 104:24–105:6 (“[PLAINTIFFS]: We served the discovery request in the discovery period. We got objections from the [g]overnment. We conferred several times with [the government] about this . . . We then . . . filed our motion. . . .”). Thus, only when it became clear the government was not going to produce plaintiffs’ requested information or any comparable data in the final days of the discovery period did plaintiffs file a motion to compel. Id. Further, the government’s cited cases for the proposition motions filed at the end of discovery are untimely are from out-of-circuit district courts and contain factual situations inapposite to this case. See Gov’t’s Disc. Resp. at 34 (first citing Rainbow Energy Mktg. Corp. v. DC Transco, LLC, No. 21-CV-313, 2022 WL 17365260, at *2 (W.D. Tex. Dec. 1, 2022) (denying a renewed motion to compel after: (1) the plaintiff’s initial motion was denied, (2) the plaintiff filed a motion to extend discovery after the period had closed, and (3) the plaintiff filed a renewed motion to compel on the last day of extended discovery); then citing U.S. ex rel. Gohil v. Sanofi U.S. Servs., Inc., No. 02-2964, 2020 WL 1888966, at *4 (E.D. Pa. Apr. 16, 2020) (rejecting a motion to compel in part because the requesting party made a “misrepresentation that it did not know” the importance of the information until just before the close of discovery); then citing Summy-Long v. Pa. State Univ., No. 06–cv–1117, 2015 WL 5924505, at *2, *5 (M.D. Pa. Oct. 9. 2015) (denying the plaintiff’s motion to compel “because [her] request [wa]s overly broad and unduly burdensome and because granting further discovery extensions . . . would strain the bounds of reasonableness and fairness to all litigants”); then citing In re Sulfuric Acid Antitrust Litig., 231 F.R.D. 331, 332–33, 337 (N.D. Ill. 2005) (acknowledging there is “great[] uncertainty” as to whether courts should deny motions to compel filed “very close to the discovery cut-off date” and recognizing “the matter is [generally] left to the broad discretion” of the trial court “to control discovery”); then citing Toone v. Fed. Express Corp., No. Civ. A. 96-2450, 1997 WL 446257, at *8 (D.D.C. July 30, 1997) (denying the plaintiff’s motion to compel filed on the last day of discovery because (1) given the close proximity to the original date for trial, “the defendant could have responded to the request . . . on Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 11 of 23 - 12 - the day of the original trial date,” and (2) it was moot); and then citing Babcock v. CAE-Link Corp., 878 F. Supp. 377, 387 (N.D.N.Y. 1995) (denying a motion to compel regarding discovery requests served on the last day of discovery). The Court therefore is not persuaded plaintiffs’ Motion to Compel was untimely. Schism, 316 F.3d at 1300 (quoting Moore, 927 F.2d at 1197). The government further contends “[p]laintiffs make no claim that it was impossible during two separate discovery periods for them to have served on the [g]overnment” this “proposed discovery request[].” Def.’s Disc. Resp. at 28. The government argues plaintiffs’ “tunnel vision” with respect to their legal theory caused plaintiffs to ignore “evidence, analysis, and law” not directly consistent with “their theories of the case, even when the [g]overnment brought such issues to the fore.” Id. at 29–30. “Turning a blind eye . . . [due to] legal error is not the same thing as having the inability to meet court deadlines,” according to the government, so “plaintiffs cannot demonstrate the requisite diligence.” Id. at 30. Although plaintiffs did not file “more motions to compel,” plaintiffs timely made their February 2020 request and timely filed their July 2020 Motion to Compel, supra. See Tr. at 85:4–9. To the extent the government alleges plaintiffs are not entitled to reopen discovery to amend their litigation strategy because the government “unmasked on summary judgment” plaintiffs’ “legal errors,” the government overlooks its own admission at oral argument, “[p]laintiffs’ request[s] [for] all class hospital data” in February and July 2020 sought the same data “[plaintiffs a]re asking for now.” Tr. 103:7–17; Def.’s Disc. Resp. at 28. Contrary to the government’s argument, plaintiffs therefore did not have “tunnel vision” causing them to ignore the requested evidence earlier in this litigation. See Def.’s Disc. Resp. at 28–30. Rather, plaintiffs requested this data during the appropriate discovery periods, only to have their request put on hold “because the [g]overnment ha[d] additional motions” it wished the Court to first decide. See Tr. at 85:12–21 (the court); Pls.’ Disc. Mot. at 4; App. to Pl.’s Disc. Mot. at 23; Tr. at 105:5–9; Def.’s Disc. Resp. at 14 (“Ultimately, the issues raised by this motion [to compel] were tabled by agreement of the parties.”); Tr. at 55:5–6 (“[PLAINTIFFS:] [T]he [g]overnment fought tooth and nail [to have the Court] hear [their] summary judgment motion first.”). Plaintiffs have thus considered these requests “a live and open issue” pending resolution of the government’s motions ever since, prompting them to file the instant Motion upon the Court issuing its Summary Judgment Order in November 2022. Tr. at 105:8–9 (“[PLAINTIFFS:] [W]e walked away from that [tabling discussion] believing this [discovery] was a live and open issue.”). Finally, while this “data [may] not [have been] necessary for summary judgment . . . [it is] for class certification.”7 Tr. at 111:10–11 (plaintiffs); Clippinger v. State Farm Mut. Auto. Ins. Co., 2021 WL 1894821, at *2 (“[C]lass certification discovery is not relevant [at the summary judgment stage].”); Tr. at 111:8–11 (“[PLAINTIFFS]: Well, I think like in Clippinger, there is some wisdom to the concept that maybe all of that data is not necessary for summary judgment, but then becomes necessary for class certification.”). To that end, the government 7 To the extent the government relies on plaintiffs’ 13 April 2020 statement plaintiffs “will not need this information [pertaining to hospitals other than the six named plaintiffs] prior to resolving [p]laintiffs’ [M]otion for [C]lass [C]ertification,” the government overlooks the substantial change in circumstances discussed infra Section IV.B.1. See Def.’s Disc. Resp. at 12–13 (quoting 21 May 2020 JSR at 3–4, ECF No. 140). The government likewise ignores plaintiffs’ agreement to table these discovery requests temporarily in October 2020, at which time plaintiffs acknowledged they would eventually re-raise these requests, even if—at the time—the plan was to do so after class certification. See Tr. at 85:12–21, 55:5–6. Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 12 of 23 - 13 - cannot “object[] to [plaintiffs’ document] request” in 2020 as “irrelevant and not proportional to the needs of the case insofar as plaintiffs seek . . . [information from] thousands of hospitals” only to now argue it is too late for this discovery and “plaintiffs [have] squandered . . . their allotted discovery periods . . . .” Gov’t’s Disc. Resp. at 11, 28; Tr. at 106:7–14 (“[PLAINTIFFS:] [I]t’s almost like the [g]overnment—they’re playing gotcha here. . . . [T]hey didn’t want to give us the information at the time [of discovery] and then they say, well, here’s summary judgment first and we can defer this until later . . . and now we’ve got a summary judgment opinion and now [they] say gotcha . . . .”). Nor can the government object to turning over the requested data in 2020 and now only to “use [plaintiffs’] lack of this data as a sword” come class certification. Tr. at 126:23–127:2. Indeed, “this has never been a case where” plaintiffs “said we’re not going to look at that [requested] data . . . [or] we’re not eventually going to be coming for that.” Tr. at 126:18–20. To the contrary, plaintiffs “requested this [data] during discovery,” and have long maintained this discovery “is the way to” “figure out . . . what are we dealing with” from a class perspective, including in the JSR filed after the Court’s November 2022 Summary Judgment Order, in which plaintiffs reserved the right to move for “additional class certification fact or expert discovery.” Tr. at 44:10, 56:21–22; 28 Dec. 2022 JSR at 2. By way of the government’s objection to plaintiffs’ February 2020 request and the parties’ tabling this request in October 2020, plaintiffs “even with the exercise of due diligence[,]” could not have obtained the requested information in a way sufficient to “meet the [Court’s discovery] timetable.” Slip Track Sys., Inc., 304 F.3d at 1270. Had they “received the data in 2020,” they “would have . . . run the DPP” for all potential class members as plaintiffs now request the opportunity to. Tr. at 113:12–15. Instead, plaintiffs did not have access to the data so continued to raise this request at all reasonably appropriate times. See Tr. at 112:8–9 (“[PLAINTIFFS:] [I]t was not possible for us to have done this [DPP] calculation without th[is] data.”). The Court accordingly finds plaintiffs were sufficiently diligent to justify a finding of good cause to reopen fact discovery as to plaintiffs’ document request for “critical data related to each Potential Class member hospital,” Pls.’ Disc. Mot. at 6. Slip Track Sys., Inc., 304 F.2d at 1270. 2. Prejudice In considering whether to reopen discovery, a trial court may consider, in addition to the requesting party’s diligence, “other relevant factors including, in particular, whether allowing the amendment . . . will prejudice [the opposing party].” High Point Design LLC, 730 F.3d at 1319 (quoting Kassner, 496 F.3d at 244). Prejudice related to the reopening of discovery may involve the delay of proceedings. Wordtech Sys., Inc. v. Integrated Networks Sols., Inc., 609 F.3d 1308, 1322 (Fed. Cir. 2010) (“[A] need to reopen discovery and therefore delay the proceedings supports a district court’s finding of prejudice from a delayed motion to amend the complaint.” (quoting Lockheed Martin Corp. v. Network Sols., Inc., 194 F.3d 980, 986 (9th Cir. 1999))). Further, RCFC 26(b)(1) provides: [P]arties may obtain discovery regarding any nonprivileged matter that is relevant to any party’s claim or defense and proportional to the needs of the case, considering the importance of the issues at stake in the action, the amount in controversy, the parties’ relative access to relevant information, the parties’ resources, the importance of the discovery in resolving the issues, and whether the Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 13 of 23 - 14 - burden or expense of the proposed discovery outweighs its likely benefit. RCFC 26(b)(1). “Questions of the scope and conduct of discovery are . . . committed to the discretion of the trial court.” Florsheim Shoe Co., Div. of Interco, Inc. v. United States, 744 F.2d 787, 797 (Fed. Cir. 1984). The government contends reopening discovery is prejudicial because “plaintiffs are proposing fact discovery on a scale never before undertaken in this case, a new expert report for the [g]overnment to then respond to, more expert depositions, and, no doubt, additional Daubert and class-related motions practice, resulting in substantial delay in bringing this matter to resolution.” Gov’t’s Disc. Resp. at 35–36 (footnote omitted). Plaintiffs, on the other hand, argue: (1) the sought after data “is . . . exclusively in [the government’s] possession”; and (2) their request will not prejudice the government because it will have an opportunity to oppose plaintiffs’ expert report. Pls.’ Disc. Reply at 3, 8. Even if there is any prejudice to the government, plaintiffs assert “the benefit to this case from the discovery would significantly outweigh any burden to the parties,” id. at 9, because of the assistance the discovery would provide the Court in ruling on class certification of the “narrower proposed class of plaintiffs,” Ingham Reg’l Med. Ctr., 163 Fed. Cl. at 428, left after summary judgment. Id. at 5, 9–10 (first citing Ingham Reg’l Med. Ctr., 163 Fed. Cl. at 428; and then citing Alta Wind I Owner Lessor C v. United States, 154 Fed. Cl. 204, 217 (2021)). Indeed, plaintiffs argue “produc[ing] the data . . . [now will be] more efficient [than production after certification] [a]s there will be less hypothetical back-and-forth between the parties [during certification briefing]” if the government’s data is available to all sides. Tr. at 118:2–6. Any prejudice could also be cured at trial by cross-examination of plaintiffs’ expert, plaintiffs contend. Pls.’ Disc. Reply at 10. The Court’s Summary Judgment Order indicated “the Court . . . needs further information regarding how plaintiffs in this post-summary judgment smaller class would meet the requirements for class certification” before deciding plaintiffs’ motion for class certification. Ingham Reg’l Med. Ctr., 163 Fed. Cl. at 428. To that end, mirroring their requests during the 2020 discovery period, plaintiffs ask the government to provide “(1) all information Kennell used in the DPP calculations for each Potential Class member hospital, as well as the underlying calculations, and (2) all hospital outpatient claims data available for each of the Potential Class member hospitals during the relevant time period.” Pls.’ Disc. Mot. at 8–9 (emphasis added). Plaintiffs argue this discovery will “benefit . . . this case” by providing the radiology data needed to determine “who is in the [now-narrowed] class.” Pls.’ Disc. Reply at 2, 9 (“Plaintiffs’ damages are now limited to those claims involving errors in the [g]overnment’s data”); Tr. at 57:1. The government has not refuted this claim. Tr. at 132:16–25 (“THE COURT: Just to make sure I understand, can you just quickly articulate the prejudice to the [g]overnment [from the Motion to Compel the data]? . . . [THE GOVERNMENT:] The [prejudice from the] [M]otion to [C]ompel is a significant reasonableness and proportionality concern . . . .”); Tr. at 56:18–57:14 (“[PLAINTIFFS:] [W]e really followed the Court’s lead, looking at the summary judgment opinion saying . . . go back and figure out now what we are dealing with . . . [with respect to] who is in the class . . . only on the [g]overnment’s [data] . . . . [THE GOVERNMENT:] I firmly disagree with that [procedural move]. I think that [p]laintiffs are trying to jump their original expert report . . . [a]nd under the law, [they] can’t.”). Rather, the government’s primary prejudice-related allegation is plaintiffs’ request violates the Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 14 of 23 - 15 - “[r]easonableness and proportionality” tenants set forth in RCFC 26(b)(1) because “[t]he [g]overnment has already incurred substantial expense,” Def.’s Disc. Resp. at 36, and plaintiffs have “not established a right to discovery of [non-named plaintiff] hospitals . . . based on what they have shown.” Tr. at 130:10–14. As the Court noted above, the government cannot argue plaintiffs’ document discovery request was too early before summary judgment and too late now that the government has incurred greater expense in litigating this case. See supra Section IV.A.1. Neither party knew the substantial impact summary judgment would have on the trajectory of this case, but the parties agreed to table plaintiffs’ discovery requests until after the Court’s summary judgment decision. See Ingham Reg’l Med. Ctr., 163 Fed. Cl. at 395; SC Tr. at 27:13–23. As evidenced by the recent data analysis performed by the government, after summary judgment, “[g]overnment data is required to evaluate which hospitals were affected by the [g]overnment’s breach of” contract. 25 Oct. 2023 JSR at 16. Plaintiffs cannot be expected to argue, and the Court cannot “rule on[,] numerosity [and related class certification factors] if there[ i]s no evidence regarding the approximate number of hospitals who would fit the . . . requirements allowed in the summary judgment order.” Tr. at 108:6–11. The parties must both have an opportunity to review the relevant data held by the government to determine which hospitals should, or should not, be included in the putative class.8 See id. The requested data, which includes the pertinent “outpatient claims data” and the information “used in the DPP calculations,” Pls.’ Disc. Mot. at 8–9, is therefore highly relevant to the next step in this case— class certification—and, rather than delay this case, having this data will enable the Court to decide plaintiffs’ motion for class certification more efficiently. Davita HealthCare Partners, Inc., 125 Fed. Cl. at 399 (“[T]he additional time . . . does not warrant the severe sanction of exclusion of data helpful to both parties in this litigation.”). To the extent the government argues the scale of the information requested is “grossly disproportionate to the needs of the case,” Tr. at 110:22, the government ignores: (1) plaintiffs’ and the Court’s substantial need to understand “who would be in the class” come time to brief and rule on class certification, Tr. at 55:24–25; and (2) the inability of plaintiffs and the Court to access this data “exclusively in [the government’s] possession” without production by the government, Pls.’ Disc. Reply at 3. See Davita HealthCare Partners, Inc., 125 Fed. Cl. at 399; RCFC 26(b)(1) (“[P]arties may obtain discovery regarding any nonprivileged matter that is relevant . . . and proportional . . . [considering] the parties’ relative access to [the] relevant information . . . .” (emphasis added)). The government likewise overlooks its ability to rebut any arguments plaintiffs make using this data both before and at trial. See Alta Wind I Owner Lessor C, 154 Fed. Cl. at 217 (“Other Court of Federal Claims judges have noted that providing the government an opportunity to file a rebuttal mitigates any prejudice that may have otherwise existed in providing plaintiff the opportunity to reopen the record.”). The documents plaintiffs request are therefore highly relevant and proportional to the needs of the case as they will provide plaintiffs and the Court 8 This is not a case where, as the government alleges, plaintiffs are “attempt[ing] to use discovery to find new clients upon learning of infirmities in the claims of putative class representatives.” Def.’s Disc. Resp. at 26–27 (first citing In re Williams-Sonoma, Inc., 947 F.3d 533, 540 (9th Cir. 2020); then citing Gawry v. Countrywide Home Loans, Inc., 395 F. App’x 152, 160 (6th Cir. 2010); Douglas v. Talk Am., Inc., 266 F.R.D. 464, 467 (C.D. Cal. 2010); Falcon v. Phillips Elec. N. Am. Corp., 304 F. App’x 896, 898 (2d Cir. 2008)). Rather, plaintiffs are requesting access to information held by the government to adequately brief class certification on behalf of the existing named plaintiffs and the putative class. See Pls.’ Disc. Mot. at 2 (“After completion of this discovery, [p]laintiffs would then file an amended motion for class certification.”). Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 15 of 23 - 16 - information necessary for a thorough analysis of class certification. Florsheim Shoe Co., Div. of Interco, Inc., 744 F.2d at 797; Davita HealthCare Partners, 125 Fed. Cl. at 399 (“[T]he additional time . . . does not warrant the severe sanction of exclusion of data helpful to both parties in this litigation.”); RCFC 26(b)(1). The Court accordingly finds any prejudice to the government caused by the scope of plaintiffs’ document request is mitigated by the benefit of the requested information to the efficient resolution of this case.9 See High Point Design LLC, 730 F.3d at 1319 (quoting Kassner, 496 F.3d at 244); Tr. at 118:2–6. The government will have ample opportunity to oppose any supplemental expert reports presented by plaintiffs using the requested data, including through cross-examination of plaintiffs’ experts at trial. See Alta Wind I Owner Lessor C, 154 Fed. Cl. at 217 (“Other Court of Federal Claims judges have noted that providing the government an opportunity to file a rebuttal mitigates any prejudice that may have otherwise existed in providing plaintiff the opportunity to reopen the record.”). The Court therefore finds plaintiffs were diligent in pursuing this document discovery request and the government will not experience prejudice sufficient to warrant denying plaintiffs’ Motion as to the request. The Court accordingly grants plaintiffs’ document discovery request as tailored, infra Section V, to the liability found in the Court’s November 2022 Summary Judgment Order, as there is good cause to do so. See High Point Design LLC, 730 F.3d at 1319 (quoting Kassner, 496 F.3d at 244); 6A CHARLES A. WRIGHT ET AL., FEDERAL PRACTICE AND PROCEDURE § 1522.2 (3d ed. 1998) (“What constitutes good cause sufficient to justify the modification of a scheduling order necessarily varies with the circumstances of each case.”); Pls.’ Disc. Mot. at 8–9. B. Plaintiffs’ Request to Depose a Government Corporate Designee Pursuant to Rule 30(b)(6) Plaintiffs also seek leave to “depose a [g]overnment corporate designee to identify which data sources were . . . available to the [g]overnment from the relevant time period, and where the relevant claims data resides.” Pls.’ Disc. Mot. at 8. Plaintiffs specify they are seeking “an hour . . . of deposition, just getting the [g]overnment to . . . confirm . . . the data sources” they have now and had during the relevant time periods “to make sure . . . there’s been no spoliation . . . .” Tr. at 117:22–25. In response, the government contends it previously identified an agency employee “as an individual with ‘discoverable information concerning TRICARE Encounter Data (TED), the DHA Military Health System Data Repository (MDR), and the creation, content and maintenance of records in both of those databases[,]’. . . [but] plaintiffs expressly declined a deposition during the established periods of fact and expert discovery[] and elected instead to proceed through limited interrogatories.” Defs.’ Disc. Resp. at 33. The government alleges “[p]laintiffs cannot reasonably be said to have been diligent in pursuing the 9 The Court emphasizes the government alone is in possession of the TMA data potentially comprising “tens of millions of records.” Tr. at 134:3. As such, the government is the only party capable of sorting and producing the large volumes of information. See RCFC 26(b)(1) (“[P]arties may obtain discovery regarding any nonprivileged matter that is relevant . . . and proportional . . . [considering] the parties’ relative access to [the] relevant information.”). Indeed, at the 19 December 2023 status conference, the government agreed it is capable of reviewing all data in its possession to identify line items of putative class members missed during DPP extraction due to issues akin to those impacting twelve out of the thirteen unextracted line items for Integris Baptist and Integris Bass Baptist. See 25 Oct. 2023 JSR; see also Ingham Reg’l Med. Ctr. v. United States, 163 Fed. Cl. 384, 409, 412 (2022). Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 16 of 23 - 17 - deposition that they now request when they intentionally eschewed [an offered deposition] during the established period of fact discovery.” Id. The government also reasserts its prejudice and diligence-related arguments discussed supra Section IV.A.1–2. See, e.g., id. at 28 (“Plaintiffs make no claim that it was impossible during two separate discovery periods for them to have served on the [g]overnment . . . the deposition notice . . . because it obviously was not.”); Tr. at 130:8–10 (“THE COURT: . . . So what’s the prejudice though? [THE GOVERNMENT]: Reasonableness and proportionality.”). 1. Diligence The government’s only novel diligence argument related to plaintiffs’ deposition request is plaintiffs previously declined an opportunity to depose an “an individual with ‘discoverable information concerning [TED and MDR], and the creation, content and maintenance of records in both of those databases.” Defs.’ Disc. Mot. Resp. at 33. The government otherwise broadly asserts plaintiffs were not diligent in pursuing their discovery requests. See, e.g., id. at 28. As determined supra Section IV.A.1, plaintiffs were diligent with respect to pursuing the government’s data and related information at the appropriate time during discovery. See, e.g., App. to Pls.’ Disc. Mot. at 23–24. The Court therefore only addresses the government’s argument related to previous deposition opportunities below. A “trial court ‘has wide discretion in setting the limits of discovery.’” Schism, 316 F.3d at 1300 (quoting Moore, 927 F.2d at 1197). Notwithstanding, modification of a court-imposed schedule may be done “only for good cause and with the judge’s consent.” RCFC 16(b)(4). “When assessing whether good cause has been shown, ‘the primary consideration is whether the moving party can demonstrate diligence.’” High Point Design LLC, 730 F.3d at 1319 (quoting Kassner, 496 F.3d at 244). The government’s primary contention—plaintiffs were not diligent in pursuing the requested deposition because they turned down an offer to depose a government employee in May 2019—assumes a party cannot be diligent if they have, at any time in the past, “eschewed [similar discovery.]” Defs.’ Disc. Mot. Resp. at 33. Over the past four and a half years, however, this case has changed substantially. See Alta Wind I Owner Lessor C, 154 Fed. Cl. at 227 (granting additional discovery upon remand and reassignment of the case); see also Geneva Pharms. Tech. Corp., 2005 WL 2132438, at *5 (“[M]aterial events have occurred since the last discovery period, which justice requires that the parties have an opportunity to develop through discovery.”). As noted by plaintiffs, “[t]he Court’s ruling on the [g]overnment’s Summary Judgment Motion . . . fundamentally altered the scope of this case,” Pls.’ Disc. Mot. at 8, by substantially narrowing the potential class members and limiting plaintiffs’ “damages . . . to [two] claims involving errors in the [g]overnment’s data,” Pls.’ Disc. Reply at 3. “[T]o analyze the extent of the . . . error[s]” in the government’s data, 25 Oct. 2023 JSR at 16, and perform “a more accurate damages calculation” for the putative class members, Pls.’ Reply at 7, plaintiffs therefore need to understand the data sources available to the government now and at the time of line item extraction. See 25 Oct. 2023 JSR at 17 (“The only way to evaluate whether Mr. Kennell failed to extract all relevant data . . . for the entire class is for the [g]overnment to produce . . . [the discovery] [p]laintiffs seek.”); Pls.’ Disc. Reply at 7. In 2020, in contrast, at which time plaintiffs “elected . . . to proceed through limited interrogatories” rather than conduct the government’s offered deposition, the Court had not yet narrowed the scope of the case or limited the damages calculations to the government’s data. Defs.’ Disc. Resp. at 33. During the Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 17 of 23 - 18 - initial discovery periods, plaintiffs still reasonably believed their own data might be relevant and did not yet understand the importance of the government’s data. See Pls.’ Disc. Reply at 3; see also 25 Oct. 2023 JSR at 16. Plaintiffs therefore did not exhibit a lack of diligence by not accepting the government’s offer to depose an individual whose testimony, at the time, was less relevant to the case. The government has accordingly failed to produce evidence sufficient to show plaintiffs were not diligent in pursuing the requested deposition. Schism, 316 F.3d at 1300; High Point Design LLC, 730 F.3d at 1319; see also Alta Wind I Owner Lessor C, 154 Fed. Cl. at 227. 2. Prejudice As noted supra Section IV.A.2, courts considering requests to reopen discovery may consider whether and to what extent granting the request will prejudice the opposing party, including via delaying the litigation. High Point Design, 730 F.3d at 1319 (quoting Kassner, 496 F.3d at 244); Wordtech Sys., 609 F.3d at 1322 (quoting Lockheed Martin Corp., 194 F.3d at 986). Regarding plaintiffs’ deposition request, the government argues granting plaintiffs’ deposition request will, like plaintiffs’ document requests, result in additional expense and “substantial delay in bringing this matter to resolution.” Def.’s Disc. Resp. at 36. Plaintiffs indicated at oral argument, however, the requested deposition will be “an hour,” with the goal being simply to understand “the data sources” in the government’s possession. Tr. at 117:22. To the extent this short deposition of a government employee, which the government was prepared to allow for several years ago, will allow the case to proceed “more efficient[ly]” to class certification with fewer “hypothetical back-and-forth[s] between the parties” related to considerations like numerosity, see Tr. at 118:2–6, the Court finds the minimal potential prejudice to the government from this deposition is outweighed by the value of this information to the later stages of this litigation. Davita HealthCare Partners, Inc., 125 Fed. Cl. at 399 (“[T]he additional time . . . does not warrant the severe sanction of exclusion of data helpful to both parties in this litigation.”). The Court therefore does not find the government’s argument regarding diligence or prejudice persuasive with respect to plaintiffs’ deposition request. The Court accordingly grants this request as there is good cause to do so.10 High Point Design LLC, 730 F.3d at 1319 (quoting Kassner, 496 F.3d at 244); 6A WRIGHT ET AL., FEDERAL PRACTICE AND PROCEDURE § 1522.2 (3d ed. 1998) (“What constitutes good cause sufficient to justify the modification of a scheduling order necessarily varies with the circumstances of each case.”). C. Supplemental Expert Report Plaintiffs finally request leave to “serve a supplemental expert report on . . . relevant class 10 To the extent the government intended its arguments related to proportionality and relevance to apply to plaintiffs’ deposition request, the Court is unpersuaded. See Def.’s Disc. Resp. at 36. A single deposition lasting approximately one hour on subject matter on which the government previously offered to permit a deposition is not disproportionate to the needs of this case. Schism v. United States, 316 F.3d 1259, 1300 (Fed. Cir. 2002) (quoting Moore v. Armour Pharm. Co., 927 F.2d 1194, 1197 (11th Cir. 1991)); RCFC 26(b)(1). Likewise, the subject matter—the sources of the data plaintiffs request access to—is highly relevant in ensuring a complete and accurate data set free of spoliation. Schism, 316 F.3d at 1300 (quoting Moore, 927 F.2d at 1197); RCFC 26(b)(1); see supra Section IV.A.2. Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 18 of 23 - 19 - issues” upon completion of the above-requested discovery. Pls.’ Disc. Mot. at 2. Specifically, plaintiffs wish to “submit a supplemental expert report analyzing the [government’s] data and applying the DPP methodology to the correct universe of outpatient radiology line items . . . .” Id. at 10; see also Pls.’ Disc. Reply at 3 (“Plaintiffs’ supplemental expert report would identify the scope of the class, as requested by the Court.”); Tr. at 73:10–14 (“[PLAINTIFFS:] [I]t is a very complex formula. And I think that it is something that . . . you would want someone with experience with these data line items going through and doing it . . . it’s [objective] math. . . . It’s essentially a claims administrator.”). Plaintiffs make clear their initial expert report was an attempt at extrapolating the named plaintiffs’ data “across the class to come up with . . . estimated number[s],” which they now wish to update with “the exact numbers” once they receive the government’s data. Tr. at 69:4–16. Plaintiffs contend “[r]eopening discovery is warranted where supplemental information from an expert would assist the Court in resolving important issues . . . [s]uch [as] . . . ‘presenting the Court with a more accurate representation of plaintiffs’ damages allegations.’” Pls.’ Disc. Reply at 6 (first citing Kennedy Heights Apartments Ltd. I, 2005 WL 6112633, at *3–4; and then quoting Alta Wind I Owner Lessor C, 154 Fed. Cl. at 217). Likening this case to Alta Wind, plaintiffs argue the Court should conclude here an “expert report will provide the Court with a damages estimate more accurately reflecting plaintiffs’ damages position [in light of the changes to the case rendered by summary judgment] . . . and therefore will likely assist the Court.” Id. at 7 (quoting Alta Wind, 154 Fed. Cl. at 216); Tr. at 68:17–69:16 (“[PLAINTIFFS]: With respect to Ms. Jerzak and the breach of contract, she did two things [in her report.] . . . One, she compared the hospital line items to the government line items for the named [p]laintiffs and did a straight objective calculation of what was the difference. . . . She also took those numbers and extrapolated them across the class to come up with an estimated number. THE COURT: A hypothetical. [PLAINTIFFS]: Yes . . . [r]ecognizing that if the class was certified . . . we’d have to do the exact numbers.”). Plaintiffs conclude this report will “not prejudice the [g]overnment in any way, and would actually benefit the [g]overnment” by providing an “opportunity . . . to oppose” additional contentions appropriate to the posture of the case. Id. at 8 (emphasis omitted) (citing Alta Wind I Owner Lessor C, 154 Fed. Cl. at 216). Plaintiffs note, however, “in [their] mind, this [report] is something that always was going to happen after certification” at the merits stage, Tr. at 73:15– 16 (emphasis added), as they do not “need an expert report for class certification because” the government “admitted breach,” Tr. at 96:3–4; Tr. at 63:22–64:6 (“[PLAINTIFFS:] [L]et’s say the Court certified a class here. The next step . . . is for merits. Someone is going to have to spit out a report saying here are the class members and when I run their . . . data . . . here are the differences and here’s the number that gets spit out.” (emphasis added)). The government reiterates its diligence and prejudice arguments discussed supra Sections IV.A–B with respect to plaintiffs’ request for leave to file a supplemental expert report. The government likewise refutes the notion plaintiffs’ current expert report is a “placeholder . . . that was[] [not] really meant to be real.” Tr. at 70:19–20. In other words, the government contends plaintiffs “meant th[eir earlier] expert report” to apply to “their currently pending motion for class cert[ification],” Tr. at 71:21–23, and now “seek to have the Court rescue them from their own litigation choices,” including the choice to file “expert damages models [that] could never be used to measure class damages.” Def.’s Disc. Resp. at 16–17. Plaintiffs should not be permitted to file a new expert report, according to the government, simply because “they have not . . . marshaled any legally cognizable expert evidence concerning the few claims that remain” Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 19 of 23 - 20 - after summary judgment. Def.’s Disc. Resp. at 17. To the extent plaintiffs concede the requested expert report “is for [the] merits” stage and not necessary for class certification, however, the government believes “a class cannot be certified without a viable expert damages methodology meeting the requirements of Comcast,” meaning plaintiffs’ pending motion for class certification automatically fails because “the only expert evidence in the record that bears on the two types of breaches found by the Court is . . . offered by the [g]overnment.” Id. at 22– 23 (citing Comcast Corp. v. Behrend, 569 U.S. 27, 33–34 (2013)). Indeed, according to the government, “plaintiffs are left with no expert model at all as to the few remaining contract claims,” meaning they cannot adequately allege “damages are capable of measurement on a class[-]wide basis” as required by Comcast. Id. at 24 (quoting Comcast, 569 U.S. at 34). Concerning plaintiffs’ request for leave to file an expert report, the government broadly asserts plaintiffs were not diligent in pursuing their discovery requests. See, e.g., Def.’s Disc. Resp. at 28. As determined supra Section IV.A.1, however, plaintiffs were diligent with respect to pursuing the requested discovery generally. Plaintiffs requested the relevant data in February and July 2020 and planned to replace “the extrapolation” present in their earlier expert reports with analysis “using actual data” upon completion of this requested discovery. See supra Section IV.A.1; Tr. at 136:15–23. The Court’s November 2022 Summary Judgement Order narrowed the scope of this case and further highlighted the need for this additional discovery related to the remaining issues and potential class members. See supra Section IV.A.1, B; Ingham Reg’l Med. Ctr., 163 Fed. Cl. at 427. Further, to the extent the government alleges plaintiffs requested expert report is prejudicial, the government will have sufficient time and opportunity to rebut any supplemental expert report filed by plaintiffs. See supra Section IV.A.2, B.2; Alta Wind I Owner Lessor C, 154 Fed. Cl. at 217 (“Other Court of Federal Claims judges have noted that providing the government an opportunity to file a rebuttal mitigates any prejudice that may have otherwise existed in providing plaintiff the opportunity to reopen the record.”). The contemplated expert report, which will perform the DPP analysis for outpatient radiology claims data within the scope of the Court’s November 2022 liability findings for each putative class member hospital using “only the [government’s] data” as required by the Court’s Summary Judgment Order, could also aid the Court at the merits stage in determining “the amount[] that each hospital is owed.” Tr. at 78:7–15. The requested report therefore would likely not be prejudicial to the government to such an extent as to “warrant the severe sanction of exclusion of [useful] data.” Davita HealthCare Partners, Inc., 125 Fed. Cl. at 399; High Point Design LLC, 730 F.3d at 1319 (quoting Kassner, 496 F.3d at 244); 6A CHARLES A. WRIGHT ET AL., FEDERAL PRACTICE AND PROCEDURE § 1522.2 (3d ed. 1998) (“What constitutes good cause sufficient to justify the modification of a scheduling order necessarily varies with the circumstances of each case.”). Plaintiffs acknowledge, however, the updated calculations they plan to include in their requested expert report are not necessary until “after [class] certification”—at the merits stage. Tr. at 73:15–16. At oral argument, plaintiffs clearly stated they do not “need an expert report for class certification,” which is the next step in this litigation. Tr. at 96:3–4. To the extent the government argues plaintiffs’ certification motion will necessarily fail because plaintiffs lack evidence “damages are [measurable] . . . on a class[-]wide basis” in response to this statement by plaintiffs, Def.’s Disc. Rep. at 23 (quoting Comcast, 569 U.S. at 34), plaintiffs respond the DPP Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 20 of 23 - 21 - is the requisite means of “calculat[ing] damages for every single class member,” Tr. at 136:4–5. While the Court reserves judgment as to plaintiffs’ class certification motion, plaintiffs’ argument the DPP provides their model for calculating damages on a class-wide basis because it is a uniform model applicable to all putative class members is sufficient to suggest plaintiffs need not fully calculate alleged damages in a supplemental expert report at this time. Tr. at 54:9–15 (“[PLAINTIFFS:] I think the type of cases that [the government] is talking about [like Comcast] where there’s been [a failure by the plaintiffs to actually address the calculation of class-wide damages, are inapposite because] we haven’t offered a model that is deviating from the contract. What we’re saying . . . the experts are going to . . . essentially crunch[ the] numbers [using the DPP].”). Plaintiffs can do so if and when the merits of this case are argued at trial. This is not a case like Comcast, in which the plaintiffs presented to the court “a methodology that identifies damages that are not the result of the wrong” at issue. Comcast, 569 U.S. at 37. Here, in contrast, the parties indicated at oral argument plaintiffs’ proffered DPP methodology from the parties’ DPP Contracts appears capable of calculating damages for all potential class members. Tr. at 136:1–5 (“[PLAINTIFFS:] But what I will tell you that we’re going to do with the data is we are going to have the auditor [i.e., the expert] plug [the government’s] data into the DPP. That is the model. That is [what] the contract . . . dictates . . . how you calculate damages for every single class member.”); Tr. at 54:12–13 (“[PLAINTIFFS:] [W]e haven’t offered a model that is deviating from the contract.”); Tr. at 93:2–5 (“THE COURT: But the model is just what you said is—if I understood correctly, is that the report is just DPP data discrepancy output. [THE GOVERNMENT]: For each individual [p]laintiff.”); see Tr. 93:2–95:25. The Court accordingly denies plaintiffs’ request for an expert report without prejudice in the interest of the efficient disposition of plaintiffs’ class certification motion. High Point Design LLC, 730 F.3d at 1319 (quoting Kassner, 496 F.3d at 244); 6A CHARLES A. WRIGHT ET AL., FEDERAL PRACTICE AND PROCEDURE § 1522.2 (3d ed. 1998) (“What constitutes good cause sufficient to justify the modification of a scheduling order necessarily varies with the circumstances of each case.”). To the extent plaintiffs “would want in [the] merits” stage an expert report from an “auditor to make sure” the parties “all agree on” damages calculated via the DPP, plaintiffs may refile this motion at that time. Tr. at 96:12–13 (plaintiffs). V. Scope of Granted Discovery and Next Steps As discussed supra Section IV: 1. The Court grants plaintiffs’ deposition request. 2. The Court grants plaintiffs’ document requests as follows: Plaintiffs are permitted to serve amended document discovery requests for all putative class member hospitals tailored to seek only those documents required for plaintiffs to identify “breach[es] of TMA’s [contractual] duty” under the DPP Contract akin to either: (1) the government’s failure to extract “thirteen line items for Integris Baptist and Integris Bass Baptist”; or (2) the government’s failure to adjust “five . . . line items” for Integris Baptist “during the DPP because of an alternate zip code.” See Ingham Reg’l Med. Ctr. v. United States, 163 Fed. Cl. 384, 409, 412 (2022). This specification ensures plaintiffs’ requests remain within the scope of the Court’s findings of liability in November 2022. Id. The Court notes at the 19 December 2023 status conference the government agreed it is possible to Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 21 of 23 - 22 - execute the same analysis performed on the named plaintiffs’ data in the 25 October 2023 JSR on the government’s data for all putative class members. 11 3. The Court denies plaintiffs’ request to file a supplemental expert report without prejudice. Plaintiffs may move to file an updated expert report later in this litigation as necessary, at which time the government will be permitted to file a response report. Within three weeks of the date this Order is issued, the parties shall file a JSR comprised of the following: 1. Plaintiffs’ discovery requests revised in accordance with the above clarifications; 2. The parties’ proposed schedule for discovery, including a timeline for plaintiffs’ deposition and the exchange of documents between the parties; and 3. The parties’ proposed schedule for re-briefing class certification after all discovery closes, including a proposed timeline for the filing of new expert reports. As noted by the Court at the 19 December status conference, plaintiffs’ next step should be to analyze the government’s data for the six named plaintiffs already in plaintiffs’ possession to assist plaintiffs in tailoring their document requests as discussed above. Further, at the 19 December 2023 status conference, the parties agreed the partial grant of plaintiffs’ Discovery Motion moots plaintiffs’ pending Motion to Certify Class Action and Appoint Class Counsel, ECF No. 146, as the parties will need to re-brief these issues following the narrowing of this case on summary judgment and the upcoming additional discovery. The government agreed its pending Motion to Exclude Inadmissible Evidence Relied Upon in Plaintiffs’ Motion for Class Certification, ECF No. 204, is accordingly moot. The government may refile a similar motion if needed during future class certification briefing. Plaintiffs likewise agreed to withdraw without prejudice their Motion to Exclude the Expert Opinions and Continued Participation of Kennell, ECF No. 251, pending further discovery and briefing. Further, plaintiffs agreed, given the scope of this case after summary judgment, the expert report of Fay is moot. Accordingly, the government’s Motion to Exclude the Expert Opinions of Fay, ECF No. 206, is moot. Finally, plaintiffs stated they plan to file a new expert report replacing that of Jerzak later in this litigation. The government noted at the 19 December status conference plaintiffs’ replacement of Ms. Jerzak’s current report will render the government’s Motion to Exclude the Expert Opinions of Jerzak, ECF No. 205, moot as well. 11 As discussed supra note 4, in the 25 October 2023 JSR, the government explained why twelve of the thirteen line items improperly excluded for Integris Baptist and Integris Bass Baptist were not extracted. At the 19 December 2023 status conference, the government indicated it can now search its database for line items improperly excluded due to this same error for all hospitals that participated in the DPP. The government noted, however, it is not aware of what caused the thirteenth line item to be missed so cannot create search criteria appropriate to identifying other similar misses. Finally, to identify missed alternate zip codes, the government stated it would need zip code information from plaintiffs and the putative class members. Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 22 of 23 - 23 - VI. Conclusion For the foregoing reasons, and as specified supra Section V, the Court GRANTS-INPART and DENIES-IN-PART plaintiffs’ Motion for Leave to Conduct Certain Limited Additional Discovery and to Submit Supplemental Expert Report, ECF No. 269, and FINDS as MOOT plaintiffs’ Motion for Clarification or, in the Alternative, to Compel Production, ECF No. 161.12 As noted supra Section V, the Court FINDS as MOOT plaintiffs’ Motion to Certify Class Action and Appoint Class Counsel, ECF No. 146, the government’s Motion to Exclude Inadmissible Evidence Relied Upon in Plaintiffs’ Motion for Class Certification, ECF No. 204, the government’s Motion to Exclude the Expert Opinions of Fay, ECF No. 206, and the government’s Motion to Exclude the Expert Opinions of Jerzak, ECF No. 205. As agreed to at the 19 December 2023 status conference, plaintiffs SHALL WITHDRAW their Motion to Exclude the Expert Opinions and Continued Participation of Kennell, ECF No. 251, without prejudice. Finally, as noted at oral argument, see Tr. at 139:10–140:8, the Court STRIKES the government’s Notice of Additional Authority, ECF No. 273, as deficient and GRANTS the government’s Unopposed Motion for Leave to File Notice of Supplemental Authority, ECF No. 274, for good cause shown. The parties SHALL FILE the joint status report discussed supra Section V on or before 23 January 2024. IT IS SO ORDERED. s/ Holte HOLTE Judge 12 At oral argument, the parties agreed the Court ruling on plaintiffs’ current Discovery Motion is also a “ruling on [plaintiffs’ previous Motion to Compel,] ECF [No.] 161.” Tr. at 139:2–9. Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24","You can only respond with the information in the context block. Please give your response in a simple tone that could be shared with a non-legal audience and easily understood. Please summarize the determinations made in the text provided and explain the consequences of the rulings made. In the United States Court of Federal Claims No. 13-821 (Filed: 2 January 2024) *************************************** INGHAM REG’L MEDICAL CENTER, * n/k/a MCLAREN GREATER LANSING, * et al., * * Plaintiffs, * * v. * * THE UNITED STATES, * * Defendant. * * Plaintiffs are six hospitals purporting to represent a class of approximately 1,610 hospitals across the United States in a suit requesting, among other things, the Court interpret what the Federal Circuit has deemed an “extremely strange” contract.1 This contract arose when hospitals complained the government underpaid reimbursements for Department of Defense Military Health System, TRICARE, outpatient services rendered between 2003 and 2009. In 2011, after completion of a data analysis, the government voluntarily entered a discretionary payment process contract with plaintiffs and offered net adjusted payments. In November 2022, after nine years of litigation and one Federal Circuit appeal, the Court granted in part and denied in part the government’s Motion for Summary Judgment. As the only surviving breach of contract claims concern the government’s duty to extract, analyze, and adjust line items from its 1 9 June 2022 Oral Arg. Tr. at 161:7–13, ECF No. 259 (“THE COURT: So the Federal Circuit panel, when the case was argued, characterized this agreement as extremely strange. [THE GOVERNMENT]: That is accurate. It is extremely strange. THE COURT: It is extremely strange? [THE GOVERNMENT]: It is.”). Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 1 of 23 - 2 - database, the Court required the parties to file a joint status report regarding the effect of summary judgment on plaintiffs’ Renewed Motion to Certify a Class Action. Following a status conference, plaintiffs filed a discovery motion related to class certification. For the following reasons, the Court grants-in-part and denies-in-part plaintiffs’ Motion. I. Background A. Factual and Procedural History2 TRICARE is a “military health care system” which “provides medical and dental care for current and former members of the military and their dependents.” Ingham Reg’l Med. Ctr. v. United States, 874 F.3d 1341, 1342 (Fed. Cir. 2017). TRICARE Management Activity (TMA), a “field office in the Defense Department [(DoD)],” managed the TRICARE system.3 N. Mich. Hosps., Inc. v. Health Net Fed. Servs., LLC, 344 F. App’x 731, 734 (3d Cir. 2009). In 2001, Congress amended the TRICARE statute to require DoD to follow Medicare rules when reimbursing outside healthcare providers. Ingham Reg’l Med. Ctr., 874 F.3d at 1343 (citing 10 U.S.C. § 1079(j)(2) (2002)). To facilitate transition to Medicare rules, in 2005, DoD issued a Final Rule which specified “[f]or most outpatient services, hospitals would receive payments ‘based on the TRICARE-allowable cost method in effect for professional providers or the [Civilian Health and Medical Program of the Uniformed Services] (CHAMPUS) Maximum Allowable Charge (CMAC).’” Id. (quoting TRICARE; Sub-Acute Care Program; Uniform Skilled Nursing Facility Benefit; Home Health Care Benefit; Adopting Medicare Payment Methods for Skilled Nursing Facilities and Home Health Care Providers, 70 Fed. Reg. 61368, 61371 (Oct. 24, 2005) (codified as amended at 32 C.F.R. § 199)). The TRICARE-allowable cost method “applied until 2009, when TRICARE introduced a new payment system for hospital outpatient services that was similar to the Medicare [Outpatient Prospective Payment System (OPPS)].” Id. In response to hospital complaints of payment issues, TRICARE hired Kennell and Associates, a consulting firm, to “undertake a study [(‘Kennell study’)] of the accuracy of its payments to the hospitals.” Ingham Reg’l Med. Ctr., 874 F.3d at 1343–44. The Kennell study “compared CMAC payments to the payments that would have been made using Medicare payment principles, and determined that DoD ‘(1) underpaid hospitals for outpatient radiology but, (2) correctly paid hospitals for all other outpatient services.’” Id. at 1344 (emphasis omitted) (citation omitted). From the Kennell study findings, “DoD created a discretionary payment process [(DPP)],” and, on 25 April 2011, DoD notified hospitals by letter of the process for them to “request a review of their TRICARE reimbursements (the ‘Letter’)” and “published a document titled ‘NOTICE TO HOSPITALS OF POTENTIAL ADJUSTMENT TO PAST PAYMENTS FOR OUTPATIENT RADIOLOGY SERVICES’ (the ‘Notice’)” on the TRICARE website. Id.; App. to Def.’s MSJ at A3–A9, ECF No. 203-1. The Notice described a nine-step methodology to “govern the review of payments for hospital outpatient radiology services and [the] payment 2 The factual and procedural history in this Order contains only those facts pertinent to plaintiffs’ Motion for Discovery, ECF No. 269. 3 The Defense Health Agency now manages activities previously managed by TMA. Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 2 of 23 - 3 - of any discretionary net adjustments” by which hospitals could “request an analysis of their claims data for possible discretionary adjustment.” App. to Def.’s MSJ at A7. On 21 October 2013, plaintiffs brought this action claiming the government underpaid them for certain outpatient medical services they provided between 1 August 2003 and 1 May 2009. See Ingham Reg’l Med. Ctr. v United States, 126 Fed. Cl. 1, 9 (2016), aff’d in part, rev’d in part, 874 F.3d 1341 (Fed. Cir. 2017). Plaintiffs allege the approximately six years of underpayment breached two contracts and violated various statutory and regulatory provisions. Id. Plaintiffs estimate several thousand hospitals submitted requests for discretionary payment, including the six named plaintiffs in this case. See id. at 16. Plaintiffs therefore seek to represent a class of as many as 1,610 similarly situated hospitals. See Pls.’ Mem. in Supp. of Mot. to Certify at 1, ECF No. 77; see also Mot. to Certify, ECF No. 76. On 11 February 2020, during the parties’ second discovery period, plaintiffs requested from the government “[a]ny and all data concerning hospital outpatient services claims and TRICARE reimbursement for hospital outpatient services claims during the relevant time period . . . .” See App. to Pls.’ Disc. Mot. at 23, ECF No. 269; Gov’t’s Disc. Resp. at 11, ECF No. 270. The government rejected this request for records from “thousands of hospitals . . . that are not [named] plaintiffs” on 16 March 2020 and instead only “produce[d] the data requested for the six plaintiffs in this lawsuit.” App. to Pls.’ Disc. Mot. at 29. Plaintiffs filed a motion to clarify the case schedule or, in the alternative, to compel discovery of “data and documents relating to the [g]overnment’s calculation of payments under the [DPP] for all putative class members, not just the named [p]laintiffs” on 31 July 2020, the last day of discovery. See Pls.’ Mot. to Compel (“Pl.’s MTC”) at 2, ECF No. 161 (emphasis added). In response, the government stated, “[t]here is no basis for the Court to . . . compel extraneous discovery of hospitals that are not now in this lawsuit.” Def.’s Resp. to Pl.’s MTC (“Def.’s MTC Resp.”) at 2, ECF No. 166. During a status conference on 13 October 2020, the parties agreed to table plaintiffs’ discovery request and associated Motion to Compel pending resolution of the government’s then-pending Motion for Reconsideration, ECF No. 150, and any additional potentially dispositive motions. See 13 Oct. 2020 Tr. (“SC Tr.”) at 27:13–28:9, ECF No. 178 (“THE COURT: . . . So to state differently, then, [plaintiffs agree] to stay consideration of this particular [discovery] issue until class certification is decided? [PLAINTIFFS:] Yes, that would be fine. THE COURT: . . . [W]ould the [g]overnment agree with that? [THE GOVERNMENT:] Yes, [y]our [h]onor . . . [but] the [g]overnment still intends to file a motion for summary judgment. . . . THE COURT: Okay. So on the [g]overnment’s motion for summary judgment . . . that should probably not be filed until at least after the motion for reconsideration is resolved? [THE GOVERNMENT:] That’s correct.”). On 5 June 2020, plaintiffs filed a renewed motion to certify a class and appoint class counsel (“Pls.’ Class Cert.”), ECF No. 146, which the parties fully briefed. See Def.’s Class Cert. Resp., ECF No. 207; Pls.’ Class Cert. Reply, EF No. 226. On 26 August 2021, the government filed a motion for summary judgment (“Def.’s MSJ”), ECF No. 203. Plaintiffs filed an opposition to the government’s motion for summary judgment on 4 February 2022 (“Pls.’ MSJ Resp.”), ECF No. 225, and on 11 March 2022, the government filed a reply (“Def.’s MSJ Reply”), ECF No. 234. Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 3 of 23 - 4 - “The Court [granted] the government’s [M]otion for [S]ummary [J]udgment as to plaintiffs’ hospital-data duty and mutual mistake of fact claims but [denied] the government’s [M]otion as to plaintiffs’ TMA-data duty and alternate zip code claims[,] . . . [and stayed] the evidentiary motions” on 28 November 2022. Ingham Reg’l Med. Ctr. v. United States, 163 Fed. Cl. 384, 428 (2022). The Court, deeming the government’s settlement arrangements with plaintiffs to be contracts (the “DPP Contracts”), specifically found “the DPP Contract[s] only obligated TMA to use its data, not the hospitals’ data,” leaving the government’s data as the only set relevant to this case. Id. at 427. The Court held the government’s (1) “failure to extract thirteen line items [meeting all qualifications for extraction] for Integris Baptist and Integris Bass Baptist”; and (2) failure to adjust “five . . . line items [for Integris Baptist] during the DPP because of an alternate zip code” constituted breach of the DPP Contracts. Id. at 409–10, 412. “Based on the summary judgment holding . . . the Court [found it needed] further information regarding how plaintiffs in this post-summary judgment smaller class would meet the requirements for class certification.” Id. “The Court accordingly decline[d] to rule on plaintiffs’ class certification motion . . . [a]s the only surviving claims are breach of contract for failure to follow the DPP in a few limited circumstances, [and] the parties did not adequately brief the narrower proposed class of plaintiffs arising under the remaining claims.” Id. The Court ordered the parties to file “a joint status report [(JSR)] providing the parties’ views on class certification for the smaller class of plaintiffs affected by the government’s breach of contract for failure to follow the DPP in limited circumstances and on whether further briefing is necessary.” Id. On 28 December 2022, the parties filed a JSR providing their opposing positions on whether plaintiffs can request further discovery related to class certification: “plaintiffs expressly reserve, and do not waive, any rights that they may currently have, or may have in the future, with respect to additional class certification fact or expert discovery”; and “the [g]overnment opposes any further fact or expert discovery in connection with plaintiffs’ amended/supplemental motion for class certification, and, in agreeing to the foregoing briefing schedule, is not agreeing to any further fact or expert discovery in this case.” 28 Dec. 2022 JSR at 2, ECF No. 262. Plaintiffs then filed a motion requesting leave to conduct further discovery and submit a supplemental expert report on 21 March 2023 (“plaintiffs’ Discovery Motion”). Pls.’ Disc. Mot., ECF No. 269. The government filed a response on 21 April 2023. Gov’t’s Disc. Resp. Plaintiffs filed a reply on 9 May 2023. Pls.’ Disc. Reply, ECF No. 271. The Court held oral argument on 19 July 2023. See 5 June 2023 Order, ECF No. 272; 19 July 2023 Oral Arg. Tr. (“Tr.”), ECF No. 276. On 31 August 2023, following oral argument on plaintiffs’ Discovery Motion, the government filed an unopposed motion to stay the case for the government to complete a “second look at the records [analyzed] . . . in the July 2019 expert report of Kennell . . . that were the subject of one of the Court’s liability rulings on summary judgment.” Def.’s Mot. to Stay at 1, ECF No. 277. The Court granted this Motion on the same day. Order, ECF No. 278. On 25 October 2023, the parties filed a JSR, ECF No. 284, in which the government addressed its findings4 and “proposed [a] way forward” in this case. 25 Oct. 2023 JSR at 2. In 4 In the 25 October 2023 JSR, the government explained twelve of the thirteen line items the government failed to extract for Integris Baptist and Integris Bass Baptist, see Ingham Reg’l Med. Ctr. v. United States, 163 Fed. Cl. 384, 412 (2022), were missed due to a “now-known” error in which “a very small set of patients comprised of military spouses . . . under age 65” were overlooked because they “receive Medicare Part A” but not Medicare Part B, Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 4 of 23 - 5 - response to the government’s data analysis, plaintiffs noted in the JSR “the [g]overnment’s update makes clear that [additional g]overnment data is required to evaluate which hospitals were affected by the [g]overnment’s breach of the DPP.” Id. at 16. Plaintiffs then likewise “[p]roposed [n]ext [s]teps” in this case, beginning with resolution of their Discovery Motion. Id. at 18. On 19 December 2023, the Court held a telephonic status conference to understand the technical aspects of plaintiffs’ discovery requests as they relate to the DPP process and algorithm. See Scheduling Order, ECF No. 285. B. Discovery Requests at Issue Plaintiffs seek leave to perform additional discovery stemming from the Court’s summary judgment holding “TMA [breached its duty] . . . to extract, analyze, and adjust radiology data from its database” by failing to (1) adjust “five . . . line items [for Integris Baptist] during the DPP because of an alternate zip code” and (2) “extract . . . thirteen line items [meeting the criteria for extraction] for Integris Baptist and Integris Bass Baptist.” Ingham Reg’l Med. Ctr., 163 Fed. Cl. at 409–10, 412. Plaintiffs’ sought-after discovery includes a request for “the same data for the [putative] class hospitals” as plaintiffs currently “have [for the] six named [p]laintiffs,” Tr. at 50:14–19, to assist plaintiffs in identifying “line items in [TMA’s radiology data] . . . that met the [DPP C]ontract criteria but were excluded from the adjustment . . . .” Gov’t’s Disc. Resp. at 15. In all, plaintiffs “seek leave to (1) depose a [g]overnment corporate designee, (2) serve document requests, and (3) thereafter serve a supplemental expert report on the relevant class issues.” Pls.’ Disc. Mot. at 2. Plaintiffs further detail the purpose of each request: First, [p]laintiffs seek leave to depose a [g]overnment corporate designee to identify the various data sources in the [g]overnment’s possession from the relevant time period. Second, [p]laintiffs seek leave to serve . . . document requests to obtain critical data related to each Potential Class member hospital. Third, once the above discovery is completed, [p]laintiffs seek leave to serve a supplemental expert report that applies the DPP methodology to the relevant claims data to identify the Final Class. Id. at 6–7 (footnote omitted) (citations omitted). The second request, mirroring plaintiffs’ February 2020 request for “[a]ny and all data concerning hospital outpatient service claims and TRICARE reimbursement for hospital outpatient services claims during the relevant time period,” App. to Pl.’s Disc. Mot. at 23, comprises “(1) all information Kennell used in the DPP calculations for each Potential Class member hospital, as well as the underlying calculations[;] and (2) all hospital outpatient claims meaning the “outpatient services that these individuals receive are paid for . . . by TRICARE.” 25 Oct. JSR at 4, ECF No. 284. As a result of this Medicare arrangement, line items for this group of patients were not extracted as the individuals were mistakenly deemed Medicare, rather than TRICARE, recipients for procedures within the scope of the DPP. Id. The cause of the thirteenth unextracted line item remains unclear. Id. at 5. Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 5 of 23 - 6 - data available for each of the Potential Class member hospitals during the relevant time period.” Pl.’s Disc. Mot. at 8–9. This request includes: (1) CMAC rate files “needed to apply the DPP methodology”; (2) “[d]ata on hospital outpatient radiology services claim line items for each Potential Class member hospital”; (3) “[d]ata concerning hospital outpatient services claim line items for each Potential Class member hospital” to verify the radiology files are complete; and (4) “TRICARE Encounter Data (‘TED’) records and Health Care Service Records (‘HCSR’).” Id. at 9–10. II. Applicable Law This court’s application of the Rules of the United States Court of Federal Claims (“RCFC”) is guided by case law interpreting the Federal Rules of Civil Procedure (FRCP). See RCFC rules committee’s note to 2002 revision (“[I]nterpretation of the court’s rules will be guided by case law and the Advisory Committee Notes that accompany the Federal Rules of Civil Procedure.”). Regarding the scope of discovery, the rules of this court provide: [P]arties may obtain discovery regarding any nonprivileged matter that is relevant to any party’s claim or defense and proportional to the needs of the case, considering the importance of the issues at stake in the action, the amount in controversy, the parties’ relative access to relevant information, the parties’ resources, the importance of the discovery in resolving the issues, and whether the burden or expense of the proposed discovery outweighs its likely benefit. RCFC 26(b)(1). “Questions of the scope and conduct of discovery are . . . committed to the discretion of the trial court.” Florsheim Shoe Co., Div. of Interco, Inc. v. United States, 744 F.2d 787, 797 (Fed. Cir. 1984). The Court of Federal Claims generally “afford[s] a liberal treatment to the rules of discovery.” Securiforce Int’l Am., LLC v. United States, 127 Fed. Cl. 386, 400 (2016), aff’d in part and vacated in part on other grounds, 879 F.3d 1354 (Fed. Cir. 2018), cert. denied, 139 S. Ct. 478 (2018) (mem.). “[T]he [C]ourt must be careful not to deprive a party of discovery that is reasonably necessary to afford a fair opportunity to develop and prepare the case.” Heat & Control, Inc. v. Hester Indus., Inc., 785 F.2d 1017, 1024 (Fed. Cir. 1986) (quoting FED. R. CIV. P. 26(b)(1) advisory committee’s note to 1983 amendment). Further, “[a] trial court ‘has wide discretion in setting the limits of discovery.’” Schism v. United States, 316 F.3d 1259, 1300 (Fed. Cir. 2002) (quoting Moore v. Armour Pharm. Co., 927 F.2d 1194, 1197 (11th Cir. 1991)). This court has previously found such “discretion [extends to] . . . deciding whether to grant a motion to . . . reopen discovery.” Croman Corp. v. United States, 94 Fed. Cl. 157, 160 (2010) (citing Te-Moak Bands of W. Shoshone Indians of Nev. v. United States, 948 F.2d 1258, 1260 (Fed. Cir. 1991)); see also Wordtech Sys., Inc. v. Integrated Networks Sols., Inc., 609 F.3d 1308, 1322–23 (Fed. Cir. 2010) (citing Coleman v. Quaker Oats Co., 232 F.3d 1271, 1294 (9th Cir. 2000)) (applying Ninth Circuit law in determining trial court did not abuse its discretion in refusing to reopen discovery). Notwithstanding, modification of a court-imposed schedule, including a discovery schedule, may be done “only for good cause and with the judge’s consent.” RCFC 16(b)(4). In Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 6 of 23 - 7 - High Point Design, the Federal Circuit applied Second Circuit law5 when discussing the good cause standard of FRCP 16(b)(4) for amending a case schedule. “When assessing whether good cause has been shown, ‘the primary consideration is whether the moving party can demonstrate diligence.’” High Point Design LLC v. Buyers Direct, Inc., 730 F.3d 1301, 1319 (Fed. Cir. 2013) (quoting Kassner v. 2nd Ave. Delicatessen, Inc., 496 F.3d 229, 244 (2d Cir. 2007)); see also Adv. Software Design Corp. v. Fiserv, Inc., 641 F.3d 1368, 1381 (Fed. Cir. 2011) (“Under the good cause standard, the threshold inquiry is whether the movant has been diligent.” (citing Sherman v. Winco Fireworks, Inc., 532 F.3d 709, 717 (8th Cir. 2008))). This “requires a showing that even with the exercise of due diligence the moving party could not meet the order’s timetable.” Slip Track Sys., Inc. v. Metal-Lite, Inc., 304 F.3d 1256, 1270 (Fed. Cir. 2002) (applying Ninth Circuit law in finding defendant’s attempt to amend the pleadings first required modification of the scheduling order under FRCP 16(b)(4)). Trial courts may also consider “other relevant factors including, in particular, whether allowing the amendment . . . will prejudice [the opposing party].” High Point Design, 730 F.3d at 1319 (quoting Kassner, 496 F.3d at 244); 6A WRIGHT ET AL., FEDERAL PRACTICE AND PROCEDURE § 1522.2 (3d ed. 1998) (“What constitutes good cause sufficient to justify the modification of a scheduling order necessarily varies with the circumstances of each case.”). Prejudice related to the reopening of discovery may involve the delay of proceedings. Wordtech Sys., 609 F.3d at 1322 (“[A] need to reopen discovery and therefore delay the proceedings supports a district court’s finding of prejudice from a delayed motion to amend the complaint.” (quoting Lockheed Martin Corp. v. Network Sols., Inc., 194 F.3d 980, 986 (9th Cir. 1999))). III. Parties’ Arguments Plaintiffs contend “good cause exists for [p]laintiffs to conduct . . . additional limited discovery,” Pls.’ Disc. Mot. at 7–8 (citing Geneva Pharms. Tech. Corp. v. Barr Lab’ys, Inc., Nos. 98 Civ. 861, 99 Civ. 3687, 2005 WL 2132438, at *5 (S.D.N.Y. Sept. 6, 2005)), largely mirroring their “live and pending request for discovery [from February 2020] that[ ha]s been tabled” since October 2020, Tr. at 37:16–17; see SC Tr. at 27:13–23. Specifically, plaintiffs argue, “[t]he Court’s ruling on the [g]overnment’s Summary Judgment Motion is a material event that has fundamentally altered the scope of this case.” Pl.’s Disc. Mot. at 7–8 (citing Ingham Reg’l Med. Ctr. v. United States, 163 Fed. Cl. 384, 428 (2022) (“[T]he parties did not adequately brief the narrower proposed class of plaintiffs arising under the remaining claims.”)). Plaintiffs state the requested “discovery will allow them to provide the Court with the information required for the determination of the Final Class, and that this will greatly assist the Court with its ruling on class certification.” Id. at 10. At oral argument, the government acknowledged “[p]laintiffs[’] [2020] request [for] all class hospital data” concerned much of the same information plaintiffs are “asking for now.” Tr. at 103:7–17. The government, however, maintains “plaintiffs’ motion to reopen fact and expert discovery should be denied.” Gov’t’s Disc. Resp. at 17. Specifically, the government argues plaintiffs “filed this case, moved for class certification twice, and proceeded through two full rounds of fact and expert discovery, based upon . . . [p]laintiffs’ view of the law.” Id. at 16. The 5 RCFC 16(b)(4) is identical to the corresponding Rule 16(b)(4) of the Federal Rules of Civil Procedure. Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 7 of 23 - 8 - government therefore argues plaintiffs should not be permitted to “reopen fact and expert discovery” simply because “on summary judgment,” the “legal theories that animated plaintiffs’ [previous] discovery and expert reports have been shown . . . to be . . . wrong.” Id. at 16–17. The government argues “[a] party’s realization that it elected to pursue the wrong litigation strategy is not good cause for amending a schedule,” so plaintiffs have failed to show good cause to reopen discovery as they request. Gov’t’s Disc. Resp. at 17 (quoting Sys. Fuels, Inc. v. United States, 111 Fed. Cl. 381, 383 (2013)). Alluding to the standard for reopening discovery, the government argues “no actions by plaintiffs . . . even remotely approximate the showing of diligence required under RCFC 16 . . . .” Id. at 35. The government also argues plaintiffs’ requests “overwhelming[ly] and incurabl[y] prejudice . . . the [g]overnment.” Id. at 38. IV. Whether Good Cause Exists to Reopen Discovery As noted supra Section III, plaintiffs contend “good cause exists for [p]laintiffs to conduct . . . additional limited discovery,” Pls.’ Disc. Mot. at 7–8 (citing Geneva Pharms. Tech. Corp. v. Barr Lab’ys, Inc., Nos. 98 Civ. 861, 99 Civ. 3687, 2005 WL 2132438, at *5 (S.D.N.Y. Sept. 6, 2005)), largely mirroring their “live and pending request for discovery [from February 2020] that[ ha]s been tabled” since October 2020, when the parties agreed to first proceed with the government’s Motion for Reconsideration and Motion for Summary Judgment. Tr. at 37:16– 17; see SC Tr. at 27:13–23. Plaintiffs believe the requested “discovery will allow them to provide the Court with the information required for the determination of the Final Class, and that this will greatly assist the Court with its ruling on class certification.” Pl.’s Disc. Mot. at 10. In contrast, the government asserts plaintiffs have, in two previous rounds of discovery and in their summary judgment briefing, chosen to pursue a litigation strategy based on a class damages model relying on hospital and government data and cannot now justify reopening discovery because they need to change tactics following the Court’s summary judgment ruling limiting the scope of this case to the government’s data. See Gov’t’s Disc. Resp. at 22–23. Specifically, the government contends plaintiffs have neither made the required showing of diligence during past discovery periods to justify modifying the Court’s discovery schedule nor adequately refuted the government’s claim this discovery is prejudicial. See Gov’t’s Disc. Resp. at 28, 35. “A trial court ‘has wide discretion in setting the limits of discovery.’” Schism v. United States, 316 F.3d 1259, 1300 (Fed. Cir. 2002) (quoting Moore v. Armour Pharm. Co., 927 F.2d 1194, 1197 (11th Cir. 1991)). This court has previously found such “discretion [is applicable] in deciding whether to grant a motion to . . . reopen discovery.” Croman Corp. v. United States, 94 Fed. Cl. 157, 160 (2010) (citing Te-Moak Bands of W. Shoshone Indians of Nev. v. United States, 948 F.2d 1258, 1260 (Fed. Cir. 1991)). RCFC 16(b)(4) permits modification of a court-imposed schedule, such as to re-open discovery, “only for good cause and with the judge’s consent.”6 Good cause “requires a showing that even with the exercise of due diligence the moving party could not meet the order’s timetable.” Slip Track Sys., Inc. v. Metal-Lite, Inc., 304 F.3d 1256, 1270 (Fed. Cir. 2002) (applying Ninth Circuit law in finding defendant’s attempt to amend the 6 At oral argument, the parties agreed plaintiffs are requesting the Court reopen discovery, meaning this good cause standard applies. Tr. 99:14–19: “[PLAINTIFFS:] I think, as between [supplementation and reopening], th[ese requests] probably fit[] better in the reopening category as between those two . . . . THE COURT: So . . . the standard for reopening is good cause? [PLAINTIFFS:] Yes. THE COURT: [The government], [do] you agree? [THE GOVERNMENT:] I agree.” Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 8 of 23 - 9 - pleadings first required modification of the scheduling order under FRCP 16(b)(4)). Likewise, in determining whether good cause exists to reopen discovery, a trial court may consider “other relevant factors including, in particular, whether allowing the amendment . . . will prejudice [the opposing party].” High Point Design LLC v. Buyers Direct, Inc., 730 F.3d 1301, 1319 (Fed. Cir. 2013) (quoting Kassner v. 2nd Ave. Delicatessen, Inc., 496 F.3d 229, 244 (2d Cir. 2007)). The Court accordingly must determine whether good cause exists to reopen discovery as requested by plaintiffs by analyzing plaintiffs’ diligence and whether the requested discovery prejudices the government. The Court begins with plaintiffs’ document requests. A. Document Requests Plaintiffs request the government turn over “critical data related to each Potential Class member hospital” and argue “denying ‘precertification discovery where it is necessary to determine the existence of a class is an abuse of discretion.’” Pls.’ Disc. Mot. at 6–7; Pls.’ Disc. Reply at 2 (quoting Perez v. Safelite Grp. Inc., 553 F. App’x 667, 669 (9th Cir. 2014)). These document requests specifically target “(1) all information Kennell used in the DPP calculations for each Potential Class member hospital, as well as the underlying calculations, and (2) all hospital outpatient claims data available for each of the Potential Class member hospitals during the relevant time period.” Pls.’ Disc. Mot. at 8–9. Plaintiffs’ goal is to acquire all “radiology line item[]” data and other information necessary to “apply the DPP methodology” to all of the putative class members’ claims data from the DPP period. Id. at 9. Plaintiffs contend “good cause exists” for the Court to reopen discovery with respect to these documents because the “Court’s ruling on the [g]overnment’s Summary Judgment Motion is a material event that . . . fundamentally altered the scope of this case.” Id. at 8. Namely, plaintiffs’ “damages are now limited to those claims involving errors in the [g]overnment’s data,” so plaintiffs allege this data, which “by its very nature [is] exclusively in [the government’s] possession,” is necessary “to identify the class members.” Pls.’ Disc. Reply at 3; see Ingham Reg’l Med. Ctr. v. United States, 163 Fed. Cl. 384, 427–29 (2022). Further, plaintiffs believe reopening discovery for this request is appropriate because in February 2020, during discovery, plaintiffs served a request for production on the government for the same “data concerning hospital outpatient services, claims, and . . . reimbursement for all class hospitals.” Tr. at 41:5–11. Plaintiffs likewise moved to compel this discovery in July 2020. Pls.’ Disc. Reply at 4 (“Plaintiffs also later moved for an order to conduct class discovery or for the [g]overnment to alternatively produce documents for all hospitals.”). Plaintiffs argue tabling this request and motion at the end of October 2020 while the case “proceeded with reconsideration, summary judgment, and other procedural” items did not do away with their “live and pending request for [this] discovery.” Tr. at 41:16–17, 37:14– 25, 128:5–6. With respect to prejudice, plaintiffs clarify their requests “will not prejudice the” government primarily because “the benefit to this case from the discovery would significantly outweigh any burden,” Pls.’ Disc. Reply at 8–9 (first citing Davita HealthCare Partners, Inc. v. United States, 125 Fed. Cl. 394, 402 n.6 (2016); and then citing Kennedy Heights Apartments Ltd. I v. United States, 2005 WL 6112633, at *4 (Fed. Cl. Apr. 26, 2005)), as this discovery will “assist the court with its ruling on class certification.” Pls.’ Disc. Mot. at 9–10. Further, plaintiffs contend any prejudice could be cured at trial by cross-examination of plaintiffs’ expert, who will use this data in a future supplemental report. Pls.’ Disc. Reply at 10 (citing Panasonic Commc’ns Corp. of Am. v. United States, 108 Fed. Cl. 412, 416 (2013)). Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 9 of 23 - 10 - The government argues good cause does not exist to reopen discovery as requested by plaintiffs. With respect to diligence, the government first asserts plaintiffs’ 31 July 2020 Motion regarding class discovery was not diligent because it was filed on the last day of the discovery period. Gov’t’s Disc. Resp. at 33–34. Next, the government argues “[p]laintiffs make no claim that it was impossible during two separate discovery periods for them to have served on the [g]overnment . . . the proposed discovery requests . . . because it obviously was not.” Id. at 28 (citation omitted). Rather, per the government, “plaintiffs disregarded, rather than responding to, evidence, analysis, and law that was inconsistent with their theories of the case, even when the [g]overnment brought such issues to the fore.” Id. at 30. The government argues “plaintiffs ignored these issues at their peril throughout the entire second period of fact and expert discovery that followed, and that means that they were not diligent under the law” and are not now entitled to discovery to assist them in changing their theory of the case. Id. at 31–32. Concerning prejudice, the government argues “plaintiffs are proposing fact discovery on a scale never before undertaken in this case, a new expert report for the [g]overnment to then respond to, more expert depositions, and, no doubt, additional Daubert and class-related motions practice, resulting in substantial delay in bringing this matter to resolution.” Id. at 36 (footnote omitted). “Permitting plaintiffs to now evade a long overdue reckoning, and attempt to moot [the government’s motions to exclude plaintiffs’ expert reports], in addition to being completely contrary to law, [according to the government,] deprives the [g]overnment of its day in court for what should be an imminent resolution of this matter.” Id. 1. Diligence A finding of diligence sufficient to modify a case schedule “requires a showing that even with the exercise of due diligence the moving party could not meet the order’s timetable.” Slip Track Sys., Inc., 304 F.3d at 1270 (applying Ninth Circuit law in finding defendant’s attempt to amend the pleadings first required modification of the scheduling order under FRCP 16(b)(4)). On 11 February 2020, at the very early stages of the “re-opened period of fact discovery,” plaintiffs “served the [g]overnment with additional document requests,” including a request for “[a]ny and all data concerning hospital outpatient services claims and TRICARE reimbursement for hospital outpatient services claims during the relevant time period . . . .” Gov’t’s Disc. Resp. at 11 (citations omitted); see also App. to Pls.’ Disc. Mot. at 23. At the time, the government “objected to this request” and only “produce[d] the data requested for the six [named] plaintiffs.” Id. at 11–12 (citations omitted). Over the next several months, the parties continued with fact and expert discovery, during which time the Court “established a schedule for briefing on class certification and summary judgment.” Id. at 13 (citing Order at 2, ECF No. 143). On 31 July 2020, “the date . . . both fact and expert discovery closed, plaintiffs filed a motion . . . [to] compel[] the [g]overnment to produce documents for all hospitals, rather than for just the six representative plaintiffs.” Id. at 14. Plaintiffs therefore requested the data at issue in this document request at least twice before the instant Motion—once on 11 February 2020 and again on 31 July 2020. Tr. at 81:10–11 (“[PLAINTIFFS:] [W]e did ask for all of those things that [the government is] talking about [before we t]abled the issues . . . .”). They thus argue they “meet [the] diligence [standard] here because [they] asked for” this information “a long time ago” and continued to believe it “was a live and open issue.” Tr. at 128:5–6; Tr. at 104:25–105:9 (“[PLAINTIFFS:] We served the discovery request in the discovery period. We got objections from the [g]overnment. We conferred several times with [the government] about this to figure Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 10 of 23 - 11 - out what we are doing here . . . . We then had the conference with the Court because we had filed our motion [to compel] and the [g]overnment fought to arrange things in the way they arranged. So we walked away from that believing this [discovery] was a live and open issue.”); see 28 Dec. 2022 JSR at 2. The government’s first diligence argument, as noted supra Section IV.A, is plaintiffs filed their Motion to Compel on the final day of discovery and thus did not diligently pursue this request. Gov’t’s Disc. Resp. at 33–34; Tr. at 84:21–23 (“[THE GOVERNMENT:] [Plaintiffs] did nothing between March and July. There was no agreement to table during that four-month period. And then in July, they filed a motion [to compel.]”). Despite the already pending 11 February 2020 “request for all class hospital data,” the government contends plaintiffs “should have filed more motions to compel” earlier in the discovery period. Tr. at 85:4–10; Tr. at 107:2– 5 (“[PLAINTIFFS:] [The government is saying] we raised [these discovery issues] too long ago and didn’t come back often enough.”). To the extent the government alleges “filing a motion to compel on the very last day of discovery is . . . untimely, not diligent,” however, the government overlooks the significance of plaintiffs’ timely February 2020 request. See Gov’t’s Disc. Resp. at 34. Plaintiffs did not first make this request the day discovery closed; they asked the government to produce these documents early in the discovery period. Pls.’ Disc. Mot. at 4–5. Plaintiffs then “conferred several times with” the government and waited to see whether the government’s production would be sufficiently responsive to their February 2020 request despite the government’s objection. Tr. at 104:24–105:6 (“[PLAINTIFFS]: We served the discovery request in the discovery period. We got objections from the [g]overnment. We conferred several times with [the government] about this . . . We then . . . filed our motion. . . .”). Thus, only when it became clear the government was not going to produce plaintiffs’ requested information or any comparable data in the final days of the discovery period did plaintiffs file a motion to compel. Id. Further, the government’s cited cases for the proposition motions filed at the end of discovery are untimely are from out-of-circuit district courts and contain factual situations inapposite to this case. See Gov’t’s Disc. Resp. at 34 (first citing Rainbow Energy Mktg. Corp. v. DC Transco, LLC, No. 21-CV-313, 2022 WL 17365260, at *2 (W.D. Tex. Dec. 1, 2022) (denying a renewed motion to compel after: (1) the plaintiff’s initial motion was denied, (2) the plaintiff filed a motion to extend discovery after the period had closed, and (3) the plaintiff filed a renewed motion to compel on the last day of extended discovery); then citing U.S. ex rel. Gohil v. Sanofi U.S. Servs., Inc., No. 02-2964, 2020 WL 1888966, at *4 (E.D. Pa. Apr. 16, 2020) (rejecting a motion to compel in part because the requesting party made a “misrepresentation that it did not know” the importance of the information until just before the close of discovery); then citing Summy-Long v. Pa. State Univ., No. 06–cv–1117, 2015 WL 5924505, at *2, *5 (M.D. Pa. Oct. 9. 2015) (denying the plaintiff’s motion to compel “because [her] request [wa]s overly broad and unduly burdensome and because granting further discovery extensions . . . would strain the bounds of reasonableness and fairness to all litigants”); then citing In re Sulfuric Acid Antitrust Litig., 231 F.R.D. 331, 332–33, 337 (N.D. Ill. 2005) (acknowledging there is “great[] uncertainty” as to whether courts should deny motions to compel filed “very close to the discovery cut-off date��� and recognizing “the matter is [generally] left to the broad discretion” of the trial court “to control discovery”); then citing Toone v. Fed. Express Corp., No. Civ. A. 96-2450, 1997 WL 446257, at *8 (D.D.C. July 30, 1997) (denying the plaintiff’s motion to compel filed on the last day of discovery because (1) given the close proximity to the original date for trial, “the defendant could have responded to the request . . . on Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 11 of 23 - 12 - the day of the original trial date,” and (2) it was moot); and then citing Babcock v. CAE-Link Corp., 878 F. Supp. 377, 387 (N.D.N.Y. 1995) (denying a motion to compel regarding discovery requests served on the last day of discovery). The Court therefore is not persuaded plaintiffs’ Motion to Compel was untimely. Schism, 316 F.3d at 1300 (quoting Moore, 927 F.2d at 1197). The government further contends “[p]laintiffs make no claim that it was impossible during two separate discovery periods for them to have served on the [g]overnment” this “proposed discovery request[].” Def.’s Disc. Resp. at 28. The government argues plaintiffs’ “tunnel vision” with respect to their legal theory caused plaintiffs to ignore “evidence, analysis, and law” not directly consistent with “their theories of the case, even when the [g]overnment brought such issues to the fore.” Id. at 29–30. “Turning a blind eye . . . [due to] legal error is not the same thing as having the inability to meet court deadlines,” according to the government, so “plaintiffs cannot demonstrate the requisite diligence.” Id. at 30. Although plaintiffs did not file “more motions to compel,” plaintiffs timely made their February 2020 request and timely filed their July 2020 Motion to Compel, supra. See Tr. at 85:4–9. To the extent the government alleges plaintiffs are not entitled to reopen discovery to amend their litigation strategy because the government “unmasked on summary judgment” plaintiffs’ “legal errors,” the government overlooks its own admission at oral argument, “[p]laintiffs’ request[s] [for] all class hospital data” in February and July 2020 sought the same data “[plaintiffs a]re asking for now.” Tr. 103:7–17; Def.’s Disc. Resp. at 28. Contrary to the government’s argument, plaintiffs therefore did not have “tunnel vision” causing them to ignore the requested evidence earlier in this litigation. See Def.’s Disc. Resp. at 28–30. Rather, plaintiffs requested this data during the appropriate discovery periods, only to have their request put on hold “because the [g]overnment ha[d] additional motions” it wished the Court to first decide. See Tr. at 85:12–21 (the court); Pls.’ Disc. Mot. at 4; App. to Pl.’s Disc. Mot. at 23; Tr. at 105:5–9; Def.’s Disc. Resp. at 14 (“Ultimately, the issues raised by this motion [to compel] were tabled by agreement of the parties.”); Tr. at 55:5–6 (“[PLAINTIFFS:] [T]he [g]overnment fought tooth and nail [to have the Court] hear [their] summary judgment motion first.”). Plaintiffs have thus considered these requests “a live and open issue” pending resolution of the government’s motions ever since, prompting them to file the instant Motion upon the Court issuing its Summary Judgment Order in November 2022. Tr. at 105:8–9 (“[PLAINTIFFS:] [W]e walked away from that [tabling discussion] believing this [discovery] was a live and open issue.”). Finally, while this “data [may] not [have been] necessary for summary judgment . . . [it is] for class certification.”7 Tr. at 111:10–11 (plaintiffs); Clippinger v. State Farm Mut. Auto. Ins. Co., 2021 WL 1894821, at *2 (“[C]lass certification discovery is not relevant [at the summary judgment stage].”); Tr. at 111:8–11 (“[PLAINTIFFS]: Well, I think like in Clippinger, there is some wisdom to the concept that maybe all of that data is not necessary for summary judgment, but then becomes necessary for class certification.”). To that end, the government 7 To the extent the government relies on plaintiffs’ 13 April 2020 statement plaintiffs “will not need this information [pertaining to hospitals other than the six named plaintiffs] prior to resolving [p]laintiffs’ [M]otion for [C]lass [C]ertification,” the government overlooks the substantial change in circumstances discussed infra Section IV.B.1. See Def.’s Disc. Resp. at 12–13 (quoting 21 May 2020 JSR at 3–4, ECF No. 140). The government likewise ignores plaintiffs’ agreement to table these discovery requests temporarily in October 2020, at which time plaintiffs acknowledged they would eventually re-raise these requests, even if—at the time—the plan was to do so after class certification. See Tr. at 85:12–21, 55:5–6. Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 12 of 23 - 13 - cannot “object[] to [plaintiffs’ document] request” in 2020 as “irrelevant and not proportional to the needs of the case insofar as plaintiffs seek . . . [information from] thousands of hospitals” only to now argue it is too late for this discovery and “plaintiffs [have] squandered . . . their allotted discovery periods . . . .” Gov’t’s Disc. Resp. at 11, 28; Tr. at 106:7–14 (“[PLAINTIFFS:] [I]t’s almost like the [g]overnment—they’re playing gotcha here. . . . [T]hey didn’t want to give us the information at the time [of discovery] and then they say, well, here’s summary judgment first and we can defer this until later . . . and now we’ve got a summary judgment opinion and now [they] say gotcha . . . .”). Nor can the government object to turning over the requested data in 2020 and now only to “use [plaintiffs’] lack of this data as a sword” come class certification. Tr. at 126:23–127:2. Indeed, “this has never been a case where” plaintiffs “said we’re not going to look at that [requested] data . . . [or] we’re not eventually going to be coming for that.” Tr. at 126:18–20. To the contrary, plaintiffs “requested this [data] during discovery,” and have long maintained this discovery “is the way to” “figure out . . . what are we dealing with” from a class perspective, including in the JSR filed after the Court’s November 2022 Summary Judgment Order, in which plaintiffs reserved the right to move for “additional class certification fact or expert discovery.” Tr. at 44:10, 56:21–22; 28 Dec. 2022 JSR at 2. By way of the government’s objection to plaintiffs’ February 2020 request and the parties’ tabling this request in October 2020, plaintiffs “even with the exercise of due diligence[,]” could not have obtained the requested information in a way sufficient to “meet the [Court’s discovery] timetable.” Slip Track Sys., Inc., 304 F.3d at 1270. Had they “received the data in 2020,” they “would have . . . run the DPP” for all potential class members as plaintiffs now request the opportunity to. Tr. at 113:12–15. Instead, plaintiffs did not have access to the data so continued to raise this request at all reasonably appropriate times. See Tr. at 112:8–9 (“[PLAINTIFFS:] [I]t was not possible for us to have done this [DPP] calculation without th[is] data.”). The Court accordingly finds plaintiffs were sufficiently diligent to justify a finding of good cause to reopen fact discovery as to plaintiffs’ document request for “critical data related to each Potential Class member hospital,” Pls.’ Disc. Mot. at 6. Slip Track Sys., Inc., 304 F.2d at 1270. 2. Prejudice In considering whether to reopen discovery, a trial court may consider, in addition to the requesting party’s diligence, “other relevant factors including, in particular, whether allowing the amendment . . . will prejudice [the opposing party].” High Point Design LLC, 730 F.3d at 1319 (quoting Kassner, 496 F.3d at 244). Prejudice related to the reopening of discovery may involve the delay of proceedings. Wordtech Sys., Inc. v. Integrated Networks Sols., Inc., 609 F.3d 1308, 1322 (Fed. Cir. 2010) (“[A] need to reopen discovery and therefore delay the proceedings supports a district court’s finding of prejudice from a delayed motion to amend the complaint.” (quoting Lockheed Martin Corp. v. Network Sols., Inc., 194 F.3d 980, 986 (9th Cir. 1999))). Further, RCFC 26(b)(1) provides: [P]arties may obtain discovery regarding any nonprivileged matter that is relevant to any party’s claim or defense and proportional to the needs of the case, considering the importance of the issues at stake in the action, the amount in controversy, the parties’ relative access to relevant information, the parties’ resources, the importance of the discovery in resolving the issues, and whether the Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 13 of 23 - 14 - burden or expense of the proposed discovery outweighs its likely benefit. RCFC 26(b)(1). “Questions of the scope and conduct of discovery are . . . committed to the discretion of the trial court.” Florsheim Shoe Co., Div. of Interco, Inc. v. United States, 744 F.2d 787, 797 (Fed. Cir. 1984). The government contends reopening discovery is prejudicial because “plaintiffs are proposing fact discovery on a scale never before undertaken in this case, a new expert report for the [g]overnment to then respond to, more expert depositions, and, no doubt, additional Daubert and class-related motions practice, resulting in substantial delay in bringing this matter to resolution.” Gov’t’s Disc. Resp. at 35–36 (footnote omitted). Plaintiffs, on the other hand, argue: (1) the sought after data “is . . . exclusively in [the government’s] possession”; and (2) their request will not prejudice the government because it will have an opportunity to oppose plaintiffs’ expert report. Pls.’ Disc. Reply at 3, 8. Even if there is any prejudice to the government, plaintiffs assert “the benefit to this case from the discovery would significantly outweigh any burden to the parties,” id. at 9, because of the assistance the discovery would provide the Court in ruling on class certification of the “narrower proposed class of plaintiffs,” Ingham Reg’l Med. Ctr., 163 Fed. Cl. at 428, left after summary judgment. Id. at 5, 9–10 (first citing Ingham Reg’l Med. Ctr., 163 Fed. Cl. at 428; and then citing Alta Wind I Owner Lessor C v. United States, 154 Fed. Cl. 204, 217 (2021)). Indeed, plaintiffs argue “produc[ing] the data . . . [now will be] more efficient [than production after certification] [a]s there will be less hypothetical back-and-forth between the parties [during certification briefing]” if the government’s data is available to all sides. Tr. at 118:2–6. Any prejudice could also be cured at trial by cross-examination of plaintiffs’ expert, plaintiffs contend. Pls.’ Disc. Reply at 10. The Court’s Summary Judgment Order indicated “the Court . . . needs further information regarding how plaintiffs in this post-summary judgment smaller class would meet the requirements for class certification” before deciding plaintiffs’ motion for class certification. Ingham Reg’l Med. Ctr., 163 Fed. Cl. at 428. To that end, mirroring their requests during the 2020 discovery period, plaintiffs ask the government to provide “(1) all information Kennell used in the DPP calculations for each Potential Class member hospital, as well as the underlying calculations, and (2) all hospital outpatient claims data available for each of the Potential Class member hospitals during the relevant time period.” Pls.’ Disc. Mot. at 8–9 (emphasis added). Plaintiffs argue this discovery will “benefit . . . this case” by providing the radiology data needed to determine “who is in the [now-narrowed] class.” Pls.’ Disc. Reply at 2, 9 (“Plaintiffs’ damages are now limited to those claims involving errors in the [g]overnment’s data”); Tr. at 57:1. The government has not refuted this claim. Tr. at 132:16–25 (“THE COURT: Just to make sure I understand, can you just quickly articulate the prejudice to the [g]overnment [from the Motion to Compel the data]? . . . [THE GOVERNMENT:] The [prejudice from the] [M]otion to [C]ompel is a significant reasonableness and proportionality concern . . . .”); Tr. at 56:18–57:14 (“[PLAINTIFFS:] [W]e really followed the Court’s lead, looking at the summary judgment opinion saying . . . go back and figure out now what we are dealing with . . . [with respect to] who is in the class . . . only on the [g]overnment’s [data] . . . . [THE GOVERNMENT:] I firmly disagree with that [procedural move]. I think that [p]laintiffs are trying to jump their original expert report . . . [a]nd under the law, [they] can’t.”). Rather, the government’s primary prejudice-related allegation is plaintiffs’ request violates the Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 14 of 23 - 15 - “[r]easonableness and proportionality” tenants set forth in RCFC 26(b)(1) because “[t]he [g]overnment has already incurred substantial expense,” Def.’s Disc. Resp. at 36, and plaintiffs have “not established a right to discovery of [non-named plaintiff] hospitals . . . based on what they have shown.” Tr. at 130:10–14. As the Court noted above, the government cannot argue plaintiffs’ document discovery request was too early before summary judgment and too late now that the government has incurred greater expense in litigating this case. See supra Section IV.A.1. Neither party knew the substantial impact summary judgment would have on the trajectory of this case, but the parties agreed to table plaintiffs’ discovery requests until after the Court’s summary judgment decision. See Ingham Reg’l Med. Ctr., 163 Fed. Cl. at 395; SC Tr. at 27:13–23. As evidenced by the recent data analysis performed by the government, after summary judgment, “[g]overnment data is required to evaluate which hospitals were affected by the [g]overnment’s breach of” contract. 25 Oct. 2023 JSR at 16. Plaintiffs cannot be expected to argue, and the Court cannot “rule on[,] numerosity [and related class certification factors] if there[ i]s no evidence regarding the approximate number of hospitals who would fit the . . . requirements allowed in the summary judgment order.” Tr. at 108:6–11. The parties must both have an opportunity to review the relevant data held by the government to determine which hospitals should, or should not, be included in the putative class.8 See id. The requested data, which includes the pertinent “outpatient claims data” and the information “used in the DPP calculations,” Pls.’ Disc. Mot. at 8–9, is therefore highly relevant to the next step in this case— class certification—and, rather than delay this case, having this data will enable the Court to decide plaintiffs’ motion for class certification more efficiently. Davita HealthCare Partners, Inc., 125 Fed. Cl. at 399 (“[T]he additional time . . . does not warrant the severe sanction of exclusion of data helpful to both parties in this litigation.”). To the extent the government argues the scale of the information requested is “grossly disproportionate to the needs of the case,” Tr. at 110:22, the government ignores: (1) plaintiffs’ and the Court’s substantial need to understand “who would be in the class” come time to brief and rule on class certification, Tr. at 55:24–25; and (2) the inability of plaintiffs and the Court to access this data “exclusively in [the government’s] possession” without production by the government, Pls.’ Disc. Reply at 3. See Davita HealthCare Partners, Inc., 125 Fed. Cl. at 399; RCFC 26(b)(1) (“[P]arties may obtain discovery regarding any nonprivileged matter that is relevant . . . and proportional . . . [considering] the parties’ relative access to [the] relevant information . . . .” (emphasis added)). The government likewise overlooks its ability to rebut any arguments plaintiffs make using this data both before and at trial. See Alta Wind I Owner Lessor C, 154 Fed. Cl. at 217 (“Other Court of Federal Claims judges have noted that providing the government an opportunity to file a rebuttal mitigates any prejudice that may have otherwise existed in providing plaintiff the opportunity to reopen the record.”). The documents plaintiffs request are therefore highly relevant and proportional to the needs of the case as they will provide plaintiffs and the Court 8 This is not a case where, as the government alleges, plaintiffs are “attempt[ing] to use discovery to find new clients upon learning of infirmities in the claims of putative class representatives.” Def.’s Disc. Resp. at 26–27 (first citing In re Williams-Sonoma, Inc., 947 F.3d 533, 540 (9th Cir. 2020); then citing Gawry v. Countrywide Home Loans, Inc., 395 F. App’x 152, 160 (6th Cir. 2010); Douglas v. Talk Am., Inc., 266 F.R.D. 464, 467 (C.D. Cal. 2010); Falcon v. Phillips Elec. N. Am. Corp., 304 F. App’x 896, 898 (2d Cir. 2008)). Rather, plaintiffs are requesting access to information held by the government to adequately brief class certification on behalf of the existing named plaintiffs and the putative class. See Pls.’ Disc. Mot. at 2 (“After completion of this discovery, [p]laintiffs would then file an amended motion for class certification.”). Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 15 of 23 - 16 - information necessary for a thorough analysis of class certification. Florsheim Shoe Co., Div. of Interco, Inc., 744 F.2d at 797; Davita HealthCare Partners, 125 Fed. Cl. at 399 (“[T]he additional time . . . does not warrant the severe sanction of exclusion of data helpful to both parties in this litigation.”); RCFC 26(b)(1). The Court accordingly finds any prejudice to the government caused by the scope of plaintiffs’ document request is mitigated by the benefit of the requested information to the efficient resolution of this case.9 See High Point Design LLC, 730 F.3d at 1319 (quoting Kassner, 496 F.3d at 244); Tr. at 118:2–6. The government will have ample opportunity to oppose any supplemental expert reports presented by plaintiffs using the requested data, including through cross-examination of plaintiffs’ experts at trial. See Alta Wind I Owner Lessor C, 154 Fed. Cl. at 217 (“Other Court of Federal Claims judges have noted that providing the government an opportunity to file a rebuttal mitigates any prejudice that may have otherwise existed in providing plaintiff the opportunity to reopen the record.”). The Court therefore finds plaintiffs were diligent in pursuing this document discovery request and the government will not experience prejudice sufficient to warrant denying plaintiffs’ Motion as to the request. The Court accordingly grants plaintiffs’ document discovery request as tailored, infra Section V, to the liability found in the Court’s November 2022 Summary Judgment Order, as there is good cause to do so. See High Point Design LLC, 730 F.3d at 1319 (quoting Kassner, 496 F.3d at 244); 6A CHARLES A. WRIGHT ET AL., FEDERAL PRACTICE AND PROCEDURE § 1522.2 (3d ed. 1998) (“What constitutes good cause sufficient to justify the modification of a scheduling order necessarily varies with the circumstances of each case.”); Pls.’ Disc. Mot. at 8–9. B. Plaintiffs’ Request to Depose a Government Corporate Designee Pursuant to Rule 30(b)(6) Plaintiffs also seek leave to “depose a [g]overnment corporate designee to identify which data sources were . . . available to the [g]overnment from the relevant time period, and where the relevant claims data resides.” Pls.’ Disc. Mot. at 8. Plaintiffs specify they are seeking “an hour . . . of deposition, just getting the [g]overnment to . . . confirm . . . the data sources” they have now and had during the relevant time periods “to make sure . . . there’s been no spoliation . . . .” Tr. at 117:22–25. In response, the government contends it previously identified an agency employee “as an individual with ‘discoverable information concerning TRICARE Encounter Data (TED), the DHA Military Health System Data Repository (MDR), and the creation, content and maintenance of records in both of those databases[,]’. . . [but] plaintiffs expressly declined a deposition during the established periods of fact and expert discovery[] and elected instead to proceed through limited interrogatories.” Defs.’ Disc. Resp. at 33. The government alleges “[p]laintiffs cannot reasonably be said to have been diligent in pursuing the 9 The Court emphasizes the government alone is in possession of the TMA data potentially comprising “tens of millions of records.” Tr. at 134:3. As such, the government is the only party capable of sorting and producing the large volumes of information. See RCFC 26(b)(1) (“[P]arties may obtain discovery regarding any nonprivileged matter that is relevant . . . and proportional . . . [considering] the parties’ relative access to [the] relevant information.”). Indeed, at the 19 December 2023 status conference, the government agreed it is capable of reviewing all data in its possession to identify line items of putative class members missed during DPP extraction due to issues akin to those impacting twelve out of the thirteen unextracted line items for Integris Baptist and Integris Bass Baptist. See 25 Oct. 2023 JSR; see also Ingham Reg’l Med. Ctr. v. United States, 163 Fed. Cl. 384, 409, 412 (2022). Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 16 of 23 - 17 - deposition that they now request when they intentionally eschewed [an offered deposition] during the established period of fact discovery.” Id. The government also reasserts its prejudice and diligence-related arguments discussed supra Section IV.A.1–2. See, e.g., id. at 28 (“Plaintiffs make no claim that it was impossible during two separate discovery periods for them to have served on the [g]overnment . . . the deposition notice . . . because it obviously was not.”); Tr. at 130:8–10 (“THE COURT: . . . So what’s the prejudice though? [THE GOVERNMENT]: Reasonableness and proportionality.”). 1. Diligence The government’s only novel diligence argument related to plaintiffs’ deposition request is plaintiffs previously declined an opportunity to depose an “an individual with ‘discoverable information concerning [TED and MDR], and the creation, content and maintenance of records in both of those databases.” Defs.’ Disc. Mot. Resp. at 33. The government otherwise broadly asserts plaintiffs were not diligent in pursuing their discovery requests. See, e.g., id. at 28. As determined supra Section IV.A.1, plaintiffs were diligent with respect to pursuing the government’s data and related information at the appropriate time during discovery. See, e.g., App. to Pls.’ Disc. Mot. at 23–24. The Court therefore only addresses the government’s argument related to previous deposition opportunities below. A “trial court ‘has wide discretion in setting the limits of discovery.’” Schism, 316 F.3d at 1300 (quoting Moore, 927 F.2d at 1197). Notwithstanding, modification of a court-imposed schedule may be done “only for good cause and with the judge’s consent.” RCFC 16(b)(4). “When assessing whether good cause has been shown, ‘the primary consideration is whether the moving party can demonstrate diligence.’” High Point Design LLC, 730 F.3d at 1319 (quoting Kassner, 496 F.3d at 244). The government’s primary contention—plaintiffs were not diligent in pursuing the requested deposition because they turned down an offer to depose a government employee in May 2019—assumes a party cannot be diligent if they have, at any time in the past, “eschewed [similar discovery.]” Defs.’ Disc. Mot. Resp. at 33. Over the past four and a half years, however, this case has changed substantially. See Alta Wind I Owner Lessor C, 154 Fed. Cl. at 227 (granting additional discovery upon remand and reassignment of the case); see also Geneva Pharms. Tech. Corp., 2005 WL 2132438, at *5 (“[M]aterial events have occurred since the last discovery period, which justice requires that the parties have an opportunity to develop through discovery.”). As noted by plaintiffs, “[t]he Court’s ruling on the [g]overnment’s Summary Judgment Motion . . . fundamentally altered the scope of this case,” Pls.’ Disc. Mot. at 8, by substantially narrowing the potential class members and limiting plaintiffs’ “damages . . . to [two] claims involving errors in the [g]overnment’s data,” Pls.’ Disc. Reply at 3. “[T]o analyze the extent of the . . . error[s]” in the government’s data, 25 Oct. 2023 JSR at 16, and perform “a more accurate damages calculation” for the putative class members, Pls.’ Reply at 7, plaintiffs therefore need to understand the data sources available to the government now and at the time of line item extraction. See 25 Oct. 2023 JSR at 17 (“The only way to evaluate whether Mr. Kennell failed to extract all relevant data . . . for the entire class is for the [g]overnment to produce . . . [the discovery] [p]laintiffs seek.”); Pls.’ Disc. Reply at 7. In 2020, in contrast, at which time plaintiffs “elected . . . to proceed through limited interrogatories” rather than conduct the government’s offered deposition, the Court had not yet narrowed the scope of the case or limited the damages calculations to the government’s data. Defs.’ Disc. Resp. at 33. During the Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 17 of 23 - 18 - initial discovery periods, plaintiffs still reasonably believed their own data might be relevant and did not yet understand the importance of the government’s data. See Pls.’ Disc. Reply at 3; see also 25 Oct. 2023 JSR at 16. Plaintiffs therefore did not exhibit a lack of diligence by not accepting the government’s offer to depose an individual whose testimony, at the time, was less relevant to the case. The government has accordingly failed to produce evidence sufficient to show plaintiffs were not diligent in pursuing the requested deposition. Schism, 316 F.3d at 1300; High Point Design LLC, 730 F.3d at 1319; see also Alta Wind I Owner Lessor C, 154 Fed. Cl. at 227. 2. Prejudice As noted supra Section IV.A.2, courts considering requests to reopen discovery may consider whether and to what extent granting the request will prejudice the opposing party, including via delaying the litigation. High Point Design, 730 F.3d at 1319 (quoting Kassner, 496 F.3d at 244); Wordtech Sys., 609 F.3d at 1322 (quoting Lockheed Martin Corp., 194 F.3d at 986). Regarding plaintiffs’ deposition request, the government argues granting plaintiffs’ deposition request will, like plaintiffs’ document requests, result in additional expense and “substantial delay in bringing this matter to resolution.” Def.’s Disc. Resp. at 36. Plaintiffs indicated at oral argument, however, the requested deposition will be “an hour,” with the goal being simply to understand “the data sources” in the government’s possession. Tr. at 117:22. To the extent this short deposition of a government employee, which the government was prepared to allow for several years ago, will allow the case to proceed “more efficient[ly]” to class certification with fewer “hypothetical back-and-forth[s] between the parties” related to considerations like numerosity, see Tr. at 118:2–6, the Court finds the minimal potential prejudice to the government from this deposition is outweighed by the value of this information to the later stages of this litigation. Davita HealthCare Partners, Inc., 125 Fed. Cl. at 399 (“[T]he additional time . . . does not warrant the severe sanction of exclusion of data helpful to both parties in this litigation.”). The Court therefore does not find the government’s argument regarding diligence or prejudice persuasive with respect to plaintiffs’ deposition request. The Court accordingly grants this request as there is good cause to do so.10 High Point Design LLC, 730 F.3d at 1319 (quoting Kassner, 496 F.3d at 244); 6A WRIGHT ET AL., FEDERAL PRACTICE AND PROCEDURE § 1522.2 (3d ed. 1998) (“What constitutes good cause sufficient to justify the modification of a scheduling order necessarily varies with the circumstances of each case.”). C. Supplemental Expert Report Plaintiffs finally request leave to “serve a supplemental expert report on . . . relevant class 10 To the extent the government intended its arguments related to proportionality and relevance to apply to plaintiffs’ deposition request, the Court is unpersuaded. See Def.’s Disc. Resp. at 36. A single deposition lasting approximately one hour on subject matter on which the government previously offered to permit a deposition is not disproportionate to the needs of this case. Schism v. United States, 316 F.3d 1259, 1300 (Fed. Cir. 2002) (quoting Moore v. Armour Pharm. Co., 927 F.2d 1194, 1197 (11th Cir. 1991)); RCFC 26(b)(1). Likewise, the subject matter—the sources of the data plaintiffs request access to—is highly relevant in ensuring a complete and accurate data set free of spoliation. Schism, 316 F.3d at 1300 (quoting Moore, 927 F.2d at 1197); RCFC 26(b)(1); see supra Section IV.A.2. Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 18 of 23 - 19 - issues” upon completion of the above-requested discovery. Pls.’ Disc. Mot. at 2. Specifically, plaintiffs wish to “submit a supplemental expert report analyzing the [government’s] data and applying the DPP methodology to the correct universe of outpatient radiology line items . . . .” Id. at 10; see also Pls.’ Disc. Reply at 3 (“Plaintiffs’ supplemental expert report would identify the scope of the class, as requested by the Court.”); Tr. at 73:10–14 (“[PLAINTIFFS:] [I]t is a very complex formula. And I think that it is something that . . . you would want someone with experience with these data line items going through and doing it . . . it’s [objective] math. . . . It’s essentially a claims administrator.”). Plaintiffs make clear their initial expert report was an attempt at extrapolating the named plaintiffs’ data “across the class to come up with . . . estimated number[s],” which they now wish to update with “the exact numbers” once they receive the government’s data. Tr. at 69:4–16. Plaintiffs contend “[r]eopening discovery is warranted where supplemental information from an expert would assist the Court in resolving important issues . . . [s]uch [as] . . . ‘presenting the Court with a more accurate representation of plaintiffs’ damages allegations.’” Pls.’ Disc. Reply at 6 (first citing Kennedy Heights Apartments Ltd. I, 2005 WL 6112633, at *3–4; and then quoting Alta Wind I Owner Lessor C, 154 Fed. Cl. at 217). Likening this case to Alta Wind, plaintiffs argue the Court should conclude here an “expert report will provide the Court with a damages estimate more accurately reflecting plaintiffs’ damages position [in light of the changes to the case rendered by summary judgment] . . . and therefore will likely assist the Court.” Id. at 7 (quoting Alta Wind, 154 Fed. Cl. at 216); Tr. at 68:17–69:16 (“[PLAINTIFFS]: With respect to Ms. Jerzak and the breach of contract, she did two things [in her report.] . . . One, she compared the hospital line items to the government line items for the named [p]laintiffs and did a straight objective calculation of what was the difference. . . . She also took those numbers and extrapolated them across the class to come up with an estimated number. THE COURT: A hypothetical. [PLAINTIFFS]: Yes . . . [r]ecognizing that if the class was certified . . . we’d have to do the exact numbers.”). Plaintiffs conclude this report will “not prejudice the [g]overnment in any way, and would actually benefit the [g]overnment” by providing an “opportunity . . . to oppose” additional contentions appropriate to the posture of the case. Id. at 8 (emphasis omitted) (citing Alta Wind I Owner Lessor C, 154 Fed. Cl. at 216). Plaintiffs note, however, “in [their] mind, this [report] is something that always was going to happen after certification” at the merits stage, Tr. at 73:15– 16 (emphasis added), as they do not “need an expert report for class certification because” the government “admitted breach,” Tr. at 96:3–4; Tr. at 63:22–64:6 (“[PLAINTIFFS:] [L]et’s say the Court certified a class here. The next step . . . is for merits. Someone is going to have to spit out a report saying here are the class members and when I run their . . . data . . . here are the differences and here’s the number that gets spit out.” (emphasis added)). The government reiterates its diligence and prejudice arguments discussed supra Sections IV.A–B with respect to plaintiffs’ request for leave to file a supplemental expert report. The government likewise refutes the notion plaintiffs’ current expert report is a “placeholder . . . that was[] [not] really meant to be real.” Tr. at 70:19–20. In other words, the government contends plaintiffs “meant th[eir earlier] expert report” to apply to “their currently pending motion for class cert[ification],” Tr. at 71:21–23, and now “seek to have the Court rescue them from their own litigation choices,” including the choice to file “expert damages models [that] could never be used to measure class damages.” Def.’s Disc. Resp. at 16–17. Plaintiffs should not be permitted to file a new expert report, according to the government, simply because “they have not . . . marshaled any legally cognizable expert evidence concerning the few claims that remain” Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 19 of 23 - 20 - after summary judgment. Def.’s Disc. Resp. at 17. To the extent plaintiffs concede the requested expert report “is for [the] merits” stage and not necessary for class certification, however, the government believes “a class cannot be certified without a viable expert damages methodology meeting the requirements of Comcast,” meaning plaintiffs’ pending motion for class certification automatically fails because “the only expert evidence in the record that bears on the two types of breaches found by the Court is . . . offered by the [g]overnment.” Id. at 22– 23 (citing Comcast Corp. v. Behrend, 569 U.S. 27, 33–34 (2013)). Indeed, according to the government, “plaintiffs are left with no expert model at all as to the few remaining contract claims,” meaning they cannot adequately allege “damages are capable of measurement on a class[-]wide basis” as required by Comcast. Id. at 24 (quoting Comcast, 569 U.S. at 34). Concerning plaintiffs’ request for leave to file an expert report, the government broadly asserts plaintiffs were not diligent in pursuing their discovery requests. See, e.g., Def.’s Disc. Resp. at 28. As determined supra Section IV.A.1, however, plaintiffs were diligent with respect to pursuing the requested discovery generally. Plaintiffs requested the relevant data in February and July 2020 and planned to replace “the extrapolation” present in their earlier expert reports with analysis “using actual data” upon completion of this requested discovery. See supra Section IV.A.1; Tr. at 136:15–23. The Court’s November 2022 Summary Judgement Order narrowed the scope of this case and further highlighted the need for this additional discovery related to the remaining issues and potential class members. See supra Section IV.A.1, B; Ingham Reg’l Med. Ctr., 163 Fed. Cl. at 427. Further, to the extent the government alleges plaintiffs requested expert report is prejudicial, the government will have sufficient time and opportunity to rebut any supplemental expert report filed by plaintiffs. See supra Section IV.A.2, B.2; Alta Wind I Owner Lessor C, 154 Fed. Cl. at 217 (“Other Court of Federal Claims judges have noted that providing the government an opportunity to file a rebuttal mitigates any prejudice that may have otherwise existed in providing plaintiff the opportunity to reopen the record.”). The contemplated expert report, which will perform the DPP analysis for outpatient radiology claims data within the scope of the Court’s November 2022 liability findings for each putative class member hospital using “only the [government’s] data” as required by the Court’s Summary Judgment Order, could also aid the Court at the merits stage in determining “the amount[] that each hospital is owed.” Tr. at 78:7–15. The requested report therefore would likely not be prejudicial to the government to such an extent as to “warrant the severe sanction of exclusion of [useful] data.” Davita HealthCare Partners, Inc., 125 Fed. Cl. at 399; High Point Design LLC, 730 F.3d at 1319 (quoting Kassner, 496 F.3d at 244); 6A CHARLES A. WRIGHT ET AL., FEDERAL PRACTICE AND PROCEDURE § 1522.2 (3d ed. 1998) (“What constitutes good cause sufficient to justify the modification of a scheduling order necessarily varies with the circumstances of each case.”). Plaintiffs acknowledge, however, the updated calculations they plan to include in their requested expert report are not necessary until “after [class] certification”—at the merits stage. Tr. at 73:15–16. At oral argument, plaintiffs clearly stated they do not “need an expert report for class certification,” which is the next step in this litigation. Tr. at 96:3–4. To the extent the government argues plaintiffs’ certification motion will necessarily fail because plaintiffs lack evidence “damages are [measurable] . . . on a class[-]wide basis” in response to this statement by plaintiffs, Def.’s Disc. Rep. at 23 (quoting Comcast, 569 U.S. at 34), plaintiffs respond the DPP Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 20 of 23 - 21 - is the requisite means of “calculat[ing] damages for every single class member,” Tr. at 136:4–5. While the Court reserves judgment as to plaintiffs’ class certification motion, plaintiffs’ argument the DPP provides their model for calculating damages on a class-wide basis because it is a uniform model applicable to all putative class members is sufficient to suggest plaintiffs need not fully calculate alleged damages in a supplemental expert report at this time. Tr. at 54:9–15 (“[PLAINTIFFS:] I think the type of cases that [the government] is talking about [like Comcast] where there’s been [a failure by the plaintiffs to actually address the calculation of class-wide damages, are inapposite because] we haven’t offered a model that is deviating from the contract. What we’re saying . . . the experts are going to . . . essentially crunch[ the] numbers [using the DPP].”). Plaintiffs can do so if and when the merits of this case are argued at trial. This is not a case like Comcast, in which the plaintiffs presented to the court “a methodology that identifies damages that are not the result of the wrong” at issue. Comcast, 569 U.S. at 37. Here, in contrast, the parties indicated at oral argument plaintiffs’ proffered DPP methodology from the parties’ DPP Contracts appears capable of calculating damages for all potential class members. Tr. at 136:1–5 (“[PLAINTIFFS:] But what I will tell you that we’re going to do with the data is we are going to have the auditor [i.e., the expert] plug [the government’s] data into the DPP. That is the model. That is [what] the contract . . . dictates . . . how you calculate damages for every single class member.”); Tr. at 54:12–13 (“[PLAINTIFFS:] [W]e haven’t offered a model that is deviating from the contract.”); Tr. at 93:2–5 (“THE COURT: But the model is just what you said is—if I understood correctly, is that the report is just DPP data discrepancy output. [THE GOVERNMENT]: For each individual [p]laintiff.”); see Tr. 93:2–95:25. The Court accordingly denies plaintiffs’ request for an expert report without prejudice in the interest of the efficient disposition of plaintiffs’ class certification motion. High Point Design LLC, 730 F.3d at 1319 (quoting Kassner, 496 F.3d at 244); 6A CHARLES A. WRIGHT ET AL., FEDERAL PRACTICE AND PROCEDURE § 1522.2 (3d ed. 1998) (“What constitutes good cause sufficient to justify the modification of a scheduling order necessarily varies with the circumstances of each case.”). To the extent plaintiffs “would want in [the] merits” stage an expert report from an “auditor to make sure” the parties “all agree on” damages calculated via the DPP, plaintiffs may refile this motion at that time. Tr. at 96:12���13 (plaintiffs). V. Scope of Granted Discovery and Next Steps As discussed supra Section IV: 1. The Court grants plaintiffs’ deposition request. 2. The Court grants plaintiffs’ document requests as follows: Plaintiffs are permitted to serve amended document discovery requests for all putative class member hospitals tailored to seek only those documents required for plaintiffs to identify “breach[es] of TMA’s [contractual] duty” under the DPP Contract akin to either: (1) the government’s failure to extract “thirteen line items for Integris Baptist and Integris Bass Baptist”; or (2) the government’s failure to adjust “five . . . line items” for Integris Baptist “during the DPP because of an alternate zip code.” See Ingham Reg’l Med. Ctr. v. United States, 163 Fed. Cl. 384, 409, 412 (2022). This specification ensures plaintiffs’ requests remain within the scope of the Court’s findings of liability in November 2022. Id. The Court notes at the 19 December 2023 status conference the government agreed it is possible to Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 21 of 23 - 22 - execute the same analysis performed on the named plaintiffs’ data in the 25 October 2023 JSR on the government’s data for all putative class members. 11 3. The Court denies plaintiffs’ request to file a supplemental expert report without prejudice. Plaintiffs may move to file an updated expert report later in this litigation as necessary, at which time the government will be permitted to file a response report. Within three weeks of the date this Order is issued, the parties shall file a JSR comprised of the following: 1. Plaintiffs’ discovery requests revised in accordance with the above clarifications; 2. The parties’ proposed schedule for discovery, including a timeline for plaintiffs’ deposition and the exchange of documents between the parties; and 3. The parties’ proposed schedule for re-briefing class certification after all discovery closes, including a proposed timeline for the filing of new expert reports. As noted by the Court at the 19 December status conference, plaintiffs’ next step should be to analyze the government’s data for the six named plaintiffs already in plaintiffs’ possession to assist plaintiffs in tailoring their document requests as discussed above. Further, at the 19 December 2023 status conference, the parties agreed the partial grant of plaintiffs’ Discovery Motion moots plaintiffs’ pending Motion to Certify Class Action and Appoint Class Counsel, ECF No. 146, as the parties will need to re-brief these issues following the narrowing of this case on summary judgment and the upcoming additional discovery. The government agreed its pending Motion to Exclude Inadmissible Evidence Relied Upon in Plaintiffs’ Motion for Class Certification, ECF No. 204, is accordingly moot. The government may refile a similar motion if needed during future class certification briefing. Plaintiffs likewise agreed to withdraw without prejudice their Motion to Exclude the Expert Opinions and Continued Participation of Kennell, ECF No. 251, pending further discovery and briefing. Further, plaintiffs agreed, given the scope of this case after summary judgment, the expert report of Fay is moot. Accordingly, the government’s Motion to Exclude the Expert Opinions of Fay, ECF No. 206, is moot. Finally, plaintiffs stated they plan to file a new expert report replacing that of Jerzak later in this litigation. The government noted at the 19 December status conference plaintiffs’ replacement of Ms. Jerzak’s current report will render the government’s Motion to Exclude the Expert Opinions of Jerzak, ECF No. 205, moot as well. 11 As discussed supra note 4, in the 25 October 2023 JSR, the government explained why twelve of the thirteen line items improperly excluded for Integris Baptist and Integris Bass Baptist were not extracted. At the 19 December 2023 status conference, the government indicated it can now search its database for line items improperly excluded due to this same error for all hospitals that participated in the DPP. The government noted, however, it is not aware of what caused the thirteenth line item to be missed so cannot create search criteria appropriate to identifying other similar misses. Finally, to identify missed alternate zip codes, the government stated it would need zip code information from plaintiffs and the putative class members. Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 22 of 23 - 23 - VI. Conclusion For the foregoing reasons, and as specified supra Section V, the Court GRANTS-INPART and DENIES-IN-PART plaintiffs’ Motion for Leave to Conduct Certain Limited Additional Discovery and to Submit Supplemental Expert Report, ECF No. 269, and FINDS as MOOT plaintiffs’ Motion for Clarification or, in the Alternative, to Compel Production, ECF No. 161.12 As noted supra Section V, the Court FINDS as MOOT plaintiffs’ Motion to Certify Class Action and Appoint Class Counsel, ECF No. 146, the government’s Motion to Exclude Inadmissible Evidence Relied Upon in Plaintiffs’ Motion for Class Certification, ECF No. 204, the government’s Motion to Exclude the Expert Opinions of Fay, ECF No. 206, and the government’s Motion to Exclude the Expert Opinions of Jerzak, ECF No. 205. As agreed to at the 19 December 2023 status conference, plaintiffs SHALL WITHDRAW their Motion to Exclude the Expert Opinions and Continued Participation of Kennell, ECF No. 251, without prejudice. Finally, as noted at oral argument, see Tr. at 139:10–140:8, the Court STRIKES the government’s Notice of Additional Authority, ECF No. 273, as deficient and GRANTS the government’s Unopposed Motion for Leave to File Notice of Supplemental Authority, ECF No. 274, for good cause shown. The parties SHALL FILE the joint status report discussed supra Section V on or before 23 January 2024. IT IS SO ORDERED. s/ Holte HOLTE Judge 12 At oral argument, the parties agreed the Court ruling on plaintiffs’ current Discovery Motion is also a “ruling on [plaintiffs’ previous Motion to Compel,] ECF [No.] 161.” Tr. at 139:2–9. Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24","You can only respond with the information in the context block. Please give your response in a simple tone that could be shared with a non-legal audience and easily understood.
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+EVIDENCE:
+In the United States Court of Federal Claims No. 13-821 (Filed: 2 January 2024) *************************************** INGHAM REG’L MEDICAL CENTER, * n/k/a MCLAREN GREATER LANSING, * et al., * * Plaintiffs, * * v. * * THE UNITED STATES, * * Defendant. * * Plaintiffs are six hospitals purporting to represent a class of approximately 1,610 hospitals across the United States in a suit requesting, among other things, the Court interpret what the Federal Circuit has deemed an “extremely strange” contract.1 This contract arose when hospitals complained the government underpaid reimbursements for Department of Defense Military Health System, TRICARE, outpatient services rendered between 2003 and 2009. In 2011, after completion of a data analysis, the government voluntarily entered a discretionary payment process contract with plaintiffs and offered net adjusted payments. In November 2022, after nine years of litigation and one Federal Circuit appeal, the Court granted in part and denied in part the government’s Motion for Summary Judgment. As the only surviving breach of contract claims concern the government’s duty to extract, analyze, and adjust line items from its 1 9 June 2022 Oral Arg. Tr. at 161:7–13, ECF No. 259 (“THE COURT: So the Federal Circuit panel, when the case was argued, characterized this agreement as extremely strange. [THE GOVERNMENT]: That is accurate. It is extremely strange. THE COURT: It is extremely strange? [THE GOVERNMENT]: It is.”). Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 1 of 23 - 2 - database, the Court required the parties to file a joint status report regarding the effect of summary judgment on plaintiffs’ Renewed Motion to Certify a Class Action. Following a status conference, plaintiffs filed a discovery motion related to class certification. For the following reasons, the Court grants-in-part and denies-in-part plaintiffs’ Motion. I. Background A. Factual and Procedural History2 TRICARE is a “military health care system” which “provides medical and dental care for current and former members of the military and their dependents.” Ingham Reg’l Med. Ctr. v. United States, 874 F.3d 1341, 1342 (Fed. Cir. 2017). TRICARE Management Activity (TMA), a “field office in the Defense Department [(DoD)],” managed the TRICARE system.3 N. Mich. Hosps., Inc. v. Health Net Fed. Servs., LLC, 344 F. App’x 731, 734 (3d Cir. 2009). In 2001, Congress amended the TRICARE statute to require DoD to follow Medicare rules when reimbursing outside healthcare providers. Ingham Reg’l Med. Ctr., 874 F.3d at 1343 (citing 10 U.S.C. § 1079(j)(2) (2002)). To facilitate transition to Medicare rules, in 2005, DoD issued a Final Rule which specified “[f]or most outpatient services, hospitals would receive payments ‘based on the TRICARE-allowable cost method in effect for professional providers or the [Civilian Health and Medical Program of the Uniformed Services] (CHAMPUS) Maximum Allowable Charge (CMAC).’” Id. (quoting TRICARE; Sub-Acute Care Program; Uniform Skilled Nursing Facility Benefit; Home Health Care Benefit; Adopting Medicare Payment Methods for Skilled Nursing Facilities and Home Health Care Providers, 70 Fed. Reg. 61368, 61371 (Oct. 24, 2005) (codified as amended at 32 C.F.R. § 199)). The TRICARE-allowable cost method “applied until 2009, when TRICARE introduced a new payment system for hospital outpatient services that was similar to the Medicare [Outpatient Prospective Payment System (OPPS)].” Id. In response to hospital complaints of payment issues, TRICARE hired Kennell and Associates, a consulting firm, to “undertake a study [(‘Kennell study’)] of the accuracy of its payments to the hospitals.” Ingham Reg’l Med. Ctr., 874 F.3d at 1343–44. The Kennell study “compared CMAC payments to the payments that would have been made using Medicare payment principles, and determined that DoD ‘(1) underpaid hospitals for outpatient radiology but, (2) correctly paid hospitals for all other outpatient services.’” Id. at 1344 (emphasis omitted) (citation omitted). From the Kennell study findings, “DoD created a discretionary payment process [(DPP)],” and, on 25 April 2011, DoD notified hospitals by letter of the process for them to “request a review of their TRICARE reimbursements (the ‘Letter’)” and “published a document titled ‘NOTICE TO HOSPITALS OF POTENTIAL ADJUSTMENT TO PAST PAYMENTS FOR OUTPATIENT RADIOLOGY SERVICES’ (the ‘Notice’)” on the TRICARE website. Id.; App. to Def.’s MSJ at A3–A9, ECF No. 203-1. The Notice described a nine-step methodology to “govern the review of payments for hospital outpatient radiology services and [the] payment 2 The factual and procedural history in this Order contains only those facts pertinent to plaintiffs’ Motion for Discovery, ECF No. 269. 3 The Defense Health Agency now manages activities previously managed by TMA. Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 2 of 23 - 3 - of any discretionary net adjustments” by which hospitals could “request an analysis of their claims data for possible discretionary adjustment.” App. to Def.’s MSJ at A7. On 21 October 2013, plaintiffs brought this action claiming the government underpaid them for certain outpatient medical services they provided between 1 August 2003 and 1 May 2009. See Ingham Reg’l Med. Ctr. v United States, 126 Fed. Cl. 1, 9 (2016), aff’d in part, rev’d in part, 874 F.3d 1341 (Fed. Cir. 2017). Plaintiffs allege the approximately six years of underpayment breached two contracts and violated various statutory and regulatory provisions. Id. Plaintiffs estimate several thousand hospitals submitted requests for discretionary payment, including the six named plaintiffs in this case. See id. at 16. Plaintiffs therefore seek to represent a class of as many as 1,610 similarly situated hospitals. See Pls.’ Mem. in Supp. of Mot. to Certify at 1, ECF No. 77; see also Mot. to Certify, ECF No. 76. On 11 February 2020, during the parties’ second discovery period, plaintiffs requested from the government “[a]ny and all data concerning hospital outpatient services claims and TRICARE reimbursement for hospital outpatient services claims during the relevant time period . . . .” See App. to Pls.’ Disc. Mot. at 23, ECF No. 269; Gov’t’s Disc. Resp. at 11, ECF No. 270. The government rejected this request for records from “thousands of hospitals . . . that are not [named] plaintiffs” on 16 March 2020 and instead only “produce[d] the data requested for the six plaintiffs in this lawsuit.” App. to Pls.’ Disc. Mot. at 29. Plaintiffs filed a motion to clarify the case schedule or, in the alternative, to compel discovery of “data and documents relating to the [g]overnment’s calculation of payments under the [DPP] for all putative class members, not just the named [p]laintiffs” on 31 July 2020, the last day of discovery. See Pls.’ Mot. to Compel (“Pl.’s MTC”) at 2, ECF No. 161 (emphasis added). In response, the government stated, “[t]here is no basis for the Court to . . . compel extraneous discovery of hospitals that are not now in this lawsuit.” Def.’s Resp. to Pl.’s MTC (“Def.’s MTC Resp.”) at 2, ECF No. 166. During a status conference on 13 October 2020, the parties agreed to table plaintiffs’ discovery request and associated Motion to Compel pending resolution of the government’s then-pending Motion for Reconsideration, ECF No. 150, and any additional potentially dispositive motions. See 13 Oct. 2020 Tr. (“SC Tr.”) at 27:13–28:9, ECF No. 178 (“THE COURT: . . . So to state differently, then, [plaintiffs agree] to stay consideration of this particular [discovery] issue until class certification is decided? [PLAINTIFFS:] Yes, that would be fine. THE COURT: . . . [W]ould the [g]overnment agree with that? [THE GOVERNMENT:] Yes, [y]our [h]onor . . . [but] the [g]overnment still intends to file a motion for summary judgment. . . . THE COURT: Okay. So on the [g]overnment’s motion for summary judgment . . . that should probably not be filed until at least after the motion for reconsideration is resolved? [THE GOVERNMENT:] That’s correct.”). On 5 June 2020, plaintiffs filed a renewed motion to certify a class and appoint class counsel (“Pls.’ Class Cert.”), ECF No. 146, which the parties fully briefed. See Def.’s Class Cert. Resp., ECF No. 207; Pls.’ Class Cert. Reply, EF No. 226. On 26 August 2021, the government filed a motion for summary judgment (“Def.’s MSJ”), ECF No. 203. Plaintiffs filed an opposition to the government’s motion for summary judgment on 4 February 2022 (“Pls.’ MSJ Resp.”), ECF No. 225, and on 11 March 2022, the government filed a reply (“Def.’s MSJ Reply”), ECF No. 234. Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 3 of 23 - 4 - “The Court [granted] the government’s [M]otion for [S]ummary [J]udgment as to plaintiffs’ hospital-data duty and mutual mistake of fact claims but [denied] the government’s [M]otion as to plaintiffs’ TMA-data duty and alternate zip code claims[,] . . . [and stayed] the evidentiary motions” on 28 November 2022. Ingham Reg’l Med. Ctr. v. United States, 163 Fed. Cl. 384, 428 (2022). The Court, deeming the government’s settlement arrangements with plaintiffs to be contracts (the “DPP Contracts”), specifically found “the DPP Contract[s] only obligated TMA to use its data, not the hospitals’ data,” leaving the government’s data as the only set relevant to this case. Id. at 427. The Court held the government’s (1) “failure to extract thirteen line items [meeting all qualifications for extraction] for Integris Baptist and Integris Bass Baptist”; and (2) failure to adjust “five . . . line items [for Integris Baptist] during the DPP because of an alternate zip code” constituted breach of the DPP Contracts. Id. at 409–10, 412. “Based on the summary judgment holding . . . the Court [found it needed] further information regarding how plaintiffs in this post-summary judgment smaller class would meet the requirements for class certification.” Id. “The Court accordingly decline[d] to rule on plaintiffs’ class certification motion . . . [a]s the only surviving claims are breach of contract for failure to follow the DPP in a few limited circumstances, [and] the parties did not adequately brief the narrower proposed class of plaintiffs arising under the remaining claims.” Id. The Court ordered the parties to file “a joint status report [(JSR)] providing the parties’ views on class certification for the smaller class of plaintiffs affected by the government’s breach of contract for failure to follow the DPP in limited circumstances and on whether further briefing is necessary.” Id. On 28 December 2022, the parties filed a JSR providing their opposing positions on whether plaintiffs can request further discovery related to class certification: “plaintiffs expressly reserve, and do not waive, any rights that they may currently have, or may have in the future, with respect to additional class certification fact or expert discovery”; and “the [g]overnment opposes any further fact or expert discovery in connection with plaintiffs’ amended/supplemental motion for class certification, and, in agreeing to the foregoing briefing schedule, is not agreeing to any further fact or expert discovery in this case.” 28 Dec. 2022 JSR at 2, ECF No. 262. Plaintiffs then filed a motion requesting leave to conduct further discovery and submit a supplemental expert report on 21 March 2023 (“plaintiffs’ Discovery Motion”). Pls.’ Disc. Mot., ECF No. 269. The government filed a response on 21 April 2023. Gov’t’s Disc. Resp. Plaintiffs filed a reply on 9 May 2023. Pls.’ Disc. Reply, ECF No. 271. The Court held oral argument on 19 July 2023. See 5 June 2023 Order, ECF No. 272; 19 July 2023 Oral Arg. Tr. (“Tr.”), ECF No. 276. On 31 August 2023, following oral argument on plaintiffs’ Discovery Motion, the government filed an unopposed motion to stay the case for the government to complete a “second look at the records [analyzed] . . . in the July 2019 expert report of Kennell . . . that were the subject of one of the Court’s liability rulings on summary judgment.” Def.’s Mot. to Stay at 1, ECF No. 277. The Court granted this Motion on the same day. Order, ECF No. 278. On 25 October 2023, the parties filed a JSR, ECF No. 284, in which the government addressed its findings4 and “proposed [a] way forward” in this case. 25 Oct. 2023 JSR at 2. In 4 In the 25 October 2023 JSR, the government explained twelve of the thirteen line items the government failed to extract for Integris Baptist and Integris Bass Baptist, see Ingham Reg’l Med. Ctr. v. United States, 163 Fed. Cl. 384, 412 (2022), were missed due to a “now-known” error in which “a very small set of patients comprised of military spouses . . . under age 65” were overlooked because they “receive Medicare Part A” but not Medicare Part B, Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 4 of 23 - 5 - response to the government’s data analysis, plaintiffs noted in the JSR “the [g]overnment’s update makes clear that [additional g]overnment data is required to evaluate which hospitals were affected by the [g]overnment’s breach of the DPP.” Id. at 16. Plaintiffs then likewise “[p]roposed [n]ext [s]teps” in this case, beginning with resolution of their Discovery Motion. Id. at 18. On 19 December 2023, the Court held a telephonic status conference to understand the technical aspects of plaintiffs’ discovery requests as they relate to the DPP process and algorithm. See Scheduling Order, ECF No. 285. B. Discovery Requests at Issue Plaintiffs seek leave to perform additional discovery stemming from the Court’s summary judgment holding “TMA [breached its duty] . . . to extract, analyze, and adjust radiology data from its database” by failing to (1) adjust “five . . . line items [for Integris Baptist] during the DPP because of an alternate zip code” and (2) “extract . . . thirteen line items [meeting the criteria for extraction] for Integris Baptist and Integris Bass Baptist.” Ingham Reg’l Med. Ctr., 163 Fed. Cl. at 409–10, 412. Plaintiffs’ sought-after discovery includes a request for “the same data for the [putative] class hospitals” as plaintiffs currently “have [for the] six named [p]laintiffs,” Tr. at 50:14–19, to assist plaintiffs in identifying “line items in [TMA’s radiology data] . . . that met the [DPP C]ontract criteria but were excluded from the adjustment . . . .” Gov’t’s Disc. Resp. at 15. In all, plaintiffs “seek leave to (1) depose a [g]overnment corporate designee, (2) serve document requests, and (3) thereafter serve a supplemental expert report on the relevant class issues.” Pls.’ Disc. Mot. at 2. Plaintiffs further detail the purpose of each request: First, [p]laintiffs seek leave to depose a [g]overnment corporate designee to identify the various data sources in the [g]overnment’s possession from the relevant time period. Second, [p]laintiffs seek leave to serve . . . document requests to obtain critical data related to each Potential Class member hospital. Third, once the above discovery is completed, [p]laintiffs seek leave to serve a supplemental expert report that applies the DPP methodology to the relevant claims data to identify the Final Class. Id. at 6–7 (footnote omitted) (citations omitted). The second request, mirroring plaintiffs’ February 2020 request for “[a]ny and all data concerning hospital outpatient service claims and TRICARE reimbursement for hospital outpatient services claims during the relevant time period,” App. to Pl.’s Disc. Mot. at 23, comprises “(1) all information Kennell used in the DPP calculations for each Potential Class member hospital, as well as the underlying calculations[;] and (2) all hospital outpatient claims meaning the “outpatient services that these individuals receive are paid for . . . by TRICARE.” 25 Oct. JSR at 4, ECF No. 284. As a result of this Medicare arrangement, line items for this group of patients were not extracted as the individuals were mistakenly deemed Medicare, rather than TRICARE, recipients for procedures within the scope of the DPP. Id. The cause of the thirteenth unextracted line item remains unclear. Id. at 5. Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 5 of 23 - 6 - data available for each of the Potential Class member hospitals during the relevant time period.” Pl.’s Disc. Mot. at 8–9. This request includes: (1) CMAC rate files “needed to apply the DPP methodology”; (2) “[d]ata on hospital outpatient radiology services claim line items for each Potential Class member hospital”; (3) “[d]ata concerning hospital outpatient services claim line items for each Potential Class member hospital” to verify the radiology files are complete; and (4) “TRICARE Encounter Data (‘TED’) records and Health Care Service Records (‘HCSR’).” Id. at 9–10. II. Applicable Law This court’s application of the Rules of the United States Court of Federal Claims (“RCFC”) is guided by case law interpreting the Federal Rules of Civil Procedure (FRCP). See RCFC rules committee’s note to 2002 revision (“[I]nterpretation of the court’s rules will be guided by case law and the Advisory Committee Notes that accompany the Federal Rules of Civil Procedure.”). Regarding the scope of discovery, the rules of this court provide: [P]arties may obtain discovery regarding any nonprivileged matter that is relevant to any party’s claim or defense and proportional to the needs of the case, considering the importance of the issues at stake in the action, the amount in controversy, the parties’ relative access to relevant information, the parties’ resources, the importance of the discovery in resolving the issues, and whether the burden or expense of the proposed discovery outweighs its likely benefit. RCFC 26(b)(1). “Questions of the scope and conduct of discovery are . . . committed to the discretion of the trial court.” Florsheim Shoe Co., Div. of Interco, Inc. v. United States, 744 F.2d 787, 797 (Fed. Cir. 1984). The Court of Federal Claims generally “afford[s] a liberal treatment to the rules of discovery.” Securiforce Int’l Am., LLC v. United States, 127 Fed. Cl. 386, 400 (2016), aff’d in part and vacated in part on other grounds, 879 F.3d 1354 (Fed. Cir. 2018), cert. denied, 139 S. Ct. 478 (2018) (mem.). “[T]he [C]ourt must be careful not to deprive a party of discovery that is reasonably necessary to afford a fair opportunity to develop and prepare the case.” Heat & Control, Inc. v. Hester Indus., Inc., 785 F.2d 1017, 1024 (Fed. Cir. 1986) (quoting FED. R. CIV. P. 26(b)(1) advisory committee’s note to 1983 amendment). Further, “[a] trial court ‘has wide discretion in setting the limits of discovery.’” Schism v. United States, 316 F.3d 1259, 1300 (Fed. Cir. 2002) (quoting Moore v. Armour Pharm. Co., 927 F.2d 1194, 1197 (11th Cir. 1991)). This court has previously found such “discretion [extends to] . . . deciding whether to grant a motion to . . . reopen discovery.” Croman Corp. v. United States, 94 Fed. Cl. 157, 160 (2010) (citing Te-Moak Bands of W. Shoshone Indians of Nev. v. United States, 948 F.2d 1258, 1260 (Fed. Cir. 1991)); see also Wordtech Sys., Inc. v. Integrated Networks Sols., Inc., 609 F.3d 1308, 1322–23 (Fed. Cir. 2010) (citing Coleman v. Quaker Oats Co., 232 F.3d 1271, 1294 (9th Cir. 2000)) (applying Ninth Circuit law in determining trial court did not abuse its discretion in refusing to reopen discovery). Notwithstanding, modification of a court-imposed schedule, including a discovery schedule, may be done “only for good cause and with the judge’s consent.” RCFC 16(b)(4). In Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 6 of 23 - 7 - High Point Design, the Federal Circuit applied Second Circuit law5 when discussing the good cause standard of FRCP 16(b)(4) for amending a case schedule. “When assessing whether good cause has been shown, ‘the primary consideration is whether the moving party can demonstrate diligence.’” High Point Design LLC v. Buyers Direct, Inc., 730 F.3d 1301, 1319 (Fed. Cir. 2013) (quoting Kassner v. 2nd Ave. Delicatessen, Inc., 496 F.3d 229, 244 (2d Cir. 2007)); see also Adv. Software Design Corp. v. Fiserv, Inc., 641 F.3d 1368, 1381 (Fed. Cir. 2011) (“Under the good cause standard, the threshold inquiry is whether the movant has been diligent.” (citing Sherman v. Winco Fireworks, Inc., 532 F.3d 709, 717 (8th Cir. 2008))). This “requires a showing that even with the exercise of due diligence the moving party could not meet the order’s timetable.” Slip Track Sys., Inc. v. Metal-Lite, Inc., 304 F.3d 1256, 1270 (Fed. Cir. 2002) (applying Ninth Circuit law in finding defendant’s attempt to amend the pleadings first required modification of the scheduling order under FRCP 16(b)(4)). Trial courts may also consider “other relevant factors including, in particular, whether allowing the amendment . . . will prejudice [the opposing party].” High Point Design, 730 F.3d at 1319 (quoting Kassner, 496 F.3d at 244); 6A WRIGHT ET AL., FEDERAL PRACTICE AND PROCEDURE § 1522.2 (3d ed. 1998) (“What constitutes good cause sufficient to justify the modification of a scheduling order necessarily varies with the circumstances of each case.”). Prejudice related to the reopening of discovery may involve the delay of proceedings. Wordtech Sys., 609 F.3d at 1322 (“[A] need to reopen discovery and therefore delay the proceedings supports a district court’s finding of prejudice from a delayed motion to amend the complaint.” (quoting Lockheed Martin Corp. v. Network Sols., Inc., 194 F.3d 980, 986 (9th Cir. 1999))). III. Parties’ Arguments Plaintiffs contend “good cause exists for [p]laintiffs to conduct . . . additional limited discovery,” Pls.’ Disc. Mot. at 7–8 (citing Geneva Pharms. Tech. Corp. v. Barr Lab’ys, Inc., Nos. 98 Civ. 861, 99 Civ. 3687, 2005 WL 2132438, at *5 (S.D.N.Y. Sept. 6, 2005)), largely mirroring their “live and pending request for discovery [from February 2020] that[ ha]s been tabled” since October 2020, Tr. at 37:16–17; see SC Tr. at 27:13–23. Specifically, plaintiffs argue, “[t]he Court’s ruling on the [g]overnment’s Summary Judgment Motion is a material event that has fundamentally altered the scope of this case.” Pl.’s Disc. Mot. at 7–8 (citing Ingham Reg’l Med. Ctr. v. United States, 163 Fed. Cl. 384, 428 (2022) (“[T]he parties did not adequately brief the narrower proposed class of plaintiffs arising under the remaining claims.”)). Plaintiffs state the requested “discovery will allow them to provide the Court with the information required for the determination of the Final Class, and that this will greatly assist the Court with its ruling on class certification.” Id. at 10. At oral argument, the government acknowledged “[p]laintiffs[’] [2020] request [for] all class hospital data” concerned much of the same information plaintiffs are “asking for now.” Tr. at 103:7–17. The government, however, maintains “plaintiffs’ motion to reopen fact and expert discovery should be denied.” Gov’t’s Disc. Resp. at 17. Specifically, the government argues plaintiffs “filed this case, moved for class certification twice, and proceeded through two full rounds of fact and expert discovery, based upon . . . [p]laintiffs’ view of the law.” Id. at 16. The 5 RCFC 16(b)(4) is identical to the corresponding Rule 16(b)(4) of the Federal Rules of Civil Procedure. Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 7 of 23 - 8 - government therefore argues plaintiffs should not be permitted to “reopen fact and expert discovery” simply because “on summary judgment,” the “legal theories that animated plaintiffs’ [previous] discovery and expert reports have been shown . . . to be . . . wrong.” Id. at 16��17. The government argues “[a] party’s realization that it elected to pursue the wrong litigation strategy is not good cause for amending a schedule,” so plaintiffs have failed to show good cause to reopen discovery as they request. Gov’t’s Disc. Resp. at 17 (quoting Sys. Fuels, Inc. v. United States, 111 Fed. Cl. 381, 383 (2013)). Alluding to the standard for reopening discovery, the government argues “no actions by plaintiffs . . . even remotely approximate the showing of diligence required under RCFC 16 . . . .” Id. at 35. The government also argues plaintiffs’ requests “overwhelming[ly] and incurabl[y] prejudice . . . the [g]overnment.” Id. at 38. IV. Whether Good Cause Exists to Reopen Discovery As noted supra Section III, plaintiffs contend “good cause exists for [p]laintiffs to conduct . . . additional limited discovery,” Pls.’ Disc. Mot. at 7–8 (citing Geneva Pharms. Tech. Corp. v. Barr Lab’ys, Inc., Nos. 98 Civ. 861, 99 Civ. 3687, 2005 WL 2132438, at *5 (S.D.N.Y. Sept. 6, 2005)), largely mirroring their “live and pending request for discovery [from February 2020] that[ ha]s been tabled” since October 2020, when the parties agreed to first proceed with the government’s Motion for Reconsideration and Motion for Summary Judgment. Tr. at 37:16– 17; see SC Tr. at 27:13–23. Plaintiffs believe the requested “discovery will allow them to provide the Court with the information required for the determination of the Final Class, and that this will greatly assist the Court with its ruling on class certification.” Pl.’s Disc. Mot. at 10. In contrast, the government asserts plaintiffs have, in two previous rounds of discovery and in their summary judgment briefing, chosen to pursue a litigation strategy based on a class damages model relying on hospital and government data and cannot now justify reopening discovery because they need to change tactics following the Court’s summary judgment ruling limiting the scope of this case to the government’s data. See Gov’t’s Disc. Resp. at 22–23. Specifically, the government contends plaintiffs have neither made the required showing of diligence during past discovery periods to justify modifying the Court’s discovery schedule nor adequately refuted the government’s claim this discovery is prejudicial. See Gov’t’s Disc. Resp. at 28, 35. “A trial court ‘has wide discretion in setting the limits of discovery.’” Schism v. United States, 316 F.3d 1259, 1300 (Fed. Cir. 2002) (quoting Moore v. Armour Pharm. Co., 927 F.2d 1194, 1197 (11th Cir. 1991)). This court has previously found such “discretion [is applicable] in deciding whether to grant a motion to . . . reopen discovery.” Croman Corp. v. United States, 94 Fed. Cl. 157, 160 (2010) (citing Te-Moak Bands of W. Shoshone Indians of Nev. v. United States, 948 F.2d 1258, 1260 (Fed. Cir. 1991)). RCFC 16(b)(4) permits modification of a court-imposed schedule, such as to re-open discovery, “only for good cause and with the judge’s consent.”6 Good cause “requires a showing that even with the exercise of due diligence the moving party could not meet the order’s timetable.” Slip Track Sys., Inc. v. Metal-Lite, Inc., 304 F.3d 1256, 1270 (Fed. Cir. 2002) (applying Ninth Circuit law in finding defendant’s attempt to amend the 6 At oral argument, the parties agreed plaintiffs are requesting the Court reopen discovery, meaning this good cause standard applies. Tr. 99:14–19: “[PLAINTIFFS:] I think, as between [supplementation and reopening], th[ese requests] probably fit[] better in the reopening category as between those two . . . . THE COURT: So . . . the standard for reopening is good cause? [PLAINTIFFS:] Yes. THE COURT: [The government], [do] you agree? [THE GOVERNMENT:] I agree.” Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 8 of 23 - 9 - pleadings first required modification of the scheduling order under FRCP 16(b)(4)). Likewise, in determining whether good cause exists to reopen discovery, a trial court may consider “other relevant factors including, in particular, whether allowing the amendment . . . will prejudice [the opposing party].” High Point Design LLC v. Buyers Direct, Inc., 730 F.3d 1301, 1319 (Fed. Cir. 2013) (quoting Kassner v. 2nd Ave. Delicatessen, Inc., 496 F.3d 229, 244 (2d Cir. 2007)). The Court accordingly must determine whether good cause exists to reopen discovery as requested by plaintiffs by analyzing plaintiffs’ diligence and whether the requested discovery prejudices the government. The Court begins with plaintiffs’ document requests. A. Document Requests Plaintiffs request the government turn over “critical data related to each Potential Class member hospital” and argue “denying ‘precertification discovery where it is necessary to determine the existence of a class is an abuse of discretion.’” Pls.’ Disc. Mot. at 6–7; Pls.’ Disc. Reply at 2 (quoting Perez v. Safelite Grp. Inc., 553 F. App’x 667, 669 (9th Cir. 2014)). These document requests specifically target “(1) all information Kennell used in the DPP calculations for each Potential Class member hospital, as well as the underlying calculations, and (2) all hospital outpatient claims data available for each of the Potential Class member hospitals during the relevant time period.” Pls.’ Disc. Mot. at 8–9. Plaintiffs’ goal is to acquire all “radiology line item[]” data and other information necessary to “apply the DPP methodology” to all of the putative class members’ claims data from the DPP period. Id. at 9. Plaintiffs contend “good cause exists” for the Court to reopen discovery with respect to these documents because the “Court’s ruling on the [g]overnment’s Summary Judgment Motion is a material event that . . . fundamentally altered the scope of this case.” Id. at 8. Namely, plaintiffs’ “damages are now limited to those claims involving errors in the [g]overnment’s data,” so plaintiffs allege this data, which “by its very nature [is] exclusively in [the government’s] possession,” is necessary “to identify the class members.” Pls.’ Disc. Reply at 3; see Ingham Reg’l Med. Ctr. v. United States, 163 Fed. Cl. 384, 427–29 (2022). Further, plaintiffs believe reopening discovery for this request is appropriate because in February 2020, during discovery, plaintiffs served a request for production on the government for the same “data concerning hospital outpatient services, claims, and . . . reimbursement for all class hospitals.” Tr. at 41:5–11. Plaintiffs likewise moved to compel this discovery in July 2020. Pls.’ Disc. Reply at 4 (“Plaintiffs also later moved for an order to conduct class discovery or for the [g]overnment to alternatively produce documents for all hospitals.”). Plaintiffs argue tabling this request and motion at the end of October 2020 while the case “proceeded with reconsideration, summary judgment, and other procedural” items did not do away with their “live and pending request for [this] discovery.” Tr. at 41:16–17, 37:14– 25, 128:5–6. With respect to prejudice, plaintiffs clarify their requests “will not prejudice the” government primarily because “the benefit to this case from the discovery would significantly outweigh any burden,” Pls.’ Disc. Reply at 8–9 (first citing Davita HealthCare Partners, Inc. v. United States, 125 Fed. Cl. 394, 402 n.6 (2016); and then citing Kennedy Heights Apartments Ltd. I v. United States, 2005 WL 6112633, at *4 (Fed. Cl. Apr. 26, 2005)), as this discovery will “assist the court with its ruling on class certification.” Pls.’ Disc. Mot. at 9–10. Further, plaintiffs contend any prejudice could be cured at trial by cross-examination of plaintiffs’ expert, who will use this data in a future supplemental report. Pls.’ Disc. Reply at 10 (citing Panasonic Commc’ns Corp. of Am. v. United States, 108 Fed. Cl. 412, 416 (2013)). Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 9 of 23 - 10 - The government argues good cause does not exist to reopen discovery as requested by plaintiffs. With respect to diligence, the government first asserts plaintiffs’ 31 July 2020 Motion regarding class discovery was not diligent because it was filed on the last day of the discovery period. Gov’t’s Disc. Resp. at 33–34. Next, the government argues “[p]laintiffs make no claim that it was impossible during two separate discovery periods for them to have served on the [g]overnment . . . the proposed discovery requests . . . because it obviously was not.” Id. at 28 (citation omitted). Rather, per the government, “plaintiffs disregarded, rather than responding to, evidence, analysis, and law that was inconsistent with their theories of the case, even when the [g]overnment brought such issues to the fore.” Id. at 30. The government argues “plaintiffs ignored these issues at their peril throughout the entire second period of fact and expert discovery that followed, and that means that they were not diligent under the law” and are not now entitled to discovery to assist them in changing their theory of the case. Id. at 31–32. Concerning prejudice, the government argues “plaintiffs are proposing fact discovery on a scale never before undertaken in this case, a new expert report for the [g]overnment to then respond to, more expert depositions, and, no doubt, additional Daubert and class-related motions practice, resulting in substantial delay in bringing this matter to resolution.” Id. at 36 (footnote omitted). “Permitting plaintiffs to now evade a long overdue reckoning, and attempt to moot [the government’s motions to exclude plaintiffs’ expert reports], in addition to being completely contrary to law, [according to the government,] deprives the [g]overnment of its day in court for what should be an imminent resolution of this matter.” Id. 1. Diligence A finding of diligence sufficient to modify a case schedule “requires a showing that even with the exercise of due diligence the moving party could not meet the order’s timetable.” Slip Track Sys., Inc., 304 F.3d at 1270 (applying Ninth Circuit law in finding defendant’s attempt to amend the pleadings first required modification of the scheduling order under FRCP 16(b)(4)). On 11 February 2020, at the very early stages of the “re-opened period of fact discovery,” plaintiffs “served the [g]overnment with additional document requests,” including a request for “[a]ny and all data concerning hospital outpatient services claims and TRICARE reimbursement for hospital outpatient services claims during the relevant time period . . . .” Gov’t’s Disc. Resp. at 11 (citations omitted); see also App. to Pls.’ Disc. Mot. at 23. At the time, the government “objected to this request” and only “produce[d] the data requested for the six [named] plaintiffs.” Id. at 11–12 (citations omitted). Over the next several months, the parties continued with fact and expert discovery, during which time the Court “established a schedule for briefing on class certification and summary judgment.” Id. at 13 (citing Order at 2, ECF No. 143). On 31 July 2020, “the date . . . both fact and expert discovery closed, plaintiffs filed a motion . . . [to] compel[] the [g]overnment to produce documents for all hospitals, rather than for just the six representative plaintiffs.” Id. at 14. Plaintiffs therefore requested the data at issue in this document request at least twice before the instant Motion—once on 11 February 2020 and again on 31 July 2020. Tr. at 81:10–11 (“[PLAINTIFFS:] [W]e did ask for all of those things that [the government is] talking about [before we t]abled the issues . . . .”). They thus argue they “meet [the] diligence [standard] here because [they] asked for” this information “a long time ago” and continued to believe it “was a live and open issue.” Tr. at 128:5–6; Tr. at 104:25–105:9 (“[PLAINTIFFS:] We served the discovery request in the discovery period. We got objections from the [g]overnment. We conferred several times with [the government] about this to figure Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 10 of 23 - 11 - out what we are doing here . . . . We then had the conference with the Court because we had filed our motion [to compel] and the [g]overnment fought to arrange things in the way they arranged. So we walked away from that believing this [discovery] was a live and open issue.”); see 28 Dec. 2022 JSR at 2. The government’s first diligence argument, as noted supra Section IV.A, is plaintiffs filed their Motion to Compel on the final day of discovery and thus did not diligently pursue this request. Gov’t’s Disc. Resp. at 33–34; Tr. at 84:21–23 (“[THE GOVERNMENT:] [Plaintiffs] did nothing between March and July. There was no agreement to table during that four-month period. And then in July, they filed a motion [to compel.]”). Despite the already pending 11 February 2020 “request for all class hospital data,” the government contends plaintiffs “should have filed more motions to compel” earlier in the discovery period. Tr. at 85:4–10; Tr. at 107:2– 5 (“[PLAINTIFFS:] [The government is saying] we raised [these discovery issues] too long ago and didn’t come back often enough.”). To the extent the government alleges “filing a motion to compel on the very last day of discovery is . . . untimely, not diligent,” however, the government overlooks the significance of plaintiffs’ timely February 2020 request. See Gov’t’s Disc. Resp. at 34. Plaintiffs did not first make this request the day discovery closed; they asked the government to produce these documents early in the discovery period. Pls.’ Disc. Mot. at 4–5. Plaintiffs then “conferred several times with” the government and waited to see whether the government’s production would be sufficiently responsive to their February 2020 request despite the government’s objection. Tr. at 104:24–105:6 (“[PLAINTIFFS]: We served the discovery request in the discovery period. We got objections from the [g]overnment. We conferred several times with [the government] about this . . . We then . . . filed our motion. . . .”). Thus, only when it became clear the government was not going to produce plaintiffs’ requested information or any comparable data in the final days of the discovery period did plaintiffs file a motion to compel. Id. Further, the government’s cited cases for the proposition motions filed at the end of discovery are untimely are from out-of-circuit district courts and contain factual situations inapposite to this case. See Gov’t’s Disc. Resp. at 34 (first citing Rainbow Energy Mktg. Corp. v. DC Transco, LLC, No. 21-CV-313, 2022 WL 17365260, at *2 (W.D. Tex. Dec. 1, 2022) (denying a renewed motion to compel after: (1) the plaintiff’s initial motion was denied, (2) the plaintiff filed a motion to extend discovery after the period had closed, and (3) the plaintiff filed a renewed motion to compel on the last day of extended discovery); then citing U.S. ex rel. Gohil v. Sanofi U.S. Servs., Inc., No. 02-2964, 2020 WL 1888966, at *4 (E.D. Pa. Apr. 16, 2020) (rejecting a motion to compel in part because the requesting party made a “misrepresentation that it did not know” the importance of the information until just before the close of discovery); then citing Summy-Long v. Pa. State Univ., No. 06–cv–1117, 2015 WL 5924505, at *2, *5 (M.D. Pa. Oct. 9. 2015) (denying the plaintiff’s motion to compel “because [her] request [wa]s overly broad and unduly burdensome and because granting further discovery extensions . . . would strain the bounds of reasonableness and fairness to all litigants”); then citing In re Sulfuric Acid Antitrust Litig., 231 F.R.D. 331, 332–33, 337 (N.D. Ill. 2005) (acknowledging there is “great[] uncertainty” as to whether courts should deny motions to compel filed “very close to the discovery cut-off date” and recognizing “the matter is [generally] left to the broad discretion” of the trial court “to control discovery”); then citing Toone v. Fed. Express Corp., No. Civ. A. 96-2450, 1997 WL 446257, at *8 (D.D.C. July 30, 1997) (denying the plaintiff’s motion to compel filed on the last day of discovery because (1) given the close proximity to the original date for trial, “the defendant could have responded to the request . . . on Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 11 of 23 - 12 - the day of the original trial date,” and (2) it was moot); and then citing Babcock v. CAE-Link Corp., 878 F. Supp. 377, 387 (N.D.N.Y. 1995) (denying a motion to compel regarding discovery requests served on the last day of discovery). The Court therefore is not persuaded plaintiffs’ Motion to Compel was untimely. Schism, 316 F.3d at 1300 (quoting Moore, 927 F.2d at 1197). The government further contends “[p]laintiffs make no claim that it was impossible during two separate discovery periods for them to have served on the [g]overnment” this “proposed discovery request[].” Def.’s Disc. Resp. at 28. The government argues plaintiffs’ “tunnel vision” with respect to their legal theory caused plaintiffs to ignore “evidence, analysis, and law” not directly consistent with “their theories of the case, even when the [g]overnment brought such issues to the fore.” Id. at 29–30. “Turning a blind eye . . . [due to] legal error is not the same thing as having the inability to meet court deadlines,” according to the government, so “plaintiffs cannot demonstrate the requisite diligence.” Id. at 30. Although plaintiffs did not file “more motions to compel,” plaintiffs timely made their February 2020 request and timely filed their July 2020 Motion to Compel, supra. See Tr. at 85:4–9. To the extent the government alleges plaintiffs are not entitled to reopen discovery to amend their litigation strategy because the government “unmasked on summary judgment” plaintiffs’ “legal errors,” the government overlooks its own admission at oral argument, “[p]laintiffs’ request[s] [for] all class hospital data” in February and July 2020 sought the same data “[plaintiffs a]re asking for now.” Tr. 103:7–17; Def.’s Disc. Resp. at 28. Contrary to the government’s argument, plaintiffs therefore did not have “tunnel vision” causing them to ignore the requested evidence earlier in this litigation. See Def.’s Disc. Resp. at 28–30. Rather, plaintiffs requested this data during the appropriate discovery periods, only to have their request put on hold “because the [g]overnment ha[d] additional motions” it wished the Court to first decide. See Tr. at 85:12–21 (the court); Pls.’ Disc. Mot. at 4; App. to Pl.’s Disc. Mot. at 23; Tr. at 105:5–9; Def.’s Disc. Resp. at 14 (“Ultimately, the issues raised by this motion [to compel] were tabled by agreement of the parties.”); Tr. at 55:5–6 (“[PLAINTIFFS:] [T]he [g]overnment fought tooth and nail [to have the Court] hear [their] summary judgment motion first.”). Plaintiffs have thus considered these requests “a live and open issue” pending resolution of the government’s motions ever since, prompting them to file the instant Motion upon the Court issuing its Summary Judgment Order in November 2022. Tr. at 105:8–9 (“[PLAINTIFFS:] [W]e walked away from that [tabling discussion] believing this [discovery] was a live and open issue.”). Finally, while this “data [may] not [have been] necessary for summary judgment . . . [it is] for class certification.”7 Tr. at 111:10–11 (plaintiffs); Clippinger v. State Farm Mut. Auto. Ins. Co., 2021 WL 1894821, at *2 (“[C]lass certification discovery is not relevant [at the summary judgment stage].”); Tr. at 111:8–11 (“[PLAINTIFFS]: Well, I think like in Clippinger, there is some wisdom to the concept that maybe all of that data is not necessary for summary judgment, but then becomes necessary for class certification.”). To that end, the government 7 To the extent the government relies on plaintiffs’ 13 April 2020 statement plaintiffs “will not need this information [pertaining to hospitals other than the six named plaintiffs] prior to resolving [p]laintiffs’ [M]otion for [C]lass [C]ertification,” the government overlooks the substantial change in circumstances discussed infra Section IV.B.1. See Def.’s Disc. Resp. at 12–13 (quoting 21 May 2020 JSR at 3–4, ECF No. 140). The government likewise ignores plaintiffs’ agreement to table these discovery requests temporarily in October 2020, at which time plaintiffs acknowledged they would eventually re-raise these requests, even if—at the time—the plan was to do so after class certification. See Tr. at 85:12–21, 55:5–6. Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 12 of 23 - 13 - cannot “object[] to [plaintiffs’ document] request” in 2020 as “irrelevant and not proportional to the needs of the case insofar as plaintiffs seek . . . [information from] thousands of hospitals” only to now argue it is too late for this discovery and “plaintiffs [have] squandered . . . their allotted discovery periods . . . .” Gov’t’s Disc. Resp. at 11, 28; Tr. at 106:7–14 (“[PLAINTIFFS:] [I]t’s almost like the [g]overnment—they’re playing gotcha here. . . . [T]hey didn’t want to give us the information at the time [of discovery] and then they say, well, here’s summary judgment first and we can defer this until later . . . and now we’ve got a summary judgment opinion and now [they] say gotcha . . . .”). Nor can the government object to turning over the requested data in 2020 and now only to “use [plaintiffs’] lack of this data as a sword” come class certification. Tr. at 126:23–127:2. Indeed, “this has never been a case where” plaintiffs “said we’re not going to look at that [requested] data . . . [or] we’re not eventually going to be coming for that.” Tr. at 126:18–20. To the contrary, plaintiffs “requested this [data] during discovery,” and have long maintained this discovery “is the way to” “figure out . . . what are we dealing with” from a class perspective, including in the JSR filed after the Court’s November 2022 Summary Judgment Order, in which plaintiffs reserved the right to move for “additional class certification fact or expert discovery.” Tr. at 44:10, 56:21–22; 28 Dec. 2022 JSR at 2. By way of the government’s objection to plaintiffs’ February 2020 request and the parties’ tabling this request in October 2020, plaintiffs “even with the exercise of due diligence[,]” could not have obtained the requested information in a way sufficient to “meet the [Court’s discovery] timetable.” Slip Track Sys., Inc., 304 F.3d at 1270. Had they “received the data in 2020,” they “would have . . . run the DPP” for all potential class members as plaintiffs now request the opportunity to. Tr. at 113:12–15. Instead, plaintiffs did not have access to the data so continued to raise this request at all reasonably appropriate times. See Tr. at 112:8–9 (“[PLAINTIFFS:] [I]t was not possible for us to have done this [DPP] calculation without th[is] data.”). The Court accordingly finds plaintiffs were sufficiently diligent to justify a finding of good cause to reopen fact discovery as to plaintiffs’ document request for “critical data related to each Potential Class member hospital,” Pls.’ Disc. Mot. at 6. Slip Track Sys., Inc., 304 F.2d at 1270. 2. Prejudice In considering whether to reopen discovery, a trial court may consider, in addition to the requesting party’s diligence, “other relevant factors including, in particular, whether allowing the amendment . . . will prejudice [the opposing party].” High Point Design LLC, 730 F.3d at 1319 (quoting Kassner, 496 F.3d at 244). Prejudice related to the reopening of discovery may involve the delay of proceedings. Wordtech Sys., Inc. v. Integrated Networks Sols., Inc., 609 F.3d 1308, 1322 (Fed. Cir. 2010) (“[A] need to reopen discovery and therefore delay the proceedings supports a district court’s finding of prejudice from a delayed motion to amend the complaint.” (quoting Lockheed Martin Corp. v. Network Sols., Inc., 194 F.3d 980, 986 (9th Cir. 1999))). Further, RCFC 26(b)(1) provides: [P]arties may obtain discovery regarding any nonprivileged matter that is relevant to any party’s claim or defense and proportional to the needs of the case, considering the importance of the issues at stake in the action, the amount in controversy, the parties’ relative access to relevant information, the parties’ resources, the importance of the discovery in resolving the issues, and whether the Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 13 of 23 - 14 - burden or expense of the proposed discovery outweighs its likely benefit. RCFC 26(b)(1). “Questions of the scope and conduct of discovery are . . . committed to the discretion of the trial court.” Florsheim Shoe Co., Div. of Interco, Inc. v. United States, 744 F.2d 787, 797 (Fed. Cir. 1984). The government contends reopening discovery is prejudicial because “plaintiffs are proposing fact discovery on a scale never before undertaken in this case, a new expert report for the [g]overnment to then respond to, more expert depositions, and, no doubt, additional Daubert and class-related motions practice, resulting in substantial delay in bringing this matter to resolution.” Gov’t’s Disc. Resp. at 35–36 (footnote omitted). Plaintiffs, on the other hand, argue: (1) the sought after data “is . . . exclusively in [the government’s] possession”; and (2) their request will not prejudice the government because it will have an opportunity to oppose plaintiffs’ expert report. Pls.’ Disc. Reply at 3, 8. Even if there is any prejudice to the government, plaintiffs assert “the benefit to this case from the discovery would significantly outweigh any burden to the parties,” id. at 9, because of the assistance the discovery would provide the Court in ruling on class certification of the “narrower proposed class of plaintiffs,” Ingham Reg’l Med. Ctr., 163 Fed. Cl. at 428, left after summary judgment. Id. at 5, 9–10 (first citing Ingham Reg’l Med. Ctr., 163 Fed. Cl. at 428; and then citing Alta Wind I Owner Lessor C v. United States, 154 Fed. Cl. 204, 217 (2021)). Indeed, plaintiffs argue “produc[ing] the data . . . [now will be] more efficient [than production after certification] [a]s there will be less hypothetical back-and-forth between the parties [during certification briefing]” if the government’s data is available to all sides. Tr. at 118:2–6. Any prejudice could also be cured at trial by cross-examination of plaintiffs’ expert, plaintiffs contend. Pls.’ Disc. Reply at 10. The Court’s Summary Judgment Order indicated “the Court . . . needs further information regarding how plaintiffs in this post-summary judgment smaller class would meet the requirements for class certification” before deciding plaintiffs’ motion for class certification. Ingham Reg’l Med. Ctr., 163 Fed. Cl. at 428. To that end, mirroring their requests during the 2020 discovery period, plaintiffs ask the government to provide “(1) all information Kennell used in the DPP calculations for each Potential Class member hospital, as well as the underlying calculations, and (2) all hospital outpatient claims data available for each of the Potential Class member hospitals during the relevant time period.” Pls.’ Disc. Mot. at 8–9 (emphasis added). Plaintiffs argue this discovery will “benefit . . . this case” by providing the radiology data needed to determine “who is in the [now-narrowed] class.” Pls.’ Disc. Reply at 2, 9 (“Plaintiffs’ damages are now limited to those claims involving errors in the [g]overnment’s data”); Tr. at 57:1. The government has not refuted this claim. Tr. at 132:16–25 (“THE COURT: Just to make sure I understand, can you just quickly articulate the prejudice to the [g]overnment [from the Motion to Compel the data]? . . . [THE GOVERNMENT:] The [prejudice from the] [M]otion to [C]ompel is a significant reasonableness and proportionality concern . . . .”); Tr. at 56:18–57:14 (“[PLAINTIFFS:] [W]e really followed the Court’s lead, looking at the summary judgment opinion saying . . . go back and figure out now what we are dealing with . . . [with respect to] who is in the class . . . only on the [g]overnment’s [data] . . . . [THE GOVERNMENT:] I firmly disagree with that [procedural move]. I think that [p]laintiffs are trying to jump their original expert report . . . [a]nd under the law, [they] can’t.”). Rather, the government’s primary prejudice-related allegation is plaintiffs’ request violates the Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 14 of 23 - 15 - “[r]easonableness and proportionality” tenants set forth in RCFC 26(b)(1) because “[t]he [g]overnment has already incurred substantial expense,” Def.’s Disc. Resp. at 36, and plaintiffs have “not established a right to discovery of [non-named plaintiff] hospitals . . . based on what they have shown.” Tr. at 130:10–14. As the Court noted above, the government cannot argue plaintiffs’ document discovery request was too early before summary judgment and too late now that the government has incurred greater expense in litigating this case. See supra Section IV.A.1. Neither party knew the substantial impact summary judgment would have on the trajectory of this case, but the parties agreed to table plaintiffs’ discovery requests until after the Court’s summary judgment decision. See Ingham Reg’l Med. Ctr., 163 Fed. Cl. at 395; SC Tr. at 27:13–23. As evidenced by the recent data analysis performed by the government, after summary judgment, “[g]overnment data is required to evaluate which hospitals were affected by the [g]overnment’s breach of” contract. 25 Oct. 2023 JSR at 16. Plaintiffs cannot be expected to argue, and the Court cannot “rule on[,] numerosity [and related class certification factors] if there[ i]s no evidence regarding the approximate number of hospitals who would fit the . . . requirements allowed in the summary judgment order.” Tr. at 108:6–11. The parties must both have an opportunity to review the relevant data held by the government to determine which hospitals should, or should not, be included in the putative class.8 See id. The requested data, which includes the pertinent “outpatient claims data” and the information “used in the DPP calculations,” Pls.’ Disc. Mot. at 8–9, is therefore highly relevant to the next step in this case— class certification—and, rather than delay this case, having this data will enable the Court to decide plaintiffs’ motion for class certification more efficiently. Davita HealthCare Partners, Inc., 125 Fed. Cl. at 399 (“[T]he additional time . . . does not warrant the severe sanction of exclusion of data helpful to both parties in this litigation.”). To the extent the government argues the scale of the information requested is “grossly disproportionate to the needs of the case,” Tr. at 110:22, the government ignores: (1) plaintiffs’ and the Court’s substantial need to understand “who would be in the class” come time to brief and rule on class certification, Tr. at 55:24–25; and (2) the inability of plaintiffs and the Court to access this data “exclusively in [the government’s] possession” without production by the government, Pls.’ Disc. Reply at 3. See Davita HealthCare Partners, Inc., 125 Fed. Cl. at 399; RCFC 26(b)(1) (“[P]arties may obtain discovery regarding any nonprivileged matter that is relevant . . . and proportional . . . [considering] the parties’ relative access to [the] relevant information . . . .” (emphasis added)). The government likewise overlooks its ability to rebut any arguments plaintiffs make using this data both before and at trial. See Alta Wind I Owner Lessor C, 154 Fed. Cl. at 217 (“Other Court of Federal Claims judges have noted that providing the government an opportunity to file a rebuttal mitigates any prejudice that may have otherwise existed in providing plaintiff the opportunity to reopen the record.”). The documents plaintiffs request are therefore highly relevant and proportional to the needs of the case as they will provide plaintiffs and the Court 8 This is not a case where, as the government alleges, plaintiffs are “attempt[ing] to use discovery to find new clients upon learning of infirmities in the claims of putative class representatives.” Def.’s Disc. Resp. at 26–27 (first citing In re Williams-Sonoma, Inc., 947 F.3d 533, 540 (9th Cir. 2020); then citing Gawry v. Countrywide Home Loans, Inc., 395 F. App’x 152, 160 (6th Cir. 2010); Douglas v. Talk Am., Inc., 266 F.R.D. 464, 467 (C.D. Cal. 2010); Falcon v. Phillips Elec. N. Am. Corp., 304 F. App’x 896, 898 (2d Cir. 2008)). Rather, plaintiffs are requesting access to information held by the government to adequately brief class certification on behalf of the existing named plaintiffs and the putative class. See Pls.’ Disc. Mot. at 2 (“After completion of this discovery, [p]laintiffs would then file an amended motion for class certification.”). Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 15 of 23 - 16 - information necessary for a thorough analysis of class certification. Florsheim Shoe Co., Div. of Interco, Inc., 744 F.2d at 797; Davita HealthCare Partners, 125 Fed. Cl. at 399 (“[T]he additional time . . . does not warrant the severe sanction of exclusion of data helpful to both parties in this litigation.”); RCFC 26(b)(1). The Court accordingly finds any prejudice to the government caused by the scope of plaintiffs’ document request is mitigated by the benefit of the requested information to the efficient resolution of this case.9 See High Point Design LLC, 730 F.3d at 1319 (quoting Kassner, 496 F.3d at 244); Tr. at 118:2–6. The government will have ample opportunity to oppose any supplemental expert reports presented by plaintiffs using the requested data, including through cross-examination of plaintiffs’ experts at trial. See Alta Wind I Owner Lessor C, 154 Fed. Cl. at 217 (“Other Court of Federal Claims judges have noted that providing the government an opportunity to file a rebuttal mitigates any prejudice that may have otherwise existed in providing plaintiff the opportunity to reopen the record.”). The Court therefore finds plaintiffs were diligent in pursuing this document discovery request and the government will not experience prejudice sufficient to warrant denying plaintiffs’ Motion as to the request. The Court accordingly grants plaintiffs’ document discovery request as tailored, infra Section V, to the liability found in the Court’s November 2022 Summary Judgment Order, as there is good cause to do so. See High Point Design LLC, 730 F.3d at 1319 (quoting Kassner, 496 F.3d at 244); 6A CHARLES A. WRIGHT ET AL., FEDERAL PRACTICE AND PROCEDURE § 1522.2 (3d ed. 1998) (“What constitutes good cause sufficient to justify the modification of a scheduling order necessarily varies with the circumstances of each case.”); Pls.’ Disc. Mot. at 8–9. B. Plaintiffs’ Request to Depose a Government Corporate Designee Pursuant to Rule 30(b)(6) Plaintiffs also seek leave to “depose a [g]overnment corporate designee to identify which data sources were . . . available to the [g]overnment from the relevant time period, and where the relevant claims data resides.” Pls.’ Disc. Mot. at 8. Plaintiffs specify they are seeking “an hour . . . of deposition, just getting the [g]overnment to . . . confirm . . . the data sources” they have now and had during the relevant time periods “to make sure . . . there’s been no spoliation . . . .” Tr. at 117:22–25. In response, the government contends it previously identified an agency employee “as an individual with ‘discoverable information concerning TRICARE Encounter Data (TED), the DHA Military Health System Data Repository (MDR), and the creation, content and maintenance of records in both of those databases[,]’. . . [but] plaintiffs expressly declined a deposition during the established periods of fact and expert discovery[] and elected instead to proceed through limited interrogatories.” Defs.’ Disc. Resp. at 33. The government alleges “[p]laintiffs cannot reasonably be said to have been diligent in pursuing the 9 The Court emphasizes the government alone is in possession of the TMA data potentially comprising “tens of millions of records.” Tr. at 134:3. As such, the government is the only party capable of sorting and producing the large volumes of information. See RCFC 26(b)(1) (“[P]arties may obtain discovery regarding any nonprivileged matter that is relevant . . . and proportional . . . [considering] the parties’ relative access to [the] relevant information.”). Indeed, at the 19 December 2023 status conference, the government agreed it is capable of reviewing all data in its possession to identify line items of putative class members missed during DPP extraction due to issues akin to those impacting twelve out of the thirteen unextracted line items for Integris Baptist and Integris Bass Baptist. See 25 Oct. 2023 JSR; see also Ingham Reg’l Med. Ctr. v. United States, 163 Fed. Cl. 384, 409, 412 (2022). Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 16 of 23 - 17 - deposition that they now request when they intentionally eschewed [an offered deposition] during the established period of fact discovery.” Id. The government also reasserts its prejudice and diligence-related arguments discussed supra Section IV.A.1–2. See, e.g., id. at 28 (“Plaintiffs make no claim that it was impossible during two separate discovery periods for them to have served on the [g]overnment . . . the deposition notice . . . because it obviously was not.”); Tr. at 130:8–10 (“THE COURT: . . . So what’s the prejudice though? [THE GOVERNMENT]: Reasonableness and proportionality.”). 1. Diligence The government’s only novel diligence argument related to plaintiffs’ deposition request is plaintiffs previously declined an opportunity to depose an “an individual with ‘discoverable information concerning [TED and MDR], and the creation, content and maintenance of records in both of those databases.” Defs.’ Disc. Mot. Resp. at 33. The government otherwise broadly asserts plaintiffs were not diligent in pursuing their discovery requests. See, e.g., id. at 28. As determined supra Section IV.A.1, plaintiffs were diligent with respect to pursuing the government’s data and related information at the appropriate time during discovery. See, e.g., App. to Pls.’ Disc. Mot. at 23–24. The Court therefore only addresses the government’s argument related to previous deposition opportunities below. A “trial court ‘has wide discretion in setting the limits of discovery.’” Schism, 316 F.3d at 1300 (quoting Moore, 927 F.2d at 1197). Notwithstanding, modification of a court-imposed schedule may be done “only for good cause and with the judge’s consent.” RCFC 16(b)(4). “When assessing whether good cause has been shown, ‘the primary consideration is whether the moving party can demonstrate diligence.’” High Point Design LLC, 730 F.3d at 1319 (quoting Kassner, 496 F.3d at 244). The government’s primary contention—plaintiffs were not diligent in pursuing the requested deposition because they turned down an offer to depose a government employee in May 2019—assumes a party cannot be diligent if they have, at any time in the past, “eschewed [similar discovery.]” Defs.’ Disc. Mot. Resp. at 33. Over the past four and a half years, however, this case has changed substantially. See Alta Wind I Owner Lessor C, 154 Fed. Cl. at 227 (granting additional discovery upon remand and reassignment of the case); see also Geneva Pharms. Tech. Corp., 2005 WL 2132438, at *5 (“[M]aterial events have occurred since the last discovery period, which justice requires that the parties have an opportunity to develop through discovery.”). As noted by plaintiffs, “[t]he Court’s ruling on the [g]overnment’s Summary Judgment Motion . . . fundamentally altered the scope of this case,” Pls.’ Disc. Mot. at 8, by substantially narrowing the potential class members and limiting plaintiffs’ “damages . . . to [two] claims involving errors in the [g]overnment’s data,” Pls.’ Disc. Reply at 3. “[T]o analyze the extent of the . . . error[s]” in the government’s data, 25 Oct. 2023 JSR at 16, and perform “a more accurate damages calculation” for the putative class members, Pls.’ Reply at 7, plaintiffs therefore need to understand the data sources available to the government now and at the time of line item extraction. See 25 Oct. 2023 JSR at 17 (“The only way to evaluate whether Mr. Kennell failed to extract all relevant data . . . for the entire class is for the [g]overnment to produce . . . [the discovery] [p]laintiffs seek.”); Pls.’ Disc. Reply at 7. In 2020, in contrast, at which time plaintiffs “elected . . . to proceed through limited interrogatories” rather than conduct the government’s offered deposition, the Court had not yet narrowed the scope of the case or limited the damages calculations to the government’s data. Defs.’ Disc. Resp. at 33. During the Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 17 of 23 - 18 - initial discovery periods, plaintiffs still reasonably believed their own data might be relevant and did not yet understand the importance of the government’s data. See Pls.’ Disc. Reply at 3; see also 25 Oct. 2023 JSR at 16. Plaintiffs therefore did not exhibit a lack of diligence by not accepting the government’s offer to depose an individual whose testimony, at the time, was less relevant to the case. The government has accordingly failed to produce evidence sufficient to show plaintiffs were not diligent in pursuing the requested deposition. Schism, 316 F.3d at 1300; High Point Design LLC, 730 F.3d at 1319; see also Alta Wind I Owner Lessor C, 154 Fed. Cl. at 227. 2. Prejudice As noted supra Section IV.A.2, courts considering requests to reopen discovery may consider whether and to what extent granting the request will prejudice the opposing party, including via delaying the litigation. High Point Design, 730 F.3d at 1319 (quoting Kassner, 496 F.3d at 244); Wordtech Sys., 609 F.3d at 1322 (quoting Lockheed Martin Corp., 194 F.3d at 986). Regarding plaintiffs’ deposition request, the government argues granting plaintiffs’ deposition request will, like plaintiffs’ document requests, result in additional expense and “substantial delay in bringing this matter to resolution.” Def.’s Disc. Resp. at 36. Plaintiffs indicated at oral argument, however, the requested deposition will be “an hour,” with the goal being simply to understand “the data sources” in the government’s possession. Tr. at 117:22. To the extent this short deposition of a government employee, which the government was prepared to allow for several years ago, will allow the case to proceed “more efficient[ly]” to class certification with fewer “hypothetical back-and-forth[s] between the parties” related to considerations like numerosity, see Tr. at 118:2–6, the Court finds the minimal potential prejudice to the government from this deposition is outweighed by the value of this information to the later stages of this litigation. Davita HealthCare Partners, Inc., 125 Fed. Cl. at 399 (“[T]he additional time . . . does not warrant the severe sanction of exclusion of data helpful to both parties in this litigation.”). The Court therefore does not find the government’s argument regarding diligence or prejudice persuasive with respect to plaintiffs’ deposition request. The Court accordingly grants this request as there is good cause to do so.10 High Point Design LLC, 730 F.3d at 1319 (quoting Kassner, 496 F.3d at 244); 6A WRIGHT ET AL., FEDERAL PRACTICE AND PROCEDURE § 1522.2 (3d ed. 1998) (“What constitutes good cause sufficient to justify the modification of a scheduling order necessarily varies with the circumstances of each case.”). C. Supplemental Expert Report Plaintiffs finally request leave to “serve a supplemental expert report on . . . relevant class 10 To the extent the government intended its arguments related to proportionality and relevance to apply to plaintiffs’ deposition request, the Court is unpersuaded. See Def.’s Disc. Resp. at 36. A single deposition lasting approximately one hour on subject matter on which the government previously offered to permit a deposition is not disproportionate to the needs of this case. Schism v. United States, 316 F.3d 1259, 1300 (Fed. Cir. 2002) (quoting Moore v. Armour Pharm. Co., 927 F.2d 1194, 1197 (11th Cir. 1991)); RCFC 26(b)(1). Likewise, the subject matter—the sources of the data plaintiffs request access to—is highly relevant in ensuring a complete and accurate data set free of spoliation. Schism, 316 F.3d at 1300 (quoting Moore, 927 F.2d at 1197); RCFC 26(b)(1); see supra Section IV.A.2. Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 18 of 23 - 19 - issues” upon completion of the above-requested discovery. Pls.’ Disc. Mot. at 2. Specifically, plaintiffs wish to “submit a supplemental expert report analyzing the [government’s] data and applying the DPP methodology to the correct universe of outpatient radiology line items . . . .” Id. at 10; see also Pls.’ Disc. Reply at 3 (“Plaintiffs’ supplemental expert report would identify the scope of the class, as requested by the Court.”); Tr. at 73:10–14 (“[PLAINTIFFS:] [I]t is a very complex formula. And I think that it is something that . . . you would want someone with experience with these data line items going through and doing it . . . it’s [objective] math. . . . It’s essentially a claims administrator.”). Plaintiffs make clear their initial expert report was an attempt at extrapolating the named plaintiffs’ data “across the class to come up with . . . estimated number[s],” which they now wish to update with “the exact numbers” once they receive the government’s data. Tr. at 69:4–16. Plaintiffs contend “[r]eopening discovery is warranted where supplemental information from an expert would assist the Court in resolving important issues . . . [s]uch [as] . . . ‘presenting the Court with a more accurate representation of plaintiffs’ damages allegations.’” Pls.’ Disc. Reply at 6 (first citing Kennedy Heights Apartments Ltd. I, 2005 WL 6112633, at *3–4; and then quoting Alta Wind I Owner Lessor C, 154 Fed. Cl. at 217). Likening this case to Alta Wind, plaintiffs argue the Court should conclude here an “expert report will provide the Court with a damages estimate more accurately reflecting plaintiffs’ damages position [in light of the changes to the case rendered by summary judgment] . . . and therefore will likely assist the Court.” Id. at 7 (quoting Alta Wind, 154 Fed. Cl. at 216); Tr. at 68:17–69:16 (“[PLAINTIFFS]: With respect to Ms. Jerzak and the breach of contract, she did two things [in her report.] . . . One, she compared the hospital line items to the government line items for the named [p]laintiffs and did a straight objective calculation of what was the difference. . . . She also took those numbers and extrapolated them across the class to come up with an estimated number. THE COURT: A hypothetical. [PLAINTIFFS]: Yes . . . [r]ecognizing that if the class was certified . . . we’d have to do the exact numbers.”). Plaintiffs conclude this report will “not prejudice the [g]overnment in any way, and would actually benefit the [g]overnment” by providing an “opportunity . . . to oppose” additional contentions appropriate to the posture of the case. Id. at 8 (emphasis omitted) (citing Alta Wind I Owner Lessor C, 154 Fed. Cl. at 216). Plaintiffs note, however, “in [their] mind, this [report] is something that always was going to happen after certification” at the merits stage, Tr. at 73:15– 16 (emphasis added), as they do not “need an expert report for class certification because” the government “admitted breach,” Tr. at 96:3–4; Tr. at 63:22–64:6 (“[PLAINTIFFS:] [L]et’s say the Court certified a class here. The next step . . . is for merits. Someone is going to have to spit out a report saying here are the class members and when I run their . . . data . . . here are the differences and here’s the number that gets spit out.” (emphasis added)). The government reiterates its diligence and prejudice arguments discussed supra Sections IV.A–B with respect to plaintiffs’ request for leave to file a supplemental expert report. The government likewise refutes the notion plaintiffs’ current expert report is a “placeholder . . . that was[] [not] really meant to be real.” Tr. at 70:19–20. In other words, the government contends plaintiffs “meant th[eir earlier] expert report” to apply to “their currently pending motion for class cert[ification],” Tr. at 71:21–23, and now “seek to have the Court rescue them from their own litigation choices,” including the choice to file “expert damages models [that] could never be used to measure class damages.” Def.’s Disc. Resp. at 16–17. Plaintiffs should not be permitted to file a new expert report, according to the government, simply because “they have not . . . marshaled any legally cognizable expert evidence concerning the few claims that remain” Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 19 of 23 - 20 - after summary judgment. Def.’s Disc. Resp. at 17. To the extent plaintiffs concede the requested expert report “is for [the] merits” stage and not necessary for class certification, however, the government believes “a class cannot be certified without a viable expert damages methodology meeting the requirements of Comcast,” meaning plaintiffs’ pending motion for class certification automatically fails because “the only expert evidence in the record that bears on the two types of breaches found by the Court is . . . offered by the [g]overnment.” Id. at 22– 23 (citing Comcast Corp. v. Behrend, 569 U.S. 27, 33–34 (2013)). Indeed, according to the government, “plaintiffs are left with no expert model at all as to the few remaining contract claims,” meaning they cannot adequately allege “damages are capable of measurement on a class[-]wide basis” as required by Comcast. Id. at 24 (quoting Comcast, 569 U.S. at 34). Concerning plaintiffs’ request for leave to file an expert report, the government broadly asserts plaintiffs were not diligent in pursuing their discovery requests. See, e.g., Def.’s Disc. Resp. at 28. As determined supra Section IV.A.1, however, plaintiffs were diligent with respect to pursuing the requested discovery generally. Plaintiffs requested the relevant data in February and July 2020 and planned to replace “the extrapolation” present in their earlier expert reports with analysis “using actual data” upon completion of this requested discovery. See supra Section IV.A.1; Tr. at 136:15–23. The Court’s November 2022 Summary Judgement Order narrowed the scope of this case and further highlighted the need for this additional discovery related to the remaining issues and potential class members. See supra Section IV.A.1, B; Ingham Reg’l Med. Ctr., 163 Fed. Cl. at 427. Further, to the extent the government alleges plaintiffs requested expert report is prejudicial, the government will have sufficient time and opportunity to rebut any supplemental expert report filed by plaintiffs. See supra Section IV.A.2, B.2; Alta Wind I Owner Lessor C, 154 Fed. Cl. at 217 (“Other Court of Federal Claims judges have noted that providing the government an opportunity to file a rebuttal mitigates any prejudice that may have otherwise existed in providing plaintiff the opportunity to reopen the record.”). The contemplated expert report, which will perform the DPP analysis for outpatient radiology claims data within the scope of the Court’s November 2022 liability findings for each putative class member hospital using “only the [government’s] data” as required by the Court’s Summary Judgment Order, could also aid the Court at the merits stage in determining “the amount[] that each hospital is owed.” Tr. at 78:7–15. The requested report therefore would likely not be prejudicial to the government to such an extent as to “warrant the severe sanction of exclusion of [useful] data.” Davita HealthCare Partners, Inc., 125 Fed. Cl. at 399; High Point Design LLC, 730 F.3d at 1319 (quoting Kassner, 496 F.3d at 244); 6A CHARLES A. WRIGHT ET AL., FEDERAL PRACTICE AND PROCEDURE § 1522.2 (3d ed. 1998) (“What constitutes good cause sufficient to justify the modification of a scheduling order necessarily varies with the circumstances of each case.”). Plaintiffs acknowledge, however, the updated calculations they plan to include in their requested expert report are not necessary until “after [class] certification”—at the merits stage. Tr. at 73:15–16. At oral argument, plaintiffs clearly stated they do not “need an expert report for class certification,” which is the next step in this litigation. Tr. at 96:3–4. To the extent the government argues plaintiffs’ certification motion will necessarily fail because plaintiffs lack evidence “damages are [measurable] . . . on a class[-]wide basis” in response to this statement by plaintiffs, Def.’s Disc. Rep. at 23 (quoting Comcast, 569 U.S. at 34), plaintiffs respond the DPP Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 20 of 23 - 21 - is the requisite means of “calculat[ing] damages for every single class member,” Tr. at 136:4–5. While the Court reserves judgment as to plaintiffs’ class certification motion, plaintiffs’ argument the DPP provides their model for calculating damages on a class-wide basis because it is a uniform model applicable to all putative class members is sufficient to suggest plaintiffs need not fully calculate alleged damages in a supplemental expert report at this time. Tr. at 54:9–15 (“[PLAINTIFFS:] I think the type of cases that [the government] is talking about [like Comcast] where there’s been [a failure by the plaintiffs to actually address the calculation of class-wide damages, are inapposite because] we haven’t offered a model that is deviating from the contract. What we’re saying . . . the experts are going to . . . essentially crunch[ the] numbers [using the DPP].”). Plaintiffs can do so if and when the merits of this case are argued at trial. This is not a case like Comcast, in which the plaintiffs presented to the court “a methodology that identifies damages that are not the result of the wrong” at issue. Comcast, 569 U.S. at 37. Here, in contrast, the parties indicated at oral argument plaintiffs’ proffered DPP methodology from the parties’ DPP Contracts appears capable of calculating damages for all potential class members. Tr. at 136:1–5 (“[PLAINTIFFS:] But what I will tell you that we’re going to do with the data is we are going to have the auditor [i.e., the expert] plug [the government’s] data into the DPP. That is the model. That is [what] the contract . . . dictates . . . how you calculate damages for every single class member.”); Tr. at 54:12–13 (“[PLAINTIFFS:] [W]e haven’t offered a model that is deviating from the contract.”); Tr. at 93:2–5 (“THE COURT: But the model is just what you said is—if I understood correctly, is that the report is just DPP data discrepancy output. [THE GOVERNMENT]: For each individual [p]laintiff.”); see Tr. 93:2–95:25. The Court accordingly denies plaintiffs’ request for an expert report without prejudice in the interest of the efficient disposition of plaintiffs’ class certification motion. High Point Design LLC, 730 F.3d at 1319 (quoting Kassner, 496 F.3d at 244); 6A CHARLES A. WRIGHT ET AL., FEDERAL PRACTICE AND PROCEDURE § 1522.2 (3d ed. 1998) (“What constitutes good cause sufficient to justify the modification of a scheduling order necessarily varies with the circumstances of each case.”). To the extent plaintiffs “would want in [the] merits” stage an expert report from an “auditor to make sure” the parties “all agree on” damages calculated via the DPP, plaintiffs may refile this motion at that time. Tr. at 96:12–13 (plaintiffs). V. Scope of Granted Discovery and Next Steps As discussed supra Section IV: 1. The Court grants plaintiffs’ deposition request. 2. The Court grants plaintiffs’ document requests as follows: Plaintiffs are permitted to serve amended document discovery requests for all putative class member hospitals tailored to seek only those documents required for plaintiffs to identify “breach[es] of TMA’s [contractual] duty” under the DPP Contract akin to either: (1) the government’s failure to extract “thirteen line items for Integris Baptist and Integris Bass Baptist”; or (2) the government’s failure to adjust “five . . . line items” for Integris Baptist “during the DPP because of an alternate zip code.” See Ingham Reg’l Med. Ctr. v. United States, 163 Fed. Cl. 384, 409, 412 (2022). This specification ensures plaintiffs’ requests remain within the scope of the Court’s findings of liability in November 2022. Id. The Court notes at the 19 December 2023 status conference the government agreed it is possible to Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 21 of 23 - 22 - execute the same analysis performed on the named plaintiffs’ data in the 25 October 2023 JSR on the government’s data for all putative class members. 11 3. The Court denies plaintiffs’ request to file a supplemental expert report without prejudice. Plaintiffs may move to file an updated expert report later in this litigation as necessary, at which time the government will be permitted to file a response report. Within three weeks of the date this Order is issued, the parties shall file a JSR comprised of the following: 1. Plaintiffs’ discovery requests revised in accordance with the above clarifications; 2. The parties’ proposed schedule for discovery, including a timeline for plaintiffs’ deposition and the exchange of documents between the parties; and 3. The parties’ proposed schedule for re-briefing class certification after all discovery closes, including a proposed timeline for the filing of new expert reports. As noted by the Court at the 19 December status conference, plaintiffs’ next step should be to analyze the government’s data for the six named plaintiffs already in plaintiffs’ possession to assist plaintiffs in tailoring their document requests as discussed above. Further, at the 19 December 2023 status conference, the parties agreed the partial grant of plaintiffs’ Discovery Motion moots plaintiffs’ pending Motion to Certify Class Action and Appoint Class Counsel, ECF No. 146, as the parties will need to re-brief these issues following the narrowing of this case on summary judgment and the upcoming additional discovery. The government agreed its pending Motion to Exclude Inadmissible Evidence Relied Upon in Plaintiffs’ Motion for Class Certification, ECF No. 204, is accordingly moot. The government may refile a similar motion if needed during future class certification briefing. Plaintiffs likewise agreed to withdraw without prejudice their Motion to Exclude the Expert Opinions and Continued Participation of Kennell, ECF No. 251, pending further discovery and briefing. Further, plaintiffs agreed, given the scope of this case after summary judgment, the expert report of Fay is moot. Accordingly, the government’s Motion to Exclude the Expert Opinions of Fay, ECF No. 206, is moot. Finally, plaintiffs stated they plan to file a new expert report replacing that of Jerzak later in this litigation. The government noted at the 19 December status conference plaintiffs’ replacement of Ms. Jerzak’s current report will render the government’s Motion to Exclude the Expert Opinions of Jerzak, ECF No. 205, moot as well. 11 As discussed supra note 4, in the 25 October 2023 JSR, the government explained why twelve of the thirteen line items improperly excluded for Integris Baptist and Integris Bass Baptist were not extracted. At the 19 December 2023 status conference, the government indicated it can now search its database for line items improperly excluded due to this same error for all hospitals that participated in the DPP. The government noted, however, it is not aware of what caused the thirteenth line item to be missed so cannot create search criteria appropriate to identifying other similar misses. Finally, to identify missed alternate zip codes, the government stated it would need zip code information from plaintiffs and the putative class members. Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 22 of 23 - 23 - VI. Conclusion For the foregoing reasons, and as specified supra Section V, the Court GRANTS-INPART and DENIES-IN-PART plaintiffs’ Motion for Leave to Conduct Certain Limited Additional Discovery and to Submit Supplemental Expert Report, ECF No. 269, and FINDS as MOOT plaintiffs’ Motion for Clarification or, in the Alternative, to Compel Production, ECF No. 161.12 As noted supra Section V, the Court FINDS as MOOT plaintiffs’ Motion to Certify Class Action and Appoint Class Counsel, ECF No. 146, the government’s Motion to Exclude Inadmissible Evidence Relied Upon in Plaintiffs’ Motion for Class Certification, ECF No. 204, the government’s Motion to Exclude the Expert Opinions of Fay, ECF No. 206, and the government’s Motion to Exclude the Expert Opinions of Jerzak, ECF No. 205. As agreed to at the 19 December 2023 status conference, plaintiffs SHALL WITHDRAW their Motion to Exclude the Expert Opinions and Continued Participation of Kennell, ECF No. 251, without prejudice. Finally, as noted at oral argument, see Tr. at 139:10–140:8, the Court STRIKES the government’s Notice of Additional Authority, ECF No. 273, as deficient and GRANTS the government’s Unopposed Motion for Leave to File Notice of Supplemental Authority, ECF No. 274, for good cause shown. The parties SHALL FILE the joint status report discussed supra Section V on or before 23 January 2024. IT IS SO ORDERED. s/ Holte HOLTE Judge 12 At oral argument, the parties agreed the Court ruling on plaintiffs’ current Discovery Motion is also a “ruling on [plaintiffs’ previous Motion to Compel,] ECF [No.] 161.” Tr. at 139:2–9. Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24
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+USER:
+Please summarize the determinations made in the text provided and explain the consequences of the rulings made.
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+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,30,17,13664,,639
+"Respond using only the text provided. Do not use prior training data or external knowledge to form your response. Structure your output in bullet point format, but if the user question asks for information related to a process, use a numbered list format.",Describe the protocol for dealing with clothing prior to beginning an autopsy.,"Introduction, Concepts and Principles It is assumed that all pathologists know the construction and requirements for reporting the findings of a complete postmortem examination. The following is a guide for use in converting the standard autopsy protocol into the report of a medicolegal autopsy. All of the usual descriptive technics should be maintained. Greater attention to detail, accurate description of abnormal findings, and the addition of final conclusions and interpretations, will bring about this transformation. The hospital autopsy is an examination performed with the consent of the deceased person's relatives for the purposes of: (1) determining the cause of death; (2) providing correlation of clinical diagnosis and clinical symptoms; (3) determining the effectiveness of therapy; (4) studying the natural course of disease processes; and (5) educating students and physicians. The medicolegal autopsy is an examination performed under the law, usually ordered by the Medical Examiner and Coroner 1 for the purposes of: (1) determining the cause, manner, 2 and time of death; (2) recovering, identifying, and preserving evidentiary material; (3) providing interpretation and correlation of facts and circumstances related to death; (4) providing a factual, objective medical report for law enforcement, prosecution, and defense agencies; and (5) separating death due to disease from death due to external causes for protection of the innocent. The essential features of a medicolegal autopsy are: (1) to perform a complete autopsy; (2) to personally perform the examination and observe all findings so that interpretation may be sound; (3) to perform a thorough examination and overlook nothing which could later prove of importance; (4) to preserve all information by written and photographic records; and (5) to provide a professional report without bias. Preliminary Procedures Before the clothing is removed, the body should be examined to determine the condition of the clothing, and to correlate tears and other defects with obvious injuries to the body, and to record the findings. The clothing, body, and hands should be protected from possible contamination prior to specific examination of each. A record of the general condition of the body and of the clothing should be made and the extent of rigo r and lividity, the temperature of the body and the environment, and any other data pertinent to the subsequent determination of the time of death also should be recorded. After the preliminary examination the clothing may be carefully removed by unbuttoning, unzippering, or unhooking to remove without tearing or cutting. If the clothing is wet or bloody, it must be hung up to dry in the air to prevent putrefaction and disintegration. Record and label each item of clothing. Preserve with proper identification for subsequent examination. Clothing may be examined in the laboratory with soft tissue x-ray and infrared photographs in addition to various chemical analyses and immunohematologic analyses. Autopsy Procedure -The..date, time and place of autopsy should be succinctly noted, and where and by whom it was performed, and any observers or participants should be named. The body should be identified, and all physical characteristics should be described. These include age, height, weight, sex, color of hair and eyes, state of nutrition and muscular development, scars,, and tattoos. Description of the teeth, the number present and absent, :and the general condition should be detailed noting any' abnormalities or deformities, or evidence of fracture, old or recent. In a separate paragraph or paragraphs describe all injuries, noting the number and characteristics of each including size, shape, pattern, and location in relation to anatomic landmarks. Describe the course, direction, and depth.of injuries and enumerate structures involved by the injury. Identify and label any'foreign object recovered ,and specify its relation to a given injury~ : ~, . ~:At' least one photograph should be taken to identify the body. Photograph injuries to document their location and be certain to, include a 'scale to show their size. Photographs can be used to demonstrate and correlate, external injuries with internal injuries and to demonstrate pathologic processes other than those of traumatic origin. ' Roentgenographic and fluoroscopic examinations tan be used to locate bullets or other radio-opaque objects, to identify the victim, and tO document fractures, anatomic deformities, and surgical procedures when such metallic.foreign bodies as plates, nails, screws, and wire sutures have been used. .. A general description of the head, neck, cervical spine., thorax, abdo2 men, genitalia, and extremities should be given in logical sequence. The course of wounds through various structures should be detailed remembering variations of position in relationships during life versus relationships after death and when supine on the autopsy table. Evidentiary items such as bullets, knives, or portions thereof, pellets or foreign materials, should be preserved and the point of recovery should be noted. Each should be labelled for proper identification. Each organ should be dissected and described, noting relationships and conditions.","Respond using only the text provided. Do not use prior training data or external knowledge to form your response. Structure your output in bullet point format, but if the user question asks for information related to a process, use a numbered list format. Introduction, Concepts and Principles It is assumed that all pathologists know the construction and requirements for reporting the findings of a complete postmortem examination. The following is a guide for use in converting the standard autopsy protocol into the report of a medicolegal autopsy. All of the usual descriptive technics should be maintained. Greater attention to detail, accurate description of abnormal findings, and the addition of final conclusions and interpretations, will bring about this transformation. The hospital autopsy is an examination performed with the consent of the deceased person's relatives for the purposes of: (1) determining the cause of death; (2) providing correlation of clinical diagnosis and clinical symptoms; (3) determining the effectiveness of therapy; (4) studying the natural course of disease processes; and (5) educating students and physicians. The medicolegal autopsy is an examination performed under the law, usually ordered by the Medical Examiner and Coroner 1 for the purposes of: (1) determining the cause, manner, 2 and time of death; (2) recovering, identifying, and preserving evidentiary material; (3) providing interpretation and correlation of facts and circumstances related to death; (4) providing a factual, objective medical report for law enforcement, prosecution, and defense agencies; and (5) separating death due to disease from death due to external causes for protection of the innocent. The essential features of a medicolegal autopsy are: (1) to perform a complete autopsy; (2) to personally perform the examination and observe all findings so that interpretation may be sound; (3) to perform a thorough examination and overlook nothing which could later prove of importance; (4) to preserve all information by written and photographic records; and (5) to provide a professional report without bias. Preliminary Procedures Before the clothing is removed, the body should be examined to determine the condition of the clothing, and to correlate tears and other defects with obvious injuries to the body, and to record the findings. The clothing, body, and hands should be protected from possible contamination prior to specific examination of each. A record of the general condition of the body and of the clothing should be made and the extent of rigo r and lividity, the temperature of the body and the environment, and any other data pertinent to the subsequent determination of the time of death also should be recorded. After the preliminary examination the clothing may be carefully removed by unbuttoning, unzippering, or unhooking to remove without tearing or cutting. If the clothing is wet or bloody, it must be hung up to dry in the air to prevent putrefaction and disintegration. Record and label each item of clothing. Preserve with proper identification for subsequent examination. Clothing may be examined in the laboratory with soft tissue x-ray and infrared photographs in addition to various chemical analyses and immunohematologic analyses. Autopsy Procedure -The..date, time and place of autopsy should be succinctly noted, and where and by whom it was performed, and any observers or participants should be named. The body should be identified, and all physical characteristics should be described. These include age, height, weight, sex, color of hair and eyes, state of nutrition and muscular development, scars,, and tattoos. Description of the teeth, the number present and absent, :and the general condition should be detailed noting any' abnormalities or deformities, or evidence of fracture, old or recent. In a separate paragraph or paragraphs describe all injuries, noting the number and characteristics of each including size, shape, pattern, and location in relation to anatomic landmarks. Describe the course, direction, and depth.of injuries and enumerate structures involved by the injury. Identify and label any'foreign object recovered ,and specify its relation to a given injury~ : ~, . ~:At' least one photograph should be taken to identify the body. Photograph injuries to document their location and be certain to, include a 'scale to show their size. Photographs can be used to demonstrate and correlate, external injuries with internal injuries and to demonstrate pathologic processes other than those of traumatic origin. ' Roentgenographic and fluoroscopic examinations tan be used to locate bullets or other radio-opaque objects, to identify the victim, and tO document fractures, anatomic deformities, and surgical procedures when such metallic.foreign bodies as plates, nails, screws, and wire sutures have been used. .. A general description of the head, neck, cervical spine., thorax, abdo2 men, genitalia, and extremities should be given in logical sequence. The course of wounds through various structures should be detailed remembering variations of position in relationships during life versus relationships after death and when supine on the autopsy table. Evidentiary items such as bullets, knives, or portions thereof, pellets or foreign materials, should be preserved and the point of recovery should be noted. Each should be labelled for proper identification. Each organ should be dissected and described, noting relationships and conditions. Describe the protocol for dealing with clothing prior to beginning an autopsy.","Respond using only the text provided. Do not use prior training data or external knowledge to form your response. Structure your output in bullet point format, but if the user question asks for information related to a process, use a numbered list format.
+
+EVIDENCE:
+Introduction, Concepts and Principles It is assumed that all pathologists know the construction and requirements for reporting the findings of a complete postmortem examination. The following is a guide for use in converting the standard autopsy protocol into the report of a medicolegal autopsy. All of the usual descriptive technics should be maintained. Greater attention to detail, accurate description of abnormal findings, and the addition of final conclusions and interpretations, will bring about this transformation. The hospital autopsy is an examination performed with the consent of the deceased person's relatives for the purposes of: (1) determining the cause of death; (2) providing correlation of clinical diagnosis and clinical symptoms; (3) determining the effectiveness of therapy; (4) studying the natural course of disease processes; and (5) educating students and physicians. The medicolegal autopsy is an examination performed under the law, usually ordered by the Medical Examiner and Coroner 1 for the purposes of: (1) determining the cause, manner, 2 and time of death; (2) recovering, identifying, and preserving evidentiary material; (3) providing interpretation and correlation of facts and circumstances related to death; (4) providing a factual, objective medical report for law enforcement, prosecution, and defense agencies; and (5) separating death due to disease from death due to external causes for protection of the innocent. The essential features of a medicolegal autopsy are: (1) to perform a complete autopsy; (2) to personally perform the examination and observe all findings so that interpretation may be sound; (3) to perform a thorough examination and overlook nothing which could later prove of importance; (4) to preserve all information by written and photographic records; and (5) to provide a professional report without bias. Preliminary Procedures Before the clothing is removed, the body should be examined to determine the condition of the clothing, and to correlate tears and other defects with obvious injuries to the body, and to record the findings. The clothing, body, and hands should be protected from possible contamination prior to specific examination of each. A record of the general condition of the body and of the clothing should be made and the extent of rigo r and lividity, the temperature of the body and the environment, and any other data pertinent to the subsequent determination of the time of death also should be recorded. After the preliminary examination the clothing may be carefully removed by unbuttoning, unzippering, or unhooking to remove without tearing or cutting. If the clothing is wet or bloody, it must be hung up to dry in the air to prevent putrefaction and disintegration. Record and label each item of clothing. Preserve with proper identification for subsequent examination. Clothing may be examined in the laboratory with soft tissue x-ray and infrared photographs in addition to various chemical analyses and immunohematologic analyses. Autopsy Procedure -The..date, time and place of autopsy should be succinctly noted, and where and by whom it was performed, and any observers or participants should be named. The body should be identified, and all physical characteristics should be described. These include age, height, weight, sex, color of hair and eyes, state of nutrition and muscular development, scars,, and tattoos. Description of the teeth, the number present and absent, :and the general condition should be detailed noting any' abnormalities or deformities, or evidence of fracture, old or recent. In a separate paragraph or paragraphs describe all injuries, noting the number and characteristics of each including size, shape, pattern, and location in relation to anatomic landmarks. Describe the course, direction, and depth.of injuries and enumerate structures involved by the injury. Identify and label any'foreign object recovered ,and specify its relation to a given injury~ : ~, . ~:At' least one photograph should be taken to identify the body. Photograph injuries to document their location and be certain to, include a 'scale to show their size. Photographs can be used to demonstrate and correlate, external injuries with internal injuries and to demonstrate pathologic processes other than those of traumatic origin. ' Roentgenographic and fluoroscopic examinations tan be used to locate bullets or other radio-opaque objects, to identify the victim, and tO document fractures, anatomic deformities, and surgical procedures when such metallic.foreign bodies as plates, nails, screws, and wire sutures have been used. .. A general description of the head, neck, cervical spine., thorax, abdo2 men, genitalia, and extremities should be given in logical sequence. The course of wounds through various structures should be detailed remembering variations of position in relationships during life versus relationships after death and when supine on the autopsy table. Evidentiary items such as bullets, knives, or portions thereof, pellets or foreign materials, should be preserved and the point of recovery should be noted. Each should be labelled for proper identification. Each organ should be dissected and described, noting relationships and conditions.
+
+USER:
+Describe the protocol for dealing with clothing prior to beginning an autopsy.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,43,12,794,,771
+"Provide your answer in full sentences, referencing the document using quotations.","According to this document only, what is the specific impacts of internet use on children?","**Are Children Smarter Because of the Internet? Website** Modern children and the adolescents represent the first generation that has grown surrounded by the Internet technology. This can be compared to the children of the 1920s and 1950s who grew up surrounded by the buzz of the radio and television respectively. In this era of advanced technology, it is almost mandatory that school going children acquire the knowledge on internet use because education curricula are quickly transforming towards technology use. Furthermore, with the widespread use of tech-related gadgets in almost all activities, such as mobile phones, play- stations and many others in day to day life, it seems embracing of technology is a foregone conclusion . This paper will aspire to explore the question on whether children are smarter or more socialized due to the Internet. Internet Use among Children The use of internet among children today is ranked in the same category with watching television or using the phone. In developed countries, up to 87% of children aged between twelve and seventeen are online. The internet is however better in comparison to the others due to the platform it offers to enhance interaction. According to a study conducted by Genevieve Marie Johnson, it was found out that children were likely to use Internet more at school than at home. However, they enjoyed using the Internet at home more than at school . Children perceive the use of Internet in a different perspective compared to adults. There is no doubt that the Internet has a significant influence on children. Impact of Internet Use The Internet is used both at school and at home by children. At school, the children’s Internet use is governed by the children’s Internet Protection Act (Yan, 2006). The children’s use of Internet is associated with various risks despite being beneficial is some ways. Parents and guardians need to implement various strategies that favor co-use and interaction rules to children to reduce the risk associated with Internet use among children. However, these strategies were found to be less effective in limiting the risks. In a study conducted regarding the influence of the Internet on children from low income families, it was indicated that children who had access to the Internet recorded high scores compared to those who had limited access to the Internet. It was also found out that age did not have an impact on the performance of the children. Another study conducted on the influence of Internet use by the children on family relationships and parental mediation established that parental recommendations on useful websites and co-using were positively associated with the frequency with children would engage in educative, online activities. Nevertheless, it was found that parental restrictions on time and websites did not impact on the actual Internet use by children. Children are difficult to tame when it comes to unsafe Internet use. It has been established that unsafe Internet use among children is likely to occur within the homes. With the Internet, it is possible to form virtual relationships among various people. In a study that was conducted by Bonetti, Campbell and Gilmore (2010), it was revealed that children who were lonely engaged more in online communications than those who did not report being lonely. Through the Internet, such children are able to fulfill special needs in respect to social interactions, self exposure, and exploring their identity. In a study conducted among the Latino children in Los Angeles, it was observed that strict parental strategies limited children in respect to Internet use. Nevertheless, these children were able to pursue their own interests and motivations online though on a restricted level. The Internet has had far-reaching impacts on the society in general and children have not been spared. From the studies that have been conducted, it can be observed that though parents have been restrictive in allowing access of their children to the Internet, this has come with various challenges. The children have always had a way to access Internet and parents have been left with very little in controlling what the children access. In general, this young generation seems to be inseparable with the internet. Much as some are opposed to internet use among children, the benefits accrued from its use surpass the negative impacts especially when used in controlled environments. Based on numerous studies by academics and social experts, it is clear that the use of internet has provided a chance for children to acquire a wide range of knowledge through easy access to information compared to the scenario in the past where information sources were quite limited. Internet also provides a perfect platform for children to gain vital communication skills that in turn enhance social development. Psychology experts have identified a link between constructive use of internet and student performance in school particularly in language expressivity. Children access information by visiting websites and this enhances their learning skills. The internet also makes learning an enjoyable experience because most websites contain graphics that effectively capture children’s’ imagination and creativity. This is important in stimulating the functioning of their brains and transforming them into effective learners. The process of acquiring the information from the internet is also vital in a child’s developmental skills such as information evaluation, research techniques as well as work planning strategies. Children with prowess in internet gaming demonstrate better levels of visual memory and pattern recognition when compared to those who did not. This has a positive impact on their ability to interpret graphical data and enhanced diagram visualization and interpretation. From the data collected by Jennifer Bremmer from Chicago University; department of Child Psychiatry, up to 84% of parents interviewed, agreed that internet use has had a positive impact on their children’s school life and particularly in academics. Eighty one percent of the respondents said that their children acquired most of their information from the internet. Majority of those interviewed said they felt that without the internet their children would perform poorly. According to government budgetary allocations of the United States in 2000, $4 billion was dedicated for connecting students to internet, a clear indication of the government’s commitment towards use of technology in education. The internet also gives access to more up-dated information compared to books, thus improving on the child’s vocabulary in the offered curriculum and in the research projects. The One Child One Laptop project in Africa is expected to give African children an opportunity to access world wide information and be able to effectively contribute their ideas on a world platform. This could also create a chance for them to earn a living as they mature since they can work on- line and link up with other people in the world. Based on the scientific background information on stimulation and response, it can be conclusively deduced that the use of internet by growing children has a positive effect on their development. The prolonged use of computer while searching for information from the internet could improve the coordination patterns of eye and hand through the use of the mouse, keyboard and screen. Though no specific research has been done on this phenomenon, it’s scientifically proven that habits enhance brain development and the associated physical development. The use of internet also has a social dimension. Antagonists on internet use argue that it has replaced human interactions. On the other hand, the protagonists claim that with professional use, internet use can be a medium to enhance this interaction. The use of the chat rooms, email services and other communication platforms available on the internet, are believed to enhance social skills alongside communication skills. Social and culture exchanges among young children has been enhanced through the internet mailing facility and through the available social sites such as Face book and Twitter. Children get an opportunity to interact in educative and productive communication. A perfect example is the Spank Magazine, which gives a platform for world wide interactions on youth issues where any one can interact and communicate their ideas for free. Social studies analysts have shown that the use of internet by school going children in class work has a marked positive impact on their performance. This has been linked to the fun associated with learning using the internet. The use of internet also enhances cooperation and sharing of ideas among the children, a vital life skill. Studies have indicated improved performances in many pupils using internet as a learning tool, and who initially had difficulties in using the conventional learning models. This in turn, positively influences their attitude toward school works as among other reasons it gives the students a relatively independent environment for learning and interaction. The internet has become a tool of entertainment. Research on internet use has shown that many children use it as a leisure tool to pursue amusement and enjoyment. The family set ups today are more individualized and physical interactions among children mostly at home is limited to a certain extent. Such children resort to internet for companionship. Through the process of enjoying themselves, they are subconsciously benefiting by acquiring other skills such as analyzing skills, creative and critical thinking leading to improved understanding of concepts. Children are also molded socially by the Internet through listening to music, watching movies and documentaries, world news and any other entertainment features. This makes the children smarter on issues happening in the world and prepares them for more networking in the social world. Internet also provides children with physical impairment, an opportunity to find pleasure they may not acquire anywhere else due to their disabilities. The experts’ research data explained above clearly indicates that, yes, internet is useful and almost a basic necessity for today’s school going children, however; on the other hand, utmost care must be observed since uncontrolled use of the internet has been reported to have negative impacts on the children. As is the norm, everything that has benefits comes along with challenges as well. Social psychologists have revealed several negative impacts of internet use on the social, physical and cognitive spheres of their life. Information fatigue syndrome is among the most common and comes as a result of reading and analyzing too much information from the internet.","[text] ========== **Are Children Smarter Because of the Internet? Website** Modern children and the adolescents represent the first generation that has grown surrounded by the Internet technology. This can be compared to the children of the 1920s and 1950s who grew up surrounded by the buzz of the radio and television respectively. In this era of advanced technology, it is almost mandatory that school going children acquire the knowledge on internet use because education curricula are quickly transforming towards technology use. Furthermore, with the widespread use of tech-related gadgets in almost all activities, such as mobile phones, play- stations and many others in day to day life, it seems embracing of technology is a foregone conclusion . This paper will aspire to explore the question on whether children are smarter or more socialized due to the Internet. Internet Use among Children The use of internet among children today is ranked in the same category with watching television or using the phone. In developed countries, up to 87% of children aged between twelve and seventeen are online. The internet is however better in comparison to the others due to the platform it offers to enhance interaction. According to a study conducted by Genevieve Marie Johnson, it was found out that children were likely to use Internet more at school than at home. However, they enjoyed using the Internet at home more than at school . Children perceive the use of Internet in a different perspective compared to adults. There is no doubt that the Internet has a significant influence on children. Impact of Internet Use The Internet is used both at school and at home by children. At school, the children’s Internet use is governed by the children’s Internet Protection Act (Yan, 2006). The children’s use of Internet is associated with various risks despite being beneficial is some ways. Parents and guardians need to implement various strategies that favor co-use and interaction rules to children to reduce the risk associated with Internet use among children. However, these strategies were found to be less effective in limiting the risks. In a study conducted regarding the influence of the Internet on children from low income families, it was indicated that children who had access to the Internet recorded high scores compared to those who had limited access to the Internet. It was also found out that age did not have an impact on the performance of the children. Another study conducted on the influence of Internet use by the children on family relationships and parental mediation established that parental recommendations on useful websites and co-using were positively associated with the frequency with children would engage in educative, online activities. Nevertheless, it was found that parental restrictions on time and websites did not impact on the actual Internet use by children. Children are difficult to tame when it comes to unsafe Internet use. It has been established that unsafe Internet use among children is likely to occur within the homes. With the Internet, it is possible to form virtual relationships among various people. In a study that was conducted by Bonetti, Campbell and Gilmore (2010), it was revealed that children who were lonely engaged more in online communications than those who did not report being lonely. Through the Internet, such children are able to fulfill special needs in respect to social interactions, self exposure, and exploring their identity. In a study conducted among the Latino children in Los Angeles, it was observed that strict parental strategies limited children in respect to Internet use. Nevertheless, these children were able to pursue their own interests and motivations online though on a restricted level. The Internet has had far-reaching impacts on the society in general and children have not been spared. From the studies that have been conducted, it can be observed that though parents have been restrictive in allowing access of their children to the Internet, this has come with various challenges. The children have always had a way to access Internet and parents have been left with very little in controlling what the children access. In general, this young generation seems to be inseparable with the internet. Much as some are opposed to internet use among children, the benefits accrued from its use surpass the negative impacts especially when used in controlled environments. Based on numerous studies by academics and social experts, it is clear that the use of internet has provided a chance for children to acquire a wide range of knowledge through easy access to information compared to the scenario in the past where information sources were quite limited. Internet also provides a perfect platform for children to gain vital communication skills that in turn enhance social development. Psychology experts have identified a link between constructive use of internet and student performance in school particularly in language expressivity. Children access information by visiting websites and this enhances their learning skills. The internet also makes learning an enjoyable experience because most websites contain graphics that effectively capture children’s’ imagination and creativity. This is important in stimulating the functioning of their brains and transforming them into effective learners. The process of acquiring the information from the internet is also vital in a child’s developmental skills such as information evaluation, research techniques as well as work planning strategies. Children with prowess in internet gaming demonstrate better levels of visual memory and pattern recognition when compared to those who did not. This has a positive impact on their ability to interpret graphical data and enhanced diagram visualization and interpretation. From the data collected by Jennifer Bremmer from Chicago University; department of Child Psychiatry, up to 84% of parents interviewed, agreed that internet use has had a positive impact on their children’s school life and particularly in academics. Eighty one percent of the respondents said that their children acquired most of their information from the internet. Majority of those interviewed said they felt that without the internet their children would perform poorly. According to government budgetary allocations of the United States in 2000, $4 billion was dedicated for connecting students to internet, a clear indication of the government’s commitment towards use of technology in education. The internet also gives access to more up-dated information compared to books, thus improving on the child’s vocabulary in the offered curriculum and in the research projects. The One Child One Laptop project in Africa is expected to give African children an opportunity to access world wide information and be able to effectively contribute their ideas on a world platform. This could also create a chance for them to earn a living as they mature since they can work on- line and link up with other people in the world. Based on the scientific background information on stimulation and response, it can be conclusively deduced that the use of internet by growing children has a positive effect on their development. The prolonged use of computer while searching for information from the internet could improve the coordination patterns of eye and hand through the use of the mouse, keyboard and screen. Though no specific research has been done on this phenomenon, it’s scientifically proven that habits enhance brain development and the associated physical development. The use of internet also has a social dimension. Antagonists on internet use argue that it has replaced human interactions. On the other hand, the protagonists claim that with professional use, internet use can be a medium to enhance this interaction. The use of the chat rooms, email services and other communication platforms available on the internet, are believed to enhance social skills alongside communication skills. Social and culture exchanges among young children has been enhanced through the internet mailing facility and through the available social sites such as Face book and Twitter. Children get an opportunity to interact in educative and productive communication. A perfect example is the Spank Magazine, which gives a platform for world wide interactions on youth issues where any one can interact and communicate their ideas for free. Social studies analysts have shown that the use of internet by school going children in class work has a marked positive impact on their performance. This has been linked to the fun associated with learning using the internet. The use of internet also enhances cooperation and sharing of ideas among the children, a vital life skill. Studies have indicated improved performances in many pupils using internet as a learning tool, and who initially had difficulties in using the conventional learning models. This in turn, positively influences their attitude toward school works as among other reasons it gives the students a relatively independent environment for learning and interaction. The internet has become a tool of entertainment. Research on internet use has shown that many children use it as a leisure tool to pursue amusement and enjoyment. The family set ups today are more individualized and physical interactions among children mostly at home is limited to a certain extent. Such children resort to internet for companionship. Through the process of enjoying themselves, they are subconsciously benefiting by acquiring other skills such as analyzing skills, creative and critical thinking leading to improved understanding of concepts. Children are also molded socially by the Internet through listening to music, watching movies and documentaries, world news and any other entertainment features. This makes the children smarter on issues happening in the world and prepares them for more networking in the social world. Internet also provides children with physical impairment, an opportunity to find pleasure they may not acquire anywhere else due to their disabilities. The experts’ research data explained above clearly indicates that, yes, internet is useful and almost a basic necessity for today’s school going children, however; on the other hand, utmost care must be observed since uncontrolled use of the internet has been reported to have negative impacts on the children. As is the norm, everything that has benefits comes along with challenges as well. Social psychologists have revealed several negative impacts of internet use on the social, physical and cognitive spheres of their life. Information fatigue syndrome is among the most common and comes as a result of reading and analyzing too much information from the internet. ---------------- [query] ========== According to this document only, what is the specific impacts of internet use on children? ---------------- [task instructions] ========== Provide your answer in full sentences, referencing the document using quotations.","Provide your answer in full sentences, referencing the document using quotations.
+
+EVIDENCE:
+**Are Children Smarter Because of the Internet? Website** Modern children and the adolescents represent the first generation that has grown surrounded by the Internet technology. This can be compared to the children of the 1920s and 1950s who grew up surrounded by the buzz of the radio and television respectively. In this era of advanced technology, it is almost mandatory that school going children acquire the knowledge on internet use because education curricula are quickly transforming towards technology use. Furthermore, with the widespread use of tech-related gadgets in almost all activities, such as mobile phones, play- stations and many others in day to day life, it seems embracing of technology is a foregone conclusion . This paper will aspire to explore the question on whether children are smarter or more socialized due to the Internet. Internet Use among Children The use of internet among children today is ranked in the same category with watching television or using the phone. In developed countries, up to 87% of children aged between twelve and seventeen are online. The internet is however better in comparison to the others due to the platform it offers to enhance interaction. According to a study conducted by Genevieve Marie Johnson, it was found out that children were likely to use Internet more at school than at home. However, they enjoyed using the Internet at home more than at school . Children perceive the use of Internet in a different perspective compared to adults. There is no doubt that the Internet has a significant influence on children. Impact of Internet Use The Internet is used both at school and at home by children. At school, the children’s Internet use is governed by the children’s Internet Protection Act (Yan, 2006). The children’s use of Internet is associated with various risks despite being beneficial is some ways. Parents and guardians need to implement various strategies that favor co-use and interaction rules to children to reduce the risk associated with Internet use among children. However, these strategies were found to be less effective in limiting the risks. In a study conducted regarding the influence of the Internet on children from low income families, it was indicated that children who had access to the Internet recorded high scores compared to those who had limited access to the Internet. It was also found out that age did not have an impact on the performance of the children. Another study conducted on the influence of Internet use by the children on family relationships and parental mediation established that parental recommendations on useful websites and co-using were positively associated with the frequency with children would engage in educative, online activities. Nevertheless, it was found that parental restrictions on time and websites did not impact on the actual Internet use by children. Children are difficult to tame when it comes to unsafe Internet use. It has been established that unsafe Internet use among children is likely to occur within the homes. With the Internet, it is possible to form virtual relationships among various people. In a study that was conducted by Bonetti, Campbell and Gilmore (2010), it was revealed that children who were lonely engaged more in online communications than those who did not report being lonely. Through the Internet, such children are able to fulfill special needs in respect to social interactions, self exposure, and exploring their identity. In a study conducted among the Latino children in Los Angeles, it was observed that strict parental strategies limited children in respect to Internet use. Nevertheless, these children were able to pursue their own interests and motivations online though on a restricted level. The Internet has had far-reaching impacts on the society in general and children have not been spared. From the studies that have been conducted, it can be observed that though parents have been restrictive in allowing access of their children to the Internet, this has come with various challenges. The children have always had a way to access Internet and parents have been left with very little in controlling what the children access. In general, this young generation seems to be inseparable with the internet. Much as some are opposed to internet use among children, the benefits accrued from its use surpass the negative impacts especially when used in controlled environments. Based on numerous studies by academics and social experts, it is clear that the use of internet has provided a chance for children to acquire a wide range of knowledge through easy access to information compared to the scenario in the past where information sources were quite limited. Internet also provides a perfect platform for children to gain vital communication skills that in turn enhance social development. Psychology experts have identified a link between constructive use of internet and student performance in school particularly in language expressivity. Children access information by visiting websites and this enhances their learning skills. The internet also makes learning an enjoyable experience because most websites contain graphics that effectively capture children’s’ imagination and creativity. This is important in stimulating the functioning of their brains and transforming them into effective learners. The process of acquiring the information from the internet is also vital in a child’s developmental skills such as information evaluation, research techniques as well as work planning strategies. Children with prowess in internet gaming demonstrate better levels of visual memory and pattern recognition when compared to those who did not. This has a positive impact on their ability to interpret graphical data and enhanced diagram visualization and interpretation. From the data collected by Jennifer Bremmer from Chicago University; department of Child Psychiatry, up to 84% of parents interviewed, agreed that internet use has had a positive impact on their children’s school life and particularly in academics. Eighty one percent of the respondents said that their children acquired most of their information from the internet. Majority of those interviewed said they felt that without the internet their children would perform poorly. According to government budgetary allocations of the United States in 2000, $4 billion was dedicated for connecting students to internet, a clear indication of the government’s commitment towards use of technology in education. The internet also gives access to more up-dated information compared to books, thus improving on the child’s vocabulary in the offered curriculum and in the research projects. The One Child One Laptop project in Africa is expected to give African children an opportunity to access world wide information and be able to effectively contribute their ideas on a world platform. This could also create a chance for them to earn a living as they mature since they can work on- line and link up with other people in the world. Based on the scientific background information on stimulation and response, it can be conclusively deduced that the use of internet by growing children has a positive effect on their development. The prolonged use of computer while searching for information from the internet could improve the coordination patterns of eye and hand through the use of the mouse, keyboard and screen. Though no specific research has been done on this phenomenon, it’s scientifically proven that habits enhance brain development and the associated physical development. The use of internet also has a social dimension. Antagonists on internet use argue that it has replaced human interactions. On the other hand, the protagonists claim that with professional use, internet use can be a medium to enhance this interaction. The use of the chat rooms, email services and other communication platforms available on the internet, are believed to enhance social skills alongside communication skills. Social and culture exchanges among young children has been enhanced through the internet mailing facility and through the available social sites such as Face book and Twitter. Children get an opportunity to interact in educative and productive communication. A perfect example is the Spank Magazine, which gives a platform for world wide interactions on youth issues where any one can interact and communicate their ideas for free. Social studies analysts have shown that the use of internet by school going children in class work has a marked positive impact on their performance. This has been linked to the fun associated with learning using the internet. The use of internet also enhances cooperation and sharing of ideas among the children, a vital life skill. Studies have indicated improved performances in many pupils using internet as a learning tool, and who initially had difficulties in using the conventional learning models. This in turn, positively influences their attitude toward school works as among other reasons it gives the students a relatively independent environment for learning and interaction. The internet has become a tool of entertainment. Research on internet use has shown that many children use it as a leisure tool to pursue amusement and enjoyment. The family set ups today are more individualized and physical interactions among children mostly at home is limited to a certain extent. Such children resort to internet for companionship. Through the process of enjoying themselves, they are subconsciously benefiting by acquiring other skills such as analyzing skills, creative and critical thinking leading to improved understanding of concepts. Children are also molded socially by the Internet through listening to music, watching movies and documentaries, world news and any other entertainment features. This makes the children smarter on issues happening in the world and prepares them for more networking in the social world. Internet also provides children with physical impairment, an opportunity to find pleasure they may not acquire anywhere else due to their disabilities. The experts’ research data explained above clearly indicates that, yes, internet is useful and almost a basic necessity for today’s school going children, however; on the other hand, utmost care must be observed since uncontrolled use of the internet has been reported to have negative impacts on the children. As is the norm, everything that has benefits comes along with challenges as well. Social psychologists have revealed several negative impacts of internet use on the social, physical and cognitive spheres of their life. Information fatigue syndrome is among the most common and comes as a result of reading and analyzing too much information from the internet.
+
+USER:
+According to this document only, what is the specific impacts of internet use on children?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,11,15,1695,,457
+"You can only respond using information in the context block, and no other sources.",What are the implications of an acrylate allergy?,"The British Association of Dermatologists has issued warnings regarding the dangers of chemicals found in nail cosmetics. The retrospective analysis of patch testing results conducted on individuals diagnosed with contact dermatitis(CD) due to nail cosmetic ingredients revealed the most frequently occurring positive reactions to specific chemicals [3].4.2.1 Acrylates are chemicals found in gel nail products, acrylic nails, and some nailadhesives. Hydroxyethyl Methacrylates (HEMA), Methyl Methacrylate and Ethyl Acrylateare commonly used in these products and resulted to be the most allergenic in the study(56.6%, 27.8% and 25.2%, respectively) [3] . Some individuals may develop contact dermatitis or allergic reactions to these chemicals, especially if they come into prolonged or repeated contact with the skin and are cross-reactive with one another [12].An EECDRG (European Environmental Contact Dermatitis Research Group) study revealed136 cases of allergic contact dermatitis (ACD) caused by nail acrylates, diagnosed through targeted testing [4] . This accounted for approximately 67% of all cases of (meth)acrylate allergy observed between the years 2013 and 2015. The study identified the main allergens responsible for these reactions, with 2-hydroxyethyl methacrylate (2-HEMA) showing a positivity rate of 91.9%, followed by hydroxypropyl methacrylate with 83.2% positivity, and ethylene glycol dimethacrylate at 69.2% positivity.The monomer commonly used in nail cosmetic procedures is typically a methacrylatemonomer. Initially, methyl methacrylate (MMA) was frequently employed in these products. 63However, due to the occurrence of severe cases of contact dermatitis associated with MMA exposure, its use has been restricted in the United States and Europe [13] . To address safety concerns, regulations were implemented in the United States, which led to the prohibition of products with 100% MMA monomer. Additionally, in Europe, many products containing over90% MMA monomer were recalled preventing potential adverse health effects [14].4.2.2 Formaldehyde is a preservative and hardening agent found in some nail hardeners and nail polishes [15] . It can cause skin irritation and allergic reactions, and long-term exposure may pose health risks. There has been a decline in sensitization to tosylamide/formaldehyde resin, a common ingredient found in ""classical"" nail polish, while the incidence of(meth)acrylate-related allergic contact dermatitis (ACD) has been on the rise [16].3.2.3 Parabens are preservatives used in some nail products to extend their shelf life [17] .They have been linked to skin irritation and may cause allergic reactions in sensitive individuals. They are very weak allergens with a sensitization prevalence of arounf 1% or less.4.3. Allergic Contact DermatitisThe most studied adverse effect of methacrylate monomers in the gel polish is allergic contact dermatitis (ACD) [18] . Recently, the incidence of allergic contact dermatitis associated with nail cosmetics has increased among beauticians and customers, particularly with the rising popularity of photo-bonded acrylic gel nails[19].ACD caused by (meth)acrylates is commonly observed in specific occupational groups, including beauticians such as nail technicians, dental personnel (dentists and technicians), and employees working in industries involved in fiberglass, printing, glue, or paint manufacturing[1] . These professionals are at an increased risk of developing allergic reactions to(meth)acrylates due to their frequent and direct exposure to products containing these compounds in their work environments. Gatica-Ortega et al. (2017) presented a picture of a typical patient with ACD caused by methacrylates in artificial nails as a young, non-atopic woman, who works as a nail technician and suffers from hand and face dermatisis [18] . They used MOAHFLA index, which is the acronym for male, occupational dermatitis, atopic dermatitis, hand dermatitis, leg dermatitis, face dermatitis, and age >40 years. Among the 1.82% patients with ACD of 2353 studied, the most frequently positive allergens were HPMA (positive reactions observed in almost all 64patients except one), HEMA, and THFMA. Only one patient had negative patch test results for both HPMA and HEMA. Patch testing with both HPMA and THFMA would have ensured that no patients with (meth)acrylate allergies were missed.Interestingly, these three allergens, HPMA, HEMA, and THFMA, were also the most identified (meth)acrylate compounds listed on the labels of the products used by the patients.This correlation between positive patch test results and the presence of these allergens in the products suggests the importance of identifying and labeling these compounds accurately to aid in diagnosing and managing allergic contact dermatitis caused by (meth)acrylates.The risk of developing allergic contact dermatitis to nail cosmetics is higher in individuals who have previously been sensitized to these allergens. Sensitization can occur through repeated or prolonged exposure to these chemicals, leading the body's immune system to recognize them as harmful substances and trigger an allergic reaction upon subsequent exposure [20]. The nail technicians are under the highest risk of allergies.The retrospective study conducted by the European Environmental Contact Dermatitis Research Group (EECDRG) revealed significant insights into acrylate-induced allergic contact dermatitis (ACD) [4].Authors showed that an overwhelming 67% of ACD cases attributed to acrylates were caused by materials used in nail stylization. Among the affected individuals, 43% were exposed as consumers using nail cosmetic products, while 56% were exposed occupationally, primarily referring to nail technicians who handle these products regularly.A notable finding from the study was that 65% of the cases of occupational ACD were identified within the first year of starting work. This indicates a high sensitizing potency of acrylate chemicals, as the allergic reactions were detected relatively early in the occupational exposure. It highlights the importance of recognizing the risks associated with acrylate exposure in the workplace and the need for preventative measures to protect the health of professionals working in nail stylization.Symptoms of allergic contact dermatitis may include redness, itching, swelling, and blistering around the nail area or on the skin exposed to the nail products [4,21] . In severe cases, the reaction may spread to other parts of the body that encountered the allergen, leading to widespread dermatitis. 654.5.1. Diagnosis Patch testing is considered the gold standard in confirming the diagnosis of allergy to acrylates [1] . During the procedure, small amounts of potential allergens, including acrylate compounds, are applied to patches that are then placed on the patient's back. The patches are left in place for a specific time, usually around 48 hours. After this period, the patches are removed, and the skin is carefully examined for any signs of allergic reactions.If a patient is allergic to acrylates, the patch test will reveal a positive reaction in the form of redness, swelling, or rash at the site of exposure to the acrylate allergen. This positive result confirms the diagnosis of acrylate allergy and helps the healthcare provider to identify the specific acrylate compounds to which the patient is sensitive.Acrylate allergies can sometimes be polyvalent, meaning patients may exhibit positive patch test reactions to multiple acrylate compounds even if they have not been directly exposed toall those substances individually [20]. This phenomenon is often attributed to cross-reactions between different acrylic monomers and concomitant allergies.4.4. Additional RiskAllergies to gel nail chemicals are more likely to occur if gel polish isn't accurately or sufficiently cured under a UV or LED lamp during the manicure, leading to skin sensitization[2]. The British Association of Dermatologists has urged caution with at-home gel nail kits, as improper curing and exposure to acrylates can cause allergic reactions [22–24].Acrylates are not only present in nail cosmetics but have a wide application in various medical purposes, such as dental ligatures, soft contact lenses, endoprostheses, hearing aids and medical devices for diabetes patients [25–28].As a result, individuals who have previously developed allergic contact dermatitis (ACD) to acrylates from artificial nails may experience allergic reactions upon re-exposure to acrylates in these other materials. Moreover, cross-reactions with other acrylic monomers may occur, leading to additional allergic responses [20].For individuals with ACD to acrylates in artificial nails, it is essential to exercise caution when using other products that contain acrylates. However, it has been reported that those 66 who are not allergic to ethyl cyanoacrylate, which is present in all nail glues, can safely use silk wrap nails as an alternative [5] . This option provides a potentially safer choice for nail enhancements without the risk of triggering allergic reactions caused by acrylates in artificial nails.","System instruction: You can only respond using information in the context block, and no other sources. question: What are the implications of an acrylate allergy? context: The British Association of Dermatologists has issued warnings regarding the dangers of chemicals found in nail cosmetics. The retrospective analysis of patch testing results conducted on individuals diagnosed with contact dermatitis(CD) due to nail cosmetic ingredients revealed the most frequently occurring positive reactions to specific chemicals [3].4.2.1 Acrylates are chemicals found in gel nail products, acrylic nails, and some nailadhesives. Hydroxyethyl Methacrylates (HEMA), Methyl Methacrylate and Ethyl Acrylateare commonly used in these products and resulted to be the most allergenic in the study(56.6%, 27.8% and 25.2%, respectively) [3] . Some individuals may develop contact dermatitis or allergic reactions to these chemicals, especially if they come into prolonged or repeated contact with the skin and are cross-reactive with one another [12].An EECDRG (European Environmental Contact Dermatitis Research Group) study revealed136 cases of allergic contact dermatitis (ACD) caused by nail acrylates, diagnosed through targeted testing [4] . This accounted for approximately 67% of all cases of (meth)acrylate allergy observed between the years 2013 and 2015. The study identified the main allergens responsible for these reactions, with 2-hydroxyethyl methacrylate (2-HEMA) showing a positivity rate of 91.9%, followed by hydroxypropyl methacrylate with 83.2% positivity, and ethylene glycol dimethacrylate at 69.2% positivity.The monomer commonly used in nail cosmetic procedures is typically a methacrylatemonomer. Initially, methyl methacrylate (MMA) was frequently employed in these products. 63However, due to the occurrence of severe cases of contact dermatitis associated with MMA exposure, its use has been restricted in the United States and Europe [13] . To address safety concerns, regulations were implemented in the United States, which led to the prohibition of products with 100% MMA monomer. Additionally, in Europe, many products containing over90% MMA monomer were recalled preventing potential adverse health effects [14].4.2.2 Formaldehyde is a preservative and hardening agent found in some nail hardeners and nail polishes [15] . It can cause skin irritation and allergic reactions, and long-term exposure may pose health risks. There has been a decline in sensitization to tosylamide/formaldehyde resin, a common ingredient found in ""classical"" nail polish, while the incidence of(meth)acrylate-related allergic contact dermatitis (ACD) has been on the rise [16].3.2.3 Parabens are preservatives used in some nail products to extend their shelf life [17] .They have been linked to skin irritation and may cause allergic reactions in sensitive individuals. They are very weak allergens with a sensitization prevalence of arounf 1% or less.4.3. Allergic Contact DermatitisThe most studied adverse effect of methacrylate monomers in the gel polish is allergic contact dermatitis (ACD) [18] . Recently, the incidence of allergic contact dermatitis associated with nail cosmetics has increased among beauticians and customers, particularly with the rising popularity of photo-bonded acrylic gel nails[19].ACD caused by (meth)acrylates is commonly observed in specific occupational groups, including beauticians such as nail technicians, dental personnel (dentists and technicians), and employees working in industries involved in fiberglass, printing, glue, or paint manufacturing[1] . These professionals are at an increased risk of developing allergic reactions to(meth)acrylates due to their frequent and direct exposure to products containing these compounds in their work environments. Gatica-Ortega et al. (2017) presented a picture of a typical patient with ACD caused by methacrylates in artificial nails as a young, non-atopic woman, who works as a nail technician and suffers from hand and face dermatisis [18] . They used MOAHFLA index, which is the acronym for male, occupational dermatitis, atopic dermatitis, hand dermatitis, leg dermatitis, face dermatitis, and age >40 years. Among the 1.82% patients with ACD of 2353 studied, the most frequently positive allergens were HPMA (positive reactions observed in almost all 64patients except one), HEMA, and THFMA. Only one patient had negative patch test results for both HPMA and HEMA. Patch testing with both HPMA and THFMA would have ensured that no patients with (meth)acrylate allergies were missed.Interestingly, these three allergens, HPMA, HEMA, and THFMA, were also the most identified (meth)acrylate compounds listed on the labels of the products used by the patients.This correlation between positive patch test results and the presence of these allergens in the products suggests the importance of identifying and labeling these compounds accurately to aid in diagnosing and managing allergic contact dermatitis caused by (meth)acrylates.The risk of developing allergic contact dermatitis to nail cosmetics is higher in individuals who have previously been sensitized to these allergens. Sensitization can occur through repeated or prolonged exposure to these chemicals, leading the body's immune system to recognize them as harmful substances and trigger an allergic reaction upon subsequent exposure [20]. The nail technicians are under the highest risk of allergies.The retrospective study conducted by the European Environmental Contact Dermatitis Research Group (EECDRG) revealed significant insights into acrylate-induced allergic contact dermatitis (ACD) [4].Authors showed that an overwhelming 67% of ACD cases attributed to acrylates were caused by materials used in nail stylization. Among the affected individuals, 43% were exposed as consumers using nail cosmetic products, while 56% were exposed occupationally, primarily referring to nail technicians who handle these products regularly.A notable finding from the study was that 65% of the cases of occupational ACD were identified within the first year of starting work. This indicates a high sensitizing potency of acrylate chemicals, as the allergic reactions were detected relatively early in the occupational exposure. It highlights the importance of recognizing the risks associated with acrylate exposure in the workplace and the need for preventative measures to protect the health of professionals working in nail stylization.Symptoms of allergic contact dermatitis may include redness, itching, swelling, and blistering around the nail area or on the skin exposed to the nail products [4,21] . In severe cases, the reaction may spread to other parts of the body that encountered the allergen, leading to widespread dermatitis. 654.5.1. Diagnosis Patch testing is considered the gold standard in confirming the diagnosis of allergy to acrylates [1] . During the procedure, small amounts of potential allergens, including acrylate compounds, are applied to patches that are then placed on the patient's back. The patches are left in place for a specific time, usually around 48 hours. After this period, the patches are removed, and the skin is carefully examined for any signs of allergic reactions.If a patient is allergic to acrylates, the patch test will reveal a positive reaction in the form of redness, swelling, or rash at the site of exposure to the acrylate allergen. This positive result confirms the diagnosis of acrylate allergy and helps the healthcare provider to identify the specific acrylate compounds to which the patient is sensitive.Acrylate allergies can sometimes be polyvalent, meaning patients may exhibit positive patch test reactions to multiple acrylate compounds even if they have not been directly exposed toall those substances individually [20]. This phenomenon is often attributed to cross-reactions between different acrylic monomers and concomitant allergies.4.4. Additional RiskAllergies to gel nail chemicals are more likely to occur if gel polish isn't accurately or sufficiently cured under a UV or LED lamp during the manicure, leading to skin sensitization[2]. The British Association of Dermatologists has urged caution with at-home gel nail kits, as improper curing and exposure to acrylates can cause allergic reactions [22–24].Acrylates are not only present in nail cosmetics but have a wide application in various medical purposes, such as dental ligatures, soft contact lenses, endoprostheses, hearing aids and medical devices for diabetes patients [25–28].As a result, individuals who have previously developed allergic contact dermatitis (ACD) to acrylates from artificial nails may experience allergic reactions upon re-exposure to acrylates in these other materials. Moreover, cross-reactions with other acrylic monomers may occur, leading to additional allergic responses [20].For individuals with ACD to acrylates in artificial nails, it is essential to exercise caution when using other products that contain acrylates. However, it has been reported that those 66 who are not allergic to ethyl cyanoacrylate, which is present in all nail glues, can safely use silk wrap nails as an alternative [5] . This option provides a potentially safer choice for nail enhancements without the risk of triggering allergic reactions caused by acrylates in artificial nails.","You can only respond using information in the context block, and no other sources.
+
+EVIDENCE:
+The British Association of Dermatologists has issued warnings regarding the dangers of chemicals found in nail cosmetics. The retrospective analysis of patch testing results conducted on individuals diagnosed with contact dermatitis(CD) due to nail cosmetic ingredients revealed the most frequently occurring positive reactions to specific chemicals [3].4.2.1 Acrylates are chemicals found in gel nail products, acrylic nails, and some nailadhesives. Hydroxyethyl Methacrylates (HEMA), Methyl Methacrylate and Ethyl Acrylateare commonly used in these products and resulted to be the most allergenic in the study(56.6%, 27.8% and 25.2%, respectively) [3] . Some individuals may develop contact dermatitis or allergic reactions to these chemicals, especially if they come into prolonged or repeated contact with the skin and are cross-reactive with one another [12].An EECDRG (European Environmental Contact Dermatitis Research Group) study revealed136 cases of allergic contact dermatitis (ACD) caused by nail acrylates, diagnosed through targeted testing [4] . This accounted for approximately 67% of all cases of (meth)acrylate allergy observed between the years 2013 and 2015. The study identified the main allergens responsible for these reactions, with 2-hydroxyethyl methacrylate (2-HEMA) showing a positivity rate of 91.9%, followed by hydroxypropyl methacrylate with 83.2% positivity, and ethylene glycol dimethacrylate at 69.2% positivity.The monomer commonly used in nail cosmetic procedures is typically a methacrylatemonomer. Initially, methyl methacrylate (MMA) was frequently employed in these products. 63However, due to the occurrence of severe cases of contact dermatitis associated with MMA exposure, its use has been restricted in the United States and Europe [13] . To address safety concerns, regulations were implemented in the United States, which led to the prohibition of products with 100% MMA monomer. Additionally, in Europe, many products containing over90% MMA monomer were recalled preventing potential adverse health effects [14].4.2.2 Formaldehyde is a preservative and hardening agent found in some nail hardeners and nail polishes [15] . It can cause skin irritation and allergic reactions, and long-term exposure may pose health risks. There has been a decline in sensitization to tosylamide/formaldehyde resin, a common ingredient found in ""classical"" nail polish, while the incidence of(meth)acrylate-related allergic contact dermatitis (ACD) has been on the rise [16].3.2.3 Parabens are preservatives used in some nail products to extend their shelf life [17] .They have been linked to skin irritation and may cause allergic reactions in sensitive individuals. They are very weak allergens with a sensitization prevalence of arounf 1% or less.4.3. Allergic Contact DermatitisThe most studied adverse effect of methacrylate monomers in the gel polish is allergic contact dermatitis (ACD) [18] . Recently, the incidence of allergic contact dermatitis associated with nail cosmetics has increased among beauticians and customers, particularly with the rising popularity of photo-bonded acrylic gel nails[19].ACD caused by (meth)acrylates is commonly observed in specific occupational groups, including beauticians such as nail technicians, dental personnel (dentists and technicians), and employees working in industries involved in fiberglass, printing, glue, or paint manufacturing[1] . These professionals are at an increased risk of developing allergic reactions to(meth)acrylates due to their frequent and direct exposure to products containing these compounds in their work environments. Gatica-Ortega et al. (2017) presented a picture of a typical patient with ACD caused by methacrylates in artificial nails as a young, non-atopic woman, who works as a nail technician and suffers from hand and face dermatisis [18] . They used MOAHFLA index, which is the acronym for male, occupational dermatitis, atopic dermatitis, hand dermatitis, leg dermatitis, face dermatitis, and age >40 years. Among the 1.82% patients with ACD of 2353 studied, the most frequently positive allergens were HPMA (positive reactions observed in almost all 64patients except one), HEMA, and THFMA. Only one patient had negative patch test results for both HPMA and HEMA. Patch testing with both HPMA and THFMA would have ensured that no patients with (meth)acrylate allergies were missed.Interestingly, these three allergens, HPMA, HEMA, and THFMA, were also the most identified (meth)acrylate compounds listed on the labels of the products used by the patients.This correlation between positive patch test results and the presence of these allergens in the products suggests the importance of identifying and labeling these compounds accurately to aid in diagnosing and managing allergic contact dermatitis caused by (meth)acrylates.The risk of developing allergic contact dermatitis to nail cosmetics is higher in individuals who have previously been sensitized to these allergens. Sensitization can occur through repeated or prolonged exposure to these chemicals, leading the body's immune system to recognize them as harmful substances and trigger an allergic reaction upon subsequent exposure [20]. The nail technicians are under the highest risk of allergies.The retrospective study conducted by the European Environmental Contact Dermatitis Research Group (EECDRG) revealed significant insights into acrylate-induced allergic contact dermatitis (ACD) [4].Authors showed that an overwhelming 67% of ACD cases attributed to acrylates were caused by materials used in nail stylization. Among the affected individuals, 43% were exposed as consumers using nail cosmetic products, while 56% were exposed occupationally, primarily referring to nail technicians who handle these products regularly.A notable finding from the study was that 65% of the cases of occupational ACD were identified within the first year of starting work. This indicates a high sensitizing potency of acrylate chemicals, as the allergic reactions were detected relatively early in the occupational exposure. It highlights the importance of recognizing the risks associated with acrylate exposure in the workplace and the need for preventative measures to protect the health of professionals working in nail stylization.Symptoms of allergic contact dermatitis may include redness, itching, swelling, and blistering around the nail area or on the skin exposed to the nail products [4,21] . In severe cases, the reaction may spread to other parts of the body that encountered the allergen, leading to widespread dermatitis. 654.5.1. Diagnosis Patch testing is considered the gold standard in confirming the diagnosis of allergy to acrylates [1] . During the procedure, small amounts of potential allergens, including acrylate compounds, are applied to patches that are then placed on the patient's back. The patches are left in place for a specific time, usually around 48 hours. After this period, the patches are removed, and the skin is carefully examined for any signs of allergic reactions.If a patient is allergic to acrylates, the patch test will reveal a positive reaction in the form of redness, swelling, or rash at the site of exposure to the acrylate allergen. This positive result confirms the diagnosis of acrylate allergy and helps the healthcare provider to identify the specific acrylate compounds to which the patient is sensitive.Acrylate allergies can sometimes be polyvalent, meaning patients may exhibit positive patch test reactions to multiple acrylate compounds even if they have not been directly exposed toall those substances individually [20]. This phenomenon is often attributed to cross-reactions between different acrylic monomers and concomitant allergies.4.4. Additional RiskAllergies to gel nail chemicals are more likely to occur if gel polish isn't accurately or sufficiently cured under a UV or LED lamp during the manicure, leading to skin sensitization[2]. The British Association of Dermatologists has urged caution with at-home gel nail kits, as improper curing and exposure to acrylates can cause allergic reactions [22–24].Acrylates are not only present in nail cosmetics but have a wide application in various medical purposes, such as dental ligatures, soft contact lenses, endoprostheses, hearing aids and medical devices for diabetes patients [25–28].As a result, individuals who have previously developed allergic contact dermatitis (ACD) to acrylates from artificial nails may experience allergic reactions upon re-exposure to acrylates in these other materials. Moreover, cross-reactions with other acrylic monomers may occur, leading to additional allergic responses [20].For individuals with ACD to acrylates in artificial nails, it is essential to exercise caution when using other products that contain acrylates. However, it has been reported that those 66 who are not allergic to ethyl cyanoacrylate, which is present in all nail glues, can safely use silk wrap nails as an alternative [5] . This option provides a potentially safer choice for nail enhancements without the risk of triggering allergic reactions caused by acrylates in artificial nails.
+
+USER:
+What are the implications of an acrylate allergy?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,14,8,1325,,354
+[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.,"Attached is a portion of an article that discusses the clinical trial results of patients who tried ozempic. Can you provide me with four sections, each titled the same as the paragraphs in the text. For each section, tell me what sustain group is being discussed, and provide a bullet-point list including: how much weight was lost for each SEM group, and what the BMI change was for each SEM group. Be sure to include information about the control groups as well. If the information is redacted, do not include it in the response.","SEM Used as First-Line Therapy SUSTAIN-1 reported change in body weight from baseline to week 30 in drug-naive patients with T2DM and had inadequate glycemic control after therapy with diet and exercise. At week 30, the mean change in body weight was -3.73 kg (SE 0.41), -4.53 kg (SE 0.41), and -0.98 kg (SE 0.43) for patients who received SEM 0.5 mg, SEM 1 mg, and placebo, respectively. The mean differences were statistically significant for both SEM groups compared with placebo (SEM 0.5 mg: -2.75 kg, 95% CI -3.92 to -1.58, P < 0.0001; SEM 1 mg: -3.56 kg, 95% CI -4.74 to -2.38) (Table 30). Because the upper limit of the two-sided 95% CI for the estimated differences was below 0 kg, superiority of SEM 0.5 mg or SEM 1 mg versus placebo in change in body weight was demonstrated. According to the clinical expert consulted for this review, the between-group differences were considered clinically important. SUSTAIN-1 also reported change in BMI from baseline to week 30 in drug-naive patients. At week 30, the mean change in BMI was -1.36 kg/m2 (SE 0.15), -1.61 kg/m2 (SE 0.14) and -0.38 kg/m2 (SE 0.15) for patients who received SEM 0.5 mg, SEM 1 mg, and placebo, respectively. The mean differences were statistically significant for both SEM groups compared with placebo (SEM 0.5 mg: -0.98 kg/m2, 95% CI -1.40 to -0.56, P < 0.0001; SEM 1 mg: -1.23 kg/m2, 95% CI -1.65 to -0.82) (Table 30). SEM Used as Second-Line Therapy (Add-On to MET) Results of post hoc subgroup analyses on body weight in SUSTAIN-2, SUSTAIN-3, and SUSTAIN-4 are presented. Patients in SUSTAIN-7 received treatment with SEM or DUL with background therapy of MET monotherapy. In patients with T2DM and received SEM as the second-line therapy (add-on to MET), treatment with either dose of SEM for 30 to 56 weeks was associated with greater reduction in body weight, compared with SIT, EXE, or IG (Table 31). The mean change from baseline in body weight ranged from ▬ for the SEM 0.5 mg group, and from ▬ for the SEM 1 mg group. Compared with SIT, the mean between-group differences were ▬ for the SEM 0.5 mg group and ▬ for the SEM 1 mg group. Compared with EXE, the mean between-group difference was ▬ for the SEM 1 mg group. Compared with IG, the mean between-group differences were ▬ for the SEM 0.5 mg group and ▬ for the SEM 1 mg group. Compared with DUL, the mean between-group differences were -2.26 kg (95% CI -3.02 to -1.51, P < 0.0001) for the SEM 0.5 mg group and -3.55 kg (95% CI -4.32 to -2.78, P < 0.0001) for the SEM 1 mg group. According to the clinical expert consulted for this review, the between-group differences in body weight were considered clinically relevant. In SUSTAIN-7, superiority in reducing body weight was concluded for each dose of SEM compared with the respective dose level of DUL. Results of post hoc subgroup analyses on BMI in SUSTAIN-2 to SUSTAIN-4 are presented. In the subgroups of patients with T2DM and received SEM as the second-line therapy (add-on to MET), treatment with either dose of SEM for 30 weeks to 56 weeks was associated with greater reduction in BMI, compared with SIT, EXE, or IG (Table 31). Patients in SUSTAIN-7 received treatment with SEM or DUL with background therapy of MET monotherapy. The mean change from baseline in BMI ranged from ▬ for the SEM 0.5 mg group, and from ▬ for the SEM 1 mg group. Compared with SIT, the mean between-group differences were ▬ for the SEM 0.5 mg group and ▬ for the SEM 1 mg group. Compared with EXE, the mean between-group difference was ▬ for the SEM 1 mg group. Compared with IG, the mean between-group differences were ▬ for the SEM 0.5 mg group and ▬ for the SEM 1 mg group. Compared with DUL, the mean between-group differences were -0.81 kg/m2 (95% CI -1.08 to -0.54) for the SEM 0.5 mg group and -1.25 kg/m2 (95% CI -1.52 to -0.98) for the SEM 1 mg group. SEM Used as Third-Line Therapy (Add-On to MET + TZD or MET + SU) Results of post hoc subgroup analyses on body weight in SUSTAIN-2 to SUSTAIN-4 are presented. In the patients receiving SEM as the third-line therapy (add-on to MET + TZD or MET + SU), treatment with either dose of SEM for 30 weeks to 56 weeks was associated with greater reduction in body weight, compared with SIT, EXE, or IG (Table 32). The mean change from baseline in A1C ranged from ▬ for the SEM 0.5 mg group, and from ▬ for the SEM 1 mg group. Compared with SIT, the mean between-group differences were ▬ for the SEM 0.5 mg group and ▬ for the SEM 1 mg group. Compared with EXE, the mean between-group difference was ▬ for the SEM 1 mg group. Compared with IG, the mean between-group differences were ▬ for the SEM 0.5 mg group and ▬ for the SEM 1 mg group. According to the clinical expert consulted for this review, the between-group differences in body weight were considered clinically relevant. Results of post hoc subgroup analyses on BMI from SUSTAIN-2 to SUSTAIN-4 are presented. In the subgroups of patients with T2DM and received SEM as the third-line therapy (add-on to MET + TZD or MET + SU), treatment with either dose of SEM for 30 weeks to 56 weeks was associated with greater reduction in BMI, compared with SIT, EXE, or IG (Table 32). The mean change from baseline in BMI ranged from ▬ for the SEM 0.5 mg group, and from ▬ for the SEM 1 mg group. Compared with SIT, the mean between-group differences were ▬ for the SEM 0.5 mg group and ▬ for the SEM 1 mg group. Compared with EXE, the mean between-group difference was ▬ for the SEM 1 mg group. Compared with IG, the mean between-group differences were ▬ for the SEM 0.5 mg group and ▬ for the SEM 1 mg group.","[question] Attached is a portion of an article that discusses the clinical trial results of patients who tried ozempic. Can you provide me with four sections, each titled the same as the paragraphs in the text. For each section, tell me what sustain group is being discussed, and provide a bullet-point list including: how much weight was lost for each SEM group, and what the BMI change was for each SEM group. Be sure to include information about the control groups as well. If the information is redacted, do not include it in the response. ===================== [text] SEM Used as First-Line Therapy SUSTAIN-1 reported change in body weight from baseline to week 30 in drug-naive patients with T2DM and had inadequate glycemic control after therapy with diet and exercise. At week 30, the mean change in body weight was -3.73 kg (SE 0.41), -4.53 kg (SE 0.41), and -0.98 kg (SE 0.43) for patients who received SEM 0.5 mg, SEM 1 mg, and placebo, respectively. The mean differences were statistically significant for both SEM groups compared with placebo (SEM 0.5 mg: -2.75 kg, 95% CI -3.92 to -1.58, P < 0.0001; SEM 1 mg: -3.56 kg, 95% CI -4.74 to -2.38) (Table 30). Because the upper limit of the two-sided 95% CI for the estimated differences was below 0 kg, superiority of SEM 0.5 mg or SEM 1 mg versus placebo in change in body weight was demonstrated. According to the clinical expert consulted for this review, the between-group differences were considered clinically important. SUSTAIN-1 also reported change in BMI from baseline to week 30 in drug-naive patients. At week 30, the mean change in BMI was -1.36 kg/m2 (SE 0.15), -1.61 kg/m2 (SE 0.14) and -0.38 kg/m2 (SE 0.15) for patients who received SEM 0.5 mg, SEM 1 mg, and placebo, respectively. The mean differences were statistically significant for both SEM groups compared with placebo (SEM 0.5 mg: -0.98 kg/m2, 95% CI -1.40 to -0.56, P < 0.0001; SEM 1 mg: -1.23 kg/m2, 95% CI -1.65 to -0.82) (Table 30). SEM Used as Second-Line Therapy (Add-On to MET) Results of post hoc subgroup analyses on body weight in SUSTAIN-2, SUSTAIN-3, and SUSTAIN-4 are presented. Patients in SUSTAIN-7 received treatment with SEM or DUL with background therapy of MET monotherapy. In patients with T2DM and received SEM as the second-line therapy (add-on to MET), treatment with either dose of SEM for 30 to 56 weeks was associated with greater reduction in body weight, compared with SIT, EXE, or IG (Table 31). The mean change from baseline in body weight ranged from ▬ for the SEM 0.5 mg group, and from ▬ for the SEM 1 mg group. Compared with SIT, the mean between-group differences were ▬ for the SEM 0.5 mg group and ▬ for the SEM 1 mg group. Compared with EXE, the mean between-group difference was ▬ for the SEM 1 mg group. Compared with IG, the mean between-group differences were ▬ for the SEM 0.5 mg group and ▬ for the SEM 1 mg group. Compared with DUL, the mean between-group differences were -2.26 kg (95% CI -3.02 to -1.51, P < 0.0001) for the SEM 0.5 mg group and -3.55 kg (95% CI -4.32 to -2.78, P < 0.0001) for the SEM 1 mg group. According to the clinical expert consulted for this review, the between-group differences in body weight were considered clinically relevant. In SUSTAIN-7, superiority in reducing body weight was concluded for each dose of SEM compared with the respective dose level of DUL. Results of post hoc subgroup analyses on BMI in SUSTAIN-2 to SUSTAIN-4 are presented. In the subgroups of patients with T2DM and received SEM as the second-line therapy (add-on to MET), treatment with either dose of SEM for 30 weeks to 56 weeks was associated with greater reduction in BMI, compared with SIT, EXE, or IG (Table 31). Patients in SUSTAIN-7 received treatment with SEM or DUL with background therapy of MET monotherapy. The mean change from baseline in BMI ranged from ▬ for the SEM 0.5 mg group, and from ▬ for the SEM 1 mg group. Compared with SIT, the mean between-group differences were ▬ for the SEM 0.5 mg group and ▬ for the SEM 1 mg group. Compared with EXE, the mean between-group difference was ▬ for the SEM 1 mg group. Compared with IG, the mean between-group differences were ▬ for the SEM 0.5 mg group and ▬ for the SEM 1 mg group. Compared with DUL, the mean between-group differences were -0.81 kg/m2 (95% CI -1.08 to -0.54) for the SEM 0.5 mg group and -1.25 kg/m2 (95% CI -1.52 to -0.98) for the SEM 1 mg group. SEM Used as Third-Line Therapy (Add-On to MET + TZD or MET + SU) Results of post hoc subgroup analyses on body weight in SUSTAIN-2 to SUSTAIN-4 are presented. In the patients receiving SEM as the third-line therapy (add-on to MET + TZD or MET + SU), treatment with either dose of SEM for 30 weeks to 56 weeks was associated with greater reduction in body weight, compared with SIT, EXE, or IG (Table 32). The mean change from baseline in A1C ranged from ▬ for the SEM 0.5 mg group, and from ▬ for the SEM 1 mg group. Compared with SIT, the mean between-group differences were ▬ for the SEM 0.5 mg group and ▬ for the SEM 1 mg group. Compared with EXE, the mean between-group difference was ▬ for the SEM 1 mg group. Compared with IG, the mean between-group differences were ▬ for the SEM 0.5 mg group and ▬ for the SEM 1 mg group. According to the clinical expert consulted for this review, the between-group differences in body weight were considered clinically relevant. Results of post hoc subgroup analyses on BMI from SUSTAIN-2 to SUSTAIN-4 are presented. In the subgroups of patients with T2DM and received SEM as the third-line therapy (add-on to MET + TZD or MET + SU), treatment with either dose of SEM for 30 weeks to 56 weeks was associated with greater reduction in BMI, compared with SIT, EXE, or IG (Table 32). The mean change from baseline in BMI ranged from ▬ for the SEM 0.5 mg group, and from ▬ for the SEM 1 mg group. Compared with SIT, the mean between-group differences were ▬ for the SEM 0.5 mg group and ▬ for the SEM 1 mg group. Compared with EXE, the mean between-group difference was ▬ for the SEM 1 mg group. Compared with IG, the mean between-group differences were ▬ for the SEM 0.5 mg group and ▬ for the SEM 1 mg group. https://www.ncbi.nlm.nih.gov/books/NBK544016/ ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.","[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
+
+EVIDENCE:
+SEM Used as First-Line Therapy SUSTAIN-1 reported change in body weight from baseline to week 30 in drug-naive patients with T2DM and had inadequate glycemic control after therapy with diet and exercise. At week 30, the mean change in body weight was -3.73 kg (SE 0.41), -4.53 kg (SE 0.41), and -0.98 kg (SE 0.43) for patients who received SEM 0.5 mg, SEM 1 mg, and placebo, respectively. The mean differences were statistically significant for both SEM groups compared with placebo (SEM 0.5 mg: -2.75 kg, 95% CI -3.92 to -1.58, P < 0.0001; SEM 1 mg: -3.56 kg, 95% CI -4.74 to -2.38) (Table 30). Because the upper limit of the two-sided 95% CI for the estimated differences was below 0 kg, superiority of SEM 0.5 mg or SEM 1 mg versus placebo in change in body weight was demonstrated. According to the clinical expert consulted for this review, the between-group differences were considered clinically important. SUSTAIN-1 also reported change in BMI from baseline to week 30 in drug-naive patients. At week 30, the mean change in BMI was -1.36 kg/m2 (SE 0.15), -1.61 kg/m2 (SE 0.14) and -0.38 kg/m2 (SE 0.15) for patients who received SEM 0.5 mg, SEM 1 mg, and placebo, respectively. The mean differences were statistically significant for both SEM groups compared with placebo (SEM 0.5 mg: -0.98 kg/m2, 95% CI -1.40 to -0.56, P < 0.0001; SEM 1 mg: -1.23 kg/m2, 95% CI -1.65 to -0.82) (Table 30). SEM Used as Second-Line Therapy (Add-On to MET) Results of post hoc subgroup analyses on body weight in SUSTAIN-2, SUSTAIN-3, and SUSTAIN-4 are presented. Patients in SUSTAIN-7 received treatment with SEM or DUL with background therapy of MET monotherapy. In patients with T2DM and received SEM as the second-line therapy (add-on to MET), treatment with either dose of SEM for 30 to 56 weeks was associated with greater reduction in body weight, compared with SIT, EXE, or IG (Table 31). The mean change from baseline in body weight ranged from ▬ for the SEM 0.5 mg group, and from ▬ for the SEM 1 mg group. Compared with SIT, the mean between-group differences were ▬ for the SEM 0.5 mg group and ▬ for the SEM 1 mg group. Compared with EXE, the mean between-group difference was ▬ for the SEM 1 mg group. Compared with IG, the mean between-group differences were ▬ for the SEM 0.5 mg group and ▬ for the SEM 1 mg group. Compared with DUL, the mean between-group differences were -2.26 kg (95% CI -3.02 to -1.51, P < 0.0001) for the SEM 0.5 mg group and -3.55 kg (95% CI -4.32 to -2.78, P < 0.0001) for the SEM 1 mg group. According to the clinical expert consulted for this review, the between-group differences in body weight were considered clinically relevant. In SUSTAIN-7, superiority in reducing body weight was concluded for each dose of SEM compared with the respective dose level of DUL. Results of post hoc subgroup analyses on BMI in SUSTAIN-2 to SUSTAIN-4 are presented. In the subgroups of patients with T2DM and received SEM as the second-line therapy (add-on to MET), treatment with either dose of SEM for 30 weeks to 56 weeks was associated with greater reduction in BMI, compared with SIT, EXE, or IG (Table 31). Patients in SUSTAIN-7 received treatment with SEM or DUL with background therapy of MET monotherapy. The mean change from baseline in BMI ranged from ▬ for the SEM 0.5 mg group, and from ▬ for the SEM 1 mg group. Compared with SIT, the mean between-group differences were ▬ for the SEM 0.5 mg group and ▬ for the SEM 1 mg group. Compared with EXE, the mean between-group difference was ▬ for the SEM 1 mg group. Compared with IG, the mean between-group differences were ▬ for the SEM 0.5 mg group and ▬ for the SEM 1 mg group. Compared with DUL, the mean between-group differences were -0.81 kg/m2 (95% CI -1.08 to -0.54) for the SEM 0.5 mg group and -1.25 kg/m2 (95% CI -1.52 to -0.98) for the SEM 1 mg group. SEM Used as Third-Line Therapy (Add-On to MET + TZD or MET + SU) Results of post hoc subgroup analyses on body weight in SUSTAIN-2 to SUSTAIN-4 are presented. In the patients receiving SEM as the third-line therapy (add-on to MET + TZD or MET + SU), treatment with either dose of SEM for 30 weeks to 56 weeks was associated with greater reduction in body weight, compared with SIT, EXE, or IG (Table 32). The mean change from baseline in A1C ranged from ▬ for the SEM 0.5 mg group, and from ▬ for the SEM 1 mg group. Compared with SIT, the mean between-group differences were ▬ for the SEM 0.5 mg group and ▬ for the SEM 1 mg group. Compared with EXE, the mean between-group difference was ▬ for the SEM 1 mg group. Compared with IG, the mean between-group differences were ▬ for the SEM 0.5 mg group and ▬ for the SEM 1 mg group. According to the clinical expert consulted for this review, the between-group differences in body weight were considered clinically relevant. Results of post hoc subgroup analyses on BMI from SUSTAIN-2 to SUSTAIN-4 are presented. In the subgroups of patients with T2DM and received SEM as the third-line therapy (add-on to MET + TZD or MET + SU), treatment with either dose of SEM for 30 weeks to 56 weeks was associated with greater reduction in BMI, compared with SIT, EXE, or IG (Table 32). The mean change from baseline in BMI ranged from ▬ for the SEM 0.5 mg group, and from ▬ for the SEM 1 mg group. Compared with SIT, the mean between-group differences were ▬ for the SEM 0.5 mg group and ▬ for the SEM 1 mg group. Compared with EXE, the mean between-group difference was ▬ for the SEM 1 mg group. Compared with IG, the mean between-group differences were ▬ for the SEM 0.5 mg group and ▬ for the SEM 1 mg group.
+
+USER:
+Attached is a portion of an article that discusses the clinical trial results of patients who tried ozempic. Can you provide me with four sections, each titled the same as the paragraphs in the text. For each section, tell me what sustain group is being discussed, and provide a bullet-point list including: how much weight was lost for each SEM group, and what the BMI change was for each SEM group. Be sure to include information about the control groups as well. If the information is redacted, do not include it in the response.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,28,94,1017,,156
+You are required to provide a response using only the information included in the context block. you are forbidden from using any external knowledge.,"What are the risks and benefits for using AI in healthcare, education, and national security?","Artificial Intelligence Technologies in Selected Sectors AI technologies have potential applications across a wide range of sectors. A selection of broad, crosscutting issues with application-specific examples of ongoing congressional interest are discussed in the CRS report Artificial Intelligence: Background, Selected Issues, and Policy Considerations. Those issues and examples include implications for the U.S. workforce, international competition and federal investment in AI R&D, standards development, and ethical AI—including questions about bias, fairness, and algorithm transparency (for example, in criminal justice applications). In addition to those issues and applications, three areas of potential use that may be of growing interest to Congress—particularly in light of the advances in, and widespread availability of, GenAI tools—are health care, education, and national security. In other parts of the federal government, experts have asserted a need to understand the impacts and future directions of AI applications in these areas. For example, the chief AI officer at the Department of Health and Human Services, Greg Singleton, at a June 2023 Health Innovation Summit discussed “the role that AI will play in health care, as well as the importance of regulations.” A May 2023 Department of Education report, Artificial Intelligence and the Future of Teaching and Learning, describes the rising interest in AI in education and highlights reasons to address AI in education now. And the 2023 Annual Threat Assessment of the U.S. Intelligence Community states, “New technologies—particularly in the fields of AI and biotechnology—are being developed and are proliferating faster than companies and governments can shape norms, protect privacy, and prevent dangerous outcomes.” This section will discuss some of the potential benefits and concerns with the use of AI technologies in these sectors. Health Care Numerous companies and researchers have been developing and testing AI technologies for use in health care—for example, to improve the drug development process by increasing efficiency and decreasing time and cost, to detect diseases earlier, and to more consistently analyze medical data. A 2022 report by the Government Accountability Office identified a variety of ML-based technologies to assist with the diagnostic processes for five selected diseases—certain cancers, diabetic retinopathy (an eye condition that can cause blindness in diabetic patients), Alzheimer’s disease, heart disease, and COVID-19—though these ML technologies have generally not been widely adopted. Some hospitals have also experimented with using voice recognition, and associated ML and natural language processing technology, to assist doctors and patients. While there are many encouraging developments for using AI technologies in health care, stakeholders have remarked on the slow progress in using AI broadly within health care settings, and various challenges remain. Researchers and clinicians have raised questions about the accuracy, security, and privacy of these technologies; the availability of sufficient health data on which to train systems; medical liability in the event of adverse outcomes; the adequacy of current user consent processes; and patient access and receptivity. These questions reflect the potential risks from using AI systems. For example, a poorly designed system might lead to misdiagnosis; systems trained on biased data can reflect or amplify those biases in their outputs; and if a flawed AI system is adopted widely, it might result in widespread injury to patients. Education According to the U.S. Department of Education, AI, ML, and related technologies “will have powerful impacts on learning, not only through direct supports for students, but also by empowering educators to be more adaptive to learner needs and less consumed by routine, repetitive tasks.” The report also notes that AI in education presents risks, including apprehension from parents and educators and the potential for AI algorithms to be biased, possibly leading to unfair decisions about what or how a student should learn. The rapid development of AI chatbots and the public release of ChatGPT in November 2022 have spurred debate among teachers and education administrators. Some teachers have begun using these AI tools in their classrooms, highlighting benefits such as making lessons more interactive, aiding the development of critical thinking skills, teaching students media literacy, generating personalized lesson plans, saving teachers time on administration, and aiding students whose first language is not English. Others have raised concerns about students using the systems to cheat on assignments by writing essays and taking tests for them, with some school systems banning the use of chatbots on their networks. Numerous researchers and companies have been developing and deploying detection tools to identify text generated by AI, though there remain issues with the accuracy of these tools. Stakeholders have also raised concerns about data privacy risks, including, for example, whether information shared or stored in AI-enabled systems is used for further product training without gaining explicit user consent and, more broadly, whether such systems are subject to federal or state privacy laws, such as the Family Educational Rights and Privacy Act. National Security AI technologies have a wide range of national security applications, including intelligence, surveillance, and reconnaissance; logistics; cyber operations; command and control; semiautonomous and autonomous vehicles; and weapons systems. Since at least 2017, the U.S. military has begun integrating AI systems into combat systems and discussing AI as a key technology to ensure future warfighting capabilities. At the same time, other countries, including China and Russia, have released national plans and statements of intent to lead in the development of AI technologies. The Department of Defense’s (DOD’s) unclassified investments in AI have grown from just over $600 million in FY2016 to approximately $1.1 billion in FY2023, with DOD maintaining over 685 active AI projects. DOD has an AI strategy, which outlines the following aims: delivering AI-enabled capabilities for key missions; partnering with leading private sector technology companies, academia, and global allies; cultivating a leading AI workforce; and leading in military ethics and AI safety. The intelligence community (IC) has also released a strategy for using AI—the AIM Initiative—as well as AI ethics principles and an AI ethics framework for the IC. While AI holds to potential to assist the IC in its work, AI systems also “pose grave security challenges for which [the United States is] currently unprepared, including the development of novel cyber weapons, large-scale disinformation attacks, and the design of advanced biological weapons.”","System Instructions: You are required to provide a response using only the information included in the context block. you are forbidden from using any external knowledge. Question: What are the risks and benefits for using AI in healthcare, education, and national security? Context Block: Artificial Intelligence Technologies in Selected Sectors AI technologies have potential applications across a wide range of sectors. A selection of broad, crosscutting issues with application-specific examples of ongoing congressional interest are discussed in the CRS report Artificial Intelligence: Background, Selected Issues, and Policy Considerations. Those issues and examples include implications for the U.S. workforce, international competition and federal investment in AI R&D, standards development, and ethical AI—including questions about bias, fairness, and algorithm transparency (for example, in criminal justice applications). In addition to those issues and applications, three areas of potential use that may be of growing interest to Congress—particularly in light of the advances in, and widespread availability of, GenAI tools—are health care, education, and national security. In other parts of the federal government, experts have asserted a need to understand the impacts and future directions of AI applications in these areas. For example, the chief AI officer at the Department of Health and Human Services, Greg Singleton, at a June 2023 Health Innovation Summit discussed “the role that AI will play in health care, as well as the importance of regulations.” A May 2023 Department of Education report, Artificial Intelligence and the Future of Teaching and Learning, describes the rising interest in AI in education and highlights reasons to address AI in education now. And the 2023 Annual Threat Assessment of the U.S. Intelligence Community states, “New technologies—particularly in the fields of AI and biotechnology—are being developed and are proliferating faster than companies and governments can shape norms, protect privacy, and prevent dangerous outcomes.” This section will discuss some of the potential benefits and concerns with the use of AI technologies in these sectors. Health Care Numerous companies and researchers have been developing and testing AI technologies for use in health care—for example, to improve the drug development process by increasing efficiency and decreasing time and cost, to detect diseases earlier, and to more consistently analyze medical data. A 2022 report by the Government Accountability Office identified a variety of ML-based technologies to assist with the diagnostic processes for five selected diseases—certain cancers, diabetic retinopathy (an eye condition that can cause blindness in diabetic patients), Alzheimer’s disease, heart disease, and COVID-19—though these ML technologies have generally not been widely adopted. Some hospitals have also experimented with using voice recognition, and associated ML and natural language processing technology, to assist doctors and patients. While there are many encouraging developments for using AI technologies in health care, stakeholders have remarked on the slow progress in using AI broadly within health care settings, and various challenges remain. Researchers and clinicians have raised questions about the accuracy, security, and privacy of these technologies; the availability of sufficient health data on which to train systems; medical liability in the event of adverse outcomes; the adequacy of current user consent processes; and patient access and receptivity. These questions reflect the potential risks from using AI systems. For example, a poorly designed system might lead to misdiagnosis; systems trained on biased data can reflect or amplify those biases in their outputs; and if a flawed AI system is adopted widely, it might result in widespread injury to patients. Education According to the U.S. Department of Education, AI, ML, and related technologies “will have powerful impacts on learning, not only through direct supports for students, but also by empowering educators to be more adaptive to learner needs and less consumed by routine, repetitive tasks.” The report also notes that AI in education presents risks, including apprehension from parents and educators and the potential for AI algorithms to be biased, possibly leading to unfair decisions about what or how a student should learn. The rapid development of AI chatbots and the public release of ChatGPT in November 2022 have spurred debate among teachers and education administrators. Some teachers have begun using these AI tools in their classrooms, highlighting benefits such as making lessons more interactive, aiding the development of critical thinking skills, teaching students media literacy, generating personalized lesson plans, saving teachers time on administration, and aiding students whose first language is not English. Others have raised concerns about students using the systems to cheat on assignments by writing essays and taking tests for them, with some school systems banning the use of chatbots on their networks. Numerous researchers and companies have been developing and deploying detection tools to identify text generated by AI, though there remain issues with the accuracy of these tools. Stakeholders have also raised concerns about data privacy risks, including, for example, whether information shared or stored in AI-enabled systems is used for further product training without gaining explicit user consent and, more broadly, whether such systems are subject to federal or state privacy laws, such as the Family Educational Rights and Privacy Act. National Security AI technologies have a wide range of national security applications, including intelligence, surveillance, and reconnaissance; logistics; cyber operations; command and control; semiautonomous and autonomous vehicles; and weapons systems. Since at least 2017, the U.S. military has begun integrating AI systems into combat systems and discussing AI as a key technology to ensure future warfighting capabilities. At the same time, other countries, including China and Russia, have released national plans and statements of intent to lead in the development of AI technologies. The Department of Defense’s (DOD’s) unclassified investments in AI have grown from just over $600 million in FY2016 to approximately $1.1 billion in FY2023, with DOD maintaining over 685 active AI projects. DOD has an AI strategy, which outlines the following aims: delivering AI-enabled capabilities for key missions; partnering with leading private sector technology companies, academia, and global allies; cultivating a leading AI workforce; and leading in military ethics and AI safety. The intelligence community (IC) has also released a strategy for using AI—the AIM Initiative—as well as AI ethics principles and an AI ethics framework for the IC. While AI holds to potential to assist the IC in its work, AI systems also “pose grave security challenges for which [the United States is] currently unprepared, including the development of novel cyber weapons, large-scale disinformation attacks, and the design of advanced biological weapons.”","You are required to provide a response using only the information included in the context block. you are forbidden from using any external knowledge.
+
+EVIDENCE:
+Artificial Intelligence Technologies in Selected Sectors AI technologies have potential applications across a wide range of sectors. A selection of broad, crosscutting issues with application-specific examples of ongoing congressional interest are discussed in the CRS report Artificial Intelligence: Background, Selected Issues, and Policy Considerations. Those issues and examples include implications for the U.S. workforce, international competition and federal investment in AI R&D, standards development, and ethical AI—including questions about bias, fairness, and algorithm transparency (for example, in criminal justice applications). In addition to those issues and applications, three areas of potential use that may be of growing interest to Congress—particularly in light of the advances in, and widespread availability of, GenAI tools—are health care, education, and national security. In other parts of the federal government, experts have asserted a need to understand the impacts and future directions of AI applications in these areas. For example, the chief AI officer at the Department of Health and Human Services, Greg Singleton, at a June 2023 Health Innovation Summit discussed “the role that AI will play in health care, as well as the importance of regulations.” A May 2023 Department of Education report, Artificial Intelligence and the Future of Teaching and Learning, describes the rising interest in AI in education and highlights reasons to address AI in education now. And the 2023 Annual Threat Assessment of the U.S. Intelligence Community states, “New technologies—particularly in the fields of AI and biotechnology—are being developed and are proliferating faster than companies and governments can shape norms, protect privacy, and prevent dangerous outcomes.” This section will discuss some of the potential benefits and concerns with the use of AI technologies in these sectors. Health Care Numerous companies and researchers have been developing and testing AI technologies for use in health care—for example, to improve the drug development process by increasing efficiency and decreasing time and cost, to detect diseases earlier, and to more consistently analyze medical data. A 2022 report by the Government Accountability Office identified a variety of ML-based technologies to assist with the diagnostic processes for five selected diseases—certain cancers, diabetic retinopathy (an eye condition that can cause blindness in diabetic patients), Alzheimer’s disease, heart disease, and COVID-19—though these ML technologies have generally not been widely adopted. Some hospitals have also experimented with using voice recognition, and associated ML and natural language processing technology, to assist doctors and patients. While there are many encouraging developments for using AI technologies in health care, stakeholders have remarked on the slow progress in using AI broadly within health care settings, and various challenges remain. Researchers and clinicians have raised questions about the accuracy, security, and privacy of these technologies; the availability of sufficient health data on which to train systems; medical liability in the event of adverse outcomes; the adequacy of current user consent processes; and patient access and receptivity. These questions reflect the potential risks from using AI systems. For example, a poorly designed system might lead to misdiagnosis; systems trained on biased data can reflect or amplify those biases in their outputs; and if a flawed AI system is adopted widely, it might result in widespread injury to patients. Education According to the U.S. Department of Education, AI, ML, and related technologies “will have powerful impacts on learning, not only through direct supports for students, but also by empowering educators to be more adaptive to learner needs and less consumed by routine, repetitive tasks.” The report also notes that AI in education presents risks, including apprehension from parents and educators and the potential for AI algorithms to be biased, possibly leading to unfair decisions about what or how a student should learn. The rapid development of AI chatbots and the public release of ChatGPT in November 2022 have spurred debate among teachers and education administrators. Some teachers have begun using these AI tools in their classrooms, highlighting benefits such as making lessons more interactive, aiding the development of critical thinking skills, teaching students media literacy, generating personalized lesson plans, saving teachers time on administration, and aiding students whose first language is not English. Others have raised concerns about students using the systems to cheat on assignments by writing essays and taking tests for them, with some school systems banning the use of chatbots on their networks. Numerous researchers and companies have been developing and deploying detection tools to identify text generated by AI, though there remain issues with the accuracy of these tools. Stakeholders have also raised concerns about data privacy risks, including, for example, whether information shared or stored in AI-enabled systems is used for further product training without gaining explicit user consent and, more broadly, whether such systems are subject to federal or state privacy laws, such as the Family Educational Rights and Privacy Act. National Security AI technologies have a wide range of national security applications, including intelligence, surveillance, and reconnaissance; logistics; cyber operations; command and control; semiautonomous and autonomous vehicles; and weapons systems. Since at least 2017, the U.S. military has begun integrating AI systems into combat systems and discussing AI as a key technology to ensure future warfighting capabilities. At the same time, other countries, including China and Russia, have released national plans and statements of intent to lead in the development of AI technologies. The Department of Defense’s (DOD’s) unclassified investments in AI have grown from just over $600 million in FY2016 to approximately $1.1 billion in FY2023, with DOD maintaining over 685 active AI projects. DOD has an AI strategy, which outlines the following aims: delivering AI-enabled capabilities for key missions; partnering with leading private sector technology companies, academia, and global allies; cultivating a leading AI workforce; and leading in military ethics and AI safety. The intelligence community (IC) has also released a strategy for using AI—the AIM Initiative—as well as AI ethics principles and an AI ethics framework for the IC. While AI holds to potential to assist the IC in its work, AI systems also “pose grave security challenges for which [the United States is] currently unprepared, including the development of novel cyber weapons, large-scale disinformation attacks, and the design of advanced biological weapons.”
+
+USER:
+What are the risks and benefits for using AI in healthcare, education, and national security?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,24,15,1017,,834
+"""================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""","My grandmother is buried in Occala, but she bought a burial plot in Orlando's city cemetery's Block B12. I am her sole heir, and I want to be buried in Orlando. Will I be entitled to it? I also want my daughter to be buried with me. Will it be possible? My daughter says that she will only accept it if her father is buried there as well. Is this feasible? If I change my mind, can I sell the plot to my friend? I have a vague memory that grandpa's ashes are interred there. Does it change the picture?","Sec. 16.02. - Greenwood Cemetery Declared Public Cemetery of City; Description; Map; Use. The tract of land, being the southwest quarter of the northwest quarter of Section 31, Township 22 South, Range 30 East, according to a plat recorded at the office of the Clerk of the Circuit Court of the County in Deed Book 87, page 227, is declared to be the public cemetery of the City, to be known as Greenwood Cemetery. An official map of the Greenwood Cemetery shall at all times be on file at the office of the supervisor of Greenwood Cemetery. The cemetery is set apart only for the burial, entombment or inurnment of human remains and shall only be used as such in perpetuity. (Ord. of 6-27-1977, § 1; Ord. of 3-30-1981, § 1) Sec. 16.03. - Greenwood Cemetery Not Perpetual Care Cemetery. Greenwood Cemetery is not one of perpetual care and the City shall be under no obligation to maintain any set standard for its care and upkeep. The City shall endeavor to provide general maintenance and care to the cemetery in keeping with the reminder that it is sacredly devoted to the interment, entombment or inurnment of the dead. (Ord. of 6-27-1977, § 1) Sec. 16.04. - Burials in City Restricted to Greenwood Cemetery and Washington Park Cemetery. No human body shall be buried within the City limits of the City of Orlando, except in Greenwood Cemetery or in Washington Park Cemetery if a privately owned cemetery, or in such other cemetery facilities and/or property as the City Council may from time to time designate, acquire or control. ... Sec. 16.10. - Spaces; Sale to Permanent Residents; Exceptions. The City shall only sell spaces in Greenwood Cemetery for prices fixed by the City Council to residents of the City of Orlando who have resided within the corporate limits of the City for a period of more than one year prior to the date of sale, and to persons who are not permanent residents of the City provided that such sales shall be only for the immediate burial of a permanent resident of the City who met the residency requirements hereunder at the time of the resident's death. The Sexton of the Greenwood Cemetery shall require satisfactory evidence of such prior residence within the City. In addition, the City may sell spaces in Blocks 12, 16, 17, 18, 19 and 20 of Greenwood Cemetery to non-City, as well as City residents. Provided, however, that a person who has not met the residency requirements set forth herein may be permitted to purchase spaces in Greenwood Cemetery at the price established by City Council for qualified non-residents if such person is related by blood or marriage to a deceased person buried in said cemetery, unless such deceased person is interred in a section of the cemetery reserved for members of the American Legion, Spanish-American War Veterans, Grand Army of the Republic, Independent Order of Odd Fellows, or United Confederate Veterans, and such deceased person, at the time of his or her death, did not meet City residency requirements. ... Sec. 16.13. - Sales to Non-Family Members; City's Right of First Refusal. A space owner may sell or transfer his or her space only to a relative by blood or marriage, provided however, a space owner may sell or transfer his or her space to a person not related by blood or marriage if the owner receives approval of said sale from City Council. In the event a space owner wishes to sell or transfer his or her space to a person other than a relative by blood or marriage in a sale or transfer not approved by City Council, the owner shall first offer in writing the space for sale to the City of Orlando. The City may repurchase the space for the original purchase price or one-half of the current sales price, whichever is greater, less a recording fee if the deed from the City to the owner is not recorded. If the City wishes to purchase the space, the City shall notify the owner thereof within five (5) days of receipt of notice, and the sale shall be closed within five (5) days after receipt by the City of evidence of title to the space satisfactory to the Office of Legal Affairs. ... Sec. 16.14. - Declaration; Rights If No Declaration. The owner of a space may present his or her deed to the Cemetery Supervisor designating in writing persons entitled to be buried in the space or spaces owned. This designation may be amended at any time by the owner(s) in the same manner as the original designation. Only relatives by blood or marriage may be designated under this section; provided however, persons other than relatives by blood or marriage may be designated if the owner receives approval of said designation from City Council. In the event the owner fails to designate burial rights for the space or spaces owned, and in the event the property is not transferred or conveyed as provided herein, the right of interment in the space or spaces shall be in the following order: (1)One space, niche or crypt shall be forever reserved for the owner and one for the owner's surviving spouse, if any.(2)The remaining spaces shall pass to the heirs or devisees of the owner in the same manner as real property passes under Florida Law: provided, however, that no person shall be interred in a space passing under this section unless such person would have been eligible under the provisions of this Chapter to be designated for burial in such space at the date of such person's death or the interment of said person is approved by City Council. Sec. 16.15. - Rights Upon Interment. Whenever an interment of the remains of any person is made in a space, the space thereby becomes inalienable and shall be held as the space of the interred person except in the case of cremated remains as set forth in Section 16.17. ... Sec. 16.17. - Interments in General. All earth interments shall be in a liner or vault of concrete or steel of a type approved by the cemetery Supervisor. No more than the remains of one body shall be interred in any one space, vault or crypt, except in the case of a mother and stillborn child(ren). However, if written permission is given by the owner of a space or, if the owner is deceased, by the owner's heirs, permitting more than the remains of one person to occupy a space, vault or crypt, an exception will be made to permit no more than one regular interment and one cremain or two cremains in any one space, vault or crypt. Installation of cremorial headstones may be permitted under the same number, size and material restrictions as set forth in Section 16.26; provided, however, that in cases where the use of a cremorial headstone causes the total number of allowable interments or inurnments in any one space to be exceeded, each additional inurnment shall be charged a fee as set forth by City Council for right of additional interment. ... Sec. 16.29. - Children; Pets. No child under fifteen (15) years of age shall be permitted in the cemetery unless accompanied by an adult. Pets shall be prohibited in the cemetery. ... Sec. 16.35. - Double Interment Permitted. Notwithstanding the provisions of Section 16.17 hereof, no more than the remains of two (2) bodies shall be interred in any one space in Block 12 of Greenwood Cemetery, provided that a mother and a stillborn child shall be considered one body. All interments in Block 12 shall be in a vault installed by the City of Orlando.","""================ <TEXT PASSAGE> ======= Sec. 16.02. - Greenwood Cemetery Declared Public Cemetery of City; Description; Map; Use. The tract of land, being the southwest quarter of the northwest quarter of Section 31, Township 22 South, Range 30 East, according to a plat recorded at the office of the Clerk of the Circuit Court of the County in Deed Book 87, page 227, is declared to be the public cemetery of the City, to be known as Greenwood Cemetery. An official map of the Greenwood Cemetery shall at all times be on file at the office of the supervisor of Greenwood Cemetery. The cemetery is set apart only for the burial, entombment or inurnment of human remains and shall only be used as such in perpetuity. (Ord. of 6-27-1977, § 1; Ord. of 3-30-1981, § 1) Sec. 16.03. - Greenwood Cemetery Not Perpetual Care Cemetery. Greenwood Cemetery is not one of perpetual care and the City shall be under no obligation to maintain any set standard for its care and upkeep. The City shall endeavor to provide general maintenance and care to the cemetery in keeping with the reminder that it is sacredly devoted to the interment, entombment or inurnment of the dead. (Ord. of 6-27-1977, § 1) Sec. 16.04. - Burials in City Restricted to Greenwood Cemetery and Washington Park Cemetery. No human body shall be buried within the City limits of the City of Orlando, except in Greenwood Cemetery or in Washington Park Cemetery if a privately owned cemetery, or in such other cemetery facilities and/or property as the City Council may from time to time designate, acquire or control. ... Sec. 16.10. - Spaces; Sale to Permanent Residents; Exceptions. The City shall only sell spaces in Greenwood Cemetery for prices fixed by the City Council to residents of the City of Orlando who have resided within the corporate limits of the City for a period of more than one year prior to the date of sale, and to persons who are not permanent residents of the City provided that such sales shall be only for the immediate burial of a permanent resident of the City who met the residency requirements hereunder at the time of the resident's death. The Sexton of the Greenwood Cemetery shall require satisfactory evidence of such prior residence within the City. In addition, the City may sell spaces in Blocks 12, 16, 17, 18, 19 and 20 of Greenwood Cemetery to non-City, as well as City residents. Provided, however, that a person who has not met the residency requirements set forth herein may be permitted to purchase spaces in Greenwood Cemetery at the price established by City Council for qualified non-residents if such person is related by blood or marriage to a deceased person buried in said cemetery, unless such deceased person is interred in a section of the cemetery reserved for members of the American Legion, Spanish-American War Veterans, Grand Army of the Republic, Independent Order of Odd Fellows, or United Confederate Veterans, and such deceased person, at the time of his or her death, did not meet City residency requirements. ... Sec. 16.13. - Sales to Non-Family Members; City's Right of First Refusal. A space owner may sell or transfer his or her space only to a relative by blood or marriage, provided however, a space owner may sell or transfer his or her space to a person not related by blood or marriage if the owner receives approval of said sale from City Council. In the event a space owner wishes to sell or transfer his or her space to a person other than a relative by blood or marriage in a sale or transfer not approved by City Council, the owner shall first offer in writing the space for sale to the City of Orlando. The City may repurchase the space for the original purchase price or one-half of the current sales price, whichever is greater, less a recording fee if the deed from the City to the owner is not recorded. If the City wishes to purchase the space, the City shall notify the owner thereof within five (5) days of receipt of notice, and the sale shall be closed within five (5) days after receipt by the City of evidence of title to the space satisfactory to the Office of Legal Affairs. ... Sec. 16.14. - Declaration; Rights If No Declaration. The owner of a space may present his or her deed to the Cemetery Supervisor designating in writing persons entitled to be buried in the space or spaces owned. This designation may be amended at any time by the owner(s) in the same manner as the original designation. Only relatives by blood or marriage may be designated under this section; provided however, persons other than relatives by blood or marriage may be designated if the owner receives approval of said designation from City Council. In the event the owner fails to designate burial rights for the space or spaces owned, and in the event the property is not transferred or conveyed as provided herein, the right of interment in the space or spaces shall be in the following order: (1)One space, niche or crypt shall be forever reserved for the owner and one for the owner's surviving spouse, if any.(2)The remaining spaces shall pass to the heirs or devisees of the owner in the same manner as real property passes under Florida Law: provided, however, that no person shall be interred in a space passing under this section unless such person would have been eligible under the provisions of this Chapter to be designated for burial in such space at the date of such person's death or the interment of said person is approved by City Council. Sec. 16.15. - Rights Upon Interment. Whenever an interment of the remains of any person is made in a space, the space thereby becomes inalienable and shall be held as the space of the interred person except in the case of cremated remains as set forth in Section 16.17. ... Sec. 16.17. - Interments in General. All earth interments shall be in a liner or vault of concrete or steel of a type approved by the cemetery Supervisor. No more than the remains of one body shall be interred in any one space, vault or crypt, except in the case of a mother and stillborn child(ren). However, if written permission is given by the owner of a space or, if the owner is deceased, by the owner's heirs, permitting more than the remains of one person to occupy a space, vault or crypt, an exception will be made to permit no more than one regular interment and one cremain or two cremains in any one space, vault or crypt. Installation of cremorial headstones may be permitted under the same number, size and material restrictions as set forth in Section 16.26; provided, however, that in cases where the use of a cremorial headstone causes the total number of allowable interments or inurnments in any one space to be exceeded, each additional inurnment shall be charged a fee as set forth by City Council for right of additional interment. ... Sec. 16.29. - Children; Pets. No child under fifteen (15) years of age shall be permitted in the cemetery unless accompanied by an adult. Pets shall be prohibited in the cemetery. ... Sec. 16.35. - Double Interment Permitted. Notwithstanding the provisions of Section 16.17 hereof, no more than the remains of two (2) bodies shall be interred in any one space in Block 12 of Greenwood Cemetery, provided that a mother and a stillborn child shall be considered one body. All interments in Block 12 shall be in a vault installed by the City of Orlando. https://library.municode.com/fl/orlando/codes/code_of_ordinances?nodeId=TITIICICO_CH16CEBU_ARTIGEPR_S16.04BUREGRCEWAPACE ================ <QUESTION> ======= My grandmother is buried in Occala, but she bought a burial plot in Orlando's city cemetery's Block B12. I am her sole heir, and I want to be buried in Orlando. Will I be entitled to it? I also want my daughter to be buried with me. Will it be possible? My daughter says that she will only accept it if her father is buried there as well. Is this feasible? If I change my mind, can I sell the plot to my friend? I have a vague memory that grandpa's ashes are interred there. Does it change the picture? ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""","""================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""
+
+EVIDENCE:
+Sec. 16.02. - Greenwood Cemetery Declared Public Cemetery of City; Description; Map; Use. The tract of land, being the southwest quarter of the northwest quarter of Section 31, Township 22 South, Range 30 East, according to a plat recorded at the office of the Clerk of the Circuit Court of the County in Deed Book 87, page 227, is declared to be the public cemetery of the City, to be known as Greenwood Cemetery. An official map of the Greenwood Cemetery shall at all times be on file at the office of the supervisor of Greenwood Cemetery. The cemetery is set apart only for the burial, entombment or inurnment of human remains and shall only be used as such in perpetuity. (Ord. of 6-27-1977, § 1; Ord. of 3-30-1981, § 1) Sec. 16.03. - Greenwood Cemetery Not Perpetual Care Cemetery. Greenwood Cemetery is not one of perpetual care and the City shall be under no obligation to maintain any set standard for its care and upkeep. The City shall endeavor to provide general maintenance and care to the cemetery in keeping with the reminder that it is sacredly devoted to the interment, entombment or inurnment of the dead. (Ord. of 6-27-1977, § 1) Sec. 16.04. - Burials in City Restricted to Greenwood Cemetery and Washington Park Cemetery. No human body shall be buried within the City limits of the City of Orlando, except in Greenwood Cemetery or in Washington Park Cemetery if a privately owned cemetery, or in such other cemetery facilities and/or property as the City Council may from time to time designate, acquire or control. ... Sec. 16.10. - Spaces; Sale to Permanent Residents; Exceptions. The City shall only sell spaces in Greenwood Cemetery for prices fixed by the City Council to residents of the City of Orlando who have resided within the corporate limits of the City for a period of more than one year prior to the date of sale, and to persons who are not permanent residents of the City provided that such sales shall be only for the immediate burial of a permanent resident of the City who met the residency requirements hereunder at the time of the resident's death. The Sexton of the Greenwood Cemetery shall require satisfactory evidence of such prior residence within the City. In addition, the City may sell spaces in Blocks 12, 16, 17, 18, 19 and 20 of Greenwood Cemetery to non-City, as well as City residents. Provided, however, that a person who has not met the residency requirements set forth herein may be permitted to purchase spaces in Greenwood Cemetery at the price established by City Council for qualified non-residents if such person is related by blood or marriage to a deceased person buried in said cemetery, unless such deceased person is interred in a section of the cemetery reserved for members of the American Legion, Spanish-American War Veterans, Grand Army of the Republic, Independent Order of Odd Fellows, or United Confederate Veterans, and such deceased person, at the time of his or her death, did not meet City residency requirements. ... Sec. 16.13. - Sales to Non-Family Members; City's Right of First Refusal. A space owner may sell or transfer his or her space only to a relative by blood or marriage, provided however, a space owner may sell or transfer his or her space to a person not related by blood or marriage if the owner receives approval of said sale from City Council. In the event a space owner wishes to sell or transfer his or her space to a person other than a relative by blood or marriage in a sale or transfer not approved by City Council, the owner shall first offer in writing the space for sale to the City of Orlando. The City may repurchase the space for the original purchase price or one-half of the current sales price, whichever is greater, less a recording fee if the deed from the City to the owner is not recorded. If the City wishes to purchase the space, the City shall notify the owner thereof within five (5) days of receipt of notice, and the sale shall be closed within five (5) days after receipt by the City of evidence of title to the space satisfactory to the Office of Legal Affairs. ... Sec. 16.14. - Declaration; Rights If No Declaration. The owner of a space may present his or her deed to the Cemetery Supervisor designating in writing persons entitled to be buried in the space or spaces owned. This designation may be amended at any time by the owner(s) in the same manner as the original designation. Only relatives by blood or marriage may be designated under this section; provided however, persons other than relatives by blood or marriage may be designated if the owner receives approval of said designation from City Council. In the event the owner fails to designate burial rights for the space or spaces owned, and in the event the property is not transferred or conveyed as provided herein, the right of interment in the space or spaces shall be in the following order: (1)One space, niche or crypt shall be forever reserved for the owner and one for the owner's surviving spouse, if any.(2)The remaining spaces shall pass to the heirs or devisees of the owner in the same manner as real property passes under Florida Law: provided, however, that no person shall be interred in a space passing under this section unless such person would have been eligible under the provisions of this Chapter to be designated for burial in such space at the date of such person's death or the interment of said person is approved by City Council. Sec. 16.15. - Rights Upon Interment. Whenever an interment of the remains of any person is made in a space, the space thereby becomes inalienable and shall be held as the space of the interred person except in the case of cremated remains as set forth in Section 16.17. ... Sec. 16.17. - Interments in General. All earth interments shall be in a liner or vault of concrete or steel of a type approved by the cemetery Supervisor. No more than the remains of one body shall be interred in any one space, vault or crypt, except in the case of a mother and stillborn child(ren). However, if written permission is given by the owner of a space or, if the owner is deceased, by the owner's heirs, permitting more than the remains of one person to occupy a space, vault or crypt, an exception will be made to permit no more than one regular interment and one cremain or two cremains in any one space, vault or crypt. Installation of cremorial headstones may be permitted under the same number, size and material restrictions as set forth in Section 16.26; provided, however, that in cases where the use of a cremorial headstone causes the total number of allowable interments or inurnments in any one space to be exceeded, each additional inurnment shall be charged a fee as set forth by City Council for right of additional interment. ... Sec. 16.29. - Children; Pets. No child under fifteen (15) years of age shall be permitted in the cemetery unless accompanied by an adult. Pets shall be prohibited in the cemetery. ... Sec. 16.35. - Double Interment Permitted. Notwithstanding the provisions of Section 16.17 hereof, no more than the remains of two (2) bodies shall be interred in any one space in Block 12 of Greenwood Cemetery, provided that a mother and a stillborn child shall be considered one body. All interments in Block 12 shall be in a vault installed by the City of Orlando.
+
+USER:
+My grandmother is buried in Occala, but she bought a burial plot in Orlando's city cemetery's Block B12. I am her sole heir, and I want to be buried in Orlando. Will I be entitled to it? I also want my daughter to be buried with me. Will it be possible? My daughter says that she will only accept it if her father is buried there as well. Is this feasible? If I change my mind, can I sell the plot to my friend? I have a vague memory that grandpa's ashes are interred there. Does it change the picture?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,49,100,1290,,404
+You can only answer using the information I am giving you. Make it sound like a dictionary definition. Make sure you are only use your own words and do copy any words or phrases from the context.,"If I don't mention sunscreen in the label for my UV lip balm, then can it even be a cosmeceutical?","Context: The FFDCA defines a “drug” in part as “articles intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease”; articles “(other than food) intended to affect the structure or any function of the body”; and “articles intended for use as a component” of such drugs.15 Drug manufacturers must comply with Current Good Manufacturing Practices (CGMP) rules for drugs. 16 Failure to comply will cause a drug to be considered adulterated.17 Drug manufacturers are required to register their facilities, 18 list their drug products with the agency, 19 and report adverse events to FDA, among other requirements. 20 Unlike cosmetics and their ingredients (with the exception of color additives), drugs are subject to FDA approval before entering interstate commerce. Drugs must either (1) receive the agency’s premarket approval under a new drug application (NDA), or an abbreviated NDA (ANDA),21 in the case of a generic drug, or (2) conform to a set of FDA requirements known as a monograph.22 Monographs govern the manufacture and marketing of most over-the-counter (OTC) drugs and specify the conditions under which OTC drugs in a particular category (such as antidandruff shampoos or antiperspirants) will be considered generally recognized as safe and effective (GRASE). 23 Monographs also indicate how OTC drugs must be labeled so they are not deemed misbranded.24 Although the term “cosmeceutical” has been used to refer to combination cosmetic/drug products, such products have no statutory or regulatory definition.25 Historically, FDA has indicated that cosmetic/drug combinations are subject to FDA’s regulations for both cosmetics and drugs.26 Determining whether a cosmetic is also a drug, and therefore subject to the additional statutory requirements that apply to drugs, depends on the distributor’s claims regarding the drug’s intent or intended use.27 A product’s intended use may be established in several ways, such as claims on the label or in advertising or promotional materials, customer perception of the product, and the inclusion of ingredients that cause the product to be considered a drug because of a known therapeutic use.28 For example, if a lipstick (a cosmetic) contains sunscreen (a drug), historically, the mere inclusion of the term “sunscreen” in the product’s labeling required the product to be regulated as a drug as well as a cosmetic. 29 The text box below provides examples of other cosmetic/drug combinations and compares cosmetic and drug classifications.30 Prior to the enactment of the Federal Food, Drug, and Cosmetic Act (FFDCA) in 1938, cosmetics were not regulated by the federal government. 31 Instead, they were regulated under a collection of state laws that had been enacted to regulate food and drugs.32 At that time, multiple “cosmetics and drugs were made from the same natural materials” and often the “laws did not include explicit definitions of the products regulated.”33 Following several incidents in which cosmetics were allegedly the cause of serious health problems, as well as industry concerns about states enacting their own laws, provisions were included in the FFDCA that prohibited the sale of adulterated or misbranded cosmetics in interstate commerce.34 The FFDCA also established uniform regulation of FDA-regulated cosmetic products nationwide. 35 However, state laws regarding cosmetics regulation have continued to evolve since FFDCA’s passage, with some states implementing stricter measures than others.","Context: The FFDCA defines a “drug” in part as “articles intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease”; articles “(other than food) intended to affect the structure or any function of the body”; and “articles intended for use as a component” of such drugs.15 Drug manufacturers must comply with Current Good Manufacturing Practices (CGMP) rules for drugs. 16 Failure to comply will cause a drug to be considered adulterated.17 Drug manufacturers are required to register their facilities, 18 list their drug products with the agency, 19 and report adverse events to FDA, among other requirements. 20 Unlike cosmetics and their ingredients (with the exception of color additives), drugs are subject to FDA approval before entering interstate commerce. Drugs must either (1) receive the agency’s premarket approval under a new drug application (NDA), or an abbreviated NDA (ANDA),21 in the case of a generic drug, or (2) conform to a set of FDA requirements known as a monograph.22 Monographs govern the manufacture and marketing of most over-the-counter (OTC) drugs and specify the conditions under which OTC drugs in a particular category (such as antidandruff shampoos or antiperspirants) will be considered generally recognized as safe and effective (GRASE). 23 Monographs also indicate how OTC drugs must be labeled so they are not deemed misbranded.24 Although the term “cosmeceutical” has been used to refer to combination cosmetic/drug products, such products have no statutory or regulatory definition.25 Historically, FDA has indicated that cosmetic/drug combinations are subject to FDA’s regulations for both cosmetics and drugs.26 Determining whether a cosmetic is also a drug, and therefore subject to the additional statutory requirements that apply to drugs, depends on the distributor’s claims regarding the drug’s intent or intended use.27 A product’s intended use may be established in several ways, such as claims on the label or in advertising or promotional materials, customer perception of the product, and the inclusion of ingredients that cause the product to be considered a drug because of a known therapeutic use.28 For example, if a lipstick (a cosmetic) contains sunscreen (a drug), historically, the mere inclusion of the term “sunscreen” in the product’s labeling required the product to be regulated as a drug as well as a cosmetic. 29 The text box below provides examples of other cosmetic/drug combinations and compares cosmetic and drug classifications.30 Prior to the enactment of the Federal Food, Drug, and Cosmetic Act (FFDCA) in 1938, cosmetics were not regulated by the federal government. 31 Instead, they were regulated under a collection of state laws that had been enacted to regulate food and drugs.32 At that time, multiple “cosmetics and drugs were made from the same natural materials” and often the “laws did not include explicit definitions of the products regulated.”33 Following several incidents in which cosmetics were allegedly the cause of serious health problems, as well as industry concerns about states enacting their own laws, provisions were included in the FFDCA that prohibited the sale of adulterated or misbranded cosmetics in interstate commerce.34 The FFDCA also established uniform regulation of FDA-regulated cosmetic products nationwide. 35 However, state laws regarding cosmetics regulation have continued to evolve since FFDCA’s passage, with some states implementing stricter measures than others. System instruction: You can only answer using the information I am giving you Make it sound like a dictionary definition. Make sure you are only use your own words and do copy any words or phrases from the context. what I want to know: If I don't mention sunscreen in the label for my UV lip balm, then can it even be a cosmeceutical?","You can only answer using the information I am giving you. Make it sound like a dictionary definition. Make sure you are only use your own words and do copy any words or phrases from the context.
+
+EVIDENCE:
+Context: The FFDCA defines a “drug” in part as “articles intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease”; articles “(other than food) intended to affect the structure or any function of the body”; and “articles intended for use as a component” of such drugs.15 Drug manufacturers must comply with Current Good Manufacturing Practices (CGMP) rules for drugs. 16 Failure to comply will cause a drug to be considered adulterated.17 Drug manufacturers are required to register their facilities, 18 list their drug products with the agency, 19 and report adverse events to FDA, among other requirements. 20 Unlike cosmetics and their ingredients (with the exception of color additives), drugs are subject to FDA approval before entering interstate commerce. Drugs must either (1) receive the agency’s premarket approval under a new drug application (NDA), or an abbreviated NDA (ANDA),21 in the case of a generic drug, or (2) conform to a set of FDA requirements known as a monograph.22 Monographs govern the manufacture and marketing of most over-the-counter (OTC) drugs and specify the conditions under which OTC drugs in a particular category (such as antidandruff shampoos or antiperspirants) will be considered generally recognized as safe and effective (GRASE). 23 Monographs also indicate how OTC drugs must be labeled so they are not deemed misbranded.24 Although the term “cosmeceutical” has been used to refer to combination cosmetic/drug products, such products have no statutory or regulatory definition.25 Historically, FDA has indicated that cosmetic/drug combinations are subject to FDA’s regulations for both cosmetics and drugs.26 Determining whether a cosmetic is also a drug, and therefore subject to the additional statutory requirements that apply to drugs, depends on the distributor’s claims regarding the drug’s intent or intended use.27 A product’s intended use may be established in several ways, such as claims on the label or in advertising or promotional materials, customer perception of the product, and the inclusion of ingredients that cause the product to be considered a drug because of a known therapeutic use.28 For example, if a lipstick (a cosmetic) contains sunscreen (a drug), historically, the mere inclusion of the term “sunscreen” in the product’s labeling required the product to be regulated as a drug as well as a cosmetic. 29 The text box below provides examples of other cosmetic/drug combinations and compares cosmetic and drug classifications.30 Prior to the enactment of the Federal Food, Drug, and Cosmetic Act (FFDCA) in 1938, cosmetics were not regulated by the federal government. 31 Instead, they were regulated under a collection of state laws that had been enacted to regulate food and drugs.32 At that time, multiple “cosmetics and drugs were made from the same natural materials” and often the “laws did not include explicit definitions of the products regulated.”33 Following several incidents in which cosmetics were allegedly the cause of serious health problems, as well as industry concerns about states enacting their own laws, provisions were included in the FFDCA that prohibited the sale of adulterated or misbranded cosmetics in interstate commerce.34 The FFDCA also established uniform regulation of FDA-regulated cosmetic products nationwide. 35 However, state laws regarding cosmetics regulation have continued to evolve since FFDCA’s passage, with some states implementing stricter measures than others.
+
+USER:
+If I don't mention sunscreen in the label for my UV lip balm, then can it even be a cosmeceutical?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,37,20,534,,276
+"<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> [user request] <TEXT> [context document]",Can you tell me about some of the health benefits of eating leafy greens listed in the articles and what are some popular leafy greens to incorporate into my diet/ways to use them. is is better to eat them cooked or raw. make the reply less than 250 words,"While we all know that organic, non-GMO fruits and vegetables of any kind are good for us, some are far better than others. Fortunately, many crowd favorites such as spinach, kale, and collard greens are packed with vitamins, minerals, fiber, and even protein. Not to mention, dark leafy greens are very versatile and can be incorporated into your diet in fun, delicious ways. If you still need convincing, I’m about to tell you about all the amazing benefits of leafy greens. Unless you’ve been taking notes, you might have missed all the leafy greens I’ve mentioned so far. Don’t worry! I’ve put together this convenient list of the healthiest leafy green vegetables for you to reference: Kale Spinach Collard greens Broccoli Broccoli sprouts Cabbage Beet greens Watercress Arugula Mustard greens Swiss chard Bok choy Romaine lettuce Raw Vegetables vs. Cooked Vegetables: Which is Better? I get asked all the time if it’s better to eat raw or cooked vegetables. The answer may surprise you! While eating raw vegetables provides your body with optimal levels of folate and water-soluble vitamins, the nutrients in cooked vegetables are actually easier to digest and absorb. However, I’m going to let you in on the most delicious and easiest way to enough leafy greens in your diet – Organic Greens! The Best Way to Get More Leafy Greens While it’s ideal to get these incredible benefits from real, whole foods, not all of these foods are always available, in season, or grown in optimal soil. It can be difficult to get the benefits of leafy greens from diet alone. That’s why Organic Greens is a great option to have when you’re just too busy to prepare a big salad or smoothie, or when you’re looking to stay healthy while on the go. One scoop of Organic Greens is a nutritional powerhouse, containing 14 USDA-certified organic plant foods, including green superstars spinach, kale, alfalfa, moringa, and broccoli sprouts. It’s perfect for anyone who: Is looking to save a lot of time versus juicing their produce every morning Needs a tasty, inexpensive alternative to pricey juice bar offerings Travels often and wants a doctor-designed source of organic nutrition while eating out Wants to mitigate stress and balanced hormone health Organic Greens is an easy and convenient way to ensure you’re getting all the amazing benefits of leafy greens! I drink a glass every day! Adding more leafy greens into your diet is a great way to support optimal health, reduce bloating, facilitate a healthy stress response, support bone health, healthy aging, and gut health, and help reduce oxidative damage from free radicals. Leafy greens are the nutritional powerhouse! Benefits of Leafy Greens FAQs What are the benefits of dark leafy greens? Adding more green leafy vegetables into your diet can support optimal brain health, fight belly bloat, relieve stress, support bone health, healthy aging, boost digestive enzymes, and tame the toxins, among many other health benefits. What are the best leafy green vegetables? The best leafy vegetables include spinach, kale, collard greens, chard, turnip greens, arugula, and watercress. How often should I eat leafy greens? According to the USDA, the optimal amount of leafy greens is between 3-5 servings per day. That’s a lot! By far, the easiest way to get your optimal daily intake of leafy green vegetables is Organic Greens.","<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> Can you tell me about some of the health benefits of eating leafy greens listed in the articles and what are some popular leafy greens to incorporate into my diet/ways to use them. is is better to eat them cooked or raw. make the reply less than 250 words <TEXT> While we all know that organic, non-GMO fruits and vegetables of any kind are good for us, some are far better than others. Fortunately, many crowd favorites such as spinach, kale, and collard greens are packed with vitamins, minerals, fiber, and even protein. Not to mention, dark leafy greens are very versatile and can be incorporated into your diet in fun, delicious ways. If you still need convincing, I’m about to tell you about all the amazing benefits of leafy greens. Unless you’ve been taking notes, you might have missed all the leafy greens I’ve mentioned so far. Don’t worry! I’ve put together this convenient list of the healthiest leafy green vegetables for you to reference: Kale Spinach Collard greens Broccoli Broccoli sprouts Cabbage Beet greens Watercress Arugula Mustard greens Swiss chard Bok choy Romaine lettuce Raw Vegetables vs. Cooked Vegetables: Which is Better? I get asked all the time if it’s better to eat raw or cooked vegetables. The answer may surprise you! While eating raw vegetables provides your body with optimal levels of folate and water-soluble vitamins, the nutrients in cooked vegetables are actually easier to digest and absorb. However, I’m going to let you in on the most delicious and easiest way to enough leafy greens in your diet – Organic Greens! The Best Way to Get More Leafy Greens While it’s ideal to get these incredible benefits from real, whole foods, not all of these foods are always available, in season, or grown in optimal soil. It can be difficult to get the benefits of leafy greens from diet alone. That’s why Organic Greens is a great option to have when you’re just too busy to prepare a big salad or smoothie, or when you’re looking to stay healthy while on the go. One scoop of Organic Greens is a nutritional powerhouse, containing 14 USDA-certified organic plant foods, including green superstars spinach, kale, alfalfa, moringa, and broccoli sprouts. It’s perfect for anyone who: Is looking to save a lot of time versus juicing their produce every morning Needs a tasty, inexpensive alternative to pricey juice bar offerings Travels often and wants a doctor-designed source of organic nutrition while eating out Wants to mitigate stress and balanced hormone health Organic Greens is an easy and convenient way to ensure you’re getting all the amazing benefits of leafy greens! I drink a glass every day! Adding more leafy greens into your diet is a great way to support optimal health, reduce bloating, facilitate a healthy stress response, support bone health, healthy aging, and gut health, and help reduce oxidative damage from free radicals. Leafy greens are the nutritional powerhouse! Benefits of Leafy Greens FAQs What are the benefits of dark leafy greens? Adding more green leafy vegetables into your diet can support optimal brain health, fight belly bloat, relieve stress, support bone health, healthy aging, boost digestive enzymes, and tame the toxins, among many other health benefits. What are the best leafy green vegetables? The best leafy vegetables include spinach, kale, collard greens, chard, turnip greens, arugula, and watercress. How often should I eat leafy greens? According to the USDA, the optimal amount of leafy greens is between 3-5 servings per day. That’s a lot! By far, the easiest way to get your optimal daily intake of leafy green vegetables is Organic Greens. https://www.amymyersmd.com/article/benefits-leafy-greens","<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> [user request] <TEXT> [context document]
+
+EVIDENCE:
+While we all know that organic, non-GMO fruits and vegetables of any kind are good for us, some are far better than others. Fortunately, many crowd favorites such as spinach, kale, and collard greens are packed with vitamins, minerals, fiber, and even protein. Not to mention, dark leafy greens are very versatile and can be incorporated into your diet in fun, delicious ways. If you still need convincing, I’m about to tell you about all the amazing benefits of leafy greens. Unless you’ve been taking notes, you might have missed all the leafy greens I’ve mentioned so far. Don’t worry! I’ve put together this convenient list of the healthiest leafy green vegetables for you to reference: Kale Spinach Collard greens Broccoli Broccoli sprouts Cabbage Beet greens Watercress Arugula Mustard greens Swiss chard Bok choy Romaine lettuce Raw Vegetables vs. Cooked Vegetables: Which is Better? I get asked all the time if it’s better to eat raw or cooked vegetables. The answer may surprise you! While eating raw vegetables provides your body with optimal levels of folate and water-soluble vitamins, the nutrients in cooked vegetables are actually easier to digest and absorb. However, I’m going to let you in on the most delicious and easiest way to enough leafy greens in your diet – Organic Greens! The Best Way to Get More Leafy Greens While it’s ideal to get these incredible benefits from real, whole foods, not all of these foods are always available, in season, or grown in optimal soil. It can be difficult to get the benefits of leafy greens from diet alone. That’s why Organic Greens is a great option to have when you’re just too busy to prepare a big salad or smoothie, or when you’re looking to stay healthy while on the go. One scoop of Organic Greens is a nutritional powerhouse, containing 14 USDA-certified organic plant foods, including green superstars spinach, kale, alfalfa, moringa, and broccoli sprouts. It’s perfect for anyone who: Is looking to save a lot of time versus juicing their produce every morning Needs a tasty, inexpensive alternative to pricey juice bar offerings Travels often and wants a doctor-designed source of organic nutrition while eating out Wants to mitigate stress and balanced hormone health Organic Greens is an easy and convenient way to ensure you’re getting all the amazing benefits of leafy greens! I drink a glass every day! Adding more leafy greens into your diet is a great way to support optimal health, reduce bloating, facilitate a healthy stress response, support bone health, healthy aging, and gut health, and help reduce oxidative damage from free radicals. Leafy greens are the nutritional powerhouse! Benefits of Leafy Greens FAQs What are the benefits of dark leafy greens? Adding more green leafy vegetables into your diet can support optimal brain health, fight belly bloat, relieve stress, support bone health, healthy aging, boost digestive enzymes, and tame the toxins, among many other health benefits. What are the best leafy green vegetables? The best leafy vegetables include spinach, kale, collard greens, chard, turnip greens, arugula, and watercress. How often should I eat leafy greens? According to the USDA, the optimal amount of leafy greens is between 3-5 servings per day. That’s a lot! By far, the easiest way to get your optimal daily intake of leafy green vegetables is Organic Greens.
+
+USER:
+Can you tell me about some of the health benefits of eating leafy greens listed in the articles and what are some popular leafy greens to incorporate into my diet/ways to use them. is is better to eat them cooked or raw. make the reply less than 250 words
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,20,49,555,,179
+"{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]","Blockchain technology is best characterized by its non-erasable and distributed framework, which brings new levels of protection in the financial industry and healthcare. However, some critics opine that by virtue of being public ledgers, blockchain poses privacy issues when used to manage data. Analyze the impact of blockchain's transparency for highly sensitive information, and consider, how blockchain's decentralized structure may bring new challenges to the protection of data in a variety of sectors like supply chain and telecommunication.","Blockchain technology has been a buzzword in recent years, often associated with cryptocurrency and financial transactions. However, its potential extends far beyond these applications. It’s becoming an essential technology, with its global market size expected to hit $1.43 US trillion by 2030. Among many other applications, this technology has the power to revolutionize the way we manage and secure data across various industries, including healthcare, finance, and supply chain management. This article will discuss the untapped potential of blockchain technology in enhancing cybersecurity beyond its association with cryptocurrency. What is Blockchain? Blockchain is a digital ledger technology that records and stores data in a decentralized manner across a network of computers. It is often referred to as a ""chain"" because each block of data is linked to the previous block through a unique alphanumeric code called a hash. This creates a chronological sequence of data that is tamper-proof and immutable. Imagine a spreadsheet shared among multiple people, each with a copy. Whenever a new transaction is added, it is verified by all the people in the network before being added to the spreadsheet. This ensures that everyone has the same version of the spreadsheet, and no single person can alter the data without the others noticing. This makes it a great way to deal with online threats such as ransomware. The benefits of Blockchain in cybersecurity While blockchain technology is not a panacea for all cybersecurity challenges, its unique features and benefits make it a valuable tool for enhancing data security, preventing tampering, and increasing system resilience against cyber threats. One of the primary benefits of blockchain in cybersecurity is its ability to ensure data integrity and prevent tampering. Each block in the blockchain contains a cryptographic hash that links it to the previous block, forming an unbroken chain. Any attempt to modify data within a block would result in a different hash, immediately revealing the tampering. This immutability ensures that data stored on the blockchain remains accurate and unaltered, protecting against data breaches and unauthorized modifications. Decentralization and transparency Another significant advantage of blockchain is its decentralized architecture, which eliminates the need for a central authority or single point of failure. Traditional centralized systems are vulnerable to cyber attacks, as compromising a single server or database can lead to a complete breach. In contrast, blockchain networks are distributed across multiple nodes, making them highly resilient against attacks. Even if some nodes are compromised, the rest of the network can continue operating and validating transactions, minimizing the impact of a cyber-attack. Transparency is another crucial benefit of blockchain in cybersecurity. Every transaction or data entry on the blockchain is visible to all network participants, creating a transparent and auditable record. This transparency promotes accountability, as any attempt to manipulate data can be easily detected and traced back to the responsible party. Furthermore, blockchain's transparency facilitates automated auditing and compliance, reducing the risk of human error or intentional fraud. Additionally, since blockchain provides immutable evidence of all network events, you won’t need someone with a psychology degree to train your team members about security risks related to malware, phishing, and other threats. Blockchain applications in cybersecurity Blockchain technology has a wide range of applications beyond cryptocurrency, such as secure data storage, smart contracts, and supply chain management. It is particularly useful for industries where transparency, security, and trust are crucial, such as finance, healthcare, and even government. Healthcare Blockchain's decentralized nature ensures that patient data is kept secure and immutable, making it nearly impossible for unauthorized users to alter or tamper with medical records. This is crucial for maintaining the integrity and confidentiality of sensitive health information. Additionally, blockchain supports the use of smart contracts, which automate various healthcare processes including claims management and billing. These contracts execute conditions automatically, minimizing the risk of fraud and errors while ensuring transactions are handled efficiently. Blockchain also facilitates secure data exchange between different healthcare systems and providers by improving interoperability. This enhances coordinated care and improves overall health outcomes​ Finance Blockchain technology’s inherent properties such as decentralization, immutability, and transparency, are particularly suited to addressing some of the most pressing cybersecurity challenges faced by financial institutions. One key application is in banking systems, where blockchain can facilitate secure and auditable money transfers while eliminating the need for intermediaries and reducing the risk of tampering or unauthorized access. The technology creates a distributed ledger of transactions, ensuring financial records remain accurate, consistent, and resistant to manipulation. Each transaction undergoes cryptographic security measures before being added as a new immutable block, establishing a permanent and verifiable trail for easy auditing. This transparency and traceability aid in detecting and preventing fraudulent activities like money laundering, identity theft, and unauthorized fund transfers. Then again, blockchain's unalterable ledger also works well with traditional solutions such as PCI-compliant hosting, which adds another layer of security reporting. In addition to having the website as a whole protected, the same server could also store copies of transactions reported on the ledger, as well as pentesting reports and all essential data. It could also be used to make same-day ACH transfers, loan issuance, and other financial activities more efficient. Blockchain's decentralized architecture also eliminates single points of failure, making financial systems more resilient against cyber-attacks and data breaches. Several major banks and financial institutions actively explore and implement blockchain solutions to streamline operations, reduce costs, and enhance security for sensitive financial data and transactions. Supply chain management Blockchain technology significantly enhances cybersecurity within supply chain management by creating a decentralized and transparent environment that makes data tampering and fraud much more difficult. Immutable ledgers allow stakeholders to audit the supply chain in real-time and verify all activities without relying on a single point of trust​. Smart contracts streamline many supply chain processes, such as procurement and payments, reducing the potential for disputes and enhancing overall efficiency. These contracts trigger automatically when predefined conditions are met, thus ensuring compliance and speeding up operations. Furthermore, blockchain's ability to provide a comprehensive record of transactions helps significantly reduce the risk of counterfeit products entering the supply chain, as each product can be traced back to its origin​. The potential for Blockchain to become a universal cybersecurity solution Blockchain technology has the potential to become a universal cybersecurity solution across various industries and applications. Its decentralized, transparent, and immutable nature makes it a robust framework for securing data, systems, and transactions. The widespread adoption of blockchain as a universal cybersecurity solution is still in its early stages. However, there are ongoing research and development efforts to address challenges such as scalability and regulatory compliance and speed up its application. As the technology continues to evolve and mature, it has the potential to become an integral part of cybersecurity frameworks across multiple sectors. It has proven its ability to provide a secure and transparent foundation for data integrity as well as to protect your overall digital footprint. Scaling up isn't an issue with blockchain either—even an options-trading platform can rely on more efficient chains to process large amounts of data on a per-second basis, which can also be applied to other niches, such as music streaming, eSports, communication platforms, etc. Not to mention, the robust authentication mechanisms that blockchain provides us with, ensuring that only authorized parties can access and interact with sensitive information. Conclusion Blockchain technology is not just good for enhancing current security systems; it's also paving the way for new, decentralized security measures that could fundamentally change how we protect digital information. As cyber threats become more complex, blockchain's role in building secure, resilient digital systems becomes increasingly crucial. It represents a future where digital security is integrated seamlessly into the fabric of our digital interactions.","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== Blockchain technology is best characterized by its non-erasable and distributed framework, which brings new levels of protection in the financial industry and healthcare. However, some critics opine that by virtue of being public ledgers, blockchain poses privacy issues when used to manage data. Analyze the impact of blockchain's transparency for highly sensitive information, and consider, how blockchain's decentralized structure may bring new challenges to the protection of data in a variety of sectors like supply chain and telecommunication. {passage 0} ========== Blockchain technology has been a buzzword in recent years, often associated with cryptocurrency and financial transactions. However, its potential extends far beyond these applications. It’s becoming an essential technology, with its global market size expected to hit $1.43 US trillion by 2030. Among many other applications, this technology has the power to revolutionize the way we manage and secure data across various industries, including healthcare, finance, and supply chain management. This article will discuss the untapped potential of blockchain technology in enhancing cybersecurity beyond its association with cryptocurrency. What is Blockchain? Blockchain is a digital ledger technology that records and stores data in a decentralized manner across a network of computers. It is often referred to as a ""chain"" because each block of data is linked to the previous block through a unique alphanumeric code called a hash. This creates a chronological sequence of data that is tamper-proof and immutable. Imagine a spreadsheet shared among multiple people, each with a copy. Whenever a new transaction is added, it is verified by all the people in the network before being added to the spreadsheet. This ensures that everyone has the same version of the spreadsheet, and no single person can alter the data without the others noticing. This makes it a great way to deal with online threats such as ransomware. The benefits of Blockchain in cybersecurity While blockchain technology is not a panacea for all cybersecurity challenges, its unique features and benefits make it a valuable tool for enhancing data security, preventing tampering, and increasing system resilience against cyber threats. One of the primary benefits of blockchain in cybersecurity is its ability to ensure data integrity and prevent tampering. Each block in the blockchain contains a cryptographic hash that links it to the previous block, forming an unbroken chain. Any attempt to modify data within a block would result in a different hash, immediately revealing the tampering. This immutability ensures that data stored on the blockchain remains accurate and unaltered, protecting against data breaches and unauthorized modifications. Decentralization and transparency Another significant advantage of blockchain is its decentralized architecture, which eliminates the need for a central authority or single point of failure. Traditional centralized systems are vulnerable to cyber attacks, as compromising a single server or database can lead to a complete breach. In contrast, blockchain networks are distributed across multiple nodes, making them highly resilient against attacks. Even if some nodes are compromised, the rest of the network can continue operating and validating transactions, minimizing the impact of a cyber-attack. Transparency is another crucial benefit of blockchain in cybersecurity. Every transaction or data entry on the blockchain is visible to all network participants, creating a transparent and auditable record. This transparency promotes accountability, as any attempt to manipulate data can be easily detected and traced back to the responsible party. Furthermore, blockchain's transparency facilitates automated auditing and compliance, reducing the risk of human error or intentional fraud. Additionally, since blockchain provides immutable evidence of all network events, you won’t need someone with a psychology degree to train your team members about security risks related to malware, phishing, and other threats. Blockchain applications in cybersecurity Blockchain technology has a wide range of applications beyond cryptocurrency, such as secure data storage, smart contracts, and supply chain management. It is particularly useful for industries where transparency, security, and trust are crucial, such as finance, healthcare, and even government. Healthcare Blockchain's decentralized nature ensures that patient data is kept secure and immutable, making it nearly impossible for unauthorized users to alter or tamper with medical records. This is crucial for maintaining the integrity and confidentiality of sensitive health information. Additionally, blockchain supports the use of smart contracts, which automate various healthcare processes including claims management and billing. These contracts execute conditions automatically, minimizing the risk of fraud and errors while ensuring transactions are handled efficiently. Blockchain also facilitates secure data exchange between different healthcare systems and providers by improving interoperability. This enhances coordinated care and improves overall health outcomes​ Finance Blockchain technology’s inherent properties such as decentralization, immutability, and transparency, are particularly suited to addressing some of the most pressing cybersecurity challenges faced by financial institutions. One key application is in banking systems, where blockchain can facilitate secure and auditable money transfers while eliminating the need for intermediaries and reducing the risk of tampering or unauthorized access. The technology creates a distributed ledger of transactions, ensuring financial records remain accurate, consistent, and resistant to manipulation. Each transaction undergoes cryptographic security measures before being added as a new immutable block, establishing a permanent and verifiable trail for easy auditing. This transparency and traceability aid in detecting and preventing fraudulent activities like money laundering, identity theft, and unauthorized fund transfers. Then again, blockchain's unalterable ledger also works well with traditional solutions such as PCI-compliant hosting, which adds another layer of security reporting. In addition to having the website as a whole protected, the same server could also store copies of transactions reported on the ledger, as well as pentesting reports and all essential data. It could also be used to make same-day ACH transfers, loan issuance, and other financial activities more efficient. Blockchain's decentralized architecture also eliminates single points of failure, making financial systems more resilient against cyber-attacks and data breaches. Several major banks and financial institutions actively explore and implement blockchain solutions to streamline operations, reduce costs, and enhance security for sensitive financial data and transactions. Supply chain management Blockchain technology significantly enhances cybersecurity within supply chain management by creating a decentralized and transparent environment that makes data tampering and fraud much more difficult. Immutable ledgers allow stakeholders to audit the supply chain in real-time and verify all activities without relying on a single point of trust​. Smart contracts streamline many supply chain processes, such as procurement and payments, reducing the potential for disputes and enhancing overall efficiency. These contracts trigger automatically when predefined conditions are met, thus ensuring compliance and speeding up operations. Furthermore, blockchain's ability to provide a comprehensive record of transactions helps significantly reduce the risk of counterfeit products entering the supply chain, as each product can be traced back to its origin​. The potential for Blockchain to become a universal cybersecurity solution Blockchain technology has the potential to become a universal cybersecurity solution across various industries and applications. Its decentralized, transparent, and immutable nature makes it a robust framework for securing data, systems, and transactions. The widespread adoption of blockchain as a universal cybersecurity solution is still in its early stages. However, there are ongoing research and development efforts to address challenges such as scalability and regulatory compliance and speed up its application. As the technology continues to evolve and mature, it has the potential to become an integral part of cybersecurity frameworks across multiple sectors. It has proven its ability to provide a secure and transparent foundation for data integrity as well as to protect your overall digital footprint. Scaling up isn't an issue with blockchain either—even an options-trading platform can rely on more efficient chains to process large amounts of data on a per-second basis, which can also be applied to other niches, such as music streaming, eSports, communication platforms, etc. Not to mention, the robust authentication mechanisms that blockchain provides us with, ensuring that only authorized parties can access and interact with sensitive information. Conclusion Blockchain technology is not just good for enhancing current security systems; it's also paving the way for new, decentralized security measures that could fundamentally change how we protect digital information. As cyber threats become more complex, blockchain's role in building secure, resilient digital systems becomes increasingly crucial. It represents a future where digital security is integrated seamlessly into the fabric of our digital interactions. https://www.secureworld.io/industry-news/blockchain-beyond-crypto-cybersecurity","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]
+
+EVIDENCE:
+Blockchain technology has been a buzzword in recent years, often associated with cryptocurrency and financial transactions. However, its potential extends far beyond these applications. It’s becoming an essential technology, with its global market size expected to hit $1.43 US trillion by 2030. Among many other applications, this technology has the power to revolutionize the way we manage and secure data across various industries, including healthcare, finance, and supply chain management. This article will discuss the untapped potential of blockchain technology in enhancing cybersecurity beyond its association with cryptocurrency. What is Blockchain? Blockchain is a digital ledger technology that records and stores data in a decentralized manner across a network of computers. It is often referred to as a ""chain"" because each block of data is linked to the previous block through a unique alphanumeric code called a hash. This creates a chronological sequence of data that is tamper-proof and immutable. Imagine a spreadsheet shared among multiple people, each with a copy. Whenever a new transaction is added, it is verified by all the people in the network before being added to the spreadsheet. This ensures that everyone has the same version of the spreadsheet, and no single person can alter the data without the others noticing. This makes it a great way to deal with online threats such as ransomware. The benefits of Blockchain in cybersecurity While blockchain technology is not a panacea for all cybersecurity challenges, its unique features and benefits make it a valuable tool for enhancing data security, preventing tampering, and increasing system resilience against cyber threats. One of the primary benefits of blockchain in cybersecurity is its ability to ensure data integrity and prevent tampering. Each block in the blockchain contains a cryptographic hash that links it to the previous block, forming an unbroken chain. Any attempt to modify data within a block would result in a different hash, immediately revealing the tampering. This immutability ensures that data stored on the blockchain remains accurate and unaltered, protecting against data breaches and unauthorized modifications. Decentralization and transparency Another significant advantage of blockchain is its decentralized architecture, which eliminates the need for a central authority or single point of failure. Traditional centralized systems are vulnerable to cyber attacks, as compromising a single server or database can lead to a complete breach. In contrast, blockchain networks are distributed across multiple nodes, making them highly resilient against attacks. Even if some nodes are compromised, the rest of the network can continue operating and validating transactions, minimizing the impact of a cyber-attack. Transparency is another crucial benefit of blockchain in cybersecurity. Every transaction or data entry on the blockchain is visible to all network participants, creating a transparent and auditable record. This transparency promotes accountability, as any attempt to manipulate data can be easily detected and traced back to the responsible party. Furthermore, blockchain's transparency facilitates automated auditing and compliance, reducing the risk of human error or intentional fraud. Additionally, since blockchain provides immutable evidence of all network events, you won’t need someone with a psychology degree to train your team members about security risks related to malware, phishing, and other threats. Blockchain applications in cybersecurity Blockchain technology has a wide range of applications beyond cryptocurrency, such as secure data storage, smart contracts, and supply chain management. It is particularly useful for industries where transparency, security, and trust are crucial, such as finance, healthcare, and even government. Healthcare Blockchain's decentralized nature ensures that patient data is kept secure and immutable, making it nearly impossible for unauthorized users to alter or tamper with medical records. This is crucial for maintaining the integrity and confidentiality of sensitive health information. Additionally, blockchain supports the use of smart contracts, which automate various healthcare processes including claims management and billing. These contracts execute conditions automatically, minimizing the risk of fraud and errors while ensuring transactions are handled efficiently. Blockchain also facilitates secure data exchange between different healthcare systems and providers by improving interoperability. This enhances coordinated care and improves overall health outcomes​ Finance Blockchain technology’s inherent properties such as decentralization, immutability, and transparency, are particularly suited to addressing some of the most pressing cybersecurity challenges faced by financial institutions. One key application is in banking systems, where blockchain can facilitate secure and auditable money transfers while eliminating the need for intermediaries and reducing the risk of tampering or unauthorized access. The technology creates a distributed ledger of transactions, ensuring financial records remain accurate, consistent, and resistant to manipulation. Each transaction undergoes cryptographic security measures before being added as a new immutable block, establishing a permanent and verifiable trail for easy auditing. This transparency and traceability aid in detecting and preventing fraudulent activities like money laundering, identity theft, and unauthorized fund transfers. Then again, blockchain's unalterable ledger also works well with traditional solutions such as PCI-compliant hosting, which adds another layer of security reporting. In addition to having the website as a whole protected, the same server could also store copies of transactions reported on the ledger, as well as pentesting reports and all essential data. It could also be used to make same-day ACH transfers, loan issuance, and other financial activities more efficient. Blockchain's decentralized architecture also eliminates single points of failure, making financial systems more resilient against cyber-attacks and data breaches. Several major banks and financial institutions actively explore and implement blockchain solutions to streamline operations, reduce costs, and enhance security for sensitive financial data and transactions. Supply chain management Blockchain technology significantly enhances cybersecurity within supply chain management by creating a decentralized and transparent environment that makes data tampering and fraud much more difficult. Immutable ledgers allow stakeholders to audit the supply chain in real-time and verify all activities without relying on a single point of trust​. Smart contracts streamline many supply chain processes, such as procurement and payments, reducing the potential for disputes and enhancing overall efficiency. These contracts trigger automatically when predefined conditions are met, thus ensuring compliance and speeding up operations. Furthermore, blockchain's ability to provide a comprehensive record of transactions helps significantly reduce the risk of counterfeit products entering the supply chain, as each product can be traced back to its origin​. The potential for Blockchain to become a universal cybersecurity solution Blockchain technology has the potential to become a universal cybersecurity solution across various industries and applications. Its decentralized, transparent, and immutable nature makes it a robust framework for securing data, systems, and transactions. The widespread adoption of blockchain as a universal cybersecurity solution is still in its early stages. However, there are ongoing research and development efforts to address challenges such as scalability and regulatory compliance and speed up its application. As the technology continues to evolve and mature, it has the potential to become an integral part of cybersecurity frameworks across multiple sectors. It has proven its ability to provide a secure and transparent foundation for data integrity as well as to protect your overall digital footprint. Scaling up isn't an issue with blockchain either—even an options-trading platform can rely on more efficient chains to process large amounts of data on a per-second basis, which can also be applied to other niches, such as music streaming, eSports, communication platforms, etc. Not to mention, the robust authentication mechanisms that blockchain provides us with, ensuring that only authorized parties can access and interact with sensitive information. Conclusion Blockchain technology is not just good for enhancing current security systems; it's also paving the way for new, decentralized security measures that could fundamentally change how we protect digital information. As cyber threats become more complex, blockchain's role in building secure, resilient digital systems becomes increasingly crucial. It represents a future where digital security is integrated seamlessly into the fabric of our digital interactions.
+
+USER:
+Blockchain technology is best characterized by its non-erasable and distributed framework, which brings new levels of protection in the financial industry and healthcare. However, some critics opine that by virtue of being public ledgers, blockchain poses privacy issues when used to manage data. Analyze the impact of blockchain's transparency for highly sensitive information, and consider, how blockchain's decentralized structure may bring new challenges to the protection of data in a variety of sectors like supply chain and telecommunication.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,26,78,1282,,387
+You must respond using only the information provided. Do not give any inaccurate answers according to the information provided. Do not respond in any way that is discriminatory or harmful. You are to respond in complete sentences using correct US grammar conventions.,"From this text, how do the five generic images for the technological future differ to the four schools of thought articulated in the Smart Internet Technology CRC’s report, ""Smart Internet""? Include a brief description of each theory in your explanation.","Abstract Australia’s Federal Government announced the National Broadband Network (NBN) in 2009. NBN’s current roll-out is scheduled for completion in 2021, with market forecasts estimating optical fibre overtaking DSL broadband connections in about 2015. This paper provides a timely contribution to more critical and expansive analysis of potential Australian internet futures. First, ‘schools of thought’ and current technological frames (Web 2.0, ‘the cloud’) for the internet and its possible futures are outlined, which provide perspectives on the emergence of the NBN. We then outline five generic images of the future which, as predetermined images, enable quick ‘incasting’ of alternative futures for a technology topic or related object of research: promised future, social/ speculative bubble(s), unfolding disruption/chaos, unintended consequences, and co-existence/‘cooption’. High-level application of the ‘schools’ and generic images to the NBN and Australia’s potential internet futures, suggests policymakers and strategists currently consider too few perspectives. Keywords: national broadband network, internet, incasting, technology foresight, Australia Introduction Analyses of internet futures often outline prevailing trends – such as the shift towards mobile internet and personal/business data capture and analysis – and project major, positive, rapid changes to business, politics and daily life. However, trends constantly evolve and can change dramatically, rendering earlier forecasts obsolete. ‘Virtual worlds’ like Second Life were touted as innovations that would rapidly alter online business and marketing – only interest waned and shifted to educational uses (Salomon, 2010). Conversely, popular social networks like Twitter were initially dismissed – only to rapidly become mainstream, due in part to celebrity uptake (Burns and Eltham, 2009). This article develops an alternative approach to technology foresight, and on prospective thinking about Australia’s internet futures. Analyses are reframe-able expressions of one of many ‘schools of thought’ or mental models on internet futures. We suggest a shift in focus towards alternative futures, and the theoretical and analytical perspectives can inform this analysis. We use a mixed-method approach to consider potential internet futures, identify generic categories of future images, and consider these for ‘incasting’ a focal topic thereby deductively conceptualising alternative futures (Dator, 2002). This article’s core aims are: (1), to present an outline of key ‘schools of thought’ and theoretical perspectives on technological change which informs a new technology futures framework; and, (2), to show how this framework could be used to quickly conceptualise possible futures, in particular, Australia’s potential internet futures. The article also addresses the need to move beyond the dualistic discussion of internet futures as either emancipatory or, alternatively, dystopian. We need to better recognise and consider the diverse mixture of positive and negative outcomes the internet will more plausibly be associated with. As Voros observed, “we can – if we are wise enough – choose the quality of our mental models and guiding images of the future and, therefore, the quality of the decisions we make based upon them” (Voros, 2006). We agree: such ‘guiding images’ are too often taken-for-granted. The paper is structured as follows. We first outline recent perspectives on internet futures. A review of relevant visions and technological change theory is synthesised as a new technological futures framework. Through ‘incasting’ we use this framework to consider the potential for alternative internet futures to emerge in Australia, focusing on the National Broadband Network (NBN) and the 2020 outlook. Current Schools of Thought and Technological Frames Schools of thought The Smart Internet Technology CRC’s report Smart Internet 2010 articulated four schools of thought about possible internet futures (Barr, Burns, & Sharp, 2005). The four ‘schools’ were Rich Media, Adaptive User Environments, Not the Smart Internet and Chaos Rules. Each school encompassed an image of the future, theoretical perspectives, and thought leaders. Each school “ought to be viewed as… shared mindsets” which “suggest possible future outcomes” (Barr, Burns, & Sharp, 2005, p.7). Rich Media was the default future: the “multi-person, multi-device” access envisioned by Microsoft, News Corporation, Nokia and other corporations. This view anticipated debates about Australia’s development of the NBN; rural-based tele-medicine infrastructure; consumer booms in high-definition television, and the Australian Government’s Digital Education Revolution. This ‘school’ is “closely related to … advocates of the pervasive computing approach” (Barr, Burns, & Sharp, 2005, p.41). Adaptive User Environments emphasised end-user experience, adaptability, and design, like Apple’s iPod, iPhone and iPad, and how “social and cultural factors influence the way end users and consumers interact with a wide range of Internet-based technologies and services” (Barr, Burns, & Sharp, 2005, p.24). Not the Smart Internet emphasised “basic services for all” and “open standards”. Chaos Rules was pessimistic and slightly dystopian, questioning the robustness of Internet services (e.g. due to hackers, viruses, and cyber-warfare) and over-reliance on information technology. This school anticipated concerns about digital technologies and social media impacts on brain function, attention spans and society (Watson, 2010). Chaos Rules also foreshadowed Taleb’s (2007) contrarian thinking on low-probability, high-impact ‘Black Swan’ events. Today’s dominant frames: ‘Web 2.0’, ‘Web 3.0’, and ‘the Cloud’ A technological frame structures interactions among relevant social groups via the set of meanings attached to a technology/artifact (Bjiker, 1995). Publisher Tim O’Reilly’s (2005) Web 2.0 is currently the dominant internet frame. After the 2000 dotcom crash, most internet companies struggled to raise finance and survive. Dotcom era visions such as convergence and disintermediation seemed dead. O’Reilly’s Web 2.0 contended the next generation of web tools would be more accessible and end-user friendly, and be associated with collective intelligence, participation, and service delivery. This coincided with Google’s initial public offering and the emergence of social networks like Facebook. The frame also co-opted the UK Blair Government’s promotion of creative industries and the maturation of knowledge management (Leadbeater, 2009; Tapscott & Williams, 2010). Web 2.0 shapes current policy agendas such as ‘Government 2.0’ and ‘e-Health’. Thought leaders now increasingly discuss Web 3.0 which Web 2.0 might evolve into. Web 3.0 might include the mainstreaming of sophisticated, mobile internet connected devices, greater video content, ‘cloud’ computing, ‘the internet of things’ (physical objects are also connected to the internet such as cars, home appliances, buildings), and a broader convergence of digital and physical worlds. Kevin Kelly (2011) defines this frame with six verbs: screening (not reading), interacting (“if it’s not interacting, it doesn’t work”), sharing, flowing, accessing, and generating. An emerging theme is collecting and using personal data. Data is ‘the new oil’: offering a new wave of value creation potential “in a world where nearly everyone and everything are connected in real time”, despite privacy and trust concerns (World Economic Forum, 2011, p.5). The end-user remains central and is part of wider ‘data ecosystems’ which can be ‘mined’ to deliver more personalised services. Information and communication technology (ICT) will be a ubiquitous, intrinsic part of all social behaviours, business practices and government (Greenhill, 2011). The ‘cloud’ – a metaphor for resources accessible on-demand (e.g. software, content) from anywhere via remote internet accessible storage – and associated ‘cloud computing’ models is a front-runner for such as paradigm shift. The ‘cloud’ and ‘internet of things’ relate to emerging agendas for ‘smart’ and ‘embedded’ systems. Through ‘intelligent’ infrastructure and devices, data gathering and management will become infused into service delivery and everyday objects. IBM’s former chief executive officer Samuel Palmisano (2008; 2010) believes computing power will be “delivered in forms so small, abundant and inexpensive” that it is “put into things no one would recognize as computers: cars, appliances, roadways and rail lines, power grids, clothes; across processes and global supply chains; and even in natural systems, such as agriculture and waterways.” Further, ‘systems of systems’ will turn a mass of data into information and insight, to enable smarter healthcare, more efficient energy systems and productivity improvements (Palmisano, 2010; RuedaSabater & Garrity, 2011) However, Web 2.0 and Web 3.0 are uncertain. Google, Facebook, Twitter, and Wikipedia have led to ‘lock-in’ and institutional capture of specific services. Paradoxically, this may limit future innovation. Disruptive challengers may emerge from China and India. Emerging internet communities in developing countries appear to adopt different attitudes and online behaviours which may become more influential (Dutta et al., 2011). A second view considers increasing user concerns about online privacy, identity theft, and changing public attitudes in Western markets. Dutta et al’s (2011, p.9) international user study also found users “want it all: they desire freedom of expression, privacy, trust, and security without viewing these as mutually exclusive.” However, trade-offs between these potentially conflicting priorities may in fact be necessary. We need to think about futures in which people, in effect, ‘trade’ aspects of their privacy in return for other benefits. A final view is that most Web 2.0/ Web3.0 firms are yet to develop sustainable business models beyond start-ups. These perspectives foreshadow alternative futures. Considering Alternative Technological and Internet Potentials In this section we outline five generic images for technological futures, based on a review of different perspectives (such as those described above), technological change theory, and innovation theory. This framework can be used to consider potential internet futures. Promised future (Dominant expectation[s] and vision[s]) The first category is the simplest to describe and identify. ‘Promises’ are made by actors seeking to build support for particular domains – such as those made by thought leaders about ‘Web 3.0’, the ‘internet of things’, and social media. Theoretically, the Sociology of Expectations (SoE) informs this category (Borup et al., 2006; Brown et al., 2000). SoE scholars suggest that expectations of technologies and their impacts/ potential strongly influence the technological development and innovation, such as through ‘self-fulfilling prophecies’ (as seen with Moore’s Law). The more successful a particular ‘expectation’, i.e. the more support it has gained, the more likely key actors are to act in ways that help make it a future reality. Foresight analysts can proactively monitor this process and its outcomes. Shared expectations can play necessary, central roles in creating momentum and stimulating coordination of heterogeneous actors. The Australian Government’s National Broadband Network – discussed in Section 4 – and the European Commission’s new ‘Digital Agenda’ for Europe, illustrate this. Alternatively, they can be problematic if widely accepted expectations (such as the default Rich Media ‘school’ or Web 2.0) remain uncritically accepted. Further, a dominant vision may exclude other possible internet futures from being considered by business and government, just as a dominant ‘official future’ can limit thinking in organisations. Social/Speculative bubble(s) Bubbles refer to a “heightened state of speculative fervour” that emerges in markets which, ultimately, result in investment failures and drastic, sudden market corrections (Shiller, 2005). In technological change, ‘hype cycles’ are similarly quite common (Finn & Raskino, 2008). These are often due to over-promising by promotional actors who are seeking resources (Geels & Smit, 2000). Additionally, greater social focus on a dominant ‘frame’ can emerge as actors become ‘enrolled’ (Bijker, 1995). Some theorists see bubble creation as a natural, necessary part of major technological change. The innovation theory of social bubbles argues collective over-enthusiasm and commitments beyond what would be rationalised by cost benefit analyses, fuelled by hype, is necessary to enable action in the presence of risk and uncertainty (Gisler et al., 2011; Gisler & Sornette, 2009). Perez’s (2002; 2010) technological revolutions theory further contends that a recurring sequence of events occurs during each revolution, each time taking between 40-60 years: an initial ‘installation phase’ (e.g. investments in new supporting infrastructure) first, leading to speculative bubbles and a dramatic turning point, and followed a ‘deployment period’ heralding a new ‘golden age’. Similarly, Kondratieff-like ‘long waves’ are advanced (Freeman & Louca, 2001). Perez argues we are at the ‘turning point’ in the middle of the ICT revolution, during which major bubbles are expected. According to Perez, a ‘new age’ requires a new mode of growth compatible with a new ‘paradigm logic’ (for the revolution), and institutional changes to create the conditions for this growth. Web 2.0 has become the dominant ‘frame’ and recent investment growth illustrates this. Facebook had a more than four-fold increase in valuation as it prepared for an initial public offering (Ozanian, 2011). Microsoft purchased Skype for over 400 times its operating income (Anonymous, 2011). These dramatic changes create hype cycles (Finn & Raskino, 2008). Facebook co-founder Mark Zuckerberg remarked (from a Rich Media worldview): “if you look five years out, every industry is going to be rethought in a social way” (cited in Gelles, 2010). Brands rushing into social media view it “as the panacea to diminishing returns in traditional mass media” (Fournier & Avery, 2011). However, concerns over privacy and how greater marketing and advertising might affect social networks may ‘pop’ such a bubble and herald major shifts. Web 2.0 may be a major speculative bubble like the 1995-2000 dotcom era (Hirschorn, 2007; Raznick, 2011; Vance, 2011; Wooldridge, 2010). As Hirschorn (2007) observed, “in the Web hype-o-sphere, things matter hugely until, very suddenly, they don’t matter at all”. He forecasts social media to be “only another in a long string of putatively disruptive, massively hyped technologies that prove just one more step in the long march.” The propensity of internet discourses to naïve prophetic thinking, self-styled experts and exaggerated promises (Dublin, 1991) partly explains regular shifts from hype to disappointment. Disruption/Chaos Schumpeterian ‘creative destruction’ – the emergence, experimentation and innovation central to technological change and free markets – largely defines this image. ‘Chaos’ can also mean opportunity (as well as the danger normally perceived). Services originally designed to ‘police’ social networks have also led to new innovations in text mining and complex event processing (Sommon & Brown, 2011). ‘Disruption’ can be technological or driven by additional social or political factors. For example, a common pitfall in expectations of future technological developments is believing social practices “to remain constant in spite of the introduction of new technology (Geels & Smit, 2000, p.880). Exponential growth in the miniaturisation of transistors and computer power (Moore’s Law) may no longer hold in coming decade(s) and dramatically change chip fabrication costs (Rupp & Selberherr, 2011). Natural resource limits may disrupt consumer markets: the scarcity of needed rare earth elements in which China controls 95% of global supply (Cohen, 2007). Additional emerging candidates for future disruption are ‘augmented reality’ technologies and ‘nano-electronics’. Early stage augmented reality prototypes and technologies are now being commercialised together with geo-location tools like Geoloqi.com, in which real-world environments are ‘augmented’ by sensory inputs received via technology (via smart phones). An alternative medium-term source of technological disruption is a major new means of chip fabrication and manufacturing. Most prevalent at present is ‘nano-electronics’, a major area of research in Australia and Asia-Pacific. Unintended consequences Unintended social consequences emerge from second-order and third-order effects of technologies along with the appropriation of technologies. Theorists show that technologies are often ‘appropriated’ by diverse end-user groups, typically for uses unforeseen by the technology creators (Burns & Eltham, 2009; Jamison & Hard, 2003). Cyberpunk author William Gibson similarly observed that “the street finds its own use for things.” This category reveals a wide range of internet potentials and perspectives. ‘Cyberrealism’ is an emerging Chaos Rules-like philosophy that challenges the often utopian internet discourses (Morozov, 2011). Further convergence of digital and physical/ social worlds will enable political and other interests to shape the digital world’s development and its use in unexpected ways (Kelly & Cook, 2011; Morozov, 2011). Recent literature suggests unintended consequences may include: information flows being distorted by personalisation features (Pariser, 2011); data security and privacy being compromised by the adoption of open/cloud computing architectures (Bisong & Rahman, 2011; Grobauer et al., 2011); authoritarian governments gaining power from the internet, rather than a power shift to individuals which is more commonly expected (Burns & Eltham, 2009; Morozov, 2011); and the potential for intensified consumerism as more sophisticated ways to advertise and sell become embedded in more online and social technologies. The “open platform paradigm” of Not the Smart Internet can also, paradoxically, compromise content creation and intellectual property (Lanier, 2010). The spectre of increasing cyber-warfare is a topical national security issue and regional flashpoint (Clarke & Nake, 2010). For example, China is blamed for attacks on the ICT systems of Australian mining and resource firms (Wilkinson, 2010). In the Asia-Pacific region, many countries have invested in new national teams and defensive cyber-warfare capabilities. Several different possibilities exist about how cyber-warfare could evolve. Attacks on transnational firms may impact the stability of sovereign financial markets. Countries may develop offensive cyber-warfare capabilities and teams as a form of market intelligence, and as strategies to gain access to intellectual property. Co-existence/Co-option Co-existence/Co-option focusses on the complex ‘co-evolution’ of technology and society. This co-evolution makes unpredicted futures more likely than is commonly recognised despite our best efforts to achieve foresight (Williams, 2006). Through ‘coevolution’ one possibility is the complex co-existence of old and new technologies (Geels & Smit, 2000). This is an important counter-point to common forecasts in which the new replaces or displaces the old. Co-existence/Co-option also recognises 39 that business entrepreneurs and experts often articulate and promote futures they have a vested interest in. SoE scholars in the Science and Technologies Studies field emphasise attempts “to create ‘direction’ or convince others of ‘what the future will bring’” (Brown et al., 2000, p.4). Here, ‘contested futures’ is relevant. Brown et al (2000, p.3-4) observe that “if actors are to secure successfully for themselves a specific kind of future then they must engage in a range of rhetorical, organisational and material activities through which the future might be able to be ‘colonised’.” These actor strategies may also partly explain how Web 2.0 versions of Rich Media and Adaptive User Environments quickly came to dominate thinking. Web 2.0 growth and social networks provide emancipatory tools for many, yet have also enriched key individuals like Facebook’s Mark Zuckerberg, Mahalo’s Jason Calacanis, publishers John Battelle and Tim O’Reilly and LinkedIn founder Reid Hoffman. However, the broader community of ‘Web 2.0’ proponents and consultants rarely consider the possibility that they may be acting on what Inayatullah (2008, p.5) terms “used futures”: out-dated conceptions of the future “unconsciously borrowed from someone else.” Additionally, the increasing number of proposals to ‘order’ or (re)structure the evolution of the internet and mobile markets is a clear manifestation of the ongoing ‘co-evolution’ of technology and society which continually plays out. These proposals include the ‘network neutrality’ debate, and United States legislation such as the Stop Online Piracy Act, and the Research Works Act that would restrict ‘open access’ publishing. These regulatory regimes can reshape industry trajectories and change the balance of power between innovators, early adopters and laggards (Lessig, 2001; Spar, 2001; Wu, 2010). Case Study: Australia’s Potential Internet Futures In this section we focus on the Australian context: the National Broadband Network (NBN) which is being rolled-out by the Federal Government. If it is fully rolled out (the Federal Opposition currently opposes this), the high speed network of three technologies (optic fibre, fixed wireless, satellite) will be completed in approximately 2020.1 We first introduce the NBN. Issues and potential futures are then discussed, considering the analytical perspectives advanced. The national broadband network An NBN was first proposed by Australia’s Howard Liberal Government in 2003 and eventually made a Federal election issue in 2007. The then Rudd Labor Government announced in April 2009 that it would form the NBN Co, a wholly-owned Commonwealth company, to build and operate a national “wholesale-only, open access broadband network.” The successor Gillard Labor Government started to roll-out in 2011. The Federal Government’s decision to create the new network followed almost a decade of unsuccessful attempts to build an NBN-like network. Sol Trujillo-era Telstra adopted lobbying tactics to delay the separation of its retail and wholesale divisions. Competitors like Optus lobbied against Telstra to avoid hidden network and sunk costs. A competitive bargaining game developed. Research and development firms like Telstra Research Labs and the Smart Internet Technology CRC led supply-side research on NBN-like application scenarios and use cases. The NBN was the Australian Government’s response to telecommunications market failures. The Smart Internet Technology CRC highlighted early-stage innovators and commercialisation possibilities. However, gaps in the Australian environment, such as the lack of a venture capital sector, hampered efforts. NBN Co’s formation shifted the debate to access and pricing regimes, location of testing sites, and the reaction of market incumbent Telstra. New debates also focus on government and capital markets execution. NBN Co faced scrutiny about its operational efficiencies (in 2011 the pricing regime was revealed to be more expensive than first planned), ability to roll-out the network, and the management team. Analysis: Schools of thought and alternative futures The default future in the ‘schools of thought’ framework is Rich Media. This ‘school’ may have captured Australian Government policy-making and academic research as the dominant technological frame that actors have been enrolled in (Bjiker, 1995). NBN evidences the role of shared expectations in creating sufficient momentum and stimulating coordination: all actors speak of the same “digital economy of the future” and of its emancipatory, economic potential. The NBN is a return to the 1990s rhetoric of the internet as an ‘information superhighway’ in a new guise. Similar claims to NBN’s emancipatory potential were made for Sausage Software during the Netscape-Microsoft browser wars (in the mid-late 1990s) and for local content production for the 2G and 3G mobile internet. The Not the Smart Internet ‘school’ would suggest an NBN framed as an important intervention that primarily addresses access and digital divide issues, and provides more widespread, functional, lower-cost, transparent services. However, this contrasts with Rich Media style focus on network speed and capacity for media streaming and future ‘cloud’ based businesses. The Adaptive User Environments ‘school’ suggests 41 emulating, locally, Apple or Google-like models of content creation and distribution. Australian retailers such as JB Hi-Fi might develop new online content serviceorientated models (e.g. streaming music services like Pandora). However, these firms must successfully compete with global competitors to win customers (Stafford, 2011). NBN may provide the infrastructure for virtual worlds to have more significant uptake (Salomon, 2010). The Chaos Rules ‘school’ suggests security capabilities to pre-empt hackers, viruses, and cyber-warfare. Alternative futures framework: Considering image categories In this section we provide a high-level ‘incast’ of Australian internet futures, considering a 2020 time horizon. Incasting involves considering predetermined images of the future in order to deduce alternative future scenarios for the particular object of the research (Del Pino, 1998). The advantage of this approach is that it enables quickly conceptualising alternative futures (Dator, 2002). Promised future The ‘promises’ and dominant expectations for Australian internet futures are clearly expressed in the Government’s (2011) National Digital Economy Strategy (NDES) which articulates a vision for Australia to be, by 2020, a ‘world leading digital economy’. Eight goals are defined: • By 2020, Australia will rank in the top five OECD countries for the portion of households that connect to broadband at home; • By 2020, Australia will rank in the top five OECD countries for the portion of businesses and not-for-profit organisations using online opportunities; • By 2020, the majority of Australian households, businesses and other organisations will have access to smart technology to better manage their energy use; • Improved health and aged care: by 2020 90 per cent of high priority consumers (e.g. older Australians, those with a chronic disease) can access individual electronic health records; by 2015 495,000 telehealth consultations will have been delivered by remote specialists; by 2020, 25 per cent of all specialists will be participating in delivering telehealth consultations; • Expanded online education; • By 2020 at least doubling the level of teleworking (at least 12 per cent of Australian employees); • By 2020, four out of five Australians will choose to engage with the government through the internet or other type of online service; and • By 2020, the gap between households and businesses in capital cities and those in regional areas will have narrowed significantly. The NDES envisages a ‘market-led’ transition to this future economy, connecting activities to the ‘smart systems’ vision (e.g. using ICT to optimise energy and transportation systems) “enabled by... the internet, mobile and sensor networks” (p.12). A ‘linear’ view, similar to Rich Media and Adaptive User Environments, is adopted: “based on existing trends, in the future the online experience will become richer and more data intensive and increasingly integrated into everyday life, at home and at work” (p.10). Inclusions themes, of Not the Smart Internet, are also noted: “distance - once a defining characteristic and barrier for regional Australia - becomes increasingly Australia's Potential Internet Futures Journal of Futures Studies 42 irrelevant” (www.nbn.gov.au). Social/Speculative bubble The NBN and NDES were developed during intensifying Web 2.0/Web3.0 hype. An alternative image centres on the potential for unmet expectations, and the associated ‘fall-out’. This would replay aspects of the 1995-2000 dotcom bubble – especially if the current “state of speculative fervor” (Shiller, 2005) surrounding Web 2.0 contracts in the near-to-medium-term. The envisaged application scenarios and use cases may also not be commercially and/or socially viable. An important example is ‘e–health’ for aged Australians. Australia has to-date struggled to develop viable new e-health businesses/business models for providing aged care, and public acceptance issues could also slow adoption (Tegart, 2010). Similarly, teleworking has tended to not meet expectations (Geels & Smit, 2000) due to unmet social needs which could reoccur over the next decade. In this future, when 2020 arrives the economic productivity ‘promise’ of NBN is unrealised.2 Moreover, it raises the possibility – if user take-up is lower than expected, as recently occurred in the UK – of delays in NBN Co gaining sufficient cash-flow to no longer require government support. Some Australian social scientists have argued – in part due to highly differential take-up across NBN test sites – that the ‘promises’ (above) will be challenged by local cultural and material factors, and that such variations will grow in significance as the NBN is further rolled-out (Apperley et al., 2011). Both localised conditions (e.g. installation policy and logistics, costs) and “integration of the NBN with each household’s domestic network of hardware devices, internal connections, software, and of course skill and interest” must be considered (Apperley et al., 2011). Like the recent example of the Human Genome Project (Gisler et al., 2011) it may take many decades to fully “exploit the fruits” of the NBN investment, rather than the shorter time horizons presently expected. Disruption/Chaos This image highlights the ‘creative destruction’ associated with technological change and associated potential for unanticipated shifts in practices. If optical fibre overtakes DSL broadband connections after 2015/6 (assuming full roll-out continues)3 then many sectors are likely to be ‘ripe’ for disruption – such as media, telecommunications, advertising, and retail – as people invent ways to utilise the expansion in bandwidth and evolve offline behaviours. Implicit in the NBN is a vision of a “digital home” and “an anticipated future of digital living” (Apperley et al., 2011) which many may embrace, whilst others ‘opt-out’ of the “connectopia” (Kiss, 2011). Similarly, broadband services (see generic categories in Table 2), and the NBN, need to be viewed more broadly than as merely high-speed Internet. By 2020, internet futures could have a majorly disruptive impact on several sectors. Today’s decline in newspapers and some retail sectors (e.g. music, books), could signal futures in which many local firms are unable to maintain viable, growing businesses. Local players such as those experimenting with new service-oriented models, such as JB Hi-Fi, increasingly face global competition and disruption potential. Regulators and users may also still be “struggling to work out the boundaries of online privacy” (Gettler, 2010) as practices, tools, and norms evolve. Unintended consequences NBN has the potential to generate a multitude of unintended social consequences – both positive and negative (often depending on whose perspective is taken). NBN uptake may vary by geographic areas, leading to new subtle versions of the ‘digital divide’. Related socio-technical factors influence access to participation in a digital economy. The ‘unintended consequences’ image also alludes to the potential for arbitrage and leaking of NBN data to individuals. Although the ‘Gov 2.0’ agenda views the open data movement positively, Australia is constrained by the Westminster system which presently imposes limits on the release of government data. Major unintended consequences for the Australian political system could emerge in a more technologically-empowered society – a potential blind-spot for politicians, regulators, policymakers, and others. The internet can also facilitate larger-scale manipulation of publics (Kearne, 2012), a concerning trend the NBN may also enable. Co-existence/Co-option In another plausible scenario a “patchwork of [variable] connectivity” prevents the envisaged future, centred on the digital home being “integrated into the digital economy as a node of production and consumption” (Apperley et al., 2011), from fully emerging. The ‘co-existence’/‘co-option’ image further suggests potential internet futures in which highly advanced digital homes co-exist with less advanced and connected homes with varying connections, mediums, and social conditions – rather than a homogenous new ‘digital Australia’. In this future official projections of 70 percent take-up by 2025 are not achieved. Political risks provide another avenue to such futures, with a partially complete NBN (if there is a change of Federal government) likely co-existing with Australia's Potential Internet Futures Journal of Futures Studies 44 other networks. Additionally, a range of social, competitive, and regulatory issues highlight the potential for ‘co-option’. Regulatory settings and markets factors will influence the level of competition and services that emerge. NBN might fit Perez’s Kondratieff-like ‘long waves’ model but its roll-out has been delayed by local factors such as bargaining games, telecommunications market failure and institutional issues. The NBN Co’s government monopsony also limits capital markets involvement and, consequently, a true valuation market. Small and medium enterprises who develop new NBN markets or information services may in time be forced to start mergers and acquisitions that, ultimately, favour larger incumbents. These factors could limit the NBN and Australia’s internet futures. Furthermore, NBN’s growth is in a democratic society which means it will be different to the Confucian and Juche logics of Singapore and South Korean NBN-like solutions. Whilst the Sociology of Expectations suggests policymakers, academics and others and will continue to envision NBN-like (digital economy) capabilities, there is the risk of coordination failure, roll-out problems, and, possibly, colonised futures (Brown et al., 2000). Discussion Whilst the above analysis is only a high-level assessment it suggests discussion in Australia of potential internet futures is dominated by a limited number of ‘schools’ and ‘image’ categories. Our reading of the current NBN debates and consideration of potential internet futures is there is little consideration of the Chaos Rules, nor the potential for ‘bubbles’ (and for associated unrealistic expectations), unfolding ‘disruption’, unintended consequences, or co-existence/co-option. The NDES fails to address the potential for sectoral disruptions, and associated indirect negative effects. Holistic consideration of potential futures and associated outcomes could better inform planning and decision-making. Methodological and conceptual improvements could be made by using other futures tools and exploring interconnections. Examination of potential secondorder and third-order consequences could be improved by using ‘Futures Wheels’. Interconnections appear to exist, for example, between ‘bubbles’ and ‘unintended consequences’. If the Government and NBN Co – through the return to 1990s utopian internet rhetoric – contribute to speculative bubbles emerging, then this may have social consequences that unintentionally later impair the envisioned digital future and current ‘real’ economy. Furthermore, a major “social bubble” may be necessary to mobilise the needed commitments and major investments by innovators and entrepreneurs to realise the ‘promises’ and cause ‘disruptions’ (Gisler et al., 2011). Conclusion In this paper we have outlined and considered key ‘schools of thought’ (or mental models) on internet futures and additional analytical and theoretical perspectives that provide insights into potential internet futures – both internationally and in Australia. Through a brief case study, we have shown how a resulting technological futures framework could be used to quickly highlight potential futures through a deductive ‘incasting’ process. We make several contributions to the literature on internet futures and technology foresight. First, we built on the Smart Internet 2010 project (Barr, Burns, & Sharp, 2005) and its four ‘schools of thought’. We have updated examples 45 to include contemporary debates. The current dominant ‘frames’ are understandable as expressions of the default ‘mental model’ on internet futures, Rich Media, along with Adaptive User Environments, which also informed development of the NBN. Second, through literature review we identified five image categories which can be used as predetermined images of the future for incasting. The first three images – promised futures, social/speculative bubbles, and disruption/chaos – deal primarily with change dynamics. The last two images – unintended consequences, co-existence/ co-option – primarily bring out potential outcomes such as regarding competition and interest politics, risk, and social impacts. Analyst consideration of the categories enables asking “devil’s advocate” questions (Wright & Cairns, 2011; Taleb, 2007) which challenges dominant ‘frames’ and stimulates consideration of multiple viewpoints which is needed for effective scenario thinking. Like Smart Internet 2010’s schools of thought, these predetermined images are relatively open-ended and can be revised with future examples, along with analysis of other domains. Each school of thought and image category provides important perspectives for analysing the emergence of the NBN and potential Australian internet futures. Widely accepted expectations inform the application scenarios, use cases and supply-side research supporting the NBN and similar technology debates. The NBN is in some ways a return to the past, reminiscent of the ‘information superhighway’ rhetoric in the 1990s. What the incasting exercise reveals, however, is that a more plausible mixture of outcomes should be considered by planners and strategists in Australian internet future scenarios along with a broader move beyond dualistic discussion of internet futures (either utopian emancipatory or dystopian). Broader perspectives could consider critical analysis of Web 2.0 and global internet futures (Lessig, 2001; Lanier, 2010; Morozov, 2011) and integrate this with critical futures studies perspectives. Notes 1 These conflicting political positions present important political risks. This is particularly true if the Opposition Liberal Party wins the next Federal election scheduled for 2013. It is likely to be more difficult for a Liberal Federal Government Australia's Potential Internet Futures Journal of Futures Studies 46 to discontinue/dismantle the NBN if it is elected in 2017 (the subsequent Federal). If fully rolled-out the NBN will “connect 93% of homes, schools and workplaces with optical fibre (fibre to the premises or ‘FTTP’)” and “for the remaining 7% we will connect to our next generation fixed wireless and satellite”. 2 Australia is a small market which raises the potential for various market failures and associated uncertainties about the how many players can be supported in some sectors (Stafford, 2011). 3 As per the market forecasts and analysis of Telsyte (http://www.telsyte.com.au).","Abstract Australia’s Federal Government announced the National Broadband Network (NBN) in 2009. NBN’s current roll-out is scheduled for completion in 2021, with market forecasts estimating optical fibre overtaking DSL broadband connections in about 2015. This paper provides a timely contribution to more critical and expansive analysis of potential Australian internet futures. First, ‘schools of thought’ and current technological frames (Web 2.0, ‘the cloud’) for the internet and its possible futures are outlined, which provide perspectives on the emergence of the NBN. We then outline five generic images of the future which, as predetermined images, enable quick ‘incasting’ of alternative futures for a technology topic or related object of research: promised future, social/ speculative bubble(s), unfolding disruption/chaos, unintended consequences, and co-existence/‘cooption’. High-level application of the ‘schools’ and generic images to the NBN and Australia’s potential internet futures, suggests policymakers and strategists currently consider too few perspectives. Keywords: national broadband network, internet, incasting, technology foresight, Australia Introduction Analyses of internet futures often outline prevailing trends – such as the shift towards mobile internet and personal/business data capture and analysis – and project major, positive, rapid changes to business, politics and daily life. However, trends constantly evolve and can change dramatically, rendering earlier forecasts obsolete. ‘Virtual worlds’ like Second Life were touted as innovations that would rapidly alter online business and marketing – only interest waned and shifted to educational uses (Salomon, 2010). Conversely, popular social networks like Twitter were initially dismissed – only to rapidly become mainstream, due in part to celebrity uptake (Burns and Eltham, 2009). This article develops an alternative approach to technology foresight, and on prospective thinking about Australia’s internet futures. Analyses are reframe-able expressions of one of many ‘schools of thought’ or mental models on internet futures. We suggest a shift in focus towards alternative futures, and the theoretical and analytical perspectives can inform this analysis. We use a mixed-method approach to consider potential internet futures, identify generic categories of future images, and consider these for ‘incasting’ a focal topic thereby deductively conceptualising alternative futures (Dator, 2002). This article’s core aims are: (1), to present an outline of key ‘schools of thought’ and theoretical perspectives on technological change which informs a new technology futures framework; and, (2), to show how this framework could be used to quickly conceptualise possible futures, in particular, Australia’s potential internet futures. The article also addresses the need to move beyond the dualistic discussion of internet futures as either emancipatory or, alternatively, dystopian. We need to better recognise and consider the diverse mixture of positive and negative outcomes the internet will more plausibly be associated with. As Voros observed, “we can – if we are wise enough – choose the quality of our mental models and guiding images of the future and, therefore, the quality of the decisions we make based upon them” (Voros, 2006). We agree: such ‘guiding images’ are too often taken-for-granted. The paper is structured as follows. We first outline recent perspectives on internet futures. A review of relevant visions and technological change theory is synthesised as a new technological futures framework. Through ‘incasting’ we use this framework to consider the potential for alternative internet futures to emerge in Australia, focusing on the National Broadband Network (NBN) and the 2020 outlook. Current Schools of Thought and Technological Frames Schools of thought The Smart Internet Technology CRC’s report Smart Internet 2010 articulated four schools of thought about possible internet futures (Barr, Burns, & Sharp, 2005). The four ‘schools’ were Rich Media, Adaptive User Environments, Not the Smart Internet and Chaos Rules. Each school encompassed an image of the future, theoretical perspectives, and thought leaders. Each school “ought to be viewed as… shared mindsets” which “suggest possible future outcomes” (Barr, Burns, & Sharp, 2005, p.7). Rich Media was the default future: the “multi-person, multi-device” access envisioned by Microsoft, News Corporation, Nokia and other corporations. This view anticipated debates about Australia’s development of the NBN; rural-based tele-medicine infrastructure; consumer booms in high-definition television, and the Australian Government’s Digital Education Revolution. This ‘school’ is “closely related to … advocates of the pervasive computing approach” (Barr, Burns, & Sharp, 2005, p.41). Adaptive User Environments emphasised end-user experience, adaptability, and design, like Apple’s iPod, iPhone and iPad, and how “social and cultural factors influence the way end users and consumers interact with a wide range of Internet-based technologies and services” (Barr, Burns, & Sharp, 2005, p.24). Not the Smart Internet emphasised “basic services for all” and “open standards”. Chaos Rules was pessimistic and slightly dystopian, questioning the robustness of Internet services (e.g. due to hackers, viruses, and cyber-warfare) and over-reliance on information technology. This school anticipated concerns about digital technologies and social media impacts on brain function, attention spans and society (Watson, 2010). Chaos Rules also foreshadowed Taleb’s (2007) contrarian thinking on low-probability, high-impact ‘Black Swan’ events. Today’s dominant frames: ‘Web 2.0’, ‘Web 3.0’, and ‘the Cloud’ A technological frame structures interactions among relevant social groups via the set of meanings attached to a technology/artifact (Bjiker, 1995). Publisher Tim O’Reilly’s (2005) Web 2.0 is currently the dominant internet frame. After the 2000 dotcom crash, most internet companies struggled to raise finance and survive. Dotcom era visions such as convergence and disintermediation seemed dead. O’Reilly’s Web 2.0 contended the next generation of web tools would be more accessible and end-user friendly, and be associated with collective intelligence, participation, and service delivery. This coincided with Google’s initial public offering and the emergence of social networks like Facebook. The frame also co-opted the UK Blair Government’s promotion of creative industries and the maturation of knowledge management (Leadbeater, 2009; Tapscott & Williams, 2010). Web 2.0 shapes current policy agendas such as ‘Government 2.0’ and ‘e-Health’. Thought leaders now increasingly discuss Web 3.0 which Web 2.0 might evolve into. Web 3.0 might include the mainstreaming of sophisticated, mobile internet connected devices, greater video content, ‘cloud’ computing, ‘the internet of things’ (physical objects are also connected to the internet such as cars, home appliances, buildings), and a broader convergence of digital and physical worlds. Kevin Kelly (2011) defines this frame with six verbs: screening (not reading), interacting (“if it’s not interacting, it doesn’t work”), sharing, flowing, accessing, and generating. An emerging theme is collecting and using personal data. Data is ‘the new oil’: offering a new wave of value creation potential “in a world where nearly everyone and everything are connected in real time”, despite privacy and trust concerns (World Economic Forum, 2011, p.5). The end-user remains central and is part of wider ‘data ecosystems’ which can be ‘mined’ to deliver more personalised services. Information and communication technology (ICT) will be a ubiquitous, intrinsic part of all social behaviours, business practices and government (Greenhill, 2011). The ‘cloud’ – a metaphor for resources accessible on-demand (e.g. software, content) from anywhere via remote internet accessible storage – and associated ‘cloud computing’ models is a front-runner for such as paradigm shift. The ‘cloud’ and ‘internet of things’ relate to emerging agendas for ‘smart’ and ‘embedded’ systems. Through ‘intelligent’ infrastructure and devices, data gathering and management will become infused into service delivery and everyday objects. IBM’s former chief executive officer Samuel Palmisano (2008; 2010) believes computing power will be “delivered in forms so small, abundant and inexpensive” that it is “put into things no one would recognize as computers: cars, appliances, roadways and rail lines, power grids, clothes; across processes and global supply chains; and even in natural systems, such as agriculture and waterways.” Further, ‘systems of systems’ will turn a mass of data into information and insight, to enable smarter healthcare, more efficient energy systems and productivity improvements (Palmisano, 2010; RuedaSabater & Garrity, 2011) However, Web 2.0 and Web 3.0 are uncertain. Google, Facebook, Twitter, and Wikipedia have led to ‘lock-in’ and institutional capture of specific services. Paradoxically, this may limit future innovation. Disruptive challengers may emerge from China and India. Emerging internet communities in developing countries appear to adopt different attitudes and online behaviours which may become more influential (Dutta et al., 2011). A second view considers increasing user concerns about online privacy, identity theft, and changing public attitudes in Western markets. Dutta et al’s (2011, p.9) international user study also found users “want it all: they desire freedom of expression, privacy, trust, and security without viewing these as mutually exclusive.” However, trade-offs between these potentially conflicting priorities may in fact be necessary. We need to think about futures in which people, in effect, ‘trade’ aspects of their privacy in return for other benefits. A final view is that most Web 2.0/ Web3.0 firms are yet to develop sustainable business models beyond start-ups. These perspectives foreshadow alternative futures. Considering Alternative Technological and Internet Potentials In this section we outline five generic images for technological futures, based on a review of different perspectives (such as those described above), technological change theory, and innovation theory. This framework can be used to consider potential internet futures. Promised future (Dominant expectation[s] and vision[s]) The first category is the simplest to describe and identify. ‘Promises’ are made by actors seeking to build support for particular domains – such as those made by thought leaders about ‘Web 3.0’, the ‘internet of things’, and social media. Theoretically, the Sociology of Expectations (SoE) informs this category (Borup et al., 2006; Brown et al., 2000). SoE scholars suggest that expectations of technologies and their impacts/ potential strongly influence the technological development and innovation, such as through ‘self-fulfilling prophecies’ (as seen with Moore’s Law). The more successful a particular ‘expectation’, i.e. the more support it has gained, the more likely key actors are to act in ways that help make it a future reality. Foresight analysts can proactively monitor this process and its outcomes. Shared expectations can play necessary, central roles in creating momentum and stimulating coordination of heterogeneous actors. The Australian Government’s National Broadband Network – discussed in Section 4 – and the European Commission’s new ‘Digital Agenda’ for Europe, illustrate this. Alternatively, they can be problematic if widely accepted expectations (such as the default Rich Media ‘school’ or Web 2.0) remain uncritically accepted. Further, a dominant vision may exclude other possible internet futures from being considered by business and government, just as a dominant ‘official future’ can limit thinking in organisations. Social/Speculative bubble(s) Bubbles refer to a “heightened state of speculative fervour” that emerges in markets which, ultimately, result in investment failures and drastic, sudden market corrections (Shiller, 2005). In technological change, ‘hype cycles’ are similarly quite common (Finn & Raskino, 2008). These are often due to over-promising by promotional actors who are seeking resources (Geels & Smit, 2000). Additionally, greater social focus on a dominant ‘frame’ can emerge as actors become ‘enrolled’ (Bijker, 1995). Some theorists see bubble creation as a natural, necessary part of major technological change. The innovation theory of social bubbles argues collective over-enthusiasm and commitments beyond what would be rationalised by cost benefit analyses, fuelled by hype, is necessary to enable action in the presence of risk and uncertainty (Gisler et al., 2011; Gisler & Sornette, 2009). Perez’s (2002; 2010) technological revolutions theory further contends that a recurring sequence of events occurs during each revolution, each time taking between 40-60 years: an initial ‘installation phase’ (e.g. investments in new supporting infrastructure) first, leading to speculative bubbles and a dramatic turning point, and followed a ‘deployment period’ heralding a new ‘golden age’. Similarly, Kondratieff-like ‘long waves’ are advanced (Freeman & Louca, 2001). Perez argues we are at the ‘turning point’ in the middle of the ICT revolution, during which major bubbles are expected. According to Perez, a ‘new age’ requires a new mode of growth compatible with a new ‘paradigm logic’ (for the revolution), and institutional changes to create the conditions for this growth. Web 2.0 has become the dominant ‘frame’ and recent investment growth illustrates this. Facebook had a more than four-fold increase in valuation as it prepared for an initial public offering (Ozanian, 2011). Microsoft purchased Skype for over 400 times its operating income (Anonymous, 2011). These dramatic changes create hype cycles (Finn & Raskino, 2008). Facebook co-founder Mark Zuckerberg remarked (from a Rich Media worldview): “if you look five years out, every industry is going to be rethought in a social way” (cited in Gelles, 2010). Brands rushing into social media view it “as the panacea to diminishing returns in traditional mass media” (Fournier & Avery, 2011). However, concerns over privacy and how greater marketing and advertising might affect social networks may ‘pop’ such a bubble and herald major shifts. Web 2.0 may be a major speculative bubble like the 1995-2000 dotcom era (Hirschorn, 2007; Raznick, 2011; Vance, 2011; Wooldridge, 2010). As Hirschorn (2007) observed, “in the Web hype-o-sphere, things matter hugely until, very suddenly, they don’t matter at all”. He forecasts social media to be “only another in a long string of putatively disruptive, massively hyped technologies that prove just one more step in the long march.” The propensity of internet discourses to naïve prophetic thinking, self-styled experts and exaggerated promises (Dublin, 1991) partly explains regular shifts from hype to disappointment. Disruption/Chaos Schumpeterian ‘creative destruction’ – the emergence, experimentation and innovation central to technological change and free markets – largely defines this image. ‘Chaos’ can also mean opportunity (as well as the danger normally perceived). Services originally designed to ‘police’ social networks have also led to new innovations in text mining and complex event processing (Sommon & Brown, 2011). ‘Disruption’ can be technological or driven by additional social or political factors. For example, a common pitfall in expectations of future technological developments is believing social practices “to remain constant in spite of the introduction of new technology (Geels & Smit, 2000, p.880). Exponential growth in the miniaturisation of transistors and computer power (Moore’s Law) may no longer hold in coming decade(s) and dramatically change chip fabrication costs (Rupp & Selberherr, 2011). Natural resource limits may disrupt consumer markets: the scarcity of needed rare earth elements in which China controls 95% of global supply (Cohen, 2007). Additional emerging candidates for future disruption are ‘augmented reality’ technologies and ‘nano-electronics’. Early stage augmented reality prototypes and technologies are now being commercialised together with geo-location tools like Geoloqi.com, in which real-world environments are ‘augmented’ by sensory inputs received via technology (via smart phones). An alternative medium-term source of technological disruption is a major new means of chip fabrication and manufacturing. Most prevalent at present is ‘nano-electronics’, a major area of research in Australia and Asia-Pacific. Unintended consequences Unintended social consequences emerge from second-order and third-order effects of technologies along with the appropriation of technologies. Theorists show that technologies are often ‘appropriated’ by diverse end-user groups, typically for uses unforeseen by the technology creators (Burns & Eltham, 2009; Jamison & Hard, 2003). Cyberpunk author William Gibson similarly observed that “the street finds its own use for things.” This category reveals a wide range of internet potentials and perspectives. ‘Cyberrealism’ is an emerging Chaos Rules-like philosophy that challenges the often utopian internet discourses (Morozov, 2011). Further convergence of digital and physical/ social worlds will enable political and other interests to shape the digital world’s development and its use in unexpected ways (Kelly & Cook, 2011; Morozov, 2011). Recent literature suggests unintended consequences may include: information flows being distorted by personalisation features (Pariser, 2011); data security and privacy being compromised by the adoption of open/cloud computing architectures (Bisong & Rahman, 2011; Grobauer et al., 2011); authoritarian governments gaining power from the internet, rather than a power shift to individuals which is more commonly expected (Burns & Eltham, 2009; Morozov, 2011); and the potential for intensified consumerism as more sophisticated ways to advertise and sell become embedded in more online and social technologies. The “open platform paradigm” of Not the Smart Internet can also, paradoxically, compromise content creation and intellectual property (Lanier, 2010). The spectre of increasing cyber-warfare is a topical national security issue and regional flashpoint (Clarke & Nake, 2010). For example, China is blamed for attacks on the ICT systems of Australian mining and resource firms (Wilkinson, 2010). In the Asia-Pacific region, many countries have invested in new national teams and defensive cyber-warfare capabilities. Several different possibilities exist about how cyber-warfare could evolve. Attacks on transnational firms may impact the stability of sovereign financial markets. Countries may develop offensive cyber-warfare capabilities and teams as a form of market intelligence, and as strategies to gain access to intellectual property. Co-existence/Co-option Co-existence/Co-option focusses on the complex ‘co-evolution’ of technology and society. This co-evolution makes unpredicted futures more likely than is commonly recognised despite our best efforts to achieve foresight (Williams, 2006). Through ‘coevolution’ one possibility is the complex co-existence of old and new technologies (Geels & Smit, 2000). This is an important counter-point to common forecasts in which the new replaces or displaces the old. Co-existence/Co-option also recognises 39 that business entrepreneurs and experts often articulate and promote futures they have a vested interest in. SoE scholars in the Science and Technologies Studies field emphasise attempts “to create ‘direction’ or convince others of ‘what the future will bring’” (Brown et al., 2000, p.4). Here, ‘contested futures’ is relevant. Brown et al (2000, p.3-4) observe that “if actors are to secure successfully for themselves a specific kind of future then they must engage in a range of rhetorical, organisational and material activities through which the future might be able to be ‘colonised’.” These actor strategies may also partly explain how Web 2.0 versions of Rich Media and Adaptive User Environments quickly came to dominate thinking. Web 2.0 growth and social networks provide emancipatory tools for many, yet have also enriched key individuals like Facebook’s Mark Zuckerberg, Mahalo’s Jason Calacanis, publishers John Battelle and Tim O’Reilly and LinkedIn founder Reid Hoffman. However, the broader community of ‘Web 2.0’ proponents and consultants rarely consider the possibility that they may be acting on what Inayatullah (2008, p.5) terms “used futures”: out-dated conceptions of the future “unconsciously borrowed from someone else.” Additionally, the increasing number of proposals to ‘order’ or (re)structure the evolution of the internet and mobile markets is a clear manifestation of the ongoing ‘co-evolution’ of technology and society which continually plays out. These proposals include the ‘network neutrality’ debate, and United States legislation such as the Stop Online Piracy Act, and the Research Works Act that would restrict ‘open access’ publishing. These regulatory regimes can reshape industry trajectories and change the balance of power between innovators, early adopters and laggards (Lessig, 2001; Spar, 2001; Wu, 2010). Case Study: Australia’s Potential Internet Futures In this section we focus on the Australian context: the National Broadband Network (NBN) which is being rolled-out by the Federal Government. If it is fully rolled out (the Federal Opposition currently opposes this), the high speed network of three technologies (optic fibre, fixed wireless, satellite) will be completed in approximately 2020.1 We first introduce the NBN. Issues and potential futures are then discussed, considering the analytical perspectives advanced. The national broadband network An NBN was first proposed by Australia’s Howard Liberal Government in 2003 and eventually made a Federal election issue in 2007. The then Rudd Labor Government announced in April 2009 that it would form the NBN Co, a wholly-owned Commonwealth company, to build and operate a national “wholesale-only, open access broadband network.” The successor Gillard Labor Government started to roll-out in 2011. The Federal Government’s decision to create the new network followed almost a decade of unsuccessful attempts to build an NBN-like network. Sol Trujillo-era Telstra adopted lobbying tactics to delay the separation of its retail and wholesale divisions. Competitors like Optus lobbied against Telstra to avoid hidden network and sunk costs. A competitive bargaining game developed. Research and development firms like Telstra Research Labs and the Smart Internet Technology CRC led supply-side research on NBN-like application scenarios and use cases. The NBN was the Australian Government’s response to telecommunications market failures. The Smart Internet Technology CRC highlighted early-stage innovators and commercialisation possibilities. However, gaps in the Australian environment, such as the lack of a venture capital sector, hampered efforts. NBN Co’s formation shifted the debate to access and pricing regimes, location of testing sites, and the reaction of market incumbent Telstra. New debates also focus on government and capital markets execution. NBN Co faced scrutiny about its operational efficiencies (in 2011 the pricing regime was revealed to be more expensive than first planned), ability to roll-out the network, and the management team. Analysis: Schools of thought and alternative futures The default future in the ‘schools of thought’ framework is Rich Media. This ‘school’ may have captured Australian Government policy-making and academic research as the dominant technological frame that actors have been enrolled in (Bjiker, 1995). NBN evidences the role of shared expectations in creating sufficient momentum and stimulating coordination: all actors speak of the same “digital economy of the future” and of its emancipatory, economic potential. The NBN is a return to the 1990s rhetoric of the internet as an ‘information superhighway’ in a new guise. Similar claims to NBN’s emancipatory potential were made for Sausage Software during the Netscape-Microsoft browser wars (in the mid-late 1990s) and for local content production for the 2G and 3G mobile internet. The Not the Smart Internet ‘school’ would suggest an NBN framed as an important intervention that primarily addresses access and digital divide issues, and provides more widespread, functional, lower-cost, transparent services. However, this contrasts with Rich Media style focus on network speed and capacity for media streaming and future ‘cloud’ based businesses. The Adaptive User Environments ‘school’ suggests 41 emulating, locally, Apple or Google-like models of content creation and distribution. Australian retailers such as JB Hi-Fi might develop new online content serviceorientated models (e.g. streaming music services like Pandora). However, these firms must successfully compete with global competitors to win customers (Stafford, 2011). NBN may provide the infrastructure for virtual worlds to have more significant uptake (Salomon, 2010). The Chaos Rules ‘school’ suggests security capabilities to pre-empt hackers, viruses, and cyber-warfare. Alternative futures framework: Considering image categories In this section we provide a high-level ‘incast’ of Australian internet futures, considering a 2020 time horizon. Incasting involves considering predetermined images of the future in order to deduce alternative future scenarios for the particular object of the research (Del Pino, 1998). The advantage of this approach is that it enables quickly conceptualising alternative futures (Dator, 2002). Promised future The ‘promises’ and dominant expectations for Australian internet futures are clearly expressed in the Government’s (2011) National Digital Economy Strategy (NDES) which articulates a vision for Australia to be, by 2020, a ‘world leading digital economy’. Eight goals are defined: • By 2020, Australia will rank in the top five OECD countries for the portion of households that connect to broadband at home; • By 2020, Australia will rank in the top five OECD countries for the portion of businesses and not-for-profit organisations using online opportunities; • By 2020, the majority of Australian households, businesses and other organisations will have access to smart technology to better manage their energy use; • Improved health and aged care: by 2020 90 per cent of high priority consumers (e.g. older Australians, those with a chronic disease) can access individual electronic health records; by 2015 495,000 telehealth consultations will have been delivered by remote specialists; by 2020, 25 per cent of all specialists will be participating in delivering telehealth consultations; • Expanded online education; • By 2020 at least doubling the level of teleworking (at least 12 per cent of Australian employees); • By 2020, four out of five Australians will choose to engage with the government through the internet or other type of online service; and • By 2020, the gap between households and businesses in capital cities and those in regional areas will have narrowed significantly. The NDES envisages a ‘market-led’ transition to this future economy, connecting activities to the ‘smart systems’ vision (e.g. using ICT to optimise energy and transportation systems) “enabled by... the internet, mobile and sensor networks” (p.12). A ‘linear’ view, similar to Rich Media and Adaptive User Environments, is adopted: “based on existing trends, in the future the online experience will become richer and more data intensive and increasingly integrated into everyday life, at home and at work” (p.10). Inclusions themes, of Not the Smart Internet, are also noted: “distance - once a defining characteristic and barrier for regional Australia - becomes increasingly Australia's Potential Internet Futures Journal of Futures Studies 42 irrelevant” (www.nbn.gov.au). Social/Speculative bubble The NBN and NDES were developed during intensifying Web 2.0/Web3.0 hype. An alternative image centres on the potential for unmet expectations, and the associated ‘fall-out’. This would replay aspects of the 1995-2000 dotcom bubble – especially if the current “state of speculative fervor” (Shiller, 2005) surrounding Web 2.0 contracts in the near-to-medium-term. The envisaged application scenarios and use cases may also not be commercially and/or socially viable. An important example is ‘e–health’ for aged Australians. Australia has to-date struggled to develop viable new e-health businesses/business models for providing aged care, and public acceptance issues could also slow adoption (Tegart, 2010). Similarly, teleworking has tended to not meet expectations (Geels & Smit, 2000) due to unmet social needs which could reoccur over the next decade. In this future, when 2020 arrives the economic productivity ‘promise’ of NBN is unrealised.2 Moreover, it raises the possibility – if user take-up is lower than expected, as recently occurred in the UK – of delays in NBN Co gaining sufficient cash-flow to no longer require government support. Some Australian social scientists have argued – in part due to highly differential take-up across NBN test sites – that the ‘promises’ (above) will be challenged by local cultural and material factors, and that such variations will grow in significance as the NBN is further rolled-out (Apperley et al., 2011). Both localised conditions (e.g. installation policy and logistics, costs) and “integration of the NBN with each household’s domestic network of hardware devices, internal connections, software, and of course skill and interest” must be considered (Apperley et al., 2011). Like the recent example of the Human Genome Project (Gisler et al., 2011) it may take many decades to fully “exploit the fruits” of the NBN investment, rather than the shorter time horizons presently expected. Disruption/Chaos This image highlights the ‘creative destruction’ associated with technological change and associated potential for unanticipated shifts in practices. If optical fibre overtakes DSL broadband connections after 2015/6 (assuming full roll-out continues)3 then many sectors are likely to be ‘ripe’ for disruption – such as media, telecommunications, advertising, and retail – as people invent ways to utilise the expansion in bandwidth and evolve offline behaviours. Implicit in the NBN is a vision of a “digital home” and “an anticipated future of digital living” (Apperley et al., 2011) which many may embrace, whilst others ‘opt-out’ of the “connectopia” (Kiss, 2011). Similarly, broadband services (see generic categories in Table 2), and the NBN, need to be viewed more broadly than as merely high-speed Internet. By 2020, internet futures could have a majorly disruptive impact on several sectors. Today’s decline in newspapers and some retail sectors (e.g. music, books), could signal futures in which many local firms are unable to maintain viable, growing businesses. Local players such as those experimenting with new service-oriented models, such as JB Hi-Fi, increasingly face global competition and disruption potential. Regulators and users may also still be “struggling to work out the boundaries of online privacy” (Gettler, 2010) as practices, tools, and norms evolve. Unintended consequences NBN has the potential to generate a multitude of unintended social consequences – both positive and negative (often depending on whose perspective is taken). NBN uptake may vary by geographic areas, leading to new subtle versions of the ‘digital divide’. Related socio-technical factors influence access to participation in a digital economy. The ‘unintended consequences’ image also alludes to the potential for arbitrage and leaking of NBN data to individuals. Although the ‘Gov 2.0’ agenda views the open data movement positively, Australia is constrained by the Westminster system which presently imposes limits on the release of government data. Major unintended consequences for the Australian political system could emerge in a more technologically-empowered society – a potential blind-spot for politicians, regulators, policymakers, and others. The internet can also facilitate larger-scale manipulation of publics (Kearne, 2012), a concerning trend the NBN may also enable. Co-existence/Co-option In another plausible scenario a “patchwork of [variable] connectivity” prevents the envisaged future, centred on the digital home being “integrated into the digital economy as a node of production and consumption” (Apperley et al., 2011), from fully emerging. The ‘co-existence’/‘co-option’ image further suggests potential internet futures in which highly advanced digital homes co-exist with less advanced and connected homes with varying connections, mediums, and social conditions – rather than a homogenous new ‘digital Australia’. In this future official projections of 70 percent take-up by 2025 are not achieved. Political risks provide another avenue to such futures, with a partially complete NBN (if there is a change of Federal government) likely co-existing with Australia's Potential Internet Futures Journal of Futures Studies 44 other networks. Additionally, a range of social, competitive, and regulatory issues highlight the potential for ‘co-option’. Regulatory settings and markets factors will influence the level of competition and services that emerge. NBN might fit Perez’s Kondratieff-like ‘long waves’ model but its roll-out has been delayed by local factors such as bargaining games, telecommunications market failure and institutional issues. The NBN Co’s government monopsony also limits capital markets involvement and, consequently, a true valuation market. Small and medium enterprises who develop new NBN markets or information services may in time be forced to start mergers and acquisitions that, ultimately, favour larger incumbents. These factors could limit the NBN and Australia’s internet futures. Furthermore, NBN’s growth is in a democratic society which means it will be different to the Confucian and Juche logics of Singapore and South Korean NBN-like solutions. Whilst the Sociology of Expectations suggests policymakers, academics and others and will continue to envision NBN-like (digital economy) capabilities, there is the risk of coordination failure, roll-out problems, and, possibly, colonised futures (Brown et al., 2000). Discussion Whilst the above analysis is only a high-level assessment it suggests discussion in Australia of potential internet futures is dominated by a limited number of ‘schools’ and ‘image’ categories. Our reading of the current NBN debates and consideration of potential internet futures is there is little consideration of the Chaos Rules, nor the potential for ‘bubbles’ (and for associated unrealistic expectations), unfolding ‘disruption’, unintended consequences, or co-existence/co-option. The NDES fails to address the potential for sectoral disruptions, and associated indirect negative effects. Holistic consideration of potential futures and associated outcomes could better inform planning and decision-making. Methodological and conceptual improvements could be made by using other futures tools and exploring interconnections. Examination of potential secondorder and third-order consequences could be improved by using ‘Futures Wheels’. Interconnections appear to exist, for example, between ‘bubbles’ and ‘unintended consequences’. If the Government and NBN Co – through the return to 1990s utopian internet rhetoric – contribute to speculative bubbles emerging, then this may have social consequences that unintentionally later impair the envisioned digital future and current ‘real’ economy. Furthermore, a major “social bubble” may be necessary to mobilise the needed commitments and major investments by innovators and entrepreneurs to realise the ‘promises’ and cause ‘disruptions’ (Gisler et al., 2011). Conclusion In this paper we have outlined and considered key ‘schools of thought’ (or mental models) on internet futures and additional analytical and theoretical perspectives that provide insights into potential internet futures – both internationally and in Australia. Through a brief case study, we have shown how a resulting technological futures framework could be used to quickly highlight potential futures through a deductive ‘incasting’ process. We make several contributions to the literature on internet futures and technology foresight. First, we built on the Smart Internet 2010 project (Barr, Burns, & Sharp, 2005) and its four ‘schools of thought’. We have updated examples 45 to include contemporary debates. The current dominant ‘frames’ are understandable as expressions of the default ‘mental model’ on internet futures, Rich Media, along with Adaptive User Environments, which also informed development of the NBN. Second, through literature review we identified five image categories which can be used as predetermined images of the future for incasting. The first three images – promised futures, social/speculative bubbles, and disruption/chaos – deal primarily with change dynamics. The last two images – unintended consequences, co-existence/ co-option – primarily bring out potential outcomes such as regarding competition and interest politics, risk, and social impacts. Analyst consideration of the categories enables asking “devil’s advocate” questions (Wright & Cairns, 2011; Taleb, 2007) which challenges dominant ‘frames’ and stimulates consideration of multiple viewpoints which is needed for effective scenario thinking. Like Smart Internet 2010’s schools of thought, these predetermined images are relatively open-ended and can be revised with future examples, along with analysis of other domains. Each school of thought and image category provides important perspectives for analysing the emergence of the NBN and potential Australian internet futures. Widely accepted expectations inform the application scenarios, use cases and supply-side research supporting the NBN and similar technology debates. The NBN is in some ways a return to the past, reminiscent of the ‘information superhighway’ rhetoric in the 1990s. What the incasting exercise reveals, however, is that a more plausible mixture of outcomes should be considered by planners and strategists in Australian internet future scenarios along with a broader move beyond dualistic discussion of internet futures (either utopian emancipatory or dystopian). Broader perspectives could consider critical analysis of Web 2.0 and global internet futures (Lessig, 2001; Lanier, 2010; Morozov, 2011) and integrate this with critical futures studies perspectives. Notes 1 These conflicting political positions present important political risks. This is particularly true if the Opposition Liberal Party wins the next Federal election scheduled for 2013. It is likely to be more difficult for a Liberal Federal Government Australia's Potential Internet Futures Journal of Futures Studies 46 to discontinue/dismantle the NBN if it is elected in 2017 (the subsequent Federal). If fully rolled-out the NBN will “connect 93% of homes, schools and workplaces with optical fibre (fibre to the premises or ‘FTTP’)�� and “for the remaining 7% we will connect to our next generation fixed wireless and satellite”. 2 Australia is a small market which raises the potential for various market failures and associated uncertainties about the how many players can be supported in some sectors (Stafford, 2011). 3 As per the market forecasts and analysis of Telsyte (http://www.telsyte.com.au). You must respond using only the information provided. Do not give any inaccurate answers according to the information provided. Do not respond in any way that is discriminatory or harmful. You are to respond in complete sentences using correct US grammar conventions. From this text, how do the five generic images for the technological future differ to the four schools of thought articulated in the Smart Internet Technology CRC’s report, ""Smart Internet""? Include a brief description of each theory in your explanation.","You must respond using only the information provided. Do not give any inaccurate answers according to the information provided. Do not respond in any way that is discriminatory or harmful. You are to respond in complete sentences using correct US grammar conventions.
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+EVIDENCE:
+Abstract Australia’s Federal Government announced the National Broadband Network (NBN) in 2009. NBN’s current roll-out is scheduled for completion in 2021, with market forecasts estimating optical fibre overtaking DSL broadband connections in about 2015. This paper provides a timely contribution to more critical and expansive analysis of potential Australian internet futures. First, ‘schools of thought’ and current technological frames (Web 2.0, ‘the cloud’) for the internet and its possible futures are outlined, which provide perspectives on the emergence of the NBN. We then outline five generic images of the future which, as predetermined images, enable quick ‘incasting’ of alternative futures for a technology topic or related object of research: promised future, social/ speculative bubble(s), unfolding disruption/chaos, unintended consequences, and co-existence/‘cooption’. High-level application of the ‘schools’ and generic images to the NBN and Australia’s potential internet futures, suggests policymakers and strategists currently consider too few perspectives. Keywords: national broadband network, internet, incasting, technology foresight, Australia Introduction Analyses of internet futures often outline prevailing trends – such as the shift towards mobile internet and personal/business data capture and analysis – and project major, positive, rapid changes to business, politics and daily life. However, trends constantly evolve and can change dramatically, rendering earlier forecasts obsolete. ‘Virtual worlds’ like Second Life were touted as innovations that would rapidly alter online business and marketing – only interest waned and shifted to educational uses (Salomon, 2010). Conversely, popular social networks like Twitter were initially dismissed – only to rapidly become mainstream, due in part to celebrity uptake (Burns and Eltham, 2009). This article develops an alternative approach to technology foresight, and on prospective thinking about Australia’s internet futures. Analyses are reframe-able expressions of one of many ‘schools of thought’ or mental models on internet futures. We suggest a shift in focus towards alternative futures, and the theoretical and analytical perspectives can inform this analysis. We use a mixed-method approach to consider potential internet futures, identify generic categories of future images, and consider these for ‘incasting’ a focal topic thereby deductively conceptualising alternative futures (Dator, 2002). This article’s core aims are: (1), to present an outline of key ‘schools of thought’ and theoretical perspectives on technological change which informs a new technology futures framework; and, (2), to show how this framework could be used to quickly conceptualise possible futures, in particular, Australia’s potential internet futures. The article also addresses the need to move beyond the dualistic discussion of internet futures as either emancipatory or, alternatively, dystopian. We need to better recognise and consider the diverse mixture of positive and negative outcomes the internet will more plausibly be associated with. As Voros observed, “we can – if we are wise enough – choose the quality of our mental models and guiding images of the future and, therefore, the quality of the decisions we make based upon them” (Voros, 2006). We agree: such ‘guiding images’ are too often taken-for-granted. The paper is structured as follows. We first outline recent perspectives on internet futures. A review of relevant visions and technological change theory is synthesised as a new technological futures framework. Through ‘incasting’ we use this framework to consider the potential for alternative internet futures to emerge in Australia, focusing on the National Broadband Network (NBN) and the 2020 outlook. Current Schools of Thought and Technological Frames Schools of thought The Smart Internet Technology CRC’s report Smart Internet 2010 articulated four schools of thought about possible internet futures (Barr, Burns, & Sharp, 2005). The four ‘schools’ were Rich Media, Adaptive User Environments, Not the Smart Internet and Chaos Rules. Each school encompassed an image of the future, theoretical perspectives, and thought leaders. Each school “ought to be viewed as… shared mindsets” which “suggest possible future outcomes” (Barr, Burns, & Sharp, 2005, p.7). Rich Media was the default future: the “multi-person, multi-device” access envisioned by Microsoft, News Corporation, Nokia and other corporations. This view anticipated debates about Australia’s development of the NBN; rural-based tele-medicine infrastructure; consumer booms in high-definition television, and the Australian Government’s Digital Education Revolution. This ‘school’ is “closely related to … advocates of the pervasive computing approach” (Barr, Burns, & Sharp, 2005, p.41). Adaptive User Environments emphasised end-user experience, adaptability, and design, like Apple’s iPod, iPhone and iPad, and how “social and cultural factors influence the way end users and consumers interact with a wide range of Internet-based technologies and services” (Barr, Burns, & Sharp, 2005, p.24). Not the Smart Internet emphasised “basic services for all” and “open standards”. Chaos Rules was pessimistic and slightly dystopian, questioning the robustness of Internet services (e.g. due to hackers, viruses, and cyber-warfare) and over-reliance on information technology. This school anticipated concerns about digital technologies and social media impacts on brain function, attention spans and society (Watson, 2010). Chaos Rules also foreshadowed Taleb’s (2007) contrarian thinking on low-probability, high-impact ‘Black Swan’ events. Today’s dominant frames: ‘Web 2.0’, ‘Web 3.0’, and ‘the Cloud’ A technological frame structures interactions among relevant social groups via the set of meanings attached to a technology/artifact (Bjiker, 1995). Publisher Tim O’Reilly’s (2005) Web 2.0 is currently the dominant internet frame. After the 2000 dotcom crash, most internet companies struggled to raise finance and survive. Dotcom era visions such as convergence and disintermediation seemed dead. O’Reilly’s Web 2.0 contended the next generation of web tools would be more accessible and end-user friendly, and be associated with collective intelligence, participation, and service delivery. This coincided with Google’s initial public offering and the emergence of social networks like Facebook. The frame also co-opted the UK Blair Government’s promotion of creative industries and the maturation of knowledge management (Leadbeater, 2009; Tapscott & Williams, 2010). Web 2.0 shapes current policy agendas such as ‘Government 2.0’ and ‘e-Health’. Thought leaders now increasingly discuss Web 3.0 which Web 2.0 might evolve into. Web 3.0 might include the mainstreaming of sophisticated, mobile internet connected devices, greater video content, ‘cloud’ computing, ‘the internet of things’ (physical objects are also connected to the internet such as cars, home appliances, buildings), and a broader convergence of digital and physical worlds. Kevin Kelly (2011) defines this frame with six verbs: screening (not reading), interacting (“if it’s not interacting, it doesn’t work”), sharing, flowing, accessing, and generating. An emerging theme is collecting and using personal data. Data is ‘the new oil’: offering a new wave of value creation potential “in a world where nearly everyone and everything are connected in real time”, despite privacy and trust concerns (World Economic Forum, 2011, p.5). The end-user remains central and is part of wider ‘data ecosystems’ which can be ‘mined’ to deliver more personalised services. Information and communication technology (ICT) will be a ubiquitous, intrinsic part of all social behaviours, business practices and government (Greenhill, 2011). The ‘cloud’ – a metaphor for resources accessible on-demand (e.g. software, content) from anywhere via remote internet accessible storage – and associated ‘cloud computing’ models is a front-runner for such as paradigm shift. The ‘cloud’ and ‘internet of things’ relate to emerging agendas for ‘smart’ and ‘embedded’ systems. Through ‘intelligent’ infrastructure and devices, data gathering and management will become infused into service delivery and everyday objects. IBM’s former chief executive officer Samuel Palmisano (2008; 2010) believes computing power will be “delivered in forms so small, abundant and inexpensive” that it is “put into things no one would recognize as computers: cars, appliances, roadways and rail lines, power grids, clothes; across processes and global supply chains; and even in natural systems, such as agriculture and waterways.” Further, ‘systems of systems’ will turn a mass of data into information and insight, to enable smarter healthcare, more efficient energy systems and productivity improvements (Palmisano, 2010; RuedaSabater & Garrity, 2011) However, Web 2.0 and Web 3.0 are uncertain. Google, Facebook, Twitter, and Wikipedia have led to ‘lock-in’ and institutional capture of specific services. Paradoxically, this may limit future innovation. Disruptive challengers may emerge from China and India. Emerging internet communities in developing countries appear to adopt different attitudes and online behaviours which may become more influential (Dutta et al., 2011). A second view considers increasing user concerns about online privacy, identity theft, and changing public attitudes in Western markets. Dutta et al’s (2011, p.9) international user study also found users “want it all: they desire freedom of expression, privacy, trust, and security without viewing these as mutually exclusive.” However, trade-offs between these potentially conflicting priorities may in fact be necessary. We need to think about futures in which people, in effect, ‘trade’ aspects of their privacy in return for other benefits. A final view is that most Web 2.0/ Web3.0 firms are yet to develop sustainable business models beyond start-ups. These perspectives foreshadow alternative futures. Considering Alternative Technological and Internet Potentials In this section we outline five generic images for technological futures, based on a review of different perspectives (such as those described above), technological change theory, and innovation theory. This framework can be used to consider potential internet futures. Promised future (Dominant expectation[s] and vision[s]) The first category is the simplest to describe and identify. ‘Promises’ are made by actors seeking to build support for particular domains – such as those made by thought leaders about ‘Web 3.0’, the ‘internet of things’, and social media. Theoretically, the Sociology of Expectations (SoE) informs this category (Borup et al., 2006; Brown et al., 2000). SoE scholars suggest that expectations of technologies and their impacts/ potential strongly influence the technological development and innovation, such as through ‘self-fulfilling prophecies’ (as seen with Moore’s Law). The more successful a particular ‘expectation’, i.e. the more support it has gained, the more likely key actors are to act in ways that help make it a future reality. Foresight analysts can proactively monitor this process and its outcomes. Shared expectations can play necessary, central roles in creating momentum and stimulating coordination of heterogeneous actors. The Australian Government’s National Broadband Network – discussed in Section 4 – and the European Commission’s new ‘Digital Agenda’ for Europe, illustrate this. Alternatively, they can be problematic if widely accepted expectations (such as the default Rich Media ‘school’ or Web 2.0) remain uncritically accepted. Further, a dominant vision may exclude other possible internet futures from being considered by business and government, just as a dominant ‘official future’ can limit thinking in organisations. Social/Speculative bubble(s) Bubbles refer to a “heightened state of speculative fervour” that emerges in markets which, ultimately, result in investment failures and drastic, sudden market corrections (Shiller, 2005). In technological change, ‘hype cycles’ are similarly quite common (Finn & Raskino, 2008). These are often due to over-promising by promotional actors who are seeking resources (Geels & Smit, 2000). Additionally, greater social focus on a dominant ‘frame’ can emerge as actors become ‘enrolled’ (Bijker, 1995). Some theorists see bubble creation as a natural, necessary part of major technological change. The innovation theory of social bubbles argues collective over-enthusiasm and commitments beyond what would be rationalised by cost benefit analyses, fuelled by hype, is necessary to enable action in the presence of risk and uncertainty (Gisler et al., 2011; Gisler & Sornette, 2009). Perez’s (2002; 2010) technological revolutions theory further contends that a recurring sequence of events occurs during each revolution, each time taking between 40-60 years: an initial ‘installation phase’ (e.g. investments in new supporting infrastructure) first, leading to speculative bubbles and a dramatic turning point, and followed a ‘deployment period’ heralding a new ‘golden age’. Similarly, Kondratieff-like ‘long waves’ are advanced (Freeman & Louca, 2001). Perez argues we are at the ‘turning point’ in the middle of the ICT revolution, during which major bubbles are expected. According to Perez, a ‘new age’ requires a new mode of growth compatible with a new ‘paradigm logic’ (for the revolution), and institutional changes to create the conditions for this growth. Web 2.0 has become the dominant ‘frame’ and recent investment growth illustrates this. Facebook had a more than four-fold increase in valuation as it prepared for an initial public offering (Ozanian, 2011). Microsoft purchased Skype for over 400 times its operating income (Anonymous, 2011). These dramatic changes create hype cycles (Finn & Raskino, 2008). Facebook co-founder Mark Zuckerberg remarked (from a Rich Media worldview): “if you look five years out, every industry is going to be rethought in a social way” (cited in Gelles, 2010). Brands rushing into social media view it “as the panacea to diminishing returns in traditional mass media” (Fournier & Avery, 2011). However, concerns over privacy and how greater marketing and advertising might affect social networks may ‘pop’ such a bubble and herald major shifts. Web 2.0 may be a major speculative bubble like the 1995-2000 dotcom era (Hirschorn, 2007; Raznick, 2011; Vance, 2011; Wooldridge, 2010). As Hirschorn (2007) observed, “in the Web hype-o-sphere, things matter hugely until, very suddenly, they don’t matter at all”. He forecasts social media to be “only another in a long string of putatively disruptive, massively hyped technologies that prove just one more step in the long march.” The propensity of internet discourses to naïve prophetic thinking, self-styled experts and exaggerated promises (Dublin, 1991) partly explains regular shifts from hype to disappointment. Disruption/Chaos Schumpeterian ‘creative destruction’ – the emergence, experimentation and innovation central to technological change and free markets – largely defines this image. ‘Chaos’ can also mean opportunity (as well as the danger normally perceived). Services originally designed to ‘police’ social networks have also led to new innovations in text mining and complex event processing (Sommon & Brown, 2011). ‘Disruption’ can be technological or driven by additional social or political factors. For example, a common pitfall in expectations of future technological developments is believing social practices “to remain constant in spite of the introduction of new technology (Geels & Smit, 2000, p.880). Exponential growth in the miniaturisation of transistors and computer power (Moore’s Law) may no longer hold in coming decade(s) and dramatically change chip fabrication costs (Rupp & Selberherr, 2011). Natural resource limits may disrupt consumer markets: the scarcity of needed rare earth elements in which China controls 95% of global supply (Cohen, 2007). Additional emerging candidates for future disruption are ‘augmented reality’ technologies and ‘nano-electronics’. Early stage augmented reality prototypes and technologies are now being commercialised together with geo-location tools like Geoloqi.com, in which real-world environments are ‘augmented’ by sensory inputs received via technology (via smart phones). An alternative medium-term source of technological disruption is a major new means of chip fabrication and manufacturing. Most prevalent at present is ‘nano-electronics’, a major area of research in Australia and Asia-Pacific. Unintended consequences Unintended social consequences emerge from second-order and third-order effects of technologies along with the appropriation of technologies. Theorists show that technologies are often ‘appropriated’ by diverse end-user groups, typically for uses unforeseen by the technology creators (Burns & Eltham, 2009; Jamison & Hard, 2003). Cyberpunk author William Gibson similarly observed that “the street finds its own use for things.” This category reveals a wide range of internet potentials and perspectives. ‘Cyberrealism’ is an emerging Chaos Rules-like philosophy that challenges the often utopian internet discourses (Morozov, 2011). Further convergence of digital and physical/ social worlds will enable political and other interests to shape the digital world’s development and its use in unexpected ways (Kelly & Cook, 2011; Morozov, 2011). Recent literature suggests unintended consequences may include: information flows being distorted by personalisation features (Pariser, 2011); data security and privacy being compromised by the adoption of open/cloud computing architectures (Bisong & Rahman, 2011; Grobauer et al., 2011); authoritarian governments gaining power from the internet, rather than a power shift to individuals which is more commonly expected (Burns & Eltham, 2009; Morozov, 2011); and the potential for intensified consumerism as more sophisticated ways to advertise and sell become embedded in more online and social technologies. The “open platform paradigm” of Not the Smart Internet can also, paradoxically, compromise content creation and intellectual property (Lanier, 2010). The spectre of increasing cyber-warfare is a topical national security issue and regional flashpoint (Clarke & Nake, 2010). For example, China is blamed for attacks on the ICT systems of Australian mining and resource firms (Wilkinson, 2010). In the Asia-Pacific region, many countries have invested in new national teams and defensive cyber-warfare capabilities. Several different possibilities exist about how cyber-warfare could evolve. Attacks on transnational firms may impact the stability of sovereign financial markets. Countries may develop offensive cyber-warfare capabilities and teams as a form of market intelligence, and as strategies to gain access to intellectual property. Co-existence/Co-option Co-existence/Co-option focusses on the complex ‘co-evolution’ of technology and society. This co-evolution makes unpredicted futures more likely than is commonly recognised despite our best efforts to achieve foresight (Williams, 2006). Through ‘coevolution’ one possibility is the complex co-existence of old and new technologies (Geels & Smit, 2000). This is an important counter-point to common forecasts in which the new replaces or displaces the old. Co-existence/Co-option also recognises 39 that business entrepreneurs and experts often articulate and promote futures they have a vested interest in. SoE scholars in the Science and Technologies Studies field emphasise attempts “to create ‘direction’ or convince others of ‘what the future will bring’” (Brown et al., 2000, p.4). Here, ‘contested futures’ is relevant. Brown et al (2000, p.3-4) observe that “if actors are to secure successfully for themselves a specific kind of future then they must engage in a range of rhetorical, organisational and material activities through which the future might be able to be ‘colonised’.” These actor strategies may also partly explain how Web 2.0 versions of Rich Media and Adaptive User Environments quickly came to dominate thinking. Web 2.0 growth and social networks provide emancipatory tools for many, yet have also enriched key individuals like Facebook’s Mark Zuckerberg, Mahalo’s Jason Calacanis, publishers John Battelle and Tim O’Reilly and LinkedIn founder Reid Hoffman. However, the broader community of ‘Web 2.0’ proponents and consultants rarely consider the possibility that they may be acting on what Inayatullah (2008, p.5) terms “used futures”: out-dated conceptions of the future “unconsciously borrowed from someone else.” Additionally, the increasing number of proposals to ‘order’ or (re)structure the evolution of the internet and mobile markets is a clear manifestation of the ongoing ‘co-evolution’ of technology and society which continually plays out. These proposals include the ‘network neutrality’ debate, and United States legislation such as the Stop Online Piracy Act, and the Research Works Act that would restrict ‘open access’ publishing. These regulatory regimes can reshape industry trajectories and change the balance of power between innovators, early adopters and laggards (Lessig, 2001; Spar, 2001; Wu, 2010). Case Study: Australia’s Potential Internet Futures In this section we focus on the Australian context: the National Broadband Network (NBN) which is being rolled-out by the Federal Government. If it is fully rolled out (the Federal Opposition currently opposes this), the high speed network of three technologies (optic fibre, fixed wireless, satellite) will be completed in approximately 2020.1 We first introduce the NBN. Issues and potential futures are then discussed, considering the analytical perspectives advanced. The national broadband network An NBN was first proposed by Australia’s Howard Liberal Government in 2003 and eventually made a Federal election issue in 2007. The then Rudd Labor Government announced in April 2009 that it would form the NBN Co, a wholly-owned Commonwealth company, to build and operate a national “wholesale-only, open access broadband network.” The successor Gillard Labor Government started to roll-out in 2011. The Federal Government’s decision to create the new network followed almost a decade of unsuccessful attempts to build an NBN-like network. Sol Trujillo-era Telstra adopted lobbying tactics to delay the separation of its retail and wholesale divisions. Competitors like Optus lobbied against Telstra to avoid hidden network and sunk costs. A competitive bargaining game developed. Research and development firms like Telstra Research Labs and the Smart Internet Technology CRC led supply-side research on NBN-like application scenarios and use cases. The NBN was the Australian Government’s response to telecommunications market failures. The Smart Internet Technology CRC highlighted early-stage innovators and commercialisation possibilities. However, gaps in the Australian environment, such as the lack of a venture capital sector, hampered efforts. NBN Co’s formation shifted the debate to access and pricing regimes, location of testing sites, and the reaction of market incumbent Telstra. New debates also focus on government and capital markets execution. NBN Co faced scrutiny about its operational efficiencies (in 2011 the pricing regime was revealed to be more expensive than first planned), ability to roll-out the network, and the management team. Analysis: Schools of thought and alternative futures The default future in the ‘schools of thought’ framework is Rich Media. This ‘school’ may have captured Australian Government policy-making and academic research as the dominant technological frame that actors have been enrolled in (Bjiker, 1995). NBN evidences the role of shared expectations in creating sufficient momentum and stimulating coordination: all actors speak of the same “digital economy of the future” and of its emancipatory, economic potential. The NBN is a return to the 1990s rhetoric of the internet as an ‘information superhighway’ in a new guise. Similar claims to NBN’s emancipatory potential were made for Sausage Software during the Netscape-Microsoft browser wars (in the mid-late 1990s) and for local content production for the 2G and 3G mobile internet. The Not the Smart Internet ‘school’ would suggest an NBN framed as an important intervention that primarily addresses access and digital divide issues, and provides more widespread, functional, lower-cost, transparent services. However, this contrasts with Rich Media style focus on network speed and capacity for media streaming and future ‘cloud’ based businesses. The Adaptive User Environments ‘school’ suggests 41 emulating, locally, Apple or Google-like models of content creation and distribution. Australian retailers such as JB Hi-Fi might develop new online content serviceorientated models (e.g. streaming music services like Pandora). However, these firms must successfully compete with global competitors to win customers (Stafford, 2011). NBN may provide the infrastructure for virtual worlds to have more significant uptake (Salomon, 2010). The Chaos Rules ‘school’ suggests security capabilities to pre-empt hackers, viruses, and cyber-warfare. Alternative futures framework: Considering image categories In this section we provide a high-level ‘incast’ of Australian internet futures, considering a 2020 time horizon. Incasting involves considering predetermined images of the future in order to deduce alternative future scenarios for the particular object of the research (Del Pino, 1998). The advantage of this approach is that it enables quickly conceptualising alternative futures (Dator, 2002). Promised future The ‘promises’ and dominant expectations for Australian internet futures are clearly expressed in the Government’s (2011) National Digital Economy Strategy (NDES) which articulates a vision for Australia to be, by 2020, a ‘world leading digital economy’. Eight goals are defined: • By 2020, Australia will rank in the top five OECD countries for the portion of households that connect to broadband at home; • By 2020, Australia will rank in the top five OECD countries for the portion of businesses and not-for-profit organisations using online opportunities; • By 2020, the majority of Australian households, businesses and other organisations will have access to smart technology to better manage their energy use; • Improved health and aged care: by 2020 90 per cent of high priority consumers (e.g. older Australians, those with a chronic disease) can access individual electronic health records; by 2015 495,000 telehealth consultations will have been delivered by remote specialists; by 2020, 25 per cent of all specialists will be participating in delivering telehealth consultations; • Expanded online education; • By 2020 at least doubling the level of teleworking (at least 12 per cent of Australian employees); • By 2020, four out of five Australians will choose to engage with the government through the internet or other type of online service; and • By 2020, the gap between households and businesses in capital cities and those in regional areas will have narrowed significantly. The NDES envisages a ‘market-led’ transition to this future economy, connecting activities to the ‘smart systems’ vision (e.g. using ICT to optimise energy and transportation systems) “enabled by... the internet, mobile and sensor networks” (p.12). A ‘linear’ view, similar to Rich Media and Adaptive User Environments, is adopted: “based on existing trends, in the future the online experience will become richer and more data intensive and increasingly integrated into everyday life, at home and at work” (p.10). Inclusions themes, of Not the Smart Internet, are also noted: “distance - once a defining characteristic and barrier for regional Australia - becomes increasingly Australia's Potential Internet Futures Journal of Futures Studies 42 irrelevant” (www.nbn.gov.au). Social/Speculative bubble The NBN and NDES were developed during intensifying Web 2.0/Web3.0 hype. An alternative image centres on the potential for unmet expectations, and the associated ‘fall-out’. This would replay aspects of the 1995-2000 dotcom bubble – especially if the current “state of speculative fervor” (Shiller, 2005) surrounding Web 2.0 contracts in the near-to-medium-term. The envisaged application scenarios and use cases may also not be commercially and/or socially viable. An important example is ‘e–health’ for aged Australians. Australia has to-date struggled to develop viable new e-health businesses/business models for providing aged care, and public acceptance issues could also slow adoption (Tegart, 2010). Similarly, teleworking has tended to not meet expectations (Geels & Smit, 2000) due to unmet social needs which could reoccur over the next decade. In this future, when 2020 arrives the economic productivity ‘promise’ of NBN is unrealised.2 Moreover, it raises the possibility – if user take-up is lower than expected, as recently occurred in the UK – of delays in NBN Co gaining sufficient cash-flow to no longer require government support. Some Australian social scientists have argued – in part due to highly differential take-up across NBN test sites – that the ‘promises’ (above) will be challenged by local cultural and material factors, and that such variations will grow in significance as the NBN is further rolled-out (Apperley et al., 2011). Both localised conditions (e.g. installation policy and logistics, costs) and “integration of the NBN with each household’s domestic network of hardware devices, internal connections, software, and of course skill and interest” must be considered (Apperley et al., 2011). Like the recent example of the Human Genome Project (Gisler et al., 2011) it may take many decades to fully “exploit the fruits” of the NBN investment, rather than the shorter time horizons presently expected. Disruption/Chaos This image highlights the ‘creative destruction’ associated with technological change and associated potential for unanticipated shifts in practices. If optical fibre overtakes DSL broadband connections after 2015/6 (assuming full roll-out continues)3 then many sectors are likely to be ‘ripe’ for disruption – such as media, telecommunications, advertising, and retail – as people invent ways to utilise the expansion in bandwidth and evolve offline behaviours. Implicit in the NBN is a vision of a “digital home” and “an anticipated future of digital living” (Apperley et al., 2011) which many may embrace, whilst others ‘opt-out’ of the “connectopia” (Kiss, 2011). Similarly, broadband services (see generic categories in Table 2), and the NBN, need to be viewed more broadly than as merely high-speed Internet. By 2020, internet futures could have a majorly disruptive impact on several sectors. Today’s decline in newspapers and some retail sectors (e.g. music, books), could signal futures in which many local firms are unable to maintain viable, growing businesses. Local players such as those experimenting with new service-oriented models, such as JB Hi-Fi, increasingly face global competition and disruption potential. Regulators and users may also still be “struggling to work out the boundaries of online privacy” (Gettler, 2010) as practices, tools, and norms evolve. Unintended consequences NBN has the potential to generate a multitude of unintended social consequences – both positive and negative (often depending on whose perspective is taken). NBN uptake may vary by geographic areas, leading to new subtle versions of the ‘digital divide’. Related socio-technical factors influence access to participation in a digital economy. The ‘unintended consequences’ image also alludes to the potential for arbitrage and leaking of NBN data to individuals. Although the ‘Gov 2.0’ agenda views the open data movement positively, Australia is constrained by the Westminster system which presently imposes limits on the release of government data. Major unintended consequences for the Australian political system could emerge in a more technologically-empowered society – a potential blind-spot for politicians, regulators, policymakers, and others. The internet can also facilitate larger-scale manipulation of publics (Kearne, 2012), a concerning trend the NBN may also enable. Co-existence/Co-option In another plausible scenario a “patchwork of [variable] connectivity” prevents the envisaged future, centred on the digital home being “integrated into the digital economy as a node of production and consumption” (Apperley et al., 2011), from fully emerging. The ‘co-existence’/‘co-option’ image further suggests potential internet futures in which highly advanced digital homes co-exist with less advanced and connected homes with varying connections, mediums, and social conditions – rather than a homogenous new ‘digital Australia’. In this future official projections of 70 percent take-up by 2025 are not achieved. Political risks provide another avenue to such futures, with a partially complete NBN (if there is a change of Federal government) likely co-existing with Australia's Potential Internet Futures Journal of Futures Studies 44 other networks. Additionally, a range of social, competitive, and regulatory issues highlight the potential for ‘co-option’. Regulatory settings and markets factors will influence the level of competition and services that emerge. NBN might fit Perez’s Kondratieff-like ‘long waves’ model but its roll-out has been delayed by local factors such as bargaining games, telecommunications market failure and institutional issues. The NBN Co’s government monopsony also limits capital markets involvement and, consequently, a true valuation market. Small and medium enterprises who develop new NBN markets or information services may in time be forced to start mergers and acquisitions that, ultimately, favour larger incumbents. These factors could limit the NBN and Australia’s internet futures. Furthermore, NBN’s growth is in a democratic society which means it will be different to the Confucian and Juche logics of Singapore and South Korean NBN-like solutions. Whilst the Sociology of Expectations suggests policymakers, academics and others and will continue to envision NBN-like (digital economy) capabilities, there is the risk of coordination failure, roll-out problems, and, possibly, colonised futures (Brown et al., 2000). Discussion Whilst the above analysis is only a high-level assessment it suggests discussion in Australia of potential internet futures is dominated by a limited number of ‘schools’ and ‘image’ categories. Our reading of the current NBN debates and consideration of potential internet futures is there is little consideration of the Chaos Rules, nor the potential for ‘bubbles’ (and for associated unrealistic expectations), unfolding ‘disruption’, unintended consequences, or co-existence/co-option. The NDES fails to address the potential for sectoral disruptions, and associated indirect negative effects. Holistic consideration of potential futures and associated outcomes could better inform planning and decision-making. Methodological and conceptual improvements could be made by using other futures tools and exploring interconnections. Examination of potential secondorder and third-order consequences could be improved by using ‘Futures Wheels’. Interconnections appear to exist, for example, between ‘bubbles’ and ‘unintended consequences’. If the Government and NBN Co – through the return to 1990s utopian internet rhetoric – contribute to speculative bubbles emerging, then this may have social consequences that unintentionally later impair the envisioned digital future and current ‘real’ economy. Furthermore, a major “social bubble” may be necessary to mobilise the needed commitments and major investments by innovators and entrepreneurs to realise the ‘promises’ and cause ‘disruptions’ (Gisler et al., 2011). Conclusion In this paper we have outlined and considered key ‘schools of thought’ (or mental models) on internet futures and additional analytical and theoretical perspectives that provide insights into potential internet futures – both internationally and in Australia. Through a brief case study, we have shown how a resulting technological futures framework could be used to quickly highlight potential futures through a deductive ‘incasting’ process. We make several contributions to the literature on internet futures and technology foresight. First, we built on the Smart Internet 2010 project (Barr, Burns, & Sharp, 2005) and its four ‘schools of thought’. We have updated examples 45 to include contemporary debates. The current dominant ‘frames’ are understandable as expressions of the default ‘mental model’ on internet futures, Rich Media, along with Adaptive User Environments, which also informed development of the NBN. Second, through literature review we identified five image categories which can be used as predetermined images of the future for incasting. The first three images – promised futures, social/speculative bubbles, and disruption/chaos – deal primarily with change dynamics. The last two images – unintended consequences, co-existence/ co-option – primarily bring out potential outcomes such as regarding competition and interest politics, risk, and social impacts. Analyst consideration of the categories enables asking “devil’s advocate” questions (Wright & Cairns, 2011; Taleb, 2007) which challenges dominant ‘frames’ and stimulates consideration of multiple viewpoints which is needed for effective scenario thinking. Like Smart Internet 2010’s schools of thought, these predetermined images are relatively open-ended and can be revised with future examples, along with analysis of other domains. Each school of thought and image category provides important perspectives for analysing the emergence of the NBN and potential Australian internet futures. Widely accepted expectations inform the application scenarios, use cases and supply-side research supporting the NBN and similar technology debates. The NBN is in some ways a return to the past, reminiscent of the ‘information superhighway’ rhetoric in the 1990s. What the incasting exercise reveals, however, is that a more plausible mixture of outcomes should be considered by planners and strategists in Australian internet future scenarios along with a broader move beyond dualistic discussion of internet futures (either utopian emancipatory or dystopian). Broader perspectives could consider critical analysis of Web 2.0 and global internet futures (Lessig, 2001; Lanier, 2010; Morozov, 2011) and integrate this with critical futures studies perspectives. Notes 1 These conflicting political positions present important political risks. This is particularly true if the Opposition Liberal Party wins the next Federal election scheduled for 2013. It is likely to be more difficult for a Liberal Federal Government Australia's Potential Internet Futures Journal of Futures Studies 46 to discontinue/dismantle the NBN if it is elected in 2017 (the subsequent Federal). If fully rolled-out the NBN will “connect 93% of homes, schools and workplaces with optical fibre (fibre to the premises or ‘FTTP’)” and “for the remaining 7% we will connect to our next generation fixed wireless and satellite”. 2 Australia is a small market which raises the potential for various market failures and associated uncertainties about the how many players can be supported in some sectors (Stafford, 2011). 3 As per the market forecasts and analysis of Telsyte (http://www.telsyte.com.au).
+
+USER:
+From this text, how do the five generic images for the technological future differ to the four schools of thought articulated in the Smart Internet Technology CRC’s report, ""Smart Internet""? Include a brief description of each theory in your explanation.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",True,42,40,5730,,88
+"<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> [user request] <TEXT> [context document]","My friend is trying to get me to start Ozempic, since it has helped her lose weight. I want to know more about what it is. Using this article, tell me how Ozempic works and what the risks are. Use at least 400 words.","Does Ozempic Have an Immediate Effect? Ozempic is a medication in the class of GLP-1 agonists, which mimic the action of a hormone called GLP-1 that your stomach naturally releases when you eat food. When blood sugar levels naturally start rising after you eat, these drugs stimulate the body to produce more insulin, which helps direct blood sugar into the body's cells to be used for energy. If you’re taking Ozempic for diabetes, “it doesn’t have the immediate effect that injecting actual insulin does,” she adds. Per the Centers for Disease Control and Prevention (CDC), rapid-acting insulin can start working in as little as 30 minutes to accelerate the entry of glucose into cells for metabolism into glycogen—a main source of energy for the body. Ozempic doesn’t have an immediate effect on weight loss either. “Ozempic is started at the lowest dose and advanced every four weeks,” says Mir Ali, M.D., a bariatric surgeon and the medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, CA. “Each patient responds differently. Some feel the effects immediately, while others may need to be on higher dose levels to feel the effects. When the patients are at the appropriate dose, they feel much less hungry and feel full for a longer period of time.” The effects of a dose of Ozempic last for about one week—this is why it’s injected once-weekly. “Some people may see a tapering of the effects towards the end of the one-week period, while others don’t,” says Dr. Ali. It should be noted that the same holds true for Wegovy. The main difference between Wegovy and Ozempic is the amount of semaglutide in each injectable dose: Wegovy’s maximum maintenance dose is 2.4 milligrams (mg), while Ozempic’s is 2 mg. Lowering Blood Sugar How Long Does It Take Ozempic to Lower Blood Sugar? Every patient is different, but you can expect to notice lower levels of blood sugar as quickly as within the first week of taking Ozempic, says Dr. Lofton. “The effect will be more dramatic as the doses increase over a period of months,” she says. For instance, if the patient’s dose is increased monthly, they should reach the maximum dose of 2 mg on the fourth month. Sticking to lower doses for the first four weeks helps lower side effects, but higher doses are required to lower blood sugar in the long term, per the official dosing guidelines. “How long it takes to achieve a healthy blood sugar level depends on how well the glucose was controlled prior to initiating Ozempic as well as the patient’s diet, exercise, and other medications,” Dr. Lofton says. Your doctor will carry out the hemoglobin A1C test—a simple blood test that measures your average blood sugar levels over the past three months. “It takes three months for hemoglobin A1C to change, so I would expect some improvement in hemoglobin A1C three months after starting Ozempic,” Dr. Lofton explains. For those individuals with type 2 diabetes who take metformin, which is the first-line medication used to treat the condition, some may find that adding—or switching to—a GPL-1 agonist drug like Ozempic may improve outcomes; this is something your doctor will evaluate if this applies to your situation. Some people with type 2 diabetes may take insulin and Ozempic. “Often, a patient’s insulin requirement decreases as Ozempic doses increase so it is likely that type 2 diabetes may no longer require insulin when on a GLP-1 agonist,” says Dr. Lofton. “This is ideal because insulin can cause weight gain.” Weight Loss How Long Does It Take Ozempic to Lead to Weight Loss? The effect of Ozempic on weight really depends on the individual, says Dr. Ali. “Some patients will experience a loss of appetite with the initial dose,” he says. “However, most patients will likely not see significant weight loss until they reach higher dose levels at eight-to-12 weeks.” In Dr. Lofton's experience, there is usually some weight loss in the first month. “If weight goals are not met, then the dose can be increased,” she notes. Ozempic’s results are impressive when compared to other types of weight management drugs. Eric Williamson, Ph.D., a dietitian who specializes in sports and weight management and the founder of Toronto, Canada-based Unlocked Fitness and Nutrition, points out that the older obesity meds like Saxenda (liraglutide) yielded modest results: an average of 5% to 8% weight loss over the course of 68 weeks. “In contrast, the recent GLP-1 agonists like semaglutide stand out as the most effective drugs to date, with individuals experiencing a substantial 15% to 20% body weight reduction over a 68-week period when coupled with lifestyle interventions including nutrition and exercise,” says Williamson. That sort of weight loss can improve your body’s insulin sensitivity and help reverse insulin resistance—your essential weapons for winning the battle when you have type 2 diabetes. Williamson believes that the success of semaglutide lies in its ability to address the most common barrier to weight loss: increased appetite. “While a calorie deficit remains essential for weight loss, semaglutide makes achieving this deficit more manageable by reducing appetite,” he explains. What to Expect What to Expect After Your First Ozempic Injection It’s normal to experience some side effects from a new medication. According to Dr. Ali, the most common side effects reported from Ozempic are gastrointestinal, such as nausea, diarrhea or constipation, stomach cramping, and vomiting. “There are receptors for GLP-1 in the GI tract, which affects how it functions and leads to side effects,” explains Dr. Ali. “However, these side effects tend to subside with continued use of the medication.” According to clinical trials, the majority of reports of nausea, vomiting, and/or diarrhea occurred during dose escalation. Dr. Lofton warns that if you’re taking Ozempic and can’t tolerate the side effects, you should speak to your prescriber. “Lifestyle intervention is still the first-line approach to obesity treatment,” Williamson says. “In most cases, physicians will recommend lifestyle support with professionals like dietitians first. Even when drugs like semaglutide are prescribed, it is meant to complement lifestyle changes by mitigating the challenge of heightened appetite.” Williamson adds that there are three main risks if certain lifestyle adjustments are not considered: Inadequate nutrient intake. “Because appetite can be lowered quite drastically with semaglutide, it’s important that people are choosing nutrient dense foods to get adequate amounts of vitamins and minerals,” he says. Muscle loss. A subset of participants taking Ozempic in a study published in the New England Journal of Medicine lost 39% of their weight as lean mass (the largest portion of which will be muscle mass). “Exercise and obtaining adequate protein is important to prevent this so that one metabolic health issue isn’t presented (i.e., low muscle mass) as another one is solved (i.e., high fat mass),” Williamson explains. Not losing weight. According to research published in Drug Design, Development and Therapy, there is still a small proportion of people (around 7%) who do not lose weight on semaglutide. Williamson points out that more studies are required, but in his practice (and coming across people on the drug on a near-daily basis), he does see some people who eat a high enough caloric density diet (i.e. a high amount of calories for small amount of food) that they do not enter a calorie deficit even on weight loss drugs. “A diet made up of mostly nutritious low-calorie density whole filling foods is still required for many to lose weight on these drugs,” he says. It’s also a habit that can help those who drop out of using drugs like Ozempic from gaining the weight back.","<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> My friend is trying to get me to start Ozempic, since it has helped her lose weight. I want to know more about what it is. Using this article, tell me how Ozempic works and what the risks are. Use at least 400 words. <TEXT> Does Ozempic Have an Immediate Effect? Ozempic is a medication in the class of GLP-1 agonists, which mimic the action of a hormone called GLP-1 that your stomach naturally releases when you eat food. When blood sugar levels naturally start rising after you eat, these drugs stimulate the body to produce more insulin, which helps direct blood sugar into the body's cells to be used for energy. If you’re taking Ozempic for diabetes, “it doesn’t have the immediate effect that injecting actual insulin does,” she adds. Per the Centers for Disease Control and Prevention (CDC), rapid-acting insulin can start working in as little as 30 minutes to accelerate the entry of glucose into cells for metabolism into glycogen—a main source of energy for the body. Ozempic doesn’t have an immediate effect on weight loss either. “Ozempic is started at the lowest dose and advanced every four weeks,” says Mir Ali, M.D., a bariatric surgeon and the medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, CA. “Each patient responds differently. Some feel the effects immediately, while others may need to be on higher dose levels to feel the effects. When the patients are at the appropriate dose, they feel much less hungry and feel full for a longer period of time.” The effects of a dose of Ozempic last for about one week—this is why it’s injected once-weekly. “Some people may see a tapering of the effects towards the end of the one-week period, while others don’t,” says Dr. Ali. It should be noted that the same holds true for Wegovy. The main difference between Wegovy and Ozempic is the amount of semaglutide in each injectable dose: Wegovy’s maximum maintenance dose is 2.4 milligrams (mg), while Ozempic’s is 2 mg. Lowering Blood Sugar How Long Does It Take Ozempic to Lower Blood Sugar? Every patient is different, but you can expect to notice lower levels of blood sugar as quickly as within the first week of taking Ozempic, says Dr. Lofton. “The effect will be more dramatic as the doses increase over a period of months,” she says. For instance, if the patient’s dose is increased monthly, they should reach the maximum dose of 2 mg on the fourth month. Sticking to lower doses for the first four weeks helps lower side effects, but higher doses are required to lower blood sugar in the long term, per the official dosing guidelines. “How long it takes to achieve a healthy blood sugar level depends on how well the glucose was controlled prior to initiating Ozempic as well as the patient’s diet, exercise, and other medications,” Dr. Lofton says. Your doctor will carry out the hemoglobin A1C test—a simple blood test that measures your average blood sugar levels over the past three months. “It takes three months for hemoglobin A1C to change, so I would expect some improvement in hemoglobin A1C three months after starting Ozempic,” Dr. Lofton explains. For those individuals with type 2 diabetes who take metformin, which is the first-line medication used to treat the condition, some may find that adding—or switching to—a GPL-1 agonist drug like Ozempic may improve outcomes; this is something your doctor will evaluate if this applies to your situation. Some people with type 2 diabetes may take insulin and Ozempic. “Often, a patient’s insulin requirement decreases as Ozempic doses increase so it is likely that type 2 diabetes may no longer require insulin when on a GLP-1 agonist,” says Dr. Lofton. “This is ideal because insulin can cause weight gain.” Weight Loss How Long Does It Take Ozempic to Lead to Weight Loss? The effect of Ozempic on weight really depends on the individual, says Dr. Ali. “Some patients will experience a loss of appetite with the initial dose,” he says. “However, most patients will likely not see significant weight loss until they reach higher dose levels at eight-to-12 weeks.” In Dr. Lofton's experience, there is usually some weight loss in the first month. “If weight goals are not met, then the dose can be increased,” she notes. Ozempic’s results are impressive when compared to other types of weight management drugs. Eric Williamson, Ph.D., a dietitian who specializes in sports and weight management and the founder of Toronto, Canada-based Unlocked Fitness and Nutrition, points out that the older obesity meds like Saxenda (liraglutide) yielded modest results: an average of 5% to 8% weight loss over the course of 68 weeks. “In contrast, the recent GLP-1 agonists like semaglutide stand out as the most effective drugs to date, with individuals experiencing a substantial 15% to 20% body weight reduction over a 68-week period when coupled with lifestyle interventions including nutrition and exercise,” says Williamson. That sort of weight loss can improve your body’s insulin sensitivity and help reverse insulin resistance—your essential weapons for winning the battle when you have type 2 diabetes. Williamson believes that the success of semaglutide lies in its ability to address the most common barrier to weight loss: increased appetite. “While a calorie deficit remains essential for weight loss, semaglutide makes achieving this deficit more manageable by reducing appetite,” he explains. What to Expect What to Expect After Your First Ozempic Injection It’s normal to experience some side effects from a new medication. According to Dr. Ali, the most common side effects reported from Ozempic are gastrointestinal, such as nausea, diarrhea or constipation, stomach cramping, and vomiting. “There are receptors for GLP-1 in the GI tract, which affects how it functions and leads to side effects,” explains Dr. Ali. “However, these side effects tend to subside with continued use of the medication.” According to clinical trials, the majority of reports of nausea, vomiting, and/or diarrhea occurred during dose escalation. Dr. Lofton warns that if you’re taking Ozempic and can’t tolerate the side effects, you should speak to your prescriber. “Lifestyle intervention is still the first-line approach to obesity treatment,” Williamson says. “In most cases, physicians will recommend lifestyle support with professionals like dietitians first. Even when drugs like semaglutide are prescribed, it is meant to complement lifestyle changes by mitigating the challenge of heightened appetite.” Williamson adds that there are three main risks if certain lifestyle adjustments are not considered: Inadequate nutrient intake. “Because appetite can be lowered quite drastically with semaglutide, it’s important that people are choosing nutrient dense foods to get adequate amounts of vitamins and minerals,” he says. Muscle loss. A subset of participants taking Ozempic in a study published in the New England Journal of Medicine lost 39% of their weight as lean mass (the largest portion of which will be muscle mass). “Exercise and obtaining adequate protein is important to prevent this so that one metabolic health issue isn’t presented (i.e., low muscle mass) as another one is solved (i.e., high fat mass),” Williamson explains. Not losing weight. According to research published in Drug Design, Development and Therapy, there is still a small proportion of people (around 7%) who do not lose weight on semaglutide. Williamson points out that more studies are required, but in his practice (and coming across people on the drug on a near-daily basis), he does see some people who eat a high enough caloric density diet (i.e. a high amount of calories for small amount of food) that they do not enter a calorie deficit even on weight loss drugs. “A diet made up of mostly nutritious low-calorie density whole filling foods is still required for many to lose weight on these drugs,” he says. It’s also a habit that can help those who drop out of using drugs like Ozempic from gaining the weight back. https://www.healthcentral.com/condition/type-2-diabetes/how-long-does-it-take-ozempic-to-work","<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> [user request] <TEXT> [context document]
+
+EVIDENCE:
+Does Ozempic Have an Immediate Effect? Ozempic is a medication in the class of GLP-1 agonists, which mimic the action of a hormone called GLP-1 that your stomach naturally releases when you eat food. When blood sugar levels naturally start rising after you eat, these drugs stimulate the body to produce more insulin, which helps direct blood sugar into the body's cells to be used for energy. If you’re taking Ozempic for diabetes, “it doesn’t have the immediate effect that injecting actual insulin does,” she adds. Per the Centers for Disease Control and Prevention (CDC), rapid-acting insulin can start working in as little as 30 minutes to accelerate the entry of glucose into cells for metabolism into glycogen—a main source of energy for the body. Ozempic doesn’t have an immediate effect on weight loss either. “Ozempic is started at the lowest dose and advanced every four weeks,” says Mir Ali, M.D., a bariatric surgeon and the medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, CA. “Each patient responds differently. Some feel the effects immediately, while others may need to be on higher dose levels to feel the effects. When the patients are at the appropriate dose, they feel much less hungry and feel full for a longer period of time.” The effects of a dose of Ozempic last for about one week—this is why it’s injected once-weekly. “Some people may see a tapering of the effects towards the end of the one-week period, while others don’t,” says Dr. Ali. It should be noted that the same holds true for Wegovy. The main difference between Wegovy and Ozempic is the amount of semaglutide in each injectable dose: Wegovy’s maximum maintenance dose is 2.4 milligrams (mg), while Ozempic’s is 2 mg. Lowering Blood Sugar How Long Does It Take Ozempic to Lower Blood Sugar? Every patient is different, but you can expect to notice lower levels of blood sugar as quickly as within the first week of taking Ozempic, says Dr. Lofton. “The effect will be more dramatic as the doses increase over a period of months,” she says. For instance, if the patient’s dose is increased monthly, they should reach the maximum dose of 2 mg on the fourth month. Sticking to lower doses for the first four weeks helps lower side effects, but higher doses are required to lower blood sugar in the long term, per the official dosing guidelines. “How long it takes to achieve a healthy blood sugar level depends on how well the glucose was controlled prior to initiating Ozempic as well as the patient’s diet, exercise, and other medications,” Dr. Lofton says. Your doctor will carry out the hemoglobin A1C test—a simple blood test that measures your average blood sugar levels over the past three months. “It takes three months for hemoglobin A1C to change, so I would expect some improvement in hemoglobin A1C three months after starting Ozempic,” Dr. Lofton explains. For those individuals with type 2 diabetes who take metformin, which is the first-line medication used to treat the condition, some may find that adding—or switching to—a GPL-1 agonist drug like Ozempic may improve outcomes; this is something your doctor will evaluate if this applies to your situation. Some people with type 2 diabetes may take insulin and Ozempic. “Often, a patient’s insulin requirement decreases as Ozempic doses increase so it is likely that type 2 diabetes may no longer require insulin when on a GLP-1 agonist,” says Dr. Lofton. “This is ideal because insulin can cause weight gain.” Weight Loss How Long Does It Take Ozempic to Lead to Weight Loss? The effect of Ozempic on weight really depends on the individual, says Dr. Ali. “Some patients will experience a loss of appetite with the initial dose,” he says. “However, most patients will likely not see significant weight loss until they reach higher dose levels at eight-to-12 weeks.” In Dr. Lofton's experience, there is usually some weight loss in the first month. “If weight goals are not met, then the dose can be increased,” she notes. Ozempic’s results are impressive when compared to other types of weight management drugs. Eric Williamson, Ph.D., a dietitian who specializes in sports and weight management and the founder of Toronto, Canada-based Unlocked Fitness and Nutrition, points out that the older obesity meds like Saxenda (liraglutide) yielded modest results: an average of 5% to 8% weight loss over the course of 68 weeks. “In contrast, the recent GLP-1 agonists like semaglutide stand out as the most effective drugs to date, with individuals experiencing a substantial 15% to 20% body weight reduction over a 68-week period when coupled with lifestyle interventions including nutrition and exercise,” says Williamson. That sort of weight loss can improve your body’s insulin sensitivity and help reverse insulin resistance—your essential weapons for winning the battle when you have type 2 diabetes. Williamson believes that the success of semaglutide lies in its ability to address the most common barrier to weight loss: increased appetite. “While a calorie deficit remains essential for weight loss, semaglutide makes achieving this deficit more manageable by reducing appetite,” he explains. What to Expect What to Expect After Your First Ozempic Injection It’s normal to experience some side effects from a new medication. According to Dr. Ali, the most common side effects reported from Ozempic are gastrointestinal, such as nausea, diarrhea or constipation, stomach cramping, and vomiting. “There are receptors for GLP-1 in the GI tract, which affects how it functions and leads to side effects,” explains Dr. Ali. “However, these side effects tend to subside with continued use of the medication.” According to clinical trials, the majority of reports of nausea, vomiting, and/or diarrhea occurred during dose escalation. Dr. Lofton warns that if you’re taking Ozempic and can’t tolerate the side effects, you should speak to your prescriber. “Lifestyle intervention is still the first-line approach to obesity treatment,” Williamson says. “In most cases, physicians will recommend lifestyle support with professionals like dietitians first. Even when drugs like semaglutide are prescribed, it is meant to complement lifestyle changes by mitigating the challenge of heightened appetite.” Williamson adds that there are three main risks if certain lifestyle adjustments are not considered: Inadequate nutrient intake. “Because appetite can be lowered quite drastically with semaglutide, it’s important that people are choosing nutrient dense foods to get adequate amounts of vitamins and minerals,” he says. Muscle loss. A subset of participants taking Ozempic in a study published in the New England Journal of Medicine lost 39% of their weight as lean mass (the largest portion of which will be muscle mass). “Exercise and obtaining adequate protein is important to prevent this so that one metabolic health issue isn’t presented (i.e., low muscle mass) as another one is solved (i.e., high fat mass),” Williamson explains. Not losing weight. According to research published in Drug Design, Development and Therapy, there is still a small proportion of people (around 7%) who do not lose weight on semaglutide. Williamson points out that more studies are required, but in his practice (and coming across people on the drug on a near-daily basis), he does see some people who eat a high enough caloric density diet (i.e. a high amount of calories for small amount of food) that they do not enter a calorie deficit even on weight loss drugs. “A diet made up of mostly nutritious low-calorie density whole filling foods is still required for many to lose weight on these drugs,” he says. It’s also a habit that can help those who drop out of using drugs like Ozempic from gaining the weight back.
+
+USER:
+My friend is trying to get me to start Ozempic, since it has helped her lose weight. I want to know more about what it is. Using this article, tell me how Ozempic works and what the risks are. Use at least 400 words.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,20,44,1272,,421
+Use the info in this document and not any other source.,"Categorize the terms into ""Device"", ""Procedure"", and ""Other"", and exclude any financial or insurance related terms.","N Non-covered charges: Costs for dental care your insurer does not cover. In some cases the service is a covered service, but the insurer is not responsible for the entire charge. In these cases, you will be responsible for any charge not covered by your dental plan. You may wish to call your insurer or consult your dental plan or dental policy to determine whether certain services are included in your plan before you receive those services from your dentist. Non-Covered Services: Dental services not listed as a benefit. If you receive non-covered services, your dental plan will not pay for them. Your provider will bill you. You will be responsible for the full cost. Usually payments count toward deductible. Check with your insurer. Make sure you know what services are covered before you see your dentist. Nonduplication of Benefits: Occurs when you have two insurance plans. It’s how our second insurance carrier calculates its payment. The secondary carrier calculates what it would have paid if it were your primary plan. Then it subtracts what the other plan paid. Examples: Your primary carrier paid 80 percent. Your secondary carrier normally covers 80 percent. Your secondary carrier would not make any additional payment. If the primary carrier paid 50 percent. The secondary carrier would pay up to 30 percent. O Occlusion: Any contact between biting or chewing surfaces of upper and lower teeth. Occlusal Guard: A removable device worn between the upper and lower teeth to prevent clenching or grinding. [NOTE: ODONTOPLASTY WAS REMOVED] Open Enrollment/Open Enrollment Period: Time of year when an eligible person may add, change or terminate a dental plan or dental policy for the next contract year. Open Panel: Allows you to receive care from any dentist. It allows any dentist to participate. Any dentist may accept or refuse to treat patients enrolled in the plan. Open panel plans often are described as freedom of choice plans. Orthodontic Retainer: Appliance to stabilize teeth following orthodontic treatment. Glossary of Dental Insurance and Dental Care Terms 12 * American Dental Association Current Dental Terminology 2011-2012, glossary. **Dental Benefits: A Guide to Dental PPOs, HMOs And Other Managed Plans, Don Mayes, Revised Edition, 2002. **FDA/ADA radiograph guidelines. National Association of Dental Plans, www.nadp.org Orthodontics and dentofacial orthopedics: Branch of dentistry. Includes the diagnosis, prevention, interception, and correction of malocclusion. Also includes neuromuscular and skeletal abnormalities of the developing or mature orofacial structures. Orthodontist: Specialist who treats malocclusion and other neuromuscular and skeletal abnormalities of the teeth and their surrounding structures. Orthotic device: Dental appliance used to support, align, prevent or correct deformities, or to improve the function of the oral Out-of-Network: Care from providers not on your plan. This includes dentists and clinics. Usually, you will pay more out of your own pocket when you receive dental care out-of-network providers. Out-of-network benefits: Coverage for services from providers who are not under a contract with your dental plan. Out-of-pocket cost: The amount plan members must pay for care. Includes the difference between the amount charged by a provider and what a health plan pays for such services. Out-of-Pocket Maximum: The most a dental plan requires a member to pay in a year. Deductibles, co-payments and co-insurance count toward the out-of-pocket maximum. The only dental benefits that have out-of-pocket maximums are child benefits purchased through public exchanges, or purchased as an individual or through a small group. The out-of-pocket maximum for one child is $350 and for more than one child is $700 in all states. After reaching an out-of-pocket maximum, the plan pays 100% of the cost of pediatric dental services. This only applies to covered services. Members are still responsible for services that are not covered by the plan. Members also continue to pay their monthly premiums. Overbilling: Stating fees as higher than actual charges. Example: when you are charged one fee and an insurance company is billed a higher fee. This is done to use your co-payment. It also done to increase your fees solely because you are covered under a dental benefits plan. Overdenture: See Denture/Overdenture. P Palate: The hard and soft tissues forming the roof of the mouth. It separates the oral and nasal cavities. Palliative: Treatment that relieves pain but may not remove the cause of the pain. Partial Denture: See Denture/Partial Denture. Glossary of Dental Insurance and Dental Care Terms 13 * American Dental Association Current Dental Terminology 2011-2012, glossary. **Dental Benefits: A Guide to Dental PPOs, HMOs And Other Managed Plans, Don Mayes, Revised Edition, 2002. **FDA/ADA radiograph guidelines. National Association of Dental Plans, www.nadp.org Participating Provider: Dentists and other licensed dental providers on your plan. They have a contract with your plan. The contract includes set service fees. Payer: Party responsible for paying your claims. It can be a self-insured employer, insurance company or governmental agency. Pediatric dentist: A dental specialist. Treats children from birth through adolescence. Provides primary and comprehensive preventive and therapeutic oral health care. Formerly known as a pedodontist. Periodontal: Branch of dentistry that involves the prevention and treatment of gum disease. Periodontal disease: Inflammation process of gums and/or periodontal membrane of the teeth. Results in an abnormally deep gingival sulcus. Possibly produces periodontal pockets and loss of supporting alveolar bone. Periodontist: A dental specialist. Treats diseases of the supporting and surrounding tissues of the teeth. Periodontitis: Inflammation and loss of the connective tissue of the supporting or surrounding structure of teeth. With loss of attachment. [NOTE: PIN REMOVED] Plan Year: See Benefit Year. Plaque: A soft sticky substance. Composed largely of bacteria and bacterial derivatives. It forms on teeth daily. Point of Service (POS) Plan: A dental plan that allows you to choose at the time of dental service whether you will go to a provider within your dental plan's network or get dental care from a provider outside the network. [NOTE: PORCELAIN/CERAMIC REMOVED] [NOTE: POST REMOVED] Preauthorization: A process that your dental plan or insurer uses to make a decision that particular dental services are covered. Your plan may require preauthorization for certain services, such as crowns, before you receive them. Preauthorization requirements are generally waived if you need emergency care. Sometimes called prior authorization. [NOTE: PRECERTIFICATION REMOVED] Predetermination: A process where a dentist submits a treatment plan to the payer before treatment begins. The payer reviews the treatment plan. The payer notifies you and your dentist about one or more of the following: your eligibility, covered services, amounts payable, co-payment and deductibles and plan maximums. See preauthorization. Glossary of Dental Insurance and Dental Care Terms 14 * American Dental Association Current Dental Terminology 2011-2012, glossary. **Dental Benefits: A Guide to Dental PPOs, HMOs And Other Managed Plans, Don Mayes, Revised Edition, 2002. **FDA/ADA radiograph guidelines. National Association of Dental Plans, www.nadp.org Pre-existing condition: A dental condition that exists for a set time prior to enrollment in a dental plan, regardless of whether the condition has been formally diagnosed. The only pre-existing condition that is common for dental plans or policies is a missing tooth. [REMOVED PRECIOUS OR HIGH NOBLE METALS – SEE METALS, CLASSIFICATIONS –ACCORDING TO CDT] Pretreatement Estimate: See predetermination. ** Preferred Provider Organization (PPO): See DPPO. Premedication: The use of medications prior to dental procedures. Prepaid dental plan: A method of funding dental care costs in advance of services. For a defined population. Premium: The amount you pay to a dental insurance company for dental coverage. The dental insurance company generally recalculates the premium each policy year. This amount is usually paid in monthly installments. When you receive dental insurance through an employer, the employer may pay a portion of the premium and you pay the rest, often through payroll deductions. Preventive Services: See diagnostic and preventive services. Primary dentition: Another name for baby teeth. See deciduous. Primary payer: The third party payer with first responsibility in a benefit determination. Prophylaxis: Scaling and polishing procedure. Performed to remove coronal plaque, calculus and stains. ** Prosthodontic: Branch of dentistry that deals with the repair of teeth by crowns, inlays or onlays and/or the replacement of missing teeth and related mouth or jaw structures by bridges, dentures, implants or other artificial devises. Prosthodontist: A dental specialist. Restores natural teeth. Replaces missing teeth with artificial substitutes. Provider: A dentist or other dental care professional, or clinic that is accredited, licensed or certified to provide dental services in their state, and is providing services within the scope of that accreditation, license or certification. Provider network: Dentists and other dental care professionals who agree to provide dental care to members of a dental plan, under the terms of a contract.","N Non-covered charges: Costs for dental care your insurer does not cover. In some cases the service is a covered service, but the insurer is not responsible for the entire charge. In these cases, you will be responsible for any charge not covered by your dental plan. You may wish to call your insurer or consult your dental plan or dental policy to determine whether certain services are included in your plan before you receive those services from your dentist. Non-Covered Services: Dental services not listed as a benefit. If you receive non-covered services, your dental plan will not pay for them. Your provider will bill you. You will be responsible for the full cost. Usually payments count toward deductible. Check with your insurer. Make sure you know what services are covered before you see your dentist. Nonduplication of Benefits: Occurs when you have two insurance plans. It’s how our second insurance carrier calculates its payment. The secondary carrier calculates what it would have paid if it were your primary plan. Then it subtracts what the other plan paid. Examples: Your primary carrier paid 80 percent. Your secondary carrier normally covers 80 percent. Your secondary carrier would not make any additional payment. If the primary carrier paid 50 percent. The secondary carrier would pay up to 30 percent. O Occlusion: Any contact between biting or chewing surfaces of upper and lower teeth. Occlusal Guard: A removable device worn between the upper and lower teeth to prevent clenching or grinding. [NOTE: ODONTOPLASTY WAS REMOVED] Open Enrollment/Open Enrollment Period: Time of year when an eligible person may add, change or terminate a dental plan or dental policy for the next contract year. Open Panel: Allows you to receive care from any dentist. It allows any dentist to participate. Any dentist may accept or refuse to treat patients enrolled in the plan. Open panel plans often are described as freedom of choice plans. Orthodontic Retainer: Appliance to stabilize teeth following orthodontic treatment. Glossary of Dental Insurance and Dental Care Terms 12 * American Dental Association Current Dental Terminology 2011-2012, glossary. **Dental Benefits: A Guide to Dental PPOs, HMOs And Other Managed Plans, Don Mayes, Revised Edition, 2002. **FDA/ADA radiograph guidelines. National Association of Dental Plans, www.nadp.org Orthodontics and dentofacial orthopedics: Branch of dentistry. Includes the diagnosis, prevention, interception, and correction of malocclusion. Also includes neuromuscular and skeletal abnormalities of the developing or mature orofacial structures. Orthodontist: Specialist who treats malocclusion and other neuromuscular and skeletal abnormalities of the teeth and their surrounding structures. Orthotic device: Dental appliance used to support, align, prevent or correct deformities, or to improve the function of the oral Out-of-Network: Care from providers not on your plan. This includes dentists and clinics. Usually, you will pay more out of your own pocket when you receive dental care out-of-network providers. Out-of-network benefits: Coverage for services from providers who are not under a contract with your dental plan. Out-of-pocket cost: The amount plan members must pay for care. Includes the difference between the amount charged by a provider and what a health plan pays for such services. Out-of-Pocket Maximum: The most a dental plan requires a member to pay in a year. Deductibles, co-payments and co-insurance count toward the out-of-pocket maximum. The only dental benefits that have out-of-pocket maximums are child benefits purchased through public exchanges, or purchased as an individual or through a small group. The out-of-pocket maximum for one child is $350 and for more than one child is $700 in all states. After reaching an out-of-pocket maximum, the plan pays 100% of the cost of pediatric dental services. This only applies to covered services. Members are still responsible for services that are not covered by the plan. Members also continue to pay their monthly premiums. Overbilling: Stating fees as higher than actual charges. Example: when you are charged one fee and an insurance company is billed a higher fee. This is done to use your co-payment. It also done to increase your fees solely because you are covered under a dental benefits plan. Overdenture: See Denture/Overdenture. P Palate: The hard and soft tissues forming the roof of the mouth. It separates the oral and nasal cavities. Palliative: Treatment that relieves pain but may not remove the cause of the pain. Partial Denture: See Denture/Partial Denture. Glossary of Dental Insurance and Dental Care Terms 13 * American Dental Association Current Dental Terminology 2011-2012, glossary. **Dental Benefits: A Guide to Dental PPOs, HMOs And Other Managed Plans, Don Mayes, Revised Edition, 2002. **FDA/ADA radiograph guidelines. National Association of Dental Plans, www.nadp.org Participating Provider: Dentists and other licensed dental providers on your plan. They have a contract with your plan. The contract includes set service fees. Payer: Party responsible for paying your claims. It can be a self-insured employer, insurance company or governmental agency. Pediatric dentist: A dental specialist. Treats children from birth through adolescence. Provides primary and comprehensive preventive and therapeutic oral health care. Formerly known as a pedodontist. Periodontal: Branch of dentistry that involves the prevention and treatment of gum disease. Periodontal disease: Inflammation process of gums and/or periodontal membrane of the teeth. Results in an abnormally deep gingival sulcus. Possibly produces periodontal pockets and loss of supporting alveolar bone. Periodontist: A dental specialist. Treats diseases of the supporting and surrounding tissues of the teeth. Periodontitis: Inflammation and loss of the connective tissue of the supporting or surrounding structure of teeth. With loss of attachment. [NOTE: PIN REMOVED] Plan Year: See Benefit Year. Plaque: A soft sticky substance. Composed largely of bacteria and bacterial derivatives. It forms on teeth daily. Point of Service (POS) Plan: A dental plan that allows you to choose at the time of dental service whether you will go to a provider within your dental plan's network or get dental care from a provider outside the network. [NOTE: PORCELAIN/CERAMIC REMOVED] [NOTE: POST REMOVED] Preauthorization: A process that your dental plan or insurer uses to make a decision that particular dental services are covered. Your plan may require preauthorization for certain services, such as crowns, before you receive them. Preauthorization requirements are generally waived if you need emergency care. Sometimes called prior authorization. [NOTE: PRECERTIFICATION REMOVED] Predetermination: A process where a dentist submits a treatment plan to the payer before treatment begins. The payer reviews the treatment plan. The payer notifies you and your dentist about one or more of the following: your eligibility, covered services, amounts payable, co-payment and deductibles and plan maximums. See preauthorization. Glossary of Dental Insurance and Dental Care Terms 14 * American Dental Association Current Dental Terminology 2011-2012, glossary. **Dental Benefits: A Guide to Dental PPOs, HMOs And Other Managed Plans, Don Mayes, Revised Edition, 2002. **FDA/ADA radiograph guidelines. National Association of Dental Plans, www.nadp.org Pre-existing condition: A dental condition that exists for a set time prior to enrollment in a dental plan, regardless of whether the condition has been formally diagnosed. The only pre-existing condition that is common for dental plans or policies is a missing tooth. [REMOVED PRECIOUS OR HIGH NOBLE METALS – SEE METALS, CLASSIFICATIONS –ACCORDING TO CDT] Pretreatement Estimate: See predetermination. ** Preferred Provider Organization (PPO): See DPPO. Premedication: The use of medications prior to dental procedures. Prepaid dental plan: A method of funding dental care costs in advance of services. For a defined population. Premium: The amount you pay to a dental insurance company for dental coverage. The dental insurance company generally recalculates the premium each policy year. This amount is usually paid in monthly installments. When you receive dental insurance through an employer, the employer may pay a portion of the premium and you pay the rest, often through payroll deductions. Preventive Services: See diagnostic and preventive services. Primary dentition: Another name for baby teeth. See deciduous. Primary payer: The third party payer with first responsibility in a benefit determination. Prophylaxis: Scaling and polishing procedure. Performed to remove coronal plaque, calculus and stains. ** Prosthodontic: Branch of dentistry that deals with the repair of teeth by crowns, inlays or onlays and/or the replacement of missing teeth and related mouth or jaw structures by bridges, dentures, implants or other artificial devises. Prosthodontist: A dental specialist. Restores natural teeth. Replaces missing teeth with artificial substitutes. Provider: A dentist or other dental care professional, or clinic that is accredited, licensed or certified to provide dental services in their state, and is providing services within the scope of that accreditation, license or certification. Provider network: Dentists and other dental care professionals who agree to provide dental care to members of a dental plan, under the terms of a contract. Use the info in this document and not any other source. Categorize the terms into ""Device"", ""Procedure"", and ""Other"", and exclude any financial or insurance related terms.","Use the info in this document and not any other source.
+
+EVIDENCE:
+N Non-covered charges: Costs for dental care your insurer does not cover. In some cases the service is a covered service, but the insurer is not responsible for the entire charge. In these cases, you will be responsible for any charge not covered by your dental plan. You may wish to call your insurer or consult your dental plan or dental policy to determine whether certain services are included in your plan before you receive those services from your dentist. Non-Covered Services: Dental services not listed as a benefit. If you receive non-covered services, your dental plan will not pay for them. Your provider will bill you. You will be responsible for the full cost. Usually payments count toward deductible. Check with your insurer. Make sure you know what services are covered before you see your dentist. Nonduplication of Benefits: Occurs when you have two insurance plans. It’s how our second insurance carrier calculates its payment. The secondary carrier calculates what it would have paid if it were your primary plan. Then it subtracts what the other plan paid. Examples: Your primary carrier paid 80 percent. Your secondary carrier normally covers 80 percent. Your secondary carrier would not make any additional payment. If the primary carrier paid 50 percent. The secondary carrier would pay up to 30 percent. O Occlusion: Any contact between biting or chewing surfaces of upper and lower teeth. Occlusal Guard: A removable device worn between the upper and lower teeth to prevent clenching or grinding. [NOTE: ODONTOPLASTY WAS REMOVED] Open Enrollment/Open Enrollment Period: Time of year when an eligible person may add, change or terminate a dental plan or dental policy for the next contract year. Open Panel: Allows you to receive care from any dentist. It allows any dentist to participate. Any dentist may accept or refuse to treat patients enrolled in the plan. Open panel plans often are described as freedom of choice plans. Orthodontic Retainer: Appliance to stabilize teeth following orthodontic treatment. Glossary of Dental Insurance and Dental Care Terms 12 * American Dental Association Current Dental Terminology 2011-2012, glossary. **Dental Benefits: A Guide to Dental PPOs, HMOs And Other Managed Plans, Don Mayes, Revised Edition, 2002. **FDA/ADA radiograph guidelines. National Association of Dental Plans, www.nadp.org Orthodontics and dentofacial orthopedics: Branch of dentistry. Includes the diagnosis, prevention, interception, and correction of malocclusion. Also includes neuromuscular and skeletal abnormalities of the developing or mature orofacial structures. Orthodontist: Specialist who treats malocclusion and other neuromuscular and skeletal abnormalities of the teeth and their surrounding structures. Orthotic device: Dental appliance used to support, align, prevent or correct deformities, or to improve the function of the oral Out-of-Network: Care from providers not on your plan. This includes dentists and clinics. Usually, you will pay more out of your own pocket when you receive dental care out-of-network providers. Out-of-network benefits: Coverage for services from providers who are not under a contract with your dental plan. Out-of-pocket cost: The amount plan members must pay for care. Includes the difference between the amount charged by a provider and what a health plan pays for such services. Out-of-Pocket Maximum: The most a dental plan requires a member to pay in a year. Deductibles, co-payments and co-insurance count toward the out-of-pocket maximum. The only dental benefits that have out-of-pocket maximums are child benefits purchased through public exchanges, or purchased as an individual or through a small group. The out-of-pocket maximum for one child is $350 and for more than one child is $700 in all states. After reaching an out-of-pocket maximum, the plan pays 100% of the cost of pediatric dental services. This only applies to covered services. Members are still responsible for services that are not covered by the plan. Members also continue to pay their monthly premiums. Overbilling: Stating fees as higher than actual charges. Example: when you are charged one fee and an insurance company is billed a higher fee. This is done to use your co-payment. It also done to increase your fees solely because you are covered under a dental benefits plan. Overdenture: See Denture/Overdenture. P Palate: The hard and soft tissues forming the roof of the mouth. It separates the oral and nasal cavities. Palliative: Treatment that relieves pain but may not remove the cause of the pain. Partial Denture: See Denture/Partial Denture. Glossary of Dental Insurance and Dental Care Terms 13 * American Dental Association Current Dental Terminology 2011-2012, glossary. **Dental Benefits: A Guide to Dental PPOs, HMOs And Other Managed Plans, Don Mayes, Revised Edition, 2002. **FDA/ADA radiograph guidelines. National Association of Dental Plans, www.nadp.org Participating Provider: Dentists and other licensed dental providers on your plan. They have a contract with your plan. The contract includes set service fees. Payer: Party responsible for paying your claims. It can be a self-insured employer, insurance company or governmental agency. Pediatric dentist: A dental specialist. Treats children from birth through adolescence. Provides primary and comprehensive preventive and therapeutic oral health care. Formerly known as a pedodontist. Periodontal: Branch of dentistry that involves the prevention and treatment of gum disease. Periodontal disease: Inflammation process of gums and/or periodontal membrane of the teeth. Results in an abnormally deep gingival sulcus. Possibly produces periodontal pockets and loss of supporting alveolar bone. Periodontist: A dental specialist. Treats diseases of the supporting and surrounding tissues of the teeth. Periodontitis: Inflammation and loss of the connective tissue of the supporting or surrounding structure of teeth. With loss of attachment. [NOTE: PIN REMOVED] Plan Year: See Benefit Year. Plaque: A soft sticky substance. Composed largely of bacteria and bacterial derivatives. It forms on teeth daily. Point of Service (POS) Plan: A dental plan that allows you to choose at the time of dental service whether you will go to a provider within your dental plan's network or get dental care from a provider outside the network. [NOTE: PORCELAIN/CERAMIC REMOVED] [NOTE: POST REMOVED] Preauthorization: A process that your dental plan or insurer uses to make a decision that particular dental services are covered. Your plan may require preauthorization for certain services, such as crowns, before you receive them. Preauthorization requirements are generally waived if you need emergency care. Sometimes called prior authorization. [NOTE: PRECERTIFICATION REMOVED] Predetermination: A process where a dentist submits a treatment plan to the payer before treatment begins. The payer reviews the treatment plan. The payer notifies you and your dentist about one or more of the following: your eligibility, covered services, amounts payable, co-payment and deductibles and plan maximums. See preauthorization. Glossary of Dental Insurance and Dental Care Terms 14 * American Dental Association Current Dental Terminology 2011-2012, glossary. **Dental Benefits: A Guide to Dental PPOs, HMOs And Other Managed Plans, Don Mayes, Revised Edition, 2002. **FDA/ADA radiograph guidelines. National Association of Dental Plans, www.nadp.org Pre-existing condition: A dental condition that exists for a set time prior to enrollment in a dental plan, regardless of whether the condition has been formally diagnosed. The only pre-existing condition that is common for dental plans or policies is a missing tooth. [REMOVED PRECIOUS OR HIGH NOBLE METALS – SEE METALS, CLASSIFICATIONS –ACCORDING TO CDT] Pretreatement Estimate: See predetermination. ** Preferred Provider Organization (PPO): See DPPO. Premedication: The use of medications prior to dental procedures. Prepaid dental plan: A method of funding dental care costs in advance of services. For a defined population. Premium: The amount you pay to a dental insurance company for dental coverage. The dental insurance company generally recalculates the premium each policy year. This amount is usually paid in monthly installments. When you receive dental insurance through an employer, the employer may pay a portion of the premium and you pay the rest, often through payroll deductions. Preventive Services: See diagnostic and preventive services. Primary dentition: Another name for baby teeth. See deciduous. Primary payer: The third party payer with first responsibility in a benefit determination. Prophylaxis: Scaling and polishing procedure. Performed to remove coronal plaque, calculus and stains. ** Prosthodontic: Branch of dentistry that deals with the repair of teeth by crowns, inlays or onlays and/or the replacement of missing teeth and related mouth or jaw structures by bridges, dentures, implants or other artificial devises. Prosthodontist: A dental specialist. Restores natural teeth. Replaces missing teeth with artificial substitutes. Provider: A dentist or other dental care professional, or clinic that is accredited, licensed or certified to provide dental services in their state, and is providing services within the scope of that accreditation, license or certification. Provider network: Dentists and other dental care professionals who agree to provide dental care to members of a dental plan, under the terms of a contract.
+
+USER:
+Categorize the terms into ""Device"", ""Procedure"", and ""Other"", and exclude any financial or insurance related terms.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,11,16,1430,,563
+"{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]","I think marijuana will soon become legal in my state, at least medically. I have concerns about this. What are the pros and cons of marijuana legalization? Does marijuana even have a legitimate medical use? Where is this leading socially with all of this legalization?","The Evidence—and Lack Thereof—About Cannabis Research is still needed on cannabis’s risks and benefits. Although the use and possession of cannabis is illegal under federal law, medicinal and recreational cannabis use has become increasingly widespread. Thirty-eight states and Washington, D.C., have legalized medical cannabis, while 23 states and D.C. have legalized recreational use. Cannabis legalization has benefits, such as removing the product from the illegal market so it can be taxed and regulated, but science is still trying to catch up as social norms evolve and different products become available. In this Q&A, adapted from the August 25 episode of Public Health On Call, Lindsay Smith Rogers talks with Johannes Thrul, PhD, MS, associate professor of Mental Health, about cannabis as medicine, potential risks involved with its use, and what research is showing about its safety and efficacy. Do you think medicinal cannabis paved the way for legalization of recreational use? The momentum has been clear for a few years now. California was the first to legalize it for medical reasons [in 1996]. Washington and Colorado were the first states to legalize recreational use back in 2012. You see one state after another changing their laws, and over time, you see a change in social norms. It's clear from the national surveys that people are becoming more and more in favor of cannabis legalization. That started with medical use, and has now continued into recreational use. But there is a murky differentiation between medical and recreational cannabis. I think a lot of people are using cannabis to self-medicate. It's not like a medication you get prescribed for a very narrow symptom or a specific disease. Anyone with a medical cannabis prescription, or who meets the age limit for recreational cannabis, can purchase it. Then what they use it for is really all over the place—maybe because it makes them feel good, or because it helps them deal with certain symptoms, diseases, and disorders. Does cannabis have viable medicinal uses? The evidence is mixed at this point. There hasn’t been a lot of funding going into testing cannabis in a rigorous way. There is more evidence for certain indications than for others, like CBD for seizures—one of the first indications that cannabis was approved for. And THC has been used effectively for things like nausea and appetite for people with cancer. There are other indications where the evidence is a lot more mixed. For example, pain—one of the main reasons that people report for using cannabis. When we talk to patients, they say cannabis improved their quality of life. In the big studies that have been done so far, there are some indications from animal models that cannabis might help [with pain]. When we look at human studies, it's very much a mixed bag. And, when we say cannabis, in a way it's a misnomer because cannabis is so many things. We have different cannabinoids and different concentrations of different cannabinoids. The main cannabinoids that are being studied are THC and CBD, but there are dozens of other minor cannabinoids and terpenes in cannabis products, all of varying concentrations. And then you also have a lot of different routes of administration available. You can smoke, vape, take edibles, use tinctures and topicals. When you think about the explosion of all of the different combinations of different products and different routes of administration, it tells you how complicated it gets to study this in a rigorous way. You almost need a randomized trial for every single one of those and then for every single indication. What do we know about the risks of marijuana use? Cannabis use disorder is a legitimate disorder in the DSM. There are, unfortunately, a lot of people who develop a problematic use of cannabis. We know there are risks for mental health consequences. The evidence is probably the strongest that if you have a family history of psychosis or schizophrenia, using cannabis early in adolescence is not the best idea. We know cannabis can trigger psychotic symptoms and potentially longer lasting problems with psychosis and schizophrenia. It is hard to study, because you also don't know if people are medicating early negative symptoms of schizophrenia. They wouldn't necessarily have a diagnosis yet, but maybe cannabis helps them to deal with negative symptoms, and then they develop psychosis. There is also some evidence that there could be something going on with the impact of cannabis on the developing brain that could prime you to be at greater risk of using other substances later down the road, or finding the use of other substances more reinforcing. What benefits do you see to legalization? When we look at the public health landscape and the effect of legislation, in this case legalization, one of the big benefits is taking cannabis out of the underground illegal market. Taking cannabis out of that particular space is a great idea. You're taking it out of the illegal market and giving it to legitimate businesses where there is going to be oversight and testing of products, so you know what you're getting. And these products undergo quality control and are labeled. Those labels so far are a bit variable, but at least we're getting there. If you're picking up cannabis at the street corner, you have no idea what's in it. And we know that drug laws in general have been used to criminalize communities of color and minorities. Legalizing cannabis [can help] reduce the overpolicing of these populations. What big questions about cannabis would you most like to see answered? We know there are certain, most-often-mentioned conditions that people are already using medical cannabis for: pain, insomnia, anxiety, and PTSD. We really need to improve the evidence base for those. I think clinical trials for different cannabis products for those conditions are warranted. Another question is, now that the states are getting more tax revenue from cannabis sales, what are they doing with that money? If you look at tobacco legislation, for example, certain states have required that those funds get used for research on those particular issues. To me, that would be a very good use of the tax revenue that is now coming in. We know, for example, that there’s a lot more tax revenue now that Maryland has legalized recreational use. Maryland could really step up here and help provide some of that evidence. Are there studies looking into the risks you mentioned? Large national studies are done every year or every other year to collect data, so we already have a pretty good sense of the prevalence of cannabis use disorder. Obviously, we'll keep tracking that to see if those numbers increase, for example, in states that are legalizing. But, you wouldn't necessarily expect to see an uptick in cannabis use disorder a month after legalization. The evidence from states that have legalized it has not demonstrated that we might all of a sudden see an increase in psychosis or in cannabis use disorder. This happens slowly over time with a change in social norms and availability, and potentially also with a change in marketing. And, with increasing use of an addictive substance, you will see over time a potential increase in problematic use and then also an increase in use disorder. If you're interested in seeing if cannabis is right for you, is this something you can talk to your doctor about? I think your mileage may vary there with how much your doctor is comfortable and knows about it. It's still relatively fringe. That will very much depend on who you talk to. But I think as providers and professionals, everybody needs to learn more about this, because patients are going to ask no matter what.","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== I think marijuana will soon become legal in my state, at least medically. I have concerns about this. What are the pros and cons of marijuana legalization? Does marijuana even have a legitimate medical use? Where is this leading socially with all of this legalization? {passage 0} ========== The Evidence—and Lack Thereof—About Cannabis Research is still needed on cannabis’s risks and benefits. Although the use and possession of cannabis is illegal under federal law, medicinal and recreational cannabis use has become increasingly widespread. Thirty-eight states and Washington, D.C., have legalized medical cannabis, while 23 states and D.C. have legalized recreational use. Cannabis legalization has benefits, such as removing the product from the illegal market so it can be taxed and regulated, but science is still trying to catch up as social norms evolve and different products become available. In this Q&A, adapted from the August 25 episode of Public Health On Call, Lindsay Smith Rogers talks with Johannes Thrul, PhD, MS, associate professor of Mental Health, about cannabis as medicine, potential risks involved with its use, and what research is showing about its safety and efficacy. Do you think medicinal cannabis paved the way for legalization of recreational use? The momentum has been clear for a few years now. California was the first to legalize it for medical reasons [in 1996]. Washington and Colorado were the first states to legalize recreational use back in 2012. You see one state after another changing their laws, and over time, you see a change in social norms. It's clear from the national surveys that people are becoming more and more in favor of cannabis legalization. That started with medical use, and has now continued into recreational use. But there is a murky differentiation between medical and recreational cannabis. I think a lot of people are using cannabis to self-medicate. It's not like a medication you get prescribed for a very narrow symptom or a specific disease. Anyone with a medical cannabis prescription, or who meets the age limit for recreational cannabis, can purchase it. Then what they use it for is really all over the place—maybe because it makes them feel good, or because it helps them deal with certain symptoms, diseases, and disorders. Does cannabis have viable medicinal uses? The evidence is mixed at this point. There hasn’t been a lot of funding going into testing cannabis in a rigorous way. There is more evidence for certain indications than for others, like CBD for seizures—one of the first indications that cannabis was approved for. And THC has been used effectively for things like nausea and appetite for people with cancer. There are other indications where the evidence is a lot more mixed. For example, pain—one of the main reasons that people report for using cannabis. When we talk to patients, they say cannabis improved their quality of life. In the big studies that have been done so far, there are some indications from animal models that cannabis might help [with pain]. When we look at human studies, it's very much a mixed bag. And, when we say cannabis, in a way it's a misnomer because cannabis is so many things. We have different cannabinoids and different concentrations of different cannabinoids. The main cannabinoids that are being studied are THC and CBD, but there are dozens of other minor cannabinoids and terpenes in cannabis products, all of varying concentrations. And then you also have a lot of different routes of administration available. You can smoke, vape, take edibles, use tinctures and topicals. When you think about the explosion of all of the different combinations of different products and different routes of administration, it tells you how complicated it gets to study this in a rigorous way. You almost need a randomized trial for every single one of those and then for every single indication. What do we know about the risks of marijuana use? Cannabis use disorder is a legitimate disorder in the DSM. There are, unfortunately, a lot of people who develop a problematic use of cannabis. We know there are risks for mental health consequences. The evidence is probably the strongest that if you have a family history of psychosis or schizophrenia, using cannabis early in adolescence is not the best idea. We know cannabis can trigger psychotic symptoms and potentially longer lasting problems with psychosis and schizophrenia. It is hard to study, because you also don't know if people are medicating early negative symptoms of schizophrenia. They wouldn't necessarily have a diagnosis yet, but maybe cannabis helps them to deal with negative symptoms, and then they develop psychosis. There is also some evidence that there could be something going on with the impact of cannabis on the developing brain that could prime you to be at greater risk of using other substances later down the road, or finding the use of other substances more reinforcing. What benefits do you see to legalization? When we look at the public health landscape and the effect of legislation, in this case legalization, one of the big benefits is taking cannabis out of the underground illegal market. Taking cannabis out of that particular space is a great idea. You're taking it out of the illegal market and giving it to legitimate businesses where there is going to be oversight and testing of products, so you know what you're getting. And these products undergo quality control and are labeled. Those labels so far are a bit variable, but at least we're getting there. If you're picking up cannabis at the street corner, you have no idea what's in it. And we know that drug laws in general have been used to criminalize communities of color and minorities. Legalizing cannabis [can help] reduce the overpolicing of these populations. What big questions about cannabis would you most like to see answered? We know there are certain, most-often-mentioned conditions that people are already using medical cannabis for: pain, insomnia, anxiety, and PTSD. We really need to improve the evidence base for those. I think clinical trials for different cannabis products for those conditions are warranted. Another question is, now that the states are getting more tax revenue from cannabis sales, what are they doing with that money? If you look at tobacco legislation, for example, certain states have required that those funds get used for research on those particular issues. To me, that would be a very good use of the tax revenue that is now coming in. We know, for example, that there’s a lot more tax revenue now that Maryland has legalized recreational use. Maryland could really step up here and help provide some of that evidence. Are there studies looking into the risks you mentioned? Large national studies are done every year or every other year to collect data, so we already have a pretty good sense of the prevalence of cannabis use disorder. Obviously, we'll keep tracking that to see if those numbers increase, for example, in states that are legalizing. But, you wouldn't necessarily expect to see an uptick in cannabis use disorder a month after legalization. The evidence from states that have legalized it has not demonstrated that we might all of a sudden see an increase in psychosis or in cannabis use disorder. This happens slowly over time with a change in social norms and availability, and potentially also with a change in marketing. And, with increasing use of an addictive substance, you will see over time a potential increase in problematic use and then also an increase in use disorder. If you're interested in seeing if cannabis is right for you, is this something you can talk to your doctor about? I think your mileage may vary there with how much your doctor is comfortable and knows about it. It's still relatively fringe. That will very much depend on who you talk to. But I think as providers and professionals, everybody needs to learn more about this, because patients are going to ask no matter what. https://publichealth.jhu.edu/2023/risks-and-benefits-of-legalized-cannabis","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]
+
+EVIDENCE:
+The Evidence—and Lack Thereof—About Cannabis Research is still needed on cannabis’s risks and benefits. Although the use and possession of cannabis is illegal under federal law, medicinal and recreational cannabis use has become increasingly widespread. Thirty-eight states and Washington, D.C., have legalized medical cannabis, while 23 states and D.C. have legalized recreational use. Cannabis legalization has benefits, such as removing the product from the illegal market so it can be taxed and regulated, but science is still trying to catch up as social norms evolve and different products become available. In this Q&A, adapted from the August 25 episode of Public Health On Call, Lindsay Smith Rogers talks with Johannes Thrul, PhD, MS, associate professor of Mental Health, about cannabis as medicine, potential risks involved with its use, and what research is showing about its safety and efficacy. Do you think medicinal cannabis paved the way for legalization of recreational use? The momentum has been clear for a few years now. California was the first to legalize it for medical reasons [in 1996]. Washington and Colorado were the first states to legalize recreational use back in 2012. You see one state after another changing their laws, and over time, you see a change in social norms. It's clear from the national surveys that people are becoming more and more in favor of cannabis legalization. That started with medical use, and has now continued into recreational use. But there is a murky differentiation between medical and recreational cannabis. I think a lot of people are using cannabis to self-medicate. It's not like a medication you get prescribed for a very narrow symptom or a specific disease. Anyone with a medical cannabis prescription, or who meets the age limit for recreational cannabis, can purchase it. Then what they use it for is really all over the place—maybe because it makes them feel good, or because it helps them deal with certain symptoms, diseases, and disorders. Does cannabis have viable medicinal uses? The evidence is mixed at this point. There hasn’t been a lot of funding going into testing cannabis in a rigorous way. There is more evidence for certain indications than for others, like CBD for seizures—one of the first indications that cannabis was approved for. And THC has been used effectively for things like nausea and appetite for people with cancer. There are other indications where the evidence is a lot more mixed. For example, pain—one of the main reasons that people report for using cannabis. When we talk to patients, they say cannabis improved their quality of life. In the big studies that have been done so far, there are some indications from animal models that cannabis might help [with pain]. When we look at human studies, it's very much a mixed bag. And, when we say cannabis, in a way it's a misnomer because cannabis is so many things. We have different cannabinoids and different concentrations of different cannabinoids. The main cannabinoids that are being studied are THC and CBD, but there are dozens of other minor cannabinoids and terpenes in cannabis products, all of varying concentrations. And then you also have a lot of different routes of administration available. You can smoke, vape, take edibles, use tinctures and topicals. When you think about the explosion of all of the different combinations of different products and different routes of administration, it tells you how complicated it gets to study this in a rigorous way. You almost need a randomized trial for every single one of those and then for every single indication. What do we know about the risks of marijuana use? Cannabis use disorder is a legitimate disorder in the DSM. There are, unfortunately, a lot of people who develop a problematic use of cannabis. We know there are risks for mental health consequences. The evidence is probably the strongest that if you have a family history of psychosis or schizophrenia, using cannabis early in adolescence is not the best idea. We know cannabis can trigger psychotic symptoms and potentially longer lasting problems with psychosis and schizophrenia. It is hard to study, because you also don't know if people are medicating early negative symptoms of schizophrenia. They wouldn't necessarily have a diagnosis yet, but maybe cannabis helps them to deal with negative symptoms, and then they develop psychosis. There is also some evidence that there could be something going on with the impact of cannabis on the developing brain that could prime you to be at greater risk of using other substances later down the road, or finding the use of other substances more reinforcing. What benefits do you see to legalization? When we look at the public health landscape and the effect of legislation, in this case legalization, one of the big benefits is taking cannabis out of the underground illegal market. Taking cannabis out of that particular space is a great idea. You're taking it out of the illegal market and giving it to legitimate businesses where there is going to be oversight and testing of products, so you know what you're getting. And these products undergo quality control and are labeled. Those labels so far are a bit variable, but at least we're getting there. If you're picking up cannabis at the street corner, you have no idea what's in it. And we know that drug laws in general have been used to criminalize communities of color and minorities. Legalizing cannabis [can help] reduce the overpolicing of these populations. What big questions about cannabis would you most like to see answered? We know there are certain, most-often-mentioned conditions that people are already using medical cannabis for: pain, insomnia, anxiety, and PTSD. We really need to improve the evidence base for those. I think clinical trials for different cannabis products for those conditions are warranted. Another question is, now that the states are getting more tax revenue from cannabis sales, what are they doing with that money? If you look at tobacco legislation, for example, certain states have required that those funds get used for research on those particular issues. To me, that would be a very good use of the tax revenue that is now coming in. We know, for example, that there’s a lot more tax revenue now that Maryland has legalized recreational use. Maryland could really step up here and help provide some of that evidence. Are there studies looking into the risks you mentioned? Large national studies are done every year or every other year to collect data, so we already have a pretty good sense of the prevalence of cannabis use disorder. Obviously, we'll keep tracking that to see if those numbers increase, for example, in states that are legalizing. But, you wouldn't necessarily expect to see an uptick in cannabis use disorder a month after legalization. The evidence from states that have legalized it has not demonstrated that we might all of a sudden see an increase in psychosis or in cannabis use disorder. This happens slowly over time with a change in social norms and availability, and potentially also with a change in marketing. And, with increasing use of an addictive substance, you will see over time a potential increase in problematic use and then also an increase in use disorder. If you're interested in seeing if cannabis is right for you, is this something you can talk to your doctor about? I think your mileage may vary there with how much your doctor is comfortable and knows about it. It's still relatively fringe. That will very much depend on who you talk to. But I think as providers and professionals, everybody needs to learn more about this, because patients are going to ask no matter what.
+
+USER:
+I think marijuana will soon become legal in my state, at least medically. I have concerns about this. What are the pros and cons of marijuana legalization? Does marijuana even have a legitimate medical use? Where is this leading socially with all of this legalization?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,26,45,1288,,324
+Only respond with the most direct answer possible. Do not discuss anything else. Use only information from the provided document.,What are the key points from this release?,"DonorPro and CardConnect Team Up to Offer Integrated Payment Processing for Nonprofits Partnership brings payment acceptance and security to medical providers through HRP’s healthcare self-pay platform PHILADELPHIA (January 7, 2014) – CardConnect, a rapidly growing payments technology company, today announced its partnership with Health Recovery Partners (HRP), a premier provider of HIPAA compliant self-pay software solutions. HRP has added CardConnect’s Payment Gateway and CardSecure tokenization technology to its end-to-end healthcare self-pay platform, Decision Partner™. By partnering with CardConnect, HRP can now provide its customers with lower costs for credit card processing and enhanced security for protecting patients’ sensitive payment data. “With abundant changes to the healthcare industry that have increased the cost of managing self-pay accounts, medical providers are increasingly seeking an easy-to-manage and low-cost self-pay software platform,” said Jeff Shanahan, President at CardConnect. “We were very impressed by HRP’s self-pay platform and are excited to include our technology in their end-to-end solution.” For HRP, finding the right payments solution provider was crucial. “Quite frankly, payment processing has always been a pain point for healthcare providers,” said Michael Sarajian, President of Health Recovery Partners. “After learning about CardConnect’s Payment Gateway, which analyzes interchange costs to ensure our customers receive the lowest rates possible, and CardSecure, the tokenization technology trusted by Fortune 500 companies, we knew we could alleviate this pain. CardConnect has made secure payment acceptance an integral part of our end-to-end solution.” Decision Partner™ is HRP’s most patient-centric self-pay solution, centralizing an array of tools and activities to guarantee the highest collection rates – and, now with CardConnect, the lowest processing costs. Decision Partner™ allows the patient to create, or medical provider to automate, personalized payment plans based on each patient’s ability to pay, as well as segment and manage probate, litigation, bankruptcy, and no-fault auto self-pay accounts. Decision Partner™ is available to healthcare providers of all sizes. For more information, visit www.healthrecoverypartners.com.","Only respond with the most direct answer possible. Do not discuss anything else. Use only information from the provided document. What are the key points from this release? DonorPro and CardConnect Team Up to Offer Integrated Payment Processing for Nonprofits Partnership brings payment acceptance and security to medical providers through HRP’s healthcare self-pay platform PHILADELPHIA (January 7, 2014) – CardConnect, a rapidly growing payments technology company, today announced its partnership with Health Recovery Partners (HRP), a premier provider of HIPAA compliant self-pay software solutions. HRP has added CardConnect’s Payment Gateway and CardSecure tokenization technology to its end-to-end healthcare self-pay platform, Decision Partner™. By partnering with CardConnect, HRP can now provide its customers with lower costs for credit card processing and enhanced security for protecting patients’ sensitive payment data. “With abundant changes to the healthcare industry that have increased the cost of managing self-pay accounts, medical providers are increasingly seeking an easy-to-manage and low-cost self-pay software platform,” said Jeff Shanahan, President at CardConnect. “We were very impressed by HRP’s self-pay platform and are excited to include our technology in their end-to-end solution.” For HRP, finding the right payments solution provider was crucial. “Quite frankly, payment processing has always been a pain point for healthcare providers,” said Michael Sarajian, President of Health Recovery Partners. “After learning about CardConnect’s Payment Gateway, which analyzes interchange costs to ensure our customers receive the lowest rates possible, and CardSecure, the tokenization technology trusted by Fortune 500 companies, we knew we could alleviate this pain. CardConnect has made secure payment acceptance an integral part of our end-to-end solution.” Decision Partner™ is HRP’s most patient-centric self-pay solution, centralizing an array of tools and activities to guarantee the highest collection rates – and, now with CardConnect, the lowest processing costs. Decision Partner™ allows the patient to create, or medical provider to automate, personalized payment plans based on each patient’s ability to pay, as well as segment and manage probate, litigation, bankruptcy, and no-fault auto self-pay accounts. Decision Partner™ is available to healthcare providers of all sizes. For more information, visit www.healthrecoverypartners.com.","Only respond with the most direct answer possible. Do not discuss anything else. Use only information from the provided document.
+
+EVIDENCE:
+DonorPro and CardConnect Team Up to Offer Integrated Payment Processing for Nonprofits Partnership brings payment acceptance and security to medical providers through HRP’s healthcare self-pay platform PHILADELPHIA (January 7, 2014) – CardConnect, a rapidly growing payments technology company, today announced its partnership with Health Recovery Partners (HRP), a premier provider of HIPAA compliant self-pay software solutions. HRP has added CardConnect’s Payment Gateway and CardSecure tokenization technology to its end-to-end healthcare self-pay platform, Decision Partner™. By partnering with CardConnect, HRP can now provide its customers with lower costs for credit card processing and enhanced security for protecting patients’ sensitive payment data. “With abundant changes to the healthcare industry that have increased the cost of managing self-pay accounts, medical providers are increasingly seeking an easy-to-manage and low-cost self-pay software platform,” said Jeff Shanahan, President at CardConnect. “We were very impressed by HRP’s self-pay platform and are excited to include our technology in their end-to-end solution.” For HRP, finding the right payments solution provider was crucial. “Quite frankly, payment processing has always been a pain point for healthcare providers,” said Michael Sarajian, President of Health Recovery Partners. “After learning about CardConnect’s Payment Gateway, which analyzes interchange costs to ensure our customers receive the lowest rates possible, and CardSecure, the tokenization technology trusted by Fortune 500 companies, we knew we could alleviate this pain. CardConnect has made secure payment acceptance an integral part of our end-to-end solution.” Decision Partner™ is HRP’s most patient-centric self-pay solution, centralizing an array of tools and activities to guarantee the highest collection rates – and, now with CardConnect, the lowest processing costs. Decision Partner™ allows the patient to create, or medical provider to automate, personalized payment plans based on each patient’s ability to pay, as well as segment and manage probate, litigation, bankruptcy, and no-fault auto self-pay accounts. Decision Partner™ is available to healthcare providers of all sizes. For more information, visit www.healthrecoverypartners.com.
+
+USER:
+What are the key points from this release?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,20,8,314,,546
+Use only the given sources to complete your responses. Do not use outside sources or any previous knowledge of the topic that you may have.,Can you list all of the ancient people mentioned by name in a bullet point list along with a brief description of their beliefs regarding the brain?,"1) A BRIEF HISTORY OF NEUROSCIENCE Humans have long been interested in exploring the nature of mind. The long history of their enquiry into the relationship between mind and body is particularly marked by several twists and turns. However, brain is the last of the human organs to be studied in all seriousness, more particularly its relation with human mind. Around 2000 BC and for long since that time the Egyptians did not think highly of the brain. They would take out the brain via the nostrils and discarded it away before mummifying the dead body. Instead, they would take great care of the heart and other internal organs. However, a few Egyptian physicians seemed to appreciate the significance of the brain early on. Certain written records have been found where Egyptian physicians had even identified parts and areas in the brain. Besides, Egyptian papyrus, believed to have been written around 1700 BC, carried careful description of the brain, suggesting the possibility of addressing mental disorders through treatment of the brain. That is the first record of its kind in the human history (Figure 1). The Greek mathematician and philosopher, Plato (427-347) believed that the brain was the seat of mental processes such as memory and feelings (Figure 2). Later, another Greek physician and writer on medicine, Galen (130-200 AD) too, believed that brain disorders were responsible for mental illnesses. He also followed Plato in concluding that the mind or soul resided in the brain. However, Aristotle (384-322 BC), the great philosopher of Greece at that time, restated the ancient belief that the heart was the superior organ over the brain (Figure 3). In support of his belief, he stated that the brain was just like a radiator which stopped the body from becoming overheated, whereas the heart served as the seat of human intelligence, thought, and imagination, etc. Medieval philosophers felt that the brain was constituted of fluid-filled spaces called ventricles where the ‘animal spirits’ circulated to form sensations, emotions, and memories. This viewpoint brought about a shift in the previously held views and also provided the scientists with the new idea of actually looking into the brains of the humans and animals. However, no such ventricles as claimed by them were found upon examination nor did the scientists find any specific location for the self or the soul in the brain. In the seventeenth century, the French philosopher Rene Descartes (1596-1650) described mind and body as separate entities (Figure 4) yet they interacted with each other via the pineal gland, the only structure not duplicated on both sides of the brain. He maintained that the mind begins its journey from the pineal gland and circulates the rest of the body via the nerve vessels. His dualist view influenced the mind-body debate for Page 4 of 35 the next two centuries. However, through the numerous experiments undertaken in the 19th century, the scientists gathered evidences and findings which all emboldened the scientists to claim that the brain is the center of feelings, thoughts, self and behaviors. Just to give an example of the kind of experiments performed on a particular physical activity which pointed to the brain as the regulator of bodily actions, imagine activating a particular area of the brain through electrical stimulus, you would actually see it effectively impacting a corresponding body-part, say the legs by making them move. Through findings such as these as well as others, we have come of know also of the special activities of the electrical impulses and chemicals in the brain. Explorations continued into the later centuries and, by the middle of 20th century, human understanding of the brain and its activities have increased manifold. Particularly, towards the end of twentieth century, with further improvement in imaging technologies enabling the researchers to undertake investigation on functioning brains, the scientists were deeply convinced that the brain and the rest of the nervous systems monitored and regulated emotions and bodily behaviors (Figures 5 & 6). Since then, the brain together with the nervous system have become the center of attention as the basis of mental activities as well as physical behaviors, and gradually a separate branch of science called neuroscience focusing specifically on the nervous systems of the body has evolved in the last 40 so years. To better understand modern neuroscience in its historical context, including why the brain and nervous system have become the center of attention in the scientific pursuit of understanding the mind, it is useful to first review some preliminary topics in the philosophy of science. Science is a method of inquiry that is grounded in empirical evidence. Questions about the unknown direct the path of science as a method. Each newly discovered answer opens the door to many new questions, and the curiosity of scientists motivates them to answer those unfolding questions. When a scientist encounters a question, she or he develops an explanatory hypothesis that has the potential to answer it. But it is not enough to simply invent an explanation. To know if an explanation is valid or not, a scientist must test the hypothesis by identifying and observing relevant, objectively measurable phenomena. Any hypothesis that cannot be tested in this way is not useful for science. A useful hypothesis must be falsifiable, meaning that it must be possible to ascertain, based on objective observations, whether the hypothesis is wrong and does not explain the phenomena in question. If a hypothesis is not falsifiable, it is impossible to know whether it is the correct explanation of a phenomenon because we cannot test the validity of the claim. Why does the scientific method rely only on objective observations? Science is a team effort, conducted across communities and generations over space and time. For a hypothesis to be accepted as valid, it must be possible for any interested scientist to test it. For example, if we want to repeat an experiment that our colleague conducted last year, we need to test the hypothesis under the same conditions as the original experiment. This means it must be possible to recreate those conditions. The only way to do this in a precise and controlled manner is if the scientific method relies on empirical evidence. Page 5 of 35 Furthermore, conclusions in science are subject to peer review. This means that any scientist’s colleagues must be able to review and even re-create the procedures, analyses, and conclusions made by that scientist before deciding if the evidence supports the conclusions. Because we don’t have access to the subjective experiences of others, it is not possible to replicate experiments that are grounded in subjectivity because we cannot recreate the conditions of such an experiment, nor can we perform identical analyses of subjective phenomena across people. No matter how many words we use, we cannot describe a single subjective experience accurately enough to allow another person to experience it the same way. Consequently, we cannot have a replicable experiment if the evidence is not objective. Therefore, two necessary features of a scientific hypothesis are the potentials to falsify and replicate it. And both of these requirements are dependent on objectively measurable evidence. This is why we began with the claim that science is a method of inquiry that is grounded in empirical evidence. Neuroscience is a scientific discipline like any other, in that the focus of investigation is on objectively measurable phenomena. But unlike most other sciences, this poses a particularly challenging problem for neuroscience. How do we investigate the mind, which is subjective by nature, if empirical evidence is the only valid form of data to support a conclusion in science? The relationship between the mind and the body has become known as the “mind-body problem” in modern neuroscience and Western philosophy of mind, because there is a fundamental challenge to explain the mind in objective terms. Scientists view this relationship as a problem because their method of inquiry investigates phenomena from a third-person (he, she, it, they) perspective, while the subjective experience of the mind has a first-person (I, we) perspective. The mindbody problem has been a central, unresolved topic in Western philosophy of mind for centuries, and is a topic we will discuss in more detail in a later chapter of this textbook when we explore the neuroscience of consciousness. For now we can start simply by stating that the majority of scientists, including neuroscientists, hold the philosophical view that all phenomena are caused by physical processes, including consciousness and its related mental phenomena. This view might be proven wrong as inquiry proceeds, but is taken as the most simple (or parsimonious) starting point. Science uses the principle of parsimony, of starting with simple rather than complex explanations, as a way to facilitate production of falsifiable hypotheses: more complex explanations are built up as evidence accumulates and more simple explanations are excluded. Modern neuroscience investigates the brain and nervous system based on the working assumption that the objective physical states of those biological systems are the cause of the subjective mental states of the organism that has those biological systems. In other words, when you smell a fresh flower, taste a cup of chai, listen to the birds, feel the wind on your cheek, and see the clouds in the sky, those subjective experiences are caused by the momentary physical processes in your body, nervous system, and brain interacting with the physical environment. Under this philosophical view, then, mental states correlate with physical states of the organism, and by investigating those physical states scientists can understand the nature of those mental Page 6 of 35 states. So while this might seem counterintuitive based on the Buddhist method of inquiry, for a neuroscientist it is obvious to begin the investigation by focusing on physical phenomena; on the empirical evidence. Neuroscientists often equate the “neural correlates” of consciousness as consciousness itself. We will explore in more depth the relationship between form and function between the body and mind later in the textbook, as well as the philosophical view of materialism in neuroscience. It will also be helpful to introduce some basic concepts in neuroscience before exploring topics in more detail. The primary goal in this year of the neuroscience curriculum is that you become familiar with the brain and nervous system. The human brain is the most complex and extraordinary object known to all of modern science. Because of this immense complexity, it can be very challenging to encounter neuroscience in an introductory course such as this one. So patience is an important part of the learning process. First, neuroscience is still very much in its infancy as a scientific discipline, and there are vastly more questions than there are answers. Second, it can be a challenge for new students of neuroscience to simultaneously learn the details of the basic concepts while understanding and appreciating the broader conclusions. It’s like learning a language while also reading the literature of that language! Neuroscience is a scientific discipline with many different levels of exploration and explanation. Therefore, it is important for you to pay attention to the level at which are we speaking when you learn new concepts. For example, the brain and nervous system are made up of cells called neurons or nerve cells, which we will discuss in detail in Chapter 4. Neurons connect with each other to form complex networks, and from those different patterns of connection emerge different phenomena (such as a thought or a sensation) in the brain and ultimately in the mind. This may sound confusing at the moment, but we will explore these topics in more detail in later chapters. In neuroscience, levels of explanation can span from very low levels such as the molecular mechanisms involved in the neuron cells, to middle levels such as particular networks of neurons in the brain, to very high levels such as how humans engage in thoughts, speech, and purposeful actions. The brain is the bodily organ that is the center of the nervous system. But it might surprise you to learn that not all animals that have neurons have a brain! For example, jellyfish have neurons, but they don’t have a brain. Jellyfish are very simple organisms that live in the ocean, and their neurons allow them to sense some basic information about their environment. But because they don’t have a brain to process that environmental information, they can only react to their immediate environment. Without a brain, jellyfish cannot think, make plans for the future, have memories of the past, or make decisions. Their behavior is limited to reactions and reflexes. Complex networks of neurons in the human brain are the physiological substrates that support what we experience as human beings. But we are not the only species with a brain. Later in this textbook we will explore the relationship between brain complexity and behavior across species. For organisms that have a brain, information can flow along the complex networks of neurons in different ways. Some networks, also called pathways or systems, flow from the sensory organs to the brain, while others flow from the brain to the muscles of the Page 7 of 35 body. Afferent neurons, also called sensory neurons or receptor neurons, communicate information from the sensory organs to the brain. Efferent neurons, also called motor neurons, communicate information from the brain to the muscles of the body. Interneurons, also called association neurons, communicate information between neurons in the central nervous system and brain. This allows for the sensory and motor systems to interact, facilitating complex behaviors and integrating across the different sensory modalities. For example, to be able to reach for an object such as a teacup, your brain needs to link together your ability to sense the presence and location of the cup with your ability to control the muscles in your arm to grasp the cup. Interneurons perform this function. Finally, before starting your journey in learning about neuroscience, pause to contemplate some of the big questions and insights as they pertain to the Western science of the mind. As you go through this textbook and learn new concepts, it will be useful to think about them within the context of these big questions. For example, what is sentience? Is a brain required for sentience? The jellyfish we mentioned earlier can have basic sensations and react to the environment without a brain, but it cannot think or have memory. What are the necessary conditions to be sentient? What is the relationship between the mind and body? As a method of inquiry, can science directly investigate subjective experience? Or must we use alternative, and perhaps complementary methods of inquiry to achieve that? Do we perceive the physical world directly, or are our perceptions constructed? If the latter, how does that happen? 2) WHAT IS NEUROSCIENCE AND WHAT ARE ITS BRANCH SCIENCES? In the case of humans, it is the branch of science that studies the brain, the spinal cord, the nerves extending from them, and the rest of the nervous systems including the synapses, etc. Recall that neurons, or nerve cells, are the biological cells that make up the nervous system, and the nervous system is the complex network of connections between those cells. In this connection, it may involve itself with the cellular and molecular bases of the nervous system as well as the systems responsible for sensory and motor activities of the body. It also deals with the physical bases of mental processes of all levels, including emotions and cognitive elements. Thus, it concerns itself with issues such as thoughts, mental activities, behaviors, the brain and the spinal cord, functions of nerves, neural disorders, etc. It wrestles with questions such as What is consciousness?, How and why do beings have mental activities?, What are the physical bases for the variety of neural and mental illnesses, etc. In identifying the sub-branches within neuroscience, there are quite a few ways of doing so. However, here we will follow the lead of the Society for Neuroscience which identifies the following five branches: Neuro-anatomy, Developmental Neuroscience, Cognitive Neuroscience, Behavioral Neuroscience, and Neurology. Of these, Page 8 of 35 neuroanatomy concerns itself mainly with the issue of structures and parts of the nervous system. In this discipline, the scientists employ special dyeing techniques in identifying neurotransmitters and in understanding the specific functions of the nerves and nerve centers. Neurotransmitters are chemicals released between neurons for transmission of signals. When a neuron communicates with its neighboring cells, it releases neurotransmitters and its neighbors receive them. In developmental neuroscience, the scientists look into the phases and processes of development of nervous system, the changes they undergo after they have matured, and their eventual degeneration. In this regard, the scientists also investigate the ways neurons go about seeking connection with other neurons, how they establish the connection, and how they maintain the connection and what chemical changes and processes they have to undergo for these activities. Neurons make connections to form networks, and the different patterns of connectivity support different functions. Patterns of connectivity can change over different time scales, such as developmental changes over a lifetime from infancy to old age, but also in the short term such as learning a new concept. Neuroplasticity is the term that describes the capacity of the brain to change in response to stimulation or even damage: it is not a static organ, but is highly adaptable. In cognitive neuroscience, they study the functions of behaviors, perceptions, and memories, etc. By making use of non-invasive methods such as the PTE and MRI technologies that allow us to take detailed pictures of the brain without opening the skull, they look into the neural pathways activated during engagement in language, solutions, and other activities. Cognitive neuroscience studies the mind-body relationship by discovering the neural correlates to mental and behavioral phenomena. Behavioral neuroscience looks into the underpinning processes of human and animal behaviors. Using electrodes, they measure the neural electrical activities occurring alongside our actions such as visual perception, language use, and generating memories. Through fMRI scan techniques, another technology that allows us to take detailed motion pictures of brain activity over time without opening the skull, they strive to arrive at closer understanding of the brain parts in real time. Finally, neurology makes use of the fundamental research findings of the other disciplines in understanding the neural and neuronal disorders and strives to explore new innovative ways of detecting, preventing, and treating these disorders. 3) THE SUBJECT MATTER OF NEUROSCIENCE: THE MAIN SYSTEMS AND THEIR PARTS The field of neuroscience is the nervous system of animals in general and of humans in particular. In the case of humans, its nervous system has two main components: the central nervous system (CNS) and the peripheral nervous system (PNS) (Figure 7). The CNS comprises of the brain and the spinal cord. Their functions involve processing and interpreting the information received the senses, skin, muscles, etc. and giving responses Page 9 of 35 that direct and dictate specific actions such as particular movements by different parts of the body. The peripheral nervous system (PNS) includes all the rest of the nervous system aside from the central nervous system. This means that it comprises the 12 pairs of cranial nerves that originate directly from the brain and spread to different parts of the body bypassing the spinal cord, and the 31 pairs of spinal nerves that pass through the spinal cord and spread to different parts of the body. Thus, the PNS is mainly constituted of nerve. PNS is sometimes further classified into voluntary nervous system and the autonomic nervous system. This is based on the fact that the nerves in the former system are involved in making conscious movements, whereas those in the latter system make movements over which the person does not have control. Obviously, the former category of nerves includes those associated with the muscles of touch, smell, vision, and skeleton. The latter includes nerves spread over muscles attached with heart beats, blood pressure, glands, and smooth muscles. 4) AN EXCLUSIVE LOOK AT ‘NEURONS’, A FUNDAMENTAL UNIT OF THE BRAIN AND THE NERVOUS SYSTEM Neurons Neurons are the cellular units of the brain and nervous system, and are otherwise called nerve cells (Figure 8). Estimates of the number of brain neurons range from 50 billion to 500 billion, and they are not even the most numerous cells in the brain. Like hepatocyte cells in the liver, osteocytes in bone, or erythrocytes in blood, each neuron is a selfcontained functioning unit. Its internal components, the organelles, include a nucleus harboring the genetic material (DNA), energy-providing mitochondria, and proteinmaking ribosomes. As in most other types of cells, the organelles are concentrated in the main cell body. In addition, characteristic features of neurons are neurites—long, thin, finger-like or threadlike extensions from the cell body (soma). The two main types are dendrites and axons. Usually, dendrites receive nerve signals, while axons send them onward. The cell body of a neuron is about 10-100 micrometers across, that is 1/100th to 1/10th of one millimeter. Also, the axon is 0.2-20 micrometers in diameter, dendrites are usually slimmer. In terms of length, dendrites are typically 10-50 micrometers long, while axons can be up a few centimeters (inches). This is mostly the case in the central nervous system (Figure 9). Classification of neurons Page 10 of 35 There are numerous ways of classifying neurons among themselves. One of them is by the direction that they send information. On this basis, we can classify all neurons into the three: sensory neurons, motor neurons, and interneurons. The sensory neurons are those that send information received from sensory receptors toward the central nervous system, whereas the motor neurons send information away from the central nervous system to muscles or glands. The interneurons are those neurons that send information between sensory neurons and motor neurons. Here, the sensory neurons receive information from sensory receptors (e.g., in skin, eyes, nose, tongue, ears) and send them toward the central nervous system. Because of this, these neurons are also called afferent neurons as they bring informational input towards the central nervous system. Likewise, the motor neurons bring motor information away from the central nervous system to muscles or glands, and are thus called efferent neurons as they bring the output from the central nervous system to the muscles or glands. Since the interneurons send information between sensory neurons and motor neurons, thus serving as connecting links between them, they are sometimes called internuncial neurons. This third type of neurons is mostly found in the central nervous system. Another way of classifying the neurons is by the number of extensions that extend from the neuron’s cell body (soma) (Figure 10). In accordance with this system, we have unipolar, bipolar, and multipolar neurons. This classification takes into account the number of extensions extending initially from the cell body of the neuron, not the overall number of extensions. This is because there can be unipolar neurons which have more than one extensions in total. However, what the difference here is from the other two types of neurons is that these unipolar neurons shall have only one initial extension from the cell body. Most of the neurons are multipolar in nature. Synapses Synapses are communication sites where neurons pass nerve impulses among themselves. The cells are not usually in actual physical contact, but are separated by an incredibly thin gap, called the synaptic cleft. Microanatomically, synapses are divided into types according to the sites where the neurons almost touch. These sites include the soma, the dendrites, the axons, and tiny narrow projections called dendritic spines found on certain kinds of dendrites. Axospinodendrittic synapses form more than 50 percent of all synapses in the brain; axodendritic synapses constitute about 30 percent (Figure 11). How signals are passed among neurons Page 11 of 35 Neurons send signals to each other across the synapses. Initially, signals enter into the cell body of a neuron through their dendrites, and they pass down the axon until their arrival at the axon terminals. From there, the signal is sent across to the next neuron. Starting from the time the signal passes along the dendrites and axon, eventually reaching the axon terminal, it consists of moving electrically charges ions, but at a synapse while making that transition, it relies more on the structural shape of the chemical neurotransmitters. Every two neurons are separated by a gap, called synaptic cleft, at their synaptic site. The neuron preceding the synapse is known as pre-synaptic neuron and the one following the synapse is known as post-synaptic neuron. When the action potential of the pre-synaptic neuron is passed along its axon and reaches the other end of it, it causes synaptic vesicles to fuse or merge with the membrane. This releases the neurotransmitter molecules to pass or diffuse across the synaptic cleft to the post-synaptic membrane and slot into receptor sites (Figure 12). Neurotransmitter molecules slot into the same-shaped receptor sites in the postsynaptic membrane. A particular neurotransmitter can either excite a receiving nerve cell and continue a nerve impulse, or inhibit it. Which of these occurs depends on the type of membrane channel on the receiving cell. The interaction among neurons or between a neuron and another type of body cell, all occur due to the transfer of neurotransmitters. Thus, our body movements, mental thought processes, as well as feelings, etc. are all dependent on the transfer of neurotransmitters. In particular, let’s take a look into how the muscle movements happen due to the transfer of neurotransmitter. The axons of motor neurons extend from the spinal cord to the muscle fibers. For intending to perform any action, either of the speech or body, the command has to originate from the brain to the spinal cord. From the spinal cord, the command has to pass through motor neurons to the specific body parts, upon which the respective actions will be performed. The electrical impulse released along the axon of the motor neuron arrives at the axon terminal. Once they are there, then the neurotransmitters are secreted to carry the signals across the synapse. The receptors in the membrane of the muscles cells attach to the neurotransmitters and stimulate the electrically charged ions within the muscle cells. This leads to the contraction or extension of the respective muscles. Page 12 of 35 5) FACTS ABOUT HUMAN BRAIN Brain is a complex organ generally found in vertebrates. Of all the brains, human brain is even more complex. On average, a human brain weighs about one and a half kilogram, and has over 100 billion neurons. Each of these neurons is connected with several other neurons and thus, just the number of synapses (nerve cell connections) exceeds 100 trillion. The sustenance required to keep these neurons alive is supplied by different parts of the body. For example, 25 percent of the body total oxygen consumption is used up by the brain. Likewise, 25 percent of the glucose produced by our food is used up by it. Of the total amount of blood pumped out by our heart, 15 percent goes to the brain. Thus, from among the different parts of the body, the brain is the single part that uses the most amount of energy. The reason for this is because the brain engages itself in unceasing activity, day and night, of interpreting data form the internal and external environment, and respond to them. To protect this important organ from harm, it is naturally enclosed in three layers of protection, with an additional cushioning fluid in between. These layers are, in turn, protected with the hard covering, the skull, which is once again wound around by the skin of the scalp (Figure 13). The main function of the brain is to enhance the chance of survival of the person by proper regulation of the body conditions based on the brain’s reading of the internal and external environment. The way it carries out this function is by first registering the information received and responding to them by undertaking several activities. The brain also gives rise to inner conscious awareness alongside performing those processes. When the data, released by the different body senses, in the form of electrical impulses uninterruptedly arrive at the brain, the brain first of all checks their importance. When it finds them to be either irrelevant or commonplace, then it makes them dissolve by themselves and the concerned person doesn’t even generate an awareness of them. This is how only around 5 percent of the overall information received by the brain ever reaches our consciousness. For the rest of the information, the brain may process them, but they never become the subject of our consciousness. If, on the other hand, the information at hand is important or novel, the brain increases it impulses and allows it to active all over its parts. Remaining active for over a period of time, a conscious awareness unto this impulse is generated. Sometimes, in the wake of generating a conscious awareness, the brain sends commands to relevant muscles for either contraction or extension, thus making the body parts in question to engage in certain actions. Page 13 of 35 6) MAJOR PARTS OF HUMAN BRAIN Human brain is enclosed within its natural enclosures. In its normal form, it is found to be composed of three major parts (Figure 14). Cerebrum Of the three parts mentioned above, cerebrum is located in the uppermost position and is also the largest in size. It takes up ¾ of the entire brain size. It is itself composed of two brain hemispheres—the right and the left hemispheres. The two hemispheres are held together by a bridge like part called corpus callosum, a large bundle of neurons. The covering layer of the hemispheres is constituted of the cortex of which the average thickness is between 2 to 4 millimeters. The higher centers of coordinating and regulating human physical activities are located in the cortex areas, such as the motor center, proprioception center (proprioception is the sense of the relative position of the body in space, for example being aware that your arm is extended when reaching for the doorknob), language center, visual center, and auditory center. The outer surface of the cortex is formed of grooves and bulges because of which, despite being quite expansive, the cortex is able to be contained in the relatively small area. In terms of its basic composition, the outer layer of cortex is mostly made of gray matter, which is mainly comprised of cell bodies and nerve tissues formed out of nerve fibers. This matter is gray with a slight reddish shade in color. In the layer below, the cortex is formed of the white matter, which is, as the name suggests, white in color and mainly comprised of nerve tissues formed out of nerve fibers wrapped around with myelin sheath. Some nerve fibers wrapped in myelin sheath bind together the right and left hemispheres of the cerebrum, while others connect it with cerebellum, brainstem, and the spinal cord. Most of the brain parts belong to cerebrum, such as amygdala and hippocampus, as well as thalamus, hypothalamus, and other associated regions. In short, of the division into forebrain, midbrain, and hindbrain—in which the entirety of brain is accounted for, the cerebrum contains the whole of forebrain (Figure 15). The surface area of the cerebral cortex is actually quite large, and described above, it becomes folded to fit inside the skull. Humans are highly intelligent and creative animals not just because of the size of our brains, but also because of the complexity of the connections among our neurons. The folded nature of the human cortex promotes more complex connections between areas. For example, take a piece of blank paper, and draw five dots, one on each corner and one in the middle. Now draw lines from each dot to the other four dots. Imagine if these five dots were buildings, and the lines you drew were roads, then it would require more time to traverse from one corner to another corner than from one corner to the center. But what if you fold the four corners of the paper on top of Page 14 of 35 the center of the page? Suddenly all five of those dots become immediate neighbors, and it becomes very easy to walk from one “building” to another. The folding of the cortex has a similar effect. Neurons make connections with their neighbors, and if folding the cortex increases the number of neighbors each neuron has, then it also increases the complexity of the networks that can be formed among those neurons. Cerebellum Cerebellum is located below the cerebrum and at the upper back of the brainstem. Its name connotes its small size. Its mass is 1/10 of the whole brain. However, in terms of the number of neurons it contains, it exceeds that of the remaining parts of the central nervous system combined. This lump of nerve tissues, bearing the look of something cut in half, covers most of the back of brainstem. With the help of three pairs of fibers, collectively called cerebral peduncles, the brainstem is bound to the cerebellum. Like the cerebrum, it also has a wrinkled surface, but its grooves and bulges are finer and organized into more regular patterns. In terms of its physical structure, this too has a long groove in the center, with two large lateral lobes, one on each side. These lobes are reminiscent of the two hemispheres of the cerebrum and are sometimes termed cerebellar hemispheres. The cerebellum has a similar layered microstructure to the cerebrum. The outer layer, or cerebellar cortex, is gray matter composed of nerve-cell bodies and their dendrite projections. Beneath this is a medullary area of white matter consisting largely of nerve fibers. As of now, it has been established that cerebellum’s main function is in coordinating the body movement. Although, it may not initiate the movements, however it helps in the coordination and timely performance of movements, ensuring their integrated control. It receives data from spinal cord and other parts of the brain, and these data undergo integration and modification, contributing to the balance and smooth functioning of the movements, and thus helps in maintaining the equilibrium. Therefore, whenever this part of the brain is plagued by a disorder, the person may not lose total movement, but their ability of performing measured and steady movements is affected as also their ability to learn new movements. Within the division of entire brain into forebrain, midbrain, and hindbrain—cerebellum forms part of the hindbrain (Figure 16). Brainstem Brainstem is located below the cerebrum and in front of cerebellum. Its lower end connects with the spinal cord. It is perhaps misnamed. It is not a stem leading to a separate brain above, but an integral part of the brain itself. Its uppermost region is the midbrain comprising an upper “roof” incorporating the superior and inferior colliculi or Page 15 of 35 bulges at the rear, and the tegmentum to the front. Below the midbrain is the hindbrain. At its front is the large bulge of the pons. Behind and below this is the medulla which narrows to merge with the uppermost end of the body’s main nerve, the spinal cord. This part of the brain in associated with the middle and lower levels of consciousness. The eye movement involved in following a moving object in front of the eye is an example. The brainstem is highly involved in mid-to low-order mental activities, for example, the almost “automatic” scanning movements of the eyes as we watch something pass by. The gray and white matter composites of the brainstem are not as well defined as in other parts of the brain. The gray matter in this part of the brain possesses some of the crucial centers responsible for basic life functions. For example, the medulla houses groups of nuclei that are centers for respiratory (breathing), cardiac (heartbeat), and vasomotor (blood pressure) monitoring and control, as well as for vomiting, sneezing, swallowing, and coughing. When brainstem is damaged, that will immediately trigger danger to life by hindering heartbeat and respiratory processes (Figures 17 & 18). 7) WAYS OF ZONING AND SECTIONING THE HUMAN BRAIN FOR STUDY PURPOSES The two hemispheres Of the obviously so many different ways of zoning the human brain for study purposes, we will take up only a few of them as samples. As briefly mentioned before, a fully matured brain has three major parts. Of these the largest is the cerebrum. It covers around ¾ of the brain size. In terms of its outer structure, it is covered with numerous folds, and has a color of purple and gray blended. The cerebrum is formed by two cerebral hemispheres, accordingly called the right and the left hemisphere, that are separated by a groove, the medial longitudinal fissure. Between the two hemispheres, there is a bundle of nerve fibers that connects the two sides, almost serving like connecting rope holding the two in place. Called corpus callosum, if this were to be cut into two, the two hemispheres would virtually become two separate entities. Just as there are two hemispheres, that look broadly like mirror images to each other, on the two sides, likewise many of the brain parts exist in pairs, one on each side. However, due to the technological advances in general, and that of the MRI, in particular, it has been shown that, on average, brains are not as symmetrical in their left-right structure as was once believed to be , almost like mirror images (Figure 19). The two apparently symmetrical hemispheres and, within them, their other paired structures are also functionally not mirror images to each other. For example, for most Page 16 of 35 people, speech and language, and stepwise reasoning and analysis and so on are based mainly on the left side. Meanwhile, the right hemisphere is more concerned with sensory inputs, auditory and visual awareness, creative abilities and spatial-temporal awareness (Figure 20). The four or the six lobes Cerebrum is covered with bulges and grooves on its surface. Based on these formations, the cerebrum is divided into the four lobes, using the anatomical system. The main and the deepest groove is the longitudinal fissure that separates the cerebral hemispheres. However, the division into the lobes is made overlooking this fissure, and thus each lobe is spread on both the hemispheres. Due to this, we often speak of the four pairs of lobes. These lobes are frontal lobes, parietal lobes, occipital lobes, and temporal lobes (Figure 21). The names of the lobes are partly related to the overlying bones of the skull such as frontal and occipital bones. In some naming systems, the limbic lobe and the insula, or central lobe, are distinguished as separate from other lobes. Frontal lobes Frontal lobes are located at the front of the two hemispheres. Of all the lobes, these are the biggest in size as well as the last to develop. In relation to the other lobes, this pair of lobes is at the front of the parietal lobes, and above the temporal lobes. Between these lobes and the parietal lobes lies the central sulcus, and between these lobes and the temporal lobes lies the lateral sulcus. Towards the end of these lobes, i. e. the site where the pre-central gyrus is located also happens to be the area of the primary motor cortex. Thus, this pair of lobes is clearly responsible for regulating the conscious movement of certain parts of the body. Besides, it is known that the cortex areas within these lobes hold the largest number of neurons that are very sensitive to the dopamine neurotransmitters. Granting this, these lobes should also be related with such mental activities as intention, short-term memory, attention, and hope. When the frontal lobes are damaged, the person lacks in ability to exercise counter measures against lapses and tend to engage in untoward behaviors. These days, neurologist can detect these disorders quite easily. Parietal lobes Parietal lobes are positioned behind (posterior to) the frontal lobes, and above (superior to) the occipital lobes. Using the anatomical system, the central sulcus divides the frontal and parietal lobes, as mentioned before. Between the parietal and the occipital lobes lies Page 17 of 35 the parieto-occipital sulcus, whereas the lateral sulcus marks the dividing line between the parietal and temporal lobes. This pair of lobes integrates sensory information from different modalities, particularly determining spatial sense and navigation, and thus is significant for the acts of touching and holding objects. For example, it comprises somatosensory cortex, which is the area of the brain that processes the sense of touch, and the dorsal stream of the visual system, which supports knowing where objects are in space and guiding the body’s actions in space. Several portions of the parietal lobe are important in language processing. Occipital lobes The two occipital lobes are the smallest of four paired lobes in the human cerebral cortex. They are located in the lower, rearmost portion of the skull. Included within the region of this pair of lobes are many areas especially associated with vision. Thus, this lobe holds special significance for vision. There are many extrastriate regions within this lobe. These regions are specialized for different visual tasks, such as visual, spatial processing, color discrimination, and motion perception. When this lobe is damaged, the patient may not be able to see part of their visual field, or may be subjected to visual illusions, or even go partial or full blind. Temporal lobes Temporal lobe is situated below the frontal and parietal lobes. It contains the hippocampus and plays a key role in the formation of explicit long-term memory modulated by the amygdala. This means that it is involved in attaching emotions to all the data received from all senses. Adjacent areas in the superior, posterior, and lateral part of the temporal lobes are involved in high-level auditory processing. The temporal lobe is involved in primary auditory perception, such as hearing, and holds the primary auditory cortex. The primary auditory cortex receives sensory information from the ears and secondary areas process the information into meaningful units such as speech and words. The ventral part of the temporal cortices appears to be involved in high-level visual processing of complex stimuli such as faces and scenes. Anterior parts of this ventral stream for visual processing are involved in object perception and recognition. Limbic System The structures of the limbic system are surrounded by an area of the cortex referred to as the limbic lobe. The lobe forms a collarlike or ringlike shape on the inner surfaces of the cerebral hemispheres, both above and below the corpus callosum. As such, the limbic lobe comprises the inward-facing parts of other cortical lobes, including the temporal, parietal, and frontal, where the left and right lobes curve around to face each other. Page 18 of 35 Important anatomical parts of this lobe are hippocampus and amygdala, associated with memory and emotions respectively. Insular cortex (or insula) Insular lobe is located between the frontal, parietal, and temporal lobes. As suggested by its name, it is almost hidden within the lateral sulcus, deep inside the core of the brain. It is believed to be associated with consciousness. Since data indicative of the inner status of the body, such as the heartbeat, body temperature, and pain assemble here, it is believed to impact the equilibrium of the body. Besides, it is also believed to be related with several aspects of the mind, such as the emotions. Among these are perception, motor regulation, self-awareness, cognition, and inter-personal emotions. Thus, insular lobe is considered to be highly related with mental instability. The forebrain, the midbrain, and the hindbrain The divisions of the brain so far, either into the two hemispheres or the four or six lobes are solely based on the cerebrum alone. None of the above divisions included any portion either of the cerebellum or the brainstem. Yet another way of dividing the portions of the brain is into the forebrain, the midbrain, and the hindbrain (Figure 22. This is the most comprehensive division of the brain, leaving no parts of it outside. There are two systems of presenting this division: one, on the basis of the portions of the brain during early development of the central nervous system, and the other, based on the full maturation of those early parts into their respective regions of an adult brain. Here, we follow the latter system. The forebrain The forebrain is so called because of its extension to the forefront of the brain. It is the largest among the three divisions. It even spreads to the top and back part of the brain. It houses both the hemispheres, as well as the entire portion of the part known as the diencephalon. Diencephalon comprises of the hippocampus, which is associated with memory, and the amygdala, which is associated with emotions. Besides them, the forebrain also includes both the thalamus and the hypothalamus, of which the former is the part of the brain that processes information received from other parts of the central nervous system and the peripheral nervous system into the brain, and the latter which is involved is several activities such as appetite, sexuality, body temperature, and hormones. Page 19 of 35 The midbrain The midbrain is located below the forebrain and above the hindbrain. It resides in the core of the brain, almost like a link between the forebrain and the midbrain. It regulates several sensory processes such as that of the visual and auditory ones, as well as motor processes. This is also the region where several visual and auditory reflexive responses take place. These are involuntary reflexes in response to the external stimuli. Several of the masses of gray matter, composed mainly of the cell bodies, such as the basal ganglia linked with movement are also present in the midbrain. Of the above three major divisions of the brain, the midbrain belongs to the brainstem, and of the two main systems within the nervous system, it belongs to the central nervous system. The hindbrain The hindbrain is located below the end-tip of the forebrain, and at the exact back of the midbrain. It includes cerebellum, the pons, and the medulla, among others. Of these, the cerebellum has influence over body movement, equilibrium, and balance. The pons not only brings the motor information to the cerebellum, but is also related with the control over sleep and wakeful states. Finally, the medulla is responsible for involuntary processes of the nervous system associated with such activities as respiration and digestion. In terms of anatomy, pons is uppermost part, and beneath it the cerebellum and the medullae, which tapers to merge with the spinal cord. Vertical organization of the brain The organization of the brain layers can be said to represent a certain gradation of mental processes (Figure 23). The uppermost brain region, the cerebral cortex, is mostly involved in conscious sensations, abstract thought processes, reasoning, planning, working memory, and similar higher mental processes. The limbic areas on the brain’s innermost sides, around the brainstem, deal largely with more emotional and instinctive behaviors and reactions, as well as long-term memory. The thalamus is a preprocessing and relay center, primarily for sensory information coming from lower in the brainstem, bound for the cerebral hemispheres above. Moving down the brainstem into the medulla are the so-called ‘vegetative’ centers of the brain, which sustain life even if the person has lost consciousness. Anatomical directions and reference planes of the brain To enable us to identify the precise location in the brain, both vertically and horizontally, it is important to be familiar with certain technical terms used by the neuroscientists. In Page 20 of 35 terms of anatomy, the front of the brain, nearest the face, is referred to as the anterior end, and polar opposite to the anterior end is the posterior end, referring to the back of the head. Superior (sometimes called dorsal) refers to the direction toward the top of the head, and inferior (sometimes called ventral) refers to the direction toward the neck/body. In terms of reference planes, the sagittal plane divides the brain into left and right portions, the coronal plane divides the brain into anterior and posterior portions, and the axial (sometimes called horizontal) plane divides the brain into superior and inferior portions (Figure 24). In both the above contexts, we can further specify the location of a particular portion or plane in terms of its position, direction, and depth in relation to the whole brain. Likewise, for each of the planes themselves, we can further speak in terms of position, direction, and depth in relation to the whole brain as well as in relation to the individual planes. Also, when representing brain parts and structures, a lateral view illustrates the section or lobes, etc. from the perspective of a whole brain, whereas a medial view illustrates the section in the dissected manner. 8) DIFFERENT TYPES OF BRAINS In general, the number of living beings who possess brain is numerous. Their brains vary both in size and function. However, if you ask whether all brains completely differ from each other. Definitely not. There are features that are common to almost all brains, such as that all brains are composed mainly of neurons, and that they all have the function of protecting the individual being from internal and external dangers. So, although there are various types of brains, here we shall focus mainly on the differences in brain types between vertebrates and invertebrates in general, and the differences within the vertebrates in particular. As you know, vertebrates are those animals who have backbone, and invertebrates do not have backbone. Most of the invertebrates do not have brain. However, those, among them, who do possess brain, theirs is usually a simple brain, composed of very few neurons. Note that majority of the animals on this earth are invertebrates. The vertebrates make up only two percent of the entire animal population. The unicellular organisms, because of practical existential reason, usually tend to be very sensitive to light. Organisms such as sea-urchins are slightly more complex and are multi-cellular. They have a few nerve cells that regulate the function of looking for sustenance and providing protection from possible dangers. Slightly more complex than the types of sea-urchins are earthworm and jellyfish, which have neurons that assist them in fighting hostile external Page 21 of 35 environment (Figure 25). It is interesting to know that the neurons these simple organisms have are similar to the human neurons in terms of structure, function, as well as their neurotransmitters. If you ask, what is the difference then? There hardly is any connection between the nerves in the invertebrates. Besides that, the nerves almost cover their entire bodies. For example, among the invertebrates, earthworms (Figure 26) have one of the simplest types of brains, possessing only a few neurons. Their brains regulate only a few simple tasks such as eating food and doing a few simple body movements, not any higher actions. The network of neurons that process and interpret the information received from the earthworm’s body parts is present in the earthworm’s head. However, even if that network were to be removed from its body, no noticeable changes would be observe in its behavior. Still, among the invertebrates, grasshoppers and bees have slightly more complex brains. Scientists have begun to understand the relation between their brains and the corresponding behaviors (Figure 27). The ants, also an invertebrate, have more complex behavior, but have a very tiny brain. Likewise, the mosquitoes perform the function of flying in the space, suck blood from others, etc. However, their brain size is still no more than a small dot. Among the vertebrates, the mice are generally quite smart, yet have brains weighing no more than 2 grams. Their entire brain size is equivalent to that of the human hypothalamus. Though generally it is said the bigger the brain, the greater the intellect. However, in actuality it is the overall area of cortices, not just the overall bulk that determines the level of intellect. Among the vertebrates, there are mammals and non-mammals. Birds and fish are examples of non-mammals. It is known that the brains of mammals and non-mammals differ greatly in terms of complexity in the areas of composition, neurons, synapses, etc. Though they still have the same basic parts and structures, they differ in the overall brain size in relation to their bodies. Besides that, depending on which parts play out more in their life, they differ in the relative size of specific parts of the brain and body. For example, birds and fish have relatively very small olfactory bulb. Also, these nonmammalian animals lack brain cortex. Cerebral cortex is a special brain part, quite prominent in primates including the humans. Not only this, human beings are known to have a disproportionately large cortex (Figures 28 & 29). The average weight of human brain amounts to only one and a half percent of their body weight. However, it consumes 20 percent of the food required by the whole body. So, the larger the brain is the greater the amount of energy consumption. Therefore, bigger brain Page 22 of 35 is not always a sign of boon to the individual species. This may be the reason why there are no many species with larger brains in the history of evolution. Social animals that depend on their social community for survival are said to have larger brains. For example, dolphins, who hunt in groups, have fairly large brain. Although, the brains of elephants and whales are much bigger in size than that of the humans, but humans have the largest brains in proportionate to their body sizes. 9) FACTS ABOUT HUMAN SPINAL CORD Spinal cord is located within the vertebrae of the backbone. It extends from brainstem down to the first lumbar vertebra. It is roughly the width of a conventional pencil, tapering at it base even thinner. It is comprised of a bundle of fibers, and the fibers are long projections of nerve cells, extending from the base of the brain to the lower region of the spine. The spinal cord carries information to and from the brain and all parts of the body except the head, which is served by the cranial nerves. The signals that travel along the spinal cord are known as nerve impulses. Data from the sensory organs in different parts of the body is collected via the spinal nerves and transmitted along the spinal cord to the brain. The spinal cord also sends motor information, such as movement commands, from the brain out to the body, again transmitted via the spinal nerve network. In terms of its anatomy, the spinal cord (Figure 30) is constituted of what is known as white matter and gray matter. The gray matter, which forms the core of the spinal cord, is composed mainly of nerve cell bodies and forms an external look of a butterfly. The white matter surrounds the gray matter and its nerve fibers play a significant role of establishing connection between different parts of the spinal cord as well as between the brain and the spinal cord. The outer regions of white matter insulate the long projecting nerve fibers (axons) coming out from the neurons. In the gray matter of the spinal cord, there are numerous low-key nerve centers that can perform certain fundamental movement responses. However, the nerve centers within the spinal cord are regulated by the brain. The ability of the humans in consciously controlling the bowl movement is an example in this regard. The fact that infants frequent to toilets more often than the adults and that many have bedwetting problem is due to the brain being not fully developed as well as lacking in control over urine. Thus, the spinal cord serves as a pathway of connection between the brain, the rest of the body, and internal organs. The spinal cord stays in contact with the majority of body organs through the medium of nerves. Page 23 of 35 10) PERIPHERAL NERVOUS SYSTEM As discussed above, the whole of nervous system is divided into the central nervous system (CNS) and the peripheral nervous system (PNS). Of these two, we have already discussed the central nervous system constituted by the brain and the spinal cord. So here, we will take up the remaining part, i.e. the peripheral nervous system. The peripheral nervous system is a complex network of nerves extending across the body, branching out from 12 pairs of cranial nerves originating in the brain and 31 pairs of spinal nerves emanating from the spinal cord. It relays information between the body and the brain in the form of nerve impulses. It has an afferent division (through which messages are sent to the brain) and an efferent division (which carries messages from the brain to the body). Finally, there is the autonomic nervous system, which shares some nerve structures with both the CNS and PNS. It functions ‘automatically’ without conscious awareness, controlling basic functions, such as body temperature, blood pressure, and heart rate. Sensory input travels quickly from receptor points throughout the body via the afferent networks of the PNS to the brain, which processes, coordinates, and interprets the data in just fractions of a second. The brain makes an executive decision that is conveyed via the efferent division of the PNS to muscles, which take the needed action. The twelve pairs of cranial nerves There are 12 pairs of cranial nerves (Figure 31). They are all linked directly to the brain and do not enter the spinal cord. They allow sensory information to pass from the organs of the head, such as the eyes and ears, to the brain and also convey motor information from the brain to these organs—for example, directions for moving the mouth and lips in speech. The cranial nerves are named for the body part they serve, such as the optic nerve for the eyes, and are also assigned Roman numerical, following anatomical convention. Of these, some are associated with sensory information and others with motor information, while some are associated with both the kinds of information. How cranial nerves attach The cranial nerves I and II connect to the cerebrum, while cranial nerves III to XII connect to the brainstem. The fibers of sensory cranial nerves each project from a cell body that is located outside the brain itself, in sensory ganglia or elsewhere along the trunks of sensory nerves. The thirty-one pairs of spinal nerves Page 24 of 35 There are 31 pairs of spinal nerves (Figure 32). These branch out from the spinal cord, dividing and subdividing to form a network connecting the spinal cord to every part of the body. The spinal nerves carry information from receptors around the body to the spinal cord. From here the information passes to the brain for processing. Spinal nerves also transmit motor information from the brain to the body’s muscles and glands so that the brain’s instructions can be carried out swiftly. Each of the 31 pairs of spinal nerves belongs to one of the four spinal regions--- cervical, thoracic, lumbar, and sacral. Of them, the cervical region has eight pairs, the thoracic has twelve pairs, the lumbar has five, and finally, the sacral has six pairs. How spinal nerves attach As mentioned above, human spinal cord is located within the vertebrae of the backbone. So, one may wonder how the spinal nerves attach to the spinal cord. There are gaps in the vertebrae of the backbone through which spinal nerves enter the spinal cord (Figure 33). The nerves divide into spinal nerve roots, each made up of tiny rootlets that enter the back and front parts of the cord. 11) A SLIGHTLY DETAILED LOOK AT THE SENSES How do our brain and the environment interact? Here is how. First the senses come in contact with the external stimuli such as light, sound wave, pressure, etc. to which the corresponding senses respond. Then those sense data are sent along the respective sensory nerves in the form of electrical signals which eventually reach their respective sites on the brain cortices. That is when we shall have the perception of the respective objects. SEEING Let’s now take up each of the senses, one by one. First, we discuss the sense of vision. We shall look into the following topics surrounding the sense of vision: the structure of eye, its receptor cells, the visual pathway, and the range of light frequency different animals, including humans, have access to. Page 25 of 35 STRUCTURE OF EYE The eyeball is a fluid-filled orb. It has a hole in the front called pupil. At the back of the eyeball, there is retina which is a sheet of nerve cells. Some of the retinal cells are lightsensitive (photoreceptive). In the center of the retina, there is a tiny pitted area called fovea, densely packed with cones which are color-picking, light-sensitive cells and are significant in detecting detailed, sensitive image of the object. Between the pupil and the retina is a lens that adjusts to help the light passing through pupil to focus on the surface of the retina. The pupil is surrounded by a muscular ring of pigmented fibers called iris. The iris is responsible for people having different eye colors, and it also controls the amount of light entering into the eye. The pupil is covered by a transparent layer of clear tissue called cornea which merges with the tough outer surface or the ‘white’ of the eye called sclera. In the back of the eye, there is a hole (optic disk) through which the optic nerves pass through to enter the brain (Figure 34). LIGHT-RECEPTIVE CELLS As mentioned before, retina is located at the back of the eye, and is composed of lightreceptive cells (photoreceptors). There are, in the main, two types of photoreceptors in the retina: cone cells and rod cells. The cone cells detect the color components from amongst the visible light spectrum, and are also responsible for detecting fine detail. However, cone photoreceptors require a huge amount of light to perform its function well. Cone cells in the humans are of three types: red-, blue-, and green-sensing cones, each detecting the respective colors. They are all formed on the surface and around the fovea. On the other hand, the rod cells are formed on the periphery of retina. These cells can detect images even in dim light. However, these cells mainly detect shape and motion, not so much the color. Of these two types of photoreceptors, the rods are much more sensitive to light, so much so that even with just a few light particles, they can at least generate a faint image. Besides, the manner of concentration of these cells in and around fovea impacts greatly the sensitivity of the sensation of the object. The majority of the 6 million cone cells are concentrated in the fovea, whereas all of the more than 120 million rod cells are spread around the fovea. Since the rods are spread over a larger area of the retina, they are relatively less concentrated, and thus, when one sees objects, they are not seen that clearly and detailed. Page 26 of 35 VISUAL PATHWAYS The light reflected from the visual objects first enters the pupil through cornea, and through pupil it enters deeper into the eyes. The iris that surrounds the pupil controls the amount of light entering the eyes by changing its shapes, due to which the pupil appears to contract when the light is bright and sharp, and expands when it is less bright. Afterwards, the light passes through the lens which bends (refracts) the light, making the light to converge on the retina. If focusing on a near object, the lens thickens to increase refraction, but if the object is distant, the lens needs to flatten. The light then hits the photoreceptors in the retina, some of which fire, sending electrical signals to the brain via the optic nerve. Information received from the outer environment upon coming in contact with eyes has to travel right to the back of the brain where the relevant cortex (visual cortex) is, and only there it is turned into a conscious vision. Here is the pathway through which the information passes from the eyes to the optic nerves to the visual cortex: the signals from the eyes passes through the two optic nerves and converge at a crossover junction called the optic chiasm. The fibers carrying the signals continue on to form the optic tracts, one on each side, which end at the lateral geniculate nucleus, part of the thalamus. However, the signals continue to the visual cortex via bands of nerve fibers, called the optic radiation (Figure 35). RANGE OF LIGHT WAVELENGTH THAT DIFFERENT ANIMALS, INCLUDING HUMANS, HAVE ACCESS TO In the course of evolution, by means of natural selection, different species of organisms, including the humans, have evolved eyes with varying structures and functions. That range of electromagnetic spectrum visible to the human eyes is called the visible light, which range from 400 to 700 nanometers on the wavelength. That is, from the violet, with the shorter wavelengths, to red, with longer wavelengths. Lights with wavelengths outside of the above range are normally not visible to humans. This illustrates the difference in the structure of eyes among different species of organisms. For example, the vultures and rabbits have different eye from each other. Due to that, vultures can see much farther than the rabbits do, yet cannot see as widely as the rabbits do. Likewise, the infrared light that the humans cannot see is visible to some types of fish and birds. Some birds can tell a male bird from a female bird just by looking at the infrared light reflected from their wings. Likewise, there are two main features distinct in the eyes of the bees that the humans do not have. First, their eyes can detect infrared light that the humans cannot. Second, their Page 27 of 35 visual processing is five-fold speedier than that of the humans. For example, when the bees observe a normal moving object, they do not see that as moving. Rather, they are said to see that in the form of a series of distinct temporal instances. What accounts for such a unique feature of the bees’ eyes? Their eyes are composed of six-sided lens, covered with about 4500 circular discs. These lens let in just the lights reflected from the object they focus on and not from around it. Besides that, unlike human eyes, the eyes of the bees are said to have nine types of light receptors. Because of the speed of the visual processing that the bees possess, they have a advantage of being able to negotiate their movement so well even while moving with so much speed with the least incidents of ever bumping against objects, etc. Also, often we wonder about the sharp lights reflected back from the eyes of cats and other animals of that family. That is now understood to be due to the fact that all the lights entering their eyes fail to be absorbed in the retina, and are thus reflected back by the membrane called the reflective white. HEARING The ear is divided into three sections: the outer ear, the middle ear, and the inner ear. The outer ear has three further sections: the visible part of the ear called the pinna, the auditory canal, and the eardrum. The middle ear has three tiny bone structures that help in our hearing process: malleus (hammer), incus (anvil), and stapes (stirrup). The inner ear has several parts, of which the important ones are oval window, cochlea, and auditory nerve. The outer ear funnels sound waves along the auditory canal to the eardrum which is situated towards the inner end of the air canal. Immediate after the eardrum, the three tiny bones of the middle ear are attached one after the other. The sound waves cause the eardrum to vibrate, which in turn causes this chain of bones to vibrate. The vibration eventually reaches a membrane known as the oval window, the start of the inner ear. The oval window is slightly smaller than the ear drum in diameter. Because of this, when the vibration enters from the middle ear into the inner ear, the vibration becomes more consolidated. Inner ear is situated deep under the skull. Commensurate with the force of sound waves striking the ear drum, the stapes will accordingly cause the oval window to vibrate. Due to this, the fluids filling the chambers of cochlea will move, causing basilar membrane to vibrate. This stimulates the sensory hair cells on the organ of corti transforming the pressure waves into electrical impulses. These impulses pass through auditory nerve to the temporal lobe and from there to the auditory cortex (Figure 36). Page 28 of 35 Because of the way human ear is structured, it has access to a limited range of sound frequency. That is between 20 and 20000 Hertz. Sounds beyond that range are not audible to the humans. Sounds vary in terms of their pitch, and the receptors corresponding to them are found in the various parts of the cochlea. The receptors for low pitch sounds are located in the front part of cochlea, whereas receptors for the higher and the highest pitch sounds are found in the middle and inner end, respectively, of the cochlea. SMELL The area within each nasal cavity that contains the olfactory receptor cells is known as the olfactory epithelium. A small amount of the air entering the nostrils will pass over the epithelium, which is covered in mucus. Smell molecules in the air dissolve in this mucus, bringing receptors into direct contact with the smell molecules. Three cell types are within the epithelium: in addition to the receptor cells, there are supporting cells which produce a constant supply of mucus and, basal cells, which produce new receptor cells every few weeks. The larger the epithelium is, the keener the sense of smell. Dogs, for example, have a considerably larger olfactory epithelium than humans. Like the sense of taste, smell is a chemical sense. Specialized receptors in the nasal cavity detect incoming molecules, which enter the nose on air currents and bind to receptor cells. Sniffing sucks up more odor molecules into the nose, allowing you to ‘sample’ a smell. Olfactory receptors located high up in the nasal cavity send electrical impulses to the olfactory bulb, in the limbic area of the brain, for processing. Odors are initially registered by receptor cells in the nasal cavity. These send electrical impulses along dedicated pathways to the olfactory bulb (each nostril connects to one olfactory bulb). The olfactory bulb is the smell gateway to the brain. It is part of the brain’s limbic system, the seat of our emotions, desires, and instincts, which is why smell can trigger strong emotional reactions. Once processed by the olfactory bulb, data is then sent to various areas of the brain, including the olfactory cortex adjacent to the hippocampus. Unlike data gathered by the other sense organs, odors are processed on the same side, not opposite, side of the brain as the nostril the sensory data was sent from (Figure 37). How do the olfactory receptors detect the different odors? Different smells are produced from different molecular structures of smell. Research shows that each receptor has zones on it. Therefore, when a specific smell enters the nose, only the receptors forming a conforming pattern, not every receptor, is activated. That is how the specific smell is Page 29 of 35 detected. So far the scientists have identified eight primary odors: camphorous, fishy, malty, minty, musky, spermatic, sweaty, and urinous. TASTE Taste and smell are both chemical senses. Therefore, tongue can detect taste only when the receptors in it bind to incoming molecules, generating electrical signals that pass through the related cranial nerves to the specific brain areas. Thus, the pathway of gustatory electrical impulses begins with mouth, going to medulla, continues to the thalamus, then to primary gustatory areas of the cerebral cortex. A person can experience the basic five flavors (sweet, sour, salty, bitter, and umami) by merely activating the taste receptors on the tongue. However, the flavors produced from the combination of these can be detected by tongue only in interaction with the sense of smell. Compared with cold food, we experience the hot food to produce greater taste. This is because, during such time, smell particles rising from the hot food bind to and excite the smell receptors inside the nose, making us also to sense their smell. Before the smell particles and taste particles are detected by the smell receptors and taste receptors respectively, these particles have to dissolve in the liquid solvents in the nose and mouth respectively. So they are similar on that front. However, what is different between the two is that while the taste receptors are not actual neurons, but a special type of cells, the smell receptors are actual neurons. Due to this difference, we see a marked difference in the degree of sensitivity towards the chemical particles. The smell receptors are 300 hundred times more sensitive (Figure 38). The tongue is the main sensory organ for taste detection. It is the body’s most flexible muscular organ. It has three interior muscles and three pairs of muscles connecting it to the mouth and throat. Its surface is dotted with tiny, pimplelike structures called papillae. Papillae are easily visible to naked eyes. Within each papilla are hundreds of taste buds and they are distributed across the tongue. Four types of papillae have been distinguished---vallate, filiform, foliate, and fungiform. Each type bears a different amount of taste buds. A taste bud is composed of a group of about 25 receptor cells alongside supporting cells layered together. In general, humans have 5000 to 10,000 taste buds, and each bud may carry 25 to 100 taste receptor cells within it. At the tip of each cell, there is a hole through which taste chemical particles enter and come in contact with the receptor molecules. The tiny hair-like receptors inside these receptor cells can hold only particular taste particles. Earlier, scientists believed that different parts of the tongue are dedicated to detecting specific tastes. However, according to recent researches, all tastes are detected equally across the tongue, and the tongue is well supplied with nerves Page 30 of 35 that carry taste-related data to the brain. Other parts of the mouth such as the palate, pharynx, and epiglottis can also detect taste stimuli. TOUCH There are many kinds of touch sensations. These include light touch, pressure, vibration, and temperature as well as pain, and awareness of the body position in space. The skin is the body’s main sense organ for touch. There are around 20 types of touch receptor that respond to various types of stimuli. For instance, light touch, a general category that covers sensations ranging from a tap on the arm to stroking a cat’s fur, is detected by four different types of receptor cells: free nerve endings, found in the epidermis; Merkel’s disks, found in deeper layers of the skin; Meissner’s corpuscles, which are common in the palms, soles of the feet, eyelids, genitals, and nipples; and, finally, the root hair plexus, which responds when the hair moves. Pacinian and Ruffini corpuscles respond to more pressure. The sensation of itching is produced by repetitive low-level stimulation of nerve fibers in the skin, while feeling ticklish involves more intense stimulation of the same nerve endings when the stimulus moves over the skin (Figure 39). As for the manner in which touch information finally makes its way to the brain, a sense receptor, when activated, sends information about touch stimuli as electrical impulses along a nerve fiber of the sensory nerve network to the nerve root on the spinal cord. The data enters the spinal cord and continues upward to the brain. The processing of sensory data is begun by the nuclei in the upper (dorsal) column of the spinal cord. From the brainstem, sensory data enters the thalamus, where processing continues. The data then travels to the postcentral gyrus of the cerebral cortex, the location of the somatosensory cortex. Here, it is finally translated into a touch perception. Somatosensory cerebral cortex curls around the brain like a horseshoe. Data from the right side of the body ends on the left side of the brain, and vice versa. THE SIXTH SENSE Proprioception is sometimes referred to as the sixth sense. It is our sense of how our bodies are positioned and moving in space. This ‘awareness’ is produced by part of the somatic sensing system, and involves structures called proprioceptors in the muscles, tendons, joints, and ligaments that monitor changes in their length, tension, and pressure linked to changes in position. Proprioceptors send impulses to the brain. Upon processing this information, a decision can be made—to change position or to stop moving. The brain then sends signals back to the muscles based on the input from the proprioceptors— Page 31 of 35 completing the feedback cycle. This information is not always made conscious. For example, keeping and adjusting balance is generally an unconscious process. Conscious proprioception uses the dorsal column-medial lemniscus pathway, which passes through the thalamus, and ends in the parietal lobe of the cortex. Unconscious proprioception involves spinocerebellar tracts, and ends in the cerebellum. Proprioception is impaired when people are under the influence of alcohol or certain drugs. The degree of impairment can be tested by field sobriety tests, which have long been used by the police in cases of suspected drunk-driving. Typical tests include asking someone to touch their index finger to their nose with eyes closed, to stand on one leg for 30 seconds, or to walk heel-to-toe in a straight line for nine steps. MIXED SENSES Sensory neurons respond to data from specific sense organs. Visual cortical neurons, for example, are most sensitive to signals from the eyes. But this specialization is not rigid. Visual neurons have been found to respond more strongly to weak light signals if accompanied by sound, suggesting that they are activated by data from the ears as well as the eyes. Other studies show that in people who are blind or deaf, some neurons that would normally process visual or auditory stimuli are “hijacked” by the other senses. Hence, blind people hear better and deaf people see better. SYNESTHESIA Most people are aware of only a single sensation in response to one type of stimulus. For example, sound waves make noise. But some people experience more than one sensation in response to a single stimulus. They may “see” sounds as well as hear them, or “taste” images. Called synesthesia, this sensory duplication occurs when the neural pathway from a sense organ diverges and carries data on one type of stimulus to a part of the brain that normally processes another type (Figure 40). PERCEPTION AS A CONSTRUCT Do we perceive the external world directly, or do we perceive a constructed reality? Neuroscience finds that the latter is a more accurate description. When our sensory organs detect something in the environment, they are responding to a physical stimulus. For example, the photoreceptor cells in the retina of the eye respond to photon particles traveling through space. These photons stimulate the receptor neurons, and start a chain reaction of neural signals to the primary visual cortex in the brain, where it becomes a perception. While the visual perception correlates with the physical stimulus, they are not Page 32 of 35 one and the same. It was described earlier that photons have a wavelength, and the wavelength can vary among photons. Each numerical difference in the wavelength of a photon correlates with a difference in the perception of color. That is, photons with a wavelength of around 500 nanometers correlate with perceiving the color blue, while a wavelength of around 700 nanometers correlates with perceiving the color red. While the physical property of wavelength exists objectively in the world, the perceived color only exists subjectively and depends on our ability to detect it. The colors we perceive are not physical properties, but rather the psychological correlates of the physical property of wavelength of light. Moreover, there are many wavelengths that we cannot detect, so our perceptions selectively represent the physical world. The same principle applies to the other senses. Each sensory modality we have has two components: the physical stimulus that is detected by the sensory organ, and the psychological perception that results from it. We do not directly perceive the wavelength of light, rather we perceive the result of how the photon particles stimulate the visual pathway. Therefore, we can say that perception is a construction that is grounded in detecting physical phenomena, but we do not directly perceive those phenomena. Nor do we perceive all objective phenomena, only those that we are capable of detecting. If perception is a construction and a limited representation of objective phenomena, why did it evolve that way? We need to be able to react to environmental circumstances to survive. To find food, to avoid predators, to meet mates, to care for offspring, to engage in social behavior, all of these actions require the ability to detect and respond to changes in the physical environment. But sensory systems can evolve to be simply good enough for survival. It is not necessary to have complete, direct perception to survive. In fact, recall the facts we discussed earlier about how the human brain is very demanding for the body’s resources. More sophisticated sensory systems require more resources, and if those resource requirements are not of great utility to the organism, then evolution likely will not favor increasing the level of sophistication. In addition, there is often a trade-off between speed and accuracy in neural systems and resulting behaviors. When it comes to visual perception, seeing a danger with less accuracy and surviving is more important than seeing a danger directly and not surviving! Page 33 of 35 12)CONSCIOUSNESS AND THE BRAIN WHAT IS CONSCIOUSNESS? Consciousness is important as well as essential. Without it, life would have no meaning. However, once we embark on identifying its nature, it is certain to find it to be like nothing else. A thought, feeling, or idea seems to be a different kind of thing from the physical objects that make up the rest of the universe. The contents of our minds cannot be located in space or time. Although to the neuroscientists the contents of our minds appear to be produced by particular types of physical activity in the brain, it is not known if this activity itself forms consciousness or if brain activity correlates with a different thing altogether that we call “the mind” or consciousness (Figure 41). If consciousness is not simply brain activity, this suggests that the material universe is just one aspect of reality and that consciousness is part of a parallel reality in which entirely different rules apply. MONISM AND DUALISM The philosophical stands of those positing the relation between mind and body can be broadly brought under two divisions: monism and dualism. According to the former, every phenomenon in the universe can be ultimately reduced to a material thing. Consciousness too is identical to the brain activity that correlates with it. However, the fact that not every physical thing has consciousness is because only in those physical bodies where complex physical processes evolved over a long period of time did cognitive mechanism develop. Thus, consciousness never existed in parallel with the material universe as an independent entity of its own. According to the latter, consciousness is not physical but exists in another dimension to the material universe. Certain brain processes are associated with the consciousness, but they are not identical to each other. Some dualists believe consciousness may even exist without the brain processes associated with it. LOCATING CONSCIOUSNESS Human consciousness arises from the interaction of every part of a person with their environment. We know that the brain plays the major role in producing conscious awareness but we do not know exactly how. Certain processes within the brain, and neuronal activity in particular areas, correlate reliably with conscious states, while others do not. Page 34 of 35 Different types of neuronal activity in the brain are associated with the emergence of conscious awareness. Neuronal activity in the cortex, and particularly in the frontal lobes, is associated with the arousal of conscious experience. It takes up to half a second for a stimulus to become conscious after it has first been registered in the brain. Initially, the neuronal activity triggered by the stimulus occurs in the “lower” areas of the brain, such as the amygdala and thalamus, and then in the “higher” brain, in the parts of the cortex that process sensations. The frontal cortex is activated usually only when an experience becomes conscious, suggesting that the involvement of this part of the brain may be an essential component of consciousness. REQUIREMENTS OF CONSCIOUSNESS Every state of conscious awareness has a specific pattern of brain activity associated with it. These are commonly referred to as the neural correlates of consciousness. For example, seeing a patch of yellow produces one pattern of brain activity, seeing grandparents, another. If the brain state changes from one pattern to another, so does the experience of consciousness. Consciousness arises only when brain cells fire at fairly high rates. So, neural activity must be complex for consciousness to occur, but not too complex. If all the neurons are firing, such as in an epileptic seizure, consciousness is lost. The processes relevant to consciousness are generally assumed to be found at the level of brain cells rather than at the level of individual molecules or atoms. Yet it is also possible that consciousness does arise at the far smaller atomic (quantum) level, and if so it may be subject to very different laws. Many neuroscientists hold the philosophical view of materialism; that there is only one fundamental substance in the universe and that is physical material. How, then, is subjective experience of the mind explained? Through a process known as emergence. Emergence is a process described as the production of a phenomenon from the interactions or processes of several other phenomena. For example, the molecule that is water is composed of two hydrogen atoms and one oxygen atom. The hydrogen and oxygen atoms on their own do not have the quality of wetness that water has. But when you combine them to form the molecule, and you have enough water molecules, then the property of wetness emerges from those interactions. Neuroscientists use this as an analogy, and argue that when many neurons are combined, consciousness emerges from those interactions. This analogy serves as a useful description within the viewpoint of materialism, but it is not an explanation, as we have yet to demonstrate the mechanisms involved in such an emergence.","Can you list all of the ancient people mentioned by name in a bullet point list along with a brief description of their beliefs regarding the brain? Use only the given sources to complete your responses. Do not use outside sources or any previous knowledge of the topic that you may have. 1) A BRIEF HISTORY OF NEUROSCIENCE Humans have long been interested in exploring the nature of mind. The long history of their enquiry into the relationship between mind and body is particularly marked by several twists and turns. However, brain is the last of the human organs to be studied in all seriousness, more particularly its relation with human mind. Around 2000 BC and for long since that time the Egyptians did not think highly of the brain. They would take out the brain via the nostrils and discarded it away before mummifying the dead body. Instead, they would take great care of the heart and other internal organs. However, a few Egyptian physicians seemed to appreciate the significance of the brain early on. Certain written records have been found where Egyptian physicians had even identified parts and areas in the brain. Besides, Egyptian papyrus, believed to have been written around 1700 BC, carried careful description of the brain, suggesting the possibility of addressing mental disorders through treatment of the brain. That is the first record of its kind in the human history (Figure 1). The Greek mathematician and philosopher, Plato (427-347) believed that the brain was the seat of mental processes such as memory and feelings (Figure 2). Later, another Greek physician and writer on medicine, Galen (130-200 AD) too, believed that brain disorders were responsible for mental illnesses. He also followed Plato in concluding that the mind or soul resided in the brain. However, Aristotle (384-322 BC), the great philosopher of Greece at that time, restated the ancient belief that the heart was the superior organ over the brain (Figure 3). In support of his belief, he stated that the brain was just like a radiator which stopped the body from becoming overheated, whereas the heart served as the seat of human intelligence, thought, and imagination, etc. Medieval philosophers felt that the brain was constituted of fluid-filled spaces called ventricles where the ‘animal spirits’ circulated to form sensations, emotions, and memories. This viewpoint brought about a shift in the previously held views and also provided the scientists with the new idea of actually looking into the brains of the humans and animals. However, no such ventricles as claimed by them were found upon examination nor did the scientists find any specific location for the self or the soul in the brain. In the seventeenth century, the French philosopher Rene Descartes (1596-1650) described mind and body as separate entities (Figure 4) yet they interacted with each other via the pineal gland, the only structure not duplicated on both sides of the brain. He maintained that the mind begins its journey from the pineal gland and circulates the rest of the body via the nerve vessels. His dualist view influenced the mind-body debate for Page 4 of 35 the next two centuries. However, through the numerous experiments undertaken in the 19th century, the scientists gathered evidences and findings which all emboldened the scientists to claim that the brain is the center of feelings, thoughts, self and behaviors. Just to give an example of the kind of experiments performed on a particular physical activity which pointed to the brain as the regulator of bodily actions, imagine activating a particular area of the brain through electrical stimulus, you would actually see it effectively impacting a corresponding body-part, say the legs by making them move. Through findings such as these as well as others, we have come of know also of the special activities of the electrical impulses and chemicals in the brain. Explorations continued into the later centuries and, by the middle of 20th century, human understanding of the brain and its activities have increased manifold. Particularly, towards the end of twentieth century, with further improvement in imaging technologies enabling the researchers to undertake investigation on functioning brains, the scientists were deeply convinced that the brain and the rest of the nervous systems monitored and regulated emotions and bodily behaviors (Figures 5 & 6). Since then, the brain together with the nervous system have become the center of attention as the basis of mental activities as well as physical behaviors, and gradually a separate branch of science called neuroscience focusing specifically on the nervous systems of the body has evolved in the last 40 so years. To better understand modern neuroscience in its historical context, including why the brain and nervous system have become the center of attention in the scientific pursuit of understanding the mind, it is useful to first review some preliminary topics in the philosophy of science. Science is a method of inquiry that is grounded in empirical evidence. Questions about the unknown direct the path of science as a method. Each newly discovered answer opens the door to many new questions, and the curiosity of scientists motivates them to answer those unfolding questions. When a scientist encounters a question, she or he develops an explanatory hypothesis that has the potential to answer it. But it is not enough to simply invent an explanation. To know if an explanation is valid or not, a scientist must test the hypothesis by identifying and observing relevant, objectively measurable phenomena. Any hypothesis that cannot be tested in this way is not useful for science. A useful hypothesis must be falsifiable, meaning that it must be possible to ascertain, based on objective observations, whether the hypothesis is wrong and does not explain the phenomena in question. If a hypothesis is not falsifiable, it is impossible to know whether it is the correct explanation of a phenomenon because we cannot test the validity of the claim. Why does the scientific method rely only on objective observations? Science is a team effort, conducted across communities and generations over space and time. For a hypothesis to be accepted as valid, it must be possible for any interested scientist to test it. For example, if we want to repeat an experiment that our colleague conducted last year, we need to test the hypothesis under the same conditions as the original experiment. This means it must be possible to recreate those conditions. The only way to do this in a precise and controlled manner is if the scientific method relies on empirical evidence. Page 5 of 35 Furthermore, conclusions in science are subject to peer review. This means that any scientist’s colleagues must be able to review and even re-create the procedures, analyses, and conclusions made by that scientist before deciding if the evidence supports the conclusions. Because we don’t have access to the subjective experiences of others, it is not possible to replicate experiments that are grounded in subjectivity because we cannot recreate the conditions of such an experiment, nor can we perform identical analyses of subjective phenomena across people. No matter how many words we use, we cannot describe a single subjective experience accurately enough to allow another person to experience it the same way. Consequently, we cannot have a replicable experiment if the evidence is not objective. Therefore, two necessary features of a scientific hypothesis are the potentials to falsify and replicate it. And both of these requirements are dependent on objectively measurable evidence. This is why we began with the claim that science is a method of inquiry that is grounded in empirical evidence. Neuroscience is a scientific discipline like any other, in that the focus of investigation is on objectively measurable phenomena. But unlike most other sciences, this poses a particularly challenging problem for neuroscience. How do we investigate the mind, which is subjective by nature, if empirical evidence is the only valid form of data to support a conclusion in science? The relationship between the mind and the body has become known as the “mind-body problem” in modern neuroscience and Western philosophy of mind, because there is a fundamental challenge to explain the mind in objective terms. Scientists view this relationship as a problem because their method of inquiry investigates phenomena from a third-person (he, she, it, they) perspective, while the subjective experience of the mind has a first-person (I, we) perspective. The mindbody problem has been a central, unresolved topic in Western philosophy of mind for centuries, and is a topic we will discuss in more detail in a later chapter of this textbook when we explore the neuroscience of consciousness. For now we can start simply by stating that the majority of scientists, including neuroscientists, hold the philosophical view that all phenomena are caused by physical processes, including consciousness and its related mental phenomena. This view might be proven wrong as inquiry proceeds, but is taken as the most simple (or parsimonious) starting point. Science uses the principle of parsimony, of starting with simple rather than complex explanations, as a way to facilitate production of falsifiable hypotheses: more complex explanations are built up as evidence accumulates and more simple explanations are excluded. Modern neuroscience investigates the brain and nervous system based on the working assumption that the objective physical states of those biological systems are the cause of the subjective mental states of the organism that has those biological systems. In other words, when you smell a fresh flower, taste a cup of chai, listen to the birds, feel the wind on your cheek, and see the clouds in the sky, those subjective experiences are caused by the momentary physical processes in your body, nervous system, and brain interacting with the physical environment. Under this philosophical view, then, mental states correlate with physical states of the organism, and by investigating those physical states scientists can understand the nature of those mental Page 6 of 35 states. So while this might seem counterintuitive based on the Buddhist method of inquiry, for a neuroscientist it is obvious to begin the investigation by focusing on physical phenomena; on the empirical evidence. Neuroscientists often equate the “neural correlates” of consciousness as consciousness itself. We will explore in more depth the relationship between form and function between the body and mind later in the textbook, as well as the philosophical view of materialism in neuroscience. It will also be helpful to introduce some basic concepts in neuroscience before exploring topics in more detail. The primary goal in this year of the neuroscience curriculum is that you become familiar with the brain and nervous system. The human brain is the most complex and extraordinary object known to all of modern science. Because of this immense complexity, it can be very challenging to encounter neuroscience in an introductory course such as this one. So patience is an important part of the learning process. First, neuroscience is still very much in its infancy as a scientific discipline, and there are vastly more questions than there are answers. Second, it can be a challenge for new students of neuroscience to simultaneously learn the details of the basic concepts while understanding and appreciating the broader conclusions. It’s like learning a language while also reading the literature of that language! Neuroscience is a scientific discipline with many different levels of exploration and explanation. Therefore, it is important for you to pay attention to the level at which are we speaking when you learn new concepts. For example, the brain and nervous system are made up of cells called neurons or nerve cells, which we will discuss in detail in Chapter 4. Neurons connect with each other to form complex networks, and from those different patterns of connection emerge different phenomena (such as a thought or a sensation) in the brain and ultimately in the mind. This may sound confusing at the moment, but we will explore these topics in more detail in later chapters. In neuroscience, levels of explanation can span from very low levels such as the molecular mechanisms involved in the neuron cells, to middle levels such as particular networks of neurons in the brain, to very high levels such as how humans engage in thoughts, speech, and purposeful actions. The brain is the bodily organ that is the center of the nervous system. But it might surprise you to learn that not all animals that have neurons have a brain! For example, jellyfish have neurons, but they don’t have a brain. Jellyfish are very simple organisms that live in the ocean, and their neurons allow them to sense some basic information about their environment. But because they don’t have a brain to process that environmental information, they can only react to their immediate environment. Without a brain, jellyfish cannot think, make plans for the future, have memories of the past, or make decisions. Their behavior is limited to reactions and reflexes. Complex networks of neurons in the human brain are the physiological substrates that support what we experience as human beings. But we are not the only species with a brain. Later in this textbook we will explore the relationship between brain complexity and behavior across species. For organisms that have a brain, information can flow along the complex networks of neurons in different ways. Some networks, also called pathways or systems, flow from the sensory organs to the brain, while others flow from the brain to the muscles of the Page 7 of 35 body. Afferent neurons, also called sensory neurons or receptor neurons, communicate information from the sensory organs to the brain. Efferent neurons, also called motor neurons, communicate information from the brain to the muscles of the body. Interneurons, also called association neurons, communicate information between neurons in the central nervous system and brain. This allows for the sensory and motor systems to interact, facilitating complex behaviors and integrating across the different sensory modalities. For example, to be able to reach for an object such as a teacup, your brain needs to link together your ability to sense the presence and location of the cup with your ability to control the muscles in your arm to grasp the cup. Interneurons perform this function. Finally, before starting your journey in learning about neuroscience, pause to contemplate some of the big questions and insights as they pertain to the Western science of the mind. As you go through this textbook and learn new concepts, it will be useful to think about them within the context of these big questions. For example, what is sentience? Is a brain required for sentience? The jellyfish we mentioned earlier can have basic sensations and react to the environment without a brain, but it cannot think or have memory. What are the necessary conditions to be sentient? What is the relationship between the mind and body? As a method of inquiry, can science directly investigate subjective experience? Or must we use alternative, and perhaps complementary methods of inquiry to achieve that? Do we perceive the physical world directly, or are our perceptions constructed? If the latter, how does that happen? 2) WHAT IS NEUROSCIENCE AND WHAT ARE ITS BRANCH SCIENCES? In the case of humans, it is the branch of science that studies the brain, the spinal cord, the nerves extending from them, and the rest of the nervous systems including the synapses, etc. Recall that neurons, or nerve cells, are the biological cells that make up the nervous system, and the nervous system is the complex network of connections between those cells. In this connection, it may involve itself with the cellular and molecular bases of the nervous system as well as the systems responsible for sensory and motor activities of the body. It also deals with the physical bases of mental processes of all levels, including emotions and cognitive elements. Thus, it concerns itself with issues such as thoughts, mental activities, behaviors, the brain and the spinal cord, functions of nerves, neural disorders, etc. It wrestles with questions such as What is consciousness?, How and why do beings have mental activities?, What are the physical bases for the variety of neural and mental illnesses, etc. In identifying the sub-branches within neuroscience, there are quite a few ways of doing so. However, here we will follow the lead of the Society for Neuroscience which identifies the following five branches: Neuro-anatomy, Developmental Neuroscience, Cognitive Neuroscience, Behavioral Neuroscience, and Neurology. Of these, Page 8 of 35 neuroanatomy concerns itself mainly with the issue of structures and parts of the nervous system. In this discipline, the scientists employ special dyeing techniques in identifying neurotransmitters and in understanding the specific functions of the nerves and nerve centers. Neurotransmitters are chemicals released between neurons for transmission of signals. When a neuron communicates with its neighboring cells, it releases neurotransmitters and its neighbors receive them. In developmental neuroscience, the scientists look into the phases and processes of development of nervous system, the changes they undergo after they have matured, and their eventual degeneration. In this regard, the scientists also investigate the ways neurons go about seeking connection with other neurons, how they establish the connection, and how they maintain the connection and what chemical changes and processes they have to undergo for these activities. Neurons make connections to form networks, and the different patterns of connectivity support different functions. Patterns of connectivity can change over different time scales, such as developmental changes over a lifetime from infancy to old age, but also in the short term such as learning a new concept. Neuroplasticity is the term that describes the capacity of the brain to change in response to stimulation or even damage: it is not a static organ, but is highly adaptable. In cognitive neuroscience, they study the functions of behaviors, perceptions, and memories, etc. By making use of non-invasive methods such as the PTE and MRI technologies that allow us to take detailed pictures of the brain without opening the skull, they look into the neural pathways activated during engagement in language, solutions, and other activities. Cognitive neuroscience studies the mind-body relationship by discovering the neural correlates to mental and behavioral phenomena. Behavioral neuroscience looks into the underpinning processes of human and animal behaviors. Using electrodes, they measure the neural electrical activities occurring alongside our actions such as visual perception, language use, and generating memories. Through fMRI scan techniques, another technology that allows us to take detailed motion pictures of brain activity over time without opening the skull, they strive to arrive at closer understanding of the brain parts in real time. Finally, neurology makes use of the fundamental research findings of the other disciplines in understanding the neural and neuronal disorders and strives to explore new innovative ways of detecting, preventing, and treating these disorders. 3) THE SUBJECT MATTER OF NEUROSCIENCE: THE MAIN SYSTEMS AND THEIR PARTS The field of neuroscience is the nervous system of animals in general and of humans in particular. In the case of humans, its nervous system has two main components: the central nervous system (CNS) and the peripheral nervous system (PNS) (Figure 7). The CNS comprises of the brain and the spinal cord. Their functions involve processing and interpreting the information received the senses, skin, muscles, etc. and giving responses Page 9 of 35 that direct and dictate specific actions such as particular movements by different parts of the body. The peripheral nervous system (PNS) includes all the rest of the nervous system aside from the central nervous system. This means that it comprises the 12 pairs of cranial nerves that originate directly from the brain and spread to different parts of the body bypassing the spinal cord, and the 31 pairs of spinal nerves that pass through the spinal cord and spread to different parts of the body. Thus, the PNS is mainly constituted of nerve. PNS is sometimes further classified into voluntary nervous system and the autonomic nervous system. This is based on the fact that the nerves in the former system are involved in making conscious movements, whereas those in the latter system make movements over which the person does not have control. Obviously, the former category of nerves includes those associated with the muscles of touch, smell, vision, and skeleton. The latter includes nerves spread over muscles attached with heart beats, blood pressure, glands, and smooth muscles. 4) AN EXCLUSIVE LOOK AT ‘NEURONS’, A FUNDAMENTAL UNIT OF THE BRAIN AND THE NERVOUS SYSTEM Neurons Neurons are the cellular units of the brain and nervous system, and are otherwise called nerve cells (Figure 8). Estimates of the number of brain neurons range from 50 billion to 500 billion, and they are not even the most numerous cells in the brain. Like hepatocyte cells in the liver, osteocytes in bone, or erythrocytes in blood, each neuron is a selfcontained functioning unit. Its internal components, the organelles, include a nucleus harboring the genetic material (DNA), energy-providing mitochondria, and proteinmaking ribosomes. As in most other types of cells, the organelles are concentrated in the main cell body. In addition, characteristic features of neurons are neurites—long, thin, finger-like or threadlike extensions from the cell body (soma). The two main types are dendrites and axons. Usually, dendrites receive nerve signals, while axons send them onward. The cell body of a neuron is about 10-100 micrometers across, that is 1/100th to 1/10th of one millimeter. Also, the axon is 0.2-20 micrometers in diameter, dendrites are usually slimmer. In terms of length, dendrites are typically 10-50 micrometers long, while axons can be up a few centimeters (inches). This is mostly the case in the central nervous system (Figure 9). Classification of neurons Page 10 of 35 There are numerous ways of classifying neurons among themselves. One of them is by the direction that they send information. On this basis, we can classify all neurons into the three: sensory neurons, motor neurons, and interneurons. The sensory neurons are those that send information received from sensory receptors toward the central nervous system, whereas the motor neurons send information away from the central nervous system to muscles or glands. The interneurons are those neurons that send information between sensory neurons and motor neurons. Here, the sensory neurons receive information from sensory receptors (e.g., in skin, eyes, nose, tongue, ears) and send them toward the central nervous system. Because of this, these neurons are also called afferent neurons as they bring informational input towards the central nervous system. Likewise, the motor neurons bring motor information away from the central nervous system to muscles or glands, and are thus called efferent neurons as they bring the output from the central nervous system to the muscles or glands. Since the interneurons send information between sensory neurons and motor neurons, thus serving as connecting links between them, they are sometimes called internuncial neurons. This third type of neurons is mostly found in the central nervous system. Another way of classifying the neurons is by the number of extensions that extend from the neuron’s cell body (soma) (Figure 10). In accordance with this system, we have unipolar, bipolar, and multipolar neurons. This classification takes into account the number of extensions extending initially from the cell body of the neuron, not the overall number of extensions. This is because there can be unipolar neurons which have more than one extensions in total. However, what the difference here is from the other two types of neurons is that these unipolar neurons shall have only one initial extension from the cell body. Most of the neurons are multipolar in nature. Synapses Synapses are communication sites where neurons pass nerve impulses among themselves. The cells are not usually in actual physical contact, but are separated by an incredibly thin gap, called the synaptic cleft. Microanatomically, synapses are divided into types according to the sites where the neurons almost touch. These sites include the soma, the dendrites, the axons, and tiny narrow projections called dendritic spines found on certain kinds of dendrites. Axospinodendrittic synapses form more than 50 percent of all synapses in the brain; axodendritic synapses constitute about 30 percent (Figure 11). How signals are passed among neurons Page 11 of 35 Neurons send signals to each other across the synapses. Initially, signals enter into the cell body of a neuron through their dendrites, and they pass down the axon until their arrival at the axon terminals. From there, the signal is sent across to the next neuron. Starting from the time the signal passes along the dendrites and axon, eventually reaching the axon terminal, it consists of moving electrically charges ions, but at a synapse while making that transition, it relies more on the structural shape of the chemical neurotransmitters. Every two neurons are separated by a gap, called synaptic cleft, at their synaptic site. The neuron preceding the synapse is known as pre-synaptic neuron and the one following the synapse is known as post-synaptic neuron. When the action potential of the pre-synaptic neuron is passed along its axon and reaches the other end of it, it causes synaptic vesicles to fuse or merge with the membrane. This releases the neurotransmitter molecules to pass or diffuse across the synaptic cleft to the post-synaptic membrane and slot into receptor sites (Figure 12). Neurotransmitter molecules slot into the same-shaped receptor sites in the postsynaptic membrane. A particular neurotransmitter can either excite a receiving nerve cell and continue a nerve impulse, or inhibit it. Which of these occurs depends on the type of membrane channel on the receiving cell. The interaction among neurons or between a neuron and another type of body cell, all occur due to the transfer of neurotransmitters. Thus, our body movements, mental thought processes, as well as feelings, etc. are all dependent on the transfer of neurotransmitters. In particular, let’s take a look into how the muscle movements happen due to the transfer of neurotransmitter. The axons of motor neurons extend from the spinal cord to the muscle fibers. For intending to perform any action, either of the speech or body, the command has to originate from the brain to the spinal cord. From the spinal cord, the command has to pass through motor neurons to the specific body parts, upon which the respective actions will be performed. The electrical impulse released along the axon of the motor neuron arrives at the axon terminal. Once they are there, then the neurotransmitters are secreted to carry the signals across the synapse. The receptors in the membrane of the muscles cells attach to the neurotransmitters and stimulate the electrically charged ions within the muscle cells. This leads to the contraction or extension of the respective muscles. Page 12 of 35 5) FACTS ABOUT HUMAN BRAIN Brain is a complex organ generally found in vertebrates. Of all the brains, human brain is even more complex. On average, a human brain weighs about one and a half kilogram, and has over 100 billion neurons. Each of these neurons is connected with several other neurons and thus, just the number of synapses (nerve cell connections) exceeds 100 trillion. The sustenance required to keep these neurons alive is supplied by different parts of the body. For example, 25 percent of the body total oxygen consumption is used up by the brain. Likewise, 25 percent of the glucose produced by our food is used up by it. Of the total amount of blood pumped out by our heart, 15 percent goes to the brain. Thus, from among the different parts of the body, the brain is the single part that uses the most amount of energy. The reason for this is because the brain engages itself in unceasing activity, day and night, of interpreting data form the internal and external environment, and respond to them. To protect this important organ from harm, it is naturally enclosed in three layers of protection, with an additional cushioning fluid in between. These layers are, in turn, protected with the hard covering, the skull, which is once again wound around by the skin of the scalp (Figure 13). The main function of the brain is to enhance the chance of survival of the person by proper regulation of the body conditions based on the brain’s reading of the internal and external environment. The way it carries out this function is by first registering the information received and responding to them by undertaking several activities. The brain also gives rise to inner conscious awareness alongside performing those processes. When the data, released by the different body senses, in the form of electrical impulses uninterruptedly arrive at the brain, the brain first of all checks their importance. When it finds them to be either irrelevant or commonplace, then it makes them dissolve by themselves and the concerned person doesn’t even generate an awareness of them. This is how only around 5 percent of the overall information received by the brain ever reaches our consciousness. For the rest of the information, the brain may process them, but they never become the subject of our consciousness. If, on the other hand, the information at hand is important or novel, the brain increases it impulses and allows it to active all over its parts. Remaining active for over a period of time, a conscious awareness unto this impulse is generated. Sometimes, in the wake of generating a conscious awareness, the brain sends commands to relevant muscles for either contraction or extension, thus making the body parts in question to engage in certain actions. Page 13 of 35 6) MAJOR PARTS OF HUMAN BRAIN Human brain is enclosed within its natural enclosures. In its normal form, it is found to be composed of three major parts (Figure 14). Cerebrum Of the three parts mentioned above, cerebrum is located in the uppermost position and is also the largest in size. It takes up ¾ of the entire brain size. It is itself composed of two brain hemispheres—the right and the left hemispheres. The two hemispheres are held together by a bridge like part called corpus callosum, a large bundle of neurons. The covering layer of the hemispheres is constituted of the cortex of which the average thickness is between 2 to 4 millimeters. The higher centers of coordinating and regulating human physical activities are located in the cortex areas, such as the motor center, proprioception center (proprioception is the sense of the relative position of the body in space, for example being aware that your arm is extended when reaching for the doorknob), language center, visual center, and auditory center. The outer surface of the cortex is formed of grooves and bulges because of which, despite being quite expansive, the cortex is able to be contained in the relatively small area. In terms of its basic composition, the outer layer of cortex is mostly made of gray matter, which is mainly comprised of cell bodies and nerve tissues formed out of nerve fibers. This matter is gray with a slight reddish shade in color. In the layer below, the cortex is formed of the white matter, which is, as the name suggests, white in color and mainly comprised of nerve tissues formed out of nerve fibers wrapped around with myelin sheath. Some nerve fibers wrapped in myelin sheath bind together the right and left hemispheres of the cerebrum, while others connect it with cerebellum, brainstem, and the spinal cord. Most of the brain parts belong to cerebrum, such as amygdala and hippocampus, as well as thalamus, hypothalamus, and other associated regions. In short, of the division into forebrain, midbrain, and hindbrain—in which the entirety of brain is accounted for, the cerebrum contains the whole of forebrain (Figure 15). The surface area of the cerebral cortex is actually quite large, and described above, it becomes folded to fit inside the skull. Humans are highly intelligent and creative animals not just because of the size of our brains, but also because of the complexity of the connections among our neurons. The folded nature of the human cortex promotes more complex connections between areas. For example, take a piece of blank paper, and draw five dots, one on each corner and one in the middle. Now draw lines from each dot to the other four dots. Imagine if these five dots were buildings, and the lines you drew were roads, then it would require more time to traverse from one corner to another corner than from one corner to the center. But what if you fold the four corners of the paper on top of Page 14 of 35 the center of the page? Suddenly all five of those dots become immediate neighbors, and it becomes very easy to walk from one “building” to another. The folding of the cortex has a similar effect. Neurons make connections with their neighbors, and if folding the cortex increases the number of neighbors each neuron has, then it also increases the complexity of the networks that can be formed among those neurons. Cerebellum Cerebellum is located below the cerebrum and at the upper back of the brainstem. Its name connotes its small size. Its mass is 1/10 of the whole brain. However, in terms of the number of neurons it contains, it exceeds that of the remaining parts of the central nervous system combined. This lump of nerve tissues, bearing the look of something cut in half, covers most of the back of brainstem. With the help of three pairs of fibers, collectively called cerebral peduncles, the brainstem is bound to the cerebellum. Like the cerebrum, it also has a wrinkled surface, but its grooves and bulges are finer and organized into more regular patterns. In terms of its physical structure, this too has a long groove in the center, with two large lateral lobes, one on each side. These lobes are reminiscent of the two hemispheres of the cerebrum and are sometimes termed cerebellar hemispheres. The cerebellum has a similar layered microstructure to the cerebrum. The outer layer, or cerebellar cortex, is gray matter composed of nerve-cell bodies and their dendrite projections. Beneath this is a medullary area of white matter consisting largely of nerve fibers. As of now, it has been established that cerebellum’s main function is in coordinating the body movement. Although, it may not initiate the movements, however it helps in the coordination and timely performance of movements, ensuring their integrated control. It receives data from spinal cord and other parts of the brain, and these data undergo integration and modification, contributing to the balance and smooth functioning of the movements, and thus helps in maintaining the equilibrium. Therefore, whenever this part of the brain is plagued by a disorder, the person may not lose total movement, but their ability of performing measured and steady movements is affected as also their ability to learn new movements. Within the division of entire brain into forebrain, midbrain, and hindbrain—cerebellum forms part of the hindbrain (Figure 16). Brainstem Brainstem is located below the cerebrum and in front of cerebellum. Its lower end connects with the spinal cord. It is perhaps misnamed. It is not a stem leading to a separate brain above, but an integral part of the brain itself. Its uppermost region is the midbrain comprising an upper “roof” incorporating the superior and inferior colliculi or Page 15 of 35 bulges at the rear, and the tegmentum to the front. Below the midbrain is the hindbrain. At its front is the large bulge of the pons. Behind and below this is the medulla which narrows to merge with the uppermost end of the body’s main nerve, the spinal cord. This part of the brain in associated with the middle and lower levels of consciousness. The eye movement involved in following a moving object in front of the eye is an example. The brainstem is highly involved in mid-to low-order mental activities, for example, the almost “automatic” scanning movements of the eyes as we watch something pass by. The gray and white matter composites of the brainstem are not as well defined as in other parts of the brain. The gray matter in this part of the brain possesses some of the crucial centers responsible for basic life functions. For example, the medulla houses groups of nuclei that are centers for respiratory (breathing), cardiac (heartbeat), and vasomotor (blood pressure) monitoring and control, as well as for vomiting, sneezing, swallowing, and coughing. When brainstem is damaged, that will immediately trigger danger to life by hindering heartbeat and respiratory processes (Figures 17 & 18). 7) WAYS OF ZONING AND SECTIONING THE HUMAN BRAIN FOR STUDY PURPOSES The two hemispheres Of the obviously so many different ways of zoning the human brain for study purposes, we will take up only a few of them as samples. As briefly mentioned before, a fully matured brain has three major parts. Of these the largest is the cerebrum. It covers around ¾ of the brain size. In terms of its outer structure, it is covered with numerous folds, and has a color of purple and gray blended. The cerebrum is formed by two cerebral hemispheres, accordingly called the right and the left hemisphere, that are separated by a groove, the medial longitudinal fissure. Between the two hemispheres, there is a bundle of nerve fibers that connects the two sides, almost serving like connecting rope holding the two in place. Called corpus callosum, if this were to be cut into two, the two hemispheres would virtually become two separate entities. Just as there are two hemispheres, that look broadly like mirror images to each other, on the two sides, likewise many of the brain parts exist in pairs, one on each side. However, due to the technological advances in general, and that of the MRI, in particular, it has been shown that, on average, brains are not as symmetrical in their left-right structure as was once believed to be , almost like mirror images (Figure 19). The two apparently symmetrical hemispheres and, within them, their other paired structures are also functionally not mirror images to each other. For example, for most Page 16 of 35 people, speech and language, and stepwise reasoning and analysis and so on are based mainly on the left side. Meanwhile, the right hemisphere is more concerned with sensory inputs, auditory and visual awareness, creative abilities and spatial-temporal awareness (Figure 20). The four or the six lobes Cerebrum is covered with bulges and grooves on its surface. Based on these formations, the cerebrum is divided into the four lobes, using the anatomical system. The main and the deepest groove is the longitudinal fissure that separates the cerebral hemispheres. However, the division into the lobes is made overlooking this fissure, and thus each lobe is spread on both the hemispheres. Due to this, we often speak of the four pairs of lobes. These lobes are frontal lobes, parietal lobes, occipital lobes, and temporal lobes (Figure 21). The names of the lobes are partly related to the overlying bones of the skull such as frontal and occipital bones. In some naming systems, the limbic lobe and the insula, or central lobe, are distinguished as separate from other lobes. Frontal lobes Frontal lobes are located at the front of the two hemispheres. Of all the lobes, these are the biggest in size as well as the last to develop. In relation to the other lobes, this pair of lobes is at the front of the parietal lobes, and above the temporal lobes. Between these lobes and the parietal lobes lies the central sulcus, and between these lobes and the temporal lobes lies the lateral sulcus. Towards the end of these lobes, i. e. the site where the pre-central gyrus is located also happens to be the area of the primary motor cortex. Thus, this pair of lobes is clearly responsible for regulating the conscious movement of certain parts of the body. Besides, it is known that the cortex areas within these lobes hold the largest number of neurons that are very sensitive to the dopamine neurotransmitters. Granting this, these lobes should also be related with such mental activities as intention, short-term memory, attention, and hope. When the frontal lobes are damaged, the person lacks in ability to exercise counter measures against lapses and tend to engage in untoward behaviors. These days, neurologist can detect these disorders quite easily. Parietal lobes Parietal lobes are positioned behind (posterior to) the frontal lobes, and above (superior to) the occipital lobes. Using the anatomical system, the central sulcus divides the frontal and parietal lobes, as mentioned before. Between the parietal and the occipital lobes lies Page 17 of 35 the parieto-occipital sulcus, whereas the lateral sulcus marks the dividing line between the parietal and temporal lobes. This pair of lobes integrates sensory information from different modalities, particularly determining spatial sense and navigation, and thus is significant for the acts of touching and holding objects. For example, it comprises somatosensory cortex, which is the area of the brain that processes the sense of touch, and the dorsal stream of the visual system, which supports knowing where objects are in space and guiding the body’s actions in space. Several portions of the parietal lobe are important in language processing. Occipital lobes The two occipital lobes are the smallest of four paired lobes in the human cerebral cortex. They are located in the lower, rearmost portion of the skull. Included within the region of this pair of lobes are many areas especially associated with vision. Thus, this lobe holds special significance for vision. There are many extrastriate regions within this lobe. These regions are specialized for different visual tasks, such as visual, spatial processing, color discrimination, and motion perception. When this lobe is damaged, the patient may not be able to see part of their visual field, or may be subjected to visual illusions, or even go partial or full blind. Temporal lobes Temporal lobe is situated below the frontal and parietal lobes. It contains the hippocampus and plays a key role in the formation of explicit long-term memory modulated by the amygdala. This means that it is involved in attaching emotions to all the data received from all senses. Adjacent areas in the superior, posterior, and lateral part of the temporal lobes are involved in high-level auditory processing. The temporal lobe is involved in primary auditory perception, such as hearing, and holds the primary auditory cortex. The primary auditory cortex receives sensory information from the ears and secondary areas process the information into meaningful units such as speech and words. The ventral part of the temporal cortices appears to be involved in high-level visual processing of complex stimuli such as faces and scenes. Anterior parts of this ventral stream for visual processing are involved in object perception and recognition. Limbic System The structures of the limbic system are surrounded by an area of the cortex referred to as the limbic lobe. The lobe forms a collarlike or ringlike shape on the inner surfaces of the cerebral hemispheres, both above and below the corpus callosum. As such, the limbic lobe comprises the inward-facing parts of other cortical lobes, including the temporal, parietal, and frontal, where the left and right lobes curve around to face each other. Page 18 of 35 Important anatomical parts of this lobe are hippocampus and amygdala, associated with memory and emotions respectively. Insular cortex (or insula) Insular lobe is located between the frontal, parietal, and temporal lobes. As suggested by its name, it is almost hidden within the lateral sulcus, deep inside the core of the brain. It is believed to be associated with consciousness. Since data indicative of the inner status of the body, such as the heartbeat, body temperature, and pain assemble here, it is believed to impact the equilibrium of the body. Besides, it is also believed to be related with several aspects of the mind, such as the emotions. Among these are perception, motor regulation, self-awareness, cognition, and inter-personal emotions. Thus, insular lobe is considered to be highly related with mental instability. The forebrain, the midbrain, and the hindbrain The divisions of the brain so far, either into the two hemispheres or the four or six lobes are solely based on the cerebrum alone. None of the above divisions included any portion either of the cerebellum or the brainstem. Yet another way of dividing the portions of the brain is into the forebrain, the midbrain, and the hindbrain (Figure 22. This is the most comprehensive division of the brain, leaving no parts of it outside. There are two systems of presenting this division: one, on the basis of the portions of the brain during early development of the central nervous system, and the other, based on the full maturation of those early parts into their respective regions of an adult brain. Here, we follow the latter system. The forebrain The forebrain is so called because of its extension to the forefront of the brain. It is the largest among the three divisions. It even spreads to the top and back part of the brain. It houses both the hemispheres, as well as the entire portion of the part known as the diencephalon. Diencephalon comprises of the hippocampus, which is associated with memory, and the amygdala, which is associated with emotions. Besides them, the forebrain also includes both the thalamus and the hypothalamus, of which the former is the part of the brain that processes information received from other parts of the central nervous system and the peripheral nervous system into the brain, and the latter which is involved is several activities such as appetite, sexuality, body temperature, and hormones. Page 19 of 35 The midbrain The midbrain is located below the forebrain and above the hindbrain. It resides in the core of the brain, almost like a link between the forebrain and the midbrain. It regulates several sensory processes such as that of the visual and auditory ones, as well as motor processes. This is also the region where several visual and auditory reflexive responses take place. These are involuntary reflexes in response to the external stimuli. Several of the masses of gray matter, composed mainly of the cell bodies, such as the basal ganglia linked with movement are also present in the midbrain. Of the above three major divisions of the brain, the midbrain belongs to the brainstem, and of the two main systems within the nervous system, it belongs to the central nervous system. The hindbrain The hindbrain is located below the end-tip of the forebrain, and at the exact back of the midbrain. It includes cerebellum, the pons, and the medulla, among others. Of these, the cerebellum has influence over body movement, equilibrium, and balance. The pons not only brings the motor information to the cerebellum, but is also related with the control over sleep and wakeful states. Finally, the medulla is responsible for involuntary processes of the nervous system associated with such activities as respiration and digestion. In terms of anatomy, pons is uppermost part, and beneath it the cerebellum and the medullae, which tapers to merge with the spinal cord. Vertical organization of the brain The organization of the brain layers can be said to represent a certain gradation of mental processes (Figure 23). The uppermost brain region, the cerebral cortex, is mostly involved in conscious sensations, abstract thought processes, reasoning, planning, working memory, and similar higher mental processes. The limbic areas on the brain’s innermost sides, around the brainstem, deal largely with more emotional and instinctive behaviors and reactions, as well as long-term memory. The thalamus is a preprocessing and relay center, primarily for sensory information coming from lower in the brainstem, bound for the cerebral hemispheres above. Moving down the brainstem into the medulla are the so-called ‘vegetative’ centers of the brain, which sustain life even if the person has lost consciousness. Anatomical directions and reference planes of the brain To enable us to identify the precise location in the brain, both vertically and horizontally, it is important to be familiar with certain technical terms used by the neuroscientists. In Page 20 of 35 terms of anatomy, the front of the brain, nearest the face, is referred to as the anterior end, and polar opposite to the anterior end is the posterior end, referring to the back of the head. Superior (sometimes called dorsal) refers to the direction toward the top of the head, and inferior (sometimes called ventral) refers to the direction toward the neck/body. In terms of reference planes, the sagittal plane divides the brain into left and right portions, the coronal plane divides the brain into anterior and posterior portions, and the axial (sometimes called horizontal) plane divides the brain into superior and inferior portions (Figure 24). In both the above contexts, we can further specify the location of a particular portion or plane in terms of its position, direction, and depth in relation to the whole brain. Likewise, for each of the planes themselves, we can further speak in terms of position, direction, and depth in relation to the whole brain as well as in relation to the individual planes. Also, when representing brain parts and structures, a lateral view illustrates the section or lobes, etc. from the perspective of a whole brain, whereas a medial view illustrates the section in the dissected manner. 8) DIFFERENT TYPES OF BRAINS In general, the number of living beings who possess brain is numerous. Their brains vary both in size and function. However, if you ask whether all brains completely differ from each other. Definitely not. There are features that are common to almost all brains, such as that all brains are composed mainly of neurons, and that they all have the function of protecting the individual being from internal and external dangers. So, although there are various types of brains, here we shall focus mainly on the differences in brain types between vertebrates and invertebrates in general, and the differences within the vertebrates in particular. As you know, vertebrates are those animals who have backbone, and invertebrates do not have backbone. Most of the invertebrates do not have brain. However, those, among them, who do possess brain, theirs is usually a simple brain, composed of very few neurons. Note that majority of the animals on this earth are invertebrates. The vertebrates make up only two percent of the entire animal population. The unicellular organisms, because of practical existential reason, usually tend to be very sensitive to light. Organisms such as sea-urchins are slightly more complex and are multi-cellular. They have a few nerve cells that regulate the function of looking for sustenance and providing protection from possible dangers. Slightly more complex than the types of sea-urchins are earthworm and jellyfish, which have neurons that assist them in fighting hostile external Page 21 of 35 environment (Figure 25). It is interesting to know that the neurons these simple organisms have are similar to the human neurons in terms of structure, function, as well as their neurotransmitters. If you ask, what is the difference then? There hardly is any connection between the nerves in the invertebrates. Besides that, the nerves almost cover their entire bodies. For example, among the invertebrates, earthworms (Figure 26) have one of the simplest types of brains, possessing only a few neurons. Their brains regulate only a few simple tasks such as eating food and doing a few simple body movements, not any higher actions. The network of neurons that process and interpret the information received from the earthworm’s body parts is present in the earthworm’s head. However, even if that network were to be removed from its body, no noticeable changes would be observe in its behavior. Still, among the invertebrates, grasshoppers and bees have slightly more complex brains. Scientists have begun to understand the relation between their brains and the corresponding behaviors (Figure 27). The ants, also an invertebrate, have more complex behavior, but have a very tiny brain. Likewise, the mosquitoes perform the function of flying in the space, suck blood from others, etc. However, their brain size is still no more than a small dot. Among the vertebrates, the mice are generally quite smart, yet have brains weighing no more than 2 grams. Their entire brain size is equivalent to that of the human hypothalamus. Though generally it is said the bigger the brain, the greater the intellect. However, in actuality it is the overall area of cortices, not just the overall bulk that determines the level of intellect. Among the vertebrates, there are mammals and non-mammals. Birds and fish are examples of non-mammals. It is known that the brains of mammals and non-mammals differ greatly in terms of complexity in the areas of composition, neurons, synapses, etc. Though they still have the same basic parts and structures, they differ in the overall brain size in relation to their bodies. Besides that, depending on which parts play out more in their life, they differ in the relative size of specific parts of the brain and body. For example, birds and fish have relatively very small olfactory bulb. Also, these nonmammalian animals lack brain cortex. Cerebral cortex is a special brain part, quite prominent in primates including the humans. Not only this, human beings are known to have a disproportionately large cortex (Figures 28 & 29). The average weight of human brain amounts to only one and a half percent of their body weight. However, it consumes 20 percent of the food required by the whole body. So, the larger the brain is the greater the amount of energy consumption. Therefore, bigger brain Page 22 of 35 is not always a sign of boon to the individual species. This may be the reason why there are no many species with larger brains in the history of evolution. Social animals that depend on their social community for survival are said to have larger brains. For example, dolphins, who hunt in groups, have fairly large brain. Although, the brains of elephants and whales are much bigger in size than that of the humans, but humans have the largest brains in proportionate to their body sizes. 9) FACTS ABOUT HUMAN SPINAL CORD Spinal cord is located within the vertebrae of the backbone. It extends from brainstem down to the first lumbar vertebra. It is roughly the width of a conventional pencil, tapering at it base even thinner. It is comprised of a bundle of fibers, and the fibers are long projections of nerve cells, extending from the base of the brain to the lower region of the spine. The spinal cord carries information to and from the brain and all parts of the body except the head, which is served by the cranial nerves. The signals that travel along the spinal cord are known as nerve impulses. Data from the sensory organs in different parts of the body is collected via the spinal nerves and transmitted along the spinal cord to the brain. The spinal cord also sends motor information, such as movement commands, from the brain out to the body, again transmitted via the spinal nerve network. In terms of its anatomy, the spinal cord (Figure 30) is constituted of what is known as white matter and gray matter. The gray matter, which forms the core of the spinal cord, is composed mainly of nerve cell bodies and forms an external look of a butterfly. The white matter surrounds the gray matter and its nerve fibers play a significant role of establishing connection between different parts of the spinal cord as well as between the brain and the spinal cord. The outer regions of white matter insulate the long projecting nerve fibers (axons) coming out from the neurons. In the gray matter of the spinal cord, there are numerous low-key nerve centers that can perform certain fundamental movement responses. However, the nerve centers within the spinal cord are regulated by the brain. The ability of the humans in consciously controlling the bowl movement is an example in this regard. The fact that infants frequent to toilets more often than the adults and that many have bedwetting problem is due to the brain being not fully developed as well as lacking in control over urine. Thus, the spinal cord serves as a pathway of connection between the brain, the rest of the body, and internal organs. The spinal cord stays in contact with the majority of body organs through the medium of nerves. Page 23 of 35 10) PERIPHERAL NERVOUS SYSTEM As discussed above, the whole of nervous system is divided into the central nervous system (CNS) and the peripheral nervous system (PNS). Of these two, we have already discussed the central nervous system constituted by the brain and the spinal cord. So here, we will take up the remaining part, i.e. the peripheral nervous system. The peripheral nervous system is a complex network of nerves extending across the body, branching out from 12 pairs of cranial nerves originating in the brain and 31 pairs of spinal nerves emanating from the spinal cord. It relays information between the body and the brain in the form of nerve impulses. It has an afferent division (through which messages are sent to the brain) and an efferent division (which carries messages from the brain to the body). Finally, there is the autonomic nervous system, which shares some nerve structures with both the CNS and PNS. It functions ‘automatically’ without conscious awareness, controlling basic functions, such as body temperature, blood pressure, and heart rate. Sensory input travels quickly from receptor points throughout the body via the afferent networks of the PNS to the brain, which processes, coordinates, and interprets the data in just fractions of a second. The brain makes an executive decision that is conveyed via the efferent division of the PNS to muscles, which take the needed action. The twelve pairs of cranial nerves There are 12 pairs of cranial nerves (Figure 31). They are all linked directly to the brain and do not enter the spinal cord. They allow sensory information to pass from the organs of the head, such as the eyes and ears, to the brain and also convey motor information from the brain to these organs—for example, directions for moving the mouth and lips in speech. The cranial nerves are named for the body part they serve, such as the optic nerve for the eyes, and are also assigned Roman numerical, following anatomical convention. Of these, some are associated with sensory information and others with motor information, while some are associated with both the kinds of information. How cranial nerves attach The cranial nerves I and II connect to the cerebrum, while cranial nerves III to XII connect to the brainstem. The fibers of sensory cranial nerves each project from a cell body that is located outside the brain itself, in sensory ganglia or elsewhere along the trunks of sensory nerves. The thirty-one pairs of spinal nerves Page 24 of 35 There are 31 pairs of spinal nerves (Figure 32). These branch out from the spinal cord, dividing and subdividing to form a network connecting the spinal cord to every part of the body. The spinal nerves carry information from receptors around the body to the spinal cord. From here the information passes to the brain for processing. Spinal nerves also transmit motor information from the brain to the body’s muscles and glands so that the brain’s instructions can be carried out swiftly. Each of the 31 pairs of spinal nerves belongs to one of the four spinal regions--- cervical, thoracic, lumbar, and sacral. Of them, the cervical region has eight pairs, the thoracic has twelve pairs, the lumbar has five, and finally, the sacral has six pairs. How spinal nerves attach As mentioned above, human spinal cord is located within the vertebrae of the backbone. So, one may wonder how the spinal nerves attach to the spinal cord. There are gaps in the vertebrae of the backbone through which spinal nerves enter the spinal cord (Figure 33). The nerves divide into spinal nerve roots, each made up of tiny rootlets that enter the back and front parts of the cord. 11) A SLIGHTLY DETAILED LOOK AT THE SENSES How do our brain and the environment interact? Here is how. First the senses come in contact with the external stimuli such as light, sound wave, pressure, etc. to which the corresponding senses respond. Then those sense data are sent along the respective sensory nerves in the form of electrical signals which eventually reach their respective sites on the brain cortices. That is when we shall have the perception of the respective objects. SEEING Let’s now take up each of the senses, one by one. First, we discuss the sense of vision. We shall look into the following topics surrounding the sense of vision: the structure of eye, its receptor cells, the visual pathway, and the range of light frequency different animals, including humans, have access to. Page 25 of 35 STRUCTURE OF EYE The eyeball is a fluid-filled orb. It has a hole in the front called pupil. At the back of the eyeball, there is retina which is a sheet of nerve cells. Some of the retinal cells are lightsensitive (photoreceptive). In the center of the retina, there is a tiny pitted area called fovea, densely packed with cones which are color-picking, light-sensitive cells and are significant in detecting detailed, sensitive image of the object. Between the pupil and the retina is a lens that adjusts to help the light passing through pupil to focus on the surface of the retina. The pupil is surrounded by a muscular ring of pigmented fibers called iris. The iris is responsible for people having different eye colors, and it also controls the amount of light entering into the eye. The pupil is covered by a transparent layer of clear tissue called cornea which merges with the tough outer surface or the ‘white’ of the eye called sclera. In the back of the eye, there is a hole (optic disk) through which the optic nerves pass through to enter the brain (Figure 34). LIGHT-RECEPTIVE CELLS As mentioned before, retina is located at the back of the eye, and is composed of lightreceptive cells (photoreceptors). There are, in the main, two types of photoreceptors in the retina: cone cells and rod cells. The cone cells detect the color components from amongst the visible light spectrum, and are also responsible for detecting fine detail. However, cone photoreceptors require a huge amount of light to perform its function well. Cone cells in the humans are of three types: red-, blue-, and green-sensing cones, each detecting the respective colors. They are all formed on the surface and around the fovea. On the other hand, the rod cells are formed on the periphery of retina. These cells can detect images even in dim light. However, these cells mainly detect shape and motion, not so much the color. Of these two types of photoreceptors, the rods are much more sensitive to light, so much so that even with just a few light particles, they can at least generate a faint image. Besides, the manner of concentration of these cells in and around fovea impacts greatly the sensitivity of the sensation of the object. The majority of the 6 million cone cells are concentrated in the fovea, whereas all of the more than 120 million rod cells are spread around the fovea. Since the rods are spread over a larger area of the retina, they are relatively less concentrated, and thus, when one sees objects, they are not seen that clearly and detailed. Page 26 of 35 VISUAL PATHWAYS The light reflected from the visual objects first enters the pupil through cornea, and through pupil it enters deeper into the eyes. The iris that surrounds the pupil controls the amount of light entering the eyes by changing its shapes, due to which the pupil appears to contract when the light is bright and sharp, and expands when it is less bright. Afterwards, the light passes through the lens which bends (refracts) the light, making the light to converge on the retina. If focusing on a near object, the lens thickens to increase refraction, but if the object is distant, the lens needs to flatten. The light then hits the photoreceptors in the retina, some of which fire, sending electrical signals to the brain via the optic nerve. Information received from the outer environment upon coming in contact with eyes has to travel right to the back of the brain where the relevant cortex (visual cortex) is, and only there it is turned into a conscious vision. Here is the pathway through which the information passes from the eyes to the optic nerves to the visual cortex: the signals from the eyes passes through the two optic nerves and converge at a crossover junction called the optic chiasm. The fibers carrying the signals continue on to form the optic tracts, one on each side, which end at the lateral geniculate nucleus, part of the thalamus. However, the signals continue to the visual cortex via bands of nerve fibers, called the optic radiation (Figure 35). RANGE OF LIGHT WAVELENGTH THAT DIFFERENT ANIMALS, INCLUDING HUMANS, HAVE ACCESS TO In the course of evolution, by means of natural selection, different species of organisms, including the humans, have evolved eyes with varying structures and functions. That range of electromagnetic spectrum visible to the human eyes is called the visible light, which range from 400 to 700 nanometers on the wavelength. That is, from the violet, with the shorter wavelengths, to red, with longer wavelengths. Lights with wavelengths outside of the above range are normally not visible to humans. This illustrates the difference in the structure of eyes among different species of organisms. For example, the vultures and rabbits have different eye from each other. Due to that, vultures can see much farther than the rabbits do, yet cannot see as widely as the rabbits do. Likewise, the infrared light that the humans cannot see is visible to some types of fish and birds. Some birds can tell a male bird from a female bird just by looking at the infrared light reflected from their wings. Likewise, there are two main features distinct in the eyes of the bees that the humans do not have. First, their eyes can detect infrared light that the humans cannot. Second, their Page 27 of 35 visual processing is five-fold speedier than that of the humans. For example, when the bees observe a normal moving object, they do not see that as moving. Rather, they are said to see that in the form of a series of distinct temporal instances. What accounts for such a unique feature of the bees’ eyes? Their eyes are composed of six-sided lens, covered with about 4500 circular discs. These lens let in just the lights reflected from the object they focus on and not from around it. Besides that, unlike human eyes, the eyes of the bees are said to have nine types of light receptors. Because of the speed of the visual processing that the bees possess, they have a advantage of being able to negotiate their movement so well even while moving with so much speed with the least incidents of ever bumping against objects, etc. Also, often we wonder about the sharp lights reflected back from the eyes of cats and other animals of that family. That is now understood to be due to the fact that all the lights entering their eyes fail to be absorbed in the retina, and are thus reflected back by the membrane called the reflective white. HEARING The ear is divided into three sections: the outer ear, the middle ear, and the inner ear. The outer ear has three further sections: the visible part of the ear called the pinna, the auditory canal, and the eardrum. The middle ear has three tiny bone structures that help in our hearing process: malleus (hammer), incus (anvil), and stapes (stirrup). The inner ear has several parts, of which the important ones are oval window, cochlea, and auditory nerve. The outer ear funnels sound waves along the auditory canal to the eardrum which is situated towards the inner end of the air canal. Immediate after the eardrum, the three tiny bones of the middle ear are attached one after the other. The sound waves cause the eardrum to vibrate, which in turn causes this chain of bones to vibrate. The vibration eventually reaches a membrane known as the oval window, the start of the inner ear. The oval window is slightly smaller than the ear drum in diameter. Because of this, when the vibration enters from the middle ear into the inner ear, the vibration becomes more consolidated. Inner ear is situated deep under the skull. Commensurate with the force of sound waves striking the ear drum, the stapes will accordingly cause the oval window to vibrate. Due to this, the fluids filling the chambers of cochlea will move, causing basilar membrane to vibrate. This stimulates the sensory hair cells on the organ of corti transforming the pressure waves into electrical impulses. These impulses pass through auditory nerve to the temporal lobe and from there to the auditory cortex (Figure 36). Page 28 of 35 Because of the way human ear is structured, it has access to a limited range of sound frequency. That is between 20 and 20000 Hertz. Sounds beyond that range are not audible to the humans. Sounds vary in terms of their pitch, and the receptors corresponding to them are found in the various parts of the cochlea. The receptors for low pitch sounds are located in the front part of cochlea, whereas receptors for the higher and the highest pitch sounds are found in the middle and inner end, respectively, of the cochlea. SMELL The area within each nasal cavity that contains the olfactory receptor cells is known as the olfactory epithelium. A small amount of the air entering the nostrils will pass over the epithelium, which is covered in mucus. Smell molecules in the air dissolve in this mucus, bringing receptors into direct contact with the smell molecules. Three cell types are within the epithelium: in addition to the receptor cells, there are supporting cells which produce a constant supply of mucus and, basal cells, which produce new receptor cells every few weeks. The larger the epithelium is, the keener the sense of smell. Dogs, for example, have a considerably larger olfactory epithelium than humans. Like the sense of taste, smell is a chemical sense. Specialized receptors in the nasal cavity detect incoming molecules, which enter the nose on air currents and bind to receptor cells. Sniffing sucks up more odor molecules into the nose, allowing you to ‘sample’ a smell. Olfactory receptors located high up in the nasal cavity send electrical impulses to the olfactory bulb, in the limbic area of the brain, for processing. Odors are initially registered by receptor cells in the nasal cavity. These send electrical impulses along dedicated pathways to the olfactory bulb (each nostril connects to one olfactory bulb). The olfactory bulb is the smell gateway to the brain. It is part of the brain’s limbic system, the seat of our emotions, desires, and instincts, which is why smell can trigger strong emotional reactions. Once processed by the olfactory bulb, data is then sent to various areas of the brain, including the olfactory cortex adjacent to the hippocampus. Unlike data gathered by the other sense organs, odors are processed on the same side, not opposite, side of the brain as the nostril the sensory data was sent from (Figure 37). How do the olfactory receptors detect the different odors? Different smells are produced from different molecular structures of smell. Research shows that each receptor has zones on it. Therefore, when a specific smell enters the nose, only the receptors forming a conforming pattern, not every receptor, is activated. That is how the specific smell is Page 29 of 35 detected. So far the scientists have identified eight primary odors: camphorous, fishy, malty, minty, musky, spermatic, sweaty, and urinous. TASTE Taste and smell are both chemical senses. Therefore, tongue can detect taste only when the receptors in it bind to incoming molecules, generating electrical signals that pass through the related cranial nerves to the specific brain areas. Thus, the pathway of gustatory electrical impulses begins with mouth, going to medulla, continues to the thalamus, then to primary gustatory areas of the cerebral cortex. A person can experience the basic five flavors (sweet, sour, salty, bitter, and umami) by merely activating the taste receptors on the tongue. However, the flavors produced from the combination of these can be detected by tongue only in interaction with the sense of smell. Compared with cold food, we experience the hot food to produce greater taste. This is because, during such time, smell particles rising from the hot food bind to and excite the smell receptors inside the nose, making us also to sense their smell. Before the smell particles and taste particles are detected by the smell receptors and taste receptors respectively, these particles have to dissolve in the liquid solvents in the nose and mouth respectively. So they are similar on that front. However, what is different between the two is that while the taste receptors are not actual neurons, but a special type of cells, the smell receptors are actual neurons. Due to this difference, we see a marked difference in the degree of sensitivity towards the chemical particles. The smell receptors are 300 hundred times more sensitive (Figure 38). The tongue is the main sensory organ for taste detection. It is the body’s most flexible muscular organ. It has three interior muscles and three pairs of muscles connecting it to the mouth and throat. Its surface is dotted with tiny, pimplelike structures called papillae. Papillae are easily visible to naked eyes. Within each papilla are hundreds of taste buds and they are distributed across the tongue. Four types of papillae have been distinguished---vallate, filiform, foliate, and fungiform. Each type bears a different amount of taste buds. A taste bud is composed of a group of about 25 receptor cells alongside supporting cells layered together. In general, humans have 5000 to 10,000 taste buds, and each bud may carry 25 to 100 taste receptor cells within it. At the tip of each cell, there is a hole through which taste chemical particles enter and come in contact with the receptor molecules. The tiny hair-like receptors inside these receptor cells can hold only particular taste particles. Earlier, scientists believed that different parts of the tongue are dedicated to detecting specific tastes. However, according to recent researches, all tastes are detected equally across the tongue, and the tongue is well supplied with nerves Page 30 of 35 that carry taste-related data to the brain. Other parts of the mouth such as the palate, pharynx, and epiglottis can also detect taste stimuli. TOUCH There are many kinds of touch sensations. These include light touch, pressure, vibration, and temperature as well as pain, and awareness of the body position in space. The skin is the body’s main sense organ for touch. There are around 20 types of touch receptor that respond to various types of stimuli. For instance, light touch, a general category that covers sensations ranging from a tap on the arm to stroking a cat’s fur, is detected by four different types of receptor cells: free nerve endings, found in the epidermis; Merkel’s disks, found in deeper layers of the skin; Meissner’s corpuscles, which are common in the palms, soles of the feet, eyelids, genitals, and nipples; and, finally, the root hair plexus, which responds when the hair moves. Pacinian and Ruffini corpuscles respond to more pressure. The sensation of itching is produced by repetitive low-level stimulation of nerve fibers in the skin, while feeling ticklish involves more intense stimulation of the same nerve endings when the stimulus moves over the skin (Figure 39). As for the manner in which touch information finally makes its way to the brain, a sense receptor, when activated, sends information about touch stimuli as electrical impulses along a nerve fiber of the sensory nerve network to the nerve root on the spinal cord. The data enters the spinal cord and continues upward to the brain. The processing of sensory data is begun by the nuclei in the upper (dorsal) column of the spinal cord. From the brainstem, sensory data enters the thalamus, where processing continues. The data then travels to the postcentral gyrus of the cerebral cortex, the location of the somatosensory cortex. Here, it is finally translated into a touch perception. Somatosensory cerebral cortex curls around the brain like a horseshoe. Data from the right side of the body ends on the left side of the brain, and vice versa. THE SIXTH SENSE Proprioception is sometimes referred to as the sixth sense. It is our sense of how our bodies are positioned and moving in space. This ‘awareness’ is produced by part of the somatic sensing system, and involves structures called proprioceptors in the muscles, tendons, joints, and ligaments that monitor changes in their length, tension, and pressure linked to changes in position. Proprioceptors send impulses to the brain. Upon processing this information, a decision can be made—to change position or to stop moving. The brain then sends signals back to the muscles based on the input from the proprioceptors— Page 31 of 35 completing the feedback cycle. This information is not always made conscious. For example, keeping and adjusting balance is generally an unconscious process. Conscious proprioception uses the dorsal column-medial lemniscus pathway, which passes through the thalamus, and ends in the parietal lobe of the cortex. Unconscious proprioception involves spinocerebellar tracts, and ends in the cerebellum. Proprioception is impaired when people are under the influence of alcohol or certain drugs. The degree of impairment can be tested by field sobriety tests, which have long been used by the police in cases of suspected drunk-driving. Typical tests include asking someone to touch their index finger to their nose with eyes closed, to stand on one leg for 30 seconds, or to walk heel-to-toe in a straight line for nine steps. MIXED SENSES Sensory neurons respond to data from specific sense organs. Visual cortical neurons, for example, are most sensitive to signals from the eyes. But this specialization is not rigid. Visual neurons have been found to respond more strongly to weak light signals if accompanied by sound, suggesting that they are activated by data from the ears as well as the eyes. Other studies show that in people who are blind or deaf, some neurons that would normally process visual or auditory stimuli are “hijacked” by the other senses. Hence, blind people hear better and deaf people see better. SYNESTHESIA Most people are aware of only a single sensation in response to one type of stimulus. For example, sound waves make noise. But some people experience more than one sensation in response to a single stimulus. They may “see” sounds as well as hear them, or “taste” images. Called synesthesia, this sensory duplication occurs when the neural pathway from a sense organ diverges and carries data on one type of stimulus to a part of the brain that normally processes another type (Figure 40). PERCEPTION AS A CONSTRUCT Do we perceive the external world directly, or do we perceive a constructed reality? Neuroscience finds that the latter is a more accurate description. When our sensory organs detect something in the environment, they are responding to a physical stimulus. For example, the photoreceptor cells in the retina of the eye respond to photon particles traveling through space. These photons stimulate the receptor neurons, and start a chain reaction of neural signals to the primary visual cortex in the brain, where it becomes a perception. While the visual perception correlates with the physical stimulus, they are not Page 32 of 35 one and the same. It was described earlier that photons have a wavelength, and the wavelength can vary among photons. Each numerical difference in the wavelength of a photon correlates with a difference in the perception of color. That is, photons with a wavelength of around 500 nanometers correlate with perceiving the color blue, while a wavelength of around 700 nanometers correlates with perceiving the color red. While the physical property of wavelength exists objectively in the world, the perceived color only exists subjectively and depends on our ability to detect it. The colors we perceive are not physical properties, but rather the psychological correlates of the physical property of wavelength of light. Moreover, there are many wavelengths that we cannot detect, so our perceptions selectively represent the physical world. The same principle applies to the other senses. Each sensory modality we have has two components: the physical stimulus that is detected by the sensory organ, and the psychological perception that results from it. We do not directly perceive the wavelength of light, rather we perceive the result of how the photon particles stimulate the visual pathway. Therefore, we can say that perception is a construction that is grounded in detecting physical phenomena, but we do not directly perceive those phenomena. Nor do we perceive all objective phenomena, only those that we are capable of detecting. If perception is a construction and a limited representation of objective phenomena, why did it evolve that way? We need to be able to react to environmental circumstances to survive. To find food, to avoid predators, to meet mates, to care for offspring, to engage in social behavior, all of these actions require the ability to detect and respond to changes in the physical environment. But sensory systems can evolve to be simply good enough for survival. It is not necessary to have complete, direct perception to survive. In fact, recall the facts we discussed earlier about how the human brain is very demanding for the body’s resources. More sophisticated sensory systems require more resources, and if those resource requirements are not of great utility to the organism, then evolution likely will not favor increasing the level of sophistication. In addition, there is often a trade-off between speed and accuracy in neural systems and resulting behaviors. When it comes to visual perception, seeing a danger with less accuracy and surviving is more important than seeing a danger directly and not surviving! Page 33 of 35 12)CONSCIOUSNESS AND THE BRAIN WHAT IS CONSCIOUSNESS? Consciousness is important as well as essential. Without it, life would have no meaning. However, once we embark on identifying its nature, it is certain to find it to be like nothing else. A thought, feeling, or idea seems to be a different kind of thing from the physical objects that make up the rest of the universe. The contents of our minds cannot be located in space or time. Although to the neuroscientists the contents of our minds appear to be produced by particular types of physical activity in the brain, it is not known if this activity itself forms consciousness or if brain activity correlates with a different thing altogether that we call “the mind” or consciousness (Figure 41). If consciousness is not simply brain activity, this suggests that the material universe is just one aspect of reality and that consciousness is part of a parallel reality in which entirely different rules apply. MONISM AND DUALISM The philosophical stands of those positing the relation between mind and body can be broadly brought under two divisions: monism and dualism. According to the former, every phenomenon in the universe can be ultimately reduced to a material thing. Consciousness too is identical to the brain activity that correlates with it. However, the fact that not every physical thing has consciousness is because only in those physical bodies where complex physical processes evolved over a long period of time did cognitive mechanism develop. Thus, consciousness never existed in parallel with the material universe as an independent entity of its own. According to the latter, consciousness is not physical but exists in another dimension to the material universe. Certain brain processes are associated with the consciousness, but they are not identical to each other. Some dualists believe consciousness may even exist without the brain processes associated with it. LOCATING CONSCIOUSNESS Human consciousness arises from the interaction of every part of a person with their environment. We know that the brain plays the major role in producing conscious awareness but we do not know exactly how. Certain processes within the brain, and neuronal activity in particular areas, correlate reliably with conscious states, while others do not. Page 34 of 35 Different types of neuronal activity in the brain are associated with the emergence of conscious awareness. Neuronal activity in the cortex, and particularly in the frontal lobes, is associated with the arousal of conscious experience. It takes up to half a second for a stimulus to become conscious after it has first been registered in the brain. Initially, the neuronal activity triggered by the stimulus occurs in the “lower” areas of the brain, such as the amygdala and thalamus, and then in the “higher” brain, in the parts of the cortex that process sensations. The frontal cortex is activated usually only when an experience becomes conscious, suggesting that the involvement of this part of the brain may be an essential component of consciousness. REQUIREMENTS OF CONSCIOUSNESS Every state of conscious awareness has a specific pattern of brain activity associated with it. These are commonly referred to as the neural correlates of consciousness. For example, seeing a patch of yellow produces one pattern of brain activity, seeing grandparents, another. If the brain state changes from one pattern to another, so does the experience of consciousness. Consciousness arises only when brain cells fire at fairly high rates. So, neural activity must be complex for consciousness to occur, but not too complex. If all the neurons are firing, such as in an epileptic seizure, consciousness is lost. The processes relevant to consciousness are generally assumed to be found at the level of brain cells rather than at the level of individual molecules or atoms. Yet it is also possible that consciousness does arise at the far smaller atomic (quantum) level, and if so it may be subject to very different laws. Many neuroscientists hold the philosophical view of materialism; that there is only one fundamental substance in the universe and that is physical material. How, then, is subjective experience of the mind explained? Through a process known as emergence. Emergence is a process described as the production of a phenomenon from the interactions or processes of several other phenomena. For example, the molecule that is water is composed of two hydrogen atoms and one oxygen atom. The hydrogen and oxygen atoms on their own do not have the quality of wetness that water has. But when you combine them to form the molecule, and you have enough water molecules, then the property of wetness emerges from those interactions. Neuroscientists use this as an analogy, and argue that when many neurons are combined, consciousness emerges from those interactions. This analogy serves as a useful description within the viewpoint of materialism, but it is not an explanation, as we have yet to demonstrate the mechanisms involved in such an emergence.","Use only the given sources to complete your responses. Do not use outside sources or any previous knowledge of the topic that you may have.
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+1) A BRIEF HISTORY OF NEUROSCIENCE Humans have long been interested in exploring the nature of mind. The long history of their enquiry into the relationship between mind and body is particularly marked by several twists and turns. However, brain is the last of the human organs to be studied in all seriousness, more particularly its relation with human mind. Around 2000 BC and for long since that time the Egyptians did not think highly of the brain. They would take out the brain via the nostrils and discarded it away before mummifying the dead body. Instead, they would take great care of the heart and other internal organs. However, a few Egyptian physicians seemed to appreciate the significance of the brain early on. Certain written records have been found where Egyptian physicians had even identified parts and areas in the brain. Besides, Egyptian papyrus, believed to have been written around 1700 BC, carried careful description of the brain, suggesting the possibility of addressing mental disorders through treatment of the brain. That is the first record of its kind in the human history (Figure 1). The Greek mathematician and philosopher, Plato (427-347) believed that the brain was the seat of mental processes such as memory and feelings (Figure 2). Later, another Greek physician and writer on medicine, Galen (130-200 AD) too, believed that brain disorders were responsible for mental illnesses. He also followed Plato in concluding that the mind or soul resided in the brain. However, Aristotle (384-322 BC), the great philosopher of Greece at that time, restated the ancient belief that the heart was the superior organ over the brain (Figure 3). In support of his belief, he stated that the brain was just like a radiator which stopped the body from becoming overheated, whereas the heart served as the seat of human intelligence, thought, and imagination, etc. Medieval philosophers felt that the brain was constituted of fluid-filled spaces called ventricles where the ‘animal spirits’ circulated to form sensations, emotions, and memories. This viewpoint brought about a shift in the previously held views and also provided the scientists with the new idea of actually looking into the brains of the humans and animals. However, no such ventricles as claimed by them were found upon examination nor did the scientists find any specific location for the self or the soul in the brain. In the seventeenth century, the French philosopher Rene Descartes (1596-1650) described mind and body as separate entities (Figure 4) yet they interacted with each other via the pineal gland, the only structure not duplicated on both sides of the brain. He maintained that the mind begins its journey from the pineal gland and circulates the rest of the body via the nerve vessels. His dualist view influenced the mind-body debate for Page 4 of 35 the next two centuries. However, through the numerous experiments undertaken in the 19th century, the scientists gathered evidences and findings which all emboldened the scientists to claim that the brain is the center of feelings, thoughts, self and behaviors. Just to give an example of the kind of experiments performed on a particular physical activity which pointed to the brain as the regulator of bodily actions, imagine activating a particular area of the brain through electrical stimulus, you would actually see it effectively impacting a corresponding body-part, say the legs by making them move. Through findings such as these as well as others, we have come of know also of the special activities of the electrical impulses and chemicals in the brain. Explorations continued into the later centuries and, by the middle of 20th century, human understanding of the brain and its activities have increased manifold. Particularly, towards the end of twentieth century, with further improvement in imaging technologies enabling the researchers to undertake investigation on functioning brains, the scientists were deeply convinced that the brain and the rest of the nervous systems monitored and regulated emotions and bodily behaviors (Figures 5 & 6). Since then, the brain together with the nervous system have become the center of attention as the basis of mental activities as well as physical behaviors, and gradually a separate branch of science called neuroscience focusing specifically on the nervous systems of the body has evolved in the last 40 so years. To better understand modern neuroscience in its historical context, including why the brain and nervous system have become the center of attention in the scientific pursuit of understanding the mind, it is useful to first review some preliminary topics in the philosophy of science. Science is a method of inquiry that is grounded in empirical evidence. Questions about the unknown direct the path of science as a method. Each newly discovered answer opens the door to many new questions, and the curiosity of scientists motivates them to answer those unfolding questions. When a scientist encounters a question, she or he develops an explanatory hypothesis that has the potential to answer it. But it is not enough to simply invent an explanation. To know if an explanation is valid or not, a scientist must test the hypothesis by identifying and observing relevant, objectively measurable phenomena. Any hypothesis that cannot be tested in this way is not useful for science. A useful hypothesis must be falsifiable, meaning that it must be possible to ascertain, based on objective observations, whether the hypothesis is wrong and does not explain the phenomena in question. If a hypothesis is not falsifiable, it is impossible to know whether it is the correct explanation of a phenomenon because we cannot test the validity of the claim. Why does the scientific method rely only on objective observations? Science is a team effort, conducted across communities and generations over space and time. For a hypothesis to be accepted as valid, it must be possible for any interested scientist to test it. For example, if we want to repeat an experiment that our colleague conducted last year, we need to test the hypothesis under the same conditions as the original experiment. This means it must be possible to recreate those conditions. The only way to do this in a precise and controlled manner is if the scientific method relies on empirical evidence. Page 5 of 35 Furthermore, conclusions in science are subject to peer review. This means that any scientist’s colleagues must be able to review and even re-create the procedures, analyses, and conclusions made by that scientist before deciding if the evidence supports the conclusions. Because we don’t have access to the subjective experiences of others, it is not possible to replicate experiments that are grounded in subjectivity because we cannot recreate the conditions of such an experiment, nor can we perform identical analyses of subjective phenomena across people. No matter how many words we use, we cannot describe a single subjective experience accurately enough to allow another person to experience it the same way. Consequently, we cannot have a replicable experiment if the evidence is not objective. Therefore, two necessary features of a scientific hypothesis are the potentials to falsify and replicate it. And both of these requirements are dependent on objectively measurable evidence. This is why we began with the claim that science is a method of inquiry that is grounded in empirical evidence. Neuroscience is a scientific discipline like any other, in that the focus of investigation is on objectively measurable phenomena. But unlike most other sciences, this poses a particularly challenging problem for neuroscience. How do we investigate the mind, which is subjective by nature, if empirical evidence is the only valid form of data to support a conclusion in science? The relationship between the mind and the body has become known as the “mind-body problem” in modern neuroscience and Western philosophy of mind, because there is a fundamental challenge to explain the mind in objective terms. Scientists view this relationship as a problem because their method of inquiry investigates phenomena from a third-person (he, she, it, they) perspective, while the subjective experience of the mind has a first-person (I, we) perspective. The mindbody problem has been a central, unresolved topic in Western philosophy of mind for centuries, and is a topic we will discuss in more detail in a later chapter of this textbook when we explore the neuroscience of consciousness. For now we can start simply by stating that the majority of scientists, including neuroscientists, hold the philosophical view that all phenomena are caused by physical processes, including consciousness and its related mental phenomena. This view might be proven wrong as inquiry proceeds, but is taken as the most simple (or parsimonious) starting point. Science uses the principle of parsimony, of starting with simple rather than complex explanations, as a way to facilitate production of falsifiable hypotheses: more complex explanations are built up as evidence accumulates and more simple explanations are excluded. Modern neuroscience investigates the brain and nervous system based on the working assumption that the objective physical states of those biological systems are the cause of the subjective mental states of the organism that has those biological systems. In other words, when you smell a fresh flower, taste a cup of chai, listen to the birds, feel the wind on your cheek, and see the clouds in the sky, those subjective experiences are caused by the momentary physical processes in your body, nervous system, and brain interacting with the physical environment. Under this philosophical view, then, mental states correlate with physical states of the organism, and by investigating those physical states scientists can understand the nature of those mental Page 6 of 35 states. So while this might seem counterintuitive based on the Buddhist method of inquiry, for a neuroscientist it is obvious to begin the investigation by focusing on physical phenomena; on the empirical evidence. Neuroscientists often equate the “neural correlates” of consciousness as consciousness itself. We will explore in more depth the relationship between form and function between the body and mind later in the textbook, as well as the philosophical view of materialism in neuroscience. It will also be helpful to introduce some basic concepts in neuroscience before exploring topics in more detail. The primary goal in this year of the neuroscience curriculum is that you become familiar with the brain and nervous system. The human brain is the most complex and extraordinary object known to all of modern science. Because of this immense complexity, it can be very challenging to encounter neuroscience in an introductory course such as this one. So patience is an important part of the learning process. First, neuroscience is still very much in its infancy as a scientific discipline, and there are vastly more questions than there are answers. Second, it can be a challenge for new students of neuroscience to simultaneously learn the details of the basic concepts while understanding and appreciating the broader conclusions. It’s like learning a language while also reading the literature of that language! Neuroscience is a scientific discipline with many different levels of exploration and explanation. Therefore, it is important for you to pay attention to the level at which are we speaking when you learn new concepts. For example, the brain and nervous system are made up of cells called neurons or nerve cells, which we will discuss in detail in Chapter 4. Neurons connect with each other to form complex networks, and from those different patterns of connection emerge different phenomena (such as a thought or a sensation) in the brain and ultimately in the mind. This may sound confusing at the moment, but we will explore these topics in more detail in later chapters. In neuroscience, levels of explanation can span from very low levels such as the molecular mechanisms involved in the neuron cells, to middle levels such as particular networks of neurons in the brain, to very high levels such as how humans engage in thoughts, speech, and purposeful actions. The brain is the bodily organ that is the center of the nervous system. But it might surprise you to learn that not all animals that have neurons have a brain! For example, jellyfish have neurons, but they don’t have a brain. Jellyfish are very simple organisms that live in the ocean, and their neurons allow them to sense some basic information about their environment. But because they don’t have a brain to process that environmental information, they can only react to their immediate environment. Without a brain, jellyfish cannot think, make plans for the future, have memories of the past, or make decisions. Their behavior is limited to reactions and reflexes. Complex networks of neurons in the human brain are the physiological substrates that support what we experience as human beings. But we are not the only species with a brain. Later in this textbook we will explore the relationship between brain complexity and behavior across species. For organisms that have a brain, information can flow along the complex networks of neurons in different ways. Some networks, also called pathways or systems, flow from the sensory organs to the brain, while others flow from the brain to the muscles of the Page 7 of 35 body. Afferent neurons, also called sensory neurons or receptor neurons, communicate information from the sensory organs to the brain. Efferent neurons, also called motor neurons, communicate information from the brain to the muscles of the body. Interneurons, also called association neurons, communicate information between neurons in the central nervous system and brain. This allows for the sensory and motor systems to interact, facilitating complex behaviors and integrating across the different sensory modalities. For example, to be able to reach for an object such as a teacup, your brain needs to link together your ability to sense the presence and location of the cup with your ability to control the muscles in your arm to grasp the cup. Interneurons perform this function. Finally, before starting your journey in learning about neuroscience, pause to contemplate some of the big questions and insights as they pertain to the Western science of the mind. As you go through this textbook and learn new concepts, it will be useful to think about them within the context of these big questions. For example, what is sentience? Is a brain required for sentience? The jellyfish we mentioned earlier can have basic sensations and react to the environment without a brain, but it cannot think or have memory. What are the necessary conditions to be sentient? What is the relationship between the mind and body? As a method of inquiry, can science directly investigate subjective experience? Or must we use alternative, and perhaps complementary methods of inquiry to achieve that? Do we perceive the physical world directly, or are our perceptions constructed? If the latter, how does that happen? 2) WHAT IS NEUROSCIENCE AND WHAT ARE ITS BRANCH SCIENCES? In the case of humans, it is the branch of science that studies the brain, the spinal cord, the nerves extending from them, and the rest of the nervous systems including the synapses, etc. Recall that neurons, or nerve cells, are the biological cells that make up the nervous system, and the nervous system is the complex network of connections between those cells. In this connection, it may involve itself with the cellular and molecular bases of the nervous system as well as the systems responsible for sensory and motor activities of the body. It also deals with the physical bases of mental processes of all levels, including emotions and cognitive elements. Thus, it concerns itself with issues such as thoughts, mental activities, behaviors, the brain and the spinal cord, functions of nerves, neural disorders, etc. It wrestles with questions such as What is consciousness?, How and why do beings have mental activities?, What are the physical bases for the variety of neural and mental illnesses, etc. In identifying the sub-branches within neuroscience, there are quite a few ways of doing so. However, here we will follow the lead of the Society for Neuroscience which identifies the following five branches: Neuro-anatomy, Developmental Neuroscience, Cognitive Neuroscience, Behavioral Neuroscience, and Neurology. Of these, Page 8 of 35 neuroanatomy concerns itself mainly with the issue of structures and parts of the nervous system. In this discipline, the scientists employ special dyeing techniques in identifying neurotransmitters and in understanding the specific functions of the nerves and nerve centers. Neurotransmitters are chemicals released between neurons for transmission of signals. When a neuron communicates with its neighboring cells, it releases neurotransmitters and its neighbors receive them. In developmental neuroscience, the scientists look into the phases and processes of development of nervous system, the changes they undergo after they have matured, and their eventual degeneration. In this regard, the scientists also investigate the ways neurons go about seeking connection with other neurons, how they establish the connection, and how they maintain the connection and what chemical changes and processes they have to undergo for these activities. Neurons make connections to form networks, and the different patterns of connectivity support different functions. Patterns of connectivity can change over different time scales, such as developmental changes over a lifetime from infancy to old age, but also in the short term such as learning a new concept. Neuroplasticity is the term that describes the capacity of the brain to change in response to stimulation or even damage: it is not a static organ, but is highly adaptable. In cognitive neuroscience, they study the functions of behaviors, perceptions, and memories, etc. By making use of non-invasive methods such as the PTE and MRI technologies that allow us to take detailed pictures of the brain without opening the skull, they look into the neural pathways activated during engagement in language, solutions, and other activities. Cognitive neuroscience studies the mind-body relationship by discovering the neural correlates to mental and behavioral phenomena. Behavioral neuroscience looks into the underpinning processes of human and animal behaviors. Using electrodes, they measure the neural electrical activities occurring alongside our actions such as visual perception, language use, and generating memories. Through fMRI scan techniques, another technology that allows us to take detailed motion pictures of brain activity over time without opening the skull, they strive to arrive at closer understanding of the brain parts in real time. Finally, neurology makes use of the fundamental research findings of the other disciplines in understanding the neural and neuronal disorders and strives to explore new innovative ways of detecting, preventing, and treating these disorders. 3) THE SUBJECT MATTER OF NEUROSCIENCE: THE MAIN SYSTEMS AND THEIR PARTS The field of neuroscience is the nervous system of animals in general and of humans in particular. In the case of humans, its nervous system has two main components: the central nervous system (CNS) and the peripheral nervous system (PNS) (Figure 7). The CNS comprises of the brain and the spinal cord. Their functions involve processing and interpreting the information received the senses, skin, muscles, etc. and giving responses Page 9 of 35 that direct and dictate specific actions such as particular movements by different parts of the body. The peripheral nervous system (PNS) includes all the rest of the nervous system aside from the central nervous system. This means that it comprises the 12 pairs of cranial nerves that originate directly from the brain and spread to different parts of the body bypassing the spinal cord, and the 31 pairs of spinal nerves that pass through the spinal cord and spread to different parts of the body. Thus, the PNS is mainly constituted of nerve. PNS is sometimes further classified into voluntary nervous system and the autonomic nervous system. This is based on the fact that the nerves in the former system are involved in making conscious movements, whereas those in the latter system make movements over which the person does not have control. Obviously, the former category of nerves includes those associated with the muscles of touch, smell, vision, and skeleton. The latter includes nerves spread over muscles attached with heart beats, blood pressure, glands, and smooth muscles. 4) AN EXCLUSIVE LOOK AT ‘NEURONS’, A FUNDAMENTAL UNIT OF THE BRAIN AND THE NERVOUS SYSTEM Neurons Neurons are the cellular units of the brain and nervous system, and are otherwise called nerve cells (Figure 8). Estimates of the number of brain neurons range from 50 billion to 500 billion, and they are not even the most numerous cells in the brain. Like hepatocyte cells in the liver, osteocytes in bone, or erythrocytes in blood, each neuron is a selfcontained functioning unit. Its internal components, the organelles, include a nucleus harboring the genetic material (DNA), energy-providing mitochondria, and proteinmaking ribosomes. As in most other types of cells, the organelles are concentrated in the main cell body. In addition, characteristic features of neurons are neurites—long, thin, finger-like or threadlike extensions from the cell body (soma). The two main types are dendrites and axons. Usually, dendrites receive nerve signals, while axons send them onward. The cell body of a neuron is about 10-100 micrometers across, that is 1/100th to 1/10th of one millimeter. Also, the axon is 0.2-20 micrometers in diameter, dendrites are usually slimmer. In terms of length, dendrites are typically 10-50 micrometers long, while axons can be up a few centimeters (inches). This is mostly the case in the central nervous system (Figure 9). Classification of neurons Page 10 of 35 There are numerous ways of classifying neurons among themselves. One of them is by the direction that they send information. On this basis, we can classify all neurons into the three: sensory neurons, motor neurons, and interneurons. The sensory neurons are those that send information received from sensory receptors toward the central nervous system, whereas the motor neurons send information away from the central nervous system to muscles or glands. The interneurons are those neurons that send information between sensory neurons and motor neurons. Here, the sensory neurons receive information from sensory receptors (e.g., in skin, eyes, nose, tongue, ears) and send them toward the central nervous system. Because of this, these neurons are also called afferent neurons as they bring informational input towards the central nervous system. Likewise, the motor neurons bring motor information away from the central nervous system to muscles or glands, and are thus called efferent neurons as they bring the output from the central nervous system to the muscles or glands. Since the interneurons send information between sensory neurons and motor neurons, thus serving as connecting links between them, they are sometimes called internuncial neurons. This third type of neurons is mostly found in the central nervous system. Another way of classifying the neurons is by the number of extensions that extend from the neuron’s cell body (soma) (Figure 10). In accordance with this system, we have unipolar, bipolar, and multipolar neurons. This classification takes into account the number of extensions extending initially from the cell body of the neuron, not the overall number of extensions. This is because there can be unipolar neurons which have more than one extensions in total. However, what the difference here is from the other two types of neurons is that these unipolar neurons shall have only one initial extension from the cell body. Most of the neurons are multipolar in nature. Synapses Synapses are communication sites where neurons pass nerve impulses among themselves. The cells are not usually in actual physical contact, but are separated by an incredibly thin gap, called the synaptic cleft. Microanatomically, synapses are divided into types according to the sites where the neurons almost touch. These sites include the soma, the dendrites, the axons, and tiny narrow projections called dendritic spines found on certain kinds of dendrites. Axospinodendrittic synapses form more than 50 percent of all synapses in the brain; axodendritic synapses constitute about 30 percent (Figure 11). How signals are passed among neurons Page 11 of 35 Neurons send signals to each other across the synapses. Initially, signals enter into the cell body of a neuron through their dendrites, and they pass down the axon until their arrival at the axon terminals. From there, the signal is sent across to the next neuron. Starting from the time the signal passes along the dendrites and axon, eventually reaching the axon terminal, it consists of moving electrically charges ions, but at a synapse while making that transition, it relies more on the structural shape of the chemical neurotransmitters. Every two neurons are separated by a gap, called synaptic cleft, at their synaptic site. The neuron preceding the synapse is known as pre-synaptic neuron and the one following the synapse is known as post-synaptic neuron. When the action potential of the pre-synaptic neuron is passed along its axon and reaches the other end of it, it causes synaptic vesicles to fuse or merge with the membrane. This releases the neurotransmitter molecules to pass or diffuse across the synaptic cleft to the post-synaptic membrane and slot into receptor sites (Figure 12). Neurotransmitter molecules slot into the same-shaped receptor sites in the postsynaptic membrane. A particular neurotransmitter can either excite a receiving nerve cell and continue a nerve impulse, or inhibit it. Which of these occurs depends on the type of membrane channel on the receiving cell. The interaction among neurons or between a neuron and another type of body cell, all occur due to the transfer of neurotransmitters. Thus, our body movements, mental thought processes, as well as feelings, etc. are all dependent on the transfer of neurotransmitters. In particular, let’s take a look into how the muscle movements happen due to the transfer of neurotransmitter. The axons of motor neurons extend from the spinal cord to the muscle fibers. For intending to perform any action, either of the speech or body, the command has to originate from the brain to the spinal cord. From the spinal cord, the command has to pass through motor neurons to the specific body parts, upon which the respective actions will be performed. The electrical impulse released along the axon of the motor neuron arrives at the axon terminal. Once they are there, then the neurotransmitters are secreted to carry the signals across the synapse. The receptors in the membrane of the muscles cells attach to the neurotransmitters and stimulate the electrically charged ions within the muscle cells. This leads to the contraction or extension of the respective muscles. Page 12 of 35 5) FACTS ABOUT HUMAN BRAIN Brain is a complex organ generally found in vertebrates. Of all the brains, human brain is even more complex. On average, a human brain weighs about one and a half kilogram, and has over 100 billion neurons. Each of these neurons is connected with several other neurons and thus, just the number of synapses (nerve cell connections) exceeds 100 trillion. The sustenance required to keep these neurons alive is supplied by different parts of the body. For example, 25 percent of the body total oxygen consumption is used up by the brain. Likewise, 25 percent of the glucose produced by our food is used up by it. Of the total amount of blood pumped out by our heart, 15 percent goes to the brain. Thus, from among the different parts of the body, the brain is the single part that uses the most amount of energy. The reason for this is because the brain engages itself in unceasing activity, day and night, of interpreting data form the internal and external environment, and respond to them. To protect this important organ from harm, it is naturally enclosed in three layers of protection, with an additional cushioning fluid in between. These layers are, in turn, protected with the hard covering, the skull, which is once again wound around by the skin of the scalp (Figure 13). The main function of the brain is to enhance the chance of survival of the person by proper regulation of the body conditions based on the brain’s reading of the internal and external environment. The way it carries out this function is by first registering the information received and responding to them by undertaking several activities. The brain also gives rise to inner conscious awareness alongside performing those processes. When the data, released by the different body senses, in the form of electrical impulses uninterruptedly arrive at the brain, the brain first of all checks their importance. When it finds them to be either irrelevant or commonplace, then it makes them dissolve by themselves and the concerned person doesn’t even generate an awareness of them. This is how only around 5 percent of the overall information received by the brain ever reaches our consciousness. For the rest of the information, the brain may process them, but they never become the subject of our consciousness. If, on the other hand, the information at hand is important or novel, the brain increases it impulses and allows it to active all over its parts. Remaining active for over a period of time, a conscious awareness unto this impulse is generated. Sometimes, in the wake of generating a conscious awareness, the brain sends commands to relevant muscles for either contraction or extension, thus making the body parts in question to engage in certain actions. Page 13 of 35 6) MAJOR PARTS OF HUMAN BRAIN Human brain is enclosed within its natural enclosures. In its normal form, it is found to be composed of three major parts (Figure 14). Cerebrum Of the three parts mentioned above, cerebrum is located in the uppermost position and is also the largest in size. It takes up ¾ of the entire brain size. It is itself composed of two brain hemispheres—the right and the left hemispheres. The two hemispheres are held together by a bridge like part called corpus callosum, a large bundle of neurons. The covering layer of the hemispheres is constituted of the cortex of which the average thickness is between 2 to 4 millimeters. The higher centers of coordinating and regulating human physical activities are located in the cortex areas, such as the motor center, proprioception center (proprioception is the sense of the relative position of the body in space, for example being aware that your arm is extended when reaching for the doorknob), language center, visual center, and auditory center. The outer surface of the cortex is formed of grooves and bulges because of which, despite being quite expansive, the cortex is able to be contained in the relatively small area. In terms of its basic composition, the outer layer of cortex is mostly made of gray matter, which is mainly comprised of cell bodies and nerve tissues formed out of nerve fibers. This matter is gray with a slight reddish shade in color. In the layer below, the cortex is formed of the white matter, which is, as the name suggests, white in color and mainly comprised of nerve tissues formed out of nerve fibers wrapped around with myelin sheath. Some nerve fibers wrapped in myelin sheath bind together the right and left hemispheres of the cerebrum, while others connect it with cerebellum, brainstem, and the spinal cord. Most of the brain parts belong to cerebrum, such as amygdala and hippocampus, as well as thalamus, hypothalamus, and other associated regions. In short, of the division into forebrain, midbrain, and hindbrain—in which the entirety of brain is accounted for, the cerebrum contains the whole of forebrain (Figure 15). The surface area of the cerebral cortex is actually quite large, and described above, it becomes folded to fit inside the skull. Humans are highly intelligent and creative animals not just because of the size of our brains, but also because of the complexity of the connections among our neurons. The folded nature of the human cortex promotes more complex connections between areas. For example, take a piece of blank paper, and draw five dots, one on each corner and one in the middle. Now draw lines from each dot to the other four dots. Imagine if these five dots were buildings, and the lines you drew were roads, then it would require more time to traverse from one corner to another corner than from one corner to the center. But what if you fold the four corners of the paper on top of Page 14 of 35 the center of the page? Suddenly all five of those dots become immediate neighbors, and it becomes very easy to walk from one “building” to another. The folding of the cortex has a similar effect. Neurons make connections with their neighbors, and if folding the cortex increases the number of neighbors each neuron has, then it also increases the complexity of the networks that can be formed among those neurons. Cerebellum Cerebellum is located below the cerebrum and at the upper back of the brainstem. Its name connotes its small size. Its mass is 1/10 of the whole brain. However, in terms of the number of neurons it contains, it exceeds that of the remaining parts of the central nervous system combined. This lump of nerve tissues, bearing the look of something cut in half, covers most of the back of brainstem. With the help of three pairs of fibers, collectively called cerebral peduncles, the brainstem is bound to the cerebellum. Like the cerebrum, it also has a wrinkled surface, but its grooves and bulges are finer and organized into more regular patterns. In terms of its physical structure, this too has a long groove in the center, with two large lateral lobes, one on each side. These lobes are reminiscent of the two hemispheres of the cerebrum and are sometimes termed cerebellar hemispheres. The cerebellum has a similar layered microstructure to the cerebrum. The outer layer, or cerebellar cortex, is gray matter composed of nerve-cell bodies and their dendrite projections. Beneath this is a medullary area of white matter consisting largely of nerve fibers. As of now, it has been established that cerebellum’s main function is in coordinating the body movement. Although, it may not initiate the movements, however it helps in the coordination and timely performance of movements, ensuring their integrated control. It receives data from spinal cord and other parts of the brain, and these data undergo integration and modification, contributing to the balance and smooth functioning of the movements, and thus helps in maintaining the equilibrium. Therefore, whenever this part of the brain is plagued by a disorder, the person may not lose total movement, but their ability of performing measured and steady movements is affected as also their ability to learn new movements. Within the division of entire brain into forebrain, midbrain, and hindbrain—cerebellum forms part of the hindbrain (Figure 16). Brainstem Brainstem is located below the cerebrum and in front of cerebellum. Its lower end connects with the spinal cord. It is perhaps misnamed. It is not a stem leading to a separate brain above, but an integral part of the brain itself. Its uppermost region is the midbrain comprising an upper “roof” incorporating the superior and inferior colliculi or Page 15 of 35 bulges at the rear, and the tegmentum to the front. Below the midbrain is the hindbrain. At its front is the large bulge of the pons. Behind and below this is the medulla which narrows to merge with the uppermost end of the body’s main nerve, the spinal cord. This part of the brain in associated with the middle and lower levels of consciousness. The eye movement involved in following a moving object in front of the eye is an example. The brainstem is highly involved in mid-to low-order mental activities, for example, the almost “automatic” scanning movements of the eyes as we watch something pass by. The gray and white matter composites of the brainstem are not as well defined as in other parts of the brain. The gray matter in this part of the brain possesses some of the crucial centers responsible for basic life functions. For example, the medulla houses groups of nuclei that are centers for respiratory (breathing), cardiac (heartbeat), and vasomotor (blood pressure) monitoring and control, as well as for vomiting, sneezing, swallowing, and coughing. When brainstem is damaged, that will immediately trigger danger to life by hindering heartbeat and respiratory processes (Figures 17 & 18). 7) WAYS OF ZONING AND SECTIONING THE HUMAN BRAIN FOR STUDY PURPOSES The two hemispheres Of the obviously so many different ways of zoning the human brain for study purposes, we will take up only a few of them as samples. As briefly mentioned before, a fully matured brain has three major parts. Of these the largest is the cerebrum. It covers around ¾ of the brain size. In terms of its outer structure, it is covered with numerous folds, and has a color of purple and gray blended. The cerebrum is formed by two cerebral hemispheres, accordingly called the right and the left hemisphere, that are separated by a groove, the medial longitudinal fissure. Between the two hemispheres, there is a bundle of nerve fibers that connects the two sides, almost serving like connecting rope holding the two in place. Called corpus callosum, if this were to be cut into two, the two hemispheres would virtually become two separate entities. Just as there are two hemispheres, that look broadly like mirror images to each other, on the two sides, likewise many of the brain parts exist in pairs, one on each side. However, due to the technological advances in general, and that of the MRI, in particular, it has been shown that, on average, brains are not as symmetrical in their left-right structure as was once believed to be , almost like mirror images (Figure 19). The two apparently symmetrical hemispheres and, within them, their other paired structures are also functionally not mirror images to each other. For example, for most Page 16 of 35 people, speech and language, and stepwise reasoning and analysis and so on are based mainly on the left side. Meanwhile, the right hemisphere is more concerned with sensory inputs, auditory and visual awareness, creative abilities and spatial-temporal awareness (Figure 20). The four or the six lobes Cerebrum is covered with bulges and grooves on its surface. Based on these formations, the cerebrum is divided into the four lobes, using the anatomical system. The main and the deepest groove is the longitudinal fissure that separates the cerebral hemispheres. However, the division into the lobes is made overlooking this fissure, and thus each lobe is spread on both the hemispheres. Due to this, we often speak of the four pairs of lobes. These lobes are frontal lobes, parietal lobes, occipital lobes, and temporal lobes (Figure 21). The names of the lobes are partly related to the overlying bones of the skull such as frontal and occipital bones. In some naming systems, the limbic lobe and the insula, or central lobe, are distinguished as separate from other lobes. Frontal lobes Frontal lobes are located at the front of the two hemispheres. Of all the lobes, these are the biggest in size as well as the last to develop. In relation to the other lobes, this pair of lobes is at the front of the parietal lobes, and above the temporal lobes. Between these lobes and the parietal lobes lies the central sulcus, and between these lobes and the temporal lobes lies the lateral sulcus. Towards the end of these lobes, i. e. the site where the pre-central gyrus is located also happens to be the area of the primary motor cortex. Thus, this pair of lobes is clearly responsible for regulating the conscious movement of certain parts of the body. Besides, it is known that the cortex areas within these lobes hold the largest number of neurons that are very sensitive to the dopamine neurotransmitters. Granting this, these lobes should also be related with such mental activities as intention, short-term memory, attention, and hope. When the frontal lobes are damaged, the person lacks in ability to exercise counter measures against lapses and tend to engage in untoward behaviors. These days, neurologist can detect these disorders quite easily. Parietal lobes Parietal lobes are positioned behind (posterior to) the frontal lobes, and above (superior to) the occipital lobes. Using the anatomical system, the central sulcus divides the frontal and parietal lobes, as mentioned before. Between the parietal and the occipital lobes lies Page 17 of 35 the parieto-occipital sulcus, whereas the lateral sulcus marks the dividing line between the parietal and temporal lobes. This pair of lobes integrates sensory information from different modalities, particularly determining spatial sense and navigation, and thus is significant for the acts of touching and holding objects. For example, it comprises somatosensory cortex, which is the area of the brain that processes the sense of touch, and the dorsal stream of the visual system, which supports knowing where objects are in space and guiding the body’s actions in space. Several portions of the parietal lobe are important in language processing. Occipital lobes The two occipital lobes are the smallest of four paired lobes in the human cerebral cortex. They are located in the lower, rearmost portion of the skull. Included within the region of this pair of lobes are many areas especially associated with vision. Thus, this lobe holds special significance for vision. There are many extrastriate regions within this lobe. These regions are specialized for different visual tasks, such as visual, spatial processing, color discrimination, and motion perception. When this lobe is damaged, the patient may not be able to see part of their visual field, or may be subjected to visual illusions, or even go partial or full blind. Temporal lobes Temporal lobe is situated below the frontal and parietal lobes. It contains the hippocampus and plays a key role in the formation of explicit long-term memory modulated by the amygdala. This means that it is involved in attaching emotions to all the data received from all senses. Adjacent areas in the superior, posterior, and lateral part of the temporal lobes are involved in high-level auditory processing. The temporal lobe is involved in primary auditory perception, such as hearing, and holds the primary auditory cortex. The primary auditory cortex receives sensory information from the ears and secondary areas process the information into meaningful units such as speech and words. The ventral part of the temporal cortices appears to be involved in high-level visual processing of complex stimuli such as faces and scenes. Anterior parts of this ventral stream for visual processing are involved in object perception and recognition. Limbic System The structures of the limbic system are surrounded by an area of the cortex referred to as the limbic lobe. The lobe forms a collarlike or ringlike shape on the inner surfaces of the cerebral hemispheres, both above and below the corpus callosum. As such, the limbic lobe comprises the inward-facing parts of other cortical lobes, including the temporal, parietal, and frontal, where the left and right lobes curve around to face each other. Page 18 of 35 Important anatomical parts of this lobe are hippocampus and amygdala, associated with memory and emotions respectively. Insular cortex (or insula) Insular lobe is located between the frontal, parietal, and temporal lobes. As suggested by its name, it is almost hidden within the lateral sulcus, deep inside the core of the brain. It is believed to be associated with consciousness. Since data indicative of the inner status of the body, such as the heartbeat, body temperature, and pain assemble here, it is believed to impact the equilibrium of the body. Besides, it is also believed to be related with several aspects of the mind, such as the emotions. Among these are perception, motor regulation, self-awareness, cognition, and inter-personal emotions. Thus, insular lobe is considered to be highly related with mental instability. The forebrain, the midbrain, and the hindbrain The divisions of the brain so far, either into the two hemispheres or the four or six lobes are solely based on the cerebrum alone. None of the above divisions included any portion either of the cerebellum or the brainstem. Yet another way of dividing the portions of the brain is into the forebrain, the midbrain, and the hindbrain (Figure 22. This is the most comprehensive division of the brain, leaving no parts of it outside. There are two systems of presenting this division: one, on the basis of the portions of the brain during early development of the central nervous system, and the other, based on the full maturation of those early parts into their respective regions of an adult brain. Here, we follow the latter system. The forebrain The forebrain is so called because of its extension to the forefront of the brain. It is the largest among the three divisions. It even spreads to the top and back part of the brain. It houses both the hemispheres, as well as the entire portion of the part known as the diencephalon. Diencephalon comprises of the hippocampus, which is associated with memory, and the amygdala, which is associated with emotions. Besides them, the forebrain also includes both the thalamus and the hypothalamus, of which the former is the part of the brain that processes information received from other parts of the central nervous system and the peripheral nervous system into the brain, and the latter which is involved is several activities such as appetite, sexuality, body temperature, and hormones. Page 19 of 35 The midbrain The midbrain is located below the forebrain and above the hindbrain. It resides in the core of the brain, almost like a link between the forebrain and the midbrain. It regulates several sensory processes such as that of the visual and auditory ones, as well as motor processes. This is also the region where several visual and auditory reflexive responses take place. These are involuntary reflexes in response to the external stimuli. Several of the masses of gray matter, composed mainly of the cell bodies, such as the basal ganglia linked with movement are also present in the midbrain. Of the above three major divisions of the brain, the midbrain belongs to the brainstem, and of the two main systems within the nervous system, it belongs to the central nervous system. The hindbrain The hindbrain is located below the end-tip of the forebrain, and at the exact back of the midbrain. It includes cerebellum, the pons, and the medulla, among others. Of these, the cerebellum has influence over body movement, equilibrium, and balance. The pons not only brings the motor information to the cerebellum, but is also related with the control over sleep and wakeful states. Finally, the medulla is responsible for involuntary processes of the nervous system associated with such activities as respiration and digestion. In terms of anatomy, pons is uppermost part, and beneath it the cerebellum and the medullae, which tapers to merge with the spinal cord. Vertical organization of the brain The organization of the brain layers can be said to represent a certain gradation of mental processes (Figure 23). The uppermost brain region, the cerebral cortex, is mostly involved in conscious sensations, abstract thought processes, reasoning, planning, working memory, and similar higher mental processes. The limbic areas on the brain’s innermost sides, around the brainstem, deal largely with more emotional and instinctive behaviors and reactions, as well as long-term memory. The thalamus is a preprocessing and relay center, primarily for sensory information coming from lower in the brainstem, bound for the cerebral hemispheres above. Moving down the brainstem into the medulla are the so-called ‘vegetative’ centers of the brain, which sustain life even if the person has lost consciousness. Anatomical directions and reference planes of the brain To enable us to identify the precise location in the brain, both vertically and horizontally, it is important to be familiar with certain technical terms used by the neuroscientists. In Page 20 of 35 terms of anatomy, the front of the brain, nearest the face, is referred to as the anterior end, and polar opposite to the anterior end is the posterior end, referring to the back of the head. Superior (sometimes called dorsal) refers to the direction toward the top of the head, and inferior (sometimes called ventral) refers to the direction toward the neck/body. In terms of reference planes, the sagittal plane divides the brain into left and right portions, the coronal plane divides the brain into anterior and posterior portions, and the axial (sometimes called horizontal) plane divides the brain into superior and inferior portions (Figure 24). In both the above contexts, we can further specify the location of a particular portion or plane in terms of its position, direction, and depth in relation to the whole brain. Likewise, for each of the planes themselves, we can further speak in terms of position, direction, and depth in relation to the whole brain as well as in relation to the individual planes. Also, when representing brain parts and structures, a lateral view illustrates the section or lobes, etc. from the perspective of a whole brain, whereas a medial view illustrates the section in the dissected manner. 8) DIFFERENT TYPES OF BRAINS In general, the number of living beings who possess brain is numerous. Their brains vary both in size and function. However, if you ask whether all brains completely differ from each other. Definitely not. There are features that are common to almost all brains, such as that all brains are composed mainly of neurons, and that they all have the function of protecting the individual being from internal and external dangers. So, although there are various types of brains, here we shall focus mainly on the differences in brain types between vertebrates and invertebrates in general, and the differences within the vertebrates in particular. As you know, vertebrates are those animals who have backbone, and invertebrates do not have backbone. Most of the invertebrates do not have brain. However, those, among them, who do possess brain, theirs is usually a simple brain, composed of very few neurons. Note that majority of the animals on this earth are invertebrates. The vertebrates make up only two percent of the entire animal population. The unicellular organisms, because of practical existential reason, usually tend to be very sensitive to light. Organisms such as sea-urchins are slightly more complex and are multi-cellular. They have a few nerve cells that regulate the function of looking for sustenance and providing protection from possible dangers. Slightly more complex than the types of sea-urchins are earthworm and jellyfish, which have neurons that assist them in fighting hostile external Page 21 of 35 environment (Figure 25). It is interesting to know that the neurons these simple organisms have are similar to the human neurons in terms of structure, function, as well as their neurotransmitters. If you ask, what is the difference then? There hardly is any connection between the nerves in the invertebrates. Besides that, the nerves almost cover their entire bodies. For example, among the invertebrates, earthworms (Figure 26) have one of the simplest types of brains, possessing only a few neurons. Their brains regulate only a few simple tasks such as eating food and doing a few simple body movements, not any higher actions. The network of neurons that process and interpret the information received from the earthworm’s body parts is present in the earthworm’s head. However, even if that network were to be removed from its body, no noticeable changes would be observe in its behavior. Still, among the invertebrates, grasshoppers and bees have slightly more complex brains. Scientists have begun to understand the relation between their brains and the corresponding behaviors (Figure 27). The ants, also an invertebrate, have more complex behavior, but have a very tiny brain. Likewise, the mosquitoes perform the function of flying in the space, suck blood from others, etc. However, their brain size is still no more than a small dot. Among the vertebrates, the mice are generally quite smart, yet have brains weighing no more than 2 grams. Their entire brain size is equivalent to that of the human hypothalamus. Though generally it is said the bigger the brain, the greater the intellect. However, in actuality it is the overall area of cortices, not just the overall bulk that determines the level of intellect. Among the vertebrates, there are mammals and non-mammals. Birds and fish are examples of non-mammals. It is known that the brains of mammals and non-mammals differ greatly in terms of complexity in the areas of composition, neurons, synapses, etc. Though they still have the same basic parts and structures, they differ in the overall brain size in relation to their bodies. Besides that, depending on which parts play out more in their life, they differ in the relative size of specific parts of the brain and body. For example, birds and fish have relatively very small olfactory bulb. Also, these nonmammalian animals lack brain cortex. Cerebral cortex is a special brain part, quite prominent in primates including the humans. Not only this, human beings are known to have a disproportionately large cortex (Figures 28 & 29). The average weight of human brain amounts to only one and a half percent of their body weight. However, it consumes 20 percent of the food required by the whole body. So, the larger the brain is the greater the amount of energy consumption. Therefore, bigger brain Page 22 of 35 is not always a sign of boon to the individual species. This may be the reason why there are no many species with larger brains in the history of evolution. Social animals that depend on their social community for survival are said to have larger brains. For example, dolphins, who hunt in groups, have fairly large brain. Although, the brains of elephants and whales are much bigger in size than that of the humans, but humans have the largest brains in proportionate to their body sizes. 9) FACTS ABOUT HUMAN SPINAL CORD Spinal cord is located within the vertebrae of the backbone. It extends from brainstem down to the first lumbar vertebra. It is roughly the width of a conventional pencil, tapering at it base even thinner. It is comprised of a bundle of fibers, and the fibers are long projections of nerve cells, extending from the base of the brain to the lower region of the spine. The spinal cord carries information to and from the brain and all parts of the body except the head, which is served by the cranial nerves. The signals that travel along the spinal cord are known as nerve impulses. Data from the sensory organs in different parts of the body is collected via the spinal nerves and transmitted along the spinal cord to the brain. The spinal cord also sends motor information, such as movement commands, from the brain out to the body, again transmitted via the spinal nerve network. In terms of its anatomy, the spinal cord (Figure 30) is constituted of what is known as white matter and gray matter. The gray matter, which forms the core of the spinal cord, is composed mainly of nerve cell bodies and forms an external look of a butterfly. The white matter surrounds the gray matter and its nerve fibers play a significant role of establishing connection between different parts of the spinal cord as well as between the brain and the spinal cord. The outer regions of white matter insulate the long projecting nerve fibers (axons) coming out from the neurons. In the gray matter of the spinal cord, there are numerous low-key nerve centers that can perform certain fundamental movement responses. However, the nerve centers within the spinal cord are regulated by the brain. The ability of the humans in consciously controlling the bowl movement is an example in this regard. The fact that infants frequent to toilets more often than the adults and that many have bedwetting problem is due to the brain being not fully developed as well as lacking in control over urine. Thus, the spinal cord serves as a pathway of connection between the brain, the rest of the body, and internal organs. The spinal cord stays in contact with the majority of body organs through the medium of nerves. Page 23 of 35 10) PERIPHERAL NERVOUS SYSTEM As discussed above, the whole of nervous system is divided into the central nervous system (CNS) and the peripheral nervous system (PNS). Of these two, we have already discussed the central nervous system constituted by the brain and the spinal cord. So here, we will take up the remaining part, i.e. the peripheral nervous system. The peripheral nervous system is a complex network of nerves extending across the body, branching out from 12 pairs of cranial nerves originating in the brain and 31 pairs of spinal nerves emanating from the spinal cord. It relays information between the body and the brain in the form of nerve impulses. It has an afferent division (through which messages are sent to the brain) and an efferent division (which carries messages from the brain to the body). Finally, there is the autonomic nervous system, which shares some nerve structures with both the CNS and PNS. It functions ‘automatically’ without conscious awareness, controlling basic functions, such as body temperature, blood pressure, and heart rate. Sensory input travels quickly from receptor points throughout the body via the afferent networks of the PNS to the brain, which processes, coordinates, and interprets the data in just fractions of a second. The brain makes an executive decision that is conveyed via the efferent division of the PNS to muscles, which take the needed action. The twelve pairs of cranial nerves There are 12 pairs of cranial nerves (Figure 31). They are all linked directly to the brain and do not enter the spinal cord. They allow sensory information to pass from the organs of the head, such as the eyes and ears, to the brain and also convey motor information from the brain to these organs—for example, directions for moving the mouth and lips in speech. The cranial nerves are named for the body part they serve, such as the optic nerve for the eyes, and are also assigned Roman numerical, following anatomical convention. Of these, some are associated with sensory information and others with motor information, while some are associated with both the kinds of information. How cranial nerves attach The cranial nerves I and II connect to the cerebrum, while cranial nerves III to XII connect to the brainstem. The fibers of sensory cranial nerves each project from a cell body that is located outside the brain itself, in sensory ganglia or elsewhere along the trunks of sensory nerves. The thirty-one pairs of spinal nerves Page 24 of 35 There are 31 pairs of spinal nerves (Figure 32). These branch out from the spinal cord, dividing and subdividing to form a network connecting the spinal cord to every part of the body. The spinal nerves carry information from receptors around the body to the spinal cord. From here the information passes to the brain for processing. Spinal nerves also transmit motor information from the brain to the body’s muscles and glands so that the brain’s instructions can be carried out swiftly. Each of the 31 pairs of spinal nerves belongs to one of the four spinal regions--- cervical, thoracic, lumbar, and sacral. Of them, the cervical region has eight pairs, the thoracic has twelve pairs, the lumbar has five, and finally, the sacral has six pairs. How spinal nerves attach As mentioned above, human spinal cord is located within the vertebrae of the backbone. So, one may wonder how the spinal nerves attach to the spinal cord. There are gaps in the vertebrae of the backbone through which spinal nerves enter the spinal cord (Figure 33). The nerves divide into spinal nerve roots, each made up of tiny rootlets that enter the back and front parts of the cord. 11) A SLIGHTLY DETAILED LOOK AT THE SENSES How do our brain and the environment interact? Here is how. First the senses come in contact with the external stimuli such as light, sound wave, pressure, etc. to which the corresponding senses respond. Then those sense data are sent along the respective sensory nerves in the form of electrical signals which eventually reach their respective sites on the brain cortices. That is when we shall have the perception of the respective objects. SEEING Let’s now take up each of the senses, one by one. First, we discuss the sense of vision. We shall look into the following topics surrounding the sense of vision: the structure of eye, its receptor cells, the visual pathway, and the range of light frequency different animals, including humans, have access to. Page 25 of 35 STRUCTURE OF EYE The eyeball is a fluid-filled orb. It has a hole in the front called pupil. At the back of the eyeball, there is retina which is a sheet of nerve cells. Some of the retinal cells are lightsensitive (photoreceptive). In the center of the retina, there is a tiny pitted area called fovea, densely packed with cones which are color-picking, light-sensitive cells and are significant in detecting detailed, sensitive image of the object. Between the pupil and the retina is a lens that adjusts to help the light passing through pupil to focus on the surface of the retina. The pupil is surrounded by a muscular ring of pigmented fibers called iris. The iris is responsible for people having different eye colors, and it also controls the amount of light entering into the eye. The pupil is covered by a transparent layer of clear tissue called cornea which merges with the tough outer surface or the ‘white’ of the eye called sclera. In the back of the eye, there is a hole (optic disk) through which the optic nerves pass through to enter the brain (Figure 34). LIGHT-RECEPTIVE CELLS As mentioned before, retina is located at the back of the eye, and is composed of lightreceptive cells (photoreceptors). There are, in the main, two types of photoreceptors in the retina: cone cells and rod cells. The cone cells detect the color components from amongst the visible light spectrum, and are also responsible for detecting fine detail. However, cone photoreceptors require a huge amount of light to perform its function well. Cone cells in the humans are of three types: red-, blue-, and green-sensing cones, each detecting the respective colors. They are all formed on the surface and around the fovea. On the other hand, the rod cells are formed on the periphery of retina. These cells can detect images even in dim light. However, these cells mainly detect shape and motion, not so much the color. Of these two types of photoreceptors, the rods are much more sensitive to light, so much so that even with just a few light particles, they can at least generate a faint image. Besides, the manner of concentration of these cells in and around fovea impacts greatly the sensitivity of the sensation of the object. The majority of the 6 million cone cells are concentrated in the fovea, whereas all of the more than 120 million rod cells are spread around the fovea. Since the rods are spread over a larger area of the retina, they are relatively less concentrated, and thus, when one sees objects, they are not seen that clearly and detailed. Page 26 of 35 VISUAL PATHWAYS The light reflected from the visual objects first enters the pupil through cornea, and through pupil it enters deeper into the eyes. The iris that surrounds the pupil controls the amount of light entering the eyes by changing its shapes, due to which the pupil appears to contract when the light is bright and sharp, and expands when it is less bright. Afterwards, the light passes through the lens which bends (refracts) the light, making the light to converge on the retina. If focusing on a near object, the lens thickens to increase refraction, but if the object is distant, the lens needs to flatten. The light then hits the photoreceptors in the retina, some of which fire, sending electrical signals to the brain via the optic nerve. Information received from the outer environment upon coming in contact with eyes has to travel right to the back of the brain where the relevant cortex (visual cortex) is, and only there it is turned into a conscious vision. Here is the pathway through which the information passes from the eyes to the optic nerves to the visual cortex: the signals from the eyes passes through the two optic nerves and converge at a crossover junction called the optic chiasm. The fibers carrying the signals continue on to form the optic tracts, one on each side, which end at the lateral geniculate nucleus, part of the thalamus. However, the signals continue to the visual cortex via bands of nerve fibers, called the optic radiation (Figure 35). RANGE OF LIGHT WAVELENGTH THAT DIFFERENT ANIMALS, INCLUDING HUMANS, HAVE ACCESS TO In the course of evolution, by means of natural selection, different species of organisms, including the humans, have evolved eyes with varying structures and functions. That range of electromagnetic spectrum visible to the human eyes is called the visible light, which range from 400 to 700 nanometers on the wavelength. That is, from the violet, with the shorter wavelengths, to red, with longer wavelengths. Lights with wavelengths outside of the above range are normally not visible to humans. This illustrates the difference in the structure of eyes among different species of organisms. For example, the vultures and rabbits have different eye from each other. Due to that, vultures can see much farther than the rabbits do, yet cannot see as widely as the rabbits do. Likewise, the infrared light that the humans cannot see is visible to some types of fish and birds. Some birds can tell a male bird from a female bird just by looking at the infrared light reflected from their wings. Likewise, there are two main features distinct in the eyes of the bees that the humans do not have. First, their eyes can detect infrared light that the humans cannot. Second, their Page 27 of 35 visual processing is five-fold speedier than that of the humans. For example, when the bees observe a normal moving object, they do not see that as moving. Rather, they are said to see that in the form of a series of distinct temporal instances. What accounts for such a unique feature of the bees’ eyes? Their eyes are composed of six-sided lens, covered with about 4500 circular discs. These lens let in just the lights reflected from the object they focus on and not from around it. Besides that, unlike human eyes, the eyes of the bees are said to have nine types of light receptors. Because of the speed of the visual processing that the bees possess, they have a advantage of being able to negotiate their movement so well even while moving with so much speed with the least incidents of ever bumping against objects, etc. Also, often we wonder about the sharp lights reflected back from the eyes of cats and other animals of that family. That is now understood to be due to the fact that all the lights entering their eyes fail to be absorbed in the retina, and are thus reflected back by the membrane called the reflective white. HEARING The ear is divided into three sections: the outer ear, the middle ear, and the inner ear. The outer ear has three further sections: the visible part of the ear called the pinna, the auditory canal, and the eardrum. The middle ear has three tiny bone structures that help in our hearing process: malleus (hammer), incus (anvil), and stapes (stirrup). The inner ear has several parts, of which the important ones are oval window, cochlea, and auditory nerve. The outer ear funnels sound waves along the auditory canal to the eardrum which is situated towards the inner end of the air canal. Immediate after the eardrum, the three tiny bones of the middle ear are attached one after the other. The sound waves cause the eardrum to vibrate, which in turn causes this chain of bones to vibrate. The vibration eventually reaches a membrane known as the oval window, the start of the inner ear. The oval window is slightly smaller than the ear drum in diameter. Because of this, when the vibration enters from the middle ear into the inner ear, the vibration becomes more consolidated. Inner ear is situated deep under the skull. Commensurate with the force of sound waves striking the ear drum, the stapes will accordingly cause the oval window to vibrate. Due to this, the fluids filling the chambers of cochlea will move, causing basilar membrane to vibrate. This stimulates the sensory hair cells on the organ of corti transforming the pressure waves into electrical impulses. These impulses pass through auditory nerve to the temporal lobe and from there to the auditory cortex (Figure 36). Page 28 of 35 Because of the way human ear is structured, it has access to a limited range of sound frequency. That is between 20 and 20000 Hertz. Sounds beyond that range are not audible to the humans. Sounds vary in terms of their pitch, and the receptors corresponding to them are found in the various parts of the cochlea. The receptors for low pitch sounds are located in the front part of cochlea, whereas receptors for the higher and the highest pitch sounds are found in the middle and inner end, respectively, of the cochlea. SMELL The area within each nasal cavity that contains the olfactory receptor cells is known as the olfactory epithelium. A small amount of the air entering the nostrils will pass over the epithelium, which is covered in mucus. Smell molecules in the air dissolve in this mucus, bringing receptors into direct contact with the smell molecules. Three cell types are within the epithelium: in addition to the receptor cells, there are supporting cells which produce a constant supply of mucus and, basal cells, which produce new receptor cells every few weeks. The larger the epithelium is, the keener the sense of smell. Dogs, for example, have a considerably larger olfactory epithelium than humans. Like the sense of taste, smell is a chemical sense. Specialized receptors in the nasal cavity detect incoming molecules, which enter the nose on air currents and bind to receptor cells. Sniffing sucks up more odor molecules into the nose, allowing you to ‘sample’ a smell. Olfactory receptors located high up in the nasal cavity send electrical impulses to the olfactory bulb, in the limbic area of the brain, for processing. Odors are initially registered by receptor cells in the nasal cavity. These send electrical impulses along dedicated pathways to the olfactory bulb (each nostril connects to one olfactory bulb). The olfactory bulb is the smell gateway to the brain. It is part of the brain’s limbic system, the seat of our emotions, desires, and instincts, which is why smell can trigger strong emotional reactions. Once processed by the olfactory bulb, data is then sent to various areas of the brain, including the olfactory cortex adjacent to the hippocampus. Unlike data gathered by the other sense organs, odors are processed on the same side, not opposite, side of the brain as the nostril the sensory data was sent from (Figure 37). How do the olfactory receptors detect the different odors? Different smells are produced from different molecular structures of smell. Research shows that each receptor has zones on it. Therefore, when a specific smell enters the nose, only the receptors forming a conforming pattern, not every receptor, is activated. That is how the specific smell is Page 29 of 35 detected. So far the scientists have identified eight primary odors: camphorous, fishy, malty, minty, musky, spermatic, sweaty, and urinous. TASTE Taste and smell are both chemical senses. Therefore, tongue can detect taste only when the receptors in it bind to incoming molecules, generating electrical signals that pass through the related cranial nerves to the specific brain areas. Thus, the pathway of gustatory electrical impulses begins with mouth, going to medulla, continues to the thalamus, then to primary gustatory areas of the cerebral cortex. A person can experience the basic five flavors (sweet, sour, salty, bitter, and umami) by merely activating the taste receptors on the tongue. However, the flavors produced from the combination of these can be detected by tongue only in interaction with the sense of smell. Compared with cold food, we experience the hot food to produce greater taste. This is because, during such time, smell particles rising from the hot food bind to and excite the smell receptors inside the nose, making us also to sense their smell. Before the smell particles and taste particles are detected by the smell receptors and taste receptors respectively, these particles have to dissolve in the liquid solvents in the nose and mouth respectively. So they are similar on that front. However, what is different between the two is that while the taste receptors are not actual neurons, but a special type of cells, the smell receptors are actual neurons. Due to this difference, we see a marked difference in the degree of sensitivity towards the chemical particles. The smell receptors are 300 hundred times more sensitive (Figure 38). The tongue is the main sensory organ for taste detection. It is the body’s most flexible muscular organ. It has three interior muscles and three pairs of muscles connecting it to the mouth and throat. Its surface is dotted with tiny, pimplelike structures called papillae. Papillae are easily visible to naked eyes. Within each papilla are hundreds of taste buds and they are distributed across the tongue. Four types of papillae have been distinguished---vallate, filiform, foliate, and fungiform. Each type bears a different amount of taste buds. A taste bud is composed of a group of about 25 receptor cells alongside supporting cells layered together. In general, humans have 5000 to 10,000 taste buds, and each bud may carry 25 to 100 taste receptor cells within it. At the tip of each cell, there is a hole through which taste chemical particles enter and come in contact with the receptor molecules. The tiny hair-like receptors inside these receptor cells can hold only particular taste particles. Earlier, scientists believed that different parts of the tongue are dedicated to detecting specific tastes. However, according to recent researches, all tastes are detected equally across the tongue, and the tongue is well supplied with nerves Page 30 of 35 that carry taste-related data to the brain. Other parts of the mouth such as the palate, pharynx, and epiglottis can also detect taste stimuli. TOUCH There are many kinds of touch sensations. These include light touch, pressure, vibration, and temperature as well as pain, and awareness of the body position in space. The skin is the body’s main sense organ for touch. There are around 20 types of touch receptor that respond to various types of stimuli. For instance, light touch, a general category that covers sensations ranging from a tap on the arm to stroking a cat’s fur, is detected by four different types of receptor cells: free nerve endings, found in the epidermis; Merkel’s disks, found in deeper layers of the skin; Meissner’s corpuscles, which are common in the palms, soles of the feet, eyelids, genitals, and nipples; and, finally, the root hair plexus, which responds when the hair moves. Pacinian and Ruffini corpuscles respond to more pressure. The sensation of itching is produced by repetitive low-level stimulation of nerve fibers in the skin, while feeling ticklish involves more intense stimulation of the same nerve endings when the stimulus moves over the skin (Figure 39). As for the manner in which touch information finally makes its way to the brain, a sense receptor, when activated, sends information about touch stimuli as electrical impulses along a nerve fiber of the sensory nerve network to the nerve root on the spinal cord. The data enters the spinal cord and continues upward to the brain. The processing of sensory data is begun by the nuclei in the upper (dorsal) column of the spinal cord. From the brainstem, sensory data enters the thalamus, where processing continues. The data then travels to the postcentral gyrus of the cerebral cortex, the location of the somatosensory cortex. Here, it is finally translated into a touch perception. Somatosensory cerebral cortex curls around the brain like a horseshoe. Data from the right side of the body ends on the left side of the brain, and vice versa. THE SIXTH SENSE Proprioception is sometimes referred to as the sixth sense. It is our sense of how our bodies are positioned and moving in space. This ‘awareness’ is produced by part of the somatic sensing system, and involves structures called proprioceptors in the muscles, tendons, joints, and ligaments that monitor changes in their length, tension, and pressure linked to changes in position. Proprioceptors send impulses to the brain. Upon processing this information, a decision can be made—to change position or to stop moving. The brain then sends signals back to the muscles based on the input from the proprioceptors— Page 31 of 35 completing the feedback cycle. This information is not always made conscious. For example, keeping and adjusting balance is generally an unconscious process. Conscious proprioception uses the dorsal column-medial lemniscus pathway, which passes through the thalamus, and ends in the parietal lobe of the cortex. Unconscious proprioception involves spinocerebellar tracts, and ends in the cerebellum. Proprioception is impaired when people are under the influence of alcohol or certain drugs. The degree of impairment can be tested by field sobriety tests, which have long been used by the police in cases of suspected drunk-driving. Typical tests include asking someone to touch their index finger to their nose with eyes closed, to stand on one leg for 30 seconds, or to walk heel-to-toe in a straight line for nine steps. MIXED SENSES Sensory neurons respond to data from specific sense organs. Visual cortical neurons, for example, are most sensitive to signals from the eyes. But this specialization is not rigid. Visual neurons have been found to respond more strongly to weak light signals if accompanied by sound, suggesting that they are activated by data from the ears as well as the eyes. Other studies show that in people who are blind or deaf, some neurons that would normally process visual or auditory stimuli are “hijacked” by the other senses. Hence, blind people hear better and deaf people see better. SYNESTHESIA Most people are aware of only a single sensation in response to one type of stimulus. For example, sound waves make noise. But some people experience more than one sensation in response to a single stimulus. They may “see” sounds as well as hear them, or “taste” images. Called synesthesia, this sensory duplication occurs when the neural pathway from a sense organ diverges and carries data on one type of stimulus to a part of the brain that normally processes another type (Figure 40). PERCEPTION AS A CONSTRUCT Do we perceive the external world directly, or do we perceive a constructed reality? Neuroscience finds that the latter is a more accurate description. When our sensory organs detect something in the environment, they are responding to a physical stimulus. For example, the photoreceptor cells in the retina of the eye respond to photon particles traveling through space. These photons stimulate the receptor neurons, and start a chain reaction of neural signals to the primary visual cortex in the brain, where it becomes a perception. While the visual perception correlates with the physical stimulus, they are not Page 32 of 35 one and the same. It was described earlier that photons have a wavelength, and the wavelength can vary among photons. Each numerical difference in the wavelength of a photon correlates with a difference in the perception of color. That is, photons with a wavelength of around 500 nanometers correlate with perceiving the color blue, while a wavelength of around 700 nanometers correlates with perceiving the color red. While the physical property of wavelength exists objectively in the world, the perceived color only exists subjectively and depends on our ability to detect it. The colors we perceive are not physical properties, but rather the psychological correlates of the physical property of wavelength of light. Moreover, there are many wavelengths that we cannot detect, so our perceptions selectively represent the physical world. The same principle applies to the other senses. Each sensory modality we have has two components: the physical stimulus that is detected by the sensory organ, and the psychological perception that results from it. We do not directly perceive the wavelength of light, rather we perceive the result of how the photon particles stimulate the visual pathway. Therefore, we can say that perception is a construction that is grounded in detecting physical phenomena, but we do not directly perceive those phenomena. Nor do we perceive all objective phenomena, only those that we are capable of detecting. If perception is a construction and a limited representation of objective phenomena, why did it evolve that way? We need to be able to react to environmental circumstances to survive. To find food, to avoid predators, to meet mates, to care for offspring, to engage in social behavior, all of these actions require the ability to detect and respond to changes in the physical environment. But sensory systems can evolve to be simply good enough for survival. It is not necessary to have complete, direct perception to survive. In fact, recall the facts we discussed earlier about how the human brain is very demanding for the body’s resources. More sophisticated sensory systems require more resources, and if those resource requirements are not of great utility to the organism, then evolution likely will not favor increasing the level of sophistication. In addition, there is often a trade-off between speed and accuracy in neural systems and resulting behaviors. When it comes to visual perception, seeing a danger with less accuracy and surviving is more important than seeing a danger directly and not surviving! Page 33 of 35 12)CONSCIOUSNESS AND THE BRAIN WHAT IS CONSCIOUSNESS? Consciousness is important as well as essential. Without it, life would have no meaning. However, once we embark on identifying its nature, it is certain to find it to be like nothing else. A thought, feeling, or idea seems to be a different kind of thing from the physical objects that make up the rest of the universe. The contents of our minds cannot be located in space or time. Although to the neuroscientists the contents of our minds appear to be produced by particular types of physical activity in the brain, it is not known if this activity itself forms consciousness or if brain activity correlates with a different thing altogether that we call “the mind” or consciousness (Figure 41). If consciousness is not simply brain activity, this suggests that the material universe is just one aspect of reality and that consciousness is part of a parallel reality in which entirely different rules apply. MONISM AND DUALISM The philosophical stands of those positing the relation between mind and body can be broadly brought under two divisions: monism and dualism. According to the former, every phenomenon in the universe can be ultimately reduced to a material thing. Consciousness too is identical to the brain activity that correlates with it. However, the fact that not every physical thing has consciousness is because only in those physical bodies where complex physical processes evolved over a long period of time did cognitive mechanism develop. Thus, consciousness never existed in parallel with the material universe as an independent entity of its own. According to the latter, consciousness is not physical but exists in another dimension to the material universe. Certain brain processes are associated with the consciousness, but they are not identical to each other. Some dualists believe consciousness may even exist without the brain processes associated with it. LOCATING CONSCIOUSNESS Human consciousness arises from the interaction of every part of a person with their environment. We know that the brain plays the major role in producing conscious awareness but we do not know exactly how. Certain processes within the brain, and neuronal activity in particular areas, correlate reliably with conscious states, while others do not. Page 34 of 35 Different types of neuronal activity in the brain are associated with the emergence of conscious awareness. Neuronal activity in the cortex, and particularly in the frontal lobes, is associated with the arousal of conscious experience. It takes up to half a second for a stimulus to become conscious after it has first been registered in the brain. Initially, the neuronal activity triggered by the stimulus occurs in the “lower” areas of the brain, such as the amygdala and thalamus, and then in the “higher” brain, in the parts of the cortex that process sensations. The frontal cortex is activated usually only when an experience becomes conscious, suggesting that the involvement of this part of the brain may be an essential component of consciousness. REQUIREMENTS OF CONSCIOUSNESS Every state of conscious awareness has a specific pattern of brain activity associated with it. These are commonly referred to as the neural correlates of consciousness. For example, seeing a patch of yellow produces one pattern of brain activity, seeing grandparents, another. If the brain state changes from one pattern to another, so does the experience of consciousness. Consciousness arises only when brain cells fire at fairly high rates. So, neural activity must be complex for consciousness to occur, but not too complex. If all the neurons are firing, such as in an epileptic seizure, consciousness is lost. The processes relevant to consciousness are generally assumed to be found at the level of brain cells rather than at the level of individual molecules or atoms. Yet it is also possible that consciousness does arise at the far smaller atomic (quantum) level, and if so it may be subject to very different laws. Many neuroscientists hold the philosophical view of materialism; that there is only one fundamental substance in the universe and that is physical material. How, then, is subjective experience of the mind explained? Through a process known as emergence. Emergence is a process described as the production of a phenomenon from the interactions or processes of several other phenomena. For example, the molecule that is water is composed of two hydrogen atoms and one oxygen atom. The hydrogen and oxygen atoms on their own do not have the quality of wetness that water has. But when you combine them to form the molecule, and you have enough water molecules, then the property of wetness emerges from those interactions. Neuroscientists use this as an analogy, and argue that when many neurons are combined, consciousness emerges from those interactions. This analogy serves as a useful description within the viewpoint of materialism, but it is not an explanation, as we have yet to demonstrate the mechanisms involved in such an emergence.
+
+USER:
+Can you list all of the ancient people mentioned by name in a bullet point list along with a brief description of their beliefs regarding the brain?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,25,27,14526,,783
+Only use the information from the document within the context block when developing your answer. You mustn't use sources from outside of the context block or previous knowledge. Include three bullet point lists in your response. Respond in between 250-500 words.,Please describe one finding for each of the studies mentioned in the document text.,"Video Game Play and Real-World Violence We must stop the glorification of violence in our society. This includes the gruesome and grisly video games that are now commonplace. It is too easy today for troubled youth to surround themselves with a culture that celebrates violence. —Donald Trump, U.S. President (2019) The tendency to link violent crimes to the playing of violent video games is so prevalent that a term exists to describe it: “the Grand Theft Fallacy.” As one might guess from the word fallacy, this tendency is not only flawed, it gets matters entirely backward. Countries that consume more video games have lower levels of violent crime than those devoid of this media (Markey and Ferguson 2017). Months when people play violent video games the most tend to be safer than months they play them less (Markey, Markey, and French 2015). Even when violent video games, like Grand Theft Auto, were first released, there tends to be a decrease in violent crimes (Beerthuizen, Weijters, and van der Laan 2017). These findings have been replicated by psychologists, economists, and sociologists at various universities considering numerous other variables (cf. Cunningham, Engelstätter, and Ward 2016; Ward 2011). Most strikingly, these findings are not unique to violent video game play— other forms of violent media have also been linked to decreases in violent crime. Contrary to the fear that violent television poses a threat to our society, violent assaults, rapes, and murders all decrease when people are watching extremely violent television shows (Messner 1986). Even violent movies have been linked to declines in real-world violence. As with violent video games, years in which the most violent films were released saw decreases in violent crime, and crime consistently decreases in the days following the release of popular violent movies (Dahl and DellaVigna 2009; Markey, French, and Markey 2015). Regardless of the type of violent media—games, movies, or television shows—the research is consistent. When society is exposed to violent media, there is a reliable reduction in real-world violence. The reason why violent video game play (and other violent media) seems to reduce crime can be traced back to what criminologists call “routine activity theory” (Felson 1994). The simple notion behind this theory is this: For a violent crime to occur, a perpetrator must be in the same location as the victim, and this location tends to be free of those who would likely prevent the crime. Now, consider how playing many hours of video games may keep these potential criminals and victims entertained and off the streets. Male gamers in the United States spend a total of 468 million hours each month playing video games (Snider 2014). These hours constitute time during which at-risk individuals remain inside their homes, instead of being out on the streets. In this manner, video game play could serve as an effective crime-reduction strategy. No taxpayer money is needed. It naturally targets those individuals who are at the highest risk for committing violence or being victims of violence, and it appears to be working. Video Game Play and Aggression If you shoot somebody in one of these games, you don’t go to jail, you don’t get penalized in some way—you get extra points! This doesn’t mean that your child will go out into the world and shoot someone. But they do use more aggressive language, they do use more aggressive images, they have less ability to control their anger, and they externalize things in these violent ways. It’s absolutely not good. —“Dr. Phil” McGraw, television personality (2005) As illustrated by Dr. Phil’s quote, although some might not think video games cause violent homicides, they are still willing to believe that video game play, especially violent video game play, causes aggressive behaviors like punching others, fighting, or bullying. In this context, aggressive behaviors are actions committed by an individual intending to harm another individual. Although similar to violent behaviors like homicides, aggressive acts tend not to cause such extreme physical harm (Bushman et al. 2016). Much of the research purporting to support the claim that video games cause more minor forms of aggression has done little more than establish associations between self-reports of video game play and self-reports of feelings. Figure 2 provides some examples researchers have used to examine whether video games cause aggression. As we can see from these items, these studies do not examine real acts of aggression. Instead, these questionnaires attempt to measure aggression by using items that assess whether an individual might be “jerky” (that is, believing that to say something nasty about an individual behind his or her back is acceptable), antisocial, (as in, “I feel unsociable”), gossipy (as in “I have spread gossip about people I do not like”), or—oddly enough—conservative (like someone who might say, “Any nation should be ready with a strong military at all times”) (Krahé and Möller 2004; Anderson and Dill 2000; Greitemeyer 2019; Anderson et al. 2004). Thus, the meaning and importance one can draw from such studies are extremely suspect. When video game researchers have conducted experiments, these studies have typically involved one group of participants who play a violent video game and another group who plays a nonviolent video game. After a short play session, participants’ aggressive thoughts or behaviors are assessed. Some researchers who have used this methodology found that individuals who play violent video games are more likely to expose others to loud irritating noises (Bushman and Gibson 2011), report feeling more hostile on a questionnaire (Anderson and Dill 2000), give longer prison sentences to hypothetical criminals (Deselms and Altman 2003), and even give hot sauce to people who do not like spicy food (Yang, Huesmann, and Bushman 2014). Importantly, many other researchers cannot replicate these effects (Kühn et al. 2019). So, even if these various experimental outcomes might be related to disagreeable thoughts, it is extremely questionable how well these responses translate to real-world aggressive behavior such as fighting, hitting, and bullying. Other scholars have raised both methodological and measurement concerns with studies examining aggression. For instance, one popular method, the competitive reaction time task (CRTT), measures how aggressive a person becomes after playing a violent video game by giving the player a chance to “blast” another person with an irritating noise. Specifically, participants are allowed to select both the duration and the intensity level (on a scale of zero to ten) of a white noise burst administered to another person. Unfortunately, no standardized scoring method exists for this measurement of aggression. Some researchers have scored aggression as the sum of the intensity and duration (Bushman and Gibson 2011), the product of the intensity and duration (Bartholow, Sestir, and Davis 2005), the log-transformation of duration, ignoring the intensity (Anderson and Dill 2000), and even the square root of the duration score multiplied by the intensity score (Carnagey and Anderson 2005). Collectively, there are at least 147 different ways researchers have scored this measurement. Given all these permutations, one can make it appear as if video games increase aggression, decrease aggression, or have no effect on aggression even within the same sample (Elson et al. 2014). Looking past such methodical problems, numerous scholars have conducted meta-analyses to try to understand better how big an effect video games have on these mundane aggressive outcomes. On average, only 0.4 percent to 4 percent of the variance in minor forms of aggression can be explained by violent video games (Ferguson 2015b; Hilgard, Engelhardt, and Rouder 2017). Keep in mind that this small effect is in reference to the effect of video game play on aggressive outcomes with minimal repercussions (e.g., giving hot sauce to another person who does not like spicy foods) that often have methodical issues (e.g., the CRTT) and are not direct measurements of real-world aggressive acts. Thus, the extremely small effect sizes linking violent video games to questionable proxy measurements of aggression found in many studies likely constitute an overestimate of any true effect video game play has on real-world aggressive behaviors.","Context: Video Game Play and Real-World Violence We must stop the glorification of violence in our society. This includes the gruesome and grisly video games that are now commonplace. It is too easy today for troubled youth to surround themselves with a culture that celebrates violence. —Donald Trump, U.S. President (2019) The tendency to link violent crimes to the playing of violent video games is so prevalent that a term exists to describe it: “the Grand Theft Fallacy.” As one might guess from the word fallacy, this tendency is not only flawed, it gets matters entirely backward. Countries that consume more video games have lower levels of violent crime than those devoid of this media (Markey and Ferguson 2017). Months when people play violent video games the most tend to be safer than months they play them less (Markey, Markey, and French 2015). Even when violent video games, like Grand Theft Auto, were first released, there tends to be a decrease in violent crimes (Beerthuizen, Weijters, and van der Laan 2017). These findings have been replicated by psychologists, economists, and sociologists at various universities considering numerous other variables (cf. Cunningham, Engelstätter, and Ward 2016; Ward 2011). Most strikingly, these findings are not unique to violent video game play— other forms of violent media have also been linked to decreases in violent crime. Contrary to the fear that violent television poses a threat to our society, violent assaults, rapes, and murders all decrease when people are watching extremely violent television shows (Messner 1986). Even violent movies have been linked to declines in real-world violence. As with violent video games, years in which the most violent films were released saw decreases in violent crime, and crime consistently decreases in the days following the release of popular violent movies (Dahl and DellaVigna 2009; Markey, French, and Markey 2015). Regardless of the type of violent media—games, movies, or television shows—the research is consistent. When society is exposed to violent media, there is a reliable reduction in real-world violence. The reason why violent video game play (and other violent media) seems to reduce crime can be traced back to what criminologists call “routine activity theory” (Felson 1994). The simple notion behind this theory is this: For a violent crime to occur, a perpetrator must be in the same location as the victim, and this location tends to be free of those who would likely prevent the crime. Now, consider how playing many hours of video games may keep these potential criminals and victims entertained and off the streets. Male gamers in the United States spend a total of 468 million hours each month playing video games (Snider 2014). These hours constitute time during which at-risk individuals remain inside their homes, instead of being out on the streets. In this manner, video game play could serve as an effective crime-reduction strategy. No taxpayer money is needed. It naturally targets those individuals who are at the highest risk for committing violence or being victims of violence, and it appears to be working. Video Game Play and Aggression If you shoot somebody in one of these games, you don’t go to jail, you don’t get penalized in some way—you get extra points! This doesn’t mean that your child will go out into the world and shoot someone. But they do use more aggressive language, they do use more aggressive images, they have less ability to control their anger, and they externalize things in these violent ways. It’s absolutely not good. —“Dr. Phil” McGraw, television personality (2005) As illustrated by Dr. Phil’s quote, although some might not think video games cause violent homicides, they are still willing to believe that video game play, especially violent video game play, causes aggressive behaviors like punching others, fighting, or bullying. In this context, aggressive behaviors are actions committed by an individual intending to harm another individual. Although similar to violent behaviors like homicides, aggressive acts tend not to cause such extreme physical harm (Bushman et al. 2016). Much of the research purporting to support the claim that video games cause more minor forms of aggression has done little more than establish associations between self-reports of video game play and self-reports of feelings. Figure 2 provides some examples researchers have used to examine whether video games cause aggression. As we can see from these items, these studies do not examine real acts of aggression. Instead, these questionnaires attempt to measure aggression by using items that assess whether an individual might be “jerky” (that is, believing that to say something nasty about an individual behind his or her back is acceptable), antisocial, (as in, “I feel unsociable”), gossipy (as in “I have spread gossip about people I do not like”), or—oddly enough—conservative (like someone who might say, “Any nation should be ready with a strong military at all times”) (Krahé and Möller 2004; Anderson and Dill 2000; Greitemeyer 2019; Anderson et al. 2004). Thus, the meaning and importance one can draw from such studies are extremely suspect. When video game researchers have conducted experiments, these studies have typically involved one group of participants who play a violent video game and another group who plays a nonviolent video game. After a short play session, participants’ aggressive thoughts or behaviors are assessed. Some researchers who have used this methodology found that individuals who play violent video games are more likely to expose others to loud irritating noises (Bushman and Gibson 2011), report feeling more hostile on a questionnaire (Anderson and Dill 2000), give longer prison sentences to hypothetical criminals (Deselms and Altman 2003), and even give hot sauce to people who do not like spicy food (Yang, Huesmann, and Bushman 2014). Importantly, many other researchers cannot replicate these effects (Kühn et al. 2019). So, even if these various experimental outcomes might be related to disagreeable thoughts, it is extremely questionable how well these responses translate to real-world aggressive behavior such as fighting, hitting, and bullying. Other scholars have raised both methodological and measurement concerns with studies examining aggression. For instance, one popular method, the competitive reaction time task (CRTT), measures how aggressive a person becomes after playing a violent video game by giving the player a chance to “blast” another person with an irritating noise. Specifically, participants are allowed to select both the duration and the intensity level (on a scale of zero to ten) of a white noise burst administered to another person. Unfortunately, no standardized scoring method exists for this measurement of aggression. Some researchers have scored aggression as the sum of the intensity and duration (Bushman and Gibson 2011), the product of the intensity and duration (Bartholow, Sestir, and Davis 2005), the log-transformation of duration, ignoring the intensity (Anderson and Dill 2000), and even the square root of the duration score multiplied by the intensity score (Carnagey and Anderson 2005). Collectively, there are at least 147 different ways researchers have scored this measurement. Given all these permutations, one can make it appear as if video games increase aggression, decrease aggression, or have no effect on aggression even within the same sample (Elson et al. 2014). Looking past such methodical problems, numerous scholars have conducted meta-analyses to try to understand better how big an effect video games have on these mundane aggressive outcomes. On average, only 0.4 percent to 4 percent of the variance in minor forms of aggression can be explained by violent video games (Ferguson 2015b; Hilgard, Engelhardt, and Rouder 2017). Keep in mind that this small effect is in reference to the effect of video game play on aggressive outcomes with minimal repercussions (e.g., giving hot sauce to another person who does not like spicy foods) that often have methodical issues (e.g., the CRTT) and are not direct measurements of real-world aggressive acts. Thus, the extremely small effect sizes linking violent video games to questionable proxy measurements of aggression found in many studies likely constitute an overestimate of any true effect video game play has on real-world aggressive behaviors. Question: Please describe one finding for each of the studies mentioned in the document text. System Instructions: Only use the information from the document within the context block when developing your answer. You mustn't use sources from outside of the context block or previous knowledge. Include three bullet point lists in your response. Respond in between 250-500 words.","Only use the information from the document within the context block when developing your answer. You mustn't use sources from outside of the context block or previous knowledge. Include three bullet point lists in your response. Respond in between 250-500 words.
+
+EVIDENCE:
+Video Game Play and Real-World Violence We must stop the glorification of violence in our society. This includes the gruesome and grisly video games that are now commonplace. It is too easy today for troubled youth to surround themselves with a culture that celebrates violence. —Donald Trump, U.S. President (2019) The tendency to link violent crimes to the playing of violent video games is so prevalent that a term exists to describe it: “the Grand Theft Fallacy.” As one might guess from the word fallacy, this tendency is not only flawed, it gets matters entirely backward. Countries that consume more video games have lower levels of violent crime than those devoid of this media (Markey and Ferguson 2017). Months when people play violent video games the most tend to be safer than months they play them less (Markey, Markey, and French 2015). Even when violent video games, like Grand Theft Auto, were first released, there tends to be a decrease in violent crimes (Beerthuizen, Weijters, and van der Laan 2017). These findings have been replicated by psychologists, economists, and sociologists at various universities considering numerous other variables (cf. Cunningham, Engelstätter, and Ward 2016; Ward 2011). Most strikingly, these findings are not unique to violent video game play— other forms of violent media have also been linked to decreases in violent crime. Contrary to the fear that violent television poses a threat to our society, violent assaults, rapes, and murders all decrease when people are watching extremely violent television shows (Messner 1986). Even violent movies have been linked to declines in real-world violence. As with violent video games, years in which the most violent films were released saw decreases in violent crime, and crime consistently decreases in the days following the release of popular violent movies (Dahl and DellaVigna 2009; Markey, French, and Markey 2015). Regardless of the type of violent media—games, movies, or television shows—the research is consistent. When society is exposed to violent media, there is a reliable reduction in real-world violence. The reason why violent video game play (and other violent media) seems to reduce crime can be traced back to what criminologists call “routine activity theory” (Felson 1994). The simple notion behind this theory is this: For a violent crime to occur, a perpetrator must be in the same location as the victim, and this location tends to be free of those who would likely prevent the crime. Now, consider how playing many hours of video games may keep these potential criminals and victims entertained and off the streets. Male gamers in the United States spend a total of 468 million hours each month playing video games (Snider 2014). These hours constitute time during which at-risk individuals remain inside their homes, instead of being out on the streets. In this manner, video game play could serve as an effective crime-reduction strategy. No taxpayer money is needed. It naturally targets those individuals who are at the highest risk for committing violence or being victims of violence, and it appears to be working. Video Game Play and Aggression If you shoot somebody in one of these games, you don’t go to jail, you don’t get penalized in some way—you get extra points! This doesn’t mean that your child will go out into the world and shoot someone. But they do use more aggressive language, they do use more aggressive images, they have less ability to control their anger, and they externalize things in these violent ways. It’s absolutely not good. —“Dr. Phil” McGraw, television personality (2005) As illustrated by Dr. Phil’s quote, although some might not think video games cause violent homicides, they are still willing to believe that video game play, especially violent video game play, causes aggressive behaviors like punching others, fighting, or bullying. In this context, aggressive behaviors are actions committed by an individual intending to harm another individual. Although similar to violent behaviors like homicides, aggressive acts tend not to cause such extreme physical harm (Bushman et al. 2016). Much of the research purporting to support the claim that video games cause more minor forms of aggression has done little more than establish associations between self-reports of video game play and self-reports of feelings. Figure 2 provides some examples researchers have used to examine whether video games cause aggression. As we can see from these items, these studies do not examine real acts of aggression. Instead, these questionnaires attempt to measure aggression by using items that assess whether an individual might be “jerky” (that is, believing that to say something nasty about an individual behind his or her back is acceptable), antisocial, (as in, “I feel unsociable”), gossipy (as in “I have spread gossip about people I do not like”), or—oddly enough—conservative (like someone who might say, “Any nation should be ready with a strong military at all times”) (Krahé and Möller 2004; Anderson and Dill 2000; Greitemeyer 2019; Anderson et al. 2004). Thus, the meaning and importance one can draw from such studies are extremely suspect. When video game researchers have conducted experiments, these studies have typically involved one group of participants who play a violent video game and another group who plays a nonviolent video game. After a short play session, participants’ aggressive thoughts or behaviors are assessed. Some researchers who have used this methodology found that individuals who play violent video games are more likely to expose others to loud irritating noises (Bushman and Gibson 2011), report feeling more hostile on a questionnaire (Anderson and Dill 2000), give longer prison sentences to hypothetical criminals (Deselms and Altman 2003), and even give hot sauce to people who do not like spicy food (Yang, Huesmann, and Bushman 2014). Importantly, many other researchers cannot replicate these effects (Kühn et al. 2019). So, even if these various experimental outcomes might be related to disagreeable thoughts, it is extremely questionable how well these responses translate to real-world aggressive behavior such as fighting, hitting, and bullying. Other scholars have raised both methodological and measurement concerns with studies examining aggression. For instance, one popular method, the competitive reaction time task (CRTT), measures how aggressive a person becomes after playing a violent video game by giving the player a chance to “blast” another person with an irritating noise. Specifically, participants are allowed to select both the duration and the intensity level (on a scale of zero to ten) of a white noise burst administered to another person. Unfortunately, no standardized scoring method exists for this measurement of aggression. Some researchers have scored aggression as the sum of the intensity and duration (Bushman and Gibson 2011), the product of the intensity and duration (Bartholow, Sestir, and Davis 2005), the log-transformation of duration, ignoring the intensity (Anderson and Dill 2000), and even the square root of the duration score multiplied by the intensity score (Carnagey and Anderson 2005). Collectively, there are at least 147 different ways researchers have scored this measurement. Given all these permutations, one can make it appear as if video games increase aggression, decrease aggression, or have no effect on aggression even within the same sample (Elson et al. 2014). Looking past such methodical problems, numerous scholars have conducted meta-analyses to try to understand better how big an effect video games have on these mundane aggressive outcomes. On average, only 0.4 percent to 4 percent of the variance in minor forms of aggression can be explained by violent video games (Ferguson 2015b; Hilgard, Engelhardt, and Rouder 2017). Keep in mind that this small effect is in reference to the effect of video game play on aggressive outcomes with minimal repercussions (e.g., giving hot sauce to another person who does not like spicy foods) that often have methodical issues (e.g., the CRTT) and are not direct measurements of real-world aggressive acts. Thus, the extremely small effect sizes linking violent video games to questionable proxy measurements of aggression found in many studies likely constitute an overestimate of any true effect video game play has on real-world aggressive behaviors.
+
+USER:
+Please describe one finding for each of the studies mentioned in the document text.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,41,14,1327,,674
+Use only the provided text to form a concise answer.,Summarize only the different types of Lupus that generally affect the organs.,"What is Lupus? Lupus is a chronic, autoimmune disease that can damage any part of the body (skin, joints, and/or organs inside the body). Chronic means that the signs and symptoms tend to last longer than six weeks and often for many years. In lupus, something goes wrong with the immune system, which is the part of the body that fights off viruses, bacteria, and germs (""foreign invaders,"" like the flu). Normally our immune system produces proteins called antibodies that protect the body from these invaders. Autoimmune means the immune system cannot tell the difference between these foreign invaders and the body’s healthy tissues (""auto"" means ""self"") and creates autoantibodies that attack and destroy healthy tissue. These autoantibodies cause inflammation, pain, and damage in various parts of the body.  Lupus is also a disease of flares (the symptoms worsen and the patient feels ill) and remissions (the symptoms improve and the patient feels better). Lupus can range from mild to life-threatening and should always be treated by a doctor. With good medical care, most people with lupus can lead a full life.  Lupus is not contagious, not even through sexual contact. You cannot ""catch"" lupus from someone or ""give"" lupus to someone.  Lupus is not like or related to cancer. Cancer is a condition of malignant, abnormal tissues that grow rapidly and spread into surrounding tissues. Lupus is an autoimmune disease, as described above.  Lupus is not like or related to HIV (Human Immune Deficiency Virus) or AIDS (Acquired Immune Deficiency Syndrome). In HIV or AIDS the immune system is underactive; in lupus, the immune system is overactive.  It is estimated that at least 1.5 million Americans have lupus. The actual number may be higher; however, there have been no large-scale studies to show the actual number of people in the U.S. living with lupus.  It is believed that 5 million people throughout the world have a form of lupus. Lupus Information Sheet (continued)  Lupus strikes mostly women of childbearing age (15-44). However, men, children, and teenagers develop lupus, too.  Women of color are 2-3 times more likely to develop lupus.  People of all races and ethnic groups can develop lupus.  More than 16,000 new cases of lupus are reported annually across the country. What causes Lupus? Genes No gene or group of genes has been proven to cause lupus. Lupus does, however, appear in certain families, and when one of two identical twins has lupus, there is an increased chance that the other twin will also develop the disease. These findings, as well as others, strongly suggest that genes are involved in the development of lupus. Although lupus can develop in people with no family history of lupus, there are likely to be other autoimmune diseases in some family members. Certain ethnic groups (people of African, Asian, Hispanic/Latino, Native American, Native Hawaiian, or Pacific Island descent) have a greater risk of developing lupus, which may be related to genes they have in common. Environment While a person’s genes may increase the chance that he or she will develop lupus, it takes some kind of environmental trigger to set off the illness or to bring on a flare. Examples include:  ultraviolet rays from the sun  ultraviolet rays from fluorescent light bulbs  sulfa drugs, which make a person more sensitive to the sun, such as: Bactrim® and Septra® (trimethoprim-sulfamethoxazole); sulfisoxazole (Gantrisin®); tolbutamide (Orinase®); sulfasalazine (Azulfidine®); diuretics  sun-sensitizing tetracycline drugs such as minocycline (Minocin®)  penicillin or other antibiotic drugs such as: amoxicillin (Amoxil®); ampicillin (Ampicillin Sodium ADD-Vantage®); cloxacillin (Cloxapen®)  an infection  a cold or a viral illness  exhaustion  an injury Lupus Information Sheet Ver3.0 – July 2013 Page - 2 Lupus Information Sheet (continued)  emotional stress, such as a divorce, illness, death in the family, or other life complications  anything that causes stress to the body, such as surgery, physical harm, pregnancy, or giving birth Although many seemingly unrelated factors can trigger the onset of lupus in a susceptible person, scientists have noted some common features among many people who have lupus, including:  exposure to the sun  an infection  being pregnant  giving birth  a drug taken to treat an illness However, many people cannot remember or identify any specific factor that occurred before they were diagnosed with lupus. Hormones Hormones are the body’s messengers and they regulate many of the body’s functions. In particular, the sex hormone estrogen plays a role in lupus. Men and women both produce estrogen, but estrogen production is much greater in females. Many women have more lupus symptoms before menstrual periods and/or during pregnancy, when estrogen production is high. This may indicate that estrogen somehow regulates the severity of lupus. However, it does not mean that estrogen, or any other hormone for that matter, causes lupus. Types of Lupus? Systemic Lupus Erythematosus. Systemic lupus is the most common form of lupus, and is what most people mean when they refer to ""lupus."" Systemic lupus can be mild or severe. Some of the more serious complications involving major organ systems are:  inflammation of the kidneys (lupus nephritis), which can affect the body’s ability to filter waste from the blood and can be so damaging that dialysis or kidney transplant may be needed  an increase in blood pressure in the lungs (pulmonary hypertension) Lupus Information Sheet Ver3.0 – July 2013 Page - 3 Lupus Information Sheet (continued)  inflammation of the nervous system and brain, which can cause memory problems, confusion, headaches, and strokes  inflammation in the brain’s blood vessels, which can cause high fevers, seizures, behavioral changes,  hardening of the arteries (coronary artery disease), which is a buildup of deposits on coronary artery walls that can lead to a heart attack Cutaneous Lupus Erythematosus. Cutaneous refers to the skin, and this form of lupus is limited to the skin. Although there are many types of rashes and lesions (sores) caused by cutaneous lupus, the most common rash is raised, scaly and red, but not itchy. It is commonly known as a discoid rash, because the areas of rash are shaped like disks, or circles. Another common example of cutaneous lupus is a rash over the cheeks and across the bridge of the nose, known as the butterfly rash. Other rashes or sores may appear on the face, neck, or scalp (areas of the skin that are exposed to sunlight or fluorescent light), or in the mouth, nose, or vagina. Hair loss and changes in the pigment, or color, of the skin are also symptoms of cutaneous lupus. Approximately 10 percent of people who have cutaneous lupus will develop systemic lupus. However, it is likely that these people already had systemic lupus, with the skin rash as their main symptom. Drug-induced Lupus Erythematosus. Drug-induced lupus is a lupus-like disease caused by certain prescription drugs. The symptoms of drug-induced lupus are similar to those of systemic lupus, but only rarely will any major organs be affected. The drugs most commonly connected with drug-induced lupus are hydralazine (used to treat high blood pressure or hypertension), procainamide (used to treat irregular heart rhythms), and isoniazid (used to treat tuberculosis). Drug-induced lupus is more common in men because they are given these drugs more often; however, not everyone who takes these drugs will develop drug-induced lupus. The lupus-like symptoms usually disappear within six months after these medications are stopped. Neonatal Lupus. Neonatal lupus is a rare condition that affects infants of women who have lupus and is caused by antibodies from the mother acting upon the infant in the womb. At birth, the infant may have a skin rash, liver problems, or low blood cell counts, but these symptoms disappear completely after several months with no lasting effects. Some infants with neonatal lupus can also have a serious heart defect. With proper testing, physicians can now identify most at-risk mothers, and the infant can be treated at or before birth. Most infants of mothers with lupus are entirely healthy.","System Instruction: Use only the provided text to form a concise answer. Context: What is Lupus? Lupus is a chronic, autoimmune disease that can damage any part of the body (skin, joints, and/or organs inside the body). Chronic means that the signs and symptoms tend to last longer than six weeks and often for many years. In lupus, something goes wrong with the immune system, which is the part of the body that fights off viruses, bacteria, and germs (""foreign invaders,"" like the flu). Normally our immune system produces proteins called antibodies that protect the body from these invaders. Autoimmune means the immune system cannot tell the difference between these foreign invaders and the body’s healthy tissues (""auto"" means ""self"") and creates autoantibodies that attack and destroy healthy tissue. These autoantibodies cause inflammation, pain, and damage in various parts of the body.  Lupus is also a disease of flares (the symptoms worsen and the patient feels ill) and remissions (the symptoms improve and the patient feels better). Lupus can range from mild to life-threatening and should always be treated by a doctor. With good medical care, most people with lupus can lead a full life.  Lupus is not contagious, not even through sexual contact. You cannot ""catch"" lupus from someone or ""give"" lupus to someone.  Lupus is not like or related to cancer. Cancer is a condition of malignant, abnormal tissues that grow rapidly and spread into surrounding tissues. Lupus is an autoimmune disease, as described above.  Lupus is not like or related to HIV (Human Immune Deficiency Virus) or AIDS (Acquired Immune Deficiency Syndrome). In HIV or AIDS the immune system is underactive; in lupus, the immune system is overactive.  It is estimated that at least 1.5 million Americans have lupus. The actual number may be higher; however, there have been no large-scale studies to show the actual number of people in the U.S. living with lupus.  It is believed that 5 million people throughout the world have a form of lupus. Lupus Information Sheet (continued)  Lupus strikes mostly women of childbearing age (15-44). However, men, children, and teenagers develop lupus, too.  Women of color are 2-3 times more likely to develop lupus.  People of all races and ethnic groups can develop lupus.  More than 16,000 new cases of lupus are reported annually across the country. What causes Lupus? Genes No gene or group of genes has been proven to cause lupus. Lupus does, however, appear in certain families, and when one of two identical twins has lupus, there is an increased chance that the other twin will also develop the disease. These findings, as well as others, strongly suggest that genes are involved in the development of lupus. Although lupus can develop in people with no family history of lupus, there are likely to be other autoimmune diseases in some family members. Certain ethnic groups (people of African, Asian, Hispanic/Latino, Native American, Native Hawaiian, or Pacific Island descent) have a greater risk of developing lupus, which may be related to genes they have in common. Environment While a person’s genes may increase the chance that he or she will develop lupus, it takes some kind of environmental trigger to set off the illness or to bring on a flare. Examples include:  ultraviolet rays from the sun  ultraviolet rays from fluorescent light bulbs  sulfa drugs, which make a person more sensitive to the sun, such as: Bactrim® and Septra® (trimethoprim-sulfamethoxazole); sulfisoxazole (Gantrisin®); tolbutamide (Orinase®); sulfasalazine (Azulfidine®); diuretics  sun-sensitizing tetracycline drugs such as minocycline (Minocin®)  penicillin or other antibiotic drugs such as: amoxicillin (Amoxil®); ampicillin (Ampicillin Sodium ADD-Vantage®); cloxacillin (Cloxapen®)  an infection  a cold or a viral illness  exhaustion  an injury Lupus Information Sheet Ver3.0 – July 2013 Page - 2 Lupus Information Sheet (continued)  emotional stress, such as a divorce, illness, death in the family, or other life complications  anything that causes stress to the body, such as surgery, physical harm, pregnancy, or giving birth Although many seemingly unrelated factors can trigger the onset of lupus in a susceptible person, scientists have noted some common features among many people who have lupus, including:  exposure to the sun  an infection  being pregnant  giving birth  a drug taken to treat an illness However, many people cannot remember or identify any specific factor that occurred before they were diagnosed with lupus. Hormones Hormones are the body’s messengers and they regulate many of the body’s functions. In particular, the sex hormone estrogen plays a role in lupus. Men and women both produce estrogen, but estrogen production is much greater in females. Many women have more lupus symptoms before menstrual periods and/or during pregnancy, when estrogen production is high. This may indicate that estrogen somehow regulates the severity of lupus. However, it does not mean that estrogen, or any other hormone for that matter, causes lupus. Types of Lupus? Systemic Lupus Erythematosus. Systemic lupus is the most common form of lupus, and is what most people mean when they refer to ""lupus."" Systemic lupus can be mild or severe. Some of the more serious complications involving major organ systems are:  inflammation of the kidneys (lupus nephritis), which can affect the body’s ability to filter waste from the blood and can be so damaging that dialysis or kidney transplant may be needed  an increase in blood pressure in the lungs (pulmonary hypertension) Lupus Information Sheet Ver3.0 – July 2013 Page - 3 Lupus Information Sheet (continued)  inflammation of the nervous system and brain, which can cause memory problems, confusion, headaches, and strokes  inflammation in the brain’s blood vessels, which can cause high fevers, seizures, behavioral changes,  hardening of the arteries (coronary artery disease), which is a buildup of deposits on coronary artery walls that can lead to a heart attack Cutaneous Lupus Erythematosus. Cutaneous refers to the skin, and this form of lupus is limited to the skin. Although there are many types of rashes and lesions (sores) caused by cutaneous lupus, the most common rash is raised, scaly and red, but not itchy. It is commonly known as a discoid rash, because the areas of rash are shaped like disks, or circles. Another common example of cutaneous lupus is a rash over the cheeks and across the bridge of the nose, known as the butterfly rash. Other rashes or sores may appear on the face, neck, or scalp (areas of the skin that are exposed to sunlight or fluorescent light), or in the mouth, nose, or vagina. Hair loss and changes in the pigment, or color, of the skin are also symptoms of cutaneous lupus. Approximately 10 percent of people who have cutaneous lupus will develop systemic lupus. However, it is likely that these people already had systemic lupus, with the skin rash as their main symptom. Drug-induced Lupus Erythematosus. Drug-induced lupus is a lupus-like disease caused by certain prescription drugs. The symptoms of drug-induced lupus are similar to those of systemic lupus, but only rarely will any major organs be affected. The drugs most commonly connected with drug-induced lupus are hydralazine (used to treat high blood pressure or hypertension), procainamide (used to treat irregular heart rhythms), and isoniazid (used to treat tuberculosis). Drug-induced lupus is more common in men because they are given these drugs more often; however, not everyone who takes these drugs will develop drug-induced lupus. The lupus-like symptoms usually disappear within six months after these medications are stopped. Neonatal Lupus. Neonatal lupus is a rare condition that affects infants of women who have lupus and is caused by antibodies from the mother acting upon the infant in the womb. At birth, the infant may have a skin rash, liver problems, or low blood cell counts, but these symptoms disappear completely after several months with no lasting effects. Some infants with neonatal lupus can also have a serious heart defect. With proper testing, physicians can now identify most at-risk mothers, and the infant can be treated at or before birth. Most infants of mothers with lupus are entirely healthy. Summarize only the different types of Lupus that usually affect the organs.","Use only the provided text to form a concise answer.
+
+EVIDENCE:
+What is Lupus? Lupus is a chronic, autoimmune disease that can damage any part of the body (skin, joints, and/or organs inside the body). Chronic means that the signs and symptoms tend to last longer than six weeks and often for many years. In lupus, something goes wrong with the immune system, which is the part of the body that fights off viruses, bacteria, and germs (""foreign invaders,"" like the flu). Normally our immune system produces proteins called antibodies that protect the body from these invaders. Autoimmune means the immune system cannot tell the difference between these foreign invaders and the body’s healthy tissues (""auto"" means ""self"") and creates autoantibodies that attack and destroy healthy tissue. These autoantibodies cause inflammation, pain, and damage in various parts of the body.  Lupus is also a disease of flares (the symptoms worsen and the patient feels ill) and remissions (the symptoms improve and the patient feels better). Lupus can range from mild to life-threatening and should always be treated by a doctor. With good medical care, most people with lupus can lead a full life.  Lupus is not contagious, not even through sexual contact. You cannot ""catch"" lupus from someone or ""give"" lupus to someone.  Lupus is not like or related to cancer. Cancer is a condition of malignant, abnormal tissues that grow rapidly and spread into surrounding tissues. Lupus is an autoimmune disease, as described above.  Lupus is not like or related to HIV (Human Immune Deficiency Virus) or AIDS (Acquired Immune Deficiency Syndrome). In HIV or AIDS the immune system is underactive; in lupus, the immune system is overactive.  It is estimated that at least 1.5 million Americans have lupus. The actual number may be higher; however, there have been no large-scale studies to show the actual number of people in the U.S. living with lupus.  It is believed that 5 million people throughout the world have a form of lupus. Lupus Information Sheet (continued)  Lupus strikes mostly women of childbearing age (15-44). However, men, children, and teenagers develop lupus, too.  Women of color are 2-3 times more likely to develop lupus.  People of all races and ethnic groups can develop lupus.  More than 16,000 new cases of lupus are reported annually across the country. What causes Lupus? Genes No gene or group of genes has been proven to cause lupus. Lupus does, however, appear in certain families, and when one of two identical twins has lupus, there is an increased chance that the other twin will also develop the disease. These findings, as well as others, strongly suggest that genes are involved in the development of lupus. Although lupus can develop in people with no family history of lupus, there are likely to be other autoimmune diseases in some family members. Certain ethnic groups (people of African, Asian, Hispanic/Latino, Native American, Native Hawaiian, or Pacific Island descent) have a greater risk of developing lupus, which may be related to genes they have in common. Environment While a person’s genes may increase the chance that he or she will develop lupus, it takes some kind of environmental trigger to set off the illness or to bring on a flare. Examples include:  ultraviolet rays from the sun  ultraviolet rays from fluorescent light bulbs  sulfa drugs, which make a person more sensitive to the sun, such as: Bactrim® and Septra® (trimethoprim-sulfamethoxazole); sulfisoxazole (Gantrisin®); tolbutamide (Orinase®); sulfasalazine (Azulfidine®); diuretics  sun-sensitizing tetracycline drugs such as minocycline (Minocin®)  penicillin or other antibiotic drugs such as: amoxicillin (Amoxil®); ampicillin (Ampicillin Sodium ADD-Vantage®); cloxacillin (Cloxapen®)  an infection  a cold or a viral illness  exhaustion  an injury Lupus Information Sheet Ver3.0 – July 2013 Page - 2 Lupus Information Sheet (continued)  emotional stress, such as a divorce, illness, death in the family, or other life complications  anything that causes stress to the body, such as surgery, physical harm, pregnancy, or giving birth Although many seemingly unrelated factors can trigger the onset of lupus in a susceptible person, scientists have noted some common features among many people who have lupus, including:  exposure to the sun  an infection  being pregnant  giving birth  a drug taken to treat an illness However, many people cannot remember or identify any specific factor that occurred before they were diagnosed with lupus. Hormones Hormones are the body’s messengers and they regulate many of the body’s functions. In particular, the sex hormone estrogen plays a role in lupus. Men and women both produce estrogen, but estrogen production is much greater in females. Many women have more lupus symptoms before menstrual periods and/or during pregnancy, when estrogen production is high. This may indicate that estrogen somehow regulates the severity of lupus. However, it does not mean that estrogen, or any other hormone for that matter, causes lupus. Types of Lupus? Systemic Lupus Erythematosus. Systemic lupus is the most common form of lupus, and is what most people mean when they refer to ""lupus."" Systemic lupus can be mild or severe. Some of the more serious complications involving major organ systems are:  inflammation of the kidneys (lupus nephritis), which can affect the body’s ability to filter waste from the blood and can be so damaging that dialysis or kidney transplant may be needed  an increase in blood pressure in the lungs (pulmonary hypertension) Lupus Information Sheet Ver3.0 – July 2013 Page - 3 Lupus Information Sheet (continued)  inflammation of the nervous system and brain, which can cause memory problems, confusion, headaches, and strokes  inflammation in the brain’s blood vessels, which can cause high fevers, seizures, behavioral changes,  hardening of the arteries (coronary artery disease), which is a buildup of deposits on coronary artery walls that can lead to a heart attack Cutaneous Lupus Erythematosus. Cutaneous refers to the skin, and this form of lupus is limited to the skin. Although there are many types of rashes and lesions (sores) caused by cutaneous lupus, the most common rash is raised, scaly and red, but not itchy. It is commonly known as a discoid rash, because the areas of rash are shaped like disks, or circles. Another common example of cutaneous lupus is a rash over the cheeks and across the bridge of the nose, known as the butterfly rash. Other rashes or sores may appear on the face, neck, or scalp (areas of the skin that are exposed to sunlight or fluorescent light), or in the mouth, nose, or vagina. Hair loss and changes in the pigment, or color, of the skin are also symptoms of cutaneous lupus. Approximately 10 percent of people who have cutaneous lupus will develop systemic lupus. However, it is likely that these people already had systemic lupus, with the skin rash as their main symptom. Drug-induced Lupus Erythematosus. Drug-induced lupus is a lupus-like disease caused by certain prescription drugs. The symptoms of drug-induced lupus are similar to those of systemic lupus, but only rarely will any major organs be affected. The drugs most commonly connected with drug-induced lupus are hydralazine (used to treat high blood pressure or hypertension), procainamide (used to treat irregular heart rhythms), and isoniazid (used to treat tuberculosis). Drug-induced lupus is more common in men because they are given these drugs more often; however, not everyone who takes these drugs will develop drug-induced lupus. The lupus-like symptoms usually disappear within six months after these medications are stopped. Neonatal Lupus. Neonatal lupus is a rare condition that affects infants of women who have lupus and is caused by antibodies from the mother acting upon the infant in the womb. At birth, the infant may have a skin rash, liver problems, or low blood cell counts, but these symptoms disappear completely after several months with no lasting effects. Some infants with neonatal lupus can also have a serious heart defect. With proper testing, physicians can now identify most at-risk mothers, and the infant can be treated at or before birth. Most infants of mothers with lupus are entirely healthy.
+
+USER:
+Summarize only the different types of Lupus that generally affect the organs.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,10,12,1346,,259
+Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document],"Summarize the provided information about Shigella in less than 600 words. At the end of the summary, list the symptoms one may experience in bold print.","Clinical Manifestations Symptoms of shigellosis include abdominal pain, tenesmus, watery diarrhea, and/or dysentery (multiple scanty, bloody, mucoid stools). Other signs may include abdominal tenderness, fever, vomiting, dehydration, and convulsions. Structure, Classification, and Antigenic Types Shigellae are Gram-negative, nonmotile, facultatively anaerobic, non-spore-forming rods. Shigella are differentiated from the closely related Escherichia coli on the basis of pathogenicity, physiology (failure to ferment lactose or decarboxylate lysine) and serology. The genus is divided into four serogroups with multiple serotypes: A (S dysenteriae, 12 serotypes); B (S flexneri, 6 serotypes); C (S boydii, 18 serotypes); and D (S sonnei, 1 serotype). Pathogenesis Infection is initiated by ingestion of shigellae (usually via fecal-oral contamination). An early symptom, diarrhea (possibly elicited by enterotoxins and/or cytotoxin), may occur as the organisms pass through the small intestine. The hallmarks of shigellosis are bacterial invasion of the colonic epithelium and inflammatory colitis. These are interdependent processes amplified by local release of cytokines and by the infiltration of inflammatory elements. Colitis in the rectosigmoid mucosa, with concomitant malabsorption, results in the characteristic sign of bacillary dysentery: scanty,. unformed stools tinged with blood and mucus. Host Defenses Inflammation, copious mucus secretion, and regeneration of the damaged colonic epithelium limit the spread of colitis and promote spontaneous recovery. Serotype-specific immunity is induced by a primary infection, suggesting a protective role of antibody recognizing the lipopolysaccharide (LPS) somatic antigen. Other Shigella antigens include enterotoxins, cytotoxin, and plasmid-encoded proteins that induce bacterial invasion of the epithelium. The protective role of immune responses against these antigens is unclear. Epidemiology Shigellosis is endemic in developing countries were sanitation is poor. Typically 10 to 20 percent of enteric disease, and 50% of the bloody diarrhea or dysentery of young children, can be characterized as shigellosis, and the prevalence of these infections decreases significantly after five years of life. In developed countries, single-source, food or water-borne outbreaks occur sporadically, and pockets of endemic shigellosis can be found in institutions and in remote areas with substandard sanitary facilities. Diagnosis Shigellosis can be correctly diagnosed in most patients on the basis of fresh blood in the stool. Neutrophils in fecal smears is also a strongly suggestive sign. Nonetheless, watery, mucoid diarrhea may be the only symptom of many S sonnei infections, and any clinical diagnosis should be confirmed by cultivation of the etiologic agent from stools. Control Prevention of fecal-oral transmission is the most effective control strategy. Severe dysentery is treated with ampicillin, trimethoprim-sulfamethoxazole, or, in patients over 17 years old, a 4-fluorquinolone such as ciprofloxacin. Vaccines are not currently available, but some promising candidates are being developed. Gram-negative, facultative anaerobes of the genus Shigella are the principal agents of bacillary dysentery. This disease differs from profuse watery diarrhea, as is commonly seen in choleraic diarrhea or in enterotoxigenic Escherichia coli diarrhea, in that the dysenteric stool is scant and contains blood, mucus, and inflammatory cells. In some individuals suffering from shigellosis, however, moderate volume diarrhea is a prodrome or the sole manifestation of the infection. Bacillary dysentery constitutes a significant proportion of acute intestinal disease in the children of developing countries, and this infection is a major contributor to stunted growth of these children. Shigellosis also presents a significant risk to travelers from developed countries when visiting in endemic areas, and sporadic food or water-borne outbreaks occur in developed countries. The pathogenic mechanism of shigellosis is complex, involving a possible enterotoxic and/or cytotoxic diarrheal prodrome, cytokine-mediated inflammation of the colon, and necrosis of the colonic epithelium. The underlying physiological insult that initiates this inflammatory cascade is the invasion of Shigella into the colonic epithelium and the lamina propria. The resulting colitis and ulceration of the mucosa result in bloody, mucoid stools, and/or febrile diarrhea.","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. Summarize the provided information about Shigella in less than 600 words. At the end of the summary, list the symptoms one may experience in bold print. Clinical Manifestations Symptoms of shigellosis include abdominal pain, tenesmus, watery diarrhea, and/or dysentery (multiple scanty, bloody, mucoid stools). Other signs may include abdominal tenderness, fever, vomiting, dehydration, and convulsions. Structure, Classification, and Antigenic Types Shigellae are Gram-negative, nonmotile, facultatively anaerobic, non-spore-forming rods. Shigella are differentiated from the closely related Escherichia coli on the basis of pathogenicity, physiology (failure to ferment lactose or decarboxylate lysine) and serology. The genus is divided into four serogroups with multiple serotypes: A (S dysenteriae, 12 serotypes); B (S flexneri, 6 serotypes); C (S boydii, 18 serotypes); and D (S sonnei, 1 serotype). Pathogenesis Infection is initiated by ingestion of shigellae (usually via fecal-oral contamination). An early symptom, diarrhea (possibly elicited by enterotoxins and/or cytotoxin), may occur as the organisms pass through the small intestine. The hallmarks of shigellosis are bacterial invasion of the colonic epithelium and inflammatory colitis. These are interdependent processes amplified by local release of cytokines and by the infiltration of inflammatory elements. Colitis in the rectosigmoid mucosa, with concomitant malabsorption, results in the characteristic sign of bacillary dysentery: scanty,. unformed stools tinged with blood and mucus. Host Defenses Inflammation, copious mucus secretion, and regeneration of the damaged colonic epithelium limit the spread of colitis and promote spontaneous recovery. Serotype-specific immunity is induced by a primary infection, suggesting a protective role of antibody recognizing the lipopolysaccharide (LPS) somatic antigen. Other Shigella antigens include enterotoxins, cytotoxin, and plasmid-encoded proteins that induce bacterial invasion of the epithelium. The protective role of immune responses against these antigens is unclear. Epidemiology Shigellosis is endemic in developing countries were sanitation is poor. Typically 10 to 20 percent of enteric disease, and 50% of the bloody diarrhea or dysentery of young children, can be characterized as shigellosis, and the prevalence of these infections decreases significantly after five years of life. In developed countries, single-source, food or water-borne outbreaks occur sporadically, and pockets of endemic shigellosis can be found in institutions and in remote areas with substandard sanitary facilities. Diagnosis Shigellosis can be correctly diagnosed in most patients on the basis of fresh blood in the stool. Neutrophils in fecal smears is also a strongly suggestive sign. Nonetheless, watery, mucoid diarrhea may be the only symptom of many S sonnei infections, and any clinical diagnosis should be confirmed by cultivation of the etiologic agent from stools. Control Prevention of fecal-oral transmission is the most effective control strategy. Severe dysentery is treated with ampicillin, trimethoprim-sulfamethoxazole, or, in patients over 17 years old, a 4-fluorquinolone such as ciprofloxacin. Vaccines are not currently available, but some promising candidates are being developed. Gram-negative, facultative anaerobes of the genus Shigella are the principal agents of bacillary dysentery. This disease differs from profuse watery diarrhea, as is commonly seen in choleraic diarrhea or in enterotoxigenic Escherichia coli diarrhea, in that the dysenteric stool is scant and contains blood, mucus, and inflammatory cells. In some individuals suffering from shigellosis, however, moderate volume diarrhea is a prodrome or the sole manifestation of the infection. Bacillary dysentery constitutes a significant proportion of acute intestinal disease in the children of developing countries, and this infection is a major contributor to stunted growth of these children. Shigellosis also presents a significant risk to travelers from developed countries when visiting in endemic areas, and sporadic food or water-borne outbreaks occur in developed countries. The pathogenic mechanism of shigellosis is complex, involving a possible enterotoxic and/or cytotoxic diarrheal prodrome, cytokine-mediated inflammation of the colon, and necrosis of the colonic epithelium. The underlying physiological insult that initiates this inflammatory cascade is the invasion of Shigella into the colonic epithelium and the lamina propria. The resulting colitis and ulceration of the mucosa result in bloody, mucoid stools, and/or febrile diarrhea. https://www.ncbi.nlm.nih.gov/books/NBK8038/","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]
+
+EVIDENCE:
+Clinical Manifestations Symptoms of shigellosis include abdominal pain, tenesmus, watery diarrhea, and/or dysentery (multiple scanty, bloody, mucoid stools). Other signs may include abdominal tenderness, fever, vomiting, dehydration, and convulsions. Structure, Classification, and Antigenic Types Shigellae are Gram-negative, nonmotile, facultatively anaerobic, non-spore-forming rods. Shigella are differentiated from the closely related Escherichia coli on the basis of pathogenicity, physiology (failure to ferment lactose or decarboxylate lysine) and serology. The genus is divided into four serogroups with multiple serotypes: A (S dysenteriae, 12 serotypes); B (S flexneri, 6 serotypes); C (S boydii, 18 serotypes); and D (S sonnei, 1 serotype). Pathogenesis Infection is initiated by ingestion of shigellae (usually via fecal-oral contamination). An early symptom, diarrhea (possibly elicited by enterotoxins and/or cytotoxin), may occur as the organisms pass through the small intestine. The hallmarks of shigellosis are bacterial invasion of the colonic epithelium and inflammatory colitis. These are interdependent processes amplified by local release of cytokines and by the infiltration of inflammatory elements. Colitis in the rectosigmoid mucosa, with concomitant malabsorption, results in the characteristic sign of bacillary dysentery: scanty,. unformed stools tinged with blood and mucus. Host Defenses Inflammation, copious mucus secretion, and regeneration of the damaged colonic epithelium limit the spread of colitis and promote spontaneous recovery. Serotype-specific immunity is induced by a primary infection, suggesting a protective role of antibody recognizing the lipopolysaccharide (LPS) somatic antigen. Other Shigella antigens include enterotoxins, cytotoxin, and plasmid-encoded proteins that induce bacterial invasion of the epithelium. The protective role of immune responses against these antigens is unclear. Epidemiology Shigellosis is endemic in developing countries were sanitation is poor. Typically 10 to 20 percent of enteric disease, and 50% of the bloody diarrhea or dysentery of young children, can be characterized as shigellosis, and the prevalence of these infections decreases significantly after five years of life. In developed countries, single-source, food or water-borne outbreaks occur sporadically, and pockets of endemic shigellosis can be found in institutions and in remote areas with substandard sanitary facilities. Diagnosis Shigellosis can be correctly diagnosed in most patients on the basis of fresh blood in the stool. Neutrophils in fecal smears is also a strongly suggestive sign. Nonetheless, watery, mucoid diarrhea may be the only symptom of many S sonnei infections, and any clinical diagnosis should be confirmed by cultivation of the etiologic agent from stools. Control Prevention of fecal-oral transmission is the most effective control strategy. Severe dysentery is treated with ampicillin, trimethoprim-sulfamethoxazole, or, in patients over 17 years old, a 4-fluorquinolone such as ciprofloxacin. Vaccines are not currently available, but some promising candidates are being developed. Gram-negative, facultative anaerobes of the genus Shigella are the principal agents of bacillary dysentery. This disease differs from profuse watery diarrhea, as is commonly seen in choleraic diarrhea or in enterotoxigenic Escherichia coli diarrhea, in that the dysenteric stool is scant and contains blood, mucus, and inflammatory cells. In some individuals suffering from shigellosis, however, moderate volume diarrhea is a prodrome or the sole manifestation of the infection. Bacillary dysentery constitutes a significant proportion of acute intestinal disease in the children of developing countries, and this infection is a major contributor to stunted growth of these children. Shigellosis also presents a significant risk to travelers from developed countries when visiting in endemic areas, and sporadic food or water-borne outbreaks occur in developed countries. The pathogenic mechanism of shigellosis is complex, involving a possible enterotoxic and/or cytotoxic diarrheal prodrome, cytokine-mediated inflammation of the colon, and necrosis of the colonic epithelium. The underlying physiological insult that initiates this inflammatory cascade is the invasion of Shigella into the colonic epithelium and the lamina propria. The resulting colitis and ulceration of the mucosa result in bloody, mucoid stools, and/or febrile diarrhea.
+
+USER:
+Summarize the provided information about Shigella in less than 600 words. At the end of the summary, list the symptoms one may experience in bold print.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,24,26,615,,447
+"""================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",My credit card interest rates are the highest they have ever been. It's really making it hard to pay them down when I can only afford the minimum payment and it mostly goes to interest. How have the interest rates changed?,"Higher APR margin has fueled the profitability of revolving balances. Typically, card issuers set an APR margin to generate a profit that is at least commensurate with the risk of lending money to consumers. In the eight years after the Great Recession, the average APR margin stayed around 10 percent, as issuers adapted to reforms in the Credit Card Accountability Responsibility and Disclosure Act of 2009 (CARD Act) that restricted harmful back-end and hidden pricing practices. But issuers began to gradually increase APR margin in 2016. The trend accelerated in 2018, and it continued through the pandemic. Over the past decade, card issuers increased APR margin despite lower charge-off rates and a relatively stable share of cardholders with subprime credit scores. The average APR margin increased 4.3 percentage points from 2013 to 2023 (while the prime rate was nearly 5 percentage points higher). As such, the profitability of revolving balances excluding loan loss provisions (the money that banks set aside for expected charge-offs) has been increasing over this time period. Figure 2: Average APR Margin and Charge-Off Rate (Federal Reserve) Figure 2 is a line graph that shows the quarterly average APR margin and charge off rate from 1995 through 2023. Since 2013, the APR margin has generally increased while the charge off rate decreased. Source: Federal Reserve Excess APR margin costs consumers billions of dollars a year. In 2023, major credit card issuers, with around $590 billion in revolving balances, charged an estimated $25 billion in additional interest fees by raising the average APR margin by 4.3 percentage points over the last ten years. For an average consumer with a $5,300 balance across credit cards, the excess APR margin cost them over $250 in 2023. Since finance charges are typically part of the minimum amount due, this additional interest burden may push consumers into persistent debt, accruing more in interest and fees than they pay towards the principal each year — or even delinquency. The increase in APR margin has occurred across all credit tiers. Even consumers with the highest credit scores are incurring higher costs. The average APR margin for accounts with credit scores at 800 or above grew 1.6 percentage points from 2015 to 2022 without a corresponding increase in late payments. Credit card interest rates are a core driver of profits. Credit card issuers are reliant on revenue from interest charged to borrowers who revolve on their balances to drive overall profits, as reflected in increasing APR margins. The return on assets on general purpose cards, one measure of profitability, was higher in 2022 (at 5.9 percent) than in 2019 (at 4.5 percent), and far greater than the returns banks received on other lines of business. Even when excluding the impact of loan loss provisions, the profitability of credit cards has been increasing. CFPB research has found high levels of concentration in the consumer credit card market and evidence of practices that inhibit consumers’ ability to find alternatives to expensive credit card products. These practices may help explain why credit card issuers have been able to prop up high interest rates to fuel profits. Our recent research has shown that while the top credit card companies dominate the market, smaller issuers many times offer credit cards with significantly lower APRs. The CFPB will continue to take steps to ensure that the consumer credit card market is fair, competitive, and transparent and to help consumers avoid debt spirals that can be difficult to escape.","""================ <TEXT PASSAGE> ======= Higher APR margin has fueled the profitability of revolving balances. Typically, card issuers set an APR margin to generate a profit that is at least commensurate with the risk of lending money to consumers. In the eight years after the Great Recession, the average APR margin stayed around 10 percent, as issuers adapted to reforms in the Credit Card Accountability Responsibility and Disclosure Act of 2009 (CARD Act) that restricted harmful back-end and hidden pricing practices. But issuers began to gradually increase APR margin in 2016. The trend accelerated in 2018, and it continued through the pandemic. Over the past decade, card issuers increased APR margin despite lower charge-off rates and a relatively stable share of cardholders with subprime credit scores. The average APR margin increased 4.3 percentage points from 2013 to 2023 (while the prime rate was nearly 5 percentage points higher). As such, the profitability of revolving balances excluding loan loss provisions (the money that banks set aside for expected charge-offs) has been increasing over this time period. Figure 2: Average APR Margin and Charge-Off Rate (Federal Reserve) Figure 2 is a line graph that shows the quarterly average APR margin and charge off rate from 1995 through 2023. Since 2013, the APR margin has generally increased while the charge off rate decreased. Source: Federal Reserve Excess APR margin costs consumers billions of dollars a year. In 2023, major credit card issuers, with around $590 billion in revolving balances, charged an estimated $25 billion in additional interest fees by raising the average APR margin by 4.3 percentage points over the last ten years. For an average consumer with a $5,300 balance across credit cards, the excess APR margin cost them over $250 in 2023. Since finance charges are typically part of the minimum amount due, this additional interest burden may push consumers into persistent debt, accruing more in interest and fees than they pay towards the principal each year — or even delinquency. The increase in APR margin has occurred across all credit tiers. Even consumers with the highest credit scores are incurring higher costs. The average APR margin for accounts with credit scores at 800 or above grew 1.6 percentage points from 2015 to 2022 without a corresponding increase in late payments. Credit card interest rates are a core driver of profits. Credit card issuers are reliant on revenue from interest charged to borrowers who revolve on their balances to drive overall profits, as reflected in increasing APR margins. The return on assets on general purpose cards, one measure of profitability, was higher in 2022 (at 5.9 percent) than in 2019 (at 4.5 percent), and far greater than the returns banks received on other lines of business. Even when excluding the impact of loan loss provisions, the profitability of credit cards has been increasing. CFPB research has found high levels of concentration in the consumer credit card market and evidence of practices that inhibit consumers’ ability to find alternatives to expensive credit card products. These practices may help explain why credit card issuers have been able to prop up high interest rates to fuel profits. Our recent research has shown that while the top credit card companies dominate the market, smaller issuers many times offer credit cards with significantly lower APRs. The CFPB will continue to take steps to ensure that the consumer credit card market is fair, competitive, and transparent and to help consumers avoid debt spirals that can be difficult to escape. https://www.consumerfinance.gov/about-us/blog/credit-card-interest-rate-margins-at-all-time-high/ ================ <QUESTION> ======= My credit card interest rates are the highest they have ever been. It's really making it hard to pay them down when I can only afford the minimum payment and it mostly goes to interest. How have the interest rates changed? ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""","""================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""
+
+EVIDENCE:
+Higher APR margin has fueled the profitability of revolving balances. Typically, card issuers set an APR margin to generate a profit that is at least commensurate with the risk of lending money to consumers. In the eight years after the Great Recession, the average APR margin stayed around 10 percent, as issuers adapted to reforms in the Credit Card Accountability Responsibility and Disclosure Act of 2009 (CARD Act) that restricted harmful back-end and hidden pricing practices. But issuers began to gradually increase APR margin in 2016. The trend accelerated in 2018, and it continued through the pandemic. Over the past decade, card issuers increased APR margin despite lower charge-off rates and a relatively stable share of cardholders with subprime credit scores. The average APR margin increased 4.3 percentage points from 2013 to 2023 (while the prime rate was nearly 5 percentage points higher). As such, the profitability of revolving balances excluding loan loss provisions (the money that banks set aside for expected charge-offs) has been increasing over this time period. Figure 2: Average APR Margin and Charge-Off Rate (Federal Reserve) Figure 2 is a line graph that shows the quarterly average APR margin and charge off rate from 1995 through 2023. Since 2013, the APR margin has generally increased while the charge off rate decreased. Source: Federal Reserve Excess APR margin costs consumers billions of dollars a year. In 2023, major credit card issuers, with around $590 billion in revolving balances, charged an estimated $25 billion in additional interest fees by raising the average APR margin by 4.3 percentage points over the last ten years. For an average consumer with a $5,300 balance across credit cards, the excess APR margin cost them over $250 in 2023. Since finance charges are typically part of the minimum amount due, this additional interest burden may push consumers into persistent debt, accruing more in interest and fees than they pay towards the principal each year — or even delinquency. The increase in APR margin has occurred across all credit tiers. Even consumers with the highest credit scores are incurring higher costs. The average APR margin for accounts with credit scores at 800 or above grew 1.6 percentage points from 2015 to 2022 without a corresponding increase in late payments. Credit card interest rates are a core driver of profits. Credit card issuers are reliant on revenue from interest charged to borrowers who revolve on their balances to drive overall profits, as reflected in increasing APR margins. The return on assets on general purpose cards, one measure of profitability, was higher in 2022 (at 5.9 percent) than in 2019 (at 4.5 percent), and far greater than the returns banks received on other lines of business. Even when excluding the impact of loan loss provisions, the profitability of credit cards has been increasing. CFPB research has found high levels of concentration in the consumer credit card market and evidence of practices that inhibit consumers’ ability to find alternatives to expensive credit card products. These practices may help explain why credit card issuers have been able to prop up high interest rates to fuel profits. Our recent research has shown that while the top credit card companies dominate the market, smaller issuers many times offer credit cards with significantly lower APRs. The CFPB will continue to take steps to ensure that the consumer credit card market is fair, competitive, and transparent and to help consumers avoid debt spirals that can be difficult to escape.
+
+USER:
+My credit card interest rates are the highest they have ever been. It's really making it hard to pay them down when I can only afford the minimum payment and it mostly goes to interest. How have the interest rates changed?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,49,41,577,,55
+Only include information available in the following text in your answer. Do not use any information or prior knowledge not included in the text. Limit your answer to 600 words or less.,How do the three new variables in the UTAUT 2 model improve our understanding of continued usage of Spotify Premium?,"Due to technological advancement, technology acceptance and adoption became an important and distinct topic of this study, especially regarding e-commerce (Rahi et al., 2020). The UTAUT 2 model was developed in research by Venkatesh et al. (2012) to enhance the explanatory power of the previous UTAUT version (Venkatesh et al., 2003). The original UTAUT model which consist of four variables which is effort expectancy (EE), performance expectancy (PE) facilitating condition (FC) and social influence (SI), was highly used by scholars to predict the intention to use new technology. Despite its’ popularity, the model was not lacking of criticism due to its incapability to include essential determinant of technology usage behaviour (Beh et al., 2019). To overcome those criticism, Venkatesh et al. (2012) compensate the limitation of the original UTAUT with the additional three variables which is habit (HB), hedonic motivation (HM) and price value (PV). On top of that, the UTAUT 2 also focusing to the post usage behaviour. Various literature has confirming that the capability of the UTAUT 2 in explaining the continuance behaviour of technology usage. Since Spotify Premium is considered a new technology in music industry, thus, it suits well with the concept in UTAUT. Furthermore, despite having high explanatory power, (Rondan-Cataluña et al., 2015) confirmed that UTAUT 2 has better predictive power compared to other technological acceptance model. Thus, provide a valid reason why the study relies on this model to predict continuance behaviour of subscribing the Spotify Premium among university students in Malaysia. Unravelling the continue of subscribing Spotify Premium 5 2.2 BI BI can be categorised as intention to use of continue of use of particular services. In the context of this study, BI refers to the intention to continue of subscribing the Spotify Premium. Continue of use always related to the behavioural of loyalty (Han et al., 2009). Since many of music streaming available in the market and each providers are offering unique features (Weinberger and Bouhnik, 2020), thus, critical to understand the reason behind the continued use of the application so that the service providers can guarantee their service remain competitive, for business sustainability and the ability to survive in a tough business environment. It is useless for the company to enhance its services if they fail to retain current customers or attract new clients. Furthermore, to increase the continue of use could be considered as a main goal in the service providers (Batouei et al., 2020). 2.3 EE EE is the level of convenience consumers experience when utilising a technology (Venkatesh et al., 2012). In this research, EE refers to the convenience of Spotify Premium usage among university students in Malaysia. Moreover, convenience refers to the ease in application usage; thus, the higher intention to use and continued usage. Also, university students classified as Generation Y (Gen. Y) are closely connected with technology use and thus experienced ease in utilising the Spotify Premium. Hence, EE is expected to produce a positive relationship with BI to continue the Spotify Premium subscription. Strengthened by a previous study, which discovered that EE has a positive relationship with BI regarding the usage of smartwatch (Beh et al., 2019), mobile financial services (Rahman et al., 2020), continued music streaming subscription (Lüders, 2020) and e-hailing technology. Therefore, this study proposes the following: Hypothesis 1 (H1) EE has a positive relationship with BI of Spotify Premium subscription. 2.4 FC FC’s refer to a person’s beliefs in the technical support available to advocate new technology use (Venkatesh et al., 2012). This study examined the availability of Spotify’s support for premium subscribers concerning the application. Paid music services require fast and up-to-date technology, namely advanced electronic equipment and an internet connection to ensure smooth and seamless music streaming. FC’s such as the skills and ability to handle the devices are crucial factors and predictors of BI due to rapid technological changes in the music streaming industry, such as computers, smartphones, tablets, the internet, online customer support (Pinochet et al., 2019). This research examined previous literature in proving the positive relationship between FC and BI, such as the study by Beh et al. (2019) and Rahman et al. (2020). University students also found that FC and BI was positively related in the context of learning management system (Sharif et al., 2019). Hence, this paper proposed that: Hypothesis 2 (H2) FC has positive effects on the BI of the Spotify Premium subscription. 6 M.S.M. Suhod et al. 2.5 Habit Habit (HB) is the extent to which an individual believes his behaviour is a result of experience; the individual tends to perform that behaviour automatically based on learning from past experience (Venkatesh et al., 2012). Habit occurs when one consistently performs an activity, such as when they experience joy and happiness while performing the activities or when the activity suits the individual. According to Soares et al. (2020), habit could be influenced by past behaviour and personal experience in applying particular system or products. If past experience produced favourable results, there is high tendency to transform the particular behaviour to become a habit. Past studies showed that habit produced a positive relationship with BI (Ameri et al., 2020; Nikolopoulou et al., 2020; Soares et al., 2020). From that, the study proposed: Hypothesis 3 (H3) Habit has positive effects on BI of Spotify Premium subscription 2.6 HM HM is the enjoyment or pleasure from technology usage (Venkatesh et al., 2012). This study defined HM as the enjoyment of Spotify Premium usage to enjoy music streaming. Based on research by Beh et al. (2019), HM showed a positive relationship with BI in the usage of smartwatches. Plus, Greece university students showed that their HM had a positive relationship with BI concerning mobile phone usage (Nikolopoulou et al., 2020). Hence, this paper suggested: Hypothesis 4 (H4) HM produced a positive effect on the BI of the Spotify Premium subscription. 2.7 PE PE refers to the competence of applications or new technology to assist users in performing certain activities substantially and conveniently (Venkatesh et al., 2012). A study by Malik (2017) stated that users are more interested in applications that improve their performance and productivity through better content knowledge and thus resulting in content awareness and the ability to provide an application that performs well. Previous studies on the continued use of technology discovered that PE has a positive relationship with BI (Ameri et al., 2020; Nikolopoulou et al., 2020; Rahman et al., 2020). With regards to that, the study proposed: Hypothesis 5 (H5) PE has a positive effect on the BI of Spotify Premium subscription. 2.8 PV PV refers to the relationship between consumers’ cognitive trade-off between the benefits gained versus the amount paid for the services (Venkatesh et al., 2012). Spotify Premium users will continue their subscription if the subscription is worth paying based on the services provided. Plus, when there is beneficial experience from using the Spotify Premium, or the received benefits are greater than the cost. Previously, it was discovered that the PV has a positive relationship with the continued subscription of music streaming services (Lüders, 2020). Unravelling the continue of subscribing Spotify Premium 7 Additionally, the PV created a positive relationship with the BI on the continued subscription to music streaming (Lüders, 2020) and continued use of mobile financial services (Rahman et al., 2020). Consequently, the study proposed: Hypothesis 6 (H6) PV produced positive effects on the BI of Spotify Premium subscription. 2.9 SI According to Venkatesh et al. (2012), SI refers to the extent of family and friend’s influence on consumers in terms of the decision to use technology. In this particular research, SI is the extent to which a university student perceives the influential person can cause them to believe that they should subscribe to Spotify Premium. Since in campus life, majority of the students spent their time with their colleague and they tend to share the experience with their people around them. Hence, what are their surrounding behaviour and thinking will have an impact in their daily life. Family and friend’s perception will influence the students’ decision. Furthermore, most students are encouraged by trend and peer pressure. SI has a positive relationship with the BI of pharmacy students’ continued use of the mobile-based educational application (Ameri et al., 2020) and Greece students’ continued use of mobile phones in their study (Nikolopoulou et al., 2020). Therefore, the study suggested:","Only include information available in the following text in your answer. Do not use any information or prior knowledge not included in the text. Limit your answer to 600 words or less. Due to technological advancement, technology acceptance and adoption became an important and distinct topic of this study, especially regarding e-commerce (Rahi et al., 2020). The UTAUT 2 model was developed in research by Venkatesh et al. (2012) to enhance the explanatory power of the previous UTAUT version (Venkatesh et al., 2003). The original UTAUT model which consist of four variables which is effort expectancy (EE), performance expectancy (PE) facilitating condition (FC) and social influence (SI), was highly used by scholars to predict the intention to use new technology. Despite its’ popularity, the model was not lacking of criticism due to its incapability to include essential determinant of technology usage behaviour (Beh et al., 2019). To overcome those criticism, Venkatesh et al. (2012) compensate the limitation of the original UTAUT with the additional three variables which is habit (HB), hedonic motivation (HM) and price value (PV). On top of that, the UTAUT 2 also focusing to the post usage behaviour. Various literature has confirming that the capability of the UTAUT 2 in explaining the continuance behaviour of technology usage. Since Spotify Premium is considered a new technology in music industry, thus, it suits well with the concept in UTAUT. Furthermore, despite having high explanatory power, (Rondan-Cataluña et al., 2015) confirmed that UTAUT 2 has better predictive power compared to other technological acceptance model. Thus, provide a valid reason why the study relies on this model to predict continuance behaviour of subscribing the Spotify Premium among university students in Malaysia. Unravelling the continue of subscribing Spotify Premium 5 2.2 BI BI can be categorised as intention to use of continue of use of particular services. In the context of this study, BI refers to the intention to continue of subscribing the Spotify Premium. Continue of use always related to the behavioural of loyalty (Han et al., 2009). Since many of music streaming available in the market and each providers are offering unique features (Weinberger and Bouhnik, 2020), thus, critical to understand the reason behind the continued use of the application so that the service providers can guarantee their service remain competitive, for business sustainability and the ability to survive in a tough business environment. It is useless for the company to enhance its services if they fail to retain current customers or attract new clients. Furthermore, to increase the continue of use could be considered as a main goal in the service providers (Batouei et al., 2020). 2.3 EE EE is the level of convenience consumers experience when utilising a technology (Venkatesh et al., 2012). In this research, EE refers to the convenience of Spotify Premium usage among university students in Malaysia. Moreover, convenience refers to the ease in application usage; thus, the higher intention to use and continued usage. Also, university students classified as Generation Y (Gen. Y) are closely connected with technology use and thus experienced ease in utilising the Spotify Premium. Hence, EE is expected to produce a positive relationship with BI to continue the Spotify Premium subscription. Strengthened by a previous study, which discovered that EE has a positive relationship with BI regarding the usage of smartwatch (Beh et al., 2019), mobile financial services (Rahman et al., 2020), continued music streaming subscription (Lüders, 2020) and e-hailing technology. Therefore, this study proposes the following: Hypothesis 1 (H1) EE has a positive relationship with BI of Spotify Premium subscription. 2.4 FC FC’s refer to a person’s beliefs in the technical support available to advocate new technology use (Venkatesh et al., 2012). This study examined the availability of Spotify’s support for premium subscribers concerning the application. Paid music services require fast and up-to-date technology, namely advanced electronic equipment and an internet connection to ensure smooth and seamless music streaming. FC’s such as the skills and ability to handle the devices are crucial factors and predictors of BI due to rapid technological changes in the music streaming industry, such as computers, smartphones, tablets, the internet, online customer support (Pinochet et al., 2019). This research examined previous literature in proving the positive relationship between FC and BI, such as the study by Beh et al. (2019) and Rahman et al. (2020). University students also found that FC and BI was positively related in the context of learning management system (Sharif et al., 2019). Hence, this paper proposed that: Hypothesis 2 (H2) FC has positive effects on the BI of the Spotify Premium subscription. 6 M.S.M. Suhod et al. 2.5 Habit Habit (HB) is the extent to which an individual believes his behaviour is a result of experience; the individual tends to perform that behaviour automatically based on learning from past experience (Venkatesh et al., 2012). Habit occurs when one consistently performs an activity, such as when they experience joy and happiness while performing the activities or when the activity suits the individual. According to Soares et al. (2020), habit could be influenced by past behaviour and personal experience in applying particular system or products. If past experience produced favourable results, there is high tendency to transform the particular behaviour to become a habit. Past studies showed that habit produced a positive relationship with BI (Ameri et al., 2020; Nikolopoulou et al., 2020; Soares et al., 2020). From that, the study proposed: Hypothesis 3 (H3) Habit has positive effects on BI of Spotify Premium subscription 2.6 HM HM is the enjoyment or pleasure from technology usage (Venkatesh et al., 2012). This study defined HM as the enjoyment of Spotify Premium usage to enjoy music streaming. Based on research by Beh et al. (2019), HM showed a positive relationship with BI in the usage of smartwatches. Plus, Greece university students showed that their HM had a positive relationship with BI concerning mobile phone usage (Nikolopoulou et al., 2020). Hence, this paper suggested: Hypothesis 4 (H4) HM produced a positive effect on the BI of the Spotify Premium subscription. 2.7 PE PE refers to the competence of applications or new technology to assist users in performing certain activities substantially and conveniently (Venkatesh et al., 2012). A study by Malik (2017) stated that users are more interested in applications that improve their performance and productivity through better content knowledge and thus resulting in content awareness and the ability to provide an application that performs well. Previous studies on the continued use of technology discovered that PE has a positive relationship with BI (Ameri et al., 2020; Nikolopoulou et al., 2020; Rahman et al., 2020). With regards to that, the study proposed: Hypothesis 5 (H5) PE has a positive effect on the BI of Spotify Premium subscription. 2.8 PV PV refers to the relationship between consumers’ cognitive trade-off between the benefits gained versus the amount paid for the services (Venkatesh et al., 2012). Spotify Premium users will continue their subscription if the subscription is worth paying based on the services provided. Plus, when there is beneficial experience from using the Spotify Premium, or the received benefits are greater than the cost. Previously, it was discovered that the PV has a positive relationship with the continued subscription of music streaming services (Lüders, 2020). Unravelling the continue of subscribing Spotify Premium 7 Additionally, the PV created a positive relationship with the BI on the continued subscription to music streaming (Lüders, 2020) and continued use of mobile financial services (Rahman et al., 2020). Consequently, the study proposed: Hypothesis 6 (H6) PV produced positive effects on the BI of Spotify Premium subscription. 2.9 SI According to Venkatesh et al. (2012), SI refers to the extent of family and friend’s influence on consumers in terms of the decision to use technology. In this particular research, SI is the extent to which a university student perceives the influential person can cause them to believe that they should subscribe to Spotify Premium. Since in campus life, majority of the students spent their time with their colleague and they tend to share the experience with their people around them. Hence, what are their surrounding behaviour and thinking will have an impact in their daily life. Family and friend’s perception will influence the students’ decision. Furthermore, most students are encouraged by trend and peer pressure. SI has a positive relationship with the BI of pharmacy students’ continued use of the mobile-based educational application (Ameri et al., 2020) and Greece students’ continued use of mobile phones in their study (Nikolopoulou et al., 2020). How do the three new variables in the UTAUT 2 model improve on our understanding of continued usage of Spotify Premium?","Only include information available in the following text in your answer. Do not use any information or prior knowledge not included in the text. Limit your answer to 600 words or less.
+
+EVIDENCE:
+Due to technological advancement, technology acceptance and adoption became an important and distinct topic of this study, especially regarding e-commerce (Rahi et al., 2020). The UTAUT 2 model was developed in research by Venkatesh et al. (2012) to enhance the explanatory power of the previous UTAUT version (Venkatesh et al., 2003). The original UTAUT model which consist of four variables which is effort expectancy (EE), performance expectancy (PE) facilitating condition (FC) and social influence (SI), was highly used by scholars to predict the intention to use new technology. Despite its’ popularity, the model was not lacking of criticism due to its incapability to include essential determinant of technology usage behaviour (Beh et al., 2019). To overcome those criticism, Venkatesh et al. (2012) compensate the limitation of the original UTAUT with the additional three variables which is habit (HB), hedonic motivation (HM) and price value (PV). On top of that, the UTAUT 2 also focusing to the post usage behaviour. Various literature has confirming that the capability of the UTAUT 2 in explaining the continuance behaviour of technology usage. Since Spotify Premium is considered a new technology in music industry, thus, it suits well with the concept in UTAUT. Furthermore, despite having high explanatory power, (Rondan-Cataluña et al., 2015) confirmed that UTAUT 2 has better predictive power compared to other technological acceptance model. Thus, provide a valid reason why the study relies on this model to predict continuance behaviour of subscribing the Spotify Premium among university students in Malaysia. Unravelling the continue of subscribing Spotify Premium 5 2.2 BI BI can be categorised as intention to use of continue of use of particular services. In the context of this study, BI refers to the intention to continue of subscribing the Spotify Premium. Continue of use always related to the behavioural of loyalty (Han et al., 2009). Since many of music streaming available in the market and each providers are offering unique features (Weinberger and Bouhnik, 2020), thus, critical to understand the reason behind the continued use of the application so that the service providers can guarantee their service remain competitive, for business sustainability and the ability to survive in a tough business environment. It is useless for the company to enhance its services if they fail to retain current customers or attract new clients. Furthermore, to increase the continue of use could be considered as a main goal in the service providers (Batouei et al., 2020). 2.3 EE EE is the level of convenience consumers experience when utilising a technology (Venkatesh et al., 2012). In this research, EE refers to the convenience of Spotify Premium usage among university students in Malaysia. Moreover, convenience refers to the ease in application usage; thus, the higher intention to use and continued usage. Also, university students classified as Generation Y (Gen. Y) are closely connected with technology use and thus experienced ease in utilising the Spotify Premium. Hence, EE is expected to produce a positive relationship with BI to continue the Spotify Premium subscription. Strengthened by a previous study, which discovered that EE has a positive relationship with BI regarding the usage of smartwatch (Beh et al., 2019), mobile financial services (Rahman et al., 2020), continued music streaming subscription (Lüders, 2020) and e-hailing technology. Therefore, this study proposes the following: Hypothesis 1 (H1) EE has a positive relationship with BI of Spotify Premium subscription. 2.4 FC FC’s refer to a person’s beliefs in the technical support available to advocate new technology use (Venkatesh et al., 2012). This study examined the availability of Spotify’s support for premium subscribers concerning the application. Paid music services require fast and up-to-date technology, namely advanced electronic equipment and an internet connection to ensure smooth and seamless music streaming. FC’s such as the skills and ability to handle the devices are crucial factors and predictors of BI due to rapid technological changes in the music streaming industry, such as computers, smartphones, tablets, the internet, online customer support (Pinochet et al., 2019). This research examined previous literature in proving the positive relationship between FC and BI, such as the study by Beh et al. (2019) and Rahman et al. (2020). University students also found that FC and BI was positively related in the context of learning management system (Sharif et al., 2019). Hence, this paper proposed that: Hypothesis 2 (H2) FC has positive effects on the BI of the Spotify Premium subscription. 6 M.S.M. Suhod et al. 2.5 Habit Habit (HB) is the extent to which an individual believes his behaviour is a result of experience; the individual tends to perform that behaviour automatically based on learning from past experience (Venkatesh et al., 2012). Habit occurs when one consistently performs an activity, such as when they experience joy and happiness while performing the activities or when the activity suits the individual. According to Soares et al. (2020), habit could be influenced by past behaviour and personal experience in applying particular system or products. If past experience produced favourable results, there is high tendency to transform the particular behaviour to become a habit. Past studies showed that habit produced a positive relationship with BI (Ameri et al., 2020; Nikolopoulou et al., 2020; Soares et al., 2020). From that, the study proposed: Hypothesis 3 (H3) Habit has positive effects on BI of Spotify Premium subscription 2.6 HM HM is the enjoyment or pleasure from technology usage (Venkatesh et al., 2012). This study defined HM as the enjoyment of Spotify Premium usage to enjoy music streaming. Based on research by Beh et al. (2019), HM showed a positive relationship with BI in the usage of smartwatches. Plus, Greece university students showed that their HM had a positive relationship with BI concerning mobile phone usage (Nikolopoulou et al., 2020). Hence, this paper suggested: Hypothesis 4 (H4) HM produced a positive effect on the BI of the Spotify Premium subscription. 2.7 PE PE refers to the competence of applications or new technology to assist users in performing certain activities substantially and conveniently (Venkatesh et al., 2012). A study by Malik (2017) stated that users are more interested in applications that improve their performance and productivity through better content knowledge and thus resulting in content awareness and the ability to provide an application that performs well. Previous studies on the continued use of technology discovered that PE has a positive relationship with BI (Ameri et al., 2020; Nikolopoulou et al., 2020; Rahman et al., 2020). With regards to that, the study proposed: Hypothesis 5 (H5) PE has a positive effect on the BI of Spotify Premium subscription. 2.8 PV PV refers to the relationship between consumers’ cognitive trade-off between the benefits gained versus the amount paid for the services (Venkatesh et al., 2012). Spotify Premium users will continue their subscription if the subscription is worth paying based on the services provided. Plus, when there is beneficial experience from using the Spotify Premium, or the received benefits are greater than the cost. Previously, it was discovered that the PV has a positive relationship with the continued subscription of music streaming services (Lüders, 2020). Unravelling the continue of subscribing Spotify Premium 7 Additionally, the PV created a positive relationship with the BI on the continued subscription to music streaming (Lüders, 2020) and continued use of mobile financial services (Rahman et al., 2020). Consequently, the study proposed: Hypothesis 6 (H6) PV produced positive effects on the BI of Spotify Premium subscription. 2.9 SI According to Venkatesh et al. (2012), SI refers to the extent of family and friend’s influence on consumers in terms of the decision to use technology. In this particular research, SI is the extent to which a university student perceives the influential person can cause them to believe that they should subscribe to Spotify Premium. Since in campus life, majority of the students spent their time with their colleague and they tend to share the experience with their people around them. Hence, what are their surrounding behaviour and thinking will have an impact in their daily life. Family and friend’s perception will influence the students’ decision. Furthermore, most students are encouraged by trend and peer pressure. SI has a positive relationship with the BI of pharmacy students’ continued use of the mobile-based educational application (Ameri et al., 2020) and Greece students’ continued use of mobile phones in their study (Nikolopoulou et al., 2020). Therefore, the study suggested:
+
+USER:
+How do the three new variables in the UTAUT 2 model improve our understanding of continued usage of Spotify Premium?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,32,20,1389,,801
+[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.,"Zero trust eliminates traditional VPNs as a secure solution by not allowing any ransomware in the first place; it requires no extra measures like encryption or network segmentation. Explain how the Zero Trust provide maximum security assurance, and how does it surpass VPNs, rendering them irrelevant for external connections and internal connections?","Introduction In May 2021, a group of hackers attacked a VPN that required only a single authentication password and gained access to the organizational network. They then demanded $4.4 million in ransom to return control of the network. In response, the company shut down its operations, which led to a fuel shortage across the east coast of the United States. The Colonial Pipeline ransomware attack was underway, and the cybersecurity industry would never be the same. Ransomware attacks have grown increasingly common (and expensive) in recent years, but organizations like yours are not doomed to become victims. Zero trust is a modern and innovative security model designed to severely limit the damage that ransomware and other cyberattacks can cause. By never inherently trusting users or devices and instead continuously verifying them before granting access, the zero trust framework: Prevents attackers from gaining easy access to critical applications And severely curtails their ability to cause damage if they do get in. In this white paper, we will examine what zero trust is and outline how to implement zero trust access in order to prevent costly and damaging ransomware attacks. Topics that we'll cover include: Zero Trust and Ransomware The current state of ransomware attacks What is Zero Trust Introducing Zero Trust to the Organization How Zero Trust mitigates ransomware attacks Securing the organization with zero trust ZTNA vs. VPNs Choosing a ZTNA provider Implementing Zero Trust in the Organization A phased approach to Zero Trust adoption Zero Trust and Ransomware Ransomware Attacks: A Costly and Worrying Reality In 2021, the number of ransomware attacks significantly increased compared to 2020, which itself saw a 150% ransomware increase compared to 2019. The number of attacks is expected to grow even more in 2022. Every month, hundreds of thousands of ransomware attacks will take place, targeting enterprises, businesses and people. Between 2019 and 2020, the amount paid by ransomware victims rose by 300%. The actual ransom demands made by attackers have also grown in recent years. Between 2019 and 2020, the amount paid by victims rose by 300%. In the first six months of 2021, ransomware payments reported by banks and other financial institutions totaled $590 million. 2021 also saw the largest ransomware demands ever per attack, with attackers demanding tens of millions of dollars following a single breach. It is clear that existing security controls, designed largely for yesterday’s legacy systems, are no longer sufficient in a world of global networks and complex cloud architectures. To prevent ransomware attacks, a new forward-looking approach is needed: zero trust. It is clear that existing security controls, designed largely for yesterday’s legacy systems, are no longer sufficient in a world of global networks and complex cloud architectures. To prevent ransomware attacks, a new forward-looking approach is needed: Zero trust. What is Zero Trust? Zero trust is a modern security architecture and model that can help mitigate ransomware attacks. Zero trust is based on the premise “Never trust, always verify,” which means that no user or machine is granted access (trust) until they are authorized. The three main principles of Zero Trust are: How Does Zero Trust Work? Zero trust is founded on the principle that no person or device should be granted system access based on inherent trust. Instead, zero trust assumes that the network has already been compromised. Therefore, no user or device can access systems or assets without first being authorized via strong authentication methods like MFA (multi-factor authentication). As an added security measure, users are continuously verified even after their initial authorization. How Zero Trust Helps Mitigate Ransomware Ransomware perpetrators attack networks and critical applications and threaten to leak or destroy valuable data unless a hefty ransom is paid. Zero trust access policies prevent the spread of ransomware. When zero trust is implemented: Ransomware attackers are blocked from accessing critical applications. Ransomware attackers are prevented from moving laterally, mitigating their ability to access and leak data. Ransomware attackers cannot see the different system components, target them and gain a foothold.see Auditing and recording capabilities help detect breaches and prevent further damage. The network is hidden, preventing attack methods like IP scanning. Potentially vulnerable VPNs are enhanced by adding an extra layer of security. Introducing Zero Trust to the Organization Securing the Organization with Zero Trust To operationally execute zero trust, it’s important to implement a technology that can secure the following domains: Data People Devices Networks Workloads The zero trust technology used to secure these domains is called ZTNA (zero trust network access). ZTNA is a software perimeter that applies the zero trust principles when authorizing users and services. ZTNA vs. VPNs Many organizations use VPNs to secure their critical applications, especially when providing access for remote users and third parties like partners and contractors. However, VPNs are not secure. First, VPNs provide external users with too much access. Any authenticated user has access to the entire network, including databases and infrastructure. In addition, VPNs providers often have major security vulnerabilities - as recent security incidents such as the Solar Winds cyberattack have demonstrated. Choosing a ZTNA Provider The zero trust tenet of “never trust, always verify” also relates to the vendors that provide zero trust access solutions. Quite paradoxically, most ZTNA providers actually demand inherent trust from their customers by requiring those customers to place their most sensitive assets, including encrypted content, passwords, and user data, in the provider’s cloud. Think of a parking valet, who holds the keys to all the cars in the lot. Rather than attacking individual car owners, a thief’s best bet would clearly be to attack the valet with his many keys. In this same way, security vendors are a tempting target for cybercriminals. This includes ZTNA providers who have access to the crown jewels of all their customers. In light of this reality, it is recommended to choose a ZTNA vendor whose architecture cannot potentially compromise your organization. Ask these 7 questions when selecting a ZTNA provider to ensure you don’t have to trust anyone – even the provider themselves: Is the users’ data exposed? Who has control of the access rules? Where are our secrets (passwords, tokens, private keys) kept? How is the risk of internal threats mitigated? What is the scope of secure access? Does it include users, networks, apps, etc.? What is the ZTNA provider’s infrastructure? Are the servers located in the cloud or in a data center? Who can access it? What happens if the ZTNA","[question] Zero trust eliminates traditional VPNs as a secure solution by not allowing any ransomware in the first place; it requires no extra measures like encryption or network segmentation. Explain how the Zero Trust provide maximum security assurance, and how does it surpass VPNs, rendering them irrelevant for external connections and internal connections? ===================== [text] Introduction In May 2021, a group of hackers attacked a VPN that required only a single authentication password and gained access to the organizational network. They then demanded $4.4 million in ransom to return control of the network. In response, the company shut down its operations, which led to a fuel shortage across the east coast of the United States. The Colonial Pipeline ransomware attack was underway, and the cybersecurity industry would never be the same. Ransomware attacks have grown increasingly common (and expensive) in recent years, but organizations like yours are not doomed to become victims. Zero trust is a modern and innovative security model designed to severely limit the damage that ransomware and other cyberattacks can cause. By never inherently trusting users or devices and instead continuously verifying them before granting access, the zero trust framework: Prevents attackers from gaining easy access to critical applications And severely curtails their ability to cause damage if they do get in. In this white paper, we will examine what zero trust is and outline how to implement zero trust access in order to prevent costly and damaging ransomware attacks. Topics that we'll cover include: Zero Trust and Ransomware The current state of ransomware attacks What is Zero Trust Introducing Zero Trust to the Organization How Zero Trust mitigates ransomware attacks Securing the organization with zero trust ZTNA vs. VPNs Choosing a ZTNA provider Implementing Zero Trust in the Organization A phased approach to Zero Trust adoption Zero Trust and Ransomware Ransomware Attacks: A Costly and Worrying Reality In 2021, the number of ransomware attacks significantly increased compared to 2020, which itself saw a 150% ransomware increase compared to 2019. The number of attacks is expected to grow even more in 2022. Every month, hundreds of thousands of ransomware attacks will take place, targeting enterprises, businesses and people. Between 2019 and 2020, the amount paid by ransomware victims rose by 300%. The actual ransom demands made by attackers have also grown in recent years. Between 2019 and 2020, the amount paid by victims rose by 300%. In the first six months of 2021, ransomware payments reported by banks and other financial institutions totaled $590 million. 2021 also saw the largest ransomware demands ever per attack, with attackers demanding tens of millions of dollars following a single breach. It is clear that existing security controls, designed largely for yesterday’s legacy systems, are no longer sufficient in a world of global networks and complex cloud architectures. To prevent ransomware attacks, a new forward-looking approach is needed: zero trust. It is clear that existing security controls, designed largely for yesterday’s legacy systems, are no longer sufficient in a world of global networks and complex cloud architectures. To prevent ransomware attacks, a new forward-looking approach is needed: Zero trust. What is Zero Trust? Zero trust is a modern security architecture and model that can help mitigate ransomware attacks. Zero trust is based on the premise “Never trust, always verify,” which means that no user or machine is granted access (trust) until they are authorized. The three main principles of Zero Trust are: How Does Zero Trust Work? Zero trust is founded on the principle that no person or device should be granted system access based on inherent trust. Instead, zero trust assumes that the network has already been compromised. Therefore, no user or device can access systems or assets without first being authorized via strong authentication methods like MFA (multi-factor authentication). As an added security measure, users are continuously verified even after their initial authorization. How Zero Trust Helps Mitigate Ransomware Ransomware perpetrators attack networks and critical applications and threaten to leak or destroy valuable data unless a hefty ransom is paid. Zero trust access policies prevent the spread of ransomware. When zero trust is implemented: Ransomware attackers are blocked from accessing critical applications. Ransomware attackers are prevented from moving laterally, mitigating their ability to access and leak data. Ransomware attackers cannot see the different system components, target them and gain a foothold.see Auditing and recording capabilities help detect breaches and prevent further damage. The network is hidden, preventing attack methods like IP scanning. Potentially vulnerable VPNs are enhanced by adding an extra layer of security. Introducing Zero Trust to the Organization Securing the Organization with Zero Trust To operationally execute zero trust, it’s important to implement a technology that can secure the following domains: Data People Devices Networks Workloads The zero trust technology used to secure these domains is called ZTNA (zero trust network access). ZTNA is a software perimeter that applies the zero trust principles when authorizing users and services. ZTNA vs. VPNs Many organizations use VPNs to secure their critical applications, especially when providing access for remote users and third parties like partners and contractors. However, VPNs are not secure. First, VPNs provide external users with too much access. Any authenticated user has access to the entire network, including databases and infrastructure. In addition, VPNs providers often have major security vulnerabilities - as recent security incidents such as the Solar Winds cyberattack have demonstrated. Choosing a ZTNA Provider The zero trust tenet of “never trust, always verify” also relates to the vendors that provide zero trust access solutions. Quite paradoxically, most ZTNA providers actually demand inherent trust from their customers by requiring those customers to place their most sensitive assets, including encrypted content, passwords, and user data, in the provider’s cloud. Think of a parking valet, who holds the keys to all the cars in the lot. Rather than attacking individual car owners, a thief’s best bet would clearly be to attack the valet with his many keys. In this same way, security vendors are a tempting target for cybercriminals. This includes ZTNA providers who have access to the crown jewels of all their customers. In light of this reality, it is recommended to choose a ZTNA vendor whose architecture cannot potentially compromise your organization. Ask these 7 questions when selecting a ZTNA provider to ensure you don’t have to trust anyone – even the provider themselves: Is the users’ data exposed? Who has control of the access rules? Where are our secrets (passwords, tokens, private keys) kept? How is the risk of internal threats mitigated? What is the scope of secure access? Does it include users, networks, apps, etc.? What is the ZTNA provider’s infrastructure? Are the servers located in the cloud or in a data center? Who can access it? What happens if the ZTNA https://cyolo.io/white-papers/how-to-stop-ransomware-attacks-with-zero-trust#:~:text=Zero%20trust%20access%20policies%20prevent,to%20access%20and%20leak%20data. ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.","[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
+
+EVIDENCE:
+Introduction In May 2021, a group of hackers attacked a VPN that required only a single authentication password and gained access to the organizational network. They then demanded $4.4 million in ransom to return control of the network. In response, the company shut down its operations, which led to a fuel shortage across the east coast of the United States. The Colonial Pipeline ransomware attack was underway, and the cybersecurity industry would never be the same. Ransomware attacks have grown increasingly common (and expensive) in recent years, but organizations like yours are not doomed to become victims. Zero trust is a modern and innovative security model designed to severely limit the damage that ransomware and other cyberattacks can cause. By never inherently trusting users or devices and instead continuously verifying them before granting access, the zero trust framework: Prevents attackers from gaining easy access to critical applications And severely curtails their ability to cause damage if they do get in. In this white paper, we will examine what zero trust is and outline how to implement zero trust access in order to prevent costly and damaging ransomware attacks. Topics that we'll cover include: Zero Trust and Ransomware The current state of ransomware attacks What is Zero Trust Introducing Zero Trust to the Organization How Zero Trust mitigates ransomware attacks Securing the organization with zero trust ZTNA vs. VPNs Choosing a ZTNA provider Implementing Zero Trust in the Organization A phased approach to Zero Trust adoption Zero Trust and Ransomware Ransomware Attacks: A Costly and Worrying Reality In 2021, the number of ransomware attacks significantly increased compared to 2020, which itself saw a 150% ransomware increase compared to 2019. The number of attacks is expected to grow even more in 2022. Every month, hundreds of thousands of ransomware attacks will take place, targeting enterprises, businesses and people. Between 2019 and 2020, the amount paid by ransomware victims rose by 300%. The actual ransom demands made by attackers have also grown in recent years. Between 2019 and 2020, the amount paid by victims rose by 300%. In the first six months of 2021, ransomware payments reported by banks and other financial institutions totaled $590 million. 2021 also saw the largest ransomware demands ever per attack, with attackers demanding tens of millions of dollars following a single breach. It is clear that existing security controls, designed largely for yesterday’s legacy systems, are no longer sufficient in a world of global networks and complex cloud architectures. To prevent ransomware attacks, a new forward-looking approach is needed: zero trust. It is clear that existing security controls, designed largely for yesterday’s legacy systems, are no longer sufficient in a world of global networks and complex cloud architectures. To prevent ransomware attacks, a new forward-looking approach is needed: Zero trust. What is Zero Trust? Zero trust is a modern security architecture and model that can help mitigate ransomware attacks. Zero trust is based on the premise “Never trust, always verify,” which means that no user or machine is granted access (trust) until they are authorized. The three main principles of Zero Trust are: How Does Zero Trust Work? Zero trust is founded on the principle that no person or device should be granted system access based on inherent trust. Instead, zero trust assumes that the network has already been compromised. Therefore, no user or device can access systems or assets without first being authorized via strong authentication methods like MFA (multi-factor authentication). As an added security measure, users are continuously verified even after their initial authorization. How Zero Trust Helps Mitigate Ransomware Ransomware perpetrators attack networks and critical applications and threaten to leak or destroy valuable data unless a hefty ransom is paid. Zero trust access policies prevent the spread of ransomware. When zero trust is implemented: Ransomware attackers are blocked from accessing critical applications. Ransomware attackers are prevented from moving laterally, mitigating their ability to access and leak data. Ransomware attackers cannot see the different system components, target them and gain a foothold.see Auditing and recording capabilities help detect breaches and prevent further damage. The network is hidden, preventing attack methods like IP scanning. Potentially vulnerable VPNs are enhanced by adding an extra layer of security. Introducing Zero Trust to the Organization Securing the Organization with Zero Trust To operationally execute zero trust, it’s important to implement a technology that can secure the following domains: Data People Devices Networks Workloads The zero trust technology used to secure these domains is called ZTNA (zero trust network access). ZTNA is a software perimeter that applies the zero trust principles when authorizing users and services. ZTNA vs. VPNs Many organizations use VPNs to secure their critical applications, especially when providing access for remote users and third parties like partners and contractors. However, VPNs are not secure. First, VPNs provide external users with too much access. Any authenticated user has access to the entire network, including databases and infrastructure. In addition, VPNs providers often have major security vulnerabilities - as recent security incidents such as the Solar Winds cyberattack have demonstrated. Choosing a ZTNA Provider The zero trust tenet of “never trust, always verify” also relates to the vendors that provide zero trust access solutions. Quite paradoxically, most ZTNA providers actually demand inherent trust from their customers by requiring those customers to place their most sensitive assets, including encrypted content, passwords, and user data, in the provider’s cloud. Think of a parking valet, who holds the keys to all the cars in the lot. Rather than attacking individual car owners, a thief’s best bet would clearly be to attack the valet with his many keys. In this same way, security vendors are a tempting target for cybercriminals. This includes ZTNA providers who have access to the crown jewels of all their customers. In light of this reality, it is recommended to choose a ZTNA vendor whose architecture cannot potentially compromise your organization. Ask these 7 questions when selecting a ZTNA provider to ensure you don’t have to trust anyone – even the provider themselves: Is the users’ data exposed? Who has control of the access rules? Where are our secrets (passwords, tokens, private keys) kept? How is the risk of internal threats mitigated? What is the scope of secure access? Does it include users, networks, apps, etc.? What is the ZTNA provider’s infrastructure? Are the servers located in the cloud or in a data center? Who can access it? What happens if the ZTNA
+
+USER:
+Zero trust eliminates traditional VPNs as a secure solution by not allowing any ransomware in the first place; it requires no extra measures like encryption or network segmentation. Explain how the Zero Trust provide maximum security assurance, and how does it surpass VPNs, rendering them irrelevant for external connections and internal connections?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,28,52,1074,,620
+[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.,"Consider the increasing use of edge computing across a range of sectors, including network optimization, agriculture, and manufacturing. In particular how, how can edge computing handle constraints on bandwidth, latency, and data sovereignty that come with typical centralized data centers? Talk about how edge computing is especially well-suited to real-time, data-intensive applications like worker safety is hazardous or remote environments and autonomous cars. What are the main elements that, in these situations, make computing essential?","Data is the lifeblood of modern business, providing valuable business insight and supporting real-time control over critical business processes and operations. Today's businesses are awash in an ocean of data, and huge amounts of data can be routinely collected from sensors and IoT devices operating in real time from remote locations and inhospitable operating environments almost anywhere in the world. But this virtual flood of data is also changing the way businesses handle computing. The traditional computing paradigm built on a centralized data center and everyday internet isn't well suited to moving endlessly growing rivers of real-world data. Bandwidth limitations, latency issues and unpredictable network disruptions can all conspire to impair such efforts. Businesses are responding to these data challenges through the use of edge computing architecture. In simplest terms, edge computing moves some portion of storage and compute resources out of the central data center and closer to the source of the data itself. Rather than transmitting raw data to a central data center for processing and analysis, that work is instead performed where the data is actually generated - Thus, edge computing is reshaping IT and business computing. Take a comprehensive look at what edge computing is, how it works, the influence of the cloud, edge use cases, tradeoffs and implementation considerations. Edge computing uses Edge computing brings data processing closer to the data source. How does edge computing work? Edge computing is all a matter of location. In traditional enterprise computing, data is produced at a client endpoint, such as a user's computer. But the number of devices connected to the internet, and the volume of data being produced by those devices and used by businesses, is growing far too quickly for traditional data center infrastructures to accommodate. So IT architects have shifted focus from the central data center to the logical edge of the infrastructure -- taking storage and computing resources from the data center and moving those resources to the point where the data is generated. Edge computing adoption Although only 27% of respondents have already implemented edge computing technologies, 54% find the idea interesting. Edge computing puts storage and servers where the data is, often requiring little more than a partial rack of gear to operate on the remote LAN to collect and process the data locally. The idea of business intelligence can vary dramatically. Some examples include retail environments where video surveillance of the showroom floor might be combined with actual sales data to determine the most desirable product configuration or consumer demand. Edge vs. cloud vs. fog computing Edge computing is closely associated with the concepts of cloud computing and fog computing. Although there is some overlap between these concepts, they aren't the same thing, and generally shouldn't be used interchangeably. It's helpful to compare the concepts and understand their differences. One of the easiest ways to understand the differences between edge, cloud and fog computing is to highlight their common theme: All three concepts relate to distributed computing and focus on the physical deployment of compute and storage resources in relation to the data that is being produced. The difference is a matter of where those resources are located. Edge computing vs. cloud Compare edge cloud, cloud computing and edge computing to determine which model is best for you. Edge. Edge computing is the deployment of computing and storage resources at the location where data is produced. This ideally puts compute and storage at the same point as the data source at the network edge. Cloud. Cloud computing is a huge, highly scalable deployment of compute and storage resources at one of several distributed global locations (regions). Cloud providers also incorporate an assortment of pre-packaged services for IoT operations, making the cloud a preferred centralized platform for IoT deployments. Edge computing architecture Unlike cloud computing, edge computing allows data to exist closer to the data sources through a network of edge devices. Fog. But the choice of compute and storage deployment isn't limited to the cloud or the edge. Fog computing environments can produce bewildering amounts of sensor or IoT data generated across expansive physical areas that are just too large to define an edge. Examples include smart buildings, smart cities or even smart utility grids Note: It's important to repeat that fog computing and edge computing share an almost identical definition and architecture, and the terms are sometimes used interchangeably even among technology experts. Why is edge computing important? Computing tasks demand suitable architectures, and the architecture that suits one type of computing task doesn't necessarily fit all types of computing tasks. Edge computing has emerged as a viable and important architecture that supports distributed computing to deploy compute and storage resources closer to -- ideally in the same physical location a But decentralization can be challenging, demanding high levels of monitoring and control that are easily overlooked when moving away from a traditional centralized computing model. Edge computing has become relevant because it offers an effective solution to emerging network problems associated with moving enormous volumes of data that today's organizations produce and consume. It's not just a problem of amount. It's also a matter of time; applications depend on processing and responses that are increasingly time-sensitive. Consider the rise of self-driving cars. They will depend on intelligent traffic control signals. Cars and traffic controls will need to produce, analyze and exchange data in real time. Multiply this requirement by huge numbers of autonomous vehicles, and the scope of the potential problems becomes clearer. Bandwidth. Bandwidth is the amount of data which a network can carry over time, usually expressed in bits per second. All networks have a limited bandwidth, and the limits are more severe for wireless communication. Latency. Latency is the time needed to send data between two points on a networkIn other cases, network outages can exacerbate congestion and even sever communication to some internet users entirely - making the internet of things useless during outages. By deploying servers and storage where the data is generated, edge computing can operate many devices over a much smaller and more efficient LAN where ample bandwidth is used exclusively by local data-generating devices, making latency and congestion virtually nonexistent. Edge computing use cases and examples In principal, edge computing techniques are used to collect, filter, process and analyze data ""in-place"" at or near the network edge. It's a powerful means of using data that can't be first moved to a centralized location -- usually because the sheer volume of data makes such moves cost-prohibitive, technologically impractical or might otherwise violate compliance obligations, such as data sovereignty. This definition has spawned myriad real-world examples and use cases: Manufacturing. An industrial manufacturer deployed edge computing to monitor manufacturing, enabling real-time analytics and machine learning at the edge to find production errors and improve product manufacturing quality. Farming. Consider a business that grows crops indoors without sunlight, soil or pesticides. The process reduces grow times by more than 60%. Using sensors enables the business to track water use, nutrient density and determine optimal harvest. Data is collected and analyzed to find the effects of environmental factors and continually improve the crop growing algorithms and ensure that crops are harvested in peak condition. Network optimization. Edge computing can help optimize network performance by measuring performance for users across the internet and then employing analytics to determine the most reliable, low-latency network path for each user's traffic. In effect, edge computing is used to ""steer"" traffic across the network for optimal time-sensitive traffic performance. Workplace safety. Edge computing can combine and analyze data from on-site cameras, employee safety devices and various other sensors to help businesses oversee workplace conditions or ensure that employees follow established safety protocols -- especially when the workplace is remote or unusually dangerous, such as construction sites or oil rigs.","[question] Consider the increasing use of edge computing across a range of sectors, including network optimization, agriculture, and manufacturing. In particular how, how can edge computing handle constraints on bandwidth, latency, and data sovereignty that come with typical centralized data centers? Talk about how edge computing is especially well-suited to real-time, data-intensive applications like worker safety is hazardous or remote environments and autonomous cars. What are the main elements that, in these situations, make computing essential? ===================== [text] Data is the lifeblood of modern business, providing valuable business insight and supporting real-time control over critical business processes and operations. Today's businesses are awash in an ocean of data, and huge amounts of data can be routinely collected from sensors and IoT devices operating in real time from remote locations and inhospitable operating environments almost anywhere in the world. But this virtual flood of data is also changing the way businesses handle computing. The traditional computing paradigm built on a centralized data center and everyday internet isn't well suited to moving endlessly growing rivers of real-world data. Bandwidth limitations, latency issues and unpredictable network disruptions can all conspire to impair such efforts. Businesses are responding to these data challenges through the use of edge computing architecture. In simplest terms, edge computing moves some portion of storage and compute resources out of the central data center and closer to the source of the data itself. Rather than transmitting raw data to a central data center for processing and analysis, that work is instead performed where the data is actually generated - Thus, edge computing is reshaping IT and business computing. Take a comprehensive look at what edge computing is, how it works, the influence of the cloud, edge use cases, tradeoffs and implementation considerations. Edge computing uses Edge computing brings data processing closer to the data source. How does edge computing work? Edge computing is all a matter of location. In traditional enterprise computing, data is produced at a client endpoint, such as a user's computer. But the number of devices connected to the internet, and the volume of data being produced by those devices and used by businesses, is growing far too quickly for traditional data center infrastructures to accommodate. So IT architects have shifted focus from the central data center to the logical edge of the infrastructure -- taking storage and computing resources from the data center and moving those resources to the point where the data is generated. Edge computing adoption Although only 27% of respondents have already implemented edge computing technologies, 54% find the idea interesting. Edge computing puts storage and servers where the data is, often requiring little more than a partial rack of gear to operate on the remote LAN to collect and process the data locally. The idea of business intelligence can vary dramatically. Some examples include retail environments where video surveillance of the showroom floor might be combined with actual sales data to determine the most desirable product configuration or consumer demand. Edge vs. cloud vs. fog computing Edge computing is closely associated with the concepts of cloud computing and fog computing. Although there is some overlap between these concepts, they aren't the same thing, and generally shouldn't be used interchangeably. It's helpful to compare the concepts and understand their differences. One of the easiest ways to understand the differences between edge, cloud and fog computing is to highlight their common theme: All three concepts relate to distributed computing and focus on the physical deployment of compute and storage resources in relation to the data that is being produced. The difference is a matter of where those resources are located. Edge computing vs. cloud Compare edge cloud, cloud computing and edge computing to determine which model is best for you. Edge. Edge computing is the deployment of computing and storage resources at the location where data is produced. This ideally puts compute and storage at the same point as the data source at the network edge. Cloud. Cloud computing is a huge, highly scalable deployment of compute and storage resources at one of several distributed global locations (regions). Cloud providers also incorporate an assortment of pre-packaged services for IoT operations, making the cloud a preferred centralized platform for IoT deployments. Edge computing architecture Unlike cloud computing, edge computing allows data to exist closer to the data sources through a network of edge devices. Fog. But the choice of compute and storage deployment isn't limited to the cloud or the edge. Fog computing environments can produce bewildering amounts of sensor or IoT data generated across expansive physical areas that are just too large to define an edge. Examples include smart buildings, smart cities or even smart utility grids Note: It's important to repeat that fog computing and edge computing share an almost identical definition and architecture, and the terms are sometimes used interchangeably even among technology experts. Why is edge computing important? Computing tasks demand suitable architectures, and the architecture that suits one type of computing task doesn't necessarily fit all types of computing tasks. Edge computing has emerged as a viable and important architecture that supports distributed computing to deploy compute and storage resources closer to -- ideally in the same physical location a But decentralization can be challenging, demanding high levels of monitoring and control that are easily overlooked when moving away from a traditional centralized computing model. Edge computing has become relevant because it offers an effective solution to emerging network problems associated with moving enormous volumes of data that today's organizations produce and consume. It's not just a problem of amount. It's also a matter of time; applications depend on processing and responses that are increasingly time-sensitive. Consider the rise of self-driving cars. They will depend on intelligent traffic control signals. Cars and traffic controls will need to produce, analyze and exchange data in real time. Multiply this requirement by huge numbers of autonomous vehicles, and the scope of the potential problems becomes clearer. Bandwidth. Bandwidth is the amount of data which a network can carry over time, usually expressed in bits per second. All networks have a limited bandwidth, and the limits are more severe for wireless communication. Latency. Latency is the time needed to send data between two points on a networkIn other cases, network outages can exacerbate congestion and even sever communication to some internet users entirely - making the internet of things useless during outages. By deploying servers and storage where the data is generated, edge computing can operate many devices over a much smaller and more efficient LAN where ample bandwidth is used exclusively by local data-generating devices, making latency and congestion virtually nonexistent. Edge computing use cases and examples In principal, edge computing techniques are used to collect, filter, process and analyze data ""in-place"" at or near the network edge. It's a powerful means of using data that can't be first moved to a centralized location -- usually because the sheer volume of data makes such moves cost-prohibitive, technologically impractical or might otherwise violate compliance obligations, such as data sovereignty. This definition has spawned myriad real-world examples and use cases: Manufacturing. An industrial manufacturer deployed edge computing to monitor manufacturing, enabling real-time analytics and machine learning at the edge to find production errors and improve product manufacturing quality. Farming. Consider a business that grows crops indoors without sunlight, soil or pesticides. The process reduces grow times by more than 60%. Using sensors enables the business to track water use, nutrient density and determine optimal harvest. Data is collected and analyzed to find the effects of environmental factors and continually improve the crop growing algorithms and ensure that crops are harvested in peak condition. Network optimization. Edge computing can help optimize network performance by measuring performance for users across the internet and then employing analytics to determine the most reliable, low-latency network path for each user's traffic. In effect, edge computing is used to ""steer"" traffic across the network for optimal time-sensitive traffic performance. Workplace safety. Edge computing can combine and analyze data from on-site cameras, employee safety devices and various other sensors to help businesses oversee workplace conditions or ensure that employees follow established safety protocols -- especially when the workplace is remote or unusually dangerous, such as construction sites or oil rigs. https://www.techtarget.com/searchdatacenter/definition/edge-computing ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.","[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
+
+EVIDENCE:
+Data is the lifeblood of modern business, providing valuable business insight and supporting real-time control over critical business processes and operations. Today's businesses are awash in an ocean of data, and huge amounts of data can be routinely collected from sensors and IoT devices operating in real time from remote locations and inhospitable operating environments almost anywhere in the world. But this virtual flood of data is also changing the way businesses handle computing. The traditional computing paradigm built on a centralized data center and everyday internet isn't well suited to moving endlessly growing rivers of real-world data. Bandwidth limitations, latency issues and unpredictable network disruptions can all conspire to impair such efforts. Businesses are responding to these data challenges through the use of edge computing architecture. In simplest terms, edge computing moves some portion of storage and compute resources out of the central data center and closer to the source of the data itself. Rather than transmitting raw data to a central data center for processing and analysis, that work is instead performed where the data is actually generated - Thus, edge computing is reshaping IT and business computing. Take a comprehensive look at what edge computing is, how it works, the influence of the cloud, edge use cases, tradeoffs and implementation considerations. Edge computing uses Edge computing brings data processing closer to the data source. How does edge computing work? Edge computing is all a matter of location. In traditional enterprise computing, data is produced at a client endpoint, such as a user's computer. But the number of devices connected to the internet, and the volume of data being produced by those devices and used by businesses, is growing far too quickly for traditional data center infrastructures to accommodate. So IT architects have shifted focus from the central data center to the logical edge of the infrastructure -- taking storage and computing resources from the data center and moving those resources to the point where the data is generated. Edge computing adoption Although only 27% of respondents have already implemented edge computing technologies, 54% find the idea interesting. Edge computing puts storage and servers where the data is, often requiring little more than a partial rack of gear to operate on the remote LAN to collect and process the data locally. The idea of business intelligence can vary dramatically. Some examples include retail environments where video surveillance of the showroom floor might be combined with actual sales data to determine the most desirable product configuration or consumer demand. Edge vs. cloud vs. fog computing Edge computing is closely associated with the concepts of cloud computing and fog computing. Although there is some overlap between these concepts, they aren't the same thing, and generally shouldn't be used interchangeably. It's helpful to compare the concepts and understand their differences. One of the easiest ways to understand the differences between edge, cloud and fog computing is to highlight their common theme: All three concepts relate to distributed computing and focus on the physical deployment of compute and storage resources in relation to the data that is being produced. The difference is a matter of where those resources are located. Edge computing vs. cloud Compare edge cloud, cloud computing and edge computing to determine which model is best for you. Edge. Edge computing is the deployment of computing and storage resources at the location where data is produced. This ideally puts compute and storage at the same point as the data source at the network edge. Cloud. Cloud computing is a huge, highly scalable deployment of compute and storage resources at one of several distributed global locations (regions). Cloud providers also incorporate an assortment of pre-packaged services for IoT operations, making the cloud a preferred centralized platform for IoT deployments. Edge computing architecture Unlike cloud computing, edge computing allows data to exist closer to the data sources through a network of edge devices. Fog. But the choice of compute and storage deployment isn't limited to the cloud or the edge. Fog computing environments can produce bewildering amounts of sensor or IoT data generated across expansive physical areas that are just too large to define an edge. Examples include smart buildings, smart cities or even smart utility grids Note: It's important to repeat that fog computing and edge computing share an almost identical definition and architecture, and the terms are sometimes used interchangeably even among technology experts. Why is edge computing important? Computing tasks demand suitable architectures, and the architecture that suits one type of computing task doesn't necessarily fit all types of computing tasks. Edge computing has emerged as a viable and important architecture that supports distributed computing to deploy compute and storage resources closer to -- ideally in the same physical location a But decentralization can be challenging, demanding high levels of monitoring and control that are easily overlooked when moving away from a traditional centralized computing model. Edge computing has become relevant because it offers an effective solution to emerging network problems associated with moving enormous volumes of data that today's organizations produce and consume. It's not just a problem of amount. It's also a matter of time; applications depend on processing and responses that are increasingly time-sensitive. Consider the rise of self-driving cars. They will depend on intelligent traffic control signals. Cars and traffic controls will need to produce, analyze and exchange data in real time. Multiply this requirement by huge numbers of autonomous vehicles, and the scope of the potential problems becomes clearer. Bandwidth. Bandwidth is the amount of data which a network can carry over time, usually expressed in bits per second. All networks have a limited bandwidth, and the limits are more severe for wireless communication. Latency. Latency is the time needed to send data between two points on a networkIn other cases, network outages can exacerbate congestion and even sever communication to some internet users entirely - making the internet of things useless during outages. By deploying servers and storage where the data is generated, edge computing can operate many devices over a much smaller and more efficient LAN where ample bandwidth is used exclusively by local data-generating devices, making latency and congestion virtually nonexistent. Edge computing use cases and examples In principal, edge computing techniques are used to collect, filter, process and analyze data ""in-place"" at or near the network edge. It's a powerful means of using data that can't be first moved to a centralized location -- usually because the sheer volume of data makes such moves cost-prohibitive, technologically impractical or might otherwise violate compliance obligations, such as data sovereignty. This definition has spawned myriad real-world examples and use cases: Manufacturing. An industrial manufacturer deployed edge computing to monitor manufacturing, enabling real-time analytics and machine learning at the edge to find production errors and improve product manufacturing quality. Farming. Consider a business that grows crops indoors without sunlight, soil or pesticides. The process reduces grow times by more than 60%. Using sensors enables the business to track water use, nutrient density and determine optimal harvest. Data is collected and analyzed to find the effects of environmental factors and continually improve the crop growing algorithms and ensure that crops are harvested in peak condition. Network optimization. Edge computing can help optimize network performance by measuring performance for users across the internet and then employing analytics to determine the most reliable, low-latency network path for each user's traffic. In effect, edge computing is used to ""steer"" traffic across the network for optimal time-sensitive traffic performance. Workplace safety. Edge computing can combine and analyze data from on-site cameras, employee safety devices and various other sensors to help businesses oversee workplace conditions or ensure that employees follow established safety protocols -- especially when the workplace is remote or unusually dangerous, such as construction sites or oil rigs.
+
+USER:
+Consider the increasing use of edge computing across a range of sectors, including network optimization, agriculture, and manufacturing. In particular how, how can edge computing handle constraints on bandwidth, latency, and data sovereignty that come with typical centralized data centers? Talk about how edge computing is especially well-suited to real-time, data-intensive applications like worker safety is hazardous or remote environments and autonomous cars. What are the main elements that, in these situations, make computing essential?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,28,75,1300,,241
+"You should answer the following question as concisely as possible, using only the provided text and no outside information.",From where did the study get its criteria for determining if a student was suffering from addiction?,"Theoretically, Problematic Online Game Use (POGU) and online game addiction are the same; they refer to an excessive online game use that results in negative impact (Kim & Kim, 2010). This is asserted by theoretical perspective from Young (1998), in his theory, POGU is derived from the characteristics of people suffering from internet addiction (IA), which is based on the criteria of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-V). Addictive behavior can be defined as a condition where an individual is addicted to a certain thing he loves on various occasions, which emerges from a lack of behavioral control, making them feel guilty when they do not satisfy their desire. This asserts that addiction is compulsive and lack of control aspect of behavior (Griffiths, 2005). They usually do what they love on any occasion. How to distinguish between addiction and addiction tendencies, researchers refer to the proposed criteria in the DSM-5 (American Psychiatric Association, 2013) which explains that the severity of the disorder is based on the extent to which it interferes with daily activities. The proposed criteria in question are continuous and repeated use of the Internet to play games, often with other players, causing clinically significant disturbance or distress that is characterized as unsuccessful attempts to control online gaming behaviour, an increase in the amount of time playing online games, playing online games has become a dominant activity in an individual's life, health problems and relationships with others arise as a result of playing online games by individuals and this in a 12 month period. Online game gains its popularity among adolescents, it offers a number of attractiveness, making adolescents prefer to play game than to study, and this has become habit among adolescents. In addition to impulsivity and aggression, enjoyment and competitive feelings can be associated with gambling addiction because dark personality traits are associated with higher levels of enjoyment and satisfaction with one's unhappiness can be facilitated by games (James, Kavanagh, Jonason, Chonody and Scrutton, 2014). There are some motivations that make someone playing online game. According to (Yee, 2006), there are ten subcomponents of motivation, causing ones to play online game, they are categorized into three components, namely achievement, social, and immersion. APJII's survey result in 2017 proves that the largest online game users were in the age of 19-34 years old (49.52%, or 70.94 million users). The survey conducted by the Ministry of Communication and Information Technology revealed that Indonesia has the sixth-largest internet users in the world, and most of them are adolescents aged 15 to 19 years old, the age of high school and university students. This phenomenon is opposite to what university students should do. Students have a number of duties in university. The students supposed to study, obey the rule, respect the teacher, be discipline, and maintain the university reputation. The present study aimed to see the level of online game addiction and online use motive among the students of Semarang State University. As Wijayanti (2013) argued, one's motive in playing online game affects their level of addiction. METHOD This was a prevalence study with cross-sectional survey approach. The study was conducted in Semarang State University. The population of the study was all students of Semarang State University. By using random sampling technique, 568 students were selected as the subjects of study. The data of study were collected using two scales, addiction scale and online game use motives scale. Addiction scale used in the present study was adapted from Game Addiction Scale developed by Lemmens, Valkenburg, & Peter (2009). This scale consists of 21 categories with 3 categories on each aspect related to the seven criteria for online gaming addiction according to Lemmens, Valkenburg and Peter, which are silence, tolerance, mood swings, relapse. , addiction, conflict and problems. This tool has a Cronbach Alpha score of 0.94. There are no adverse factors in this measurement tool. Besides, online game use motives scale was adapted from instrument developed by Demetrovics et al. (2011), namely, motives for Online Gaming Questionnaire (MOGQ). This scale consists of 27 items that measure seven aspects of gambling motivation: escape (escape from reality), cope (overcome stress and distress), fantasy (gambling identity and experience), skill development (such as attention and coordination), Recreation (entertainment and fun), Competition (challenge and compete with others) and Social (establishment and maintenance of social relationship). MOGQ is the first tool designed to measure the motivation of online gamers of all ages. These include the major gambling motives identified in previous studies and exhibit high internal consistency. Univariate data analysis and bivariate correlation were employed. There were five interval criteria to interpret the percentage, Very Low, Low, Fair, High, and Very High. The result was categorized as Very High if its percentage is in the range of 84%-100%. It was categorized as High if its percentage is in the range of 68%-83%. It was categorized as Fair if its percentage is in the range of 52%-67%. It was categorized as Low if its percentage is in the range of 36%-51%. While it was categorized as Very Low if its percentage is in the range of 20%-35%. Data analysis using correlation analysis and multiple linear regression. Researchers used the application of Statistical Product and Service Solution (SPSS) version 22.","System Instruction: You should answer the following question as concisely as possible, using only the provided text and no outside information. Question: From where did the study get its criteria for determining if a student was suffering from addiction? Context: Theoretically, Problematic Online Game Use (POGU) and online game addiction are the same; they refer to an excessive online game use that results in negative impact (Kim & Kim, 2010). This is asserted by theoretical perspective from Young (1998), in his theory, POGU is derived from the characteristics of people suffering from internet addiction (IA), which is based on the criteria of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-V). Addictive behavior can be defined as a condition where an individual is addicted to a certain thing he loves on various occasions, which emerges from a lack of behavioral control, making them feel guilty when they do not satisfy their desire. This asserts that addiction is compulsive and lack of control aspect of behavior (Griffiths, 2005). They usually do what they love on any occasion. How to distinguish between addiction and addiction tendencies, researchers refer to the proposed criteria in the DSM-5 (American Psychiatric Association, 2013) which explains that the severity of the disorder is based on the extent to which it interferes with daily activities. The proposed criteria in question are continuous and repeated use of the Internet to play games, often with other players, causing clinically significant disturbance or distress that is characterized as unsuccessful attempts to control online gaming behaviour, an increase in the amount of time playing online games, playing online games has become a dominant activity in an individual's life, health problems and relationships with others arise as a result of playing online games by individuals and this in a 12 month period. Online game gains its popularity among adolescents, it offers a number of attractiveness, making adolescents prefer to play game than to study, and this has become habit among adolescents. In addition to impulsivity and aggression, enjoyment and competitive feelings can be associated with gambling addiction because dark personality traits are associated with higher levels of enjoyment and satisfaction with one's unhappiness can be facilitated by games (James, Kavanagh, Jonason, Chonody and Scrutton, 2014). There are some motivations that make someone playing online game. According to (Yee, 2006), there are ten subcomponents of motivation, causing ones to play online game, they are categorized into three components, namely achievement, social, and immersion. APJII's survey result in 2017 proves that the largest online game users were in the age of 19-34 years old (49.52%, or 70.94 million users). The survey conducted by the Ministry of Communication and Information Technology revealed that Indonesia has the sixth-largest internet users in the world, and most of them are adolescents aged 15 to 19 years old, the age of high school and university students. This phenomenon is opposite to what university students should do. Students have a number of duties in university. The students supposed to study, obey the rule, respect the teacher, be discipline, and maintain the university reputation. The present study aimed to see the level of online game addiction and online use motive among the students of Semarang State University. As Wijayanti (2013) argued, one's motive in playing online game affects their level of addiction. METHOD This was a prevalence study with cross-sectional survey approach. The study was conducted in Semarang State University. The population of the study was all students of Semarang State University. By using random sampling technique, 568 students were selected as the subjects of study. The data of study were collected using two scales, addiction scale and online game use motives scale. Addiction scale used in the present study was adapted from Game Addiction Scale developed by Lemmens, Valkenburg, & Peter (2009). This scale consists of 21 categories with 3 categories on each aspect related to the seven criteria for online gaming addiction according to Lemmens, Valkenburg and Peter, which are silence, tolerance, mood swings, relapse. , addiction, conflict and problems. This tool has a Cronbach Alpha score of 0.94. There are no adverse factors in this measurement tool. Besides, online game use motives scale was adapted from instrument developed by Demetrovics et al. (2011), namely, motives for Online Gaming Questionnaire (MOGQ). This scale consists of 27 items that measure seven aspects of gambling motivation: escape (escape from reality), cope (overcome stress and distress), fantasy (gambling identity and experience), skill development (such as attention and coordination), Recreation (entertainment and fun), Competition (challenge and compete with others) and Social (establishment and maintenance of social relationship). MOGQ is the first tool designed to measure the motivation of online gamers of all ages. These include the major gambling motives identified in previous studies and exhibit high internal consistency. Univariate data analysis and bivariate correlation were employed. There were five interval criteria to interpret the percentage, Very Low, Low, Fair, High, and Very High. The result was categorized as Very High if its percentage is in the range of 84%-100%. It was categorized as High if its percentage is in the range of 68%-83%. It was categorized as Fair if its percentage is in the range of 52%-67%. It was categorized as Low if its percentage is in the range of 36%-51%. While it was categorized as Very Low if its percentage is in the range of 20%-35%. Data analysis using correlation analysis and multiple linear regression. Researchers used the application of Statistical Product and Service Solution (SPSS) version 22.","You should answer the following question as concisely as possible, using only the provided text and no outside information.
+
+EVIDENCE:
+Theoretically, Problematic Online Game Use (POGU) and online game addiction are the same; they refer to an excessive online game use that results in negative impact (Kim & Kim, 2010). This is asserted by theoretical perspective from Young (1998), in his theory, POGU is derived from the characteristics of people suffering from internet addiction (IA), which is based on the criteria of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-V). Addictive behavior can be defined as a condition where an individual is addicted to a certain thing he loves on various occasions, which emerges from a lack of behavioral control, making them feel guilty when they do not satisfy their desire. This asserts that addiction is compulsive and lack of control aspect of behavior (Griffiths, 2005). They usually do what they love on any occasion. How to distinguish between addiction and addiction tendencies, researchers refer to the proposed criteria in the DSM-5 (American Psychiatric Association, 2013) which explains that the severity of the disorder is based on the extent to which it interferes with daily activities. The proposed criteria in question are continuous and repeated use of the Internet to play games, often with other players, causing clinically significant disturbance or distress that is characterized as unsuccessful attempts to control online gaming behaviour, an increase in the amount of time playing online games, playing online games has become a dominant activity in an individual's life, health problems and relationships with others arise as a result of playing online games by individuals and this in a 12 month period. Online game gains its popularity among adolescents, it offers a number of attractiveness, making adolescents prefer to play game than to study, and this has become habit among adolescents. In addition to impulsivity and aggression, enjoyment and competitive feelings can be associated with gambling addiction because dark personality traits are associated with higher levels of enjoyment and satisfaction with one's unhappiness can be facilitated by games (James, Kavanagh, Jonason, Chonody and Scrutton, 2014). There are some motivations that make someone playing online game. According to (Yee, 2006), there are ten subcomponents of motivation, causing ones to play online game, they are categorized into three components, namely achievement, social, and immersion. APJII's survey result in 2017 proves that the largest online game users were in the age of 19-34 years old (49.52%, or 70.94 million users). The survey conducted by the Ministry of Communication and Information Technology revealed that Indonesia has the sixth-largest internet users in the world, and most of them are adolescents aged 15 to 19 years old, the age of high school and university students. This phenomenon is opposite to what university students should do. Students have a number of duties in university. The students supposed to study, obey the rule, respect the teacher, be discipline, and maintain the university reputation. The present study aimed to see the level of online game addiction and online use motive among the students of Semarang State University. As Wijayanti (2013) argued, one's motive in playing online game affects their level of addiction. METHOD This was a prevalence study with cross-sectional survey approach. The study was conducted in Semarang State University. The population of the study was all students of Semarang State University. By using random sampling technique, 568 students were selected as the subjects of study. The data of study were collected using two scales, addiction scale and online game use motives scale. Addiction scale used in the present study was adapted from Game Addiction Scale developed by Lemmens, Valkenburg, & Peter (2009). This scale consists of 21 categories with 3 categories on each aspect related to the seven criteria for online gaming addiction according to Lemmens, Valkenburg and Peter, which are silence, tolerance, mood swings, relapse. , addiction, conflict and problems. This tool has a Cronbach Alpha score of 0.94. There are no adverse factors in this measurement tool. Besides, online game use motives scale was adapted from instrument developed by Demetrovics et al. (2011), namely, motives for Online Gaming Questionnaire (MOGQ). This scale consists of 27 items that measure seven aspects of gambling motivation: escape (escape from reality), cope (overcome stress and distress), fantasy (gambling identity and experience), skill development (such as attention and coordination), Recreation (entertainment and fun), Competition (challenge and compete with others) and Social (establishment and maintenance of social relationship). MOGQ is the first tool designed to measure the motivation of online gamers of all ages. These include the major gambling motives identified in previous studies and exhibit high internal consistency. Univariate data analysis and bivariate correlation were employed. There were five interval criteria to interpret the percentage, Very Low, Low, Fair, High, and Very High. The result was categorized as Very High if its percentage is in the range of 84%-100%. It was categorized as High if its percentage is in the range of 68%-83%. It was categorized as Fair if its percentage is in the range of 52%-67%. It was categorized as Low if its percentage is in the range of 36%-51%. While it was categorized as Very Low if its percentage is in the range of 20%-35%. Data analysis using correlation analysis and multiple linear regression. Researchers used the application of Statistical Product and Service Solution (SPSS) version 22.
+
+USER:
+From where did the study get its criteria for determining if a student was suffering from addiction?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,19,17,876,,803
+"{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]","Given that churn exists in the subscription application game, why is it beneficial at times to promote and create this churn. Explain this in 300 words.","Consumer subscription apps are relatively easy to launch, which is why there are hundreds of thousands of them in the app stores. Compared with more complex models like B2B SaaS or marketplaces, these businesses can launch faster with less capital for many reasons: no sales teams, rapid purchasing cycles, high gross margins with low marginal costs to serving additional subscribers, and turnkey global distribution, payments, and support tools through the app stores. But these apps face several fundamental challenges that make them very hard to scale: Lack of control over distribution: The Apple and Google app stores exert significant control over product placements, promotions, TOS and usage guidelines, payments, and cancellation terms. This locks consumer subscription apps into paying expensive app store fees and restricts their ability to distribute and monetize their products. Overdependence on paid acquisition: Since consumer subscription apps don’t have sales teams and often can’t rely on virality as much as social networks or marketplaces, many turn to paid acquisition as their primary growth lever. This strategy always had flaws, and Apple’s App Tracking Transparency (ATT) restrictions have only made it harder. High subscriber churn rates: Churn is generally higher for consumer subscription apps vs. B2B SaaS businesses, and most don’t benefit from strong network effects like social networks or marketplaces. This makes products less sticky and retention more difficult. Many also have products and growth strategies that are fairly easy to replicate and thus prone to copycats, weakening their defensibility and further exacerbating churn rates. ARPU is often low and hard to grow: Consumer subscription apps generally have much lower Average Revenue per User (ARPU) vs. B2B SaaS, and they have a harder time expanding ARPU than many other business models. B2B SaaS businesses increase Net Revenue Retention (NRR) by growing the value of retained accounts to offset churn. Marketplaces can boost ARPU by increasing transactions as they gain liquidity. Social networks grow ad revenue by increasing user engagement. But most consumer subscription apps offer only one subscription, which means they have a hard time extracting additional value from users. In fact, it is because consumer subscription apps are relatively easy to launch that so many exist, leading to fierce competition, channel saturation, and subscription fatigue. Meanwhile, Apple’s recent ATT restrictions have rendered paid acquisition less efficient, making it even more difficult for these companies to maintain healthy unit economics. This explains why out of all the consumer subscription apps out there, fewer than 50 have ever reached $1B+ valuations, and fewer than 10 are publicly traded companies with $10B+ market caps. Public company market caps are from 8/30/24. Private company valuations are based on the most recent publicly available data, which may be out of date relative to internal valuations. Public companies like Bumble, Stitch Fix, and Chegg that once had market caps over $1B are included even though their current market caps are below $1B. Companies like Canva, Grammarly, Figma, Notion, and Dropbox are excluded because they are considered B2B SaaS businesses since they have sales teams and sell to both prosumers and enterprises. Products like ChatGPT, Hulu, ESPN+, Disney+, and Pandora that are subsidiaries of larger companies are excluded. These challenges are supported by RevenueCat’s proprietary data from the past year, which has been aggregated from over 30,000 subscription apps accounting for over 290M subscribers: Even top-quartile consumer subscription apps only convert roughly 1 in 20 installs into a paid subscription. They also lose more than half of their annual subscribers after the first year, and more than half of their monthly subscribers after just three months. This makes it hard to build a sustainable business, but not impossible. 95th-percentile apps, like those in the figure above, outperform the rest by a wide margin, with metrics that provide a strong foundation for growth. So what makes these top apps different? Using the Subscription Value Loop to grow your consumer subscription business The best consumer subscription apps overcome these challenges by doing two things: 1. Building their businesses on a core value promise that provides enduring value. This core value promise is what attracts users to the app and keeps them coming back over time. The stronger and more differentiated the value promise, the more subscribers will pay and the longer they’ll keep paying. The value promises of category-leading consumer subscription apps are clear and compelling, to the point where I can describe these promises in a single sentence without naming the associated companies and you can probably guess the ones I am talking about: Listen to music you love, build playlists, and find new artists who match your taste. Enjoy gamified study experiences that make language learning fun. Record and share your workouts with a supportive community of athletes. Find, match, and connect with attractive single people in your area with one swipe. 2. Harnessing their value promise to drive a compounding Subscription Value Loop that increases LTV/CAC and accelerates Payback Period: Step 1: Value Creation: Quickly connecting new users to the app’s core value promise and offering enduring value that keeps them coming back Step 2: Value Delivery: Cost-efficiently distributing the app to users organically through word of mouth and SEO, as well as through sustainable paid acquisition Step 3: Value Capture: Converting free users into subscribers, which generates revenue that can be reinvested into the business to strengthen the rest of the loop As a company bolsters its Subscription Value Loop, LTV/CAC goes up and Payback Period comes down, driving faster and more efficient growth. What makes consumer subscription apps unusual is that most don’t have sales teams, which means the product must be able to sell itself organically and through paid advertisements. Core product, growth product, and marketing teams must work together to build an integrated system that converts their app’s core value promise into subscription revenue by maximizing each step in the Subscription Value Loop. I built a Subscription Value Loop Calculator with RevenueCat where you can plug in your numbers, measure the performance of your loop, and identify growth opportunities. There are five steps to using this tool: Identify metrics that drive Value Creation, Value Delivery, and Value Capture for your app. Calculate your company’s recent performance against each metric. Compare your performance on each metric vs. category-specific benchmarks. Discover opportunities based on metrics where you underperform vs. these benchmarks. Prioritize initiatives to improve the metrics with the greatest upside potential. For a detailed step-by-step guide on how to use this tool","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== Given that churn exists in the subscription application game, why is it beneficial at times to promote and create this churn. Explain this in 300 words. {passage 0} ========== Consumer subscription apps are relatively easy to launch, which is why there are hundreds of thousands of them in the app stores. Compared with more complex models like B2B SaaS or marketplaces, these businesses can launch faster with less capital for many reasons: no sales teams, rapid purchasing cycles, high gross margins with low marginal costs to serving additional subscribers, and turnkey global distribution, payments, and support tools through the app stores. But these apps face several fundamental challenges that make them very hard to scale: Lack of control over distribution: The Apple and Google app stores exert significant control over product placements, promotions, TOS and usage guidelines, payments, and cancellation terms. This locks consumer subscription apps into paying expensive app store fees and restricts their ability to distribute and monetize their products. Overdependence on paid acquisition: Since consumer subscription apps don’t have sales teams and often can’t rely on virality as much as social networks or marketplaces, many turn to paid acquisition as their primary growth lever. This strategy always had flaws, and Apple’s App Tracking Transparency (ATT) restrictions have only made it harder. High subscriber churn rates: Churn is generally higher for consumer subscription apps vs. B2B SaaS businesses, and most don’t benefit from strong network effects like social networks or marketplaces. This makes products less sticky and retention more difficult. Many also have products and growth strategies that are fairly easy to replicate and thus prone to copycats, weakening their defensibility and further exacerbating churn rates. ARPU is often low and hard to grow: Consumer subscription apps generally have much lower Average Revenue per User (ARPU) vs. B2B SaaS, and they have a harder time expanding ARPU than many other business models. B2B SaaS businesses increase Net Revenue Retention (NRR) by growing the value of retained accounts to offset churn. Marketplaces can boost ARPU by increasing transactions as they gain liquidity. Social networks grow ad revenue by increasing user engagement. But most consumer subscription apps offer only one subscription, which means they have a hard time extracting additional value from users. In fact, it is because consumer subscription apps are relatively easy to launch that so many exist, leading to fierce competition, channel saturation, and subscription fatigue. Meanwhile, Apple’s recent ATT restrictions have rendered paid acquisition less efficient, making it even more difficult for these companies to maintain healthy unit economics. This explains why out of all the consumer subscription apps out there, fewer than 50 have ever reached $1B+ valuations, and fewer than 10 are publicly traded companies with $10B+ market caps. Public company market caps are from 8/30/24. Private company valuations are based on the most recent publicly available data, which may be out of date relative to internal valuations. Public companies like Bumble, Stitch Fix, and Chegg that once had market caps over $1B are included even though their current market caps are below $1B. Companies like Canva, Grammarly, Figma, Notion, and Dropbox are excluded because they are considered B2B SaaS businesses since they have sales teams and sell to both prosumers and enterprises. Products like ChatGPT, Hulu, ESPN+, Disney+, and Pandora that are subsidiaries of larger companies are excluded. These challenges are supported by RevenueCat’s proprietary data from the past year, which has been aggregated from over 30,000 subscription apps accounting for over 290M subscribers: Even top-quartile consumer subscription apps only convert roughly 1 in 20 installs into a paid subscription. They also lose more than half of their annual subscribers after the first year, and more than half of their monthly subscribers after just three months. This makes it hard to build a sustainable business, but not impossible. 95th-percentile apps, like those in the figure above, outperform the rest by a wide margin, with metrics that provide a strong foundation for growth. So what makes these top apps different? Using the Subscription Value Loop to grow your consumer subscription business The best consumer subscription apps overcome these challenges by doing two things: 1. Building their businesses on a core value promise that provides enduring value. This core value promise is what attracts users to the app and keeps them coming back over time. The stronger and more differentiated the value promise, the more subscribers will pay and the longer they’ll keep paying. The value promises of category-leading consumer subscription apps are clear and compelling, to the point where I can describe these promises in a single sentence without naming the associated companies and you can probably guess the ones I am talking about: Listen to music you love, build playlists, and find new artists who match your taste. Enjoy gamified study experiences that make language learning fun. Record and share your workouts with a supportive community of athletes. Find, match, and connect with attractive single people in your area with one swipe. 2. Harnessing their value promise to drive a compounding Subscription Value Loop that increases LTV/CAC and accelerates Payback Period: Step 1: Value Creation: Quickly connecting new users to the app’s core value promise and offering enduring value that keeps them coming back Step 2: Value Delivery: Cost-efficiently distributing the app to users organically through word of mouth and SEO, as well as through sustainable paid acquisition Step 3: Value Capture: Converting free users into subscribers, which generates revenue that can be reinvested into the business to strengthen the rest of the loop As a company bolsters its Subscription Value Loop, LTV/CAC goes up and Payback Period comes down, driving faster and more efficient growth. What makes consumer subscription apps unusual is that most don’t have sales teams, which means the product must be able to sell itself organically and through paid advertisements. Core product, growth product, and marketing teams must work together to build an integrated system that converts their app’s core value promise into subscription revenue by maximizing each step in the Subscription Value Loop. I built a Subscription Value Loop Calculator with RevenueCat where you can plug in your numbers, measure the performance of your loop, and identify growth opportunities. There are five steps to using this tool: Identify metrics that drive Value Creation, Value Delivery, and Value Capture for your app. Calculate your company’s recent performance against each metric. Compare your performance on each metric vs. category-specific benchmarks. Discover opportunities based on metrics where you underperform vs. these benchmarks. Prioritize initiatives to improve the metrics with the greatest upside potential. For a detailed step-by-step guide on how to use this tool https://www.lennysnewsletter.com/p/the-subscription-value-loop-a-framework","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]
+
+EVIDENCE:
+Consumer subscription apps are relatively easy to launch, which is why there are hundreds of thousands of them in the app stores. Compared with more complex models like B2B SaaS or marketplaces, these businesses can launch faster with less capital for many reasons: no sales teams, rapid purchasing cycles, high gross margins with low marginal costs to serving additional subscribers, and turnkey global distribution, payments, and support tools through the app stores. But these apps face several fundamental challenges that make them very hard to scale: Lack of control over distribution: The Apple and Google app stores exert significant control over product placements, promotions, TOS and usage guidelines, payments, and cancellation terms. This locks consumer subscription apps into paying expensive app store fees and restricts their ability to distribute and monetize their products. Overdependence on paid acquisition: Since consumer subscription apps don’t have sales teams and often can’t rely on virality as much as social networks or marketplaces, many turn to paid acquisition as their primary growth lever. This strategy always had flaws, and Apple’s App Tracking Transparency (ATT) restrictions have only made it harder. High subscriber churn rates: Churn is generally higher for consumer subscription apps vs. B2B SaaS businesses, and most don’t benefit from strong network effects like social networks or marketplaces. This makes products less sticky and retention more difficult. Many also have products and growth strategies that are fairly easy to replicate and thus prone to copycats, weakening their defensibility and further exacerbating churn rates. ARPU is often low and hard to grow: Consumer subscription apps generally have much lower Average Revenue per User (ARPU) vs. B2B SaaS, and they have a harder time expanding ARPU than many other business models. B2B SaaS businesses increase Net Revenue Retention (NRR) by growing the value of retained accounts to offset churn. Marketplaces can boost ARPU by increasing transactions as they gain liquidity. Social networks grow ad revenue by increasing user engagement. But most consumer subscription apps offer only one subscription, which means they have a hard time extracting additional value from users. In fact, it is because consumer subscription apps are relatively easy to launch that so many exist, leading to fierce competition, channel saturation, and subscription fatigue. Meanwhile, Apple’s recent ATT restrictions have rendered paid acquisition less efficient, making it even more difficult for these companies to maintain healthy unit economics. This explains why out of all the consumer subscription apps out there, fewer than 50 have ever reached $1B+ valuations, and fewer than 10 are publicly traded companies with $10B+ market caps. Public company market caps are from 8/30/24. Private company valuations are based on the most recent publicly available data, which may be out of date relative to internal valuations. Public companies like Bumble, Stitch Fix, and Chegg that once had market caps over $1B are included even though their current market caps are below $1B. Companies like Canva, Grammarly, Figma, Notion, and Dropbox are excluded because they are considered B2B SaaS businesses since they have sales teams and sell to both prosumers and enterprises. Products like ChatGPT, Hulu, ESPN+, Disney+, and Pandora that are subsidiaries of larger companies are excluded. These challenges are supported by RevenueCat’s proprietary data from the past year, which has been aggregated from over 30,000 subscription apps accounting for over 290M subscribers: Even top-quartile consumer subscription apps only convert roughly 1 in 20 installs into a paid subscription. They also lose more than half of their annual subscribers after the first year, and more than half of their monthly subscribers after just three months. This makes it hard to build a sustainable business, but not impossible. 95th-percentile apps, like those in the figure above, outperform the rest by a wide margin, with metrics that provide a strong foundation for growth. So what makes these top apps different? Using the Subscription Value Loop to grow your consumer subscription business The best consumer subscription apps overcome these challenges by doing two things: 1. Building their businesses on a core value promise that provides enduring value. This core value promise is what attracts users to the app and keeps them coming back over time. The stronger and more differentiated the value promise, the more subscribers will pay and the longer they’ll keep paying. The value promises of category-leading consumer subscription apps are clear and compelling, to the point where I can describe these promises in a single sentence without naming the associated companies and you can probably guess the ones I am talking about: Listen to music you love, build playlists, and find new artists who match your taste. Enjoy gamified study experiences that make language learning fun. Record and share your workouts with a supportive community of athletes. Find, match, and connect with attractive single people in your area with one swipe. 2. Harnessing their value promise to drive a compounding Subscription Value Loop that increases LTV/CAC and accelerates Payback Period: Step 1: Value Creation: Quickly connecting new users to the app’s core value promise and offering enduring value that keeps them coming back Step 2: Value Delivery: Cost-efficiently distributing the app to users organically through word of mouth and SEO, as well as through sustainable paid acquisition Step 3: Value Capture: Converting free users into subscribers, which generates revenue that can be reinvested into the business to strengthen the rest of the loop As a company bolsters its Subscription Value Loop, LTV/CAC goes up and Payback Period comes down, driving faster and more efficient growth. What makes consumer subscription apps unusual is that most don’t have sales teams, which means the product must be able to sell itself organically and through paid advertisements. Core product, growth product, and marketing teams must work together to build an integrated system that converts their app’s core value promise into subscription revenue by maximizing each step in the Subscription Value Loop. I built a Subscription Value Loop Calculator with RevenueCat where you can plug in your numbers, measure the performance of your loop, and identify growth opportunities. There are five steps to using this tool: Identify metrics that drive Value Creation, Value Delivery, and Value Capture for your app. Calculate your company’s recent performance against each metric. Compare your performance on each metric vs. category-specific benchmarks. Discover opportunities based on metrics where you underperform vs. these benchmarks. Prioritize initiatives to improve the metrics with the greatest upside potential. For a detailed step-by-step guide on how to use this tool
+
+USER:
+Given that churn exists in the subscription application game, why is it beneficial at times to promote and create this churn. Explain this in 300 words.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,26,26,1074,,694
+Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document],"I am an adult currently on ADHD medication. I am thinking about getting pregnant but am not sure if my ADHD medication would need any adjustments. If I want to continue taking Adderall, what are some potential benefits or detriments that I should be aware of? Use under 400 words.","This sheet is about exposure to dextroamphetamine-amphetamine in pregnancy and while breastfeeding. This information is based on available published literature. It should not take the place of medical care and advice from your healthcare provider. What is dextroamphetamine-amphetamine? Dextroamphetamine-amphetamine (Adderall®) is a combination prescription medication that has been used to treat attention deficit hyperactive disorder (ADHD) and narcolepsy (a condition that affects the brain's ability to control sleeping and waking up). Sometimes when people find out they are pregnant, they think about changing how they take their medication, or stopping their medication altogether. However, it is important to talk with your healthcare providers before making any changes to how you take your medication. Stopping this medication suddenly can cause withdrawal in some people. It is not known if or how withdrawal may affect a pregnancy. If you are going to stop using this medication, your healthcare providers may talk with you about slowly reducing your dose over time. Your healthcare providers can also talk with you about the benefits of treating your condition and the risks of untreated illness during pregnancy. Dextroamphetamine-amphetamine is different from methamphetamine. MotherToBaby has a fact sheet on methamphetamine here: https://mothertobaby.org/fact-sheets/methamphetamine/. This sheet will focus on the use of dextroamphetamine-amphetamine under medical supervision. MotherToBaby has a fact sheet on dextroamphetamine here: https://mothertobaby.org/fact-sheets/dextroamphetamine-pregnancy/. I take dextroamphetamine-amphetamine. Can it make it harder for me to get pregnant? Taking prescribed dextroamphetamine-amphetamine as directed by your healthcare provider is not expected to make it harder to get pregnant. Does taking dextroamphetamine-amphetamine increase the chance of miscarriage? Miscarriage is common and can occur in any pregnancy for many different reasons. Taking prescribed dextroamphetamine-amphetamine as directed by your healthcare provider is not expected to increase the chance of miscarriage. Does taking dextroamphetamine-amphetamine increase the chance of birth defects? Every pregnancy starts out with a 3-5% chance of having a birth defect. This is called the background risk. Most studies suggest that taking dextroamphetamine or amphetamine during the first trimester does not increase the chance of birth defects. In a large study of people taking stimulants for ADHD during pregnancy, there was no increased risk for birth defects reported when taking amphetamines, such as dextroamphetamine-amphetamine, for ADHD treatment. Does taking dextroamphetamine-amphetamine in pregnancy increase the chance of other pregnancy-related problems? Although data is limited, when used as directed by a healthcare provider, taking dextroamphetamine-amphetamine during pregnancy has sometimes been associated with a higher chance of pregnancy-related problems, such as poor growth (babies born small and/or with a small head size), low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth), or preterm delivery (birth before week 37). People taking dextroamphetamine-amphetamine may experience side effects from their medication, such as weight loss due to decreased appetite, changes in heart rate, and changes in blood pressure. Talk with your healthcare provider about monitoring these side effects to help improve outcomes for you and your baby. I need to take dextroamphetamine-amphetamine throughout my entire pregnancy. Will it cause withdrawal symptoms in my baby after birth? It is not known if taking dextroamphetamine-amphetamine could cause withdrawal symptoms in a newborn after birth. This has not been well studied in people only taking dextroamphetamine-amphetamine as directed during pregnancy. Does taking dextroamphetamine-amphetamine in pregnancy affect future behavior or learning for the child? Although limited by looking at all ADHD medications together, a Danish study suggested no increase in neurodevelopmental disorders, like ADHD, in the children of people who continued their ADHD medication during pregnancy versus those who stopped their medication before becoming pregnant. Breastfeeding while taking dextroamphetamine-amphetamine: There are no studies on the combination of amphetamine-dextroamphetamine in breastfeeding. Individually, amphetamine and dextroamphetamine have been found to pass into breast milk. The effect of amphetamine in milk on behavior and brain development of infants has not been well studied. No adverse effects were reported in 4 infants (ages range from 3 months to 10 months) whose mothers were taking dextroamphetamine for ADHD. If you suspect the baby has any symptoms such as trouble eating, trouble sleeping, or irritability, contact the child’s healthcare provider. Some evidence suggests that large doses of dextroamphetamine could lower milk supply in people who are newly breastfeeding. If you have any questions or concerns about breastfeeding, talk with your healthcare provider, your baby’s pediatrician, or a lactation consultant. The product label for dextroamphetamine-amphetamine recommends people who are breastfeeding not use this medication. But the benefit of using dextroamphetamine-amphetamine may outweigh possible risks. Your healthcare providers can talk with you about using dextroamphetamine-amphetamine and what treatment is best for you. Be sure to talk to your healthcare provider about all your breastfeeding questions. If a male takes dextroamphetamine-amphetamine, could it affect fertility or increase the chance of birth defects? It is not known if dextroamphetamine-amphetamine could affect male fertility (make it harder to get a partner pregnant) or increase the chance of birth defects above the background risk. In general, exposures that fathers or sperm donors have are unlikely to increase risks to a pregnancy. For more information, please see the MotherToBaby fact sheet Paternal Exposures at https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/.","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. I am an adult currently on ADHD medication. I am thinking about getting pregnant but am not sure if my ADHD medication would need any adjustments. If I want to continue taking Adderall, what are some potential benefits or detriments that I should be aware of? Use under 400 words. This sheet is about exposure to dextroamphetamine-amphetamine in pregnancy and while breastfeeding. This information is based on available published literature. It should not take the place of medical care and advice from your healthcare provider. What is dextroamphetamine-amphetamine? Dextroamphetamine-amphetamine (Adderall®) is a combination prescription medication that has been used to treat attention deficit hyperactive disorder (ADHD) and narcolepsy (a condition that affects the brain's ability to control sleeping and waking up). Sometimes when people find out they are pregnant, they think about changing how they take their medication, or stopping their medication altogether. However, it is important to talk with your healthcare providers before making any changes to how you take your medication. Stopping this medication suddenly can cause withdrawal in some people. It is not known if or how withdrawal may affect a pregnancy. If you are going to stop using this medication, your healthcare providers may talk with you about slowly reducing your dose over time. Your healthcare providers can also talk with you about the benefits of treating your condition and the risks of untreated illness during pregnancy. Dextroamphetamine-amphetamine is different from methamphetamine. MotherToBaby has a fact sheet on methamphetamine here: https://mothertobaby.org/fact-sheets/methamphetamine/. This sheet will focus on the use of dextroamphetamine-amphetamine under medical supervision. MotherToBaby has a fact sheet on dextroamphetamine here: https://mothertobaby.org/fact-sheets/dextroamphetamine-pregnancy/. I take dextroamphetamine-amphetamine. Can it make it harder for me to get pregnant? Taking prescribed dextroamphetamine-amphetamine as directed by your healthcare provider is not expected to make it harder to get pregnant. Does taking dextroamphetamine-amphetamine increase the chance of miscarriage? Miscarriage is common and can occur in any pregnancy for many different reasons. Taking prescribed dextroamphetamine-amphetamine as directed by your healthcare provider is not expected to increase the chance of miscarriage. Does taking dextroamphetamine-amphetamine increase the chance of birth defects? Every pregnancy starts out with a 3-5% chance of having a birth defect. This is called the background risk. Most studies suggest that taking dextroamphetamine or amphetamine during the first trimester does not increase the chance of birth defects. In a large study of people taking stimulants for ADHD during pregnancy, there was no increased risk for birth defects reported when taking amphetamines, such as dextroamphetamine-amphetamine, for ADHD treatment. Does taking dextroamphetamine-amphetamine in pregnancy increase the chance of other pregnancy-related problems? Although data is limited, when used as directed by a healthcare provider, taking dextroamphetamine-amphetamine during pregnancy has sometimes been associated with a higher chance of pregnancy-related problems, such as poor growth (babies born small and/or with a small head size), low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth), or preterm delivery (birth before week 37). People taking dextroamphetamine-amphetamine may experience side effects from their medication, such as weight loss due to decreased appetite, changes in heart rate, and changes in blood pressure. Talk with your healthcare provider about monitoring these side effects to help improve outcomes for you and your baby. I need to take dextroamphetamine-amphetamine throughout my entire pregnancy. Will it cause withdrawal symptoms in my baby after birth? It is not known if taking dextroamphetamine-amphetamine could cause withdrawal symptoms in a newborn after birth. This has not been well studied in people only taking dextroamphetamine-amphetamine as directed during pregnancy. Does taking dextroamphetamine-amphetamine in pregnancy affect future behavior or learning for the child? Although limited by looking at all ADHD medications together, a Danish study suggested no increase in neurodevelopmental disorders, like ADHD, in the children of people who continued their ADHD medication during pregnancy versus those who stopped their medication before becoming pregnant. Breastfeeding while taking dextroamphetamine-amphetamine: There are no studies on the combination of amphetamine-dextroamphetamine in breastfeeding. Individually, amphetamine and dextroamphetamine have been found to pass into breast milk. The effect of amphetamine in milk on behavior and brain development of infants has not been well studied. No adverse effects were reported in 4 infants (ages range from 3 months to 10 months) whose mothers were taking dextroamphetamine for ADHD. If you suspect the baby has any symptoms such as trouble eating, trouble sleeping, or irritability, contact the child’s healthcare provider. Some evidence suggests that large doses of dextroamphetamine could lower milk supply in people who are newly breastfeeding. If you have any questions or concerns about breastfeeding, talk with your healthcare provider, your baby’s pediatrician, or a lactation consultant. The product label for dextroamphetamine-amphetamine recommends people who are breastfeeding not use this medication. But the benefit of using dextroamphetamine-amphetamine may outweigh possible risks. Your healthcare providers can talk with you about using dextroamphetamine-amphetamine and what treatment is best for you. Be sure to talk to your healthcare provider about all your breastfeeding questions. If a male takes dextroamphetamine-amphetamine, could it affect fertility or increase the chance of birth defects? It is not known if dextroamphetamine-amphetamine could affect male fertility (make it harder to get a partner pregnant) or increase the chance of birth defects above the background risk. In general, exposures that fathers or sperm donors have are unlikely to increase risks to a pregnancy. For more information, please see the MotherToBaby fact sheet Paternal Exposures at https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/. https://www.ncbi.nlm.nih.gov/books/NBK603254/","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]
+
+EVIDENCE:
+This sheet is about exposure to dextroamphetamine-amphetamine in pregnancy and while breastfeeding. This information is based on available published literature. It should not take the place of medical care and advice from your healthcare provider. What is dextroamphetamine-amphetamine? Dextroamphetamine-amphetamine (Adderall®) is a combination prescription medication that has been used to treat attention deficit hyperactive disorder (ADHD) and narcolepsy (a condition that affects the brain's ability to control sleeping and waking up). Sometimes when people find out they are pregnant, they think about changing how they take their medication, or stopping their medication altogether. However, it is important to talk with your healthcare providers before making any changes to how you take your medication. Stopping this medication suddenly can cause withdrawal in some people. It is not known if or how withdrawal may affect a pregnancy. If you are going to stop using this medication, your healthcare providers may talk with you about slowly reducing your dose over time. Your healthcare providers can also talk with you about the benefits of treating your condition and the risks of untreated illness during pregnancy. Dextroamphetamine-amphetamine is different from methamphetamine. MotherToBaby has a fact sheet on methamphetamine here: https://mothertobaby.org/fact-sheets/methamphetamine/. This sheet will focus on the use of dextroamphetamine-amphetamine under medical supervision. MotherToBaby has a fact sheet on dextroamphetamine here: https://mothertobaby.org/fact-sheets/dextroamphetamine-pregnancy/. I take dextroamphetamine-amphetamine. Can it make it harder for me to get pregnant? Taking prescribed dextroamphetamine-amphetamine as directed by your healthcare provider is not expected to make it harder to get pregnant. Does taking dextroamphetamine-amphetamine increase the chance of miscarriage? Miscarriage is common and can occur in any pregnancy for many different reasons. Taking prescribed dextroamphetamine-amphetamine as directed by your healthcare provider is not expected to increase the chance of miscarriage. Does taking dextroamphetamine-amphetamine increase the chance of birth defects? Every pregnancy starts out with a 3-5% chance of having a birth defect. This is called the background risk. Most studies suggest that taking dextroamphetamine or amphetamine during the first trimester does not increase the chance of birth defects. In a large study of people taking stimulants for ADHD during pregnancy, there was no increased risk for birth defects reported when taking amphetamines, such as dextroamphetamine-amphetamine, for ADHD treatment. Does taking dextroamphetamine-amphetamine in pregnancy increase the chance of other pregnancy-related problems? Although data is limited, when used as directed by a healthcare provider, taking dextroamphetamine-amphetamine during pregnancy has sometimes been associated with a higher chance of pregnancy-related problems, such as poor growth (babies born small and/or with a small head size), low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth), or preterm delivery (birth before week 37). People taking dextroamphetamine-amphetamine may experience side effects from their medication, such as weight loss due to decreased appetite, changes in heart rate, and changes in blood pressure. Talk with your healthcare provider about monitoring these side effects to help improve outcomes for you and your baby. I need to take dextroamphetamine-amphetamine throughout my entire pregnancy. Will it cause withdrawal symptoms in my baby after birth? It is not known if taking dextroamphetamine-amphetamine could cause withdrawal symptoms in a newborn after birth. This has not been well studied in people only taking dextroamphetamine-amphetamine as directed during pregnancy. Does taking dextroamphetamine-amphetamine in pregnancy affect future behavior or learning for the child? Although limited by looking at all ADHD medications together, a Danish study suggested no increase in neurodevelopmental disorders, like ADHD, in the children of people who continued their ADHD medication during pregnancy versus those who stopped their medication before becoming pregnant. Breastfeeding while taking dextroamphetamine-amphetamine: There are no studies on the combination of amphetamine-dextroamphetamine in breastfeeding. Individually, amphetamine and dextroamphetamine have been found to pass into breast milk. The effect of amphetamine in milk on behavior and brain development of infants has not been well studied. No adverse effects were reported in 4 infants (ages range from 3 months to 10 months) whose mothers were taking dextroamphetamine for ADHD. If you suspect the baby has any symptoms such as trouble eating, trouble sleeping, or irritability, contact the child’s healthcare provider. Some evidence suggests that large doses of dextroamphetamine could lower milk supply in people who are newly breastfeeding. If you have any questions or concerns about breastfeeding, talk with your healthcare provider, your baby’s pediatrician, or a lactation consultant. The product label for dextroamphetamine-amphetamine recommends people who are breastfeeding not use this medication. But the benefit of using dextroamphetamine-amphetamine may outweigh possible risks. Your healthcare providers can talk with you about using dextroamphetamine-amphetamine and what treatment is best for you. Be sure to talk to your healthcare provider about all your breastfeeding questions. If a male takes dextroamphetamine-amphetamine, could it affect fertility or increase the chance of birth defects? It is not known if dextroamphetamine-amphetamine could affect male fertility (make it harder to get a partner pregnant) or increase the chance of birth defects above the background risk. In general, exposures that fathers or sperm donors have are unlikely to increase risks to a pregnancy. For more information, please see the MotherToBaby fact sheet Paternal Exposures at https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/.
+
+USER:
+I am an adult currently on ADHD medication. I am thinking about getting pregnant but am not sure if my ADHD medication would need any adjustments. If I want to continue taking Adderall, what are some potential benefits or detriments that I should be aware of? Use under 400 words.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",True,24,50,845,,285
+Provide a response using only information in the context block. Limit the response to 300 words.,"Based on the context, would an owner of a business owning less than 10% of an insurance company regulated by the state of New Jersey be considered a legal entity customer and/or be required to report the identity of the beneficial owner?","Under the Beneficial Ownership Rule, 1 a bank must establish and maintain written procedures that are reasonably designed to identify and verify beneficial owner(s) of legal entity customers and to include such procedures in its anti-money laundering compliance program. Legal entities, whether domestic or foreign, can be used to facilitate money laundering and other crimes because their true ownership can be concealed. The collection of beneficial ownership information by banks about legal entity customers can provide law enforcement with key details about suspected criminals who use legal entity structures to conceal their illicit activity and assets. Requiring legal entity customers seeking access to banks to disclose identifying information, such as the name, date of birth, and Social Security number of natural persons who own or control them will make such entities more transparent, and thus less attractive to criminals and those who assist them. Similar to other customer information that a bank may gather, beneficial ownership information collected under the rule may be relevant to other regulatory requirements. These other regulatory requirements include, but are not limited to, identifying suspicious activity, and determining Office of Foreign Assets Control (OFAC) sanctioned parties. Banks should define in their policies, procedures, and processes how beneficial ownership information will be used to meet other regulatory requirements. Legal Entity Customers For the purposes of the Beneficial Ownership Rule, 2 a legal entity customer is defined as a corporation, limited liability company, or other entity that is created by the filing of a public document with a Secretary of State or other similar office, a general partnership, and any similar entity formed under the laws of a foreign jurisdiction that opens an account. A number of types of business entities are excluded from the definition of legal entity customer under the Beneficial Ownership rule. In addition, and subject to certain limitations, banks are not required to identify and verify the identity of the beneficial owner(s) of a legal entity customer when the customer opens certain types of accounts. For further information on exclusions and exemptions to the Beneficial Ownership Rule, see Appendix 1. These exclusions and exemptions do not alter or supersede other existing requirements related to BSA/AML and OFAC sanctions. Beneficial Owner(s) Beneficial ownership is determined under both a control prong and an ownership prong. Under the control prong, the beneficial owner is a single individual with significant responsibility to control, manage or direct a legal entity customer.3 This includes, an executive officer or senior manager (Chief Executive Officer, Chief Financial Officer, Chief Operating Officer, President), or any other individual who regularly performs similar functions. One beneficial owner must be identified under the control prong for each legal entity customer. Under the ownership prong, a beneficial owner is each individual, if any, who, directly or indirectly, through any contract, arrangement, understanding, relationship or otherwise, owns 25 percent or more of the equity interests of a legal entity customer.4 If a trust owns directly or indirectly, through any contract, arrangement, understanding, relationship or otherwise, 25 percent or more of the equity interests of a legal entity customer, the beneficial owner is the trustee.5 Identification of a beneficial owner under the ownership prong is not required if no individual owns 25 percent or more of a legal entity customer. Therefore, all legal entity customers will have a total of between one and five beneficial owner(s) – one individual under the control prong and zero to four individuals under the ownership prong. Exclusions from the definition of Legal Entity Customer Under 31 CFR 1010.230(e)(2) a legal entity customer does not include: • A financial institution regulated by a federal functional regulator14 or a bank regulated by a state bank regulator; • A person described in 31 CFR 1020.315(b)(2) through (5): o A department or agency of the United States, of any state, or of any political subdivision of any State; o Any entity established under the laws of the United States, of any state, or of any political subdivision of any state, or under an interstate compact between two or more states, that exercises governmental authority on behalf of the United States or any such state or political subdivision; o Any entity (other than a bank) whose common stock or analogous equity interests are listed on the New York Stock Exchange or the American Stock Exchange (currently known as the NYSE American) or have been designated as a NASDAQ National Market Security listed on the NASDAQ stock exchange (with some exceptions); o Any subsidiary (other than a bank) of any “listed entity” that is organized under the laws of the United States or of any state and at least 51 percent of whose common stock or analogous equity interest is owned by the listed entity, provided that a person that is a financial institution, other than a bank, is an exempt person only to the extent of its domestic operations; • An issuer of a class of securities registered under section 12 of the Securities Exchange Act of 1934 or that is required to file reports under section 15(d) of that Act; • An investment company, investment adviser, an exchange or clearing agency, or any other entity that is registered with the SEC; • A registered entity, commodity pool operator, commodity trading advisor, retail foreign exchange dealer, swap dealer, or major swap participant that is registered with the CFTC; • A public accounting firm registered under section 102 of the Sarbanes-Oxley Act; • A bank holding company or savings and loan holding company; • A pooled investment vehicle that is operated or advised by a financial institution that is excluded under paragraph (e)(2); • An insurance company that is regulated by a state;","Provide a response using only information in the context block. Limit the response to 300 words. Based on the context, would an owner of a business owning less than 10% of an insurance company regulated by the state of New Jersey be considered a legal entity customer and/or be required to report the identity of the beneficial owner? Under the Beneficial Ownership Rule, 1 a bank must establish and maintain written procedures that are reasonably designed to identify and verify beneficial owner(s) of legal entity customers and to include such procedures in its anti-money laundering compliance program. Legal entities, whether domestic or foreign, can be used to facilitate money laundering and other crimes because their true ownership can be concealed. The collection of beneficial ownership information by banks about legal entity customers can provide law enforcement with key details about suspected criminals who use legal entity structures to conceal their illicit activity and assets. Requiring legal entity customers seeking access to banks to disclose identifying information, such as the name, date of birth, and Social Security number of natural persons who own or control them will make such entities more transparent, and thus less attractive to criminals and those who assist them. Similar to other customer information that a bank may gather, beneficial ownership information collected under the rule may be relevant to other regulatory requirements. These other regulatory requirements include, but are not limited to, identifying suspicious activity, and determining Office of Foreign Assets Control (OFAC) sanctioned parties. Banks should define in their policies, procedures, and processes how beneficial ownership information will be used to meet other regulatory requirements. Legal Entity Customers For the purposes of the Beneficial Ownership Rule, 2 a legal entity customer is defined as a corporation, limited liability company, or other entity that is created by the filing of a public document with a Secretary of State or other similar office, a general partnership, and any similar entity formed under the laws of a foreign jurisdiction that opens an account. A number of types of business entities are excluded from the definition of legal entity customer under the Beneficial Ownership rule. In addition, and subject to certain limitations, banks are not required to identify and verify the identity of the beneficial owner(s) of a legal entity customer when the customer opens certain types of accounts. For further information on exclusions and exemptions to the Beneficial Ownership Rule, see Appendix 1. These exclusions and exemptions do not alter or supersede other existing requirements related to BSA/AML and OFAC sanctions. Beneficial Owner(s) Beneficial ownership is determined under both a control prong and an ownership prong. Under the control prong, the beneficial owner is a single individual with significant responsibility to control, manage or direct a legal entity customer.3 This includes, an executive officer or senior manager (Chief Executive Officer, Chief Financial Officer, Chief Operating Officer, President), or any other individual who regularly performs similar functions. One beneficial owner must be identified under the control prong for each legal entity customer. Under the ownership prong, a beneficial owner is each individual, if any, who, directly or indirectly, through any contract, arrangement, understanding, relationship or otherwise, owns 25 percent or more of the equity interests of a legal entity customer.4 If a trust owns directly or indirectly, through any contract, arrangement, understanding, relationship or otherwise, 25 percent or more of the equity interests of a legal entity customer, the beneficial owner is the trustee.5 Identification of a beneficial owner under the ownership prong is not required if no individual owns 25 percent or more of a legal entity customer. Therefore, all legal entity customers will have a total of between one and five beneficial owner(s) – one individual under the control prong and zero to four individuals under the ownership prong. Exclusions from the definition of Legal Entity Customer Under 31 CFR 1010.230(e)(2) a legal entity customer does not include: • A financial institution regulated by a federal functional regulator14 or a bank regulated by a state bank regulator; • A person described in 31 CFR 1020.315(b)(2) through (5): o A department or agency of the United States, of any state, or of any political subdivision of any State; o Any entity established under the laws of the United States, of any state, or of any political subdivision of any state, or under an interstate compact between two or more states, that exercises governmental authority on behalf of the United States or any such state or political subdivision; o Any entity (other than a bank) whose common stock or analogous equity interests are listed on the New York Stock Exchange or the American Stock Exchange (currently known as the NYSE American) or have been designated as a NASDAQ National Market Security listed on the NASDAQ stock exchange (with some exceptions); o Any subsidiary (other than a bank) of any “listed entity” that is organized under the laws of the United States or of any state and at least 51 percent of whose common stock or analogous equity interest is owned by the listed entity, provided that a person that is a financial institution, other than a bank, is an exempt person only to the extent of its domestic operations; • An issuer of a class of securities registered under section 12 of the Securities Exchange Act of 1934 or that is required to file reports under section 15(d) of that Act; • An investment company, investment adviser, an exchange or clearing agency, or any other entity that is registered with the SEC; • A registered entity, commodity pool operator, commodity trading advisor, retail foreign exchange dealer, swap dealer, or major swap participant that is registered with the CFTC; • A public accounting firm registered under section 102 of the Sarbanes-Oxley Act; • A bank holding company or savings and loan holding company; • A pooled investment vehicle that is operated or advised by a financial institution that is excluded under paragraph (e)(2); • An insurance company that is regulated by a state;","Provide a response using only information in the context block. Limit the response to 300 words.
+
+EVIDENCE:
+Under the Beneficial Ownership Rule, 1 a bank must establish and maintain written procedures that are reasonably designed to identify and verify beneficial owner(s) of legal entity customers and to include such procedures in its anti-money laundering compliance program. Legal entities, whether domestic or foreign, can be used to facilitate money laundering and other crimes because their true ownership can be concealed. The collection of beneficial ownership information by banks about legal entity customers can provide law enforcement with key details about suspected criminals who use legal entity structures to conceal their illicit activity and assets. Requiring legal entity customers seeking access to banks to disclose identifying information, such as the name, date of birth, and Social Security number of natural persons who own or control them will make such entities more transparent, and thus less attractive to criminals and those who assist them. Similar to other customer information that a bank may gather, beneficial ownership information collected under the rule may be relevant to other regulatory requirements. These other regulatory requirements include, but are not limited to, identifying suspicious activity, and determining Office of Foreign Assets Control (OFAC) sanctioned parties. Banks should define in their policies, procedures, and processes how beneficial ownership information will be used to meet other regulatory requirements. Legal Entity Customers For the purposes of the Beneficial Ownership Rule, 2 a legal entity customer is defined as a corporation, limited liability company, or other entity that is created by the filing of a public document with a Secretary of State or other similar office, a general partnership, and any similar entity formed under the laws of a foreign jurisdiction that opens an account. A number of types of business entities are excluded from the definition of legal entity customer under the Beneficial Ownership rule. In addition, and subject to certain limitations, banks are not required to identify and verify the identity of the beneficial owner(s) of a legal entity customer when the customer opens certain types of accounts. For further information on exclusions and exemptions to the Beneficial Ownership Rule, see Appendix 1. These exclusions and exemptions do not alter or supersede other existing requirements related to BSA/AML and OFAC sanctions. Beneficial Owner(s) Beneficial ownership is determined under both a control prong and an ownership prong. Under the control prong, the beneficial owner is a single individual with significant responsibility to control, manage or direct a legal entity customer.3 This includes, an executive officer or senior manager (Chief Executive Officer, Chief Financial Officer, Chief Operating Officer, President), or any other individual who regularly performs similar functions. One beneficial owner must be identified under the control prong for each legal entity customer. Under the ownership prong, a beneficial owner is each individual, if any, who, directly or indirectly, through any contract, arrangement, understanding, relationship or otherwise, owns 25 percent or more of the equity interests of a legal entity customer.4 If a trust owns directly or indirectly, through any contract, arrangement, understanding, relationship or otherwise, 25 percent or more of the equity interests of a legal entity customer, the beneficial owner is the trustee.5 Identification of a beneficial owner under the ownership prong is not required if no individual owns 25 percent or more of a legal entity customer. Therefore, all legal entity customers will have a total of between one and five beneficial owner(s) – one individual under the control prong and zero to four individuals under the ownership prong. Exclusions from the definition of Legal Entity Customer Under 31 CFR 1010.230(e)(2) a legal entity customer does not include: • A financial institution regulated by a federal functional regulator14 or a bank regulated by a state bank regulator; • A person described in 31 CFR 1020.315(b)(2) through (5): o A department or agency of the United States, of any state, or of any political subdivision of any State; o Any entity established under the laws of the United States, of any state, or of any political subdivision of any state, or under an interstate compact between two or more states, that exercises governmental authority on behalf of the United States or any such state or political subdivision; o Any entity (other than a bank) whose common stock or analogous equity interests are listed on the New York Stock Exchange or the American Stock Exchange (currently known as the NYSE American) or have been designated as a NASDAQ National Market Security listed on the NASDAQ stock exchange (with some exceptions); o Any subsidiary (other than a bank) of any “listed entity” that is organized under the laws of the United States or of any state and at least 51 percent of whose common stock or analogous equity interest is owned by the listed entity, provided that a person that is a financial institution, other than a bank, is an exempt person only to the extent of its domestic operations; • An issuer of a class of securities registered under section 12 of the Securities Exchange Act of 1934 or that is required to file reports under section 15(d) of that Act; • An investment company, investment adviser, an exchange or clearing agency, or any other entity that is registered with the SEC; • A registered entity, commodity pool operator, commodity trading advisor, retail foreign exchange dealer, swap dealer, or major swap participant that is registered with the CFTC; • A public accounting firm registered under section 102 of the Sarbanes-Oxley Act; • A bank holding company or savings and loan holding company; • A pooled investment vehicle that is operated or advised by a financial institution that is excluded under paragraph (e)(2); • An insurance company that is regulated by a state;
+
+USER:
+Based on the context, would an owner of a business owning less than 10% of an insurance company regulated by the state of New Jersey be considered a legal entity customer and/or be required to report the identity of the beneficial owner?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,16,42,945,,570
+"For this task, you should answer questions only based on the information provided in the prompt. You are not allowed to use any internal information, prior knowledge, or external resources to answer questions. Do not exceed 250 words, and provide the answer in paragraph form.",What are the ideal features that could be added to an institutional data repository that would make them more appealing/helpful to researchers?,"Scientists’ data practices Participants across all the focus groups indicated having a DMP for at least one of their recent or current projects. Regarding data storage, some participants across four focus groups (atmosphere and earth science, chemistry, computer science, and neuroscience) used institutional repositories (IRs) for their data at some point within the data lifecycle, with five participants explicitly indicating use of IRs in their DMPs. The other popular choice discussed across four focus groups (atmospheric and earth science, computer science, ecology, and neuroscience) was proprietary cloud storage systems (e.g., DropBox, GitHub, and Google Drive). These users were concerned about file size limitations, costs, long-term preservation, data mining by the service providers, and the number of storage solutions becoming burdensome. Desired repository features Data traceability Participants across four focus groups (atmosphere and earth science, chemistry, ecology, and neuroscience) mentioned wanting different kinds of information about how their data were being used to be tracked after data deposit in repositories. They wanted to know how many researchers view, cite, and publish based on the data they deposit. Additionally, participants wanted repositories to track any changes to their data post-deposit. For example, they suggested the creation of a path for updates to items in repositories after initial submission. They also wanted repositories to allow explicit versioning of their materials to clearly inform users of changes to materials over time. Relatedly, participants wanted repositories to provide notification systems for data depositors and users to know when new versions or derivative works based on their data become available as well as notifications for depositors about when their data has been viewed, cited, or included in a publication. Metadata Participants across three focus groups (atmospheric and earth science, chemistry, and neuroscience) discussed wanting high quality metadata within repositories. Some argued for automated metadata creation when uploading their data into repositories to save time and provide at least some level of description of their data (e.g., P1, P4, Chemistry). Within their own projects and in utilizing repositories, participants wanted help with metadata quality control issues. Participants within atmospheric and earth science who frequently created or interacted with complex files wanted expanded types of metadata (e.g., greater spatial metadata for geographic information system (GIS) data). Atmospheric and earth scientists, chemists, and neuroscientists wanted greater searchability and machine readability of data and entities within datasets housed in repositories, specifically to find a variable by multiple search parameters. Data use restrictions Participants across all five focus groups agreed that repositories need to clearly explain what a researcher can and cannot do with a dataset. For example, participants thought repositories should clearly state on every dataset whether researchers can: base new research on the data, publish based on the data, and use the data for business purposes. Participants stated current data restrictions can be confusing to those not acquainted with legal principles. For example, one data professional (P2, Chemistry) explained that researchers often mislabeled their datasets with ill-suited licenses. Participants commonly reported using Open Access or Creative Commons, but articulated the necessity of having the option for restrictive or proprietary licenses, although most had not used such licenses. Some participants used embargoes and others never had. Most viewed embargoes as “a necessary evil,” provided that they are limited to approximately a few years after repository submission or until time of publication. Participants did not think it was fair to repository staff or potential data reusers to have any data embargoed in perpetuity. Stable infrastructure Participants across two focus groups (atmospheric and earth science, and chemistry) expressed concern about the long-term stability of their data in repositories. Some stated that their fear of a repository not being able to provide long-term preservation of their data led them to seek out and utilize alternative storage solutions. Others expected repositories to commit to the future of their data and have satisfactory funding structures to fulfill their stated missions. Participants described stable repository infrastructure in terms of updating data files (i.e., versioning) and formats over time and ensuring their usability. Security Participants across four focus groups (atmospheric and earth science, chemistry, computer science, and neuroscience) discussed wanting their data to be secure. They feared lax security could compromise their data. Specific to embargoed data, they feared lax security could enable “scooping” of research before data depositors are able to make use of the data through publication. Those handling data with confidential, sensitive or personally identifiable information expressed the most concern about potential security breaches because it could result in a breach and loss of trust with their current and future study participants, making it harder for themselves and future researchers to recruit study participants in the long-term, and it would result in noncompliance with mandates from their IRBs.","System Instruction: [For this task, you should answer questions only based on the information provided in the prompt. You are not allowed to use any internal information, prior knowledge, or external resources to answer questions. Do not exceed 250 words, and provide the answer in paragraph form.] Question: [What are the ideal features that could be added to an institutional data repository that would make them more appealing/helpful to researchers?] Context Block: [Scientists’ data practices Participants across all the focus groups indicated having a DMP for at least one of their recent or current projects. Regarding data storage, some participants across four focus groups (atmosphere and earth science, chemistry, computer science, and neuroscience) used institutional repositories (IRs) for their data at some point within the data lifecycle, with five participants explicitly indicating use of IRs in their DMPs. The other popular choice discussed across four focus groups (atmospheric and earth science, computer science, ecology, and neuroscience) was proprietary cloud storage systems (e.g., DropBox, GitHub, and Google Drive). These users were concerned about file size limitations, costs, long-term preservation, data mining by the service providers, and the number of storage solutions becoming burdensome. Desired repository features Data traceability Participants across four focus groups (atmosphere and earth science, chemistry, ecology, and neuroscience) mentioned wanting different kinds of information about how their data were being used to be tracked after data deposit in repositories. They wanted to know how many researchers view, cite, and publish based on the data they deposit. Additionally, participants wanted repositories to track any changes to their data post-deposit. For example, they suggested the creation of a path for updates to items in repositories after initial submission. They also wanted repositories to allow explicit versioning of their materials to clearly inform users of changes to materials over time. Relatedly, participants wanted repositories to provide notification systems for data depositors and users to know when new versions or derivative works based on their data become available as well as notifications for depositors about when their data has been viewed, cited, or included in a publication. Metadata Participants across three focus groups (atmospheric and earth science, chemistry, and neuroscience) discussed wanting high quality metadata within repositories. Some argued for automated metadata creation when uploading their data into repositories to save time and provide at least some level of description of their data (e.g., P1, P4, Chemistry). Within their own projects and in utilizing repositories, participants wanted help with metadata quality control issues. Participants within atmospheric and earth science who frequently created or interacted with complex files wanted expanded types of metadata (e.g., greater spatial metadata for geographic information system (GIS) data). Atmospheric and earth scientists, chemists, and neuroscientists wanted greater searchability and machine readability of data and entities within datasets housed in repositories, specifically to find a variable by multiple search parameters. Data use restrictions Participants across all five focus groups agreed that repositories need to clearly explain what a researcher can and cannot do with a dataset. For example, participants thought repositories should clearly state on every dataset whether researchers can: base new research on the data, publish based on the data, and use the data for business purposes. Participants stated current data restrictions can be confusing to those not acquainted with legal principles. For example, one data professional (P2, Chemistry) explained that researchers often mislabeled their datasets with ill-suited licenses. Participants commonly reported using Open Access or Creative Commons, but articulated the necessity of having the option for restrictive or proprietary licenses, although most had not used such licenses. Some participants used embargoes and others never had. Most viewed embargoes as “a necessary evil,” provided that they are limited to approximately a few years after repository submission or until time of publication. Participants did not think it was fair to repository staff or potential data reusers to have any data embargoed in perpetuity. Stable infrastructure Participants across two focus groups (atmospheric and earth science, and chemistry) expressed concern about the long-term stability of their data in repositories. Some stated that their fear of a repository not being able to provide long-term preservation of their data led them to seek out and utilize alternative storage solutions. Others expected repositories to commit to the future of their data and have satisfactory funding structures to fulfill their stated missions. Participants described stable repository infrastructure in terms of updating data files (i.e., versioning) and formats over time and ensuring their usability. Security Participants across four focus groups (atmospheric and earth science, chemistry, computer science, and neuroscience) discussed wanting their data to be secure. They feared lax security could compromise their data. Specific to embargoed data, they feared lax security could enable “scooping” of research before data depositors are able to make use of the data through publication. Those handling data with confidential, sensitive or personally identifiable information expressed the most concern about potential security breaches because it could result in a breach and loss of trust with their current and future study participants, making it harder for themselves and future researchers to recruit study participants in the long-term, and it would result in noncompliance with mandates from their IRBs.]","For this task, you should answer questions only based on the information provided in the prompt. You are not allowed to use any internal information, prior knowledge, or external resources to answer questions. Do not exceed 250 words, and provide the answer in paragraph form.
+
+EVIDENCE:
+Scientists’ data practices Participants across all the focus groups indicated having a DMP for at least one of their recent or current projects. Regarding data storage, some participants across four focus groups (atmosphere and earth science, chemistry, computer science, and neuroscience) used institutional repositories (IRs) for their data at some point within the data lifecycle, with five participants explicitly indicating use of IRs in their DMPs. The other popular choice discussed across four focus groups (atmospheric and earth science, computer science, ecology, and neuroscience) was proprietary cloud storage systems (e.g., DropBox, GitHub, and Google Drive). These users were concerned about file size limitations, costs, long-term preservation, data mining by the service providers, and the number of storage solutions becoming burdensome. Desired repository features Data traceability Participants across four focus groups (atmosphere and earth science, chemistry, ecology, and neuroscience) mentioned wanting different kinds of information about how their data were being used to be tracked after data deposit in repositories. They wanted to know how many researchers view, cite, and publish based on the data they deposit. Additionally, participants wanted repositories to track any changes to their data post-deposit. For example, they suggested the creation of a path for updates to items in repositories after initial submission. They also wanted repositories to allow explicit versioning of their materials to clearly inform users of changes to materials over time. Relatedly, participants wanted repositories to provide notification systems for data depositors and users to know when new versions or derivative works based on their data become available as well as notifications for depositors about when their data has been viewed, cited, or included in a publication. Metadata Participants across three focus groups (atmospheric and earth science, chemistry, and neuroscience) discussed wanting high quality metadata within repositories. Some argued for automated metadata creation when uploading their data into repositories to save time and provide at least some level of description of their data (e.g., P1, P4, Chemistry). Within their own projects and in utilizing repositories, participants wanted help with metadata quality control issues. Participants within atmospheric and earth science who frequently created or interacted with complex files wanted expanded types of metadata (e.g., greater spatial metadata for geographic information system (GIS) data). Atmospheric and earth scientists, chemists, and neuroscientists wanted greater searchability and machine readability of data and entities within datasets housed in repositories, specifically to find a variable by multiple search parameters. Data use restrictions Participants across all five focus groups agreed that repositories need to clearly explain what a researcher can and cannot do with a dataset. For example, participants thought repositories should clearly state on every dataset whether researchers can: base new research on the data, publish based on the data, and use the data for business purposes. Participants stated current data restrictions can be confusing to those not acquainted with legal principles. For example, one data professional (P2, Chemistry) explained that researchers often mislabeled their datasets with ill-suited licenses. Participants commonly reported using Open Access or Creative Commons, but articulated the necessity of having the option for restrictive or proprietary licenses, although most had not used such licenses. Some participants used embargoes and others never had. Most viewed embargoes as “a necessary evil,” provided that they are limited to approximately a few years after repository submission or until time of publication. Participants did not think it was fair to repository staff or potential data reusers to have any data embargoed in perpetuity. Stable infrastructure Participants across two focus groups (atmospheric and earth science, and chemistry) expressed concern about the long-term stability of their data in repositories. Some stated that their fear of a repository not being able to provide long-term preservation of their data led them to seek out and utilize alternative storage solutions. Others expected repositories to commit to the future of their data and have satisfactory funding structures to fulfill their stated missions. Participants described stable repository infrastructure in terms of updating data files (i.e., versioning) and formats over time and ensuring their usability. Security Participants across four focus groups (atmospheric and earth science, chemistry, computer science, and neuroscience) discussed wanting their data to be secure. They feared lax security could compromise their data. Specific to embargoed data, they feared lax security could enable “scooping” of research before data depositors are able to make use of the data through publication. Those handling data with confidential, sensitive or personally identifiable information expressed the most concern about potential security breaches because it could result in a breach and loss of trust with their current and future study participants, making it harder for themselves and future researchers to recruit study participants in the long-term, and it would result in noncompliance with mandates from their IRBs.
+
+USER:
+What are the ideal features that could be added to an institutional data repository that would make them more appealing/helpful to researchers?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,45,22,784,,222
+Respond only with information drawn from the text. Use bullet points to format your response.,"According to the context, what's the difference between a migraine and a cluster headache?","PART 1. THE PRIMARY HEADACHES 1. Migraine 1.1 Migraine without aura A. At least five attacks fulfilling criteria B-D B. Headache attacks lasting 4-72 hours (when untreated or unsuccessfully treated) C. Headache has at least two of the following four characteristics: 1. unilateral location 2. pulsating quality 3. moderate or severe pain intensity 4. aggravation by or causing avoidance of routine physical activity (eg, walking or climbing stairs) D. During headache at least one of the following: 1. nausea and/or vomiting 2. photophobia and phonophobia E. Not better accounted for by another ICHD-3 diagnosis. 1.2 Migraine with aura A. At least two attacks fulfilling criteria B and C B. One or more of the following fully reversible aura symptoms: 1. visual 2. sensory 3. speech and/or language 4. motor 5. brainstem 6. retinal C. At least three of the following six characteristics: 1. at least one aura symptom spreads gradually over ≥5 minutes 2. two or more aura symptoms occur in succession 3. each individual aura symptom lasts 5-60 minutes 4. at least one aura symptom is unilateral 5. at least one aura symptom is positive 6. the aura is accompanied, or followed within 60 minutes, by headache D. Not better accounted for by another ICHD-3 diagnosis. 1.2.1 Migraine with typical aura A. Attacks fulfilling criteria for 1.2 Migraine with aura and criterion B below B. Aura with both of the following: 1. fully reversible visual, sensory and/or speech/language symptoms 2. no motor, brainstem or retinal symptoms. 1.2.1.1 Typical aura with headache A. Attacks fulfilling criteria for 1.2.1 Migraine with typical aura and criterion B below B. Headache, with or without migraine characteristics, accompanies or follows the aura within 60 minutes. 1.2.1.2 Typical aura without headache A. Attacks fulfilling criteria for 1.2.1 Migraine with typical aura and criterion B below B. No headache accompanies or follows the aura within 60 minutes. 1.2.2 Migraine with brainstem aura A. Attacks fulfilling criteria for 1.2 Migraine with aura and criterion B below B. Aura with both of the following: 1. at least two of the following fully reversible brainstem symptoms: a) dysarthria b) vertigo c) tinnitus d) hypacusis e) diplopia f) ataxia not attributable to sensory deficit g) decreased level of consciousness (GCS ≤13) 2. no motor or retinal symptoms. 1.2.3 Hemiplegic migraine A. Attacks fulfilling criteria for 1.2 Migraine with aura and criterion B below B. Aura consisting of both of the following: 1. fully reversible motor weakness 2. fully reversible visual, sensory and/or speech/language symptoms. 1.2.3.1 Familial hemiplegic migraine A. Attacks fulfilling criteria for 1.2.3 Hemiplegic migraine B. At least one first- or second-degree relative has had attacks fulfilling criteria for 1.2.3 Hemiplegic migraine. 1.3 Chronic migraine A. Headache (migraine-like or tension-type-like) on ≥15 days/month for >3 months, and fulfilling criteria B and C B. Occurring in a patient who has had at least five attacks fulfilling criteria B-D for 1.1 Migraine without aura and/or criteria B and C for 1.2 Migraine with aura C. On ≥8 days/month for >3 months, fulfilling any of the following: 1. criteria C and D for 1.1 Migraine without aura 2. criteria B and C for 1.2 Migraine with aura 3. believed by the patient to be migraine at onset and relieved by a triptan or ergot derivative D. Not better accounted for by another ICHD-3 diagnosis. 2. Tension-type headache (TTH) 2.1 Infrequent episodic TTH A. At least 10 episodes of headache occurring on <1 day/month on average (<12 days/year) and fulfilling criteria B-D B. Lasting from 30 minutes to 7 days C. At least two of the following four characteristics: 1. bilateral location 2. pressing or tightening (non-pulsating) quality 3. mild or moderate intensity 4. not aggravated by routine physical activity such as walking or climbing stairs D. Both of the following: 1. no nausea or vomiting 2. no more than one of photophobia or phonophobia E. Not better accounted for by another ICHD-3 diagnosis. 2.2 Frequent episodic TTH As 2.1 except: A. At least 10 episodes of headache occurring on 1-14 days/month on average for >3 months (12 and <180 days/year) and fulfilling criteria B-D. 2.3 Chronic TTH As 2.1 except: A. Headache occurring on 15 days/month on average for >3 months (180 days/year), fulfilling criteria B-D B. Lasting hours to days, or unremitting D. Both of the following: 1. no more than one of photophobia, phonophobia or mild nausea 2. neither moderate or severe nausea nor vomiting 3. Trigeminal autonomic cephalalgias 3.1 Cluster headache A. At least five attacks fulfilling criteria B-D B. Severe or very severe unilateral orbital, supraorbital and/or temporal pain lasting 15-180 minutes (when untreated) C. Either or both of the following: 1. at least one of the following symptoms or signs, ipsilateral to the headache: a) conjunctival injection and/or lacrimation b) nasal congestion and/or rhinorrhoea c) eyelid oedema d) forehead and facial sweating e) miosis and/or ptosis 2. a sense of restlessness or agitation D. Occurring with a frequency between one every other day and 8 per day E. Not better accounted for by another ICHD-3 diagnosis. 3.1.1 Episodic cluster headache A. Attacks fulfilling criteria for 3.1 Cluster headache and occurring in bouts (cluster periods) B. At least two cluster periods lasting from 7 days to 1 year (when untreated) and separated by pain-free remission periods of ≥3 months. 3.1.2 Chronic cluster headache A. Attacks fulfilling criteria for 3.1 Cluster headache, and criterion B below B. Occurring without a remission period, or with remissions lasting <3 months, for at least 1 year. 3.4 Hemicrania continua A. Unilateral headache fulfilling criteria B-D B. Present for >3 months, with exacerbations of moderate or greater intensity C. Either or both of the following: 1. at least one of the following symptoms or signs, ipsilateral to the headache: a) conjunctival injection and/or lacrimation b) nasal congestion and/or rhinorrhoea c) eyelid oedema d) forehead and facial sweating e) miosis and/or ptosis 2. a sense of restlessness or agitation, or aggravation of the pain by movement D. Responds absolutely to therapeutic doses of indomethacin E. Not better accounted for by another ICHD-3 diagnosis. 4. Other primary headache disorders 4.3 Primary headache associated with sexual activity A. At least two episodes of pain in the head and/or neck fulfilling criteria B-D B. Brought on by and occurring only during sexual activity C. Either or both of the following: 1. increasing in intensity with increasing sexual excitement 2. abrupt explosive intensity just before or with orgasm D. Lasting from 1 minute to 24 hours with severe intensity and/or up to 72 hours with mild intensity E. Not better accounted for by another ICHD-3 diagnosis. 4.5 Cold-stimulus headache 4.5.1 Headache attributed to ingestion or inhalation of a cold stimulus A. At least two episodes of acute frontal or temporal headache fulfilling criteria B and C B. Brought on by and occurring immediately after a cold stimulus to the palate and/or posterior pharyngeal wall from ingestion of cold food or drink or inhalation of cold air C. Resolving within 10 minutes after removal of the cold stimulus D. Not better accounted for by another ICHD-3 diagnosis. 4.7 Primary stabbing headache A. Head pain occurring spontaneously as a single stab or series of stabs and fulfilling criteria B and C B. Each stab lasts for up to a few seconds C. Stabs recur with irregular frequency, from one to many per day D. No cranial autonomic symptoms E. Not better accounted for by another ICHD-3 diagnosis. 4.8 Nummular headache A. Continuous or intermittent head pain fulfilling criterion B B. Felt exclusively in an area of the scalp, with all of the following four characteristics: 1. sharply-contoured 2. fixed in size and shape 3. round or elliptical 4. 1-6 cm in diameter C. Not better accounted for by another ICHD-3 diagnosis. 4.9 Hypnic headache A. Recurrent headache attacks fulfilling criteria B-D B. Developing only during sleep, and causing wakening C. Occurring on ≥10 days/month for >3 months D. Lasting from 15 minutes up to 4 hours after waking E. No cranial autonomic symptoms or restlessness F. Not better accounted for by another ICHD-3 diagnosis. 4.10 New daily persistent headache (NDPH) A. Persistent headache fulfilling criteria B and C B. Distinct and clearly-remembered onset, with pain becoming continuous and unremitting within 24 hours C. Present for >3 months D. Not better accounted for by another ICHD-3 diagnosis.","Question: According to the context, what's the difference between a migraine and a cluster headache? System Instructions: Respond only with information drawn from the text. Use bullet points to format your response. Context: The International Classification of Headache Disorders 3rd Edition (ICHD-3) PART 1. THE PRIMARY HEADACHES 1. Migraine 1.1 Migraine without aura A. At least five attacks fulfilling criteria B-D B. Headache attacks lasting 4-72 hours (when untreated or unsuccessfully treated) C. Headache has at least two of the following four characteristics: 1. unilateral location 2. pulsating quality 3. moderate or severe pain intensity 4. aggravation by or causing avoidance of routine physical activity (eg, walking or climbing stairs) D. During headache at least one of the following: 1. nausea and/or vomiting 2. photophobia and phonophobia E. Not better accounted for by another ICHD-3 diagnosis. 1.2 Migraine with aura A. At least two attacks fulfilling criteria B and C B. One or more of the following fully reversible aura symptoms: 1. visual 2. sensory 3. speech and/or language 4. motor 5. brainstem 6. retinal C. At least three of the following six characteristics: 1. at least one aura symptom spreads gradually over ≥5 minutes 2. two or more aura symptoms occur in succession 3. each individual aura symptom lasts 5-60 minutes 4. at least one aura symptom is unilateral 5. at least one aura symptom is positive 6. the aura is accompanied, or followed within 60 minutes, by headache D. Not better accounted for by another ICHD-3 diagnosis. 1.2.1 Migraine with typical aura A. Attacks fulfilling criteria for 1.2 Migraine with aura and criterion B below B. Aura with both of the following: 1. fully reversible visual, sensory and/or speech/language symptoms 2. no motor, brainstem or retinal symptoms. 1.2.1.1 Typical aura with headache A. Attacks fulfilling criteria for 1.2.1 Migraine with typical aura and criterion B below B. Headache, with or without migraine characteristics, accompanies or follows the aura within 60 minutes. 1.2.1.2 Typical aura without headache A. Attacks fulfilling criteria for 1.2.1 Migraine with typical aura and criterion B below B. No headache accompanies or follows the aura within 60 minutes. 1.2.2 Migraine with brainstem aura A. Attacks fulfilling criteria for 1.2 Migraine with aura and criterion B below B. Aura with both of the following: 1. at least two of the following fully reversible brainstem symptoms: a) dysarthria b) vertigo c) tinnitus d) hypacusis e) diplopia f) ataxia not attributable to sensory deficit g) decreased level of consciousness (GCS ≤13) 2. no motor or retinal symptoms. 1.2.3 Hemiplegic migraine A. Attacks fulfilling criteria for 1.2 Migraine with aura and criterion B below B. Aura consisting of both of the following: 1. fully reversible motor weakness 2. fully reversible visual, sensory and/or speech/language symptoms. 1.2.3.1 Familial hemiplegic migraine A. Attacks fulfilling criteria for 1.2.3 Hemiplegic migraine B. At least one first- or second-degree relative has had attacks fulfilling criteria for 1.2.3 Hemiplegic migraine. 1.3 Chronic migraine A. Headache (migraine-like or tension-type-like) on ≥15 days/month for >3 months, and fulfilling criteria B and C B. Occurring in a patient who has had at least five attacks fulfilling criteria B-D for 1.1 Migraine without aura and/or criteria B and C for 1.2 Migraine with aura C. On ≥8 days/month for >3 months, fulfilling any of the following: 1. criteria C and D for 1.1 Migraine without aura 2. criteria B and C for 1.2 Migraine with aura 3. believed by the patient to be migraine at onset and relieved by a triptan or ergot derivative D. Not better accounted for by another ICHD-3 diagnosis. 2. Tension-type headache (TTH) 2.1 Infrequent episodic TTH A. At least 10 episodes of headache occurring on <1 day/month on average (<12 days/year) and fulfilling criteria B-D B. Lasting from 30 minutes to 7 days C. At least two of the following four characteristics: 1. bilateral location 2. pressing or tightening (non-pulsating) quality 3. mild or moderate intensity 4. not aggravated by routine physical activity such as walking or climbing stairs D. Both of the following: 1. no nausea or vomiting 2. no more than one of photophobia or phonophobia E. Not better accounted for by another ICHD-3 diagnosis. 2.2 Frequent episodic TTH As 2.1 except: A. At least 10 episodes of headache occurring on 1-14 days/month on average for >3 months (12 and <180 days/year) and fulfilling criteria B-D. 2.3 Chronic TTH As 2.1 except: A. Headache occurring on 15 days/month on average for >3 months (180 days/year), fulfilling criteria B-D B. Lasting hours to days, or unremitting D. Both of the following: 1. no more than one of photophobia, phonophobia or mild nausea 2. neither moderate or severe nausea nor vomiting 3. Trigeminal autonomic cephalalgias 3.1 Cluster headache A. At least five attacks fulfilling criteria B-D B. Severe or very severe unilateral orbital, supraorbital and/or temporal pain lasting 15-180 minutes (when untreated) C. Either or both of the following: 1. at least one of the following symptoms or signs, ipsilateral to the headache: a) conjunctival injection and/or lacrimation b) nasal congestion and/or rhinorrhoea c) eyelid oedema d) forehead and facial sweating e) miosis and/or ptosis 2. a sense of restlessness or agitation D. Occurring with a frequency between one every other day and 8 per day E. Not better accounted for by another ICHD-3 diagnosis. 3.1.1 Episodic cluster headache A. Attacks fulfilling criteria for 3.1 Cluster headache and occurring in bouts (cluster periods) B. At least two cluster periods lasting from 7 days to 1 year (when untreated) and separated by pain-free remission periods of ≥3 months. 3.1.2 Chronic cluster headache A. Attacks fulfilling criteria for 3.1 Cluster headache, and criterion B below B. Occurring without a remission period, or with remissions lasting <3 months, for at least 1 year. 3.4 Hemicrania continua A. Unilateral headache fulfilling criteria B-D B. Present for >3 months, with exacerbations of moderate or greater intensity C. Either or both of the following: 1. at least one of the following symptoms or signs, ipsilateral to the headache: a) conjunctival injection and/or lacrimation b) nasal congestion and/or rhinorrhoea c) eyelid oedema d) forehead and facial sweating e) miosis and/or ptosis 2. a sense of restlessness or agitation, or aggravation of the pain by movement D. Responds absolutely to therapeutic doses of indomethacin E. Not better accounted for by another ICHD-3 diagnosis. 4. Other primary headache disorders 4.3 Primary headache associated with sexual activity A. At least two episodes of pain in the head and/or neck fulfilling criteria B-D B. Brought on by and occurring only during sexual activity C. Either or both of the following: 1. increasing in intensity with increasing sexual excitement 2. abrupt explosive intensity just before or with orgasm D. Lasting from 1 minute to 24 hours with severe intensity and/or up to 72 hours with mild intensity E. Not better accounted for by another ICHD-3 diagnosis. 4.5 Cold-stimulus headache 4.5.1 Headache attributed to ingestion or inhalation of a cold stimulus A. At least two episodes of acute frontal or temporal headache fulfilling criteria B and C B. Brought on by and occurring immediately after a cold stimulus to the palate and/or posterior pharyngeal wall from ingestion of cold food or drink or inhalation of cold air C. Resolving within 10 minutes after removal of the cold stimulus D. Not better accounted for by another ICHD-3 diagnosis. 4.7 Primary stabbing headache A. Head pain occurring spontaneously as a single stab or series of stabs and fulfilling criteria B and C B. Each stab lasts for up to a few seconds C. Stabs recur with irregular frequency, from one to many per day D. No cranial autonomic symptoms E. Not better accounted for by another ICHD-3 diagnosis. 4.8 Nummular headache A. Continuous or intermittent head pain fulfilling criterion B B. Felt exclusively in an area of the scalp, with all of the following four characteristics: 1. sharply-contoured 2. fixed in size and shape 3. round or elliptical 4. 1-6 cm in diameter C. Not better accounted for by another ICHD-3 diagnosis. 4.9 Hypnic headache A. Recurrent headache attacks fulfilling criteria B-D B. Developing only during sleep, and causing wakening C. Occurring on ≥10 days/month for >3 months D. Lasting from 15 minutes up to 4 hours after waking E. No cranial autonomic symptoms or restlessness F. Not better accounted for by another ICHD-3 diagnosis. 4.10 New daily persistent headache (NDPH) A. Persistent headache fulfilling criteria B and C B. Distinct and clearly-remembered onset, with pain becoming continuous and unremitting within 24 hours C. Present for >3 months D. Not better accounted for by another ICHD-3 diagnosis.","Respond only with information drawn from the text. Use bullet points to format your response.
+
+EVIDENCE:
+PART 1. THE PRIMARY HEADACHES 1. Migraine 1.1 Migraine without aura A. At least five attacks fulfilling criteria B-D B. Headache attacks lasting 4-72 hours (when untreated or unsuccessfully treated) C. Headache has at least two of the following four characteristics: 1. unilateral location 2. pulsating quality 3. moderate or severe pain intensity 4. aggravation by or causing avoidance of routine physical activity (eg, walking or climbing stairs) D. During headache at least one of the following: 1. nausea and/or vomiting 2. photophobia and phonophobia E. Not better accounted for by another ICHD-3 diagnosis. 1.2 Migraine with aura A. At least two attacks fulfilling criteria B and C B. One or more of the following fully reversible aura symptoms: 1. visual 2. sensory 3. speech and/or language 4. motor 5. brainstem 6. retinal C. At least three of the following six characteristics: 1. at least one aura symptom spreads gradually over ≥5 minutes 2. two or more aura symptoms occur in succession 3. each individual aura symptom lasts 5-60 minutes 4. at least one aura symptom is unilateral 5. at least one aura symptom is positive 6. the aura is accompanied, or followed within 60 minutes, by headache D. Not better accounted for by another ICHD-3 diagnosis. 1.2.1 Migraine with typical aura A. Attacks fulfilling criteria for 1.2 Migraine with aura and criterion B below B. Aura with both of the following: 1. fully reversible visual, sensory and/or speech/language symptoms 2. no motor, brainstem or retinal symptoms. 1.2.1.1 Typical aura with headache A. Attacks fulfilling criteria for 1.2.1 Migraine with typical aura and criterion B below B. Headache, with or without migraine characteristics, accompanies or follows the aura within 60 minutes. 1.2.1.2 Typical aura without headache A. Attacks fulfilling criteria for 1.2.1 Migraine with typical aura and criterion B below B. No headache accompanies or follows the aura within 60 minutes. 1.2.2 Migraine with brainstem aura A. Attacks fulfilling criteria for 1.2 Migraine with aura and criterion B below B. Aura with both of the following: 1. at least two of the following fully reversible brainstem symptoms: a) dysarthria b) vertigo c) tinnitus d) hypacusis e) diplopia f) ataxia not attributable to sensory deficit g) decreased level of consciousness (GCS ≤13) 2. no motor or retinal symptoms. 1.2.3 Hemiplegic migraine A. Attacks fulfilling criteria for 1.2 Migraine with aura and criterion B below B. Aura consisting of both of the following: 1. fully reversible motor weakness 2. fully reversible visual, sensory and/or speech/language symptoms. 1.2.3.1 Familial hemiplegic migraine A. Attacks fulfilling criteria for 1.2.3 Hemiplegic migraine B. At least one first- or second-degree relative has had attacks fulfilling criteria for 1.2.3 Hemiplegic migraine. 1.3 Chronic migraine A. Headache (migraine-like or tension-type-like) on ≥15 days/month for >3 months, and fulfilling criteria B and C B. Occurring in a patient who has had at least five attacks fulfilling criteria B-D for 1.1 Migraine without aura and/or criteria B and C for 1.2 Migraine with aura C. On ≥8 days/month for >3 months, fulfilling any of the following: 1. criteria C and D for 1.1 Migraine without aura 2. criteria B and C for 1.2 Migraine with aura 3. believed by the patient to be migraine at onset and relieved by a triptan or ergot derivative D. Not better accounted for by another ICHD-3 diagnosis. 2. Tension-type headache (TTH) 2.1 Infrequent episodic TTH A. At least 10 episodes of headache occurring on <1 day/month on average (<12 days/year) and fulfilling criteria B-D B. Lasting from 30 minutes to 7 days C. At least two of the following four characteristics: 1. bilateral location 2. pressing or tightening (non-pulsating) quality 3. mild or moderate intensity 4. not aggravated by routine physical activity such as walking or climbing stairs D. Both of the following: 1. no nausea or vomiting 2. no more than one of photophobia or phonophobia E. Not better accounted for by another ICHD-3 diagnosis. 2.2 Frequent episodic TTH As 2.1 except: A. At least 10 episodes of headache occurring on 1-14 days/month on average for >3 months (12 and <180 days/year) and fulfilling criteria B-D. 2.3 Chronic TTH As 2.1 except: A. Headache occurring on 15 days/month on average for >3 months (180 days/year), fulfilling criteria B-D B. Lasting hours to days, or unremitting D. Both of the following: 1. no more than one of photophobia, phonophobia or mild nausea 2. neither moderate or severe nausea nor vomiting 3. Trigeminal autonomic cephalalgias 3.1 Cluster headache A. At least five attacks fulfilling criteria B-D B. Severe or very severe unilateral orbital, supraorbital and/or temporal pain lasting 15-180 minutes (when untreated) C. Either or both of the following: 1. at least one of the following symptoms or signs, ipsilateral to the headache: a) conjunctival injection and/or lacrimation b) nasal congestion and/or rhinorrhoea c) eyelid oedema d) forehead and facial sweating e) miosis and/or ptosis 2. a sense of restlessness or agitation D. Occurring with a frequency between one every other day and 8 per day E. Not better accounted for by another ICHD-3 diagnosis. 3.1.1 Episodic cluster headache A. Attacks fulfilling criteria for 3.1 Cluster headache and occurring in bouts (cluster periods) B. At least two cluster periods lasting from 7 days to 1 year (when untreated) and separated by pain-free remission periods of ≥3 months. 3.1.2 Chronic cluster headache A. Attacks fulfilling criteria for 3.1 Cluster headache, and criterion B below B. Occurring without a remission period, or with remissions lasting <3 months, for at least 1 year. 3.4 Hemicrania continua A. Unilateral headache fulfilling criteria B-D B. Present for >3 months, with exacerbations of moderate or greater intensity C. Either or both of the following: 1. at least one of the following symptoms or signs, ipsilateral to the headache: a) conjunctival injection and/or lacrimation b) nasal congestion and/or rhinorrhoea c) eyelid oedema d) forehead and facial sweating e) miosis and/or ptosis 2. a sense of restlessness or agitation, or aggravation of the pain by movement D. Responds absolutely to therapeutic doses of indomethacin E. Not better accounted for by another ICHD-3 diagnosis. 4. Other primary headache disorders 4.3 Primary headache associated with sexual activity A. At least two episodes of pain in the head and/or neck fulfilling criteria B-D B. Brought on by and occurring only during sexual activity C. Either or both of the following: 1. increasing in intensity with increasing sexual excitement 2. abrupt explosive intensity just before or with orgasm D. Lasting from 1 minute to 24 hours with severe intensity and/or up to 72 hours with mild intensity E. Not better accounted for by another ICHD-3 diagnosis. 4.5 Cold-stimulus headache 4.5.1 Headache attributed to ingestion or inhalation of a cold stimulus A. At least two episodes of acute frontal or temporal headache fulfilling criteria B and C B. Brought on by and occurring immediately after a cold stimulus to the palate and/or posterior pharyngeal wall from ingestion of cold food or drink or inhalation of cold air C. Resolving within 10 minutes after removal of the cold stimulus D. Not better accounted for by another ICHD-3 diagnosis. 4.7 Primary stabbing headache A. Head pain occurring spontaneously as a single stab or series of stabs and fulfilling criteria B and C B. Each stab lasts for up to a few seconds C. Stabs recur with irregular frequency, from one to many per day D. No cranial autonomic symptoms E. Not better accounted for by another ICHD-3 diagnosis. 4.8 Nummular headache A. Continuous or intermittent head pain fulfilling criterion B B. Felt exclusively in an area of the scalp, with all of the following four characteristics: 1. sharply-contoured 2. fixed in size and shape 3. round or elliptical 4. 1-6 cm in diameter C. Not better accounted for by another ICHD-3 diagnosis. 4.9 Hypnic headache A. Recurrent headache attacks fulfilling criteria B-D B. Developing only during sleep, and causing wakening C. Occurring on ≥10 days/month for >3 months D. Lasting from 15 minutes up to 4 hours after waking E. No cranial autonomic symptoms or restlessness F. Not better accounted for by another ICHD-3 diagnosis. 4.10 New daily persistent headache (NDPH) A. Persistent headache fulfilling criteria B and C B. Distinct and clearly-remembered onset, with pain becoming continuous and unremitting within 24 hours C. Present for >3 months D. Not better accounted for by another ICHD-3 diagnosis.
+
+USER:
+According to the context, what's the difference between a migraine and a cluster headache?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,15,14,1386,,678
+"<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> [user request] <TEXT> [context document]",Clinical prediction models are being developed and used in the diagnosis of neonatal sepsis. Give me a summary of the predictors that are used in the models included in the study. Emphasize the numbers and percentages.,"Clinical prediction models to diagnose neonatal sepsis in low-income and middle-income countries: a scoping review Neonatal sepsis causes significant morbidity and mortality worldwide but is difficult to diagnose clinically. Clinical prediction models (CPMs) could improve diagnostic accuracy. Neonates in lowincome and middle-income countries are disproportionately affected by sepsis, yet no review has comprehensively synthesised CPMs validated in this setting. We performed a scoping review of CPMs for neonatal sepsis diagnosis validated in low-income and middle-income countries. From 4598 unique records, we included 82 studies validating 44 distinct models. Most studies were set in neonatal intensive or special care units in middle-income countries and included neonates already suspected of sepsis. Three quarters of models were only validated in one study. Our review highlights several literature gaps, particularly a paucity of studies validating models in low-income countries and the WHO African region, and models for the general neonatal population. Furthermore, heterogeneity in study populations, definitions of sepsis and reporting of models may hinder progress in this field. METHODS We conducted this review according to an a priori published protocol,15 developed with reference to the scoping review guidelines provided by the Joanna Briggs Institute.16 We report methods and results in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (see supplementary appendix).17 Search strategy Eligibility criteria are shown in Table 1. After reviewing the extent and breadth of the literature from our initial searches, we narrowed the scope of our original protocol to focus specifically on studies that validate a CPM to diagnose neonatal sepsis in a LMIC, as defined by the World Bank in 2020. 18 We searched six electronic databases from their inception: Ovid MEDLINE, Ovid Embase, Scopus, Web of Science Core Collection, Global Index Medicus, and the Cochrane Library. Searches were initially performed on 20 December 2019 and updated on 5 September 2022 and 16 June 2024. Search terms were chosen to capture the three domains of the research question (‘neonate’, ‘sepsis’, and ‘clinical prediction model’) through collaboration with a child health specialist librarian. The search strategy was developed for Ovid MEDLINE and adapted for each database (see supplementary appendix). Additional studies were identified by citation analysis and by hand searching the reference lists of included studies. Record screening We imported identified records into EndNote 21 for deduplication.19 Unique records were then uploaded to the Rayyan application for screening by two independent reviewers (DM, HG, MZ, SRN or SS). 20 Titles and abstracts were first examined against the eligibility criteria to determine if each record was potentially eligible for inclusion. Next, full texts of potentially eligible studies were obtained and reviewed to confirm eligibility. Authors were contacted to request full texts where these could not be found online. Conflicts were resolved by discussion amongst the review team. Data extraction and synthesis Data extraction was performed independently by two reviewers for the initial searches (SRN and SS) and by one reviewer for each updated search (SRN or SS). We extracted data on study, participant and model characteristics, and model performance using a pre-piloted data extraction form (see supplementary appendix). Data items were chosen based on the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) statement.21 We summarised results by narrative synthesis. Data for quantitative outcomes were not pooled in a meta-analysis as this is beyond the scoping review methodology. Where multiple variations of a model were presented in the same study (e.g. different combinations of predictors presented during model specification), or model performance was presented at multiple classification thresholds, we only included data for the ‘optimal’ or ‘final’ model at a single classification threshold. RESULTS Searches and included studies Searches identified 4598 unique records (Figure 1). From these, 82 studies published between 2003 and 2024 were included, 22-103 and are summarised in Tables 2 and 3. The number of published studies validating a CPM to diagnose neonatal sepsis in LMICs has increased rapidly in recent years (Figure 2). Studies were conducted in 22 individual countries (Figure 3 and Table 4), with the greatest number of studies conducted in the World Health Organization (WHO) South-East Asian Region (n=48, 59%), particularly in India (n=37, 45%). The fewest studies were conducted in the WHO African Region (n=4, 5%). Regarding economic status, 51 studies were conducted exclusively in lower middle-income countries (62%) and 30 exclusively in upper middle-income countries (37%). One study pooled data from both low-income and lower middle-income countries.98 Most studies were set in intensive care or special care admission units (n=64, 78%). The remainder included all live births at study sites (n=12, 15%), neonates presenting to emergency care services (n=3, 4%), all hospitalised neonates (n=1, 1%), or the setting was unclear (n=2, 2%). In total, 24252 neonates were included across all studies. The median number of participants per study was 151 (range 36 to 3303, interquartile range [IQR] 200). Few studies restricted the study population based on gestational age or birthweight, with only 4 studies (5%) specifically investigating preterm neonates and 5 studies (6%) specifically investigating low or very low birthweight neonates. Most studies included neonates clinically suspected of sepsis or with specific maternal risk factors including chorioamnionitis (n=58, 71%). Almost all studies included a positive blood and/or CSF culture in their outcome definition for sepsis (n=75, 91%). Of these, 18 (22% of all studies) also included clinical features or clinical suspicion of sepsis. One study used a consultant neonatologist’s clinical diagnosis of sepsis, 76 one study used the International Classification of Diseases 10th Revision criteria for sepsis,77 and in three studies the outcome was unclear. Model characteristics The 82 included studies performed 109 evaluations validating 44 distinct models (Table 3).22- 25,32,33,40,46,47,49-51,54,56,57,63,68,72,76-78,81,83,86,87,90,92,98-101,103-113 The most frequently validated model was the Hematological Scoring System by Rodwell et al. (n=32, 39% of studies; including studies that made minor modifications to the original model).112 Most models were only validated in one study (n=34, 77% of models). A total of 135 predictors of sepsis were included across all models, of which 82 were clinical parameters (signs, symptoms or risk factors) and 53 were laboratory parameters (see supplementary appendix). The median number of predictors per model was 6 (range 2 to 110, IQR 4). 14 models (32%) included only clinical parameters, 12 models (27%) included only laboratory parameters, and 18 models (41%) included both. The commonest laboratory parameters were white cell count (n=17 models, 39%), C-reactive protein (CRP) (n=16 models, 36%) and platelet count (n=15 models, 34%). The commonest clinical parameters were neonatal fever (n=13 models, 30%) and gestational age (n=11 models, 25%). Most models were developed using logistic regression (n=16 models, 36%) (often with stepwise selection to select predictors) or consisted of a scoring system based on univariable predictor performance or literature review and expert opinion (n=10 models, 23%).","<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> Clinical prediction models are being developed and used in the diagnosis of neonatal sepsis. Give me a summary of the predictors that are used in the models included in the study. Emphasize the numbers and percentages. <TEXT> Clinical prediction models to diagnose neonatal sepsis in low-income and middle-income countries: a scoping review Neonatal sepsis causes significant morbidity and mortality worldwide but is difficult to diagnose clinically. Clinical prediction models (CPMs) could improve diagnostic accuracy. Neonates in lowincome and middle-income countries are disproportionately affected by sepsis, yet no review has comprehensively synthesised CPMs validated in this setting. We performed a scoping review of CPMs for neonatal sepsis diagnosis validated in low-income and middle-income countries. From 4598 unique records, we included 82 studies validating 44 distinct models. Most studies were set in neonatal intensive or special care units in middle-income countries and included neonates already suspected of sepsis. Three quarters of models were only validated in one study. Our review highlights several literature gaps, particularly a paucity of studies validating models in low-income countries and the WHO African region, and models for the general neonatal population. Furthermore, heterogeneity in study populations, definitions of sepsis and reporting of models may hinder progress in this field. METHODS We conducted this review according to an a priori published protocol,15 developed with reference to the scoping review guidelines provided by the Joanna Briggs Institute.16 We report methods and results in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (see supplementary appendix).17 Search strategy Eligibility criteria are shown in Table 1. After reviewing the extent and breadth of the literature from our initial searches, we narrowed the scope of our original protocol to focus specifically on studies that validate a CPM to diagnose neonatal sepsis in a LMIC, as defined by the World Bank in 2020. 18 We searched six electronic databases from their inception: Ovid MEDLINE, Ovid Embase, Scopus, Web of Science Core Collection, Global Index Medicus, and the Cochrane Library. Searches were initially performed on 20 December 2019 and updated on 5 September 2022 and 16 June 2024. Search terms were chosen to capture the three domains of the research question (‘neonate’, ‘sepsis’, and ‘clinical prediction model’) through collaboration with a child health specialist librarian. The search strategy was developed for Ovid MEDLINE and adapted for each database (see supplementary appendix). Additional studies were identified by citation analysis and by hand searching the reference lists of included studies. Record screening We imported identified records into EndNote 21 for deduplication.19 Unique records were then uploaded to the Rayyan application for screening by two independent reviewers (DM, HG, MZ, SRN or SS). 20 Titles and abstracts were first examined against the eligibility criteria to determine if each record was potentially eligible for inclusion. Next, full texts of potentially eligible studies were obtained and reviewed to confirm eligibility. Authors were contacted to request full texts where these could not be found online. Conflicts were resolved by discussion amongst the review team. Data extraction and synthesis Data extraction was performed independently by two reviewers for the initial searches (SRN and SS) and by one reviewer for each updated search (SRN or SS). We extracted data on study, participant and model characteristics, and model performance using a pre-piloted data extraction form (see supplementary appendix). Data items were chosen based on the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) statement.21 We summarised results by narrative synthesis. Data for quantitative outcomes were not pooled in a meta-analysis as this is beyond the scoping review methodology. Where multiple variations of a model were presented in the same study (e.g. different combinations of predictors presented during model specification), or model performance was presented at multiple classification thresholds, we only included data for the ‘optimal’ or ‘final’ model at a single classification threshold. RESULTS Searches and included studies Searches identified 4598 unique records (Figure 1). From these, 82 studies published between 2003 and 2024 were included, 22-103 and are summarised in Tables 2 and 3. The number of published studies validating a CPM to diagnose neonatal sepsis in LMICs has increased rapidly in recent years (Figure 2). Studies were conducted in 22 individual countries (Figure 3 and Table 4), with the greatest number of studies conducted in the World Health Organization (WHO) South-East Asian Region (n=48, 59%), particularly in India (n=37, 45%). The fewest studies were conducted in the WHO African Region (n=4, 5%). Regarding economic status, 51 studies were conducted exclusively in lower middle-income countries (62%) and 30 exclusively in upper middle-income countries (37%). One study pooled data from both low-income and lower middle-income countries.98 Most studies were set in intensive care or special care admission units (n=64, 78%). The remainder included all live births at study sites (n=12, 15%), neonates presenting to emergency care services (n=3, 4%), all hospitalised neonates (n=1, 1%), or the setting was unclear (n=2, 2%). In total, 24252 neonates were included across all studies. The median number of participants per study was 151 (range 36 to 3303, interquartile range [IQR] 200). Few studies restricted the study population based on gestational age or birthweight, with only 4 studies (5%) specifically investigating preterm neonates and 5 studies (6%) specifically investigating low or very low birthweight neonates. Most studies included neonates clinically suspected of sepsis or with specific maternal risk factors including chorioamnionitis (n=58, 71%). Almost all studies included a positive blood and/or CSF culture in their outcome definition for sepsis (n=75, 91%). Of these, 18 (22% of all studies) also included clinical features or clinical suspicion of sepsis. One study used a consultant neonatologist’s clinical diagnosis of sepsis, 76 one study used the International Classification of Diseases 10th Revision criteria for sepsis,77 and in three studies the outcome was unclear. Model characteristics The 82 included studies performed 109 evaluations validating 44 distinct models (Table 3).22- 25,32,33,40,46,47,49-51,54,56,57,63,68,72,76-78,81,83,86,87,90,92,98-101,103-113 The most frequently validated model was the Hematological Scoring System by Rodwell et al. (n=32, 39% of studies; including studies that made minor modifications to the original model).112 Most models were only validated in one study (n=34, 77% of models). A total of 135 predictors of sepsis were included across all models, of which 82 were clinical parameters (signs, symptoms or risk factors) and 53 were laboratory parameters (see supplementary appendix). The median number of predictors per model was 6 (range 2 to 110, IQR 4). 14 models (32%) included only clinical parameters, 12 models (27%) included only laboratory parameters, and 18 models (41%) included both. The commonest laboratory parameters were white cell count (n=17 models, 39%), C-reactive protein (CRP) (n=16 models, 36%) and platelet count (n=15 models, 34%). The commonest clinical parameters were neonatal fever (n=13 models, 30%) and gestational age (n=11 models, 25%). Most models were developed using logistic regression (n=16 models, 36%) (often with stepwise selection to select predictors) or consisted of a scoring system based on univariable predictor performance or literature review and expert opinion (n=10 models, 23%). https://www.medrxiv.org/content/10.1101/2024.09.05.24313133v2.full.pdf","<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> [user request] <TEXT> [context document]
+
+EVIDENCE:
+Clinical prediction models to diagnose neonatal sepsis in low-income and middle-income countries: a scoping review Neonatal sepsis causes significant morbidity and mortality worldwide but is difficult to diagnose clinically. Clinical prediction models (CPMs) could improve diagnostic accuracy. Neonates in lowincome and middle-income countries are disproportionately affected by sepsis, yet no review has comprehensively synthesised CPMs validated in this setting. We performed a scoping review of CPMs for neonatal sepsis diagnosis validated in low-income and middle-income countries. From 4598 unique records, we included 82 studies validating 44 distinct models. Most studies were set in neonatal intensive or special care units in middle-income countries and included neonates already suspected of sepsis. Three quarters of models were only validated in one study. Our review highlights several literature gaps, particularly a paucity of studies validating models in low-income countries and the WHO African region, and models for the general neonatal population. Furthermore, heterogeneity in study populations, definitions of sepsis and reporting of models may hinder progress in this field. METHODS We conducted this review according to an a priori published protocol,15 developed with reference to the scoping review guidelines provided by the Joanna Briggs Institute.16 We report methods and results in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (see supplementary appendix).17 Search strategy Eligibility criteria are shown in Table 1. After reviewing the extent and breadth of the literature from our initial searches, we narrowed the scope of our original protocol to focus specifically on studies that validate a CPM to diagnose neonatal sepsis in a LMIC, as defined by the World Bank in 2020. 18 We searched six electronic databases from their inception: Ovid MEDLINE, Ovid Embase, Scopus, Web of Science Core Collection, Global Index Medicus, and the Cochrane Library. Searches were initially performed on 20 December 2019 and updated on 5 September 2022 and 16 June 2024. Search terms were chosen to capture the three domains of the research question (‘neonate’, ‘sepsis’, and ‘clinical prediction model’) through collaboration with a child health specialist librarian. The search strategy was developed for Ovid MEDLINE and adapted for each database (see supplementary appendix). Additional studies were identified by citation analysis and by hand searching the reference lists of included studies. Record screening We imported identified records into EndNote 21 for deduplication.19 Unique records were then uploaded to the Rayyan application for screening by two independent reviewers (DM, HG, MZ, SRN or SS). 20 Titles and abstracts were first examined against the eligibility criteria to determine if each record was potentially eligible for inclusion. Next, full texts of potentially eligible studies were obtained and reviewed to confirm eligibility. Authors were contacted to request full texts where these could not be found online. Conflicts were resolved by discussion amongst the review team. Data extraction and synthesis Data extraction was performed independently by two reviewers for the initial searches (SRN and SS) and by one reviewer for each updated search (SRN or SS). We extracted data on study, participant and model characteristics, and model performance using a pre-piloted data extraction form (see supplementary appendix). Data items were chosen based on the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) statement.21 We summarised results by narrative synthesis. Data for quantitative outcomes were not pooled in a meta-analysis as this is beyond the scoping review methodology. Where multiple variations of a model were presented in the same study (e.g. different combinations of predictors presented during model specification), or model performance was presented at multiple classification thresholds, we only included data for the ‘optimal’ or ‘final’ model at a single classification threshold. RESULTS Searches and included studies Searches identified 4598 unique records (Figure 1). From these, 82 studies published between 2003 and 2024 were included, 22-103 and are summarised in Tables 2 and 3. The number of published studies validating a CPM to diagnose neonatal sepsis in LMICs has increased rapidly in recent years (Figure 2). Studies were conducted in 22 individual countries (Figure 3 and Table 4), with the greatest number of studies conducted in the World Health Organization (WHO) South-East Asian Region (n=48, 59%), particularly in India (n=37, 45%). The fewest studies were conducted in the WHO African Region (n=4, 5%). Regarding economic status, 51 studies were conducted exclusively in lower middle-income countries (62%) and 30 exclusively in upper middle-income countries (37%). One study pooled data from both low-income and lower middle-income countries.98 Most studies were set in intensive care or special care admission units (n=64, 78%). The remainder included all live births at study sites (n=12, 15%), neonates presenting to emergency care services (n=3, 4%), all hospitalised neonates (n=1, 1%), or the setting was unclear (n=2, 2%). In total, 24252 neonates were included across all studies. The median number of participants per study was 151 (range 36 to 3303, interquartile range [IQR] 200). Few studies restricted the study population based on gestational age or birthweight, with only 4 studies (5%) specifically investigating preterm neonates and 5 studies (6%) specifically investigating low or very low birthweight neonates. Most studies included neonates clinically suspected of sepsis or with specific maternal risk factors including chorioamnionitis (n=58, 71%). Almost all studies included a positive blood and/or CSF culture in their outcome definition for sepsis (n=75, 91%). Of these, 18 (22% of all studies) also included clinical features or clinical suspicion of sepsis. One study used a consultant neonatologist’s clinical diagnosis of sepsis, 76 one study used the International Classification of Diseases 10th Revision criteria for sepsis,77 and in three studies the outcome was unclear. Model characteristics The 82 included studies performed 109 evaluations validating 44 distinct models (Table 3).22- 25,32,33,40,46,47,49-51,54,56,57,63,68,72,76-78,81,83,86,87,90,92,98-101,103-113 The most frequently validated model was the Hematological Scoring System by Rodwell et al. (n=32, 39% of studies; including studies that made minor modifications to the original model).112 Most models were only validated in one study (n=34, 77% of models). A total of 135 predictors of sepsis were included across all models, of which 82 were clinical parameters (signs, symptoms or risk factors) and 53 were laboratory parameters (see supplementary appendix). The median number of predictors per model was 6 (range 2 to 110, IQR 4). 14 models (32%) included only clinical parameters, 12 models (27%) included only laboratory parameters, and 18 models (41%) included both. The commonest laboratory parameters were white cell count (n=17 models, 39%), C-reactive protein (CRP) (n=16 models, 36%) and platelet count (n=15 models, 34%). The commonest clinical parameters were neonatal fever (n=13 models, 30%) and gestational age (n=11 models, 25%). Most models were developed using logistic regression (n=16 models, 36%) (often with stepwise selection to select predictors) or consisted of a scoring system based on univariable predictor performance or literature review and expert opinion (n=10 models, 23%).
+
+USER:
+Clinical prediction models are being developed and used in the diagnosis of neonatal sepsis. Give me a summary of the predictors that are used in the models included in the study. Emphasize the numbers and percentages.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,20,36,1123,,310
+Only use the information provided in the context document. Present the answer in a markdown formatted table.,Give me an example daily nutrition plan with food recommendations for a 42-year-old female in the week before a race.,"4 NUTRITION Nutrition is extremely important for individuals who are doing a sport in competitive level and for recreational individuals as well. Proper nutrition makes exercising more efficient and improves recovery from the exercises. A versatile diet that considers limitations ensures that the most important areas e.g. vitamins, mineralsand macro- nutrients are covered. The recommended total energy intake varies between individuals, sports and training period. The emphasis of macronutrients varies between sports. Endurance sports require more energy from carbohydrates than sports related to speed and power. (Mero 2016, 177.) The specific training period, as mentioned before affects energy requirement level. During the general preparation periods, energy intake varies from 3000 kcal to 6000 kcal depending on the exercise duration and intensity. One rule of thumb is to calculate daily need with 45-70 kcal/kg of body weight. Total energy intake should vary depending on the need, however, the amount of carbohydrates should remain high to be able to maintain proper recovery. Total energy intake should be 100-300 kcal over the daily consumption to recover and improve optimally. (Mero 2016, 204 –205.) 4.1 Carbohydrates Carbohydrates form the base of nutrition for endurance athletes. Carbohydrates are needed as an energy source during long lasting exercises and in recovery. The amount of carbohydrates consumed should be 6-10 g/kg or 60-75% of total energy intake. Carbohydrates that are consumed before training ensure that the blood glucose level stays high and the intensity can be as high as planned. This can be achieved by consuming a meal that includes carbohydrates and protein 1- 4 hours before the exercise. (Mero 2016, 204 – 205.) Good sources of carbohydrates include e.g. rice, pasta, potatoes, bread and fruits. It is recommended that recreational runners should prefer fiber rich carbohydrate sources because they fit for wellbeing purposes also. However, for athletes with high-energy expenditure, sugars can be used to reach high enough carbohydrate intake level. Sugar rich energy sources are e.g. juices, jams and honey. (Ilander, 2014a, 136—137.) 4.2 Fat Fats are needed to maintain hormonal functions in the body, and to enhance the absorption of vitamins. Fat intake level should be 1,0-1,5 g/kg or 20-30% of total energy intake (Mero 2016, 204). Due to high amount of energy that fats contain, the amount should be limited. The high requirement of carbohydrates and protein also affect to the intake level of fat. Fats that are consumed should mainly be unsaturated fat. Athletes should favor products that include low levels of fat. (Arjanne, Laaksonen & Ojala 2016, 164 – 168.) Good sources of fat include high amount of un-saturated fats and are low on saturated fats. Un-saturated fats can be found from e.g. nuts, fish and vegetable oils. Saturated fat can be found from e.g. red meat, and thus too extensive use should be avoided. (Ilander, 2014b, 229—238.) 4.3 Protein Proteins are used to build muscle mass, and serve as an energy source during long lasting performances. Protein intake level should be 2-3 g/kg or 15-20% of total energy intake (Mero 2016, 204). A high amount of proteins in the diet ensures, that there is no loss in muscle mass, and that the recovery from the training is optimal. Proteins also help in weight control by giving a feeling of satiety. (Arjanne, Laaksonen & Ojala, 2016, 164 – 168.) In versatile diet, the amount of protein is covered, but in case additional protein is needed, it can be consumed from supplements or from other sources. For people with special diets e.g. vegetarians and vegans, it is extremely important to make sure that the protein intake level is sufficient. Good sources of protein are e.g. milk, eggs, fish, seeds and nuts. (Ilander & Lindblad, 2014, 222—225.) 4.4 Carbohydrate and hydration loading for competitions Carbohydrate loading is beneficial before long lasting events, because the body’s glycogen stores can become a limiting factor for performance. Filling up the glycogen stores will allow one to perform longer with high intensity. There are several strategies for carbohydrate loading, some being riskier than others. In the guide, we introduced a fast and low risk way to do it. A fast and low risk method for carbohydrate loading starts with a short, but maximal intensity exercise, which is done 48 hours before the competition. After the exercise, a very high carbohydrate intake is maintained for 24 hours. The amount of carbohydrates consumed correspond to 12 g/kg of fat free body mass. During this 24 hours, no training should be done to avoid depletion of the glycogen stores. After the 24 hour period, a normal, high carbohydrate diet (6-10 g/kg) is maintained until the competition. (Fairchild et al 2002.) Good carbohydrate sources for loading purposes are pasta, white bread, rice and sports drinks. During the carbohydrate loading, protein and fat rich food should be avoided as well as low energy foods e.g. vegetables (Collier & O’dea 1983; Fairchild et al 2002). Dehydration is a risk factor that can ruin a well-planned competition. It can be avoided by consuming additional two liters of liquid for every day for 3-4 days before the competition and by consuming liquids during the competition as well. The competition day should have normal liquid consumption. A sufficient amount of liquids during the competition is 0,5-1 liter per hour. (Juoksijalehti n.d.) However, consuming too much liquid can predispose one to hyponatremia (Mayoclinic 2014).","Give me an example daily nutrition plan with food recommendations for a 42 year old female in the week before a race. System Instructions: Only use the information provided in the context document. Present the answer in a markdown formatted table. 4 NUTRITION Nutrition is extremely important for individuals who are doing a sport in competitive level and for recreational individuals as well. Proper nutrition makes exercising more efficient and improves recovery from the exercises. A versatile diet that considers limitations ensures that the most important areas e.g. vitamins, mineralsand macro- nutrients are covered. The recommended total energy intake varies between individuals, sports and training period. The emphasis of macronutrients varies between sports. Endurance sports require more energy from carbohydrates than sports related to speed and power. (Mero 2016, 177.) The specific training period, as mentioned before affects energy requirement level. During the general preparation periods, energy intake varies from 3000 kcal to 6000 kcal depending on the exercise duration and intensity. One rule of thumb is to calculate daily need with 45-70 kcal/kg of body weight. Total energy intake should vary depending on the need, however, the amount of carbohydrates should remain high to be able to maintain proper recovery. Total energy intake should be 100-300 kcal over the daily consumption to recover and improve optimally. (Mero 2016, 204 –205.) 4.1 Carbohydrates Carbohydrates form the base of nutrition for endurance athletes. Carbohydrates are needed as an energy source during long lasting exercises and in recovery. The amount of carbohydrates consumed should be 6-10 g/kg or 60-75% of total energy intake. Carbohydrates that are consumed before training ensure that the blood glucose level stays high and the intensity can be as high as planned. This can be achieved by consuming a meal that includes carbohydrates and protein 1- 4 hours before the exercise. (Mero 2016, 204 – 205.) Good sources of carbohydrates include e.g. rice, pasta, potatoes, bread and fruits. It is recommended that recreational runners should prefer fiber rich carbohydrate sources because they fit for wellbeing purposes also. However, for athletes with high-energy expenditure, sugars can be used to reach high enough carbohydrate intake level. Sugar rich energy sources are e.g. juices, jams and honey. (Ilander, 2014a, 136—137.) 4.2 Fat Fats are needed to maintain hormonal functions in the body, and to enhance the absorption of vitamins. Fat intake level should be 1,0-1,5 g/kg or 20-30% of total energy intake (Mero 2016, 204). Due to high amount of energy that fats contain, the amount should be limited. The high requirement of carbohydrates and protein also affect to the intake level of fat. Fats that are consumed should mainly be unsaturated fat. Athletes should favor products that include low levels of fat. (Arjanne, Laaksonen & Ojala 2016, 164 – 168.) Good sources of fat include high amount of un-saturated fats and are low on saturated fats. Un-saturated fats can be found from e.g. nuts, fish and vegetable oils. Saturated fat can be found from e.g. red meat, and thus too extensive use should be avoided. (Ilander, 2014b, 229—238.) 4.3 Protein Proteins are used to build muscle mass, and serve as an energy source during long lasting performances. Protein intake level should be 2-3 g/kg or 15-20% of total energy intake (Mero 2016, 204). A high amount of proteins in the diet ensures, that there is no loss in muscle mass, and that the recovery from the training is optimal. Proteins also help in weight control by giving a feeling of satiety. (Arjanne, Laaksonen & Ojala, 2016, 164 – 168.) In versatile diet, the amount of protein is covered, but in case additional protein is needed, it can be consumed from supplements or from other sources. For people with special diets e.g. vegetarians and vegans, it is extremely important to make sure that the protein intake level is sufficient. Good sources of protein are e.g. milk, eggs, fish, seeds and nuts. (Ilander & Lindblad, 2014, 222—225.) 4.4 Carbohydrate and hydration loading for competitions Carbohydrate loading is beneficial before long lasting events, because the body’s glycogen stores can become a limiting factor for performance. Filling up the glycogen stores will allow one to perform longer with high intensity. There are several strategies for carbohydrate loading, some being riskier than others. In the guide, we introduced a fast and low risk way to do it. A fast and low risk method for carbohydrate loading starts with a short, but maximal intensity exercise, which is done 48 hours before the competition. After the exercise, a very high carbohydrate intake is maintained for 24 hours. The amount of carbohydrates consumed correspond to 12 g/kg of fat free body mass. During this 24 hours, no training should be done to avoid depletion of the glycogen stores. After the 24 hour period, a normal, high carbohydrate diet (6-10 g/kg) is maintained until the competition. (Fairchild et al 2002.) Good carbohydrate sources for loading purposes are pasta, white bread, rice and sports drinks. During the carbohydrate loading, protein and fat rich food should be avoided as well as low energy foods e.g. vegetables (Collier & O’dea 1983; Fairchild et al 2002). Dehydration is a risk factor that can ruin a well-planned competition. It can be avoided by consuming additional two liters of liquid for every day for 3-4 days before the competition and by consuming liquids during the competition as well. The competition day should have normal liquid consumption. A sufficient amount of liquids during the competition is 0,5-1 liter per hour. (Juoksijalehti n.d.) However, consuming too much liquid can predispose one to hyponatremia (Mayoclinic 2014).","Only use the information provided in the context document. Present the answer in a markdown formatted table.
+
+EVIDENCE:
+4 NUTRITION Nutrition is extremely important for individuals who are doing a sport in competitive level and for recreational individuals as well. Proper nutrition makes exercising more efficient and improves recovery from the exercises. A versatile diet that considers limitations ensures that the most important areas e.g. vitamins, mineralsand macro- nutrients are covered. The recommended total energy intake varies between individuals, sports and training period. The emphasis of macronutrients varies between sports. Endurance sports require more energy from carbohydrates than sports related to speed and power. (Mero 2016, 177.) The specific training period, as mentioned before affects energy requirement level. During the general preparation periods, energy intake varies from 3000 kcal to 6000 kcal depending on the exercise duration and intensity. One rule of thumb is to calculate daily need with 45-70 kcal/kg of body weight. Total energy intake should vary depending on the need, however, the amount of carbohydrates should remain high to be able to maintain proper recovery. Total energy intake should be 100-300 kcal over the daily consumption to recover and improve optimally. (Mero 2016, 204 –205.) 4.1 Carbohydrates Carbohydrates form the base of nutrition for endurance athletes. Carbohydrates are needed as an energy source during long lasting exercises and in recovery. The amount of carbohydrates consumed should be 6-10 g/kg or 60-75% of total energy intake. Carbohydrates that are consumed before training ensure that the blood glucose level stays high and the intensity can be as high as planned. This can be achieved by consuming a meal that includes carbohydrates and protein 1- 4 hours before the exercise. (Mero 2016, 204 – 205.) Good sources of carbohydrates include e.g. rice, pasta, potatoes, bread and fruits. It is recommended that recreational runners should prefer fiber rich carbohydrate sources because they fit for wellbeing purposes also. However, for athletes with high-energy expenditure, sugars can be used to reach high enough carbohydrate intake level. Sugar rich energy sources are e.g. juices, jams and honey. (Ilander, 2014a, 136—137.) 4.2 Fat Fats are needed to maintain hormonal functions in the body, and to enhance the absorption of vitamins. Fat intake level should be 1,0-1,5 g/kg or 20-30% of total energy intake (Mero 2016, 204). Due to high amount of energy that fats contain, the amount should be limited. The high requirement of carbohydrates and protein also affect to the intake level of fat. Fats that are consumed should mainly be unsaturated fat. Athletes should favor products that include low levels of fat. (Arjanne, Laaksonen & Ojala 2016, 164 – 168.) Good sources of fat include high amount of un-saturated fats and are low on saturated fats. Un-saturated fats can be found from e.g. nuts, fish and vegetable oils. Saturated fat can be found from e.g. red meat, and thus too extensive use should be avoided. (Ilander, 2014b, 229—238.) 4.3 Protein Proteins are used to build muscle mass, and serve as an energy source during long lasting performances. Protein intake level should be 2-3 g/kg or 15-20% of total energy intake (Mero 2016, 204). A high amount of proteins in the diet ensures, that there is no loss in muscle mass, and that the recovery from the training is optimal. Proteins also help in weight control by giving a feeling of satiety. (Arjanne, Laaksonen & Ojala, 2016, 164 – 168.) In versatile diet, the amount of protein is covered, but in case additional protein is needed, it can be consumed from supplements or from other sources. For people with special diets e.g. vegetarians and vegans, it is extremely important to make sure that the protein intake level is sufficient. Good sources of protein are e.g. milk, eggs, fish, seeds and nuts. (Ilander & Lindblad, 2014, 222—225.) 4.4 Carbohydrate and hydration loading for competitions Carbohydrate loading is beneficial before long lasting events, because the body’s glycogen stores can become a limiting factor for performance. Filling up the glycogen stores will allow one to perform longer with high intensity. There are several strategies for carbohydrate loading, some being riskier than others. In the guide, we introduced a fast and low risk way to do it. A fast and low risk method for carbohydrate loading starts with a short, but maximal intensity exercise, which is done 48 hours before the competition. After the exercise, a very high carbohydrate intake is maintained for 24 hours. The amount of carbohydrates consumed correspond to 12 g/kg of fat free body mass. During this 24 hours, no training should be done to avoid depletion of the glycogen stores. After the 24 hour period, a normal, high carbohydrate diet (6-10 g/kg) is maintained until the competition. (Fairchild et al 2002.) Good carbohydrate sources for loading purposes are pasta, white bread, rice and sports drinks. During the carbohydrate loading, protein and fat rich food should be avoided as well as low energy foods e.g. vegetables (Collier & O’dea 1983; Fairchild et al 2002). Dehydration is a risk factor that can ruin a well-planned competition. It can be avoided by consuming additional two liters of liquid for every day for 3-4 days before the competition and by consuming liquids during the competition as well. The competition day should have normal liquid consumption. A sufficient amount of liquids during the competition is 0,5-1 liter per hour. (Juoksijalehti n.d.) However, consuming too much liquid can predispose one to hyponatremia (Mayoclinic 2014).
+
+USER:
+Give me an example daily nutrition plan with food recommendations for a 42-year-old female in the week before a race.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,17,20,887,,352
+Use the information in the context block only; do not rely on your prior knowledge or any external sources.,Summarize the arguments that support and oppose the claim that the ICWA is unconstitutional.,"Is the Indian Child Welfare Act Constitutional? In Brackeen v. Zinke, a federal district court declared that the Indian Child Welfare Act (ICWA)—a 1978 law meant “to protect the best interests of Indian children and to promote the stability and security of Indian tribes and families”—was unconstitutional in several ways. This decision is currently pending before the U.S. Court of Appeals for the Fifth Circuit (Fifth Circuit), and its practical implications have been paused until the appeal is decided. If upheld, this decision would eliminate many of the special rules that apply to the adoption and foster care placements of Indian children in the three states involved in this case: Texas, Louisiana, and Indiana. Among other things, these rules allow a tribe to assume jurisdiction over, or otherwise to have input into, the placements of children who are eligible for tribal membership. In 1978, Congress recognized that an “alarmingly high percentage of Indian families” were being broken up by often-unwarranted removal of their children by nontribal entities, placing many of these children in non-Indian foster and adoptive homes. Citing its responsibility for protecting and preserving Indian tribes, Congressional Research Service https://crsreports.congress.gov LSB10245 Congressional Research Service 2 Congress passed ICWA to protect Indian children as vital to the tribes’ continued existence. ICWA is designed to do two primary things: (1) set standards for placing Indian children with foster or adoptive families, and (2) help tribes set up child and family programs. Though a number of lawsuits have challenged ICWA over the past 40 years, including on the grounds that the statute impermissibly treated Indian children differently on the basis of race, until Brackeen, none of those challenges had been successful. Instead, courts in prior cases had noted Congress’s “plenary” authority over Indian affairs—derived principally from the Indian Commerce Clause and the Treaty Power—and concluded that applying special rules to Indian children was constitutional because, among other things, the distinction between Indians and non-Indians was not an impermissible race-based classification, but was instead a recognition of the unique political status of Indian tribes. This Sidebar gives a brief overview of ICWA, outlines the Brackeen court’s decision with relevant legal context, and explores the possible impacts, including potential for higher court and congressional action. Relevant ICWA provisions and associated regulations Most relevant to the claims at issue in Brackeen, ICWA sets forth a series of duties that must be fulfilled for Indian child placements. For the purposes of ICWA, an “Indian child” is any unmarried person under eighteen who is either a member of an Indian tribe or is both eligible for membership in an Indian tribe and the biological child of a member of an Indian tribe. Three main aspects of ICWA are relevant to the issues raised in Brackeen. First, under ICWA, any party seeking involuntary termination of parental rights to an Indian child under state law must first demonstrate that active efforts have been made to provide remedial services and rehabilitative programs designed to prevent the breakup of the Indian family. Second, involuntary termination requires evidence beyond a reasonable doubt (including expert witness testimony), that the continued custody of the child by the parent or Indian custodian would likely result in serious emotional or physical damage to the child. Third, when an Indian child is placed with a foster or adoptive family under state law, ICWA lists general preferences for that placement: (1) a member of the child’s extended family; (2) other members of the Indian child’s tribe; or (3) other Indian families. However, if a tribe wants to re-order those preferences for Indian children associated with that tribe, it may pass a resolution doing so, and state agencies and courts generally must follow that amended order of preference. In any event, ICWA provides that these preferences may be circumvented in an individual case upon a showing of “good cause.” The Bureau of Indian Affairs (BIA) has authority to make regulations governing ICWA’s implementation. Though BIA chose not to do so when the statute was first passed, in 2016 it issued a Final Rule aimed at reconciling different states’ interpretations of ICWA—for example, by clarifying the circumstances in which “good cause” exists for circumventing ICWA’s placement preferences. Brackeen v. Zinke: the plaintiffs’ claims and the district court’s decision A group of plaintiffs comprising three states (Indiana, Louisiana, and Texas) and several private parties— primarily non-Indian couples who had adopted or wanted to adopt an Indian child—challenged several facets of ICWA and related regulations (including the 2016 Final Rule, as well as certain funding provisions conditioned on ICWA compliance), seeking to have them declared unconstitutional or otherwise rendered invalid. They filed these challenges in the United States District Court for the Northern District of Texas, where Judge Reed O’Connor did declare much of ICWA unconstitutional, granting nearly all of the plaintiffs’ claims. (This decision is arguably the second-most consequential decision by Judge O’Connor in recent months, as he ruled in December 2018 that the Affordable Care Act was also unconstitutional). The federal defendants, intervening tribes, and a group of amicus curiae Congressional Research Service 3 including numerous federally recognized tribes, several Indian organizations, and a number of states, disputed plaintiffs’ characterization of ICWA and contended the challenged laws and implementing regulations were lawful. The plaintiffs’ claims about ICWA’s validity, and the court’s responses to them, are discussed below. Equal protection: does ICWA use a race-based classification, and if so, can it survive strict scrutiny? The state and the individual plaintiffs together claimed that ICWA ran afoul of the Fifth Amendment’s equal protection guarantees, by impermissibly using a race-based classification. The plaintiffs’ claim relied primarily on the Supreme Court’s decisions in two cases. First, in Adarand Constructors v. Peña, the Supreme Court established that any time the federal government subjects individuals to unequal treatment based on their race, that action is subject to “strict scrutiny”—a test that asks whether the classification (1) serves a compelling government interest and (2) is narrowly tailored to further that interest. Second, in Rice v. Cayetano, in the course of invalidating a Hawaiian law that permitted only persons of native Hawaiian descent to vote in certain elections, the Supreme Court recognized that “[a]ncestry can be a proxy for race” and may be subject to the same constitutional limitations as directly race-based classifications. The plaintiffs in Brackeen argued that ICWA involved a race-based classification because its definition of Indian children was based on the children’s ancestry, rather than strictly on membership in a federally recognized tribe. Plaintiffs alleged that this classification neither served any compelling interest, nor was narrowly tailored. The federal defendants, intervening tribes, and several amici disputed plaintiffs’ characterization of ICWA as a race-based classification. In particular, they emphasized longstanding Supreme Court jurisprudence holding that the federal government’s relationship with federally recognized Indian tribes is based on a political, rather than racial categorization. For example, in Morton v. Mancari, the Court upheld BIA’s employment preference for members of federally recognized tribes because the preference was a political classification—it singled out members of tribal entities who have a unique relationship with the federal government—rather than a racial one. The Supreme Court further opined that because “[l]iterally every piece of legislation dealing with Indian tribes” is “explicitly designed to help only Indians,” deeming such legislation racial discrimination would jeopardize “the solemn commitment of the Government toward the Indians.” Because the federal defendants relied on the argument that ICWA’s distinctions were political rather than racial in nature, they proffered no arguments on whether ICWA would withstand the strict scrutiny that would be applied if it were a race-based classification. However, they asked that the court permit additional briefing in the event strict scrutiny applied—a request that the court denied. The district court, however, agreed with the plaintiffs that the definition of Indian children was race-based rather than political. In doing so, the court concluded that this case was more like Rice than like Mancari, because Mancari involved only tribe members rather than Indians eligible for tribal membership. The court then decided—in the absence of any counterarguments from the government—that the race-based classification was not narrowly tailored, even assuming that it served a compelling interest. Nondelegation: does ICWA impermissibly delegate legislative power to tribes? The state plaintiffs argued that giving the tribes power to reorder ICWA’s placement preferences violated the nondelegation doctrine, which generally prohibits Congress from delegating its core legislative powers, whether to other government entities or to private parties. Courts generally use the “intelligible principle” test to assess whether a congressional delegation of legislative power to governmental entities is permissible. This is a forgiving standard; the Supreme Court has not invalidated a statute on these Congressional Research Service 4 grounds since 1935. However, some have also read the Court’s jurisprudence as prohibiting Congress from delegating its powers to private entities outside the government. Here, the district court relied upon both these understandings of the nondelegation doctrine to conclude that ICWA was invalid. First, the court held that Congress had not delineated a clear legal framework to guide how the delegated authority under ICWA would be implemented. Instead, the district court agreed with plaintiffs that the Indian tribes’ authority to reorder adoption placement preferences under ICWA was an essentially legislative authority that could not be delegated. Moreover, the court decided that even if that power could be delegated in some circumstances, Indian tribes were akin to private entities that could not exercise delegated powers. The district court was not receptive to arguments that Indian tribes are fundamentally distinct from other private parties (such as corporations), and should thus be treated differently in nondelegation analysis. Anti-commandeering: does ICWA infringe on state sovereignty over child custody matters, forcing the state to perform federal regulatory functions? The state plaintiffs claimed ICWA violated the anti-commandeering doctrine, rooted in the Constitution’s allocation of powers between the federal government and the states, which prohibits Congress from forcing state political branches to perform regulatory functions on the federal government’s behalf. The court granted this claim, agreeing that ICWA requires state courts and executive agencies to apply federal standards and directives to policy areas that are normally reserved for non-federal jurisdiction, such as adoptions, foster care policies, and other child custody issues. The district court tersely rejected the federal government’s argument that ICWA is instead an exercise of Congress’s “plenary and exclusive” authority over Indian tribes. Agency rulemaking: did a 2016 regulation violate the APA? The plaintiffs also used the Administrative Procedure Act (APA) to challenge the BIA’s 2016 Final Rule. The challenged rule tried to establish uniformity in ICWA’s application by, among other things, clarifying the “good cause” requirement for circumventing ICWA’s placement preferences for Indian children. The district court took a two-pronged approach to plaintiffs’ claims that BIA’s regulation was impermissible under the APA. First, the court announced that any regulation implementing the newly invalid portions of ICWA (i.e., the parts of ICWA that the court had already declared unconstitutional) should be struck down. The court then held in the alternative that the regulation exceeded the scope of BIA’s statutory regulatory authority—in the court’s view, the regulation “clarified” a provision that was not ambiguous and needed no clarification. Because the district court viewed the underlying provision as unambiguous, it gave no deference to the agency’s determination that the regulation was necessary. Remaining claims: Indian Commerce Clause and due process The court purported to grant plaintiffs’ claim that ICWA itself exceeded Congress’s legislative powers under the Indian Commerce Clause, but did so as an extension of its ruling that ICWA violated the anticommandeering doctrine, as Congress’s exercise of its power over Indian commerce cannot be employed to commandeer the states. Finally, the court denied the individual plaintiffs’ substantive due process claims, premised on ICWA allegedly infringing upon their fundamental rights of custody and family togetherness as foster or wouldbe adoptive parents of Indian children. The district court observed that the Supreme Court has not applied the fundamental rights of custody and of keeping families together to foster families, and the district court declined to extend recognition of such rights to the individual plaintiffs challenging ICWA. Congressional Research Service 5 Additional Context Similar challenges to ICWA have been brought over the years. At least one advocacy group has made challenging ICWA part of its core mission, claiming that Native American children are being harmed because ICWA hinders the ability of (non-Native) persons to adopt them. By contrast, ICWA’s supporters fear that challengers are jeopardizing longstanding principles underlying tribal sovereignty, while “[c]loaking [their] efforts in the language of civil rights.” Until Brackeen, however, direct challenges to ICWA generally had been unsuccessful—with perhaps one limited, but notable, exception. In a 2013 case, Adoptive Couple v. Baby Girl (popularly known as the Baby Veronica case), the U.S. Supreme Court limited the range of circumstances in which ICWA might apply. In a 5-4 decision, the Court ruled that several of ICWA’s provisions were inapplicable if the parent seeking to invoke them never had legal or physical custody of the Indian child. In the Baby Veronica case, that meant that the Indian father—who had never had custody of his daughter—could not invoke his and his tribe’s rights under ICWA to block her adoption. Second, the Court stated that the ICWA’s placement preferences for an Indian child adoption were relevant only if multiple parties actually sought to adopt the Indian child. In the Baby Veronica case, because only one party—a non-Indian couple—was trying to adopt the child, ICWA’s placement preferences could not prevent the adoption from being finalized. The Baby Veronica case was only the second ICWA case heard by the Supreme Court. The first came more than twenty years earlier, in 1989, when the Supreme Court held that, for ICWA purposes, the domicile of an Indian child was the domicile of the parents, regardless of where the child was actually born. The Baby Veronica case thus seemed to signal to some that ICWA was newly ripe for challenges, but the Supreme Court has so far declined to hear other cases challenging ICWA. However, many challenges like Brackeen have been raised in federal or state courts. As one example, the United States Court of Appeals for the Ninth Circuit recently dismissed a challenge to ICWA’s constitutionality, holding that it was mooted by the fact that the would-be adoptive parents had been able to complete their adoptions. In Brackeen v. Zinke, however, Judge O’Connor denied a motion to dismiss on similar grounds. What’s Next? The Brackeen v. Zinke decision has already been appealed to the Fifth Circuit. By stipulation of the parties, briefing in the appeal has been expedited and is scheduled to be completed in February 2019; the case is tentatively calendared for oral argument in March 2019. Although Judge O’Connor declined to stay the effect of his ruling pending appeal, the Fifth Circuit granted just such a stay despite the plaintiffs’ objection, so at least for now, the district court decision will not change the way ICWA is administered in Texas, Louisiana, or Indiana. In the event the Fifth Circuit agrees that ICWA is unconstitutional on one or more grounds, the adversely affected parties would likely seek appeal to the United States Supreme Court. The federal defendants filed their brief in January, arguing that each aspect of the district court’s decision was “unprecedented and in conflict with binding authority.” The brief also renewed challenges to the plaintiffs’ standing and argued that ICWA’s severability clause meant the ruling should have been narrower in any case. With regard to the equal protection claim, the government previewed the argument it would have made in supplemental briefing below: ICWA protects tribe members and their families, which includes the not-yet-enrolled children of tribal members, and is narrowly tailored to protect the best interests of those children. Nonetheless, the government suggested that if the Fifth Circuit agreed that strict scrutiny applied, it should remand to the district court for full briefing on the issue. In addition to ruling on the merits of the constitutional challenge to ICWA, the Fifth Circuit’s decision might also provide an opportunity for an appellate court to elaborate further on many of the Congressional Research Service 6 LSB10245 · VERSION 5 · UPDATED constitutional issues discussed, oftentimes in succinct terms, by the district court in Brackeen. The relationship between the Supreme Court’s jurisprudence on equal protection and tribal issues has prompted extensive legal commentary, and some have questioned what, if any, relevance the Brackeen decision might have for other Indian law statutes. The significance of these issues might make the Brackeen decision, to the extent it is upheld by the Fifth Circuit, particularly ripe for Supreme Court resolution.","Use the information in the context block only; do not rely on your prior knowledge or any external sources. Is the Indian Child Welfare Act Constitutional? In Brackeen v. Zinke, a federal district court declared that the Indian Child Welfare Act (ICWA)—a 1978 law meant “to protect the best interests of Indian children and to promote the stability and security of Indian tribes and families”—was unconstitutional in several ways. This decision is currently pending before the U.S. Court of Appeals for the Fifth Circuit (Fifth Circuit), and its practical implications have been paused until the appeal is decided. If upheld, this decision would eliminate many of the special rules that apply to the adoption and foster care placements of Indian children in the three states involved in this case: Texas, Louisiana, and Indiana. Among other things, these rules allow a tribe to assume jurisdiction over, or otherwise to have input into, the placements of children who are eligible for tribal membership. In 1978, Congress recognized that an “alarmingly high percentage of Indian families” were being broken up by often-unwarranted removal of their children by nontribal entities, placing many of these children in non-Indian foster and adoptive homes. Citing its responsibility for protecting and preserving Indian tribes, Congressional Research Service https://crsreports.congress.gov LSB10245 Congressional Research Service 2 Congress passed ICWA to protect Indian children as vital to the tribes’ continued existence. ICWA is designed to do two primary things: (1) set standards for placing Indian children with foster or adoptive families, and (2) help tribes set up child and family programs. Though a number of lawsuits have challenged ICWA over the past 40 years, including on the grounds that the statute impermissibly treated Indian children differently on the basis of race, until Brackeen, none of those challenges had been successful. Instead, courts in prior cases had noted Congress’s “plenary” authority over Indian affairs—derived principally from the Indian Commerce Clause and the Treaty Power—and concluded that applying special rules to Indian children was constitutional because, among other things, the distinction between Indians and non-Indians was not an impermissible race-based classification, but was instead a recognition of the unique political status of Indian tribes. This Sidebar gives a brief overview of ICWA, outlines the Brackeen court’s decision with relevant legal context, and explores the possible impacts, including potential for higher court and congressional action. Relevant ICWA provisions and associated regulations Most relevant to the claims at issue in Brackeen, ICWA sets forth a series of duties that must be fulfilled for Indian child placements. For the purposes of ICWA, an “Indian child” is any unmarried person under eighteen who is either a member of an Indian tribe or is both eligible for membership in an Indian tribe and the biological child of a member of an Indian tribe. Three main aspects of ICWA are relevant to the issues raised in Brackeen. First, under ICWA, any party seeking involuntary termination of parental rights to an Indian child under state law must first demonstrate that active efforts have been made to provide remedial services and rehabilitative programs designed to prevent the breakup of the Indian family. Second, involuntary termination requires evidence beyond a reasonable doubt (including expert witness testimony), that the continued custody of the child by the parent or Indian custodian would likely result in serious emotional or physical damage to the child. Third, when an Indian child is placed with a foster or adoptive family under state law, ICWA lists general preferences for that placement: (1) a member of the child’s extended family; (2) other members of the Indian child’s tribe; or (3) other Indian families. However, if a tribe wants to re-order those preferences for Indian children associated with that tribe, it may pass a resolution doing so, and state agencies and courts generally must follow that amended order of preference. In any event, ICWA provides that these preferences may be circumvented in an individual case upon a showing of “good cause.” The Bureau of Indian Affairs (BIA) has authority to make regulations governing ICWA’s implementation. Though BIA chose not to do so when the statute was first passed, in 2016 it issued a Final Rule aimed at reconciling different states’ interpretations of ICWA—for example, by clarifying the circumstances in which “good cause” exists for circumventing ICWA’s placement preferences. Brackeen v. Zinke: the plaintiffs’ claims and the district court’s decision A group of plaintiffs comprising three states (Indiana, Louisiana, and Texas) and several private parties— primarily non-Indian couples who had adopted or wanted to adopt an Indian child—challenged several facets of ICWA and related regulations (including the 2016 Final Rule, as well as certain funding provisions conditioned on ICWA compliance), seeking to have them declared unconstitutional or otherwise rendered invalid. They filed these challenges in the United States District Court for the Northern District of Texas, where Judge Reed O’Connor did declare much of ICWA unconstitutional, granting nearly all of the plaintiffs’ claims. (This decision is arguably the second-most consequential decision by Judge O’Connor in recent months, as he ruled in December 2018 that the Affordable Care Act was also unconstitutional). The federal defendants, intervening tribes, and a group of amicus curiae Congressional Research Service 3 including numerous federally recognized tribes, several Indian organizations, and a number of states, disputed plaintiffs’ characterization of ICWA and contended the challenged laws and implementing regulations were lawful. The plaintiffs’ claims about ICWA’s validity, and the court’s responses to them, are discussed below. Equal protection: does ICWA use a race-based classification, and if so, can it survive strict scrutiny? The state and the individual plaintiffs together claimed that ICWA ran afoul of the Fifth Amendment’s equal protection guarantees, by impermissibly using a race-based classification. The plaintiffs’ claim relied primarily on the Supreme Court’s decisions in two cases. First, in Adarand Constructors v. Peña, the Supreme Court established that any time the federal government subjects individuals to unequal treatment based on their race, that action is subject to “strict scrutiny”—a test that asks whether the classification (1) serves a compelling government interest and (2) is narrowly tailored to further that interest. Second, in Rice v. Cayetano, in the course of invalidating a Hawaiian law that permitted only persons of native Hawaiian descent to vote in certain elections, the Supreme Court recognized that “[a]ncestry can be a proxy for race” and may be subject to the same constitutional limitations as directly race-based classifications. The plaintiffs in Brackeen argued that ICWA involved a race-based classification because its definition of Indian children was based on the children’s ancestry, rather than strictly on membership in a federally recognized tribe. Plaintiffs alleged that this classification neither served any compelling interest, nor was narrowly tailored. The federal defendants, intervening tribes, and several amici disputed plaintiffs’ characterization of ICWA as a race-based classification. In particular, they emphasized longstanding Supreme Court jurisprudence holding that the federal government’s relationship with federally recognized Indian tribes is based on a political, rather than racial categorization. For example, in Morton v. Mancari, the Court upheld BIA’s employment preference for members of federally recognized tribes because the preference was a political classification—it singled out members of tribal entities who have a unique relationship with the federal government—rather than a racial one. The Supreme Court further opined that because “[l]iterally every piece of legislation dealing with Indian tribes” is “explicitly designed to help only Indians,” deeming such legislation racial discrimination would jeopardize “the solemn commitment of the Government toward the Indians.” Because the federal defendants relied on the argument that ICWA’s distinctions were political rather than racial in nature, they proffered no arguments on whether ICWA would withstand the strict scrutiny that would be applied if it were a race-based classification. However, they asked that the court permit additional briefing in the event strict scrutiny applied—a request that the court denied. The district court, however, agreed with the plaintiffs that the definition of Indian children was race-based rather than political. In doing so, the court concluded that this case was more like Rice than like Mancari, because Mancari involved only tribe members rather than Indians eligible for tribal membership. The court then decided—in the absence of any counterarguments from the government—that the race-based classification was not narrowly tailored, even assuming that it served a compelling interest. Nondelegation: does ICWA impermissibly delegate legislative power to tribes? The state plaintiffs argued that giving the tribes power to reorder ICWA’s placement preferences violated the nondelegation doctrine, which generally prohibits Congress from delegating its core legislative powers, whether to other government entities or to private parties. Courts generally use the “intelligible principle” test to assess whether a congressional delegation of legislative power to governmental entities is permissible. This is a forgiving standard; the Supreme Court has not invalidated a statute on these Congressional Research Service 4 grounds since 1935. However, some have also read the Court’s jurisprudence as prohibiting Congress from delegating its powers to private entities outside the government. Here, the district court relied upon both these understandings of the nondelegation doctrine to conclude that ICWA was invalid. First, the court held that Congress had not delineated a clear legal framework to guide how the delegated authority under ICWA would be implemented. Instead, the district court agreed with plaintiffs that the Indian tribes’ authority to reorder adoption placement preferences under ICWA was an essentially legislative authority that could not be delegated. Moreover, the court decided that even if that power could be delegated in some circumstances, Indian tribes were akin to private entities that could not exercise delegated powers. The district court was not receptive to arguments that Indian tribes are fundamentally distinct from other private parties (such as corporations), and should thus be treated differently in nondelegation analysis. Anti-commandeering: does ICWA infringe on state sovereignty over child custody matters, forcing the state to perform federal regulatory functions? The state plaintiffs claimed ICWA violated the anti-commandeering doctrine, rooted in the Constitution’s allocation of powers between the federal government and the states, which prohibits Congress from forcing state political branches to perform regulatory functions on the federal government’s behalf. The court granted this claim, agreeing that ICWA requires state courts and executive agencies to apply federal standards and directives to policy areas that are normally reserved for non-federal jurisdiction, such as adoptions, foster care policies, and other child custody issues. The district court tersely rejected the federal government’s argument that ICWA is instead an exercise of Congress’s “plenary and exclusive” authority over Indian tribes. Agency rulemaking: did a 2016 regulation violate the APA? The plaintiffs also used the Administrative Procedure Act (APA) to challenge the BIA’s 2016 Final Rule. The challenged rule tried to establish uniformity in ICWA’s application by, among other things, clarifying the “good cause” requirement for circumventing ICWA’s placement preferences for Indian children. The district court took a two-pronged approach to plaintiffs’ claims that BIA’s regulation was impermissible under the APA. First, the court announced that any regulation implementing the newly invalid portions of ICWA (i.e., the parts of ICWA that the court had already declared unconstitutional) should be struck down. The court then held in the alternative that the regulation exceeded the scope of BIA’s statutory regulatory authority—in the court’s view, the regulation “clarified” a provision that was not ambiguous and needed no clarification. Because the district court viewed the underlying provision as unambiguous, it gave no deference to the agency’s determination that the regulation was necessary. Remaining claims: Indian Commerce Clause and due process The court purported to grant plaintiffs’ claim that ICWA itself exceeded Congress’s legislative powers under the Indian Commerce Clause, but did so as an extension of its ruling that ICWA violated the anticommandeering doctrine, as Congress’s exercise of its power over Indian commerce cannot be employed to commandeer the states. Finally, the court denied the individual plaintiffs’ substantive due process claims, premised on ICWA allegedly infringing upon their fundamental rights of custody and family togetherness as foster or wouldbe adoptive parents of Indian children. The district court observed that the Supreme Court has not applied the fundamental rights of custody and of keeping families together to foster families, and the district court declined to extend recognition of such rights to the individual plaintiffs challenging ICWA. Congressional Research Service 5 Additional Context Similar challenges to ICWA have been brought over the years. At least one advocacy group has made challenging ICWA part of its core mission, claiming that Native American children are being harmed because ICWA hinders the ability of (non-Native) persons to adopt them. By contrast, ICWA’s supporters fear that challengers are jeopardizing longstanding principles underlying tribal sovereignty, while “[c]loaking [their] efforts in the language of civil rights.” Until Brackeen, however, direct challenges to ICWA generally had been unsuccessful—with perhaps one limited, but notable, exception. In a 2013 case, Adoptive Couple v. Baby Girl (popularly known as the Baby Veronica case), the U.S. Supreme Court limited the range of circumstances in which ICWA might apply. In a 5-4 decision, the Court ruled that several of ICWA’s provisions were inapplicable if the parent seeking to invoke them never had legal or physical custody of the Indian child. In the Baby Veronica case, that meant that the Indian father—who had never had custody of his daughter—could not invoke his and his tribe’s rights under ICWA to block her adoption. Second, the Court stated that the ICWA’s placement preferences for an Indian child adoption were relevant only if multiple parties actually sought to adopt the Indian child. In the Baby Veronica case, because only one party—a non-Indian couple—was trying to adopt the child, ICWA’s placement preferences could not prevent the adoption from being finalized. The Baby Veronica case was only the second ICWA case heard by the Supreme Court. The first came more than twenty years earlier, in 1989, when the Supreme Court held that, for ICWA purposes, the domicile of an Indian child was the domicile of the parents, regardless of where the child was actually born. The Baby Veronica case thus seemed to signal to some that ICWA was newly ripe for challenges, but the Supreme Court has so far declined to hear other cases challenging ICWA. However, many challenges like Brackeen have been raised in federal or state courts. As one example, the United States Court of Appeals for the Ninth Circuit recently dismissed a challenge to ICWA’s constitutionality, holding that it was mooted by the fact that the would-be adoptive parents had been able to complete their adoptions. In Brackeen v. Zinke, however, Judge O’Connor denied a motion to dismiss on similar grounds. What’s Next? The Brackeen v. Zinke decision has already been appealed to the Fifth Circuit. By stipulation of the parties, briefing in the appeal has been expedited and is scheduled to be completed in February 2019; the case is tentatively calendared for oral argument in March 2019. Although Judge O’Connor declined to stay the effect of his ruling pending appeal, the Fifth Circuit granted just such a stay despite the plaintiffs’ objection, so at least for now, the district court decision will not change the way ICWA is administered in Texas, Louisiana, or Indiana. In the event the Fifth Circuit agrees that ICWA is unconstitutional on one or more grounds, the adversely affected parties would likely seek appeal to the United States Supreme Court. The federal defendants filed their brief in January, arguing that each aspect of the district court’s decision was “unprecedented and in conflict with binding authority.” The brief also renewed challenges to the plaintiffs’ standing and argued that ICWA’s severability clause meant the ruling should have been narrower in any case. With regard to the equal protection claim, the government previewed the argument it would have made in supplemental briefing below: ICWA protects tribe members and their families, which includes the not-yet-enrolled children of tribal members, and is narrowly tailored to protect the best interests of those children. Nonetheless, the government suggested that if the Fifth Circuit agreed that strict scrutiny applied, it should remand to the district court for full briefing on the issue. In addition to ruling on the merits of the constitutional challenge to ICWA, the Fifth Circuit’s decision might also provide an opportunity for an appellate court to elaborate further on many of the Congressional Research Service 6 LSB10245 · VERSION 5 · UPDATED constitutional issues discussed, oftentimes in succinct terms, by the district court in Brackeen. The relationship between the Supreme Court’s jurisprudence on equal protection and tribal issues has prompted extensive legal commentary, and some have questioned what, if any, relevance the Brackeen decision might have for other Indian law statutes. The significance of these issues might make the Brackeen decision, to the extent it is upheld by the Fifth Circuit, particularly ripe for Supreme Court resolution. Summarize the arguments that support and oppose the claim that the ICWA is unconstitutional.","Use the information in the context block only; do not rely on your prior knowledge or any external sources.
+
+EVIDENCE:
+Is the Indian Child Welfare Act Constitutional? In Brackeen v. Zinke, a federal district court declared that the Indian Child Welfare Act (ICWA)—a 1978 law meant “to protect the best interests of Indian children and to promote the stability and security of Indian tribes and families”—was unconstitutional in several ways. This decision is currently pending before the U.S. Court of Appeals for the Fifth Circuit (Fifth Circuit), and its practical implications have been paused until the appeal is decided. If upheld, this decision would eliminate many of the special rules that apply to the adoption and foster care placements of Indian children in the three states involved in this case: Texas, Louisiana, and Indiana. Among other things, these rules allow a tribe to assume jurisdiction over, or otherwise to have input into, the placements of children who are eligible for tribal membership. In 1978, Congress recognized that an “alarmingly high percentage of Indian families” were being broken up by often-unwarranted removal of their children by nontribal entities, placing many of these children in non-Indian foster and adoptive homes. Citing its responsibility for protecting and preserving Indian tribes, Congressional Research Service https://crsreports.congress.gov LSB10245 Congressional Research Service 2 Congress passed ICWA to protect Indian children as vital to the tribes’ continued existence. ICWA is designed to do two primary things: (1) set standards for placing Indian children with foster or adoptive families, and (2) help tribes set up child and family programs. Though a number of lawsuits have challenged ICWA over the past 40 years, including on the grounds that the statute impermissibly treated Indian children differently on the basis of race, until Brackeen, none of those challenges had been successful. Instead, courts in prior cases had noted Congress’s “plenary” authority over Indian affairs—derived principally from the Indian Commerce Clause and the Treaty Power—and concluded that applying special rules to Indian children was constitutional because, among other things, the distinction between Indians and non-Indians was not an impermissible race-based classification, but was instead a recognition of the unique political status of Indian tribes. This Sidebar gives a brief overview of ICWA, outlines the Brackeen court’s decision with relevant legal context, and explores the possible impacts, including potential for higher court and congressional action. Relevant ICWA provisions and associated regulations Most relevant to the claims at issue in Brackeen, ICWA sets forth a series of duties that must be fulfilled for Indian child placements. For the purposes of ICWA, an “Indian child” is any unmarried person under eighteen who is either a member of an Indian tribe or is both eligible for membership in an Indian tribe and the biological child of a member of an Indian tribe. Three main aspects of ICWA are relevant to the issues raised in Brackeen. First, under ICWA, any party seeking involuntary termination of parental rights to an Indian child under state law must first demonstrate that active efforts have been made to provide remedial services and rehabilitative programs designed to prevent the breakup of the Indian family. Second, involuntary termination requires evidence beyond a reasonable doubt (including expert witness testimony), that the continued custody of the child by the parent or Indian custodian would likely result in serious emotional or physical damage to the child. Third, when an Indian child is placed with a foster or adoptive family under state law, ICWA lists general preferences for that placement: (1) a member of the child’s extended family; (2) other members of the Indian child’s tribe; or (3) other Indian families. However, if a tribe wants to re-order those preferences for Indian children associated with that tribe, it may pass a resolution doing so, and state agencies and courts generally must follow that amended order of preference. In any event, ICWA provides that these preferences may be circumvented in an individual case upon a showing of “good cause.” The Bureau of Indian Affairs (BIA) has authority to make regulations governing ICWA’s implementation. Though BIA chose not to do so when the statute was first passed, in 2016 it issued a Final Rule aimed at reconciling different states’ interpretations of ICWA—for example, by clarifying the circumstances in which “good cause” exists for circumventing ICWA’s placement preferences. Brackeen v. Zinke: the plaintiffs’ claims and the district court’s decision A group of plaintiffs comprising three states (Indiana, Louisiana, and Texas) and several private parties— primarily non-Indian couples who had adopted or wanted to adopt an Indian child—challenged several facets of ICWA and related regulations (including the 2016 Final Rule, as well as certain funding provisions conditioned on ICWA compliance), seeking to have them declared unconstitutional or otherwise rendered invalid. They filed these challenges in the United States District Court for the Northern District of Texas, where Judge Reed O’Connor did declare much of ICWA unconstitutional, granting nearly all of the plaintiffs’ claims. (This decision is arguably the second-most consequential decision by Judge O’Connor in recent months, as he ruled in December 2018 that the Affordable Care Act was also unconstitutional). The federal defendants, intervening tribes, and a group of amicus curiae Congressional Research Service 3 including numerous federally recognized tribes, several Indian organizations, and a number of states, disputed plaintiffs’ characterization of ICWA and contended the challenged laws and implementing regulations were lawful. The plaintiffs’ claims about ICWA’s validity, and the court’s responses to them, are discussed below. Equal protection: does ICWA use a race-based classification, and if so, can it survive strict scrutiny? The state and the individual plaintiffs together claimed that ICWA ran afoul of the Fifth Amendment’s equal protection guarantees, by impermissibly using a race-based classification. The plaintiffs’ claim relied primarily on the Supreme Court’s decisions in two cases. First, in Adarand Constructors v. Peña, the Supreme Court established that any time the federal government subjects individuals to unequal treatment based on their race, that action is subject to “strict scrutiny”—a test that asks whether the classification (1) serves a compelling government interest and (2) is narrowly tailored to further that interest. Second, in Rice v. Cayetano, in the course of invalidating a Hawaiian law that permitted only persons of native Hawaiian descent to vote in certain elections, the Supreme Court recognized that “[a]ncestry can be a proxy for race” and may be subject to the same constitutional limitations as directly race-based classifications. The plaintiffs in Brackeen argued that ICWA involved a race-based classification because its definition of Indian children was based on the children’s ancestry, rather than strictly on membership in a federally recognized tribe. Plaintiffs alleged that this classification neither served any compelling interest, nor was narrowly tailored. The federal defendants, intervening tribes, and several amici disputed plaintiffs’ characterization of ICWA as a race-based classification. In particular, they emphasized longstanding Supreme Court jurisprudence holding that the federal government’s relationship with federally recognized Indian tribes is based on a political, rather than racial categorization. For example, in Morton v. Mancari, the Court upheld BIA’s employment preference for members of federally recognized tribes because the preference was a political classification—it singled out members of tribal entities who have a unique relationship with the federal government—rather than a racial one. The Supreme Court further opined that because “[l]iterally every piece of legislation dealing with Indian tribes” is “explicitly designed to help only Indians,” deeming such legislation racial discrimination would jeopardize “the solemn commitment of the Government toward the Indians.” Because the federal defendants relied on the argument that ICWA’s distinctions were political rather than racial in nature, they proffered no arguments on whether ICWA would withstand the strict scrutiny that would be applied if it were a race-based classification. However, they asked that the court permit additional briefing in the event strict scrutiny applied—a request that the court denied. The district court, however, agreed with the plaintiffs that the definition of Indian children was race-based rather than political. In doing so, the court concluded that this case was more like Rice than like Mancari, because Mancari involved only tribe members rather than Indians eligible for tribal membership. The court then decided—in the absence of any counterarguments from the government—that the race-based classification was not narrowly tailored, even assuming that it served a compelling interest. Nondelegation: does ICWA impermissibly delegate legislative power to tribes? The state plaintiffs argued that giving the tribes power to reorder ICWA’s placement preferences violated the nondelegation doctrine, which generally prohibits Congress from delegating its core legislative powers, whether to other government entities or to private parties. Courts generally use the “intelligible principle” test to assess whether a congressional delegation of legislative power to governmental entities is permissible. This is a forgiving standard; the Supreme Court has not invalidated a statute on these Congressional Research Service 4 grounds since 1935. However, some have also read the Court’s jurisprudence as prohibiting Congress from delegating its powers to private entities outside the government. Here, the district court relied upon both these understandings of the nondelegation doctrine to conclude that ICWA was invalid. First, the court held that Congress had not delineated a clear legal framework to guide how the delegated authority under ICWA would be implemented. Instead, the district court agreed with plaintiffs that the Indian tribes’ authority to reorder adoption placement preferences under ICWA was an essentially legislative authority that could not be delegated. Moreover, the court decided that even if that power could be delegated in some circumstances, Indian tribes were akin to private entities that could not exercise delegated powers. The district court was not receptive to arguments that Indian tribes are fundamentally distinct from other private parties (such as corporations), and should thus be treated differently in nondelegation analysis. Anti-commandeering: does ICWA infringe on state sovereignty over child custody matters, forcing the state to perform federal regulatory functions? The state plaintiffs claimed ICWA violated the anti-commandeering doctrine, rooted in the Constitution’s allocation of powers between the federal government and the states, which prohibits Congress from forcing state political branches to perform regulatory functions on the federal government’s behalf. The court granted this claim, agreeing that ICWA requires state courts and executive agencies to apply federal standards and directives to policy areas that are normally reserved for non-federal jurisdiction, such as adoptions, foster care policies, and other child custody issues. The district court tersely rejected the federal government’s argument that ICWA is instead an exercise of Congress’s “plenary and exclusive” authority over Indian tribes. Agency rulemaking: did a 2016 regulation violate the APA? The plaintiffs also used the Administrative Procedure Act (APA) to challenge the BIA’s 2016 Final Rule. The challenged rule tried to establish uniformity in ICWA’s application by, among other things, clarifying the “good cause” requirement for circumventing ICWA’s placement preferences for Indian children. The district court took a two-pronged approach to plaintiffs’ claims that BIA’s regulation was impermissible under the APA. First, the court announced that any regulation implementing the newly invalid portions of ICWA (i.e., the parts of ICWA that the court had already declared unconstitutional) should be struck down. The court then held in the alternative that the regulation exceeded the scope of BIA’s statutory regulatory authority—in the court’s view, the regulation “clarified” a provision that was not ambiguous and needed no clarification. Because the district court viewed the underlying provision as unambiguous, it gave no deference to the agency’s determination that the regulation was necessary. Remaining claims: Indian Commerce Clause and due process The court purported to grant plaintiffs’ claim that ICWA itself exceeded Congress’s legislative powers under the Indian Commerce Clause, but did so as an extension of its ruling that ICWA violated the anticommandeering doctrine, as Congress’s exercise of its power over Indian commerce cannot be employed to commandeer the states. Finally, the court denied the individual plaintiffs’ substantive due process claims, premised on ICWA allegedly infringing upon their fundamental rights of custody and family togetherness as foster or wouldbe adoptive parents of Indian children. The district court observed that the Supreme Court has not applied the fundamental rights of custody and of keeping families together to foster families, and the district court declined to extend recognition of such rights to the individual plaintiffs challenging ICWA. Congressional Research Service 5 Additional Context Similar challenges to ICWA have been brought over the years. At least one advocacy group has made challenging ICWA part of its core mission, claiming that Native American children are being harmed because ICWA hinders the ability of (non-Native) persons to adopt them. By contrast, ICWA’s supporters fear that challengers are jeopardizing longstanding principles underlying tribal sovereignty, while “[c]loaking [their] efforts in the language of civil rights.” Until Brackeen, however, direct challenges to ICWA generally had been unsuccessful—with perhaps one limited, but notable, exception. In a 2013 case, Adoptive Couple v. Baby Girl (popularly known as the Baby Veronica case), the U.S. Supreme Court limited the range of circumstances in which ICWA might apply. In a 5-4 decision, the Court ruled that several of ICWA’s provisions were inapplicable if the parent seeking to invoke them never had legal or physical custody of the Indian child. In the Baby Veronica case, that meant that the Indian father—who had never had custody of his daughter—could not invoke his and his tribe’s rights under ICWA to block her adoption. Second, the Court stated that the ICWA’s placement preferences for an Indian child adoption were relevant only if multiple parties actually sought to adopt the Indian child. In the Baby Veronica case, because only one party—a non-Indian couple—was trying to adopt the child, ICWA’s placement preferences could not prevent the adoption from being finalized. The Baby Veronica case was only the second ICWA case heard by the Supreme Court. The first came more than twenty years earlier, in 1989, when the Supreme Court held that, for ICWA purposes, the domicile of an Indian child was the domicile of the parents, regardless of where the child was actually born. The Baby Veronica case thus seemed to signal to some that ICWA was newly ripe for challenges, but the Supreme Court has so far declined to hear other cases challenging ICWA. However, many challenges like Brackeen have been raised in federal or state courts. As one example, the United States Court of Appeals for the Ninth Circuit recently dismissed a challenge to ICWA’s constitutionality, holding that it was mooted by the fact that the would-be adoptive parents had been able to complete their adoptions. In Brackeen v. Zinke, however, Judge O’Connor denied a motion to dismiss on similar grounds. What’s Next? The Brackeen v. Zinke decision has already been appealed to the Fifth Circuit. By stipulation of the parties, briefing in the appeal has been expedited and is scheduled to be completed in February 2019; the case is tentatively calendared for oral argument in March 2019. Although Judge O’Connor declined to stay the effect of his ruling pending appeal, the Fifth Circuit granted just such a stay despite the plaintiffs’ objection, so at least for now, the district court decision will not change the way ICWA is administered in Texas, Louisiana, or Indiana. In the event the Fifth Circuit agrees that ICWA is unconstitutional on one or more grounds, the adversely affected parties would likely seek appeal to the United States Supreme Court. The federal defendants filed their brief in January, arguing that each aspect of the district court’s decision was “unprecedented and in conflict with binding authority.” The brief also renewed challenges to the plaintiffs’ standing and argued that ICWA’s severability clause meant the ruling should have been narrower in any case. With regard to the equal protection claim, the government previewed the argument it would have made in supplemental briefing below: ICWA protects tribe members and their families, which includes the not-yet-enrolled children of tribal members, and is narrowly tailored to protect the best interests of those children. Nonetheless, the government suggested that if the Fifth Circuit agreed that strict scrutiny applied, it should remand to the district court for full briefing on the issue. In addition to ruling on the merits of the constitutional challenge to ICWA, the Fifth Circuit’s decision might also provide an opportunity for an appellate court to elaborate further on many of the Congressional Research Service 6 LSB10245 · VERSION 5 · UPDATED constitutional issues discussed, oftentimes in succinct terms, by the district court in Brackeen. The relationship between the Supreme Court’s jurisprudence on equal protection and tribal issues has prompted extensive legal commentary, and some have questioned what, if any, relevance the Brackeen decision might have for other Indian law statutes. The significance of these issues might make the Brackeen decision, to the extent it is upheld by the Fifth Circuit, particularly ripe for Supreme Court resolution.
+
+USER:
+Summarize the arguments that support and oppose the claim that the ICWA is unconstitutional.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",True,19,14,2764,,38
+Answer only using the information in the provided context and limit your answer to 200 words.,Why is it important for patients with chronic illnesses to engage with their own care?,"2.1.1. Importance of social networks, family support, and peer relationships in chronic disease management Social networks, family support, and peer relationships play a vital role in the effective management of chronic diseases. These forms of support provide emotional, practical, and informational assistance, which are crucial for helping individuals navigate the complexities of their conditions [23]. Family support, for instance, can offer direct help with daily tasks, medication management, and encouragement to adhere to treatment plans, thereby reducing the patient's stress and burden. Strong social networks, including friends and community connections, contribute to a sense of belonging and emotional well-being, which can buffer against the psychological challenges of chronic illness. Peer relationships, such as those found in support groups, provide opportunities for individuals to share experiences, exchange coping strategies, and receive empathy and understanding from others facing similar challenges. These interactions can enhance motivation, reduce feelings of isolation, and improve overall mental health. By leveraging these social resources, patients with chronic diseases are better equipped to manage their health, adhere to treatment regimens, and maintain a higher quality of life [24]. 2.1.2. Impact of social isolation and loneliness on treatment adherence and health-related behaviors Social isolation and loneliness have profound negative impacts on treatment adherence and health-related behaviors in individuals with chronic diseases. When patients feel isolated, they often experience higher levels of stress, anxiety, and depression, which can diminish their motivation to follow treatment regimens and engage in self-care activities. The absence of a supportive social network means there is no one to remind or encourage them to take their medications, attend medical appointments, or maintain healthy lifestyle practices such as regular exercise and proper nutrition [25]. Loneliness can also lead to unhealthy behaviors, such as poor diet, lack of physical activity, and increased substance use, further exacerbating the patient's condition. Furthermore, isolated individuals may lack access to crucial health information and resources that could aid in their disease management. Consequently, social isolation and loneliness not only hinder effective disease management but also contribute to a decline in overall physical and mental health, highlighting the importance of fostering social connections and support systems for individuals with chronic illnesses [26] 2.2. Coping Strategies and Resilience Effective coping strategies are essential for managing chronic illness. Adaptive coping mechanisms, such as problemfocused coping, which involves tackling the problem directly, and emotion-focused coping, which aims to manage emotional responses, can help patients better manage the challenges of chronic disease [27]. These strategies can mitigate the adverse effects of stress and improve overall quality of life. Resilience factors, such as optimism, selfefficacy, and the ability to find meaning in the face of illness, play a significant role in enhancing a patient's ability to cope with chronic conditions. Resilient individuals are more likely to maintain a positive outlook, adhere to treatment regimens, and engage in proactive health behaviors, all of which contribute to better health outcomes and improved quality of life [28]. 2.2.1. Adaptive coping mechanisms Adaptive coping mechanisms play a critical role in managing chronic illness by helping individuals navigate the emotional and practical challenges associated with their condition. Problem-focused coping involves actively addressing the issues causing stress, such as developing a structured treatment plan, seeking information about the illness, or finding solutions to daily obstacles related to the condition [29][30]. This approach empowers patients to take control of their health by directly tackling the problems at hand. Emotion-focused coping, on the other hand, helps individuals manage the emotional responses to their illness. Techniques such as relaxation exercises, mindfulness, and seeking emotional support from friends and family can reduce feelings of anxiety, depression, and frustration. By employing these adaptive coping strategies, patients can mitigate the adverse effects of stress, improve their psychological well-being, and enhance their ability to adhere to treatment plans. Ultimately, these coping mechanisms contribute to a better quality of life and more effective management of chronic illness [31]. 2.2.2. Resilience factors and their role in mitigating stress and enhancing quality of life Resilience factors, such as optimism, self-efficacy, and a strong sense of purpose, play a crucial role in mitigating stress and enhancing the quality of life for individuals managing chronic illness. Optimism helps patients maintain a positive outlook despite their challenges, fostering hope and a belief in positive outcomes [32]. This positive mindset can buffer the impact of stress and encourage proactive health behaviors. Self-efficacy, or the belief in one's ability to manage and control life events, empowers patients to take charge of their treatment and make informed decisions about their health. A strong sense of purpose provides motivation and direction, helping patients find meaning and value in their experiences, which can be particularly important in coping with long-term health issues. These resilience factors collectively reduce the psychological burden of chronic illness, promote better adherence to treatment regimens, and enhance overall well-being, leading to an improved quality of life. By fostering resilience, healthcare providers can help patients build the mental and emotional strength needed to navigate the complexities of chronic disease management [33][34]. 3. Health Beliefs and Patient Engagement Health beliefs, including perceptions of illness and beliefs about treatment efficacy, significantly influence patient behaviors and engagement in self-care. Patients who believe their condition is manageable and that their treatment plan is effective are more likely to adhere to medical advice and participate actively in their care[26]. Conversely, negative health beliefs can lead to disengagement and poor adherence to treatment regimens. Strategies to promote patient engagement include education about the disease and its management, motivational interviewing to build confidence and commitment, and creating a collaborative care environment where patients feel empowered to take an active role in their health. By fostering positive health beliefs and encouraging active participation, healthcare providers can improve treatment adherence and health outcomes [28]. 3.1. Influence of health beliefs, perceptions of illness, and treatment efficacy on patient behaviors Health beliefs, perceptions of illness, and views on treatment efficacy significantly influence patient behaviors and their approach to managing chronic disease. Patients' beliefs about their health, including how they perceive their illness and its severity, can determine their willingness to adhere to treatment plans and engage in self-care activities [35][36]. For instance, if a patient believes that their condition is manageable and that the prescribed treatment is effective, they are more likely to follow medical advice, take medications as directed, and make necessary lifestyle changes. Conversely, if a patient perceives their illness as overwhelming or doubts the efficacy of the treatment, they may be less motivated to adhere to their treatment regimen, potentially leading to poorer health outcomes. These health beliefs also affect psychological responses to illness; patients with a positive outlook are more likely to experience lower levels of stress and anxiety, further promoting better health behaviors. Understanding and addressing these beliefs through patient education and motivational interviewing can help healthcare providers enhance patient engagement, encourage active participation in care, and ultimately improve health outcomes [37]. 3.2. Strategies for promoting patient engagement and active participation in self-care Promoting patient engagement and active participation in self-care involves implementing strategies that empower patients and enhance their motivation to manage their health effectively. One key approach is patient education, which provides individuals with comprehensive information about their condition, treatment options, and the importance of adherence to medical advice. This education can be delivered through various mediums such as brochures, workshops, or digital platforms [39]. Motivational interviewing is another effective technique, where healthcare providers engage in open-ended discussions to explore patients' beliefs and barriers, helping them set achievable goals and find intrinsic motivation for self-care. Building a collaborative care environment is also crucial, where patients are encouraged to take an active role in decision-making processes regarding their treatment plans. Additionally, providing tools and resources, such as self-monitoring apps and support groups, can facilitate self-management by offering continuous support and tracking progress. By creating a supportive and informative environment, healthcare providers can foster greater patient engagement, leading to improved adherence to treatment regimens and better health outcomes [40].","2.1.1. Importance of social networks, family support, and peer relationships in chronic disease management Social networks, family support, and peer relationships play a vital role in the effective management of chronic diseases. These forms of support provide emotional, practical, and informational assistance, which are crucial for helping individuals navigate the complexities of their conditions [23]. Family support, for instance, can offer direct help with daily tasks, medication management, and encouragement to adhere to treatment plans, thereby reducing the patient's stress and burden. Strong social networks, including friends and community connections, contribute to a sense of belonging and emotional well-being, which can buffer against the psychological challenges of chronic illness. Peer relationships, such as those found in support groups, provide opportunities for individuals to share experiences, exchange coping strategies, and receive empathy and understanding from others facing similar challenges. These interactions can enhance motivation, reduce feelings of isolation, and improve overall mental health. By leveraging these social resources, patients with chronic diseases are better equipped to manage their health, adhere to treatment regimens, and maintain a higher quality of life [24]. 2.1.2. Impact of social isolation and loneliness on treatment adherence and health-related behaviors Social isolation and loneliness have profound negative impacts on treatment adherence and health-related behaviors in individuals with chronic diseases. When patients feel isolated, they often experience higher levels of stress, anxiety, and depression, which can diminish their motivation to follow treatment regimens and engage in self-care activities. The absence of a supportive social network means there is no one to remind or encourage them to take their medications, attend medical appointments, or maintain healthy lifestyle practices such as regular exercise and proper nutrition [25]. Loneliness can also lead to unhealthy behaviors, such as poor diet, lack of physical activity, and increased substance use, further exacerbating the patient's condition. Furthermore, isolated individuals may lack access to crucial health information and resources that could aid in their disease management. Consequently, social isolation and loneliness not only hinder effective disease management but also contribute to a decline in overall physical and mental health, highlighting the importance of fostering social connections and support systems for individuals with chronic illnesses [26] 2.2. Coping Strategies and Resilience Effective coping strategies are essential for managing chronic illness. Adaptive coping mechanisms, such as problemfocused coping, which involves tackling the problem directly, and emotion-focused coping, which aims to manage emotional responses, can help patients better manage the challenges of chronic disease [27]. These strategies can mitigate the adverse effects of stress and improve overall quality of life. Resilience factors, such as optimism, selfefficacy, and the ability to find meaning in the face of illness, play a significant role in enhancing a patient's ability to cope with chronic conditions. Resilient individuals are more likely to maintain a positive outlook, adhere to treatment regimens, and engage in proactive health behaviors, all of which contribute to better health outcomes and improved quality of life [28]. 2.2.1. Adaptive coping mechanisms Adaptive coping mechanisms play a critical role in managing chronic illness by helping individuals navigate the emotional and practical challenges associated with their condition. Problem-focused coping involves actively addressing the issues causing stress, such as developing a structured treatment plan, seeking information about the illness, or finding solutions to daily obstacles related to the condition [29][30]. This approach empowers patients to take control of their health by directly tackling the problems at hand. Emotion-focused coping, on the other hand, helps individuals manage the emotional responses to their illness. Techniques such as relaxation exercises, mindfulness, and seeking emotional support from friends and family can reduce feelings of anxiety, depression, and frustration. By employing these adaptive coping strategies, patients can mitigate the adverse effects of stress, improve their psychological well-being, and enhance their ability to adhere to treatment plans. Ultimately, these coping mechanisms contribute to a better quality of life and more effective management of chronic illness [31]. 2.2.2. Resilience factors and their role in mitigating stress and enhancing quality of life Resilience factors, such as optimism, self-efficacy, and a strong sense of purpose, play a crucial role in mitigating stress and enhancing the quality of life for individuals managing chronic illness. Optimism helps patients maintain a positive outlook despite their challenges, fostering hope and a belief in positive outcomes [32]. This positive mindset can buffer the impact of stress and encourage proactive health behaviors. Self-efficacy, or the belief in one's ability to manage and control life events, empowers patients to take charge of their treatment and make informed decisions about their health. A strong sense of purpose provides motivation and direction, helping patients find meaning and value in their experiences, which can be particularly important in coping with long-term health issues. These resilience factors collectively reduce the psychological burden of chronic illness, promote better adherence to treatment regimens, and enhance overall well-being, leading to an improved quality of life. By fostering resilience, healthcare providers can help patients build the mental and emotional strength needed to navigate the complexities of chronic disease management [33][34]. 3. Health Beliefs and Patient Engagement Health beliefs, including perceptions of illness and beliefs about treatment efficacy, significantly influence patient behaviors and engagement in self-care. Patients who believe their condition is manageable and that their treatment plan is effective are more likely to adhere to medical advice and participate actively in their care[26]. Conversely, negative health beliefs can lead to disengagement and poor adherence to treatment regimens. Strategies to promote patient engagement include education about the disease and its management, motivational interviewing to build confidence and commitment, and creating a collaborative care environment where patients feel empowered to take an active role in their health. By fostering positive health beliefs and encouraging active participation, healthcare providers can improve treatment adherence and health outcomes [28]. 3.1. Influence of health beliefs, perceptions of illness, and treatment efficacy on patient behaviors Health beliefs, perceptions of illness, and views on treatment efficacy significantly influence patient behaviors and their approach to managing chronic disease. Patients' beliefs about their health, including how they perceive their illness and its severity, can determine their willingness to adhere to treatment plans and engage in self-care activities [35][36]. For instance, if a patient believes that their condition is manageable and that the prescribed treatment is effective, they are more likely to follow medical advice, take medications as directed, and make necessary lifestyle changes. Conversely, if a patient perceives their illness as overwhelming or doubts the efficacy of the treatment, they may be less motivated to adhere to their treatment regimen, potentially leading to poorer health outcomes. These health beliefs also affect psychological responses to illness; patients with a positive outlook are more likely to experience lower levels of stress and anxiety, further promoting better health behaviors. Understanding and addressing these beliefs through patient education and motivational interviewing can help healthcare providers enhance patient engagement, encourage active participation in care, and ultimately improve health outcomes [37]. 3.2. Strategies for promoting patient engagement and active participation in self-care Promoting patient engagement and active participation in self-care involves implementing strategies that empower patients and enhance their motivation to manage their health effectively. One key approach is patient education, which provides individuals with comprehensive information about their condition, treatment options, and the importance of adherence to medical advice. This education can be delivered through various mediums such as brochures, workshops, or digital platforms [39]. Motivational interviewing is another effective technique, where healthcare providers engage in open-ended discussions to explore patients' beliefs and barriers, helping them set achievable goals and find intrinsic motivation for self-care. Building a collaborative care environment is also crucial, where patients are encouraged to take an active role in decision-making processes regarding their treatment plans. Additionally, providing tools and resources, such as self-monitoring apps and support groups, can facilitate self-management by offering continuous support and tracking progress. By creating a supportive and informative environment, healthcare providers can foster greater patient engagement, leading to improved adherence to treatment regimens and better health outcomes [40]. Why is it important for patients with chronic illnesses to engage with their own care? Answer only using the information in the provided context and limit your answer to 200 words.","Answer only using the information in the provided context and limit your answer to 200 words.
+
+EVIDENCE:
+2.1.1. Importance of social networks, family support, and peer relationships in chronic disease management Social networks, family support, and peer relationships play a vital role in the effective management of chronic diseases. These forms of support provide emotional, practical, and informational assistance, which are crucial for helping individuals navigate the complexities of their conditions [23]. Family support, for instance, can offer direct help with daily tasks, medication management, and encouragement to adhere to treatment plans, thereby reducing the patient's stress and burden. Strong social networks, including friends and community connections, contribute to a sense of belonging and emotional well-being, which can buffer against the psychological challenges of chronic illness. Peer relationships, such as those found in support groups, provide opportunities for individuals to share experiences, exchange coping strategies, and receive empathy and understanding from others facing similar challenges. These interactions can enhance motivation, reduce feelings of isolation, and improve overall mental health. By leveraging these social resources, patients with chronic diseases are better equipped to manage their health, adhere to treatment regimens, and maintain a higher quality of life [24]. 2.1.2. Impact of social isolation and loneliness on treatment adherence and health-related behaviors Social isolation and loneliness have profound negative impacts on treatment adherence and health-related behaviors in individuals with chronic diseases. When patients feel isolated, they often experience higher levels of stress, anxiety, and depression, which can diminish their motivation to follow treatment regimens and engage in self-care activities. The absence of a supportive social network means there is no one to remind or encourage them to take their medications, attend medical appointments, or maintain healthy lifestyle practices such as regular exercise and proper nutrition [25]. Loneliness can also lead to unhealthy behaviors, such as poor diet, lack of physical activity, and increased substance use, further exacerbating the patient's condition. Furthermore, isolated individuals may lack access to crucial health information and resources that could aid in their disease management. Consequently, social isolation and loneliness not only hinder effective disease management but also contribute to a decline in overall physical and mental health, highlighting the importance of fostering social connections and support systems for individuals with chronic illnesses [26] 2.2. Coping Strategies and Resilience Effective coping strategies are essential for managing chronic illness. Adaptive coping mechanisms, such as problemfocused coping, which involves tackling the problem directly, and emotion-focused coping, which aims to manage emotional responses, can help patients better manage the challenges of chronic disease [27]. These strategies can mitigate the adverse effects of stress and improve overall quality of life. Resilience factors, such as optimism, selfefficacy, and the ability to find meaning in the face of illness, play a significant role in enhancing a patient's ability to cope with chronic conditions. Resilient individuals are more likely to maintain a positive outlook, adhere to treatment regimens, and engage in proactive health behaviors, all of which contribute to better health outcomes and improved quality of life [28]. 2.2.1. Adaptive coping mechanisms Adaptive coping mechanisms play a critical role in managing chronic illness by helping individuals navigate the emotional and practical challenges associated with their condition. Problem-focused coping involves actively addressing the issues causing stress, such as developing a structured treatment plan, seeking information about the illness, or finding solutions to daily obstacles related to the condition [29][30]. This approach empowers patients to take control of their health by directly tackling the problems at hand. Emotion-focused coping, on the other hand, helps individuals manage the emotional responses to their illness. Techniques such as relaxation exercises, mindfulness, and seeking emotional support from friends and family can reduce feelings of anxiety, depression, and frustration. By employing these adaptive coping strategies, patients can mitigate the adverse effects of stress, improve their psychological well-being, and enhance their ability to adhere to treatment plans. Ultimately, these coping mechanisms contribute to a better quality of life and more effective management of chronic illness [31]. 2.2.2. Resilience factors and their role in mitigating stress and enhancing quality of life Resilience factors, such as optimism, self-efficacy, and a strong sense of purpose, play a crucial role in mitigating stress and enhancing the quality of life for individuals managing chronic illness. Optimism helps patients maintain a positive outlook despite their challenges, fostering hope and a belief in positive outcomes [32]. This positive mindset can buffer the impact of stress and encourage proactive health behaviors. Self-efficacy, or the belief in one's ability to manage and control life events, empowers patients to take charge of their treatment and make informed decisions about their health. A strong sense of purpose provides motivation and direction, helping patients find meaning and value in their experiences, which can be particularly important in coping with long-term health issues. These resilience factors collectively reduce the psychological burden of chronic illness, promote better adherence to treatment regimens, and enhance overall well-being, leading to an improved quality of life. By fostering resilience, healthcare providers can help patients build the mental and emotional strength needed to navigate the complexities of chronic disease management [33][34]. 3. Health Beliefs and Patient Engagement Health beliefs, including perceptions of illness and beliefs about treatment efficacy, significantly influence patient behaviors and engagement in self-care. Patients who believe their condition is manageable and that their treatment plan is effective are more likely to adhere to medical advice and participate actively in their care[26]. Conversely, negative health beliefs can lead to disengagement and poor adherence to treatment regimens. Strategies to promote patient engagement include education about the disease and its management, motivational interviewing to build confidence and commitment, and creating a collaborative care environment where patients feel empowered to take an active role in their health. By fostering positive health beliefs and encouraging active participation, healthcare providers can improve treatment adherence and health outcomes [28]. 3.1. Influence of health beliefs, perceptions of illness, and treatment efficacy on patient behaviors Health beliefs, perceptions of illness, and views on treatment efficacy significantly influence patient behaviors and their approach to managing chronic disease. Patients' beliefs about their health, including how they perceive their illness and its severity, can determine their willingness to adhere to treatment plans and engage in self-care activities [35][36]. For instance, if a patient believes that their condition is manageable and that the prescribed treatment is effective, they are more likely to follow medical advice, take medications as directed, and make necessary lifestyle changes. Conversely, if a patient perceives their illness as overwhelming or doubts the efficacy of the treatment, they may be less motivated to adhere to their treatment regimen, potentially leading to poorer health outcomes. These health beliefs also affect psychological responses to illness; patients with a positive outlook are more likely to experience lower levels of stress and anxiety, further promoting better health behaviors. Understanding and addressing these beliefs through patient education and motivational interviewing can help healthcare providers enhance patient engagement, encourage active participation in care, and ultimately improve health outcomes [37]. 3.2. Strategies for promoting patient engagement and active participation in self-care Promoting patient engagement and active participation in self-care involves implementing strategies that empower patients and enhance their motivation to manage their health effectively. One key approach is patient education, which provides individuals with comprehensive information about their condition, treatment options, and the importance of adherence to medical advice. This education can be delivered through various mediums such as brochures, workshops, or digital platforms [39]. Motivational interviewing is another effective technique, where healthcare providers engage in open-ended discussions to explore patients' beliefs and barriers, helping them set achievable goals and find intrinsic motivation for self-care. Building a collaborative care environment is also crucial, where patients are encouraged to take an active role in decision-making processes regarding their treatment plans. Additionally, providing tools and resources, such as self-monitoring apps and support groups, can facilitate self-management by offering continuous support and tracking progress. By creating a supportive and informative environment, healthcare providers can foster greater patient engagement, leading to improved adherence to treatment regimens and better health outcomes [40].
+
+USER:
+Why is it important for patients with chronic illnesses to engage with their own care?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,16,15,1324,,509
+[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.,"What about composites, like what the Titan was made of, make them unsafe in deep water, and why do they design subs with new advanced materials and composites when we already know steel works fine? Also what are some of the actual materials they use?","Several new technologies have been introduced in the submersibles developed during this period compared to the submersibles developed during the first period. The technical characteristics of these submersibles can be summarized as follows: (a) Use of a solid buoyancy material. This change allows for a more compact design and eliminates the need for large gasoline tanks, contributing significantly to the miniaturization of submersibles. (b) Use of ultra-high-strength steel and lightweight metals such as maraging steel, aluminum, and titanium. These materials offer a combination of strength and lightness, enabling the construction of smaller and more maneuverable submersibles and reducing manufacturing and operating costs. As a result of these advancements, submersible technology has been significantly improved in terms of miniaturization, cost reduction, and increased production. This has led to a larger number of submersibles being built in many countries, reflecting the widespread adoption and utilization of this technology. Pressure hull The primary design objective of the pressure hull in submersibles is to achieve a balance between reducing the hull weight and increasing the internal volume while ensuring structural strength and stability [19]. This balance is crucial because it directly affects the payload capacity of submersible. The weight displacement ratio is a key factor influenced by the shape and materials used in constructing the pressure hull. The weight displacement ratio refers to the ratio of the weight of the submersible (including its equipment, payload, and crew) to the volume of water displaced by the submersible hull [8]. To maximize the payload capacity, submersible designers aim to minimize the weight displacement ratio. This can be achieved through careful consideration of the shape and materials used in the construction of the pressure hull. The shape of the hull should be optimized to reduce drag and improve hydrodynamics, while the materials used should be strong and lightweight. By reducing the weight displacement ratio, submersibles can provide a greater payload capacity, allowing for the inclusion of more equipment, sensors, and scientific instruments. This, in turn, enhances the submersible’s capabilities for various applications, such as scientific research, underwater exploration, and deep-sea operations. Regarding the shape, pressure hulls in submersibles often take on conventional forms such as spherical, cylindrical, or a combination of these shapes. Spherical pressure hulls are commonly used in large depth manned submersibles such as New Alvin, Nautile, MIR I, MIR II, Shinkai 6500, Jiaolong, Shenhaiyongshi, Fendouzhe, and Limiting Factor. The spherical shape provides structural strength and evenly distributes external pressure, making it suitable for withstanding extreme depths. Additionally, some small manned submersibles used for scientific research, such as Triton, c-explorer3, and Deep Flight Dragon, are also spherically shaped for similar reasons. Cylindrical pressure hulls are relatively easy to process and manufacture, and they offer high utilization of internal space. This shape is commonly adopted by large sightseeing submersibles and small private submersibles such as Atlantis, MarkII, Aurora-5, and C-Explorer5. The cylindrical shape allows for the efficient use of space for passengers or equipment while maintaining structural integrity. The lotus-root shape represents a novel pressure hull structure consisting of a series of intersecting spherical shells [20]. This shape can consist of double, triple, quadruple, or multiple intersecting spherical shells. The AURORA-6 submersible is based on this innovative lotus-root shape, which provides increased strength and stability while maximizing the internal volume. Selecting a suitable pressure hull shape depends on various factors, including the intended purpose, depth requirements, structural considerations, and design objectives of the submersible. Each shape offers unique advantages and considerations in terms of structural strength, internal space utilization, and overall performance. In terms of materials, special marine environments impose greater requirements on the pressure hull materials of submersibles. The materials used in submersibles can be categorized into two types: metallic and nonmetallic materials [21]. Metallic materials commonly include ultra-high strength steel, aluminum alloys, and titanium alloys [8]. For instance, the Mir1 and Mir2 submersibles were built with pressure hulls made from ultra-high strengh steel. On the other hand, underwater gliders such as Spray Glider, Seaglider, Slocum, and PETREL were built with pressure hulls made from aluminum alloys. Notable submersibles such as Nautile, Shinakai, Alvin, New Alvin, Limiting Factor, Jiaolong, Fendouzhe, and Shenhaiyongshi were all built with pressured hulls made from titanium alloys. Nonmetallic materials mainly consist of structural ceramics, advanced polymer matrix composites [22], and organic glass. In the Nereus submersible, structural ceramics were utilized as the buoyancy material. Submersibles such as AUSSMOD2, Deep Glider, Cyclops1, and Haiyi were developed with pressure hulls made from advanced polymer matrix composites. Additionally, organic glass is used in Huandao Jiaolong as its pressure hull material. The weaknesses of composites have been revealed in several manned submersibles, such as the Deepflight Challenger and Titan. The recent tragedy involving Titan serves as a reminder that the use of inhomogeneous materials in a manned cabin must be approached with great caution, considering the homogeneity of deep-water pressure. The utilization of advanced materials has facilitated the construction of stronger and lighter pressure hulls, providing increased interior space for submersible operators. These innovative materials enable the pressure hulls to withstand higher underwater pressures, allowing for deeper diving depths. This advancement in materials not only enables deeper exploration but also enables the miniaturization of submersibles. Regarding the design of manned cabins, designing the viewport is technically difficult. Presently, most people apply the American Society of Mechanical Engineers (ASME) PVHO-1 rule [23]. In cooperative studies of full ocean depth manned submersibles [5], Sauli Ruohonen, the chief designer of the MIR submersible, Anatoly Sagalevitch, the chief pilot of the MIR submersible, and Weicheng Cui, the chief designer of the Rainbowfish full ocean depth manned submersible, all agreed that the ASME rule is too conservative and that its thickness can be reduced. After a series of 13 models tested by Cui’s team, they found that the thickness can be reduced from 403 mm for the rule requirement to 240 mm for a full ocean depth manned cabin with a diameter of 2.1 m [24]. This approach can significantly reduce the total weight of the manned cabin.","[question] What about composites, like what the Titan was made of, make them unsafe in deep water, and why do they design subs with new advanced materials and composites when we already know steel works fine? Also what are some of the actual materials they use? ===================== [text] Several new technologies have been introduced in the submersibles developed during this period compared to the submersibles developed during the first period. The technical characteristics of these submersibles can be summarized as follows: (a) Use of a solid buoyancy material. This change allows for a more compact design and eliminates the need for large gasoline tanks, contributing significantly to the miniaturization of submersibles. (b) Use of ultra-high-strength steel and lightweight metals such as maraging steel, aluminum, and titanium. These materials offer a combination of strength and lightness, enabling the construction of smaller and more maneuverable submersibles and reducing manufacturing and operating costs. As a result of these advancements, submersible technology has been significantly improved in terms of miniaturization, cost reduction, and increased production. This has led to a larger number of submersibles being built in many countries, reflecting the widespread adoption and utilization of this technology. Pressure hull The primary design objective of the pressure hull in submersibles is to achieve a balance between reducing the hull weight and increasing the internal volume while ensuring structural strength and stability [19]. This balance is crucial because it directly affects the payload capacity of submersible. The weight displacement ratio is a key factor influenced by the shape and materials used in constructing the pressure hull. The weight displacement ratio refers to the ratio of the weight of the submersible (including its equipment, payload, and crew) to the volume of water displaced by the submersible hull [8]. To maximize the payload capacity, submersible designers aim to minimize the weight displacement ratio. This can be achieved through careful consideration of the shape and materials used in the construction of the pressure hull. The shape of the hull should be optimized to reduce drag and improve hydrodynamics, while the materials used should be strong and lightweight. By reducing the weight displacement ratio, submersibles can provide a greater payload capacity, allowing for the inclusion of more equipment, sensors, and scientific instruments. This, in turn, enhances the submersible’s capabilities for various applications, such as scientific research, underwater exploration, and deep-sea operations. Regarding the shape, pressure hulls in submersibles often take on conventional forms such as spherical, cylindrical, or a combination of these shapes. Spherical pressure hulls are commonly used in large depth manned submersibles such as New Alvin, Nautile, MIR I, MIR II, Shinkai 6500, Jiaolong, Shenhaiyongshi, Fendouzhe, and Limiting Factor. The spherical shape provides structural strength and evenly distributes external pressure, making it suitable for withstanding extreme depths. Additionally, some small manned submersibles used for scientific research, such as Triton, c-explorer3, and Deep Flight Dragon, are also spherically shaped for similar reasons. Cylindrical pressure hulls are relatively easy to process and manufacture, and they offer high utilization of internal space. This shape is commonly adopted by large sightseeing submersibles and small private submersibles such as Atlantis, MarkII, Aurora-5, and C-Explorer5. The cylindrical shape allows for the efficient use of space for passengers or equipment while maintaining structural integrity. The lotus-root shape represents a novel pressure hull structure consisting of a series of intersecting spherical shells [20]. This shape can consist of double, triple, quadruple, or multiple intersecting spherical shells. The AURORA-6 submersible is based on this innovative lotus-root shape, which provides increased strength and stability while maximizing the internal volume. Selecting a suitable pressure hull shape depends on various factors, including the intended purpose, depth requirements, structural considerations, and design objectives of the submersible. Each shape offers unique advantages and considerations in terms of structural strength, internal space utilization, and overall performance. In terms of materials, special marine environments impose greater requirements on the pressure hull materials of submersibles. The materials used in submersibles can be categorized into two types: metallic and nonmetallic materials [21]. Metallic materials commonly include ultra-high strength steel, aluminum alloys, and titanium alloys [8]. For instance, the Mir1 and Mir2 submersibles were built with pressure hulls made from ultra-high strengh steel. On the other hand, underwater gliders such as Spray Glider, Seaglider, Slocum, and PETREL were built with pressure hulls made from aluminum alloys. Notable submersibles such as Nautile, Shinakai, Alvin, New Alvin, Limiting Factor, Jiaolong, Fendouzhe, and Shenhaiyongshi were all built with pressured hulls made from titanium alloys. Nonmetallic materials mainly consist of structural ceramics, advanced polymer matrix composites [22], and organic glass. In the Nereus submersible, structural ceramics were utilized as the buoyancy material. Submersibles such as AUSSMOD2, Deep Glider, Cyclops1, and Haiyi were developed with pressure hulls made from advanced polymer matrix composites. Additionally, organic glass is used in Huandao Jiaolong as its pressure hull material. The weaknesses of composites have been revealed in several manned submersibles, such as the Deepflight Challenger and Titan. The recent tragedy involving Titan serves as a reminder that the use of inhomogeneous materials in a manned cabin must be approached with great caution, considering the homogeneity of deep-water pressure. The utilization of advanced materials has facilitated the construction of stronger and lighter pressure hulls, providing increased interior space for submersible operators. These innovative materials enable the pressure hulls to withstand higher underwater pressures, allowing for deeper diving depths. This advancement in materials not only enables deeper exploration but also enables the miniaturization of submersibles. Regarding the design of manned cabins, designing the viewport is technically difficult. Presently, most people apply the American Society of Mechanical Engineers (ASME) PVHO-1 rule [23]. In cooperative studies of full ocean depth manned submersibles [5], Sauli Ruohonen, the chief designer of the MIR submersible, Anatoly Sagalevitch, the chief pilot of the MIR submersible, and Weicheng Cui, the chief designer of the Rainbowfish full ocean depth manned submersible, all agreed that the ASME rule is too conservative and that its thickness can be reduced. After a series of 13 models tested by Cui’s team, they found that the thickness can be reduced from 403 mm for the rule requirement to 240 mm for a full ocean depth manned cabin with a diameter of 2.1 m [24]. This approach can significantly reduce the total weight of the manned cabin. https://spj.science.org/doi/10.34133/olar.0036 ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.","[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
+
+EVIDENCE:
+Several new technologies have been introduced in the submersibles developed during this period compared to the submersibles developed during the first period. The technical characteristics of these submersibles can be summarized as follows: (a) Use of a solid buoyancy material. This change allows for a more compact design and eliminates the need for large gasoline tanks, contributing significantly to the miniaturization of submersibles. (b) Use of ultra-high-strength steel and lightweight metals such as maraging steel, aluminum, and titanium. These materials offer a combination of strength and lightness, enabling the construction of smaller and more maneuverable submersibles and reducing manufacturing and operating costs. As a result of these advancements, submersible technology has been significantly improved in terms of miniaturization, cost reduction, and increased production. This has led to a larger number of submersibles being built in many countries, reflecting the widespread adoption and utilization of this technology. Pressure hull The primary design objective of the pressure hull in submersibles is to achieve a balance between reducing the hull weight and increasing the internal volume while ensuring structural strength and stability [19]. This balance is crucial because it directly affects the payload capacity of submersible. The weight displacement ratio is a key factor influenced by the shape and materials used in constructing the pressure hull. The weight displacement ratio refers to the ratio of the weight of the submersible (including its equipment, payload, and crew) to the volume of water displaced by the submersible hull [8]. To maximize the payload capacity, submersible designers aim to minimize the weight displacement ratio. This can be achieved through careful consideration of the shape and materials used in the construction of the pressure hull. The shape of the hull should be optimized to reduce drag and improve hydrodynamics, while the materials used should be strong and lightweight. By reducing the weight displacement ratio, submersibles can provide a greater payload capacity, allowing for the inclusion of more equipment, sensors, and scientific instruments. This, in turn, enhances the submersible’s capabilities for various applications, such as scientific research, underwater exploration, and deep-sea operations. Regarding the shape, pressure hulls in submersibles often take on conventional forms such as spherical, cylindrical, or a combination of these shapes. Spherical pressure hulls are commonly used in large depth manned submersibles such as New Alvin, Nautile, MIR I, MIR II, Shinkai 6500, Jiaolong, Shenhaiyongshi, Fendouzhe, and Limiting Factor. The spherical shape provides structural strength and evenly distributes external pressure, making it suitable for withstanding extreme depths. Additionally, some small manned submersibles used for scientific research, such as Triton, c-explorer3, and Deep Flight Dragon, are also spherically shaped for similar reasons. Cylindrical pressure hulls are relatively easy to process and manufacture, and they offer high utilization of internal space. This shape is commonly adopted by large sightseeing submersibles and small private submersibles such as Atlantis, MarkII, Aurora-5, and C-Explorer5. The cylindrical shape allows for the efficient use of space for passengers or equipment while maintaining structural integrity. The lotus-root shape represents a novel pressure hull structure consisting of a series of intersecting spherical shells [20]. This shape can consist of double, triple, quadruple, or multiple intersecting spherical shells. The AURORA-6 submersible is based on this innovative lotus-root shape, which provides increased strength and stability while maximizing the internal volume. Selecting a suitable pressure hull shape depends on various factors, including the intended purpose, depth requirements, structural considerations, and design objectives of the submersible. Each shape offers unique advantages and considerations in terms of structural strength, internal space utilization, and overall performance. In terms of materials, special marine environments impose greater requirements on the pressure hull materials of submersibles. The materials used in submersibles can be categorized into two types: metallic and nonmetallic materials [21]. Metallic materials commonly include ultra-high strength steel, aluminum alloys, and titanium alloys [8]. For instance, the Mir1 and Mir2 submersibles were built with pressure hulls made from ultra-high strengh steel. On the other hand, underwater gliders such as Spray Glider, Seaglider, Slocum, and PETREL were built with pressure hulls made from aluminum alloys. Notable submersibles such as Nautile, Shinakai, Alvin, New Alvin, Limiting Factor, Jiaolong, Fendouzhe, and Shenhaiyongshi were all built with pressured hulls made from titanium alloys. Nonmetallic materials mainly consist of structural ceramics, advanced polymer matrix composites [22], and organic glass. In the Nereus submersible, structural ceramics were utilized as the buoyancy material. Submersibles such as AUSSMOD2, Deep Glider, Cyclops1, and Haiyi were developed with pressure hulls made from advanced polymer matrix composites. Additionally, organic glass is used in Huandao Jiaolong as its pressure hull material. The weaknesses of composites have been revealed in several manned submersibles, such as the Deepflight Challenger and Titan. The recent tragedy involving Titan serves as a reminder that the use of inhomogeneous materials in a manned cabin must be approached with great caution, considering the homogeneity of deep-water pressure. The utilization of advanced materials has facilitated the construction of stronger and lighter pressure hulls, providing increased interior space for submersible operators. These innovative materials enable the pressure hulls to withstand higher underwater pressures, allowing for deeper diving depths. This advancement in materials not only enables deeper exploration but also enables the miniaturization of submersibles. Regarding the design of manned cabins, designing the viewport is technically difficult. Presently, most people apply the American Society of Mechanical Engineers (ASME) PVHO-1 rule [23]. In cooperative studies of full ocean depth manned submersibles [5], Sauli Ruohonen, the chief designer of the MIR submersible, Anatoly Sagalevitch, the chief pilot of the MIR submersible, and Weicheng Cui, the chief designer of the Rainbowfish full ocean depth manned submersible, all agreed that the ASME rule is too conservative and that its thickness can be reduced. After a series of 13 models tested by Cui’s team, they found that the thickness can be reduced from 403 mm for the rule requirement to 240 mm for a full ocean depth manned cabin with a diameter of 2.1 m [24]. This approach can significantly reduce the total weight of the manned cabin.
+
+USER:
+What about composites, like what the Titan was made of, make them unsafe in deep water, and why do they design subs with new advanced materials and composites when we already know steel works fine? Also what are some of the actual materials they use?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,28,45,999,,696
+Draw your answer from the below context block.,I am having trouble understanding the text; please summarize it so that people who are unfamiliar with nanomaterials can understand and learn about them.,"Aim of Work Nanomaterials (nanocrystalline materials) are substances possessing grain sizes on the order of a billionth of a meter. They manifest extraordinarily charming and beneficial properties, which can be exploited for a ramification of structural and nonstructural packages. Seeing that Nanomaterials own unique, beneficial chemical, bodily, and mechanical houses, they may be use for an extensive form of programs, like next era laptop chips, kinetic power (KE) penetrators with more advantageous lethality, better insulation materials, Phosphors for excessive-Defination TV, Low cost Flat-Panel displays, more and more difficult cutting tools, elimination of pollution, excessive strength density, Batteries, excessive power magnets, high sensitive sensors, motors with greater gas efficiency, Aerospace addititives with superior performance characteristics, higher and density weapons platforms, Longer-Lasting Satellites. Longer-Lasting medical implants, Ductile, Machinable ceramics, huge electro chromic show devices. Nanotechnology has the potential to be the key to a brand new world in the field of construction and building materials. Although replication of natural systems is one of the most promising areas of this technology, scientists are still trying to grasp their astonishing complexities. Furthermore, a nanotechnology is a rapidly expanding area of research where novel properties of materials manufactured on nanoscale can be utilized for the benefit of construction infrastructure, Therefore, the main objective of preparing this study is the importance of nanomaterials and their use in many modern industries due to their mechanical, electrical and chemical properties and for the purpose of identifying the most important methods of preparation, detection methods, types and applications of each type. Abstract Nanomaterials (NMs) are gaining significance in technological applications due to their tunable chemical, physical, and mechanical properties and enhanced performance when compared with their bulkier counterparts. This study presents a summary of the general types of NMs and provides an overview of the various synthesis methods of nanoparticles (NPs) and their functionalization via covalent or noncovalent interactions using different methods. It highlights the techniques used for the characterization of NPs and discusses their physical and chemical properties. Due to their unique properties, NMs have several applications and have become part of our daily lives. As a result, research is gaining attention since some NPs are not easily degraded by the environment. Thus, this study also highlights research efforts into the fate, behavior, of different classes of (NMs) in the environment. General Introduction Nanotechnology is an interdisciplinary study which allows us to develop new materials with new, interesting and useful properties. These new materials are nanomaterials made from nanoparticles. Nanoparticles are ultra-small particles with exceptional properties which can direct medicines straight to the place where the human body needs them, they can make materials stronger and they can convert solar energy more efficiently. Nanoparticles possess different properties and behave differently to the classical, larger building blocks of substances. From a scientific point of view, these interesting new properties are not so much the results from the fact that nanoparticles are small, but they result from the fact that a particle consisting of a relatively limited number of molecules behaves and interacts differently with its surroundings for fundamental physical reasons. Nanoparticles and nanomaterials have gained prominence in technological advancements due to their adjustable physicochemical characteristics such as melting point, wettability, electrical and thermal conductivity, catalytic activity, light absorption and scattering resulting in enhanced performance over their bulk counterparts. By controlling the shape, size and internal order of the nanostructures, properties (electrical conductivity, colour, chemical reactivity, elasticity, etc.) can be modified. Some nanomaterials occur naturally, but of particular interest are engineered nanomaterials (EN), which are designed for, and already being used in many commercial products and processes. They can be found in such things as sunscreens, cosmetics, sporting goods, stainresistant clothing, tires, electronics, as well as many other everyday items, and are used in medicine for purposes of diagnosis, imaging and drug delivery. Engineered nanomaterials are resources designed at the molecular (nanometre) level to take advantage of their small size and novel properties which are generally not seen in their conventional, bulk counterparts. The two main reasons why materials at the nano scale can have different properties are increased relative surface area and new quantum effects. Nanomaterials have a much greater surface area to volume ratio than their conventional forms, which can lead to greater chemical reactivity and affect their strength. Also at the nano scale, quantum effects can become much more important in determining the materials properties and characteristics, leading to novel optical, electrical and magnetic behaviors. 1.1 Definition of Nanomaterials Nanoscale materials are defined as a set of substances where at least one dimension is less than approximately 100 nanometers. A nanometer is one millionth of a millimeter - approximately 100,000 times smaller than the diameter of a human hair. Nanomaterials are of interest because at this scale unique optical, magnetic, electrical, and other properties emerge. These emergent properties have the potential for great impacts in electronics, medicine, and other fields [1] . 1.2 History of Nanomaterials Nanotechnology involves the synthesis and application of materials in dimensions of the order of a billionth of a meter (1x10-9). This categorizes them under ultrafine particles. (Figure 1.1) reveals the size comparison of the nanoparticles against different living and nonliving species [2]. The properties of nanoparticles vary from their bulk counterpart and their chemistry [2]. The electronic structure, reactivity, and thermal and mechanical properties tend to change when the particles reach the nanoscale. Through nanotechnology, we can build materials and devices with control down to the level of individual atoms and molecules. In the past two decades, there were reports of colloids and nanoparticles designed by nature [3, 4]. The history of nanomaterials began immediately after the big bang when Nanostructures were formed in the early meteorites. Nature later evolved many other Nanostructures like seashells, skeletons etc. Nanoscaled smoke particles were formed during the use of fire by early humans. The scientific story of nanomaterials however began much later. One of the first scientific report is the colloidal gold particles synthesized by Michael Faraday as early as 1857. Nanostructured catalysts have also been investigated for over 70 years. By the early 1940’s, precipitated and fumed silica nanoparticles were being manufactured and sold in USA and Germany as substitutes for ultrafine carbon black for rubber reinforcements [1]. Over the past few years, nanomaterials (NMs) have attracted the researchers because of their nanosize, physical, biological, and chemical properties compared to their bulk materials. These NMs are classified based on their size, chemical composition, shape, and sources. Different types of NMs have been synthetized from different sources and they are being classified accordingly. Many NMs have been produced in large quantities based on the requirements for many industrial applications. The two main sources through which NMs are being produced are synthetic source and naturally occurring nanoparticles (NPs). In this chapter, we discuss the types and classifications of NMs and broadly discuss the different types of nanomaterials isolated from natural and synthetic sources [5]. 1.3 Main differences between nanomaterials and bulk materials Nanomaterials are particles that have their size in 1-100 nm range at least in one dimension. We cannot see their particles through the naked eye. Moreover, examples of these materials include nanozymes, titanium dioxide nanoparticles, graphene, etc. Bulk materials are particles that have their size above 100 nm in all dimensions. We can see their particles through the naked eye. The examples of these materials include plaster, sand, gravel, cement, ore, slag, salts, etc.","System Instructions: Draw your answer from the below context block. Question: I am having trouble understanding the text; please summarize it so that people who are unfamiliar with nanomaterials can understand and learn about them. Context Block: Aim of Work Nanomaterials (nanocrystalline materials) are substances possessing grain sizes on the order of a billionth of a meter. They manifest extraordinarily charming and beneficial properties, which can be exploited for a ramification of structural and nonstructural packages. Seeing that Nanomaterials own unique, beneficial chemical, bodily, and mechanical houses, they may be use for an extensive form of programs, like next era laptop chips, kinetic power (KE) penetrators with more advantageous lethality, better insulation materials, Phosphors for excessive-Defination TV, Low cost Flat-Panel displays, more and more difficult cutting tools, elimination of pollution, excessive strength density, Batteries, excessive power magnets, high sensitive sensors, motors with greater gas efficiency, Aerospace addititives with superior performance characteristics, higher and density weapons platforms, Longer-Lasting Satellites. Longer-Lasting medical implants, Ductile, Machinable ceramics, huge electro chromic show devices. Nanotechnology has the potential to be the key to a brand new world in the field of construction and building materials. Although replication of natural systems is one of the most promising areas of this technology, scientists are still trying to grasp their astonishing complexities. Furthermore, a nanotechnology is a rapidly expanding area of research where novel properties of materials manufactured on nanoscale can be utilized for the benefit of construction infrastructure, Therefore, the main objective of preparing this study is the importance of nanomaterials and their use in many modern industries due to their mechanical, electrical and chemical properties and for the purpose of identifying the most important methods of preparation, detection methods, types and applications of each type. Abstract Nanomaterials (NMs) are gaining significance in technological applications due to their tunable chemical, physical, and mechanical properties and enhanced performance when compared with their bulkier counterparts. This study presents a summary of the general types of NMs and provides an overview of the various synthesis methods of nanoparticles (NPs) and their functionalization via covalent or noncovalent interactions using different methods. It highlights the techniques used for the characterization of NPs and discusses their physical and chemical properties. Due to their unique properties, NMs have several applications and have become part of our daily lives. As a result, research is gaining attention since some NPs are not easily degraded by the environment. Thus, this study also highlights research efforts into the fate, behavior, of different classes of (NMs) in the environment. General Introduction Nanotechnology is an interdisciplinary study which allows us to develop new materials with new, interesting and useful properties. These new materials are nanomaterials made from nanoparticles. Nanoparticles are ultra-small particles with exceptional properties which can direct medicines straight to the place where the human body needs them, they can make materials stronger and they can convert solar energy more efficiently. Nanoparticles possess different properties and behave differently to the classical, larger building blocks of substances. From a scientific point of view, these interesting new properties are not so much the results from the fact that nanoparticles are small, but they result from the fact that a particle consisting of a relatively limited number of molecules behaves and interacts differently with its surroundings for fundamental physical reasons. Nanoparticles and nanomaterials have gained prominence in technological advancements due to their adjustable physicochemical characteristics such as melting point, wettability, electrical and thermal conductivity, catalytic activity, light absorption and scattering resulting in enhanced performance over their bulk counterparts. By controlling the shape, size and internal order of the nanostructures, properties (electrical conductivity, colour, chemical reactivity, elasticity, etc.) can be modified. Some nanomaterials occur naturally, but of particular interest are engineered nanomaterials (EN), which are designed for, and already being used in many commercial products and processes. They can be found in such things as sunscreens, cosmetics, sporting goods, stainresistant clothing, tires, electronics, as well as many other everyday items, and are used in medicine for purposes of diagnosis, imaging and drug delivery. Engineered nanomaterials are resources designed at the molecular (nanometre) level to take advantage of their small size and novel properties which are generally not seen in their conventional, bulk counterparts. The two main reasons why materials at the nano scale can have different properties are increased relative surface area and new quantum effects. Nanomaterials have a much greater surface area to volume ratio than their conventional forms, which can lead to greater chemical reactivity and affect their strength. Also at the nano scale, quantum effects can become much more important in determining the materials properties and characteristics, leading to novel optical, electrical and magnetic behaviors. 1.1 Definition of Nanomaterials Nanoscale materials are defined as a set of substances where at least one dimension is less than approximately 100 nanometers. A nanometer is one millionth of a millimeter - approximately 100,000 times smaller than the diameter of a human hair. Nanomaterials are of interest because at this scale unique optical, magnetic, electrical, and other properties emerge. These emergent properties have the potential for great impacts in electronics, medicine, and other fields [1] . 1.2 History of Nanomaterials Nanotechnology involves the synthesis and application of materials in dimensions of the order of a billionth of a meter (1x10-9). This categorizes them under ultrafine particles. (Figure 1.1) reveals the size comparison of the nanoparticles against different living and nonliving species [2]. The properties of nanoparticles vary from their bulk counterpart and their chemistry [2]. The electronic structure, reactivity, and thermal and mechanical properties tend to change when the particles reach the nanoscale. Through nanotechnology, we can build materials and devices with control down to the level of individual atoms and molecules. In the past two decades, there were reports of colloids and nanoparticles designed by nature [3, 4]. The history of nanomaterials began immediately after the big bang when Nanostructures were formed in the early meteorites. Nature later evolved many other Nanostructures like seashells, skeletons etc. Nanoscaled smoke particles were formed during the use of fire by early humans. The scientific story of nanomaterials however began much later. One of the first scientific report is the colloidal gold particles synthesized by Michael Faraday as early as 1857. Nanostructured catalysts have also been investigated for over 70 years. By the early 1940’s, precipitated and fumed silica nanoparticles were being manufactured and sold in USA and Germany as substitutes for ultrafine carbon black for rubber reinforcements [1]. Over the past few years, nanomaterials (NMs) have attracted the researchers because of their nanosize, physical, biological, and chemical properties compared to their bulk materials. These NMs are classified based on their size, chemical composition, shape, and sources. Different types of NMs have been synthetized from different sources and they are being classified accordingly. Many NMs have been produced in large quantities based on the requirements for many industrial applications. The two main sources through which NMs are being produced are synthetic source and naturally occurring nanoparticles (NPs). In this chapter, we discuss the types and classifications of NMs and broadly discuss the different types of nanomaterials isolated from natural and synthetic sources [5]. 1.3 Main differences between nanomaterials and bulk materials Nanomaterials are particles that have their size in 1-100 nm range at least in one dimension. We cannot see their particles through the naked eye. Moreover, examples of these materials include nanozymes, titanium dioxide nanoparticles, graphene, etc. Bulk materials are particles that have their size above 100 nm in all dimensions. We can see their particles through the naked eye. The examples of these materials include plaster, sand, gravel, cement, ore, slag, salts, etc.","Draw your answer from the below context block.
+
+EVIDENCE:
+Aim of Work Nanomaterials (nanocrystalline materials) are substances possessing grain sizes on the order of a billionth of a meter. They manifest extraordinarily charming and beneficial properties, which can be exploited for a ramification of structural and nonstructural packages. Seeing that Nanomaterials own unique, beneficial chemical, bodily, and mechanical houses, they may be use for an extensive form of programs, like next era laptop chips, kinetic power (KE) penetrators with more advantageous lethality, better insulation materials, Phosphors for excessive-Defination TV, Low cost Flat-Panel displays, more and more difficult cutting tools, elimination of pollution, excessive strength density, Batteries, excessive power magnets, high sensitive sensors, motors with greater gas efficiency, Aerospace addititives with superior performance characteristics, higher and density weapons platforms, Longer-Lasting Satellites. Longer-Lasting medical implants, Ductile, Machinable ceramics, huge electro chromic show devices. Nanotechnology has the potential to be the key to a brand new world in the field of construction and building materials. Although replication of natural systems is one of the most promising areas of this technology, scientists are still trying to grasp their astonishing complexities. Furthermore, a nanotechnology is a rapidly expanding area of research where novel properties of materials manufactured on nanoscale can be utilized for the benefit of construction infrastructure, Therefore, the main objective of preparing this study is the importance of nanomaterials and their use in many modern industries due to their mechanical, electrical and chemical properties and for the purpose of identifying the most important methods of preparation, detection methods, types and applications of each type. Abstract Nanomaterials (NMs) are gaining significance in technological applications due to their tunable chemical, physical, and mechanical properties and enhanced performance when compared with their bulkier counterparts. This study presents a summary of the general types of NMs and provides an overview of the various synthesis methods of nanoparticles (NPs) and their functionalization via covalent or noncovalent interactions using different methods. It highlights the techniques used for the characterization of NPs and discusses their physical and chemical properties. Due to their unique properties, NMs have several applications and have become part of our daily lives. As a result, research is gaining attention since some NPs are not easily degraded by the environment. Thus, this study also highlights research efforts into the fate, behavior, of different classes of (NMs) in the environment. General Introduction Nanotechnology is an interdisciplinary study which allows us to develop new materials with new, interesting and useful properties. These new materials are nanomaterials made from nanoparticles. Nanoparticles are ultra-small particles with exceptional properties which can direct medicines straight to the place where the human body needs them, they can make materials stronger and they can convert solar energy more efficiently. Nanoparticles possess different properties and behave differently to the classical, larger building blocks of substances. From a scientific point of view, these interesting new properties are not so much the results from the fact that nanoparticles are small, but they result from the fact that a particle consisting of a relatively limited number of molecules behaves and interacts differently with its surroundings for fundamental physical reasons. Nanoparticles and nanomaterials have gained prominence in technological advancements due to their adjustable physicochemical characteristics such as melting point, wettability, electrical and thermal conductivity, catalytic activity, light absorption and scattering resulting in enhanced performance over their bulk counterparts. By controlling the shape, size and internal order of the nanostructures, properties (electrical conductivity, colour, chemical reactivity, elasticity, etc.) can be modified. Some nanomaterials occur naturally, but of particular interest are engineered nanomaterials (EN), which are designed for, and already being used in many commercial products and processes. They can be found in such things as sunscreens, cosmetics, sporting goods, stainresistant clothing, tires, electronics, as well as many other everyday items, and are used in medicine for purposes of diagnosis, imaging and drug delivery. Engineered nanomaterials are resources designed at the molecular (nanometre) level to take advantage of their small size and novel properties which are generally not seen in their conventional, bulk counterparts. The two main reasons why materials at the nano scale can have different properties are increased relative surface area and new quantum effects. Nanomaterials have a much greater surface area to volume ratio than their conventional forms, which can lead to greater chemical reactivity and affect their strength. Also at the nano scale, quantum effects can become much more important in determining the materials properties and characteristics, leading to novel optical, electrical and magnetic behaviors. 1.1 Definition of Nanomaterials Nanoscale materials are defined as a set of substances where at least one dimension is less than approximately 100 nanometers. A nanometer is one millionth of a millimeter - approximately 100,000 times smaller than the diameter of a human hair. Nanomaterials are of interest because at this scale unique optical, magnetic, electrical, and other properties emerge. These emergent properties have the potential for great impacts in electronics, medicine, and other fields [1] . 1.2 History of Nanomaterials Nanotechnology involves the synthesis and application of materials in dimensions of the order of a billionth of a meter (1x10-9). This categorizes them under ultrafine particles. (Figure 1.1) reveals the size comparison of the nanoparticles against different living and nonliving species [2]. The properties of nanoparticles vary from their bulk counterpart and their chemistry [2]. The electronic structure, reactivity, and thermal and mechanical properties tend to change when the particles reach the nanoscale. Through nanotechnology, we can build materials and devices with control down to the level of individual atoms and molecules. In the past two decades, there were reports of colloids and nanoparticles designed by nature [3, 4]. The history of nanomaterials began immediately after the big bang when Nanostructures were formed in the early meteorites. Nature later evolved many other Nanostructures like seashells, skeletons etc. Nanoscaled smoke particles were formed during the use of fire by early humans. The scientific story of nanomaterials however began much later. One of the first scientific report is the colloidal gold particles synthesized by Michael Faraday as early as 1857. Nanostructured catalysts have also been investigated for over 70 years. By the early 1940’s, precipitated and fumed silica nanoparticles were being manufactured and sold in USA and Germany as substitutes for ultrafine carbon black for rubber reinforcements [1]. Over the past few years, nanomaterials (NMs) have attracted the researchers because of their nanosize, physical, biological, and chemical properties compared to their bulk materials. These NMs are classified based on their size, chemical composition, shape, and sources. Different types of NMs have been synthetized from different sources and they are being classified accordingly. Many NMs have been produced in large quantities based on the requirements for many industrial applications. The two main sources through which NMs are being produced are synthetic source and naturally occurring nanoparticles (NPs). In this chapter, we discuss the types and classifications of NMs and broadly discuss the different types of nanomaterials isolated from natural and synthetic sources [5]. 1.3 Main differences between nanomaterials and bulk materials Nanomaterials are particles that have their size in 1-100 nm range at least in one dimension. We cannot see their particles through the naked eye. Moreover, examples of these materials include nanozymes, titanium dioxide nanoparticles, graphene, etc. Bulk materials are particles that have their size above 100 nm in all dimensions. We can see their particles through the naked eye. The examples of these materials include plaster, sand, gravel, cement, ore, slag, salts, etc.
+
+USER:
+I am having trouble understanding the text; please summarize it so that people who are unfamiliar with nanomaterials can understand and learn about them.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,8,24,1231,,469
+"Only use information presented in the prompt itself. Do not use any external sources or prior knowledge. Please say ""I don't have enough information to answer this question"" if the necessary information isn't available.",Why was China's economy so important during the pandemic?,"Other Sources of Data and Information Sizing up the U.S. government’s reliance on foreign goods faces similar challenges in data limitations.113 The U.S. General Services Administration (GSA) maintains a database, the Federal Procurement Data System-Next Generation (FPDS-NG, or FPDS), where federal agencies are required to report procurement contracts whose estimated value is $10,000 or more.114 The procurement data in FPDS-NG are not fully reliable. There are documented quality issues documented relating to accuracy, completeness, and timeliness of its data.115 These limitations have prompted many analysts to rely on FPDS-NG data primarily to identify broad trends and produce rough estimates, or to gather information about specific contracts. With these limitations in mind, FPDS-NG data may provide general information regarding the value, quantity, and types of domestic and foreign-made goods hat U.S. government agencies procure. Other information on domestic capacity, as well as changes resulting from increased production in the aftermath of the COVID-19 outbreak, generally comes from private research firms, news outlets, and trade associations. Many of the figures cited are often based on surveys, firms’ press releases, or firms/industries’ forecasts, which may differ significantly from actual production. China’s Economic Recovery: Prospects and Implications China’s leaders have focused on resuming manufacturing production to jumpstart economic growth.116 At an executive session of China’s cabinet, the State Council, on March 17, 2020, Chinese officials emphasized the importance of stabilizing employment and announced that the government would streamline business approvals and fast-track approvals for large infrastructure projects. They also offered government support to alleviate shortages of labor, raw materials, funds, and protective gear.117 To facilitate economic activity, the Chinese government also appears Congressional Research Service 38 to have liberalized company health requirements and lifted intra-provincial and intra-city travel and transportation restrictions. NDRC spokesperson Meng Wei said on March 17, 2020 that transportation was operating normally. Zhejiang, Jiangsu, and Shanghai were operating at close to 100% of normal capacity; and over 90% of large-scale industrial companies outside of Hubei had resumed production.118 Company reports of opening and resumption of operations did not necessarily mean that these facilities were fully online or operating at pre-crisis levels, however. Several economic analysts and news outlets, including the Financial Times, published alternative measures of business resumption rates using proxies for economic activity—such as data on traffic congestion, air pollution levels, and container freight movement. Overall, many of these measures suggested that businesses across China did not return to full capacity at the rates reported by local and provincial governments.119 In Wuhan, the center of the original outbreak, the Hubei provincial government issued a notice in March—that applies to Wuhan as Hubei’s capital—allowing certain companies to resume work ahead of other production. This included companies in the medical and health industry, as well as companies producing protective gear, disinfectant, daily necessities, agriculture, and products critical to national and global supply chains.120 China emerged in June 2020 as the first major country to announce a return to economic growth since the outbreak of COVID-19, but consumption lagged production recovery and the economic recovery has relied on government spending and exports to boost growth. The government reported 3.2% gross domestic product (GDP) growth in the second quarter and 4.9% GDP growth in the third quarter of 2020.121 The International Monetary Fund (IMF) projects China’s economy to grow by 1.9% in 2020. China since February 2020 has provided an estimated $506 billion in stimulus and increased the government’s budget deficit target to a record high of 3.6% of GDP, up from 2.8% in 2019. Shifting from efforts to reduce debt, the government announced the issuance of $142.9 billion of special treasury bonds for the first time since 2007; increased the quota for local government special bonds (a source of infrastructure funding); and fast-tracked issuance of corporate bonds to cover pandemic costs, but with potential broader uses. The IMF estimates that the fiscal measures and financing plans announced amounted to 4.1% of the China’s GDP, as of July 2020.122 China’s National Bureau of Statistics in November 2020 recorded a 5% year-on-year increase in retail sales, a 2.6% year-on-year increase in fixed asset investment, and a 7% year-on-year increase in value-added industrial output. COVID-19: China Medical Supply Chains and Broader Trade Issues Congressional Research Service 39 in investment in industrial output growth, however, was recorded in non-ferrous metals and real estate investment, not broader areas of domestic consumption.123 China Positioning to Export China’s economy depends on exports and the foreign exchange it earns through exports, as well as on the large productive role that foreign firms play in the domestic market and as exporters. Seeking to stabilize drops in foreign investment and trade, on March 12, Commerce Vice Minister Wang Shouwen held a call with 400 members of the American Chamber of Commerce in China, and on March 13, he held a similar webinar with the European Chamber of Commerce in China’s Advisory Council. Vice Minister Wang pressed companies to reopen operations and increase investments in China. Other Chinese agencies represented included NDRC, MIIT, the National Health Commission, the General Administration of Drug Supervision, the State Administration for Market Regulation, the General Administration of Customers, the Civil Aviation Administration of China, the Ministry of Transportation, and the State Taxation Administration.124 During past crises, such as the global financial crisis of 2008-09, China has pressed firms to idle facilities and keep them production-ready (instead of shuttering them) and retain workers (instead of laying them off) to maintain social stability and facilitate efforts to quickly ramp up production and exports later.125 These stimulus efforts are sometimes less visible than fiscal policies in other countries. Several market watchers have noted that, while a 17% drop in Chinese exports in January-February 2020 was significant, it was not as dramatic when considering China’s economy was shuttered for much of February. This indicates that Chinese industry may have had sufficient stock already at ports for export when the crisis hit. This also signals how China was able to resume an export push in the third quarter of 2020.126 China’s economic recovery has been important to the United States and the global economy, as it is an important center of demand and supply. At the same time, during this period of global economic downturn, the United States and other countries are now potentially vulnerable to a concerted PRC export push that has been expanding since summer 2020 and any effort China makes to take additional market share in strategic sectors. Congressional Research Service 40 Steel Overcapacity Chinese overcapacity in steel has been highly contentious for its global impacts, and China could potentially see exports as a quick way to reduce inventories and secure needed cash. Similar to what happened during the global financial crisis in 2008-09, China is poised to take additional global market share in 2020 because it did not dial back production during the COVID-19 outbreak. Chinese blast furnaces continued to run during the COVID-19 crisis, and China’s steel production for January-February 2020 was up 3% over the same period in 2019. Meanwhile, due to collapsing domestic demand and logistics constraints, China’s finished steel inventories rose by 45% in January-February 2020 over the same period in 2019.127 China’s steel production at the end of 2019 was already at an all-time high of almost 1 billion tons, with China producing over 50% of global supply, according to the World Steel Association and China’s State Statistical Bureau (Figure 8).128 China’s crude steel production recovered in July 2020, rising 9.1% year-on-year. China’s crude steel production during the January-September 2020 period is up 4.5% over the same period in 2019. In contrast, crude steel production over the same period is down 17.9% in the EU; down 18.2% in North America; down 16.5% in India; down 19.1% in Japan; and down 7.5% in South Korea.","[Other Sources of Data and Information Sizing up the U.S. government’s reliance on foreign goods faces similar challenges in data limitations.113 The U.S. General Services Administration (GSA) maintains a database, the Federal Procurement Data System-Next Generation (FPDS-NG, or FPDS), where federal agencies are required to report procurement contracts whose estimated value is $10,000 or more.114 The procurement data in FPDS-NG are not fully reliable. There are documented quality issues documented relating to accuracy, completeness, and timeliness of its data.115 These limitations have prompted many analysts to rely on FPDS-NG data primarily to identify broad trends and produce rough estimates, or to gather information about specific contracts. With these limitations in mind, FPDS-NG data may provide general information regarding the value, quantity, and types of domestic and foreign-made goods hat U.S. government agencies procure. Other information on domestic capacity, as well as changes resulting from increased production in the aftermath of the COVID-19 outbreak, generally comes from private research firms, news outlets, and trade associations. Many of the figures cited are often based on surveys, firms’ press releases, or firms/industries’ forecasts, which may differ significantly from actual production. China’s Economic Recovery: Prospects and Implications China’s leaders have focused on resuming manufacturing production to jumpstart economic growth.116 At an executive session of China’s cabinet, the State Council, on March 17, 2020, Chinese officials emphasized the importance of stabilizing employment and announced that the government would streamline business approvals and fast-track approvals for large infrastructure projects. They also offered government support to alleviate shortages of labor, raw materials, funds, and protective gear.117 To facilitate economic activity, the Chinese government also appears Congressional Research Service 38 to have liberalized company health requirements and lifted intra-provincial and intra-city travel and transportation restrictions. NDRC spokesperson Meng Wei said on March 17, 2020 that transportation was operating normally. Zhejiang, Jiangsu, and Shanghai were operating at close to 100% of normal capacity; and over 90% of large-scale industrial companies outside of Hubei had resumed production.118 Company reports of opening and resumption of operations did not necessarily mean that these facilities were fully online or operating at pre-crisis levels, however. Several economic analysts and news outlets, including the Financial Times, published alternative measures of business resumption rates using proxies for economic activity—such as data on traffic congestion, air pollution levels, and container freight movement. Overall, many of these measures suggested that businesses across China did not return to full capacity at the rates reported by local and provincial governments.119 In Wuhan, the center of the original outbreak, the Hubei provincial government issued a notice in March—that applies to Wuhan as Hubei’s capital—allowing certain companies to resume work ahead of other production. This included companies in the medical and health industry, as well as companies producing protective gear, disinfectant, daily necessities, agriculture, and products critical to national and global supply chains.120 China emerged in June 2020 as the first major country to announce a return to economic growth since the outbreak of COVID-19, but consumption lagged production recovery and the economic recovery has relied on government spending and exports to boost growth. The government reported 3.2% gross domestic product (GDP) growth in the second quarter and 4.9% GDP growth in the third quarter of 2020.121 The International Monetary Fund (IMF) projects China’s economy to grow by 1.9% in 2020. China since February 2020 has provided an estimated $506 billion in stimulus and increased the government’s budget deficit target to a record high of 3.6% of GDP, up from 2.8% in 2019. Shifting from efforts to reduce debt, the government announced the issuance of $142.9 billion of special treasury bonds for the first time since 2007; increased the quota for local government special bonds (a source of infrastructure funding); and fast-tracked issuance of corporate bonds to cover pandemic costs, but with potential broader uses. The IMF estimates that the fiscal measures and financing plans announced amounted to 4.1% of the China’s GDP, as of July 2020.122 China’s National Bureau of Statistics in November 2020 recorded a 5% year-on-year increase in retail sales, a 2.6% year-on-year increase in fixed asset investment, and a 7% year-on-year increase in value-added industrial output. COVID-19: China Medical Supply Chains and Broader Trade Issues Congressional Research Service 39 in investment in industrial output growth, however, was recorded in non-ferrous metals and real estate investment, not broader areas of domestic consumption.123 China Positioning to Export China’s economy depends on exports and the foreign exchange it earns through exports, as well as on the large productive role that foreign firms play in the domestic market and as exporters. Seeking to stabilize drops in foreign investment and trade, on March 12, Commerce Vice Minister Wang Shouwen held a call with 400 members of the American Chamber of Commerce in China, and on March 13, he held a similar webinar with the European Chamber of Commerce in China’s Advisory Council. Vice Minister Wang pressed companies to reopen operations and increase investments in China. Other Chinese agencies represented included NDRC, MIIT, the National Health Commission, the General Administration of Drug Supervision, the State Administration for Market Regulation, the General Administration of Customers, the Civil Aviation Administration of China, the Ministry of Transportation, and the State Taxation Administration.124 During past crises, such as the global financial crisis of 2008-09, China has pressed firms to idle facilities and keep them production-ready (instead of shuttering them) and retain workers (instead of laying them off) to maintain social stability and facilitate efforts to quickly ramp up production and exports later.125 These stimulus efforts are sometimes less visible than fiscal policies in other countries. Several market watchers have noted that, while a 17% drop in Chinese exports in January-February 2020 was significant, it was not as dramatic when considering China’s economy was shuttered for much of February. This indicates that Chinese industry may have had sufficient stock already at ports for export when the crisis hit. This also signals how China was able to resume an export push in the third quarter of 2020.126 China’s economic recovery has been important to the United States and the global economy, as it is an important center of demand and supply. At the same time, during this period of global economic downturn, the United States and other countries are now potentially vulnerable to a concerted PRC export push that has been expanding since summer 2020 and any effort China makes to take additional market share in strategic sectors. Congressional Research Service 40 Steel Overcapacity Chinese overcapacity in steel has been highly contentious for its global impacts, and China could potentially see exports as a quick way to reduce inventories and secure needed cash. Similar to what happened during the global financial crisis in 2008-09, China is poised to take additional global market share in 2020 because it did not dial back production during the COVID-19 outbreak. Chinese blast furnaces continued to run during the COVID-19 crisis, and China’s steel production for January-February 2020 was up 3% over the same period in 2019. Meanwhile, due to collapsing domestic demand and logistics constraints, China’s finished steel inventories rose by 45% in January-February 2020 over the same period in 2019.127 China’s steel production at the end of 2019 was already at an all-time high of almost 1 billion tons, with China producing over 50% of global supply, according to the World Steel Association and China’s State Statistical Bureau (Figure 8).128 China’s crude steel production recovered in July 2020, rising 9.1% year-on-year. China’s crude steel production during the January-September 2020 period is up 4.5% over the same period in 2019. In contrast, crude steel production over the same period is down 17.9% in the EU; down 18.2% in North America; down 16.5% in India; down 19.1% in Japan; and down 7.5% in South Korea.] [Why was China's economy so important during the pandemic?] [Only use information presented in the prompt itself. Do not use any external sources or prior knowledge. Please say ""I don't have enough information to answer this question"" if the necessary information isn't available.]","Only use information presented in the prompt itself. Do not use any external sources or prior knowledge. Please say ""I don't have enough information to answer this question"" if the necessary information isn't available.
+
+EVIDENCE:
+Other Sources of Data and Information Sizing up the U.S. government’s reliance on foreign goods faces similar challenges in data limitations.113 The U.S. General Services Administration (GSA) maintains a database, the Federal Procurement Data System-Next Generation (FPDS-NG, or FPDS), where federal agencies are required to report procurement contracts whose estimated value is $10,000 or more.114 The procurement data in FPDS-NG are not fully reliable. There are documented quality issues documented relating to accuracy, completeness, and timeliness of its data.115 These limitations have prompted many analysts to rely on FPDS-NG data primarily to identify broad trends and produce rough estimates, or to gather information about specific contracts. With these limitations in mind, FPDS-NG data may provide general information regarding the value, quantity, and types of domestic and foreign-made goods hat U.S. government agencies procure. Other information on domestic capacity, as well as changes resulting from increased production in the aftermath of the COVID-19 outbreak, generally comes from private research firms, news outlets, and trade associations. Many of the figures cited are often based on surveys, firms’ press releases, or firms/industries’ forecasts, which may differ significantly from actual production. China’s Economic Recovery: Prospects and Implications China’s leaders have focused on resuming manufacturing production to jumpstart economic growth.116 At an executive session of China’s cabinet, the State Council, on March 17, 2020, Chinese officials emphasized the importance of stabilizing employment and announced that the government would streamline business approvals and fast-track approvals for large infrastructure projects. They also offered government support to alleviate shortages of labor, raw materials, funds, and protective gear.117 To facilitate economic activity, the Chinese government also appears Congressional Research Service 38 to have liberalized company health requirements and lifted intra-provincial and intra-city travel and transportation restrictions. NDRC spokesperson Meng Wei said on March 17, 2020 that transportation was operating normally. Zhejiang, Jiangsu, and Shanghai were operating at close to 100% of normal capacity; and over 90% of large-scale industrial companies outside of Hubei had resumed production.118 Company reports of opening and resumption of operations did not necessarily mean that these facilities were fully online or operating at pre-crisis levels, however. Several economic analysts and news outlets, including the Financial Times, published alternative measures of business resumption rates using proxies for economic activity—such as data on traffic congestion, air pollution levels, and container freight movement. Overall, many of these measures suggested that businesses across China did not return to full capacity at the rates reported by local and provincial governments.119 In Wuhan, the center of the original outbreak, the Hubei provincial government issued a notice in March—that applies to Wuhan as Hubei’s capital—allowing certain companies to resume work ahead of other production. This included companies in the medical and health industry, as well as companies producing protective gear, disinfectant, daily necessities, agriculture, and products critical to national and global supply chains.120 China emerged in June 2020 as the first major country to announce a return to economic growth since the outbreak of COVID-19, but consumption lagged production recovery and the economic recovery has relied on government spending and exports to boost growth. The government reported 3.2% gross domestic product (GDP) growth in the second quarter and 4.9% GDP growth in the third quarter of 2020.121 The International Monetary Fund (IMF) projects China’s economy to grow by 1.9% in 2020. China since February 2020 has provided an estimated $506 billion in stimulus and increased the government’s budget deficit target to a record high of 3.6% of GDP, up from 2.8% in 2019. Shifting from efforts to reduce debt, the government announced the issuance of $142.9 billion of special treasury bonds for the first time since 2007; increased the quota for local government special bonds (a source of infrastructure funding); and fast-tracked issuance of corporate bonds to cover pandemic costs, but with potential broader uses. The IMF estimates that the fiscal measures and financing plans announced amounted to 4.1% of the China’s GDP, as of July 2020.122 China’s National Bureau of Statistics in November 2020 recorded a 5% year-on-year increase in retail sales, a 2.6% year-on-year increase in fixed asset investment, and a 7% year-on-year increase in value-added industrial output. COVID-19: China Medical Supply Chains and Broader Trade Issues Congressional Research Service 39 in investment in industrial output growth, however, was recorded in non-ferrous metals and real estate investment, not broader areas of domestic consumption.123 China Positioning to Export China’s economy depends on exports and the foreign exchange it earns through exports, as well as on the large productive role that foreign firms play in the domestic market and as exporters. Seeking to stabilize drops in foreign investment and trade, on March 12, Commerce Vice Minister Wang Shouwen held a call with 400 members of the American Chamber of Commerce in China, and on March 13, he held a similar webinar with the European Chamber of Commerce in China’s Advisory Council. Vice Minister Wang pressed companies to reopen operations and increase investments in China. Other Chinese agencies represented included NDRC, MIIT, the National Health Commission, the General Administration of Drug Supervision, the State Administration for Market Regulation, the General Administration of Customers, the Civil Aviation Administration of China, the Ministry of Transportation, and the State Taxation Administration.124 During past crises, such as the global financial crisis of 2008-09, China has pressed firms to idle facilities and keep them production-ready (instead of shuttering them) and retain workers (instead of laying them off) to maintain social stability and facilitate efforts to quickly ramp up production and exports later.125 These stimulus efforts are sometimes less visible than fiscal policies in other countries. Several market watchers have noted that, while a 17% drop in Chinese exports in January-February 2020 was significant, it was not as dramatic when considering China’s economy was shuttered for much of February. This indicates that Chinese industry may have had sufficient stock already at ports for export when the crisis hit. This also signals how China was able to resume an export push in the third quarter of 2020.126 China’s economic recovery has been important to the United States and the global economy, as it is an important center of demand and supply. At the same time, during this period of global economic downturn, the United States and other countries are now potentially vulnerable to a concerted PRC export push that has been expanding since summer 2020 and any effort China makes to take additional market share in strategic sectors. Congressional Research Service 40 Steel Overcapacity Chinese overcapacity in steel has been highly contentious for its global impacts, and China could potentially see exports as a quick way to reduce inventories and secure needed cash. Similar to what happened during the global financial crisis in 2008-09, China is poised to take additional global market share in 2020 because it did not dial back production during the COVID-19 outbreak. Chinese blast furnaces continued to run during the COVID-19 crisis, and China’s steel production for January-February 2020 was up 3% over the same period in 2019. Meanwhile, due to collapsing domestic demand and logistics constraints, China’s finished steel inventories rose by 45% in January-February 2020 over the same period in 2019.127 China’s steel production at the end of 2019 was already at an all-time high of almost 1 billion tons, with China producing over 50% of global supply, according to the World Steel Association and China’s State Statistical Bureau (Figure 8).128 China’s crude steel production recovered in July 2020, rising 9.1% year-on-year. China’s crude steel production during the January-September 2020 period is up 4.5% over the same period in 2019. In contrast, crude steel production over the same period is down 17.9% in the EU; down 18.2% in North America; down 16.5% in India; down 19.1% in Japan; and down 7.5% in South Korea.
+
+USER:
+Why was China's economy so important during the pandemic?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,34,9,1290,,400
+"""================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Why did Berkshire Hathaway reduce its position in Apple despite its continued dominance in AI and what does this suggest about Warren Buffett's broader market view?,"Warren Buffett has been at the helm of the Berkshire Hathaway (BRK.A -0.17%) (BRK.B -0.15%) investment company since 1965. During his 59 years of leadership, Berkshire Hathaway stock has delivered a compound annual return of 19.8%, which would have been enough to turn an investment of $1,000 back then into more than $42.5 million today. Buffett's investment strategy is simple. He looks for growing companies with robust profitability and strong management teams, and he especially likes those with shareholder-friendly programs like dividend payments and stock-buyback plans. One thing Buffett doesn't focus on is the latest stock market trend, so you won't find him piling money into artificial intelligence (AI) stocks right now. However, two stocks Berkshire already holds are becoming significant players in the AI industry, and they account for about 29.5% of the total value of the conglomerate's $305.7 billion portfolio of publicly traded stocks and securities. Warren Buffett smiling, surrounded by cameras. Image source: The Motley Fool. 1. Apple: 28.9% of Berkshire Hathaway's portfolio Apple (AAPL -0.36%) is the world's largest company with a $3.3 trillion market capitalization, but it was worth a fraction of that when Buffett started buying the stock in 2016. Between then and 2023, Berkshire spent about $38 billion building its stake in Apple, and thanks to a staggering return, that position had a value of more than $170 billion earlier this year. However, Berkshire has sold more than half of its stake in the iPhone maker during the past few months. Its remaining position is still worth $88.3 billion, so it's still the largest holding in the conglomerate's portfolio, and I think the recent sales reflect Buffett's cautious view on the broader market as opposed to Apple itself. After all, the S&P 500 is trading at a price-to-earnings ratio (P/E) of 27.6 right now, which is significantly more expensive than its average of 18.1 going back to the 1950s. Collapse NASDAQ: AAPL Apple Today's Change (-0.36%) -$0.80 Current Price $220.11 YTD 1w 1m 3m 6m 1y 5y Price VS S&P AAPL Key Data Points Market Cap $3,359B Day's Range $216.73 - $221.48 52wk Range $164.07 - $237.23 Volume 51,528,321 Avg Vol 63,493,642 Gross Margin 45.96% Dividend Yield 0.44% Besides, Apple is preparing for one of the most important periods in its history. With more than 2.2 billion active devices globally -- including iPhones, iPads, and Mac computers -- Apple could become the world's biggest distributor of AI to consumers. The company unveiled Apple Intelligence earlier this year, which it developed in partnership with ChatGPT creator OpenAI. It's embedded in the new iOS 18 operating system, and it will only be available on the latest iPhone 16 and the previous iPhone 15 Pro models because they are fitted with next-generation chips designed to process AI workloads. Considering Apple Intelligence is going to transform many of the company's existing software applications, it could drive a big upgrade cycle for the iPhone. Apps like Notes, Mail, and iMessage will feature new writing tools capable of instantly summarizing and generating text content on command. Plus, Apple's existing Siri voice assistant is going to be enhanced by ChatGPT, which will bolster its knowledge base and its capabilities. Although Apple's revenue growth has been sluggish in recent quarters, the company still ticks nearly all of Buffett's boxes. It's highly profitable, it has an incredible management team led by Chief Executive Officer Tim Cook, and it's returning truckloads of money to shareholders through dividends and buybacks -- in fact, Apple recently launched a new $110 billion stock buyback program, which is the largest in corporate American history. There is no guarantee Berkshire has finished selling Apple stock, but the rise of AI will likely drive a renewed phase of growth for the company, so that's a good reason to remain bullish no matter what Buffett does next. 2. Amazon: 0.6% of Berkshire Hathaway's portfolio Berkshire bought a relatively small stake in Amazon (AMZN 2.37%) in 2019, which is currently worth $1.7 billion and represents just 0.6% of the conglomerate's portfolio. However, Buffett has often expressed regret for not recognizing the opportunity much sooner, because Amazon has expanded beyond its roots as an e-commerce company and now has a dominant presence in streaming, digital advertising, and cloud computing. Amazon Web Services (AWS) is the largest business-to-business cloud platform in the world, offering hundreds of solutions designed to help organizations operate in the digital era. But AWS also wants to be the go-to provider of AI solutions for businesses, which could be its largest financial opportunity ever. Collapse NASDAQ: AMZN Amazon Today's Change (2.37%) $4.15 Current Price $179.55 YTD 1w 1m 3m 6m 1y 5y Price VS S&P AMZN Key Data Points Market Cap $1,841B Day's Range $176.79 - $180.50 52wk Range $118.35 - $201.20 Volume 36,173,896 Avg Vol 42,567,060 Gross Margin 48.04% Dividend Yield N/A AWS developed its own data center chips like Trainium, which can offer cost savings of up to 50% compared to competing hardware from suppliers like Nvidia. Plus, the cloud provider also built a family of large language models (LLMs) called Titan, which developers can use if they don't want to create their own. They are accessible through Amazon Bedrock, along with a portfolio of third-party LLMs from leading AI start-ups like Anthropic. LLMs are at the foundation of every AI chat bot application. Finally, AWS now offers its own AI assistant called Q. Amazon Q Business can be trained on an organization's data so employees can instantly find answers to their queries, and it can also generate content to boost productivity. Amazon Q Developer, on the other hand, can debug and generate code to help accelerate the completion of software projects. According to consulting firm PwC, AI could add a whopping $15.7 trillion to the global economy by 2030, and the combination of chips, LLMs, and software apps will help Amazon stake its claim to that enormous pie. Amazon was consistently losing money when Berkshire bought the stock, and it doesn't offer a dividend nor does it have a stock buyback program, so it doesn't tick many of Buffett's boxes (hence the small position). But it might be the most diverse AI stock investors can buy right now, and Berkshire will likely be pleased with its long-term return from here even if Buffett wishes it owned a bigger stake. Where Should You Invest $1,000 Right Now? Before you put a single dollar into the stock market, we think you’ll want to hear this. Our S&P/TSX market beating* Stock Advisor Canada team just released their top 10 starter stocks for 2024 that we believe could supercharge any portfolio. Want to see what made our list? Get started with Stock Advisor Canada today to receive all 10 of our starter stocks, a fully stocked treasure trove of industry reports, two brand-new stock recommendations every month, and much more. Click here to learn more. John Mackey, former CEO of Whole Foods Market, an Amazon subsidiary, is a member of The Motley Fool's board of directors. Anthony Di Pizio has no position in any of the stocks mentioned. The Motley Fool has positions in and recommends Amazon, Apple, Berkshire Hathaway, and Nvidia. The Motley Fool has a disclosure policy.","""================ <TEXT PASSAGE> ======= Warren Buffett has been at the helm of the Berkshire Hathaway (BRK.A -0.17%) (BRK.B -0.15%) investment company since 1965. During his 59 years of leadership, Berkshire Hathaway stock has delivered a compound annual return of 19.8%, which would have been enough to turn an investment of $1,000 back then into more than $42.5 million today. Buffett's investment strategy is simple. He looks for growing companies with robust profitability and strong management teams, and he especially likes those with shareholder-friendly programs like dividend payments and stock-buyback plans. One thing Buffett doesn't focus on is the latest stock market trend, so you won't find him piling money into artificial intelligence (AI) stocks right now. However, two stocks Berkshire already holds are becoming significant players in the AI industry, and they account for about 29.5% of the total value of the conglomerate's $305.7 billion portfolio of publicly traded stocks and securities. Warren Buffett smiling, surrounded by cameras. Image source: The Motley Fool. 1. Apple: 28.9% of Berkshire Hathaway's portfolio Apple (AAPL -0.36%) is the world's largest company with a $3.3 trillion market capitalization, but it was worth a fraction of that when Buffett started buying the stock in 2016. Between then and 2023, Berkshire spent about $38 billion building its stake in Apple, and thanks to a staggering return, that position had a value of more than $170 billion earlier this year. However, Berkshire has sold more than half of its stake in the iPhone maker during the past few months. Its remaining position is still worth $88.3 billion, so it's still the largest holding in the conglomerate's portfolio, and I think the recent sales reflect Buffett's cautious view on the broader market as opposed to Apple itself. After all, the S&P 500 is trading at a price-to-earnings ratio (P/E) of 27.6 right now, which is significantly more expensive than its average of 18.1 going back to the 1950s. Collapse NASDAQ: AAPL Apple Today's Change (-0.36%) -$0.80 Current Price $220.11 YTD 1w 1m 3m 6m 1y 5y Price VS S&P AAPL Key Data Points Market Cap $3,359B Day's Range $216.73 - $221.48 52wk Range $164.07 - $237.23 Volume 51,528,321 Avg Vol 63,493,642 Gross Margin 45.96% Dividend Yield 0.44% Besides, Apple is preparing for one of the most important periods in its history. With more than 2.2 billion active devices globally -- including iPhones, iPads, and Mac computers -- Apple could become the world's biggest distributor of AI to consumers. The company unveiled Apple Intelligence earlier this year, which it developed in partnership with ChatGPT creator OpenAI. It's embedded in the new iOS 18 operating system, and it will only be available on the latest iPhone 16 and the previous iPhone 15 Pro models because they are fitted with next-generation chips designed to process AI workloads. Considering Apple Intelligence is going to transform many of the company's existing software applications, it could drive a big upgrade cycle for the iPhone. Apps like Notes, Mail, and iMessage will feature new writing tools capable of instantly summarizing and generating text content on command. Plus, Apple's existing Siri voice assistant is going to be enhanced by ChatGPT, which will bolster its knowledge base and its capabilities. Although Apple's revenue growth has been sluggish in recent quarters, the company still ticks nearly all of Buffett's boxes. It's highly profitable, it has an incredible management team led by Chief Executive Officer Tim Cook, and it's returning truckloads of money to shareholders through dividends and buybacks -- in fact, Apple recently launched a new $110 billion stock buyback program, which is the largest in corporate American history. There is no guarantee Berkshire has finished selling Apple stock, but the rise of AI will likely drive a renewed phase of growth for the company, so that's a good reason to remain bullish no matter what Buffett does next. 2. Amazon: 0.6% of Berkshire Hathaway's portfolio Berkshire bought a relatively small stake in Amazon (AMZN 2.37%) in 2019, which is currently worth $1.7 billion and represents just 0.6% of the conglomerate's portfolio. However, Buffett has often expressed regret for not recognizing the opportunity much sooner, because Amazon has expanded beyond its roots as an e-commerce company and now has a dominant presence in streaming, digital advertising, and cloud computing. Amazon Web Services (AWS) is the largest business-to-business cloud platform in the world, offering hundreds of solutions designed to help organizations operate in the digital era. But AWS also wants to be the go-to provider of AI solutions for businesses, which could be its largest financial opportunity ever. Collapse NASDAQ: AMZN Amazon Today's Change (2.37%) $4.15 Current Price $179.55 YTD 1w 1m 3m 6m 1y 5y Price VS S&P AMZN Key Data Points Market Cap $1,841B Day's Range $176.79 - $180.50 52wk Range $118.35 - $201.20 Volume 36,173,896 Avg Vol 42,567,060 Gross Margin 48.04% Dividend Yield N/A AWS developed its own data center chips like Trainium, which can offer cost savings of up to 50% compared to competing hardware from suppliers like Nvidia. Plus, the cloud provider also built a family of large language models (LLMs) called Titan, which developers can use if they don't want to create their own. They are accessible through Amazon Bedrock, along with a portfolio of third-party LLMs from leading AI start-ups like Anthropic. LLMs are at the foundation of every AI chat bot application. Finally, AWS now offers its own AI assistant called Q. Amazon Q Business can be trained on an organization's data so employees can instantly find answers to their queries, and it can also generate content to boost productivity. Amazon Q Developer, on the other hand, can debug and generate code to help accelerate the completion of software projects. According to consulting firm PwC, AI could add a whopping $15.7 trillion to the global economy by 2030, and the combination of chips, LLMs, and software apps will help Amazon stake its claim to that enormous pie. Amazon was consistently losing money when Berkshire bought the stock, and it doesn't offer a dividend nor does it have a stock buyback program, so it doesn't tick many of Buffett's boxes (hence the small position). But it might be the most diverse AI stock investors can buy right now, and Berkshire will likely be pleased with its long-term return from here even if Buffett wishes it owned a bigger stake. Where Should You Invest $1,000 Right Now? Before you put a single dollar into the stock market, we think you’ll want to hear this. Our S&P/TSX market beating* Stock Advisor Canada team just released their top 10 starter stocks for 2024 that we believe could supercharge any portfolio. Want to see what made our list? Get started with Stock Advisor Canada today to receive all 10 of our starter stocks, a fully stocked treasure trove of industry reports, two brand-new stock recommendations every month, and much more. Click here to learn more. John Mackey, former CEO of Whole Foods Market, an Amazon subsidiary, is a member of The Motley Fool's board of directors. Anthony Di Pizio has no position in any of the stocks mentioned. The Motley Fool has positions in and recommends Amazon, Apple, Berkshire Hathaway, and Nvidia. The Motley Fool has a disclosure policy. https://www.fool.com/investing/2024/09/10/295-warren-buffetts-3057-billion-in-2-ai-stocks/ ================ <QUESTION> ======= Why did Berkshire Hathaway reduce its position in Apple despite its continued dominance in AI and what does this suggest about Warren Buffett's broader market view? ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""","""================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""
+
+EVIDENCE:
+Warren Buffett has been at the helm of the Berkshire Hathaway (BRK.A -0.17%) (BRK.B -0.15%) investment company since 1965. During his 59 years of leadership, Berkshire Hathaway stock has delivered a compound annual return of 19.8%, which would have been enough to turn an investment of $1,000 back then into more than $42.5 million today. Buffett's investment strategy is simple. He looks for growing companies with robust profitability and strong management teams, and he especially likes those with shareholder-friendly programs like dividend payments and stock-buyback plans. One thing Buffett doesn't focus on is the latest stock market trend, so you won't find him piling money into artificial intelligence (AI) stocks right now. However, two stocks Berkshire already holds are becoming significant players in the AI industry, and they account for about 29.5% of the total value of the conglomerate's $305.7 billion portfolio of publicly traded stocks and securities. Warren Buffett smiling, surrounded by cameras. Image source: The Motley Fool. 1. Apple: 28.9% of Berkshire Hathaway's portfolio Apple (AAPL -0.36%) is the world's largest company with a $3.3 trillion market capitalization, but it was worth a fraction of that when Buffett started buying the stock in 2016. Between then and 2023, Berkshire spent about $38 billion building its stake in Apple, and thanks to a staggering return, that position had a value of more than $170 billion earlier this year. However, Berkshire has sold more than half of its stake in the iPhone maker during the past few months. Its remaining position is still worth $88.3 billion, so it's still the largest holding in the conglomerate's portfolio, and I think the recent sales reflect Buffett's cautious view on the broader market as opposed to Apple itself. After all, the S&P 500 is trading at a price-to-earnings ratio (P/E) of 27.6 right now, which is significantly more expensive than its average of 18.1 going back to the 1950s. Collapse NASDAQ: AAPL Apple Today's Change (-0.36%) -$0.80 Current Price $220.11 YTD 1w 1m 3m 6m 1y 5y Price VS S&P AAPL Key Data Points Market Cap $3,359B Day's Range $216.73 - $221.48 52wk Range $164.07 - $237.23 Volume 51,528,321 Avg Vol 63,493,642 Gross Margin 45.96% Dividend Yield 0.44% Besides, Apple is preparing for one of the most important periods in its history. With more than 2.2 billion active devices globally -- including iPhones, iPads, and Mac computers -- Apple could become the world's biggest distributor of AI to consumers. The company unveiled Apple Intelligence earlier this year, which it developed in partnership with ChatGPT creator OpenAI. It's embedded in the new iOS 18 operating system, and it will only be available on the latest iPhone 16 and the previous iPhone 15 Pro models because they are fitted with next-generation chips designed to process AI workloads. Considering Apple Intelligence is going to transform many of the company's existing software applications, it could drive a big upgrade cycle for the iPhone. Apps like Notes, Mail, and iMessage will feature new writing tools capable of instantly summarizing and generating text content on command. Plus, Apple's existing Siri voice assistant is going to be enhanced by ChatGPT, which will bolster its knowledge base and its capabilities. Although Apple's revenue growth has been sluggish in recent quarters, the company still ticks nearly all of Buffett's boxes. It's highly profitable, it has an incredible management team led by Chief Executive Officer Tim Cook, and it's returning truckloads of money to shareholders through dividends and buybacks -- in fact, Apple recently launched a new $110 billion stock buyback program, which is the largest in corporate American history. There is no guarantee Berkshire has finished selling Apple stock, but the rise of AI will likely drive a renewed phase of growth for the company, so that's a good reason to remain bullish no matter what Buffett does next. 2. Amazon: 0.6% of Berkshire Hathaway's portfolio Berkshire bought a relatively small stake in Amazon (AMZN 2.37%) in 2019, which is currently worth $1.7 billion and represents just 0.6% of the conglomerate's portfolio. However, Buffett has often expressed regret for not recognizing the opportunity much sooner, because Amazon has expanded beyond its roots as an e-commerce company and now has a dominant presence in streaming, digital advertising, and cloud computing. Amazon Web Services (AWS) is the largest business-to-business cloud platform in the world, offering hundreds of solutions designed to help organizations operate in the digital era. But AWS also wants to be the go-to provider of AI solutions for businesses, which could be its largest financial opportunity ever. Collapse NASDAQ: AMZN Amazon Today's Change (2.37%) $4.15 Current Price $179.55 YTD 1w 1m 3m 6m 1y 5y Price VS S&P AMZN Key Data Points Market Cap $1,841B Day's Range $176.79 - $180.50 52wk Range $118.35 - $201.20 Volume 36,173,896 Avg Vol 42,567,060 Gross Margin 48.04% Dividend Yield N/A AWS developed its own data center chips like Trainium, which can offer cost savings of up to 50% compared to competing hardware from suppliers like Nvidia. Plus, the cloud provider also built a family of large language models (LLMs) called Titan, which developers can use if they don't want to create their own. They are accessible through Amazon Bedrock, along with a portfolio of third-party LLMs from leading AI start-ups like Anthropic. LLMs are at the foundation of every AI chat bot application. Finally, AWS now offers its own AI assistant called Q. Amazon Q Business can be trained on an organization's data so employees can instantly find answers to their queries, and it can also generate content to boost productivity. Amazon Q Developer, on the other hand, can debug and generate code to help accelerate the completion of software projects. According to consulting firm PwC, AI could add a whopping $15.7 trillion to the global economy by 2030, and the combination of chips, LLMs, and software apps will help Amazon stake its claim to that enormous pie. Amazon was consistently losing money when Berkshire bought the stock, and it doesn't offer a dividend nor does it have a stock buyback program, so it doesn't tick many of Buffett's boxes (hence the small position). But it might be the most diverse AI stock investors can buy right now, and Berkshire will likely be pleased with its long-term return from here even if Buffett wishes it owned a bigger stake. Where Should You Invest $1,000 Right Now? Before you put a single dollar into the stock market, we think you’ll want to hear this. Our S&P/TSX market beating* Stock Advisor Canada team just released their top 10 starter stocks for 2024 that we believe could supercharge any portfolio. Want to see what made our list? Get started with Stock Advisor Canada today to receive all 10 of our starter stocks, a fully stocked treasure trove of industry reports, two brand-new stock recommendations every month, and much more. Click here to learn more. John Mackey, former CEO of Whole Foods Market, an Amazon subsidiary, is a member of The Motley Fool's board of directors. Anthony Di Pizio has no position in any of the stocks mentioned. The Motley Fool has positions in and recommends Amazon, Apple, Berkshire Hathaway, and Nvidia. The Motley Fool has a disclosure policy.
+
+USER:
+Why did Berkshire Hathaway reduce its position in Apple despite its continued dominance in AI and what does this suggest about Warren Buffett's broader market view?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,49,26,1199,,734
+System Instructions: [You may only use the provided context to answer. You must not use any outside sources or prior knowledge.],Question: [Summarize the role of Pros.],"Context: [DIFM Customers Intersecting our DIY customers and our Pros are our DIFM customers. These customers are typically homeowners who use Pros to complete their project or installation. Currently, we offer installation services in a variety of categories, such as flooring, water heaters, bath, garage doors, cabinets, cabinet makeovers, countertops, sheds, furnaces and central air systems, and windows. DIFM customers can purchase these services in our stores, online, or in their homes through in-home consultations. In addition to serving our DIFM customer needs, we believe our focus on the Pros who perform services for these customers helps us drive higher product sales. OUR PRODUCTS AND SERVICES A typical The Home Depot store stocks approximately 30,000 to 40,000 items during the year, including both national brand name and proprietary products. Our online product offerings complement our stores by serving as an extended aisle, and we offer a significantly broader product assortment through our websites and mobile applications, including homedepot.com, our primary website; homedepot.ca and homedepot.com.mx, our websites in Canada and Mexico, respectively; hdsupply.com, our website for our MRO products and related services; our websites for custom window coverings including blinds.com, justblinds.com and americanblinds.com; and thecompanystore.com, our website featuring textiles and décor products. Fiscal 2023 Form 10-K 2 Table of Contents We believe our merchandising organization is a key competitive advantage, delivering product innovation, assortment and value, which reinforces our position as the product authority in home improvement. In fiscal 2023, we continued to invest in merchandising resets in our stores to refine assortments, optimize space productivity, introduce innovative new products to our customers, and improve visual merchandising to drive a better shopping experience. At the same time, we remain focused on offering everyday values in our stores and online. To help our merchandising organization keep pace with changing customer expectations and increasing desire for innovation, localization, and personalization, we are continuing to invest in tools to better leverage our data and drive a deeper level of collaboration with our supplier partners. As a result, we have continued to focus on enhanced merchandising information technology tools to help us: (1) build an interconnected shopping experience that is tailored to our customers’ shopping intent and location; (2) provide the best value in the market; and (3) optimize our product assortments. Our merchandising team leverages technology and works closely with our inventory and supply chain teams, as well as our supplier partners, to manage our assortments, drive innovation, manage the cost environment, and adjust inventory levels to respond to fluctuations in demand. To complement our merchandising efforts, we offer a number of services for our customers, including installation services for our DIY and DIFM customers, as noted above. We also provide tool and equipment rentals at locations across the U.S. and Canada, providing value and convenience for both Pros and consumers. To improve the customer experience and continue to grow this differentiated service offering, we are continuing to invest in more locations (including continuing to pilot rental locations in Mexico), more tools, and better technology. Sourcing and Quality Assurance We maintain a global sourcing program to obtain high-quality and innovative products directly from manufacturers in the U.S. and around the world. During fiscal 2023, in addition to our U.S. sourcing operations, we maintained sourcing offices in Mexico, Canada, China, India, Vietnam and Europe. To ensure that suppliers adhere to our high standards of social and environmental responsibility, we also have a global responsible sourcing program. Under our supplier contracts, our suppliers are obligated to ensure that their products comply with applicable international, federal, state and local laws. These contracts also require compliance with our responsible sourcing standards, which cover a variety of expectations across multiple areas of social compliance, including supply chain transparency, compliance with applicable laws and regulations addressing prohibitions on child and forced labor, health and safety, environmental matters, compensation, and hours of work. To drive accountability with our suppliers, our standard supplier buying agreement includes a factory audit right related to these standards, and we conduct factory audits and compliance visits with non-Canada and non-U.S. suppliers of private branded and direct import products. Our 2023 Responsible Sourcing Report, available on our website at https://corporate.homedepot.com under “Responsibility > Sourcing Responsibly,” provides more information about this program. In addition, we have both quality assurance and engineering resources dedicated to establishing criteria and overseeing compliance with safety, quality and performance standards for our private branded products. Intellectual Property Our business has one of the most recognized brands in North America. As a result, we believe that The Home Depot trademark has significant value and is an important factor in the marketing of our products, e-commerce, stores and business. We have registered or applied for registration of trademarks, service marks, copyrights and internet domain names, both domestically and internationally, for use in our business, including our proprietary brands such as HDX , Husky , Hampton Bay , Home Decorators Collection , Glacier Bay , Vigoro , Everbilt and Lifeproof . The duration of trademark registrations varies from country to country. However, trademarks are generally valid and may be renewed indefinitely as long as they are in use and/or their registrations are properly maintained. We also maintain patent portfolios relating to our business operations, retail services, and products, and we seek to patent or otherwise protect innovations we incorporate into our business. Patents generally have a term of twenty years from the date they are filed. As our patent portfolio has been built over time, the remaining terms of the individual patents across our patent portfolio vary. Although our patents have value, no single patent is essential to our business. We continuously assess our merchandising departments and product lines for opportunities to expand the assortment of products offered within The Home Depot’s portfolio of proprietary and exclusive brands. COMPETITION AND SEASONALITY Our industry is highly competitive, fragmented, and evolving. As a result, we face competition for customers for our products and services from a variety of retailers, suppliers, service providers, and distributors and manufacturers that sell products directly to their respective customer bases. These competitors range from traditional brick-and-mortar, to multichannel, to exclusively online, and they include a number of other home improvement retailers; local, ® ® ® ® ® ® ® ® ® Fiscal 2023 Form 10-K 3 Table of Contents regional and national hardware stores; electrical, plumbing and building materials supply houses; and lumber yards. With respect to some products and services, we also compete with specialty design stores, showrooms, discount stores, paint stores, specialty and mass digital retailers, warehouse clubs, MRO distributors, home décor retailers, and other retailers, as well as with providers of home improvement services and tool and equipment rental. The internet facilitates competitive entry, price transparency, and comparison shopping, increasing the level of competition we face. Both in-store and online, we compete primarily based on customer experience, price, quality, product availability and assortment, and delivery options. We also compete based on store location and appearance, presentation of merchandise, and ease of shopping experience. Our Pros also look for dedicated sales support, competitive credit and pricing options, project planning tools, and product depth and job lot quantities, particularly for their complex purchase needs. Furthermore, with respect to delivery options, customers are seeking faster and/or guaranteed delivery times, low-price or free shipping, and/or convenient pickup options. Our ability to be competitive on delivery and pickup times, options and costs depends on many factors, including the success of our supply chain investments, described more fully under “Our Supply Chain” below. Our business is subject to seasonal influences. Generally, our highest volume of sales occurs in our second fiscal quarter, as we move into the spring season in the regions in which we operate.]","System Instructions: [You may only use the provided context to answer. You must not use any outside sources or prior knowledge.] Question: [Summarize the role of Pros.] Context: [DIFM Customers Intersecting our DIY customers and our Pros are our DIFM customers. These customers are typically homeowners who use Pros to complete their project or installation. Currently, we offer installation services in a variety of categories, such as flooring, water heaters, bath, garage doors, cabinets, cabinet makeovers, countertops, sheds, furnaces and central air systems, and windows. DIFM customers can purchase these services in our stores, online, or in their homes through in-home consultations. In addition to serving our DIFM customer needs, we believe our focus on the Pros who perform services for these customers helps us drive higher product sales. OUR PRODUCTS AND SERVICES A typical The Home Depot store stocks approximately 30,000 to 40,000 items during the year, including both national brand name and proprietary products. Our online product offerings complement our stores by serving as an extended aisle, and we offer a significantly broader product assortment through our websites and mobile applications, including homedepot.com, our primary website; homedepot.ca and homedepot.com.mx, our websites in Canada and Mexico, respectively; hdsupply.com, our website for our MRO products and related services; our websites for custom window coverings including blinds.com, justblinds.com and americanblinds.com; and thecompanystore.com, our website featuring textiles and décor products. Fiscal 2023 Form 10-K 2 Table of Contents We believe our merchandising organization is a key competitive advantage, delivering product innovation, assortment and value, which reinforces our position as the product authority in home improvement. In fiscal 2023, we continued to invest in merchandising resets in our stores to refine assortments, optimize space productivity, introduce innovative new products to our customers, and improve visual merchandising to drive a better shopping experience. At the same time, we remain focused on offering everyday values in our stores and online. To help our merchandising organization keep pace with changing customer expectations and increasing desire for innovation, localization, and personalization, we are continuing to invest in tools to better leverage our data and drive a deeper level of collaboration with our supplier partners. As a result, we have continued to focus on enhanced merchandising information technology tools to help us: (1) build an interconnected shopping experience that is tailored to our customers’ shopping intent and location; (2) provide the best value in the market; and (3) optimize our product assortments. Our merchandising team leverages technology and works closely with our inventory and supply chain teams, as well as our supplier partners, to manage our assortments, drive innovation, manage the cost environment, and adjust inventory levels to respond to fluctuations in demand. To complement our merchandising efforts, we offer a number of services for our customers, including installation services for our DIY and DIFM customers, as noted above. We also provide tool and equipment rentals at locations across the U.S. and Canada, providing value and convenience for both Pros and consumers. To improve the customer experience and continue to grow this differentiated service offering, we are continuing to invest in more locations (including continuing to pilot rental locations in Mexico), more tools, and better technology. Sourcing and Quality Assurance We maintain a global sourcing program to obtain high-quality and innovative products directly from manufacturers in the U.S. and around the world. During fiscal 2023, in addition to our U.S. sourcing operations, we maintained sourcing offices in Mexico, Canada, China, India, Vietnam and Europe. To ensure that suppliers adhere to our high standards of social and environmental responsibility, we also have a global responsible sourcing program. Under our supplier contracts, our suppliers are obligated to ensure that their products comply with applicable international, federal, state and local laws. These contracts also require compliance with our responsible sourcing standards, which cover a variety of expectations across multiple areas of social compliance, including supply chain transparency, compliance with applicable laws and regulations addressing prohibitions on child and forced labor, health and safety, environmental matters, compensation, and hours of work. To drive accountability with our suppliers, our standard supplier buying agreement includes a factory audit right related to these standards, and we conduct factory audits and compliance visits with non-Canada and non-U.S. suppliers of private branded and direct import products. Our 2023 Responsible Sourcing Report, available on our website at https://corporate.homedepot.com under “Responsibility > Sourcing Responsibly,” provides more information about this program. In addition, we have both quality assurance and engineering resources dedicated to establishing criteria and overseeing compliance with safety, quality and performance standards for our private branded products. Intellectual Property Our business has one of the most recognized brands in North America. As a result, we believe that The Home Depot trademark has significant value and is an important factor in the marketing of our products, e-commerce, stores and business. We have registered or applied for registration of trademarks, service marks, copyrights and internet domain names, both domestically and internationally, for use in our business, including our proprietary brands such as HDX , Husky , Hampton Bay , Home Decorators Collection , Glacier Bay , Vigoro , Everbilt and Lifeproof . The duration of trademark registrations varies from country to country. However, trademarks are generally valid and may be renewed indefinitely as long as they are in use and/or their registrations are properly maintained. We also maintain patent portfolios relating to our business operations, retail services, and products, and we seek to patent or otherwise protect innovations we incorporate into our business. Patents generally have a term of twenty years from the date they are filed. As our patent portfolio has been built over time, the remaining terms of the individual patents across our patent portfolio vary. Although our patents have value, no single patent is essential to our business. We continuously assess our merchandising departments and product lines for opportunities to expand the assortment of products offered within The Home Depot’s portfolio of proprietary and exclusive brands. COMPETITION AND SEASONALITY Our industry is highly competitive, fragmented, and evolving. As a result, we face competition for customers for our products and services from a variety of retailers, suppliers, service providers, and distributors and manufacturers that sell products directly to their respective customer bases. These competitors range from traditional brick-and-mortar, to multichannel, to exclusively online, and they include a number of other home improvement retailers; local, ® ® ® ® ® ® ® ® ® Fiscal 2023 Form 10-K 3 Table of Contents regional and national hardware stores; electrical, plumbing and building materials supply houses; and lumber yards. With respect to some products and services, we also compete with specialty design stores, showrooms, discount stores, paint stores, specialty and mass digital retailers, warehouse clubs, MRO distributors, home décor retailers, and other retailers, as well as with providers of home improvement services and tool and equipment rental. The internet facilitates competitive entry, price transparency, and comparison shopping, increasing the level of competition we face. Both in-store and online, we compete primarily based on customer experience, price, quality, product availability and assortment, and delivery options. We also compete based on store location and appearance, presentation of merchandise, and ease of shopping experience. Our Pros also look for dedicated sales support, competitive credit and pricing options, project planning tools, and product depth and job lot quantities, particularly for their complex purchase needs. Furthermore, with respect to delivery options, customers are seeking faster and/or guaranteed delivery times, low-price or free shipping, and/or convenient pickup options. Our ability to be competitive on delivery and pickup times, options and costs depends on many factors, including the success of our supply chain investments, described more fully under “Our Supply Chain” below. Our business is subject to seasonal influences. Generally, our highest volume of sales occurs in our second fiscal quarter, as we move into the spring season in the regions in which we operate.]","System Instructions: [You may only use the provided context to answer. You must not use any outside sources or prior knowledge.]
+
+EVIDENCE:
+Context: [DIFM Customers Intersecting our DIY customers and our Pros are our DIFM customers. These customers are typically homeowners who use Pros to complete their project or installation. Currently, we offer installation services in a variety of categories, such as flooring, water heaters, bath, garage doors, cabinets, cabinet makeovers, countertops, sheds, furnaces and central air systems, and windows. DIFM customers can purchase these services in our stores, online, or in their homes through in-home consultations. In addition to serving our DIFM customer needs, we believe our focus on the Pros who perform services for these customers helps us drive higher product sales. OUR PRODUCTS AND SERVICES A typical The Home Depot store stocks approximately 30,000 to 40,000 items during the year, including both national brand name and proprietary products. Our online product offerings complement our stores by serving as an extended aisle, and we offer a significantly broader product assortment through our websites and mobile applications, including homedepot.com, our primary website; homedepot.ca and homedepot.com.mx, our websites in Canada and Mexico, respectively; hdsupply.com, our website for our MRO products and related services; our websites for custom window coverings including blinds.com, justblinds.com and americanblinds.com; and thecompanystore.com, our website featuring textiles and décor products. Fiscal 2023 Form 10-K 2 Table of Contents We believe our merchandising organization is a key competitive advantage, delivering product innovation, assortment and value, which reinforces our position as the product authority in home improvement. In fiscal 2023, we continued to invest in merchandising resets in our stores to refine assortments, optimize space productivity, introduce innovative new products to our customers, and improve visual merchandising to drive a better shopping experience. At the same time, we remain focused on offering everyday values in our stores and online. To help our merchandising organization keep pace with changing customer expectations and increasing desire for innovation, localization, and personalization, we are continuing to invest in tools to better leverage our data and drive a deeper level of collaboration with our supplier partners. As a result, we have continued to focus on enhanced merchandising information technology tools to help us: (1) build an interconnected shopping experience that is tailored to our customers’ shopping intent and location; (2) provide the best value in the market; and (3) optimize our product assortments. Our merchandising team leverages technology and works closely with our inventory and supply chain teams, as well as our supplier partners, to manage our assortments, drive innovation, manage the cost environment, and adjust inventory levels to respond to fluctuations in demand. To complement our merchandising efforts, we offer a number of services for our customers, including installation services for our DIY and DIFM customers, as noted above. We also provide tool and equipment rentals at locations across the U.S. and Canada, providing value and convenience for both Pros and consumers. To improve the customer experience and continue to grow this differentiated service offering, we are continuing to invest in more locations (including continuing to pilot rental locations in Mexico), more tools, and better technology. Sourcing and Quality Assurance We maintain a global sourcing program to obtain high-quality and innovative products directly from manufacturers in the U.S. and around the world. During fiscal 2023, in addition to our U.S. sourcing operations, we maintained sourcing offices in Mexico, Canada, China, India, Vietnam and Europe. To ensure that suppliers adhere to our high standards of social and environmental responsibility, we also have a global responsible sourcing program. Under our supplier contracts, our suppliers are obligated to ensure that their products comply with applicable international, federal, state and local laws. These contracts also require compliance with our responsible sourcing standards, which cover a variety of expectations across multiple areas of social compliance, including supply chain transparency, compliance with applicable laws and regulations addressing prohibitions on child and forced labor, health and safety, environmental matters, compensation, and hours of work. To drive accountability with our suppliers, our standard supplier buying agreement includes a factory audit right related to these standards, and we conduct factory audits and compliance visits with non-Canada and non-U.S. suppliers of private branded and direct import products. Our 2023 Responsible Sourcing Report, available on our website at https://corporate.homedepot.com under “Responsibility > Sourcing Responsibly,” provides more information about this program. In addition, we have both quality assurance and engineering resources dedicated to establishing criteria and overseeing compliance with safety, quality and performance standards for our private branded products. Intellectual Property Our business has one of the most recognized brands in North America. As a result, we believe that The Home Depot trademark has significant value and is an important factor in the marketing of our products, e-commerce, stores and business. We have registered or applied for registration of trademarks, service marks, copyrights and internet domain names, both domestically and internationally, for use in our business, including our proprietary brands such as HDX , Husky , Hampton Bay , Home Decorators Collection , Glacier Bay , Vigoro , Everbilt and Lifeproof . The duration of trademark registrations varies from country to country. However, trademarks are generally valid and may be renewed indefinitely as long as they are in use and/or their registrations are properly maintained. We also maintain patent portfolios relating to our business operations, retail services, and products, and we seek to patent or otherwise protect innovations we incorporate into our business. Patents generally have a term of twenty years from the date they are filed. As our patent portfolio has been built over time, the remaining terms of the individual patents across our patent portfolio vary. Although our patents have value, no single patent is essential to our business. We continuously assess our merchandising departments and product lines for opportunities to expand the assortment of products offered within The Home Depot’s portfolio of proprietary and exclusive brands. COMPETITION AND SEASONALITY Our industry is highly competitive, fragmented, and evolving. As a result, we face competition for customers for our products and services from a variety of retailers, suppliers, service providers, and distributors and manufacturers that sell products directly to their respective customer bases. These competitors range from traditional brick-and-mortar, to multichannel, to exclusively online, and they include a number of other home improvement retailers; local, ® ® ® ® ® ® ® ® ® Fiscal 2023 Form 10-K 3 Table of Contents regional and national hardware stores; electrical, plumbing and building materials supply houses; and lumber yards. With respect to some products and services, we also compete with specialty design stores, showrooms, discount stores, paint stores, specialty and mass digital retailers, warehouse clubs, MRO distributors, home décor retailers, and other retailers, as well as with providers of home improvement services and tool and equipment rental. The internet facilitates competitive entry, price transparency, and comparison shopping, increasing the level of competition we face. Both in-store and online, we compete primarily based on customer experience, price, quality, product availability and assortment, and delivery options. We also compete based on store location and appearance, presentation of merchandise, and ease of shopping experience. Our Pros also look for dedicated sales support, competitive credit and pricing options, project planning tools, and product depth and job lot quantities, particularly for their complex purchase needs. Furthermore, with respect to delivery options, customers are seeking faster and/or guaranteed delivery times, low-price or free shipping, and/or convenient pickup options. Our ability to be competitive on delivery and pickup times, options and costs depends on many factors, including the success of our supply chain investments, described more fully under “Our Supply Chain” below. Our business is subject to seasonal influences. Generally, our highest volume of sales occurs in our second fiscal quarter, as we move into the spring season in the regions in which we operate.]
+
+USER:
+Question: [Summarize the role of Pros.]
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",True,21,6,1280,,131
+"You will be provided with a user prompt and a context block. Only respond to prompts using information that has been provided in the context block. Do not use any outside knowledge to answer prompts. If you cannot answer a prompt based on the information in the context block alone, please state ""I unable to determine that without additional context"" and do not add anything further.","According to the author of the preface, who cannot accept that value investing works?","Preface to the Sixth Edition THE TIMELESS WISDOM OF GRAHAM AND DODD BY SETH A. KLARMAN Seventy-five years after Benjamin Graham and David Dodd wrote Security Analysis, a growing coterie of modern-day value investors remain deeply indebted to them. Graham and David were two assiduous and unusually insightful thinkers seeking to give order to the mostly uncharted financial wilderness of their era. They kindled a flame that has illuminated the way for value investors ever since. Today, Security Analysis remains an invaluable roadmap for investors as they navigate through unpredictable, often volatile, and sometimes treacherous finan- cial markets. Frequently referred to as the “bible of value investing,” Secu- rity Analysis is extremely thorough and detailed, teeming with wisdom for the ages. Although many of the examples are obviously dated, their les- sons are timeless. And while the prose may sometimes seem dry, readers can yet discover valuable ideas on nearly every page. The financial mar- kets have morphed since 1934 in almost unimaginable ways, but Graham and Dodd’s approach to investing remains remarkably applicable today. Value investing, today as in the era of Graham and Dodd, is the prac- tice of purchasing securities or assets for less than they are worth—the proverbial dollar for 50 cents. Investing in bargain-priced securities pro- vides a “margin of safety”—room for error, imprecision, bad luck, or the vicissitudes of the economy and stock market. While some might mistak- enly consider value investing a mechanical tool for identifying bargains, it is actually a comprehensive investment philosophy that emphasizes the need to perform in-depth fundamental analysis, pursue long-term investment results, limit risk, and resist crowd psychology. Far too many people approach the stock market with a focus on mak- ing money quickly. Such an orientation involves speculation rather than investment and is based on the hope that share prices will rise irrespec- tive of valuation. Speculators generally regard stocks as pieces of paper to be quickly traded back and forth, foolishly decoupling them from business reality and valuation criteria. Speculative approaches—which pay little or no attention to downside risk—are especially popular in ris- ing markets. In heady times, few are sufficiently disciplined to maintain strict standards of valuation and risk aversion, especially when most of those abandoning such standards are quickly getting rich. After all, it is easy to confuse genius with a bull market. In recent years, some people have attempted to expand the defini- tion of an investment to include any asset that has recently—or might soon—appreciate in price: art, rare stamps, or a wine collection. Because these items have no ascertainable fundamental value, generate no pres- ent or future cash flow, and depend for their value entirely on buyer whim, they clearly constitute speculations rather than investments. In contrast to the speculator’s preoccupation with rapid gain, value investors demonstrate their risk aversion by striving to avoid loss. A risk- averse investor is one for whom the perceived benefit of any gain is out- weighed by the perceived cost of an equivalent loss. Once any of us has accumulated a modicum of capital, the incremental benefit of gaining more is typically eclipsed by the pain of having less.1 Imagine how you would respond to the proposition of a coin flip that would either double your net worth or extinguish it. Being risk averse, nearly all people would respectfully decline such a gamble. Such risk aversion is deeply ingrained in human nature. Yet many unwittingly set aside their risk aversion when the sirens of market speculation call. Value investors regard securities not as speculative instruments but as fractional ownership in, or debt claims on, the underlying businesses. This orientation is key to value investing. When a small slice of a business is offered at a bargain price, it is helpful to evaluate it as if the whole business were offered for sale there. This analytical anchor helps value investors remain focused on the pursuit of long-term results rather than the profitability of their daily trading ledger. At the root of Graham and Dodd’s philosophy is the principle that the financial markets are the ultimate creators of opportunity. Sometimes the markets price securities correctly, other times not. Indeed, in the short run, the market can be quite inefficient, with great deviations between price and underlying value. Unexpected developments, increased uncer- tainty, and capital flows can boost short-term market volatility, with prices overshooting in either direction.2 In the words of Graham and Dodd, “The price [of a security] is frequently an essential element, so that a stock . . . may have investment merit at one price level but not at another.” (p. 106) As Graham has instructed, those who view the market as a weighing machine—a precise and efficient assessor of value—are part of the emo- tionally driven herd. Those who regard the market as a voting machine—a sentiment-driven popularity contest—will be well positioned to take proper advantage of the extremes of market sentiment. While it might seem that anyone can be a value investor, the essential characteristics of this type of investor—patience, discipline, and risk aver- sion—may well be genetically determined. When you first learn of the value approach, it either resonates with you or it doesn’t. Either you are able to remain disciplined and patient, or you aren’t. As Warren Buffett said in his famous article, “The Superinvestors of Graham-and-Doddsville,” “It is extraordinary to me that the idea of buying dollar bills for 40 cents takes immediately with people or it doesn’t take at all. It’s like an inocula- tion. If it doesn’t grab a person right away, I find you can talk to him for years and show him records, and it doesn’t make any difference.” 3,4 If Security Analysis resonates with you—if you can resist speculating and sometimes sit on your hands—perhaps you have a predisposition toward value investing. If not, at least the book will help you understand where you fit into the investing landscape and give you an appreciation for what the value-investing community may be thinking. Just as Relevant Now Perhaps the most exceptional achievement of Security Analysis, first pub- lished in 1934 and revised in the acclaimed 1940 edition, is that its les- sons are timeless. Generations of value investors have adopted the teachings of Graham and Dodd and successfully implemented them across highly varied market environments, countries, and asset classes. 3 “The Superinvestors of Graham-and-Doddsville,” Hermes, the Columbia Business School magazine, 1984. 4 My own experience has been exactly the one that Buffett describes. My 1978 summer job at Mutual Shares, a no-load value-based mutual fund, set the course for my professional career. The planned liquidation of Telecor and spin-off of its Electro Rent subsidiary in 1980 forever imprinted in my mind the merit of fundamental investment analysis. A buyer of Telecor stock was effectively creating an investment in the shares of Electro Rent, a fast-growing equipment rental company, at the giveaway valuation of approximately 1 times the cash flow. You always remember your first value investment.This would delight the authors, who hoped to set forth principles that would “stand the test of the ever enigmatic future.” (p. xliv) In 1992, Tweedy, Browne Company LLC, a well-known value invest- ment firm, published a compilation of 44 research studies entitled, “What Has Worked in Investing.” The study found that what has worked is fairly simple: cheap stocks (measured by price-to-book values, price- to-earnings ratios, or dividend yields) reliably outperform expensive ones, and stocks that have underperformed (over three- and five-year periods) subsequently beat those that have lately performed well. In other words, value investing works! I know of no long-time practitioner who regrets adhering to a value philosophy; few investors who embrace the fundamental principles ever abandon this investment approach for another. Today, when you read Graham and Dodd’s description of how they navigated through the financial markets of the 1930s, it seems as if they were detailing a strange, foreign, and antiquated era of economic depression, extreme risk aversion, and obscure and obsolete businesses. But such an exploration is considerably more valuable than it superfi- cially appears. After all, each new day has the potential to bring with it a strange and foreign environment. Investors tend to assume that tomor- row’s markets will look very much like today’s, and, most of the time, they will. But every once in a while,5 conventional wisdom is turned on its head, circular reasoning is unraveled, prices revert to the mean, and speculative behavior is exposed as such. At those times, when today fails to resemble yesterday, most investors will be paralyzed. In the words of Graham and Dodd, “We have striven throughout to guard the student against overemphasis upon the superficial and the temporary,” which is “at once the delusion and the nemesis of the world of finance.” (p. xliv) It is during periods of tumult that a value-investing philosophy is particu- larly beneficial. In 1934, Graham and Dodd had witnessed over a five-year span the best and the worst of times in the markets—the run-up to the 1929 peak, the October 1929 crash, and the relentless grind of the Great Depression. They laid out a plan for how investors in any environment might sort through hundreds or even thousands of common stocks, pre- ferred shares, and bonds to identify those worthy of investment. Remark- ably, their approach is essentially the same one that value investors employ today. The same principles they applied to the U.S. stock and bond markets of the 1920s and 1930s apply to the global capital markets of the early twenty-first century, to less liquid asset classes like real estate and private equity, and even to derivative instruments that hardly existed when Security Analysis was written. While formulas such as the classic “net working capital” test are nec- essary to support an investment analysis, value investing is not a paint- by-numbers exercise.6 Skepticism and judgment are always required. For one thing, not all elements affecting value are captured in a company’s financial statements—inventories can grow obsolete and receivables uncollectible; liabilities are sometimes unrecorded and property values over- or understated. Second, valuation is an art, not a science. Because the value of a business depends on numerous variables, it can typically be assessed only within a range. Third, the outcomes of all investments depend to some extent on the future, which cannot be predicted with certainty; for this reason, even some carefully analyzed investments fail to achieve profitable outcomes. Sometimes a stock becomes cheap for good reason: a broken business model, hidden liabilities, protracted litigation, or incompetent or corrupt management. Investors must always act with caution and humility, relentlessly searching for additional infor- mation while realizing that they will never know everything about a company. In the end, the most successful value investors combine detailed business research and valuation work with endless discipline and patience, a well-considered sensitivity analysis, intellectual honesty, and years of analytical and investment experience. Interestingly, Graham and Dodd’s value-investing principles apply beyond the financial markets—including, for example, to the market for baseball talent, as eloquently captured in Moneyball, Michael Lewis’s 2003 bestseller. The market for baseball players, like the market for stocks and bonds, is inefficient—and for many of the same reasons. In both investing and baseball, there is no single way to ascertain value, no one metric that tells the whole story. In both, there are mountains of information and no broad consensus on how to assess it. Decision makers in both arenas mis- interpret available data, misdirect their analyses, and reach inaccurate conclusions. In baseball, as in securities, many overpay because they fear standing apart from the crowd and being criticized. They often make decisions for emotional, not rational, reasons. They become exuberant; they panic. Their orientation sometimes becomes overly short term. They fail to understand what is mean reverting and what isn’t. Baseball’s value investors, like financial market value investors, have achieved significant outperformance over time. While Graham and Dodd didn’t apply value principles to baseball, the applicability of their insights to the market for athletic talent attests to the universality and timelessness of this approach. Value Investing Today Amidst the Great Depression, the stock market and the national econ- omy were exceedingly risky. Downward movements in share prices and business activity came suddenly and could be severe and protracted. Optimists were regularly rebuffed by circumstances. Winning, in a sense, was accomplished by not losing. Investors could achieve a margin of safety by buying shares in businesses at a large discount to their under- lying value, and they needed a margin of safety because of all the things that could—and often did—go wrong. Even in the worst of markets, Graham and Dodd remained faithful to their principles, including their view that the economy and markets sometimes go through painful cycles, which must simply be endured. They expressed confidence, in those dark days, that the economy and stock market would eventually rebound: “While we were writing, we had to combat a widespread conviction that financial debacle was to be the permanent order.” (p. xliv) Of course, just as investors must deal with down cycles when busi- ness results deteriorate and cheap stocks become cheaper, they must also endure up cycles when bargains are scarce and investment capital is plentiful. In recent years, the financial markets have performed exceed- ingly well by historic standards, attracting substantial fresh capital in need of managers. Today, a meaningful portion of that capital—likely totaling in the trillions of dollars globally—invests with a value approach. This includes numerous value-based asset management firms and mutual funds, a number of today’s roughly 9,000 hedge funds, and some of the largest and most successful university endowments and family investment offices. It is important to note that not all value investors are alike. In the aforementioned “Superinvestors of Graham-and-Doddsville,” Buffett describes numerous successful value investors who have little portfolio overlap. Some value investors hold obscure, “pink-sheet shares” while others focus on the large-cap universe. Some have gone global, while others focus on a single market sector such as real estate or energy. Some run computer screens to identify statistically inexpensive compa- nies, while others assess “private market value”—the value an industry buyer would pay for the entire company. Some are activists who aggres- sively fight for corporate change, while others seek out undervalued securities with a catalyst already in place—such as a spin-off, asset sale, major share repurchase plan, or new management team—for the partial or full realization of the underlying value. And, of course, as in any pro- fession, some value investors are simply more talented than others. In the aggregate, the value-investing community is no longer the very small group of adherents that it was several decades ago. Competition can have a powerful corrective effect on market inefficiencies and mis- pricings. With today’s many amply capitalized and skilled investors, what are the prospects for a value practitioner? Better than you might expect, for several reasons. First, even with a growing value community, there are far more market participants with little or no value orientation. Most man- agers, including growth and momentum investors and market indexers, pay little or no attention to value criteria. Instead, they concentrate almost single-mindedly on the growth rate of a company’s earnings, the momentum of its share price, or simply its inclusion in a market index. Second, nearly all money managers today, including some hapless value managers, are forced by the (real or imagined) performance pres- sures of the investment business to have an absurdly short investment horizon, sometimes as brief as a calendar quarter, month, or less. A value strategy is of little use to the impatient investor since it usually takes time to pay off. Finally, human nature never changes. Capital market manias regularly occur on a grand scale: Japanese stocks in the late 1980s, Internet and technology stocks in 1999 and 2000, subprime mortgage lending in 2006 and 2007, and alternative investments currently. It is always difficult to take a contrarian approach. Even highly capable investors can wither under the relentless message from the market that they are wrong. The pressures to succumb are enormous; many investment managers fear they’ll lose business if they stand too far apart from the crowd. Some also fail to pursue value because they’ve handcuffed themselves (or been saddled by clients) with constraints preventing them from buying stocks selling at low dollar prices, small-cap stocks, stocks of companies that don’t pay dividends or are losing money, or debt instruments with below investment-grade ratings.7 Many also engage in career manage- ment techniques like “window dressing” their portfolios at the end of cal- endar quarters or selling off losers (even if they are undervalued) while buying more of the winners (even if overvalued). Of course, for those value investors who are truly long term oriented, it is a wonderful thing that many potential competitors are thrown off course by constraints that render them unable or unwilling to effectively compete. Another reason that greater competition may not hinder today’s value investors is the broader and more diverse investment landscape in which they operate. Graham faced a limited lineup of publicly traded U.S. equity and debt securities. Today, there are many thousands of publicly traded stocks in the United States alone, and many tens of thousands worldwide, plus thousands of corporate bonds and asset-backed debt securities. Previously illiquid assets, such as bank loans, now trade regu- larly. Investors may also choose from an almost limitless number of derivative instruments, including customized contracts designed to meet any need or hunch. Nevertheless, 25 years of historically strong stock market perform- ance have left the market far from bargain-priced. High valuations and intensified competition raise the specter of lower returns for value investors generally. Also, some value investment firms have become extremely large, and size can be the enemy of investment performance because decision making is slowed by bureaucracy and smaller opportu- nities cease to move the needle. In addition, because growing numbers of competent buy-side and sell-side analysts are plying their trade with the assistance of sophisti- cated information technology, far fewer securities seem likely to fall through the cracks to become extremely undervalued.8 Today’s value investors are unlikely to find opportunity armed only with a Value Line guide or by thumbing through stock tables. While bargains still occasion- ally hide in plain sight, securities today are most likely to become mis- priced when they are either accidentally overlooked or deliberately avoided. Consequently, value investors have had to become thoughtful about where to focus their analysis. In the early 2000s, for example, investors became so disillusioned with the capital allocation procedures of many South Korean companies that few considered them candidates for worthwhile investment. As a result, the shares of numerous South Korean companies traded at great discounts from prevailing international valuations: at two or three times the cash flow, less than half the underly- ing business value, and, in several cases, less than the cash (net of debt) held on their balance sheets. Bargain issues, such as Posco and SK Tele- com, ultimately attracted many value seekers; Warren Buffett reportedly profited handsomely from a number of South Korean holdings. Today’s value investors also find opportunity in the stocks and bonds of companies stigmatized on Wall Street because of involvement in pro-tracted litigation, scandal, accounting fraud, or financial distress. The securities of such companies sometimes trade down to bargain levels, where they become good investments for those who are able to remain stalwart in the face of bad news. For example, the debt of Enron, per- haps the world’s most stigmatized company after an accounting scandal forced it into bankruptcy in 2001, traded as low as 10 cents on the dollar of claim; ultimate recoveries are expected to be six times that amount. Similarly, companies with tobacco or asbestos exposure have in recent years periodically come under severe selling pressure due to the uncer- tainties surrounding litigation and the resultant risk of corporate finan- cial distress. More generally, companies that disappoint or surprise investors with lower-than-expected results, sudden management changes, accounting problems, or ratings downgrades are more likely than consistently strong performers to be sources of opportunity. When bargains are scarce, value investors must be patient; compro- mising standards is a slippery slope to disaster. New opportunities will emerge, even if we don’t know when or where. In the absence of com- pelling opportunity, holding at least a portion of one’s portfolio in cash equivalents (for example, U.S. Treasury bills) awaiting future deployment will sometimes be the most sensible option. Recently, Warren Buffett stated that he has more cash to invest than he has good investments. As all value investors must do from time to time, Buffett is waiting patiently. Still, value investors are bottom-up analysts, good at assessing securi- ties one at a time based on the fundamentals. They don’t need the entire market to be bargain priced, just 20 or 25 unrelated securities—a num- ber sufficient for diversification of risk. Even in an expensive market, value investors must keep analyzing securities and assessing businesses, gaining knowledge and experience that will be useful in the future. Value investors, therefore, should not try to time the market or guess whether it will rise or fall in the near term. Rather, they should rely on a bottom-up approach, sifting the financial markets for bargains and then buying them, regardless of the level or recent direction of the market or economy. Only when they cannot find bargains should they default to holding cash. A Flexible Approach Because our nation’s founders could not foresee—and knew they could not foresee—technological, social, cultural, and economic changes that the future would bring, they wrote a flexible constitution that still guides us over two centuries later. Similarly, Benjamin Graham and David Dodd acknowledged that they could not anticipate the business, economic, technological, and competitive changes that would sweep through the investment world over the ensuing years. But they, too, wrote a flexible treatise that provides us with the tools to function in an investment landscape that was destined—and remains destined—to undergo pro- found and unpredictable change. For example, companies today sell products that Graham and Dodd could not have imagined. Indeed, there are companies and entire indus- tries that they could not have envisioned. Security Analysis offers no examples of how to value cellular phone carriers, software companies, satellite television providers, or Internet search engines. But the book provides the analytical tools to evaluate almost any company, to assess the value of its marketable securities, and to determine the existence of a margin of safety. Questions of solvency, liquidity, predictability, busi- ness strategy, and risk cut across businesses, nations, and time. Graham and Dodd did not specifically address how to value private businesses or how to determine the value of an entire company rather than the value of a fractional interest through ownership of its shares.9 9 They did consider the relative merits of corporate control enjoyed by a private business owner ver- sus the value of marketability for a listed stock (p. 372). But their analytical principles apply equally well to these different issues. Investors still need to ask, how stable is the enterprise, and what are its future prospects? What are its earnings and cash flow? What is the downside risk of owning it? What is its liquidation value? How capable and honest is its management? What would you pay for the stock of this company if it were public? What factors might cause the owner of this business to sell control at a bargain price? Similarly, the pair never addressed how to analyze the purchase of an office building or apartment complex. Real estate bargains come about for the same reasons as securities bargains—an urgent need for cash, inability to perform proper analysis, a bearish macro view, or investor disfavor or neglect. In a bad real estate climate, tighter lending standards can cause even healthy properties to sell at distressed prices. Graham and Dodd’s principles—such as the stability of cash flow, sufficiency of return, and analysis of downside risk—allow us to identify real estate investments with a margin of safety in any market environment. Even complex derivatives not imagined in an earlier era can be scruti- nized with the value investor’s eye. While traders today typically price put and call options via the Black-Scholes model, one can instead use value-investing precepts—upside potential, downside risk, and the likeli- hood that each of various possible scenarios will occur—to analyze these instruments. An inexpensive option may, in effect, have the favorable risk-return characteristics of a value investment—regardless of what the Black-Scholes model dictates. Institutional Investing Perhaps the most important change in the investment landscape over the past 75 years is the ascendancy of institutional investing. In the 1930s, individual investors dominated the stock market. Today, by contrast, most market activity is driven by institutional investors—large pools of pension, endowment, and aggregated individual capital. While the advent of these large, quasi-permanent capital pools might have resulted in the wide-scale adoption of a long-term value-oriented approach, in fact this has not occurred. Instead, institutional investing has evolved into a short-term performance derby, which makes it diffi- cult for institutional managers to take contrarian or long-term positions. Indeed, rather than standing apart from the crowd and possibly suffering disappointing short-term results that could cause clients to withdraw capital, institutional investors often prefer the safe haven of assured mediocre performance that can be achieved only by closely following the herd. Alternative investments—a catch-all category that includes venture capital, leveraged buyouts, private equity, and hedge funds—are the cur- rent institutional rage. No investment treatise written today could fail to comment on this development. Fueled by performance pressures and a growing expectation of low (and inadequate) returns from traditional equity and debt investments, institutional investors have sought high returns and diversification by allocating a growing portion of their endowments and pension funds to alternatives. Pioneering Portfolio Management, written in 2000 by David Swensen, the groundbreaking head of Yale’s Investment Office, makes a strong case for alternative investments. In it, Swensen points to the historically inefficient pricing of many asset classes,10 the historically high risk-adjusted returns of many alternative managers, and the limited 10 Many investors make the mistake of thinking about returns to asset classes as if they were perma- nent. Returns are not inherent to an asset class; they result from the fundamentals of the underlying businesses and the price paid by investors for the related securities. Capital flowing into an asset class can, reflexively, impair the ability of those investing in that asset class to continue to generate the anticipated, historically attractive returns. He highlights the importance of alternative manager selection by noting the large dispersion of returns achieved between top-quartile and third- quartile performers. A great many endowment managers have emulated Swensen, following him into a large commitment to alternative investments, almost certainly on worse terms and amidst a more competitive environment than when he entered the area. Graham and Dodd would be greatly concerned by the commitment of virtually all major university endowments to one type of alternative investment: venture capital. The authors of the margin-of-safety approach to investing would not find one in the entire venture capital universe.11 While there is often the prospect of substantial upside in ven- ture capital, there is also very high risk of failure. Even with the diversifi- cation provided by a venture fund, it is not clear how to analyze the underlying investments to determine whether the potential return justi- fies the risk. Venture capital investment would, therefore, have to be characterized as pure speculation, with no margin of safety whatsoever. Hedge funds—a burgeoning area of institutional interest with nearly $2 trillion of assets under management—are pools of capital that vary widely in their tactics but have a common fee structure that typically pays the manager 1% to 2% annually of assets under management and 20% (and sometimes more) of any profits generated. They had their start in the 1920s, when Ben Graham himself ran one of the first hedge funds. What would Graham and Dodd say about the hedge funds operating in today’s markets? They would likely disapprove of hedge funds that make investments based on macroeconomic assessments or that pursue 11 Nor would they find one in leveraged buyouts, through which businesses are purchased at lofty prices using mostly debt financing and a thin layer of equity capital. The only value-investing ration- ale for venture capital or leveraged buyouts might be if they were regarded as mispriced call options. Even so, it is not clear that these areas constitute good value. Such funds, by avoiding or even sell- ing undervalued securities to participate in one or another folly, inadver- tently create opportunities for value investors. The illiquidity, lack of transparency, gargantuan size, embedded leverage, and hefty fees of some hedge funds would no doubt raise red flags. But Graham and Dodd would probably approve of hedge funds that practice value-ori- ented investment selection. Importantly, while Graham and Dodd emphasized limiting risk on an investment-by-investment basis, they also believed that diversification and hedging could protect the downside for an entire portfolio. (p. 106) This is what most hedge funds attempt to do. While they hold individual securities that, considered alone, may involve an uncomfortable degree of risk, they attempt to offset the risks for the entire portfolio through the short sale of similar but more highly valued securities, through the purchase of put options on individual securities or market indexes, and through adequate diversification (although many are guilty of overdiver- sification, holding too little of their truly good ideas and too much of their mediocre ones). In this way, a hedge fund portfolio could (in theory, anyway) have characteristics of good potential return with limited risk that its individual components may not have. Modern-day Developments As mentioned, the analysis of businesses and securities has become increasingly sophisticated over the years. Spreadsheet technology, for example, allows for vastly more sophisticated modeling than was possible even one generation ago. Benjamin Graham’s pencil, clearly one of the sharpest of his era, might not be sharp enough today. On the other hand, technology can easily be misused; computer modeling requires making a series of assumptions about the future that can lead to a spurious preci- sion of which Graham would have been quite dubious. While Graham was interested in companies that produced consistent earnings, analysis in his day was less sophisticated regarding why some company’s earnings might be more consistent than others. Analysts today examine businesses but also business models; the bottom-line impact of changes in revenues, profit margins, product mix, and other variables is carefully studied by managements and financial analysts alike. Investors know that businesses do not exist in a vacuum; the actions of competitors, suppliers, and cus- tomers can greatly impact corporate profitability and must be considered.12 Another important change in focus over time is that while Graham looked at corporate earnings and dividend payments as barometers of a company’s health, most value investors today analyze free cash flow. This is the cash generated annually from the operations of a business after all capital expenditures are made and changes in working capital are con- sidered. Investors have increasingly turned to this metric because reported earnings can be an accounting fiction, masking the cash gener- ated by a business or implying positive cash generation when there is none. Today’s investors have rightly concluded that following the cash— as the manager of a business must do—is the most reliable and reveal- ing means of assessing a company. In addition, many value investors today consider balance sheet analy- sis less important than was generally thought a few generations ago. With returns on capital much higher at present than in the past, most stocks trade far above book value; balance sheet analysis is less helpful in understanding upside potential or downside risk of stocks priced at 12 Professor Michael Porter of Harvard Business School, in his seminal book Competitive Strategy (Free Press, 1980), lays out the groundwork for a more intensive, thorough, and dynamic analysis of busi- nesses and industries in the modern economy. A broad industry analysis has become particularly necessary as a result of the passage in 2000 of Regulation FD (Fair Disclosure), which regulates and restricts the communications between a company and its actual or potential shareholders. Wall Street analysts, facing a dearth of information from the companies they cover, have been forced to expand their areas of inquiry. The effects of sustained inflation over time have also wreaked havoc with the accuracy of assets accounted for using historic cost; this means that two companies owning identical assets could report very different book values. Of course, balance sheets must still be carefully scrutinized. Astute observers of corporate balance sheets are often the first to see business deterioration or vulnerability as inventories and receivables build, debt grows, and cash evaporates. And for investors in the equity and debt of underperforming companies, balance sheet analysis remains one generally reliable way of assessing downside protection. Globalization has increasingly affected the investment landscape, with most investors looking beyond their home countries for opportunity and diversification. Graham and Dodd’s principles fully apply to international markets, which are, if anything, even more subject to the vicissitudes of investor sentiment—and thus more inefficiently priced—than the U.S. market is today. Investors must be cognizant of the risks of international investing, including exposure to foreign currencies and the need to consider hedging them. Among the other risks are political instability, different (or absent) securities laws and investor protections, varying accounting standards, and limited availability of information. Oddly enough, despite 75 years of success achieved by value investors, one group of observers largely ignores or dismisses this disci- pline: academics. Academics tend to create elegant theories that purport to explain the real world but in fact oversimplify it. One such theory, the Efficient Market Hypothesis (EMH), holds that security prices always and immediately reflect all available information, an idea deeply at odds with Graham and Dodd’s notion that there is great value to fundamental security analysis. The Capital Asset Pricing Model (CAPM) relates risk to return but always mistakes volatility, or beta, for risk. Modern Portfolio Theory (MPT) applauds the benefits of diversification in constructing an optimal portfolio. But by insisting that higher expected return comes only with greater risk, MPT effectively repudiates the entire value-invest- ing philosophy and its long-term record of risk-adjusted investment out- performance. Value investors have no time for these theories and generally ignore them. The assumptions made by these theories—including continuous markets, perfect information, and low or no transaction costs—are unre- alistic. Academics, broadly speaking, are so entrenched in their theories that they cannot accept that value investing works. Instead of launching a series of studies to understand the remarkable 50-year investment record of Warren Buffett, academics instead explain him away as an aber- ration. Greater attention has been paid recently to behavioral economics, a field recognizing that individuals do not always act rationally and have systematic cognitive biases that contribute to market inefficiencies and security mispricings. These teachings—which would not seem alien to Graham—have not yet entered the academic mainstream, but they are building some momentum. Academics have espoused nuanced permutations of their flawed the- ories for several decades. Countless thousands of their students have been taught that security analysis is worthless, that risk is the same as volatility, and that investors must avoid overconcentration in good ideas (because in efficient markets there can be no good ideas) and thus diver- sify into mediocre or bad ones. Of course, for value investors, the propa- gation of these academic theories has been deeply gratifying: the brainwashing of generations of young investors produces the very ineffi- ciencies that savvy stock pickers can exploit. Another important factor for value investors to take into account is the growing propensity of the Federal Reserve to intervene in financial markets at the first sign of trouble. Amidst severe turbulence, the Fed frequently lowers interest rates to prop up securities prices and restore investor confidence. While the intention of Fed officials is to maintain orderly capital markets, some money managers view Fed intervention as a virtual license to speculate. Aggressive Fed tactics, sometimes referred to as the “Greenspan put” (now the “Bernanke put”), create a moral haz- ard that encourages speculation while prolonging overvaluation. So long as value investors aren’t lured into a false sense of security, so long as they can maintain a long-term horizon and ensure their staying power, market dislocations caused by Fed action (or investor anticipation of it) may ultimately be a source of opportunity. Another modern development of relevance is the ubiquitous cable television coverage of the stock market. This frenetic lunacy exacerbates the already short-term orientation of most investors. It foments the view that it is possible—or even necessary—to have an opinion on everything pertinent to the financial markets, as opposed to the patient and highly selective approach endorsed by Graham and Dodd. This sound-bite cul- ture reinforces the popular impression that investing is easy, not rigorous and painstaking. The daily cheerleading pundits exult at rallies and record highs and commiserate over market reversals; viewers get the impression that up is the only rational market direction and that selling or sitting on the sidelines is almost unpatriotic. The hysterical tenor is exacerbated at every turn. For example, CNBC frequently uses a format- ted screen that constantly updates the level of the major market indexes against a digital clock. Not only is the time displayed in hours, minutes, and seconds but in completely useless hundredths of seconds, the num- bers flashing by so rapidly (like tenths of a cent on the gas pump) as to be completely unreadable. The only conceivable purpose is to grab the viewers’ attention and ratchet their adrenaline to full throttle. Cable business channels bring the herdlike mentality of the crowd into everyone’s living room, thus making it much harder for viewers to stand apart from the masses. Only on financial cable TV would a commentator with a crazed persona become a celebrity whose pronouncements regularly move markets. In a world in which the differences between investing and speculating are frequently blurred, the nonsense on financial cable channels only compounds the problem. Graham would have been appalled. The only saving grace is that value investors prosper at the expense of those who fall under the spell of the cable pundits. Meanwhile, human nature virtually ensures that there will never be a Graham and Dodd channel. Unanswered Questions Today’s investors still wrestle, as Graham and Dodd did in their day, with a number of important investment questions. One is whether to focus on relative or absolute value. Relative value involves the assessment that one security is cheaper than another, that Microsoft is a better bargain than IBM. Relative value is easier to determine than absolute value, the two-dimensional assessment of whether a security is cheaper than other securities and cheap enough to be worth purchasing. The most intrepid investors in relative value manage hedge funds where they purchase the relatively less expensive securities and sell short the relatively more expensive ones. This enables them potentially to profit on both sides of the ledger, long and short. Of course, it also exposes them to double- barreled losses if they are wrong.13 It is harder to think about absolute value than relative value. When is a stock cheap enough to buy and hold without a short sale as a hedge? One standard is to buy when a security trades at an appreciable—say, 30%, 40%, or greater—discount from its underlying value, calculated either as its liquidation value, going-concern value, or private-market 13 Many hedge funds also use significant leverage to goose their returns further, which backfires when analysis is faulty or judgment is flawed. Another standard is to invest when a security offers an acceptably attractive return to a long-term holder, such as a low-risk bond priced to yield 10% or more, or a stock with an 8% to 10% or higher free cash flow yield at a time when “risk-free” U.S. government bonds deliver 4% to 5% nominal and 2% to 3% real returns. Such demanding standards virtually ensure that absolute value will be quite scarce. Another area where investors struggle is trying to define what consti- tutes a good business. Someone once defined the best possible business as a post office box to which people send money. That idea has certainly been eclipsed by the creation of subscription Web sites that accept credit cards. Today’s most profitable businesses are those in which you sell a fixed amount of work product—say, a piece of software or a hit recording—millions and millions of times at very low marginal cost. Good businesses are generally considered those with strong barriers to entry, limited capital requirements, reliable customers, low risk of tech- nological obsolescence, abundant growth possibilities, and thus signifi- cant and growing free cash flow. Businesses are also subject to changes in the technological and com- petitive landscape. Because of the Internet, the competitive moat sur- rounding the newspaper business—which was considered a very good business only a decade ago—has eroded faster than almost anyone anticipated. In an era of rapid technological change, investors must be ever vigilant, even with regard to companies that are not involved in technology but are simply affected by it. In short, today’s good busi- nesses may not be tomorrow’s. Investors also expend considerable effort attempting to assess the quality of a company’s management. Some managers are more capable or scrupulous than others, and some may be able to manage certain businesses and environments better than others. Yet, as Graham and Dodd noted, “Objective tests of managerial ability are few and far from scientific.” (p. 84) Make no mistake about it: a management’s acumen, foresight, integrity, and motivation all make a huge difference in share- holder returns. In the present era of aggressive corporate financial engi- neering, managers have many levers at their disposal to positively impact returns, including share repurchases, prudent use of leverage, and a valuation-based approach to acquisitions. Managers who are unwilling to make shareholder-friendly decisions risk their companies becoming perceived as “value traps”: inexpensively valued, but ulti- mately poor investments, because the assets are underutilized. Such companies often attract activist investors seeking to unlock this trapped value. Even more difficult, investors must decide whether to take the risk of investing—at any price—with management teams that have not always done right by shareholders. Shares of such companies may sell at steeply discounted levels, but perhaps the discount is warranted; value that today belongs to the equity holders may tomorrow have been spir- ited away or squandered. An age-old difficulty for investors is ascertaining the value of future growth. In the preface to the first edition of Security Analysis, the authors said as much: “Some matters of vital significance, e.g., the determination of the future prospects of an enterprise, have received little space, because little of definite value can be said on the subject.” (p. xliii) Clearly, a company that will earn (or have free cash flow of) $1 per share today and $2 per share in five years is worth considerably more than a company with identical current per share earnings and no growth. This is especially true if the growth of the first company is likely to continue and is not subject to great variability. Another complication is that companies can grow in many different ways—for example, selling the same number of units at higher prices; selling more units at the same (or even lower) prices; changing the product mix (selling proportionately more of the higher-profit-margin products); or developing an entirely new product line. Obviously, some forms of growth are worth more than others. There is a significant downside to paying up for growth or, worse, to obsessing over it. Graham and Dodd astutely observed that “analysis is concerned primarily with values which are supported by the facts and not with those which depend largely upon expectations.” (p. 86) Strongly preferring the actual to the possible, they regarded the “future as a haz- ard which his [the analyst’s] conclusions must encounter rather than as the source of his vindication.” (p. 86) Investors should be especially vigi- lant against focusing on growth to the exclusion of all else, including the risk of overpaying. Again, Graham and Dodd were spot on, warning that “carried to its logical extreme, . . . [there is no price] too high for a good stock, and that such an issue was equally ‘safe’ after it had advanced to 200 as it had been at 25.” (p. 105) Precisely this mistake was made when stock prices surged skyward during the Nifty Fifty era of the early 1970s and the dot-com bubble of 1999 to 2000. The flaw in such a growth-at-any-price approach becomes obvious when the anticipated growth fails to materialize. When the future disap- points, what should investors do? Hope growth resumes? Or give up and sell? Indeed, failed growth stocks are often so aggressively dumped by disappointed holders that their price falls to levels at which value investors, who stubbornly pay little or nothing for growth characteristics, become major holders. This was the case with many technology stocks that suffered huge declines after the dot-com bubble burst in the spring of 2000. By 2002, hundreds of fallen tech stocks traded for less than the cash on their balance sheets, a value investor’s dream. One such com- pany was Radvision, an Israeli provider of voice, video, and data products whose stock subsequently rose from under $5 to the mid-$20s after the urgent selling abated and investors refocused on fundamentals. Another conundrum for value investors is knowing when to sell. Buy- ing bargains is the sweet spot of value investors, although how small a discount one might accept can be subject to debate. Selling is more dif- ficult because it involves securities that are closer to fully priced. As with buying, investors need a discipline for selling. First, sell targets, once set, should be regularly adjusted to reflect all currently available information. Second, individual investors must consider tax consequences. Third, whether or not an investor is fully invested may influence the urgency of raising cash from a stockholding as it approaches full valuation. The availability of better bargains might also make one a more eager seller. Finally, value investors should completely exit a security by the time it reaches full value; owning overvalued securities is the realm of specula- tors. Value investors typically begin selling at a 10% to 20% discount to their assessment of underlying value—based on the liquidity of the security, the possible presence of a catalyst for value realization, the quality of management, the riskiness and leverage of the underlying business, and the investors’ confidence level regarding the assumptions underlying the investment. Finally, investors need to deal with the complex subject of risk. As mentioned earlier, academics and many professional investors have come to define risk in terms of the Greek letter beta, which they use as a measure of past share price volatility: a historically more volatile stock is seen as riskier. But value investors, who are inclined to think about risk as the probability and amount of potential loss, find such reasoning absurd. In fact, a volatile stock may become deeply undervalued, rendering it a very low risk investment. One of the most difficult questions for value investors is how much risk to incur. One facet of this question involves position size and its impact on portfolio diversification. How much can you comfortably own of even the most attractive opportunities? Naturally, investors desire to profit fully from their good ideas. Yet this tendency is tempered by the fear of being unlucky or wrong. Nonetheless, value investors should concentrate their holdings in their best ideas; if you can tell a good investment from a bad one, you can also distinguish a great one from a good one. Investors must also ponder the risks of investing in politically unsta- ble countries, as well as the uncertainties involving currency, interest rate, and economic fluctuations. How much of your capital do you want tied up in Argentina or Thailand, or even France or Australia, no matter how undervalued the stocks may be in those markets? Another risk consideration for value investors, as with all investors, is whether or not to use leverage. While some value-oriented hedge funds and even endowments use leverage to enhance their returns, I side with those who are unwilling to incur the added risks that come with margin debt. Just as leverage enhances the return of successful investments, it magnifies the losses from unsuccessful ones. More importantly, nonre- course (margin) debt raises risk to unacceptable levels because it places one’s staying power in jeopardy. One risk-related consideration should be paramount above all others: the ability to sleep well at night, confi- dent that your financial position is secure whatever the future may bring. Final Thoughts In a rising market, everyone makes money and a value philosophy is unnecessary. But because there is no certain way to predict what the market will do, one must follow a value philosophy at all times. By con- trolling risk and limiting loss through extensive fundamental analysis, strict discipline, and endless patience, value investors can expect good results with limited downside. You may not get rich quick, but you will keep what you have, and if the future of value investing resembles its past, you are likely to get rich slowly. As investment strategies go, this is the most that any reasonable investor can hope for. The real secret to investing is that there is no secret to investing. Every important aspect of value investing has been made available to the public many times over, beginning in 1934 with the first edition of Security Analysis. That so many people fail to follow this timeless and almost foolproof approach enables those who adopt it to remain suc- cessful. The foibles of human nature that result in the mass pursuit of instant wealth and effortless gain seem certain to be with us forever. So long as people succumb to this aspect of their natures, value investing will remain, as it has been for 75 years, a sound and low-risk approach to successful long-term investing. SETH A. KLARMAN Boston, Massachusetts, May, 2008 Introduction to the Sixth Edition It was a distracted world before which McGraw-Hill set, with a thud, the first edition of Security Analysis in July 1934. From Berlin dribbled reports of a shake-up at the top of the German government. “It will simplify the Führer’s whole work immensely if he need not first ask some- body if he may do this or that,” the Associated Press quoted an informant on August 1 as saying of Hitler’s ascension from chancellor to dictator. Set against such epochal proceedings, a 727-page textbook on the fine points of value investing must have seemed an unlikely candidate for bestsellerdom, then or later. In his posthumously published autobiography, The Memoirs of the Dean of Wall Street, Graham (1894–1976) thanked his lucky stars that he had entered the investment business when he did. The timing seemed not so propitious in the year of the first edition of Security Analysis, or, indeed, that of the second edition—expanded and revised—six years later. From its 1929 peak to its 1932 trough, the Dow Jones Industrial Average had lost 87% of its value. At cyclical low ebb, in 1933, the national unemployment rate topped 25%. That the Great Depression ended in 1933 was the considered judgment of the timekeepers of the National Bureau of Economic Research. Millions of Americans, however— not least, the relatively few who tried to squeeze a living out of a profit- less Wall Street—had reason to doubt it. The bear market and credit liquidation of the early 1930s gave the institutions of American finance a top-to-bottom scouring. What was left of them presently came in for a rough handling by the first Roosevelt administration. Graham had learned his trade in the Wall Street of the mid–nineteen teens, an era of lightly regulated markets. He began work on Security Analysis as the administration of Herbert Hoover was giving the country its first taste of thoroughgoing federal intervention in a peacetime economy. He was correcting page proofs as the Roosevelt administration was implementing its first radical forays into macroeco- nomic management. By 1934, there were laws to institute federal regula- tion of the securities markets, federal insurance of bank deposits, and federal price controls (not to put a cap on prices, as in later, inflationary times, but rather to put a floor under them). To try to prop up prices, the administration devalued the dollar. It is a testament to the enduring quality of Graham’s thought, not to mention the resiliency of America’s financial markets, that Security Analysis lost none of its relevance even as the economy was being turned upside down and inside out. Five full months elapsed following publication of the first edition before Louis Rich got around to reviewing it in the New York Times. Who knows? Maybe the conscientious critic read every page. In any case, Rich gave the book a rave, albeit a slightly rueful one. “On the assumption,” he wrote, on December 2, 1934, “that despite the debacle of recent history there are still people left whose money burns a hole in their pockets, it is hoped that they will read this book. It is a full-bodied, mature, meticu- lous and wholly meritorious outgrowth of scholarly probing and practi- cal sagacity. Although cast in the form and spirit of a textbook, the presentation is endowed with all the qualities likely to engage the liveli- est interest of the layman.”1 How few laymen seemed to care about investing was brought home to Wall Street more forcefully with every passing year of the unprosperous postcrash era. Just when it seemed that trading volume could get no smaller, or New York Stock Exchange seat prices no lower, or equity valu- ations more absurdly cheap, a new, dispiriting record was set. It required every effort of the editors of the Big Board’s house organ, the Exchange magazine, to keep up a brave face. “Must There Be an End to Progress?” was the inquiring headline over an essay by the Swedish economist Gus- tav Cassel published around the time of the release of Graham and Dodd’s second edition (the professor thought not).2 “Why Do Securities Brokers Stay in Business?” the editors posed and helpfully answered, “Despite wearying lethargy over long periods, confidence abounds that when the public recognizes fully the value of protective measures which lately have been ranged about market procedure, investment interest in securities will increase.” It did not amuse the Exchange that a New York City magistrate, sarcastically addressing in his court a collection of defen- dants hauled in by the police for shooting craps on the sidewalk, had derided the financial profession. “The first thing you know,” the judge had upbraided the suspects, “you’ll wind up as stock brokers in Wall Street with yachts and country homes on Long Island.”3 In ways now difficult to imagine, Murphy’s Law was the order of the day; what could go wrong, did. “Depression” was more than a long-lin- gering state of economic affairs. It had become a worldview. The aca- demic exponents of “secular stagnation,” notably Alvin Hansen and Joseph Schumpeter, each a Harvard economics professor, predicted a long decline in American population growth. This deceleration, Hansen contended in his 1939 essay, “together with the failure of any really important innovations of a magnitude to absorb large capital outlays, weighs very heavily as an explanation for the failure of the recent recov- ery to reach full employment.”4 Neither Hansen nor his readers had any way of knowing that a baby boom was around the corner. Nothing could have seemed more unlikely to a world preoccupied with a new war in Europe and the evident decline and fall of capitalism. Certainly, Hansen’s ideas must have struck a chord with the chronically underemployed brokers and traders in lower Manhat- tan. As a business, the New York Stock Exchange was running at a steady loss. From 1933, the year in which it began to report its financial results, through 1940, the Big Board recorded a profit in only one year, 1935 (and a nominal one, at that). And when, in 1937, Chelcie C. Bosland, an assis- tant professor of economics at Brown University, brought forth a book entitled The Common Stock Theory of Investment, he remarked as if he were repeating a commonplace that the American economy had peaked two decades earlier at about the time of what was not yet called World War I. The professor added, quoting unnamed authorities, that American population growth could be expected to stop in its tracks by 1975.5 Small wonder that Graham was to write that the acid test of a bond issuer was its capacity to meet its obligations not in a time of middling prosperity (which modest test today’s residential mortgage–backed securities strug- gle to meet) but in a depression. Altogether, an investor in those days was well advised to keep up his guard. “The combination of a record high level for bonds,” writes Graham in the 1940 edition, “with a history of two catastrophic price collapses in the preceding 20 years and a major war in progress is not one to justify airy confidence in the future.” (p. 142) Wall Street, not such a big place even during the 1920s’ boom, got considerably smaller in the subsequent bust. Ben Graham, in conjunction with his partner Jerry Newman, made a very small cog of this low-horse- power machine. The two of them conducted a specialty investment busi- ness at 52 Wall Street. Their strong suits were arbitrage, reorganizations, bankruptcies, and other complex matters. A schematic drawing of the financial district published by Fortune in 1937 made no reference to the Graham-Newman offices. Then again, the partnerships and corporate headquarters that did rate a spot on the Wall Street map were them- selves—by the standards of twenty-first-century finance—remarkably compact. One floor at 40 Wall Street was enough to contain the entire office of Merrill Lynch & Co. And a single floor at 2 Wall Street was all the space required to house Morgan Stanley, the hands-down leader in 1936 corporate securities underwriting, with originations of all of $195 million. Compensation was in keeping with the slow pace of business, especially at the bottom of the corporate ladder.6 After a 20% rise in the new fed- eral minimum wage, effective October 1939, brokerage employees could earn no less than 30 cents an hour.7 In March 1940, the Exchange documented in all the detail its readers could want (and possibly then some) the collapse of public participation in the stock market. In the first three decades of the twentieth century, the annual volume of trading had almost invariably exceeded the quantity of listed shares outstanding, sometimes by a wide margin. And in only one year between 1900 and 1930 had annual volume amounted to less than 50% of listed shares—the exception being 1914, the year in which the exchange was closed for 41/2 months to allow for the shock of the out- break of World War I to sink in. Then came the 1930s, and the annual turnover as a percentage of listed shares struggled to reach as high as 50%. In 1939, despite a short-lived surge of trading on the outbreak of World War II in Europe, the turnover ratio had fallen to a shockingly low 18.4%. (For comparison, in 2007, the ratio of trading volume to listed shares amounted to 123%.) “Perhaps,” sighed the author of the study, “it is a fair statement that if the farming industry showed a similar record, government subsidies would have been voted long ago. Unfortunately for Wall Street, it seems to have too little sponsorship in officialdom.”8 If a reader took hope from the idea that things were so bad that they could hardly get worse, he or she was in for yet another disappointment. The second edition of Security Analysis had been published only months earlier when, on August 19, 1940, the stock exchange volume totaled just 129,650 shares. It was one of the sleepiest sessions since the 49,000- share mark set on August 5, 1916. For the entire 1940 calendar year, vol- ume totaled 207,599,749 shares—a not very busy two hours’ turnover at this writing and 18.5% of the turnover of 1929, that year of seemingly irrecoverable prosperity. The cost of a membership, or seat, on the stock exchange sank along with turnover and with the major price indexes. At the nadir in 1942, a seat fetched just $17,000. It was the lowest price since 1897 and 97% below the record high price of $625,000, set—natu- rally—in 1929. “‘The Cleaners,’” quipped Fred Schwed, Jr., in his funny and wise book Where Are the Customers’ Yachts? (which, like Graham’s second edition, appeared in 1940), “was not one of those exclusive clubs; by 1932, every- body who had ever tried speculation had been admitted to membership.”9 And if an investor did, somehow, manage to avoid the cleaner’s during the formally designated Great Depression, he or she was by no means home free. In August 1937, the market began a violent sell-off that would carry the averages down by 50% by March 1938. The nonfinancial portion of the economy fared little better than the financial side. In just nine months, industrial production fell by 34.5%, a sharper contraction even than that in the depression of 1920 to 1921, a slump that, for Graham’s generation, had seemed to set the standard for the most economic damage in the shortest elapsed time.10 The Roosevelt administration insisted that the slump of 1937 to 1938 was no depression but rather a “recession.” The national unemployment rate in 1938 was, on average, 18.8%. In April 1937, four months before the bottom fell out of the stock mar- ket for the second time in 10 years, Robert Lovett, a partner at the invest- ment firm of Brown Brothers Harriman & Co., served warning to the American public in the pages of the weekly Saturday Evening Post. Lovett, a member of the innermost circle of the Wall Street establishment, set out to demonstrate that there is no such thing as financial security—none, at least, to be had in stocks and bonds. The gist of Lovett’s argument was that, in capitalism, capital is consumed and that businesses are just as fragile, and mortal, as the people who own them. He invited his millions of readers to examine the record, as he had done: “If an investor had pur- chased 100 shares of the 20 most popular dividend-paying stocks on December 31, 1901, and held them through 1936, adding, in the mean- time, all the melons in the form of stock dividends, and all the plums in the form of stock split-ups, and had exercised all the valuable rights to subscribe to additional stock, the aggregate market value of his total holdings on December 31, 1936, would have shown a shrinkage of 39% as compared with the cost of his original investment. In plain English, the average investor paid $294,911.90 for things worth $180,072.06 on December 31, 1936. That’s a big disappearance of dollar value in any lan- guage.” In the innocent days before the crash, people had blithely spoken of “permanent investments.” “For our part,” wrote this partner of an emi- nent Wall Street private bank, “we are convinced that the only permanent investment is one which has become a total and irretrievable loss.”11 Lovett turned out to be a prophet. At the nadir of the 1937 to 1938 bear market, one in five NYSE-listed industrial companies was valued in the market for less than its net current assets. Subtract from cash and quick assets all liabilities and the remainder was greater than the company’s market value. That is, business value was negative. The Great Atlantic & Pacific Tea Company (A&P), the Wal-Mart of its day, was one of these corporate castoffs. At the 1938 lows, the market value of the com- mon and preferred shares of A&P at $126 million was less than the value of its cash, inventories, and receivables, conservatively valued at $134 million. In the words of Graham and Dodd, the still-profitable company was selling for “scrap.” (p. 673) A Different Wall Street Few institutional traces of that Wall Street remain. Nowadays, the big broker-dealers keep as much as $1 trillion in securities in inventory; in Graham’s day, they customarily held none. Nowadays, the big broker- dealers are in a perpetual competitive lather to see which can bring the greatest number of initial public offerings (IPOs) to the public market. In Graham’s day, no frontline member firm would stoop to placing an IPO in public hands, the risks and rewards for this kind of offering being reserved for professionals. Federal securities regulation was a new thing in the 1930s. What had preceded the Securities and Exchange Commis- sion (SEC) was a regime of tribal sanction. Some things were simply beyond the pale. Both during and immediately after World War I, no self- respecting NYSE member firm facilitated a client’s switch from Liberty bonds into potentially more lucrative, if less patriotic, alternatives. There was no law against such a business development overture. Rather, according to Graham, it just wasn’t done. A great many things weren’t done in the Wall Street of the 1930s. Newly empowered regulators were resistant to financial innovation, trans- action costs were high, technology was (at least by today’s digital stan- dards) primitive, and investors were demoralized. After the vicious bear market of 1937 to 1938, not a few decided they’d had enough. What was the point of it all? “In June 1939,” writes Graham in a note to a discussion about corporate finance in the second edition, “the S.E.C. set a salutary precedent by refusing to authorize the issuance of ‘Capital Income Debentures’ in the reorganization of the Griess-Pfleger Tanning Company, on the ground that the devising of new types of hybrid issues had gone far enough.” (p. 115, fn. 4) In the same conservative vein, he expresses his approval of the institution of the “legal list,” a document compiled by state banking departments to stipulate which bonds the regulated sav- ings banks could safely own. The very idea of such a list flies in the face of nearly every millennial notion about good regulatory practice. But Gra- ham defends it thus: “Since the selection of high-grade bonds has been shown to be in good part a process of exclusion, it lends itself reasonably well to the application of definite rules and standards designed to dis- qualify unsuitable issues.” (p. 169) No collateralized debt obligations stocked with subprime mortgages for the father of value investing! The 1930s ushered in a revolution in financial disclosure. The new federal securities acts directed investor-owned companies to brief their stockholders once a quarter as well as at year-end. But the new stan- dards were not immediately applicable to all public companies, and more than a few continued doing business the old-fashioned way, with their cards to their chests. One of these informational holdouts was none other than Dun & Bradstreet (D&B), the financial information company. Graham seemed to relish the irony of D&B not revealing “its own earn- ings to its own stockholders.” (p. 92, fn. 4) On the whole, by twenty-first- century standards, information in Graham’s time was as slow moving as it was sparse. There were no conference calls, no automated spread- sheets, and no nonstop news from distant markets—indeed, not much truck with the world outside the 48 states. Security Analysis barely acknowledges the existence of foreign markets. Such an institutional setting was hardly conducive to the develop- ment of “efficient markets,” as the economists today call them—markets in which information is disseminated rapidly, human beings process it flawlessly, and prices incorporate it instantaneously. Graham would have scoffed at such an idea. Equally, he would have smiled at the discovery— so late in the evolution of the human species—that there was a place in economics for a subdiscipline called “behavioral finance.” Reading Security Analysis, one is led to wonder what facet of investing is not behavioral. The stock market, Graham saw, is a source of entertainment value as well as investment value: “Even when the underlying motive of purchase is mere speculative greed, human nature desires to conceal this unlovely impulse behind a screen of apparent logic and good sense. To adapt the aphorism of Voltaire, it may be said that if there were no such thing as common-stock analysis, it would be necessary to counterfeit it.” (p. 348) Anomalies of undervaluation and overvaluation—of underdoing it and overdoing it—fill these pages. It bemused Graham, but did not shock him, that so many businesses could be valued in the stock market for less than their net current assets, even during the late 1920s’ boom, or that, in the dislocations to the bond market immediately following World War I, investors became disoriented enough to assign a higher price and a lower yield to the Union Pacific First Mortgage 4s than they did to the U.S. Treasury’s own Fourth Liberty 41⁄4s. Graham writes of the “inveterate tendency of the stock market to exaggerate.” (p. 679) He would not have exaggerated much if he had written, instead, “all markets.” Though he did not dwell long on the cycles in finance, Graham was certainly aware of them. He could see that ideas, no less than prices and categories of investment assets, had their seasons. The discussion in Security Analysis of the flame-out of the mortgage guarantee business in the early 1930s is a perfect miniature of the often-ruinous competition in which financial institutions periodically engage. “The rise of the newer and more aggressive real estate bond organizations had a most unfortu- nate effect upon the policies of the older concerns,” Graham writes of his time and also of ours. “By force of competition they were led to relax their standards of making loans. New mortgages were granted on an increasingly liberal basis, and when old mortgages matured, they were frequently renewed in a larger sum. Furthermore, the face amount of the mortgages guaranteed rose to so high a multiple of the capital of the guarantor companies that it should have been obvious that the guaranty would afford only the flimsiest of protection in the event of a general decline in values.” (p. 217) Security analysis itself is a cyclical phenomenon; it, too, goes in and out of fashion, Graham observed. It holds a strong, intuitive appeal for the kind of businessperson who thinks about stocks the way he or she thinks about his or her own family business. What would such a fount of com- mon sense care about earnings momentum or Wall Street’s pseudo-scien- tific guesses about the economic future? Such an investor, appraising a common stock, would much rather know what the company behind it is worth. That is, he or she would want to study its balance sheet. Well, Gra- ham relates here, that kind of analysis went out of style when stocks started levitating without reference to anything except hope and prophecy. So, by about 1927, fortune-telling and chart-reading had dis- placed the value discipline by which he and his partner were earning a very good living. It is characteristic of Graham that his critique of the “new era” method of investing is measured and not derisory. The old, conserva- tive approach—his own—had been rather backward looking, Graham admits. It had laid more emphasis on the past than on the future, on sta- ble earning power rather than tomorrow’s earnings prospects. But new technologies, new methods, and new forms of corporate organization had introduced new risks into the post–World War I economy. This fact— “the increasing instability of the typical business”—had blown a small hole in the older analytical approach that emphasized stable earnings power over forecast earnings growth. Beyond that mitigating considera- tion, however, Graham does not go. The new era approach, “which turned upon the earnings trend as the sole criterion of value, . . . was certain to end in an appalling debacle.” (p. 366) Which, of course, it did, and—in the CNBC-driven markets of the twenty-first century—continues to do at intervals today. A Man of Many Talents Benjamin Graham was born Benjamin Grossbaum on May 9, 1894, in London, and sailed to New York with his family before he was two. Young Benjamin was a prodigy in mathematics, classical languages, modern languages, expository writing (as readers of this volume will see for themselves), and anything else that the public schools had to offer. He had a tenacious memory and a love of reading—a certain ticket to aca- demic success, then or later. His father’s death at the age of 35 left him, his two brothers, and their mother in the social and financial lurch. Ben- jamin early learned to work and to do without. No need here for a biographical profile of the principal author of Security Analysis: Graham’s own memoir delightfully covers that ground. Suffice it to say that the high school brainiac entered Columbia College as an Alumni Scholar in September 1911 at the age of 17. So much material had he already absorbed that he began with a semester’s head start, “the highest possible advanced standing.”12 He mixed his academic studies with a grab bag of jobs, part-time and full-time alike. Upon his graduation in 1914, he started work as a runner and board-boy at the New York Stock Exchange member firm of Newberger, Henderson & Loeb. Within a year, the board-boy was playing the liquidation of the Guggenheim Exploration Company by astutely going long the shares of Guggenheim and short the stocks of the companies in which Guggen- heim had made a minority investment, as his no-doubt bemused elders looked on: “The profit was realized exactly as calculated; and everyone was happy, not least myself.”13 Security Analysis did not come out of the blue. Graham had supple- mented his modest salary by contributing articles to the Magazine of Wall Street. His productions are unmistakably those of a self-assured and superbly educated Wall Street moneymaker. There was no need to quote expert opinion. He and the documents he interpreted were all the authority he needed. His favorite topics were the ones that he subse- quently developed in the book you hold in your hands. He was partial to the special situations in which Graham-Newman was to become so suc- cessful. Thus, when a high-flying, and highly complex, American Interna- tional Corp. fell from the sky in 1920, Graham was able to show that the stock was cheap in relation to the evident value of its portfolio of miscel- laneous (and not especially well disclosed) investment assets.14 The shocking insolvency of Goodyear Tire and Rubber attracted his attention in 1921. “The downfall of Goodyear is a remarkable incident even in the present plenitude of business disasters,” he wrote, in a characteristic Gra- ham sentence (how many financial journalists, then or later, had “pleni- tude” on the tips of their tongues?). He shrewdly judged that Goodyear would be a survivor.15 In the summer of 1924, he hit on a theme that would echo through Security Analysis: it was the evident non sequitor of stocks valued in the market at less than the liquidating value of the com- panies that issued them. “Eight Stock Bargains Off the Beaten Track,” said the headline over the Benjamin Graham byline: “Stocks that Are Covered Chiefly by Cash or the Equivalent—No Bonds or Preferred Stock Ahead of These Issues—An Unusually Interesting Group of Securities.” In one case, that of Tonopah Mining, liquid assets of $4.31 per share towered over a market price of just $1.38 a share.16 For Graham, an era of sweet reasonableness in investment thinking seemed to end around 1914. Before that time, the typical investor was a businessman who analyzed a stock or a bond much as he might a claim on a private business. He—it was usually a he—would naturally try to determine what the security-issuing company owned, free and clear of any encumbrances. If the prospective investment was a bond—and it usually was—the businessman-investor would seek assurances that the borrowing company had the financial strength to weather a depression. “It’s not undue modesty,” Graham wrote in his memoir, “to say that I had become something of a smart cookie in my particular field.” His spe- cialty was the carefully analyzed out-of-the-way investment: castaway stocks or bonds, liquidations, bankruptcies, arbitrage. Since at least the early 1920s, Graham had preached the sermon of the “margin of safety.” As the future is a closed book, he urged in his writings, an investor, as a matter of self-defense against the unknown, should contrive to pay less than “intrinsic” value. Intrinsic value, as defined in Security Analysis, is “that value which is justified by the facts, e.g., the assets, earnings, divi- dends, definite prospects, as distinct, let us say, from market quotations established by artificial manipulation or distorted by psychological excesses.” (p. 64) He himself had gone from the ridiculous to the sublime (and some- times back again) in the conduct of his own investment career. His quick and easy grasp of mathematics made him a natural arbitrageur. He would sell one stock and simultaneously buy another. Or he would buy or sell shares of stock against the convertible bonds of the identical issu- ing company. So doing, he would lock in a profit that, if not certain, was as close to guaranteed as the vicissitudes of finance allowed. In one instance, in the early 1920s, he exploited an inefficiency in the relation- ship between DuPont and the then red-hot General Motors (GM). DuPont held a sizable stake in GM. And it was for that interest alone which the market valued the big chemical company. By implication, the rest of the business was worth nothing. To exploit this anomaly, Graham bought shares in DuPont and sold short the hedge-appropriate number of shares in GM. And when the market came to its senses, and the price gap between DuPont and GM widened in the expected direction, Gra- ham took his profit.17 However, Graham, like many another value investors after him, some- times veered from the austere precepts of safe-and-cheap investing. A Graham only slightly younger than the master who sold GM and bought DuPont allowed himself to be hoodwinked by a crooked promoter of a company that seems not actually to have existed—at least, in anything like the state of glowing prosperity described by the manager of the pool to which Graham entrusted his money. An electric sign in Colum- bus Circle, on the upper West Side of Manhattan, did bear the name of the object of Graham’s misplaced confidence, Savold Tire. But, as the author of Security Analysis confessed in his memoir, that could have been the only tangible marker of the company’s existence. “Also, as far as I knew,” Graham added, “nobody complained to the district attorney’s office about the promoter’s bare-faced theft of the public’s money.” Cer- tainly, by his own telling, Graham didn’t.18 By 1929, when he was 35, Graham was well on his way to fame and fortune. His wife and he kept a squadron of servants, including—for the first and only time in his life—a manservant for himself. With JerryNewman, Graham had compiled an investment record so enviable that the great Bernard M. Baruch sought him out. Would Graham wind up his busi- ness to manage Baruch’s money? “I replied,” Graham writes, “that I was highly flattered—flabbergasted, in fact—by his proposal, but I could not end so abruptly the close and highly satisfactory relations I had with my friends and clients.”19 Those relations soon became much less satisfactory. Graham relates that, though he was worried at the top of the market, he failed to act on his bearish hunch. The Graham-Newman partnership went into the 1929 break with $2.5 million of capital. And they con- trolled about $2.5 million in hedged positions—stocks owned long offset by stocks sold short. They had, besides, about $4.5 million in outright long positions. It was bad enough that they were leveraged, as Graham later came to realize. Compounding that tactical error was a deeply rooted conviction that the stocks they owned were cheap enough to withstand any imaginable blow. They came through the crash creditably: down by only 20% was, for the final quarter of 1929, almost heroic. But they gave up 50% in 1930, 16% in 1931, and 3% in 1932 (another relatively excellent showing), for a cumulative loss of 70%.20 “I blamed myself not so much for my failure to protect myself against the disaster I had been predicting,” Graham writes, “as for having slipped into an extravagant way of life which I hadn’t the temperament or capacity to enjoy. I quickly convinced myself that the true key to material happiness lay in a modest standard of living which could be achieved with little difficulty under almost all economic condi- tions”—the margin-of-safety idea applied to personal finance.21 It can’t be said that the academic world immediately clasped Security Analysis to its breast as the definitive elucidation of value investing, or of anything else. The aforementioned survey of the field in which Graham and Dodd made their signal contribution, The Common Stock Theory of Investment, by Chelcie C. Bosland, published three years after the appear- ance of the first edition of Security Analysis, cited 53 different sources and 43 different authors. Not one of them was named Graham or Dodd. Edgar Lawrence Smith, however, did receive Bosland’s full and respectful attention. Smith’s Common Stocks as Long Term Investments, published in 1924, had challenged the long-held view that bonds were innately superior to equities. For one thing, Smith argued, the dollar (even the gold-backed 1924 edition) was inflation-prone, which meant that creditors were inherently disadvantaged. Not so the owners of com- mon stock. If the companies in which they invested earned a profit, and if the managements of those companies retained a portion of that profit in the business, and if those retained earnings, in turn, produced future earnings, the principal value of an investor’s portfolio would tend “to increase in accordance with the operation of compound interest.”22 Smith’s timing was impeccable. Not a year after he published, the great Coolidge bull market erupted. Common Stocks as Long Term Investments, only 129 pages long, provided a handy rationale for chasing the market higher. That stocks do, in fact, tend to excel in the long run has entered the canon of American investment thought as a revealed truth (it looked any- thing but obvious in the 1930s). For his part, Graham entered a strong dis- sent to Smith’s thesis, or, more exactly, its uncritical bullish application. It was one thing to pay 10 times earnings for an equity investment, he notes, quite another to pay 20 to 40 times earnings. Besides, the Smith analysis skirted the important question of what asset values lay behind the stock certificates that people so feverishly and uncritically traded back and forth. Finally, embedded in Smith’s argument was the assumption that common stocks could be counted on to deliver in the future what they had done in the past. Graham was not a believer. (pp. 362–363) If Graham was a hard critic, however, he was also a generous one. In 1939 he was given John Burr Williams’s The Theory of Investment Value to review for the Journal of Political Economy (no small honor for a Wall Street author-practitioner). Williams’s thesis was as important as it was concise. The investment value of a common stock is the present value of all future dividends, he proposed. Williams did not underestimate the significance of these loaded words. Armed with that critical knowledge, the author ventured to hope, investors might restrain themselves from bidding stocks back up to the moon again. Graham, in whose capacious brain dwelled the talents both of the quant and behavioral financier, voiced his doubts about that forecast. The rub, as he pointed out, was that, in order to apply Williams’s method, one needed to make some very large assumptions about the future course of interest rates, the growth of profit, and the terminal value of the shares when growth stops. “One wonders,” Graham mused, “whether there may not be too great a discrepancy between the necessarily hit-or-miss character of these assumptions and the highly refined mathematical treatment to which they are subjected.” Graham closed his essay on a characteristi- cally generous and witty note, commending Williams for the refreshing level-headedness of his approach and adding: “This conservatism is not really implicit in the author’s formulas; but if the investor can be per- suaded by higher algebra to take a sane attitude toward common-stock prices, the reviewer will cast a loud vote for higher algebra.”23 Graham’s technical accomplishments in securities analysis, by them- selves, could hardly have carried Security Analysis through its five edi- tions. It’s the book’s humanity and good humor that, to me, explain its long life and the adoring loyalty of a certain remnant of Graham readers, myself included. Was there ever a Wall Street moneymaker better steeped than Graham in classical languages and literature and in the financial history of his own time? I would bet “no” with all the confidence of a value investor laying down money to buy an especially cheap stock. Yet this great investment philosopher was, to a degree, a prisoner of his own times. He could see that the experiences through which he lived were unique, that the Great Depression was, in fact, a great anomaly. If anyone understood the folly of projecting current experience into the unpredictable future, it was Graham. Yet this investment-philosopher king, having spent 727 pages (not including the gold mine of an appendix) describing how a careful and risk-averse investor could prosper in every kind of macroeconomic conditions, arrives at a remarkable conclusion. What of the institutional investor, he asks. How should he invest? At first, Graham diffidently ducks the question—who is he to prescribe for the experienced financiers at the head of America’s philanthropic and educational institutions? But then he takes the astonishing plunge. “An institution,” he writes, “that can manage to get along on the low income provided by high-grade fixed-value issues should, in our opinion, confine its holdings to this field. We doubt if the better performance of common- stock indexes over past periods will, in itself, warrant the heavy responsi- bilities and the recurring uncertainties that are inseparable from a common-stock investment program.” (pp. 709–710) Could the greatest value investor have meant that? Did the man who stuck it out through ruinous losses in the Depression years and went on to compile a remarkable long-term investment record really mean that common stocks were not worth the bother? In 1940, with a new world war fanning the Roosevelt administration’s fiscal and monetary policies, high-grade corporate bonds yielded just 2.75%, while blue-chip equities yielded 5.1%. Did Graham mean to say that bonds were a safer proposi- tion than stocks? Well, he did say it. If Homer could nod, so could Gra- ham—and so can the rest of us, whoever we are. Let it be a lesson.","You will be provided with a user prompt and a context block. Only respond to prompts using information that has been provided in the context block. Do not use any outside knowledge to answer prompts. If you cannot answer a prompt based on the information in the context block alone, please state ""I unable to determine that without additional context"" and do not add anything further. According to the author of the preface, who cannot accept that value investing works? Preface to the Sixth Edition THE TIMELESS WISDOM OF GRAHAM AND DODD BY SETH A. KLARMAN Seventy-five years after Benjamin Graham and David Dodd wrote Security Analysis, a growing coterie of modern-day value investors remain deeply indebted to them. Graham and David were two assiduous and unusually insightful thinkers seeking to give order to the mostly uncharted financial wilderness of their era. They kindled a flame that has illuminated the way for value investors ever since. Today, Security Analysis remains an invaluable roadmap for investors as they navigate through unpredictable, often volatile, and sometimes treacherous finan- cial markets. Frequently referred to as the “bible of value investing,” Secu- rity Analysis is extremely thorough and detailed, teeming with wisdom for the ages. Although many of the examples are obviously dated, their les- sons are timeless. And while the prose may sometimes seem dry, readers can yet discover valuable ideas on nearly every page. The financial mar- kets have morphed since 1934 in almost unimaginable ways, but Graham and Dodd’s approach to investing remains remarkably applicable today. Value investing, today as in the era of Graham and Dodd, is the prac- tice of purchasing securities or assets for less than they are worth—the proverbial dollar for 50 cents. Investing in bargain-priced securities pro- vides a “margin of safety”—room for error, imprecision, bad luck, or the vicissitudes of the economy and stock market. While some might mistak- enly consider value investing a mechanical tool for identifying bargains, it is actually a comprehensive investment philosophy that emphasizes the need to perform in-depth fundamental analysis, pursue long-term investment results, limit risk, and resist crowd psychology. Far too many people approach the stock market with a focus on mak- ing money quickly. Such an orientation involves speculation rather than investment and is based on the hope that share prices will rise irrespec- tive of valuation. Speculators generally regard stocks as pieces of paper to be quickly traded back and forth, foolishly decoupling them from business reality and valuation criteria. Speculative approaches—which pay little or no attention to downside risk—are especially popular in ris- ing markets. In heady times, few are sufficiently disciplined to maintain strict standards of valuation and risk aversion, especially when most of those abandoning such standards are quickly getting rich. After all, it is easy to confuse genius with a bull market. In recent years, some people have attempted to expand the defini- tion of an investment to include any asset that has recently—or might soon—appreciate in price: art, rare stamps, or a wine collection. Because these items have no ascertainable fundamental value, generate no pres- ent or future cash flow, and depend for their value entirely on buyer whim, they clearly constitute speculations rather than investments. In contrast to the speculator’s preoccupation with rapid gain, value investors demonstrate their risk aversion by striving to avoid loss. A risk- averse investor is one for whom the perceived benefit of any gain is out- weighed by the perceived cost of an equivalent loss. Once any of us has accumulated a modicum of capital, the incremental benefit of gaining more is typically eclipsed by the pain of having less.1 Imagine how you would respond to the proposition of a coin flip that would either double your net worth or extinguish it. Being risk averse, nearly all people would respectfully decline such a gamble. Such risk aversion is deeply ingrained in human nature. Yet many unwittingly set aside their risk aversion when the sirens of market speculation call. Value investors regard securities not as speculative instruments but as fractional ownership in, or debt claims on, the underlying businesses. This orientation is key to value investing. When a small slice of a business is offered at a bargain price, it is helpful to evaluate it as if the whole business were offered for sale there. This analytical anchor helps value investors remain focused on the pursuit of long-term results rather than the profitability of their daily trading ledger. At the root of Graham and Dodd’s philosophy is the principle that the financial markets are the ultimate creators of opportunity. Sometimes the markets price securities correctly, other times not. Indeed, in the short run, the market can be quite inefficient, with great deviations between price and underlying value. Unexpected developments, increased uncer- tainty, and capital flows can boost short-term market volatility, with prices overshooting in either direction.2 In the words of Graham and Dodd, “The price [of a security] is frequently an essential element, so that a stock . . . may have investment merit at one price level but not at another.” (p. 106) As Graham has instructed, those who view the market as a weighing machine—a precise and efficient assessor of value—are part of the emo- tionally driven herd. Those who regard the market as a voting machine—a sentiment-driven popularity contest—will be well positioned to take proper advantage of the extremes of market sentiment. While it might seem that anyone can be a value investor, the essential characteristics of this type of investor—patience, discipline, and risk aver- sion—may well be genetically determined. When you first learn of the value approach, it either resonates with you or it doesn’t. Either you are able to remain disciplined and patient, or you aren’t. As Warren Buffett said in his famous article, “The Superinvestors of Graham-and-Doddsville,” “It is extraordinary to me that the idea of buying dollar bills for 40 cents takes immediately with people or it doesn’t take at all. It’s like an inocula- tion. If it doesn’t grab a person right away, I find you can talk to him for years and show him records, and it doesn’t make any difference.” 3,4 If Security Analysis resonates with you—if you can resist speculating and sometimes sit on your hands—perhaps you have a predisposition toward value investing. If not, at least the book will help you understand where you fit into the investing landscape and give you an appreciation for what the value-investing community may be thinking. Just as Relevant Now Perhaps the most exceptional achievement of Security Analysis, first pub- lished in 1934 and revised in the acclaimed 1940 edition, is that its les- sons are timeless. Generations of value investors have adopted the teachings of Graham and Dodd and successfully implemented them across highly varied market environments, countries, and asset classes. 3 “The Superinvestors of Graham-and-Doddsville,” Hermes, the Columbia Business School magazine, 1984. 4 My own experience has been exactly the one that Buffett describes. My 1978 summer job at Mutual Shares, a no-load value-based mutual fund, set the course for my professional career. The planned liquidation of Telecor and spin-off of its Electro Rent subsidiary in 1980 forever imprinted in my mind the merit of fundamental investment analysis. A buyer of Telecor stock was effectively creating an investment in the shares of Electro Rent, a fast-growing equipment rental company, at the giveaway valuation of approximately 1 times the cash flow. You always remember your first value investment.This would delight the authors, who hoped to set forth principles that would “stand the test of the ever enigmatic future.” (p. xliv) In 1992, Tweedy, Browne Company LLC, a well-known value invest- ment firm, published a compilation of 44 research studies entitled, “What Has Worked in Investing.” The study found that what has worked is fairly simple: cheap stocks (measured by price-to-book values, price- to-earnings ratios, or dividend yields) reliably outperform expensive ones, and stocks that have underperformed (over three- and five-year periods) subsequently beat those that have lately performed well. In other words, value investing works! I know of no long-time practitioner who regrets adhering to a value philosophy; few investors who embrace the fundamental principles ever abandon this investment approach for another. Today, when you read Graham and Dodd’s description of how they navigated through the financial markets of the 1930s, it seems as if they were detailing a strange, foreign, and antiquated era of economic depression, extreme risk aversion, and obscure and obsolete businesses. But such an exploration is considerably more valuable than it superfi- cially appears. After all, each new day has the potential to bring with it a strange and foreign environment. Investors tend to assume that tomor- row’s markets will look very much like today’s, and, most of the time, they will. But every once in a while,5 conventional wisdom is turned on its head, circular reasoning is unraveled, prices revert to the mean, and speculative behavior is exposed as such. At those times, when today fails to resemble yesterday, most investors will be paralyzed. In the words of Graham and Dodd, “We have striven throughout to guard the student against overemphasis upon the superficial and the temporary,” which is “at once the delusion and the nemesis of the world of finance.” (p. xliv) It is during periods of tumult that a value-investing philosophy is particu- larly beneficial. In 1934, Graham and Dodd had witnessed over a five-year span the best and the worst of times in the markets—the run-up to the 1929 peak, the October 1929 crash, and the relentless grind of the Great Depression. They laid out a plan for how investors in any environment might sort through hundreds or even thousands of common stocks, pre- ferred shares, and bonds to identify those worthy of investment. Remark- ably, their approach is essentially the same one that value investors employ today. The same principles they applied to the U.S. stock and bond markets of the 1920s and 1930s apply to the global capital markets of the early twenty-first century, to less liquid asset classes like real estate and private equity, and even to derivative instruments that hardly existed when Security Analysis was written. While formulas such as the classic “net working capital” test are nec- essary to support an investment analysis, value investing is not a paint- by-numbers exercise.6 Skepticism and judgment are always required. For one thing, not all elements affecting value are captured in a company’s financial statements—inventories can grow obsolete and receivables uncollectible; liabilities are sometimes unrecorded and property values over- or understated. Second, valuation is an art, not a science. Because the value of a business depends on numerous variables, it can typically be assessed only within a range. Third, the outcomes of all investments depend to some extent on the future, which cannot be predicted with certainty; for this reason, even some carefully analyzed investments fail to achieve profitable outcomes. Sometimes a stock becomes cheap for good reason: a broken business model, hidden liabilities, protracted litigation, or incompetent or corrupt management. Investors must always act with caution and humility, relentlessly searching for additional infor- mation while realizing that they will never know everything about a company. In the end, the most successful value investors combine detailed business research and valuation work with endless discipline and patience, a well-considered sensitivity analysis, intellectual honesty, and years of analytical and investment experience. Interestingly, Graham and Dodd’s value-investing principles apply beyond the financial markets—including, for example, to the market for baseball talent, as eloquently captured in Moneyball, Michael Lewis’s 2003 bestseller. The market for baseball players, like the market for stocks and bonds, is inefficient—and for many of the same reasons. In both investing and baseball, there is no single way to ascertain value, no one metric that tells the whole story. In both, there are mountains of information and no broad consensus on how to assess it. Decision makers in both arenas mis- interpret available data, misdirect their analyses, and reach inaccurate conclusions. In baseball, as in securities, many overpay because they fear standing apart from the crowd and being criticized. They often make decisions for emotional, not rational, reasons. They become exuberant; they panic. Their orientation sometimes becomes overly short term. They fail to understand what is mean reverting and what isn’t. Baseball’s value investors, like financial market value investors, have achieved significant outperformance over time. While Graham and Dodd didn’t apply value principles to baseball, the applicability of their insights to the market for athletic talent attests to the universality and timelessness of this approach. Value Investing Today Amidst the Great Depression, the stock market and the national econ- omy were exceedingly risky. Downward movements in share prices and business activity came suddenly and could be severe and protracted. Optimists were regularly rebuffed by circumstances. Winning, in a sense, was accomplished by not losing. Investors could achieve a margin of safety by buying shares in businesses at a large discount to their under- lying value, and they needed a margin of safety because of all the things that could—and often did—go wrong. Even in the worst of markets, Graham and Dodd remained faithful to their principles, including their view that the economy and markets sometimes go through painful cycles, which must simply be endured. They expressed confidence, in those dark days, that the economy and stock market would eventually rebound: “While we were writing, we had to combat a widespread conviction that financial debacle was to be the permanent order.” (p. xliv) Of course, just as investors must deal with down cycles when busi- ness results deteriorate and cheap stocks become cheaper, they must also endure up cycles when bargains are scarce and investment capital is plentiful. In recent years, the financial markets have performed exceed- ingly well by historic standards, attracting substantial fresh capital in need of managers. Today, a meaningful portion of that capital—likely totaling in the trillions of dollars globally—invests with a value approach. This includes numerous value-based asset management firms and mutual funds, a number of today’s roughly 9,000 hedge funds, and some of the largest and most successful university endowments and family investment offices. It is important to note that not all value investors are alike. In the aforementioned “Superinvestors of Graham-and-Doddsville,” Buffett describes numerous successful value investors who have little portfolio overlap. Some value investors hold obscure, “pink-sheet shares” while others focus on the large-cap universe. Some have gone global, while others focus on a single market sector such as real estate or energy. Some run computer screens to identify statistically inexpensive compa- nies, while others assess “private market value”—the value an industry buyer would pay for the entire company. Some are activists who aggres- sively fight for corporate change, while others seek out undervalued securities with a catalyst already in place—such as a spin-off, asset sale, major share repurchase plan, or new management team—for the partial or full realization of the underlying value. And, of course, as in any pro- fession, some value investors are simply more talented than others. In the aggregate, the value-investing community is no longer the very small group of adherents that it was several decades ago. Competition can have a powerful corrective effect on market inefficiencies and mis- pricings. With today’s many amply capitalized and skilled investors, what are the prospects for a value practitioner? Better than you might expect, for several reasons. First, even with a growing value community, there are far more market participants with little or no value orientation. Most man- agers, including growth and momentum investors and market indexers, pay little or no attention to value criteria. Instead, they concentrate almost single-mindedly on the growth rate of a company’s earnings, the momentum of its share price, or simply its inclusion in a market index. Second, nearly all money managers today, including some hapless value managers, are forced by the (real or imagined) performance pres- sures of the investment business to have an absurdly short investment horizon, sometimes as brief as a calendar quarter, month, or less. A value strategy is of little use to the impatient investor since it usually takes time to pay off. Finally, human nature never changes. Capital market manias regularly occur on a grand scale: Japanese stocks in the late 1980s, Internet and technology stocks in 1999 and 2000, subprime mortgage lending in 2006 and 2007, and alternative investments currently. It is always difficult to take a contrarian approach. Even highly capable investors can wither under the relentless message from the market that they are wrong. The pressures to succumb are enormous; many investment managers fear they’ll lose business if they stand too far apart from the crowd. Some also fail to pursue value because they’ve handcuffed themselves (or been saddled by clients) with constraints preventing them from buying stocks selling at low dollar prices, small-cap stocks, stocks of companies that don’t pay dividends or are losing money, or debt instruments with below investment-grade ratings.7 Many also engage in career manage- ment techniques like “window dressing” their portfolios at the end of cal- endar quarters or selling off losers (even if they are undervalued) while buying more of the winners (even if overvalued). Of course, for those value investors who are truly long term oriented, it is a wonderful thing that many potential competitors are thrown off course by constraints that render them unable or unwilling to effectively compete. Another reason that greater competition may not hinder today’s value investors is the broader and more diverse investment landscape in which they operate. Graham faced a limited lineup of publicly traded U.S. equity and debt securities. Today, there are many thousands of publicly traded stocks in the United States alone, and many tens of thousands worldwide, plus thousands of corporate bonds and asset-backed debt securities. Previously illiquid assets, such as bank loans, now trade regu- larly. Investors may also choose from an almost limitless number of derivative instruments, including customized contracts designed to meet any need or hunch. Nevertheless, 25 years of historically strong stock market perform- ance have left the market far from bargain-priced. High valuations and intensified competition raise the specter of lower returns for value investors generally. Also, some value investment firms have become extremely large, and size can be the enemy of investment performance because decision making is slowed by bureaucracy and smaller opportu- nities cease to move the needle. In addition, because growing numbers of competent buy-side and sell-side analysts are plying their trade with the assistance of sophisti- cated information technology, far fewer securities seem likely to fall through the cracks to become extremely undervalued.8 Today’s value investors are unlikely to find opportunity armed only with a Value Line guide or by thumbing through stock tables. While bargains still occasion- ally hide in plain sight, securities today are most likely to become mis- priced when they are either accidentally overlooked or deliberately avoided. Consequently, value investors have had to become thoughtful about where to focus their analysis. In the early 2000s, for example, investors became so disillusioned with the capital allocation procedures of many South Korean companies that few considered them candidates for worthwhile investment. As a result, the shares of numerous South Korean companies traded at great discounts from prevailing international valuations: at two or three times the cash flow, less than half the underly- ing business value, and, in several cases, less than the cash (net of debt) held on their balance sheets. Bargain issues, such as Posco and SK Tele- com, ultimately attracted many value seekers; Warren Buffett reportedly profited handsomely from a number of South Korean holdings. Today’s value investors also find opportunity in the stocks and bonds of companies stigmatized on Wall Street because of involvement in pro-tracted litigation, scandal, accounting fraud, or financial distress. The securities of such companies sometimes trade down to bargain levels, where they become good investments for those who are able to remain stalwart in the face of bad news. For example, the debt of Enron, per- haps the world’s most stigmatized company after an accounting scandal forced it into bankruptcy in 2001, traded as low as 10 cents on the dollar of claim; ultimate recoveries are expected to be six times that amount. Similarly, companies with tobacco or asbestos exposure have in recent years periodically come under severe selling pressure due to the uncer- tainties surrounding litigation and the resultant risk of corporate finan- cial distress. More generally, companies that disappoint or surprise investors with lower-than-expected results, sudden management changes, accounting problems, or ratings downgrades are more likely than consistently strong performers to be sources of opportunity. When bargains are scarce, value investors must be patient; compro- mising standards is a slippery slope to disaster. New opportunities will emerge, even if we don’t know when or where. In the absence of com- pelling opportunity, holding at least a portion of one’s portfolio in cash equivalents (for example, U.S. Treasury bills) awaiting future deployment will sometimes be the most sensible option. Recently, Warren Buffett stated that he has more cash to invest than he has good investments. As all value investors must do from time to time, Buffett is waiting patiently. Still, value investors are bottom-up analysts, good at assessing securi- ties one at a time based on the fundamentals. They don’t need the entire market to be bargain priced, just 20 or 25 unrelated securities—a num- ber sufficient for diversification of risk. Even in an expensive market, value investors must keep analyzing securities and assessing businesses, gaining knowledge and experience that will be useful in the future. Value investors, therefore, should not try to time the market or guess whether it will rise or fall in the near term. Rather, they should rely on a bottom-up approach, sifting the financial markets for bargains and then buying them, regardless of the level or recent direction of the market or economy. Only when they cannot find bargains should they default to holding cash. A Flexible Approach Because our nation’s founders could not foresee—and knew they could not foresee—technological, social, cultural, and economic changes that the future would bring, they wrote a flexible constitution that still guides us over two centuries later. Similarly, Benjamin Graham and David Dodd acknowledged that they could not anticipate the business, economic, technological, and competitive changes that would sweep through the investment world over the ensuing years. But they, too, wrote a flexible treatise that provides us with the tools to function in an investment landscape that was destined—and remains destined—to undergo pro- found and unpredictable change. For example, companies today sell products that Graham and Dodd could not have imagined. Indeed, there are companies and entire indus- tries that they could not have envisioned. Security Analysis offers no examples of how to value cellular phone carriers, software companies, satellite television providers, or Internet search engines. But the book provides the analytical tools to evaluate almost any company, to assess the value of its marketable securities, and to determine the existence of a margin of safety. Questions of solvency, liquidity, predictability, busi- ness strategy, and risk cut across businesses, nations, and time. Graham and Dodd did not specifically address how to value private businesses or how to determine the value of an entire company rather than the value of a fractional interest through ownership of its shares.9 9 They did consider the relative merits of corporate control enjoyed by a private business owner ver- sus the value of marketability for a listed stock (p. 372). But their analytical principles apply equally well to these different issues. Investors still need to ask, how stable is the enterprise, and what are its future prospects? What are its earnings and cash flow? What is the downside risk of owning it? What is its liquidation value? How capable and honest is its management? What would you pay for the stock of this company if it were public? What factors might cause the owner of this business to sell control at a bargain price? Similarly, the pair never addressed how to analyze the purchase of an office building or apartment complex. Real estate bargains come about for the same reasons as securities bargains—an urgent need for cash, inability to perform proper analysis, a bearish macro view, or investor disfavor or neglect. In a bad real estate climate, tighter lending standards can cause even healthy properties to sell at distressed prices. Graham and Dodd’s principles—such as the stability of cash flow, sufficiency of return, and analysis of downside risk—allow us to identify real estate investments with a margin of safety in any market environment. Even complex derivatives not imagined in an earlier era can be scruti- nized with the value investor’s eye. While traders today typically price put and call options via the Black-Scholes model, one can instead use value-investing precepts—upside potential, downside risk, and the likeli- hood that each of various possible scenarios will occur—to analyze these instruments. An inexpensive option may, in effect, have the favorable risk-return characteristics of a value investment—regardless of what the Black-Scholes model dictates. Institutional Investing Perhaps the most important change in the investment landscape over the past 75 years is the ascendancy of institutional investing. In the 1930s, individual investors dominated the stock market. Today, by contrast, most market activity is driven by institutional investors—large pools of pension, endowment, and aggregated individual capital. While the advent of these large, quasi-permanent capital pools might have resulted in the wide-scale adoption of a long-term value-oriented approach, in fact this has not occurred. Instead, institutional investing has evolved into a short-term performance derby, which makes it diffi- cult for institutional managers to take contrarian or long-term positions. Indeed, rather than standing apart from the crowd and possibly suffering disappointing short-term results that could cause clients to withdraw capital, institutional investors often prefer the safe haven of assured mediocre performance that can be achieved only by closely following the herd. Alternative investments—a catch-all category that includes venture capital, leveraged buyouts, private equity, and hedge funds—are the cur- rent institutional rage. No investment treatise written today could fail to comment on this development. Fueled by performance pressures and a growing expectation of low (and inadequate) returns from traditional equity and debt investments, institutional investors have sought high returns and diversification by allocating a growing portion of their endowments and pension funds to alternatives. Pioneering Portfolio Management, written in 2000 by David Swensen, the groundbreaking head of Yale’s Investment Office, makes a strong case for alternative investments. In it, Swensen points to the historically inefficient pricing of many asset classes,10 the historically high risk-adjusted returns of many alternative managers, and the limited 10 Many investors make the mistake of thinking about returns to asset classes as if they were perma- nent. Returns are not inherent to an asset class; they result from the fundamentals of the underlying businesses and the price paid by investors for the related securities. Capital flowing into an asset class can, reflexively, impair the ability of those investing in that asset class to continue to generate the anticipated, historically attractive returns. He highlights the importance of alternative manager selection by noting the large dispersion of returns achieved between top-quartile and third- quartile performers. A great many endowment managers have emulated Swensen, following him into a large commitment to alternative investments, almost certainly on worse terms and amidst a more competitive environment than when he entered the area. Graham and Dodd would be greatly concerned by the commitment of virtually all major university endowments to one type of alternative investment: venture capital. The authors of the margin-of-safety approach to investing would not find one in the entire venture capital universe.11 While there is often the prospect of substantial upside in ven- ture capital, there is also very high risk of failure. Even with the diversifi- cation provided by a venture fund, it is not clear how to analyze the underlying investments to determine whether the potential return justi- fies the risk. Venture capital investment would, therefore, have to be characterized as pure speculation, with no margin of safety whatsoever. Hedge funds—a burgeoning area of institutional interest with nearly $2 trillion of assets under management—are pools of capital that vary widely in their tactics but have a common fee structure that typically pays the manager 1% to 2% annually of assets under management and 20% (and sometimes more) of any profits generated. They had their start in the 1920s, when Ben Graham himself ran one of the first hedge funds. What would Graham and Dodd say about the hedge funds operating in today’s markets? They would likely disapprove of hedge funds that make investments based on macroeconomic assessments or that pursue 11 Nor would they find one in leveraged buyouts, through which businesses are purchased at lofty prices using mostly debt financing and a thin layer of equity capital. The only value-investing ration- ale for venture capital or leveraged buyouts might be if they were regarded as mispriced call options. Even so, it is not clear that these areas constitute good value. Such funds, by avoiding or even sell- ing undervalued securities to participate in one or another folly, inadver- tently create opportunities for value investors. The illiquidity, lack of transparency, gargantuan size, embedded leverage, and hefty fees of some hedge funds would no doubt raise red flags. But Graham and Dodd would probably approve of hedge funds that practice value-ori- ented investment selection. Importantly, while Graham and Dodd emphasized limiting risk on an investment-by-investment basis, they also believed that diversification and hedging could protect the downside for an entire portfolio. (p. 106) This is what most hedge funds attempt to do. While they hold individual securities that, considered alone, may involve an uncomfortable degree of risk, they attempt to offset the risks for the entire portfolio through the short sale of similar but more highly valued securities, through the purchase of put options on individual securities or market indexes, and through adequate diversification (although many are guilty of overdiver- sification, holding too little of their truly good ideas and too much of their mediocre ones). In this way, a hedge fund portfolio could (in theory, anyway) have characteristics of good potential return with limited risk that its individual components may not have. Modern-day Developments As mentioned, the analysis of businesses and securities has become increasingly sophisticated over the years. Spreadsheet technology, for example, allows for vastly more sophisticated modeling than was possible even one generation ago. Benjamin Graham’s pencil, clearly one of the sharpest of his era, might not be sharp enough today. On the other hand, technology can easily be misused; computer modeling requires making a series of assumptions about the future that can lead to a spurious preci- sion of which Graham would have been quite dubious. While Graham was interested in companies that produced consistent earnings, analysis in his day was less sophisticated regarding why some company’s earnings might be more consistent than others. Analysts today examine businesses but also business models; the bottom-line impact of changes in revenues, profit margins, product mix, and other variables is carefully studied by managements and financial analysts alike. Investors know that businesses do not exist in a vacuum; the actions of competitors, suppliers, and cus- tomers can greatly impact corporate profitability and must be considered.12 Another important change in focus over time is that while Graham looked at corporate earnings and dividend payments as barometers of a company’s health, most value investors today analyze free cash flow. This is the cash generated annually from the operations of a business after all capital expenditures are made and changes in working capital are con- sidered. Investors have increasingly turned to this metric because reported earnings can be an accounting fiction, masking the cash gener- ated by a business or implying positive cash generation when there is none. Today’s investors have rightly concluded that following the cash— as the manager of a business must do—is the most reliable and reveal- ing means of assessing a company. In addition, many value investors today consider balance sheet analy- sis less important than was generally thought a few generations ago. With returns on capital much higher at present than in the past, most stocks trade far above book value; balance sheet analysis is less helpful in understanding upside potential or downside risk of stocks priced at 12 Professor Michael Porter of Harvard Business School, in his seminal book Competitive Strategy (Free Press, 1980), lays out the groundwork for a more intensive, thorough, and dynamic analysis of busi- nesses and industries in the modern economy. A broad industry analysis has become particularly necessary as a result of the passage in 2000 of Regulation FD (Fair Disclosure), which regulates and restricts the communications between a company and its actual or potential shareholders. Wall Street analysts, facing a dearth of information from the companies they cover, have been forced to expand their areas of inquiry. The effects of sustained inflation over time have also wreaked havoc with the accuracy of assets accounted for using historic cost; this means that two companies owning identical assets could report very different book values. Of course, balance sheets must still be carefully scrutinized. Astute observers of corporate balance sheets are often the first to see business deterioration or vulnerability as inventories and receivables build, debt grows, and cash evaporates. And for investors in the equity and debt of underperforming companies, balance sheet analysis remains one generally reliable way of assessing downside protection. Globalization has increasingly affected the investment landscape, with most investors looking beyond their home countries for opportunity and diversification. Graham and Dodd’s principles fully apply to international markets, which are, if anything, even more subject to the vicissitudes of investor sentiment—and thus more inefficiently priced—than the U.S. market is today. Investors must be cognizant of the risks of international investing, including exposure to foreign currencies and the need to consider hedging them. Among the other risks are political instability, different (or absent) securities laws and investor protections, varying accounting standards, and limited availability of information. Oddly enough, despite 75 years of success achieved by value investors, one group of observers largely ignores or dismisses this disci- pline: academics. Academics tend to create elegant theories that purport to explain the real world but in fact oversimplify it. One such theory, the Efficient Market Hypothesis (EMH), holds that security prices always and immediately reflect all available information, an idea deeply at odds with Graham and Dodd’s notion that there is great value to fundamental security analysis. The Capital Asset Pricing Model (CAPM) relates risk to return but always mistakes volatility, or beta, for risk. Modern Portfolio Theory (MPT) applauds the benefits of diversification in constructing an optimal portfolio. But by insisting that higher expected return comes only with greater risk, MPT effectively repudiates the entire value-invest- ing philosophy and its long-term record of risk-adjusted investment out- performance. Value investors have no time for these theories and generally ignore them. The assumptions made by these theories—including continuous markets, perfect information, and low or no transaction costs—are unre- alistic. Academics, broadly speaking, are so entrenched in their theories that they cannot accept that value investing works. Instead of launching a series of studies to understand the remarkable 50-year investment record of Warren Buffett, academics instead explain him away as an aber- ration. Greater attention has been paid recently to behavioral economics, a field recognizing that individuals do not always act rationally and have systematic cognitive biases that contribute to market inefficiencies and security mispricings. These teachings—which would not seem alien to Graham—have not yet entered the academic mainstream, but they are building some momentum. Academics have espoused nuanced permutations of their flawed the- ories for several decades. Countless thousands of their students have been taught that security analysis is worthless, that risk is the same as volatility, and that investors must avoid overconcentration in good ideas (because in efficient markets there can be no good ideas) and thus diver- sify into mediocre or bad ones. Of course, for value investors, the propa- gation of these academic theories has been deeply gratifying: the brainwashing of generations of young investors produces the very ineffi- ciencies that savvy stock pickers can exploit. Another important factor for value investors to take into account is the growing propensity of the Federal Reserve to intervene in financial markets at the first sign of trouble. Amidst severe turbulence, the Fed frequently lowers interest rates to prop up securities prices and restore investor confidence. While the intention of Fed officials is to maintain orderly capital markets, some money managers view Fed intervention as a virtual license to speculate. Aggressive Fed tactics, sometimes referred to as the “Greenspan put” (now the “Bernanke put”), create a moral haz- ard that encourages speculation while prolonging overvaluation. So long as value investors aren’t lured into a false sense of security, so long as they can maintain a long-term horizon and ensure their staying power, market dislocations caused by Fed action (or investor anticipation of it) may ultimately be a source of opportunity. Another modern development of relevance is the ubiquitous cable television coverage of the stock market. This frenetic lunacy exacerbates the already short-term orientation of most investors. It foments the view that it is possible—or even necessary—to have an opinion on everything pertinent to the financial markets, as opposed to the patient and highly selective approach endorsed by Graham and Dodd. This sound-bite cul- ture reinforces the popular impression that investing is easy, not rigorous and painstaking. The daily cheerleading pundits exult at rallies and record highs and commiserate over market reversals; viewers get the impression that up is the only rational market direction and that selling or sitting on the sidelines is almost unpatriotic. The hysterical tenor is exacerbated at every turn. For example, CNBC frequently uses a format- ted screen that constantly updates the level of the major market indexes against a digital clock. Not only is the time displayed in hours, minutes, and seconds but in completely useless hundredths of seconds, the num- bers flashing by so rapidly (like tenths of a cent on the gas pump) as to be completely unreadable. The only conceivable purpose is to grab the viewers’ attention and ratchet their adrenaline to full throttle. Cable business channels bring the herdlike mentality of the crowd into everyone’s living room, thus making it much harder for viewers to stand apart from the masses. Only on financial cable TV would a commentator with a crazed persona become a celebrity whose pronouncements regularly move markets. In a world in which the differences between investing and speculating are frequently blurred, the nonsense on financial cable channels only compounds the problem. Graham would have been appalled. The only saving grace is that value investors prosper at the expense of those who fall under the spell of the cable pundits. Meanwhile, human nature virtually ensures that there will never be a Graham and Dodd channel. Unanswered Questions Today’s investors still wrestle, as Graham and Dodd did in their day, with a number of important investment questions. One is whether to focus on relative or absolute value. Relative value involves the assessment that one security is cheaper than another, that Microsoft is a better bargain than IBM. Relative value is easier to determine than absolute value, the two-dimensional assessment of whether a security is cheaper than other securities and cheap enough to be worth purchasing. The most intrepid investors in relative value manage hedge funds where they purchase the relatively less expensive securities and sell short the relatively more expensive ones. This enables them potentially to profit on both sides of the ledger, long and short. Of course, it also exposes them to double- barreled losses if they are wrong.13 It is harder to think about absolute value than relative value. When is a stock cheap enough to buy and hold without a short sale as a hedge? One standard is to buy when a security trades at an appreciable—say, 30%, 40%, or greater—discount from its underlying value, calculated either as its liquidation value, going-concern value, or private-market 13 Many hedge funds also use significant leverage to goose their returns further, which backfires when analysis is faulty or judgment is flawed. Another standard is to invest when a security offers an acceptably attractive return to a long-term holder, such as a low-risk bond priced to yield 10% or more, or a stock with an 8% to 10% or higher free cash flow yield at a time when “risk-free” U.S. government bonds deliver 4% to 5% nominal and 2% to 3% real returns. Such demanding standards virtually ensure that absolute value will be quite scarce. Another area where investors struggle is trying to define what consti- tutes a good business. Someone once defined the best possible business as a post office box to which people send money. That idea has certainly been eclipsed by the creation of subscription Web sites that accept credit cards. Today’s most profitable businesses are those in which you sell a fixed amount of work product—say, a piece of software or a hit recording—millions and millions of times at very low marginal cost. Good businesses are generally considered those with strong barriers to entry, limited capital requirements, reliable customers, low risk of tech- nological obsolescence, abundant growth possibilities, and thus signifi- cant and growing free cash flow. Businesses are also subject to changes in the technological and com- petitive landscape. Because of the Internet, the competitive moat sur- rounding the newspaper business—which was considered a very good business only a decade ago—has eroded faster than almost anyone anticipated. In an era of rapid technological change, investors must be ever vigilant, even with regard to companies that are not involved in technology but are simply affected by it. In short, today’s good busi- nesses may not be tomorrow’s. Investors also expend considerable effort attempting to assess the quality of a company’s management. Some managers are more capable or scrupulous than others, and some may be able to manage certain businesses and environments better than others. Yet, as Graham and Dodd noted, “Objective tests of managerial ability are few and far from scientific.” (p. 84) Make no mistake about it: a management’s acumen, foresight, integrity, and motivation all make a huge difference in share- holder returns. In the present era of aggressive corporate financial engi- neering, managers have many levers at their disposal to positively impact returns, including share repurchases, prudent use of leverage, and a valuation-based approach to acquisitions. Managers who are unwilling to make shareholder-friendly decisions risk their companies becoming perceived as “value traps”: inexpensively valued, but ulti- mately poor investments, because the assets are underutilized. Such companies often attract activist investors seeking to unlock this trapped value. Even more difficult, investors must decide whether to take the risk of investing—at any price—with management teams that have not always done right by shareholders. Shares of such companies may sell at steeply discounted levels, but perhaps the discount is warranted; value that today belongs to the equity holders may tomorrow have been spir- ited away or squandered. An age-old difficulty for investors is ascertaining the value of future growth. In the preface to the first edition of Security Analysis, the authors said as much: “Some matters of vital significance, e.g., the determination of the future prospects of an enterprise, have received little space, because little of definite value can be said on the subject.” (p. xliii) Clearly, a company that will earn (or have free cash flow of) $1 per share today and $2 per share in five years is worth considerably more than a company with identical current per share earnings and no growth. This is especially true if the growth of the first company is likely to continue and is not subject to great variability. Another complication is that companies can grow in many different ways—for example, selling the same number of units at higher prices; selling more units at the same (or even lower) prices; changing the product mix (selling proportionately more of the higher-profit-margin products); or developing an entirely new product line. Obviously, some forms of growth are worth more than others. There is a significant downside to paying up for growth or, worse, to obsessing over it. Graham and Dodd astutely observed that “analysis is concerned primarily with values which are supported by the facts and not with those which depend largely upon expectations.” (p. 86) Strongly preferring the actual to the possible, they regarded the “future as a haz- ard which his [the analyst’s] conclusions must encounter rather than as the source of his vindication.” (p. 86) Investors should be especially vigi- lant against focusing on growth to the exclusion of all else, including the risk of overpaying. Again, Graham and Dodd were spot on, warning that “carried to its logical extreme, . . . [there is no price] too high for a good stock, and that such an issue was equally ‘safe’ after it had advanced to 200 as it had been at 25.” (p. 105) Precisely this mistake was made when stock prices surged skyward during the Nifty Fifty era of the early 1970s and the dot-com bubble of 1999 to 2000. The flaw in such a growth-at-any-price approach becomes obvious when the anticipated growth fails to materialize. When the future disap- points, what should investors do? Hope growth resumes? Or give up and sell? Indeed, failed growth stocks are often so aggressively dumped by disappointed holders that their price falls to levels at which value investors, who stubbornly pay little or nothing for growth characteristics, become major holders. This was the case with many technology stocks that suffered huge declines after the dot-com bubble burst in the spring of 2000. By 2002, hundreds of fallen tech stocks traded for less than the cash on their balance sheets, a value investor’s dream. One such com- pany was Radvision, an Israeli provider of voice, video, and data products whose stock subsequently rose from under $5 to the mid-$20s after the urgent selling abated and investors refocused on fundamentals. Another conundrum for value investors is knowing when to sell. Buy- ing bargains is the sweet spot of value investors, although how small a discount one might accept can be subject to debate. Selling is more dif- ficult because it involves securities that are closer to fully priced. As with buying, investors need a discipline for selling. First, sell targets, once set, should be regularly adjusted to reflect all currently available information. Second, individual investors must consider tax consequences. Third, whether or not an investor is fully invested may influence the urgency of raising cash from a stockholding as it approaches full valuation. The availability of better bargains might also make one a more eager seller. Finally, value investors should completely exit a security by the time it reaches full value; owning overvalued securities is the realm of specula- tors. Value investors typically begin selling at a 10% to 20% discount to their assessment of underlying value—based on the liquidity of the security, the possible presence of a catalyst for value realization, the quality of management, the riskiness and leverage of the underlying business, and the investors’ confidence level regarding the assumptions underlying the investment. Finally, investors need to deal with the complex subject of risk. As mentioned earlier, academics and many professional investors have come to define risk in terms of the Greek letter beta, which they use as a measure of past share price volatility: a historically more volatile stock is seen as riskier. But value investors, who are inclined to think about risk as the probability and amount of potential loss, find such reasoning absurd. In fact, a volatile stock may become deeply undervalued, rendering it a very low risk investment. One of the most difficult questions for value investors is how much risk to incur. One facet of this question involves position size and its impact on portfolio diversification. How much can you comfortably own of even the most attractive opportunities? Naturally, investors desire to profit fully from their good ideas. Yet this tendency is tempered by the fear of being unlucky or wrong. Nonetheless, value investors should concentrate their holdings in their best ideas; if you can tell a good investment from a bad one, you can also distinguish a great one from a good one. Investors must also ponder the risks of investing in politically unsta- ble countries, as well as the uncertainties involving currency, interest rate, and economic fluctuations. How much of your capital do you want tied up in Argentina or Thailand, or even France or Australia, no matter how undervalued the stocks may be in those markets? Another risk consideration for value investors, as with all investors, is whether or not to use leverage. While some value-oriented hedge funds and even endowments use leverage to enhance their returns, I side with those who are unwilling to incur the added risks that come with margin debt. Just as leverage enhances the return of successful investments, it magnifies the losses from unsuccessful ones. More importantly, nonre- course (margin) debt raises risk to unacceptable levels because it places one’s staying power in jeopardy. One risk-related consideration should be paramount above all others: the ability to sleep well at night, confi- dent that your financial position is secure whatever the future may bring. Final Thoughts In a rising market, everyone makes money and a value philosophy is unnecessary. But because there is no certain way to predict what the market will do, one must follow a value philosophy at all times. By con- trolling risk and limiting loss through extensive fundamental analysis, strict discipline, and endless patience, value investors can expect good results with limited downside. You may not get rich quick, but you will keep what you have, and if the future of value investing resembles its past, you are likely to get rich slowly. As investment strategies go, this is the most that any reasonable investor can hope for. The real secret to investing is that there is no secret to investing. Every important aspect of value investing has been made available to the public many times over, beginning in 1934 with the first edition of Security Analysis. That so many people fail to follow this timeless and almost foolproof approach enables those who adopt it to remain suc- cessful. The foibles of human nature that result in the mass pursuit of instant wealth and effortless gain seem certain to be with us forever. So long as people succumb to this aspect of their natures, value investing will remain, as it has been for 75 years, a sound and low-risk approach to successful long-term investing. SETH A. KLARMAN Boston, Massachusetts, May, 2008 Introduction to the Sixth Edition It was a distracted world before which McGraw-Hill set, with a thud, the first edition of Security Analysis in July 1934. From Berlin dribbled reports of a shake-up at the top of the German government. “It will simplify the Führer’s whole work immensely if he need not first ask some- body if he may do this or that,” the Associated Press quoted an informant on August 1 as saying of Hitler’s ascension from chancellor to dictator. Set against such epochal proceedings, a 727-page textbook on the fine points of value investing must have seemed an unlikely candidate for bestsellerdom, then or later. In his posthumously published autobiography, The Memoirs of the Dean of Wall Street, Graham (1894–1976) thanked his lucky stars that he had entered the investment business when he did. The timing seemed not so propitious in the year of the first edition of Security Analysis, or, indeed, that of the second edition—expanded and revised—six years later. From its 1929 peak to its 1932 trough, the Dow Jones Industrial Average had lost 87% of its value. At cyclical low ebb, in 1933, the national unemployment rate topped 25%. That the Great Depression ended in 1933 was the considered judgment of the timekeepers of the National Bureau of Economic Research. Millions of Americans, however— not least, the relatively few who tried to squeeze a living out of a profit- less Wall Street—had reason to doubt it. The bear market and credit liquidation of the early 1930s gave the institutions of American finance a top-to-bottom scouring. What was left of them presently came in for a rough handling by the first Roosevelt administration. Graham had learned his trade in the Wall Street of the mid–nineteen teens, an era of lightly regulated markets. He began work on Security Analysis as the administration of Herbert Hoover was giving the country its first taste of thoroughgoing federal intervention in a peacetime economy. He was correcting page proofs as the Roosevelt administration was implementing its first radical forays into macroeco- nomic management. By 1934, there were laws to institute federal regula- tion of the securities markets, federal insurance of bank deposits, and federal price controls (not to put a cap on prices, as in later, inflationary times, but rather to put a floor under them). To try to prop up prices, the administration devalued the dollar. It is a testament to the enduring quality of Graham’s thought, not to mention the resiliency of America’s financial markets, that Security Analysis lost none of its relevance even as the economy was being turned upside down and inside out. Five full months elapsed following publication of the first edition before Louis Rich got around to reviewing it in the New York Times. Who knows? Maybe the conscientious critic read every page. In any case, Rich gave the book a rave, albeit a slightly rueful one. “On the assumption,” he wrote, on December 2, 1934, “that despite the debacle of recent history there are still people left whose money burns a hole in their pockets, it is hoped that they will read this book. It is a full-bodied, mature, meticu- lous and wholly meritorious outgrowth of scholarly probing and practi- cal sagacity. Although cast in the form and spirit of a textbook, the presentation is endowed with all the qualities likely to engage the liveli- est interest of the layman.”1 How few laymen seemed to care about investing was brought home to Wall Street more forcefully with every passing year of the unprosperous postcrash era. Just when it seemed that trading volume could get no smaller, or New York Stock Exchange seat prices no lower, or equity valu- ations more absurdly cheap, a new, dispiriting record was set. It required every effort of the editors of the Big Board’s house organ, the Exchange magazine, to keep up a brave face. “Must There Be an End to Progress?” was the inquiring headline over an essay by the Swedish economist Gus- tav Cassel published around the time of the release of Graham and Dodd’s second edition (the professor thought not).2 “Why Do Securities Brokers Stay in Business?” the editors posed and helpfully answered, “Despite wearying lethargy over long periods, confidence abounds that when the public recognizes fully the value of protective measures which lately have been ranged about market procedure, investment interest in securities will increase.” It did not amuse the Exchange that a New York City magistrate, sarcastically addressing in his court a collection of defen- dants hauled in by the police for shooting craps on the sidewalk, had derided the financial profession. “The first thing you know,” the judge had upbraided the suspects, “you’ll wind up as stock brokers in Wall Street with yachts and country homes on Long Island.”3 In ways now difficult to imagine, Murphy’s Law was the order of the day; what could go wrong, did. “Depression” was more than a long-lin- gering state of economic affairs. It had become a worldview. The aca- demic exponents of “secular stagnation,” notably Alvin Hansen and Joseph Schumpeter, each a Harvard economics professor, predicted a long decline in American population growth. This deceleration, Hansen contended in his 1939 essay, “together with the failure of any really important innovations of a magnitude to absorb large capital outlays, weighs very heavily as an explanation for the failure of the recent recov- ery to reach full employment.”4 Neither Hansen nor his readers had any way of knowing that a baby boom was around the corner. Nothing could have seemed more unlikely to a world preoccupied with a new war in Europe and the evident decline and fall of capitalism. Certainly, Hansen’s ideas must have struck a chord with the chronically underemployed brokers and traders in lower Manhat- tan. As a business, the New York Stock Exchange was running at a steady loss. From 1933, the year in which it began to report its financial results, through 1940, the Big Board recorded a profit in only one year, 1935 (and a nominal one, at that). And when, in 1937, Chelcie C. Bosland, an assis- tant professor of economics at Brown University, brought forth a book entitled The Common Stock Theory of Investment, he remarked as if he were repeating a commonplace that the American economy had peaked two decades earlier at about the time of what was not yet called World War I. The professor added, quoting unnamed authorities, that American population growth could be expected to stop in its tracks by 1975.5 Small wonder that Graham was to write that the acid test of a bond issuer was its capacity to meet its obligations not in a time of middling prosperity (which modest test today’s residential mortgage–backed securities strug- gle to meet) but in a depression. Altogether, an investor in those days was well advised to keep up his guard. “The combination of a record high level for bonds,” writes Graham in the 1940 edition, “with a history of two catastrophic price collapses in the preceding 20 years and a major war in progress is not one to justify airy confidence in the future.” (p. 142) Wall Street, not such a big place even during the 1920s’ boom, got considerably smaller in the subsequent bust. Ben Graham, in conjunction with his partner Jerry Newman, made a very small cog of this low-horse- power machine. The two of them conducted a specialty investment busi- ness at 52 Wall Street. Their strong suits were arbitrage, reorganizations, bankruptcies, and other complex matters. A schematic drawing of the financial district published by Fortune in 1937 made no reference to the Graham-Newman offices. Then again, the partnerships and corporate headquarters that did rate a spot on the Wall Street map were them- selves—by the standards of twenty-first-century finance—remarkably compact. One floor at 40 Wall Street was enough to contain the entire office of Merrill Lynch & Co. And a single floor at 2 Wall Street was all the space required to house Morgan Stanley, the hands-down leader in 1936 corporate securities underwriting, with originations of all of $195 million. Compensation was in keeping with the slow pace of business, especially at the bottom of the corporate ladder.6 After a 20% rise in the new fed- eral minimum wage, effective October 1939, brokerage employees could earn no less than 30 cents an hour.7 In March 1940, the Exchange documented in all the detail its readers could want (and possibly then some) the collapse of public participation in the stock market. In the first three decades of the twentieth century, the annual volume of trading had almost invariably exceeded the quantity of listed shares outstanding, sometimes by a wide margin. And in only one year between 1900 and 1930 had annual volume amounted to less than 50% of listed shares—the exception being 1914, the year in which the exchange was closed for 41/2 months to allow for the shock of the out- break of World War I to sink in. Then came the 1930s, and the annual turnover as a percentage of listed shares struggled to reach as high as 50%. In 1939, despite a short-lived surge of trading on the outbreak of World War II in Europe, the turnover ratio had fallen to a shockingly low 18.4%. (For comparison, in 2007, the ratio of trading volume to listed shares amounted to 123%.) “Perhaps,” sighed the author of the study, “it is a fair statement that if the farming industry showed a similar record, government subsidies would have been voted long ago. Unfortunately for Wall Street, it seems to have too little sponsorship in officialdom.”8 If a reader took hope from the idea that things were so bad that they could hardly get worse, he or she was in for yet another disappointment. The second edition of Security Analysis had been published only months earlier when, on August 19, 1940, the stock exchange volume totaled just 129,650 shares. It was one of the sleepiest sessions since the 49,000- share mark set on August 5, 1916. For the entire 1940 calendar year, vol- ume totaled 207,599,749 shares—a not very busy two hours’ turnover at this writing and 18.5% of the turnover of 1929, that year of seemingly irrecoverable prosperity. The cost of a membership, or seat, on the stock exchange sank along with turnover and with the major price indexes. At the nadir in 1942, a seat fetched just $17,000. It was the lowest price since 1897 and 97% below the record high price of $625,000, set—natu- rally—in 1929. “‘The Cleaners,’” quipped Fred Schwed, Jr., in his funny and wise book Where Are the Customers’ Yachts? (which, like Graham’s second edition, appeared in 1940), “was not one of those exclusive clubs; by 1932, every- body who had ever tried speculation had been admitted to membership.”9 And if an investor did, somehow, manage to avoid the cleaner’s during the formally designated Great Depression, he or she was by no means home free. In August 1937, the market began a violent sell-off that would carry the averages down by 50% by March 1938. The nonfinancial portion of the economy fared little better than the financial side. In just nine months, industrial production fell by 34.5%, a sharper contraction even than that in the depression of 1920 to 1921, a slump that, for Graham’s generation, had seemed to set the standard for the most economic damage in the shortest elapsed time.10 The Roosevelt administration insisted that the slump of 1937 to 1938 was no depression but rather a “recession.” The national unemployment rate in 1938 was, on average, 18.8%. In April 1937, four months before the bottom fell out of the stock mar- ket for the second time in 10 years, Robert Lovett, a partner at the invest- ment firm of Brown Brothers Harriman & Co., served warning to the American public in the pages of the weekly Saturday Evening Post. Lovett, a member of the innermost circle of the Wall Street establishment, set out to demonstrate that there is no such thing as financial security—none, at least, to be had in stocks and bonds. The gist of Lovett’s argument was that, in capitalism, capital is consumed and that businesses are just as fragile, and mortal, as the people who own them. He invited his millions of readers to examine the record, as he had done: “If an investor had pur- chased 100 shares of the 20 most popular dividend-paying stocks on December 31, 1901, and held them through 1936, adding, in the mean- time, all the melons in the form of stock dividends, and all the plums in the form of stock split-ups, and had exercised all the valuable rights to subscribe to additional stock, the aggregate market value of his total holdings on December 31, 1936, would have shown a shrinkage of 39% as compared with the cost of his original investment. In plain English, the average investor paid $294,911.90 for things worth $180,072.06 on December 31, 1936. That’s a big disappearance of dollar value in any lan- guage.” In the innocent days before the crash, people had blithely spoken of “permanent investments.” “For our part,” wrote this partner of an emi- nent Wall Street private bank, “we are convinced that the only permanent investment is one which has become a total and irretrievable loss.”11 Lovett turned out to be a prophet. At the nadir of the 1937 to 1938 bear market, one in five NYSE-listed industrial companies was valued in the market for less than its net current assets. Subtract from cash and quick assets all liabilities and the remainder was greater than the company’s market value. That is, business value was negative. The Great Atlantic & Pacific Tea Company (A&P), the Wal-Mart of its day, was one of these corporate castoffs. At the 1938 lows, the market value of the com- mon and preferred shares of A&P at $126 million was less than the value of its cash, inventories, and receivables, conservatively valued at $134 million. In the words of Graham and Dodd, the still-profitable company was selling for “scrap.” (p. 673) A Different Wall Street Few institutional traces of that Wall Street remain. Nowadays, the big broker-dealers keep as much as $1 trillion in securities in inventory; in Graham’s day, they customarily held none. Nowadays, the big broker- dealers are in a perpetual competitive lather to see which can bring the greatest number of initial public offerings (IPOs) to the public market. In Graham’s day, no frontline member firm would stoop to placing an IPO in public hands, the risks and rewards for this kind of offering being reserved for professionals. Federal securities regulation was a new thing in the 1930s. What had preceded the Securities and Exchange Commis- sion (SEC) was a regime of tribal sanction. Some things were simply beyond the pale. Both during and immediately after World War I, no self- respecting NYSE member firm facilitated a client’s switch from Liberty bonds into potentially more lucrative, if less patriotic, alternatives. There was no law against such a business development overture. Rather, according to Graham, it just wasn’t done. A great many things weren’t done in the Wall Street of the 1930s. Newly empowered regulators were resistant to financial innovation, trans- action costs were high, technology was (at least by today’s digital stan- dards) primitive, and investors were demoralized. After the vicious bear market of 1937 to 1938, not a few decided they’d had enough. What was the point of it all? “In June 1939,” writes Graham in a note to a discussion about corporate finance in the second edition, “the S.E.C. set a salutary precedent by refusing to authorize the issuance of ‘Capital Income Debentures’ in the reorganization of the Griess-Pfleger Tanning Company, on the ground that the devising of new types of hybrid issues had gone far enough.” (p. 115, fn. 4) In the same conservative vein, he expresses his approval of the institution of the “legal list,” a document compiled by state banking departments to stipulate which bonds the regulated sav- ings banks could safely own. The very idea of such a list flies in the face of nearly every millennial notion about good regulatory practice. But Gra- ham defends it thus: “Since the selection of high-grade bonds has been shown to be in good part a process of exclusion, it lends itself reasonably well to the application of definite rules and standards designed to dis- qualify unsuitable issues.” (p. 169) No collateralized debt obligations stocked with subprime mortgages for the father of value investing! The 1930s ushered in a revolution in financial disclosure. The new federal securities acts directed investor-owned companies to brief their stockholders once a quarter as well as at year-end. But the new stan- dards were not immediately applicable to all public companies, and more than a few continued doing business the old-fashioned way, with their cards to their chests. One of these informational holdouts was none other than Dun & Bradstreet (D&B), the financial information company. Graham seemed to relish the irony of D&B not revealing “its own earn- ings to its own stockholders.” (p. 92, fn. 4) On the whole, by twenty-first- century standards, information in Graham’s time was as slow moving as it was sparse. There were no conference calls, no automated spread- sheets, and no nonstop news from distant markets—indeed, not much truck with the world outside the 48 states. Security Analysis barely acknowledges the existence of foreign markets. Such an institutional setting was hardly conducive to the develop- ment of “efficient markets,” as the economists today call them—markets in which information is disseminated rapidly, human beings process it flawlessly, and prices incorporate it instantaneously. Graham would have scoffed at such an idea. Equally, he would have smiled at the discovery— so late in the evolution of the human species—that there was a place in economics for a subdiscipline called “behavioral finance.” Reading Security Analysis, one is led to wonder what facet of investing is not behavioral. The stock market, Graham saw, is a source of entertainment value as well as investment value: “Even when the underlying motive of purchase is mere speculative greed, human nature desires to conceal this unlovely impulse behind a screen of apparent logic and good sense. To adapt the aphorism of Voltaire, it may be said that if there were no such thing as common-stock analysis, it would be necessary to counterfeit it.” (p. 348) Anomalies of undervaluation and overvaluation—of underdoing it and overdoing it—fill these pages. It bemused Graham, but did not shock him, that so many businesses could be valued in the stock market for less than their net current assets, even during the late 1920s’ boom, or that, in the dislocations to the bond market immediately following World War I, investors became disoriented enough to assign a higher price and a lower yield to the Union Pacific First Mortgage 4s than they did to the U.S. Treasury’s own Fourth Liberty 41⁄4s. Graham writes of the “inveterate tendency of the stock market to exaggerate.” (p. 679) He would not have exaggerated much if he had written, instead, “all markets.” Though he did not dwell long on the cycles in finance, Graham was certainly aware of them. He could see that ideas, no less than prices and categories of investment assets, had their seasons. The discussion in Security Analysis of the flame-out of the mortgage guarantee business in the early 1930s is a perfect miniature of the often-ruinous competition in which financial institutions periodically engage. “The rise of the newer and more aggressive real estate bond organizations had a most unfortu- nate effect upon the policies of the older concerns,” Graham writes of his time and also of ours. “By force of competition they were led to relax their standards of making loans. New mortgages were granted on an increasingly liberal basis, and when old mortgages matured, they were frequently renewed in a larger sum. Furthermore, the face amount of the mortgages guaranteed rose to so high a multiple of the capital of the guarantor companies that it should have been obvious that the guaranty would afford only the flimsiest of protection in the event of a general decline in values.” (p. 217) Security analysis itself is a cyclical phenomenon; it, too, goes in and out of fashion, Graham observed. It holds a strong, intuitive appeal for the kind of businessperson who thinks about stocks the way he or she thinks about his or her own family business. What would such a fount of com- mon sense care about earnings momentum or Wall Street’s pseudo-scien- tific guesses about the economic future? Such an investor, appraising a common stock, would much rather know what the company behind it is worth. That is, he or she would want to study its balance sheet. Well, Gra- ham relates here, that kind of analysis went out of style when stocks started levitating without reference to anything except hope and prophecy. So, by about 1927, fortune-telling and chart-reading had dis- placed the value discipline by which he and his partner were earning a very good living. It is characteristic of Graham that his critique of the “new era” method of investing is measured and not derisory. The old, conserva- tive approach—his own—had been rather backward looking, Graham admits. It had laid more emphasis on the past than on the future, on sta- ble earning power rather than tomorrow’s earnings prospects. But new technologies, new methods, and new forms of corporate organization had introduced new risks into the post–World War I economy. This fact— “the increasing instability of the typical business”—had blown a small hole in the older analytical approach that emphasized stable earnings power over forecast earnings growth. Beyond that mitigating considera- tion, however, Graham does not go. The new era approach, “which turned upon the earnings trend as the sole criterion of value, . . . was certain to end in an appalling debacle.” (p. 366) Which, of course, it did, and—in the CNBC-driven markets of the twenty-first century—continues to do at intervals today. A Man of Many Talents Benjamin Graham was born Benjamin Grossbaum on May 9, 1894, in London, and sailed to New York with his family before he was two. Young Benjamin was a prodigy in mathematics, classical languages, modern languages, expository writing (as readers of this volume will see for themselves), and anything else that the public schools had to offer. He had a tenacious memory and a love of reading—a certain ticket to aca- demic success, then or later. His father’s death at the age of 35 left him, his two brothers, and their mother in the social and financial lurch. Ben- jamin early learned to work and to do without. No need here for a biographical profile of the principal author of Security Analysis: Graham’s own memoir delightfully covers that ground. Suffice it to say that the high school brainiac entered Columbia College as an Alumni Scholar in September 1911 at the age of 17. So much material had he already absorbed that he began with a semester’s head start, “the highest possible advanced standing.”12 He mixed his academic studies with a grab bag of jobs, part-time and full-time alike. Upon his graduation in 1914, he started work as a runner and board-boy at the New York Stock Exchange member firm of Newberger, Henderson & Loeb. Within a year, the board-boy was playing the liquidation of the Guggenheim Exploration Company by astutely going long the shares of Guggenheim and short the stocks of the companies in which Guggen- heim had made a minority investment, as his no-doubt bemused elders looked on: “The profit was realized exactly as calculated; and everyone was happy, not least myself.”13 Security Analysis did not come out of the blue. Graham had supple- mented his modest salary by contributing articles to the Magazine of Wall Street. His productions are unmistakably those of a self-assured and superbly educated Wall Street moneymaker. There was no need to quote expert opinion. He and the documents he interpreted were all the authority he needed. His favorite topics were the ones that he subse- quently developed in the book you hold in your hands. He was partial to the special situations in which Graham-Newman was to become so suc- cessful. Thus, when a high-flying, and highly complex, American Interna- tional Corp. fell from the sky in 1920, Graham was able to show that the stock was cheap in relation to the evident value of its portfolio of miscel- laneous (and not especially well disclosed) investment assets.14 The shocking insolvency of Goodyear Tire and Rubber attracted his attention in 1921. “The downfall of Goodyear is a remarkable incident even in the present plenitude of business disasters,” he wrote, in a characteristic Gra- ham sentence (how many financial journalists, then or later, had “pleni- tude” on the tips of their tongues?). He shrewdly judged that Goodyear would be a survivor.15 In the summer of 1924, he hit on a theme that would echo through Security Analysis: it was the evident non sequitor of stocks valued in the market at less than the liquidating value of the com- panies that issued them. “Eight Stock Bargains Off the Beaten Track,” said the headline over the Benjamin Graham byline: “Stocks that Are Covered Chiefly by Cash or the Equivalent—No Bonds or Preferred Stock Ahead of These Issues—An Unusually Interesting Group of Securities.” In one case, that of Tonopah Mining, liquid assets of $4.31 per share towered over a market price of just $1.38 a share.16 For Graham, an era of sweet reasonableness in investment thinking seemed to end around 1914. Before that time, the typical investor was a businessman who analyzed a stock or a bond much as he might a claim on a private business. He—it was usually a he—would naturally try to determine what the security-issuing company owned, free and clear of any encumbrances. If the prospective investment was a bond—and it usually was—the businessman-investor would seek assurances that the borrowing company had the financial strength to weather a depression. “It’s not undue modesty,” Graham wrote in his memoir, “to say that I had become something of a smart cookie in my particular field.” His spe- cialty was the carefully analyzed out-of-the-way investment: castaway stocks or bonds, liquidations, bankruptcies, arbitrage. Since at least the early 1920s, Graham had preached the sermon of the “margin of safety.” As the future is a closed book, he urged in his writings, an investor, as a matter of self-defense against the unknown, should contrive to pay less than “intrinsic” value. Intrinsic value, as defined in Security Analysis, is “that value which is justified by the facts, e.g., the assets, earnings, divi- dends, definite prospects, as distinct, let us say, from market quotations established by artificial manipulation or distorted by psychological excesses.” (p. 64) He himself had gone from the ridiculous to the sublime (and some- times back again) in the conduct of his own investment career. His quick and easy grasp of mathematics made him a natural arbitrageur. He would sell one stock and simultaneously buy another. Or he would buy or sell shares of stock against the convertible bonds of the identical issu- ing company. So doing, he would lock in a profit that, if not certain, was as close to guaranteed as the vicissitudes of finance allowed. In one instance, in the early 1920s, he exploited an inefficiency in the relation- ship between DuPont and the then red-hot General Motors (GM). DuPont held a sizable stake in GM. And it was for that interest alone which the market valued the big chemical company. By implication, the rest of the business was worth nothing. To exploit this anomaly, Graham bought shares in DuPont and sold short the hedge-appropriate number of shares in GM. And when the market came to its senses, and the price gap between DuPont and GM widened in the expected direction, Gra- ham took his profit.17 However, Graham, like many another value investors after him, some- times veered from the austere precepts of safe-and-cheap investing. A Graham only slightly younger than the master who sold GM and bought DuPont allowed himself to be hoodwinked by a crooked promoter of a company that seems not actually to have existed—at least, in anything like the state of glowing prosperity described by the manager of the pool to which Graham entrusted his money. An electric sign in Colum- bus Circle, on the upper West Side of Manhattan, did bear the name of the object of Graham’s misplaced confidence, Savold Tire. But, as the author of Security Analysis confessed in his memoir, that could have been the only tangible marker of the company’s existence. “Also, as far as I knew,” Graham added, “nobody complained to the district attorney’s office about the promoter’s bare-faced theft of the public’s money.” Cer- tainly, by his own telling, Graham didn’t.18 By 1929, when he was 35, Graham was well on his way to fame and fortune. His wife and he kept a squadron of servants, including—for the first and only time in his life—a manservant for himself. With JerryNewman, Graham had compiled an investment record so enviable that the great Bernard M. Baruch sought him out. Would Graham wind up his busi- ness to manage Baruch’s money? “I replied,” Graham writes, “that I was highly flattered—flabbergasted, in fact—by his proposal, but I could not end so abruptly the close and highly satisfactory relations I had with my friends and clients.”19 Those relations soon became much less satisfactory. Graham relates that, though he was worried at the top of the market, he failed to act on his bearish hunch. The Graham-Newman partnership went into the 1929 break with $2.5 million of capital. And they con- trolled about $2.5 million in hedged positions—stocks owned long offset by stocks sold short. They had, besides, about $4.5 million in outright long positions. It was bad enough that they were leveraged, as Graham later came to realize. Compounding that tactical error was a deeply rooted conviction that the stocks they owned were cheap enough to withstand any imaginable blow. They came through the crash creditably: down by only 20% was, for the final quarter of 1929, almost heroic. But they gave up 50% in 1930, 16% in 1931, and 3% in 1932 (another relatively excellent showing), for a cumulative loss of 70%.20 “I blamed myself not so much for my failure to protect myself against the disaster I had been predicting,” Graham writes, “as for having slipped into an extravagant way of life which I hadn’t the temperament or capacity to enjoy. I quickly convinced myself that the true key to material happiness lay in a modest standard of living which could be achieved with little difficulty under almost all economic condi- tions”—the margin-of-safety idea applied to personal finance.21 It can’t be said that the academic world immediately clasped Security Analysis to its breast as the definitive elucidation of value investing, or of anything else. The aforementioned survey of the field in which Graham and Dodd made their signal contribution, The Common Stock Theory of Investment, by Chelcie C. Bosland, published three years after the appear- ance of the first edition of Security Analysis, cited 53 different sources and 43 different authors. Not one of them was named Graham or Dodd. Edgar Lawrence Smith, however, did receive Bosland’s full and respectful attention. Smith’s Common Stocks as Long Term Investments, published in 1924, had challenged the long-held view that bonds were innately superior to equities. For one thing, Smith argued, the dollar (even the gold-backed 1924 edition) was inflation-prone, which meant that creditors were inherently disadvantaged. Not so the owners of com- mon stock. If the companies in which they invested earned a profit, and if the managements of those companies retained a portion of that profit in the business, and if those retained earnings, in turn, produced future earnings, the principal value of an investor’s portfolio would tend “to increase in accordance with the operation of compound interest.”22 Smith’s timing was impeccable. Not a year after he published, the great Coolidge bull market erupted. Common Stocks as Long Term Investments, only 129 pages long, provided a handy rationale for chasing the market higher. That stocks do, in fact, tend to excel in the long run has entered the canon of American investment thought as a revealed truth (it looked any- thing but obvious in the 1930s). For his part, Graham entered a strong dis- sent to Smith’s thesis, or, more exactly, its uncritical bullish application. It was one thing to pay 10 times earnings for an equity investment, he notes, quite another to pay 20 to 40 times earnings. Besides, the Smith analysis skirted the important question of what asset values lay behind the stock certificates that people so feverishly and uncritically traded back and forth. Finally, embedded in Smith’s argument was the assumption that common stocks could be counted on to deliver in the future what they had done in the past. Graham was not a believer. (pp. 362–363) If Graham was a hard critic, however, he was also a generous one. In 1939 he was given John Burr Williams’s The Theory of Investment Value to review for the Journal of Political Economy (no small honor for a Wall Street author-practitioner). Williams’s thesis was as important as it was concise. The investment value of a common stock is the present value of all future dividends, he proposed. Williams did not underestimate the significance of these loaded words. Armed with that critical knowledge, the author ventured to hope, investors might restrain themselves from bidding stocks back up to the moon again. Graham, in whose capacious brain dwelled the talents both of the quant and behavioral financier, voiced his doubts about that forecast. The rub, as he pointed out, was that, in order to apply Williams’s method, one needed to make some very large assumptions about the future course of interest rates, the growth of profit, and the terminal value of the shares when growth stops. “One wonders,” Graham mused, “whether there may not be too great a discrepancy between the necessarily hit-or-miss character of these assumptions and the highly refined mathematical treatment to which they are subjected.” Graham closed his essay on a characteristi- cally generous and witty note, commending Williams for the refreshing level-headedness of his approach and adding: “This conservatism is not really implicit in the author’s formulas; but if the investor can be per- suaded by higher algebra to take a sane attitude toward common-stock prices, the reviewer will cast a loud vote for higher algebra.”23 Graham’s technical accomplishments in securities analysis, by them- selves, could hardly have carried Security Analysis through its five edi- tions. It’s the book’s humanity and good humor that, to me, explain its long life and the adoring loyalty of a certain remnant of Graham readers, myself included. Was there ever a Wall Street moneymaker better steeped than Graham in classical languages and literature and in the financial history of his own time? I would bet “no” with all the confidence of a value investor laying down money to buy an especially cheap stock. Yet this great investment philosopher was, to a degree, a prisoner of his own times. He could see that the experiences through which he lived were unique, that the Great Depression was, in fact, a great anomaly. If anyone understood the folly of projecting current experience into the unpredictable future, it was Graham. Yet this investment-philosopher king, having spent 727 pages (not including the gold mine of an appendix) describing how a careful and risk-averse investor could prosper in every kind of macroeconomic conditions, arrives at a remarkable conclusion. What of the institutional investor, he asks. How should he invest? At first, Graham diffidently ducks the question—who is he to prescribe for the experienced financiers at the head of America’s philanthropic and educational institutions? But then he takes the astonishing plunge. “An institution,” he writes, “that can manage to get along on the low income provided by high-grade fixed-value issues should, in our opinion, confine its holdings to this field. We doubt if the better performance of common- stock indexes over past periods will, in itself, warrant the heavy responsi- bilities and the recurring uncertainties that are inseparable from a common-stock investment program.” (pp. 709–710) Could the greatest value investor have meant that? Did the man who stuck it out through ruinous losses in the Depression years and went on to compile a remarkable long-term investment record really mean that common stocks were not worth the bother? In 1940, with a new world war fanning the Roosevelt administration’s fiscal and monetary policies, high-grade corporate bonds yielded just 2.75%, while blue-chip equities yielded 5.1%. Did Graham mean to say that bonds were a safer proposi- tion than stocks? Well, he did say it. If Homer could nod, so could Gra- ham—and so can the rest of us, whoever we are. Let it be a lesson.","You will be provided with a user prompt and a context block. Only respond to prompts using information that has been provided in the context block. Do not use any outside knowledge to answer prompts. If you cannot answer a prompt based on the information in the context block alone, please state ""I unable to determine that without additional context"" and do not add anything further.
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+EVIDENCE:
+Preface to the Sixth Edition THE TIMELESS WISDOM OF GRAHAM AND DODD BY SETH A. KLARMAN Seventy-five years after Benjamin Graham and David Dodd wrote Security Analysis, a growing coterie of modern-day value investors remain deeply indebted to them. Graham and David were two assiduous and unusually insightful thinkers seeking to give order to the mostly uncharted financial wilderness of their era. They kindled a flame that has illuminated the way for value investors ever since. Today, Security Analysis remains an invaluable roadmap for investors as they navigate through unpredictable, often volatile, and sometimes treacherous finan- cial markets. Frequently referred to as the “bible of value investing,” Secu- rity Analysis is extremely thorough and detailed, teeming with wisdom for the ages. Although many of the examples are obviously dated, their les- sons are timeless. And while the prose may sometimes seem dry, readers can yet discover valuable ideas on nearly every page. The financial mar- kets have morphed since 1934 in almost unimaginable ways, but Graham and Dodd’s approach to investing remains remarkably applicable today. Value investing, today as in the era of Graham and Dodd, is the prac- tice of purchasing securities or assets for less than they are worth—the proverbial dollar for 50 cents. Investing in bargain-priced securities pro- vides a “margin of safety”—room for error, imprecision, bad luck, or the vicissitudes of the economy and stock market. While some might mistak- enly consider value investing a mechanical tool for identifying bargains, it is actually a comprehensive investment philosophy that emphasizes the need to perform in-depth fundamental analysis, pursue long-term investment results, limit risk, and resist crowd psychology. Far too many people approach the stock market with a focus on mak- ing money quickly. Such an orientation involves speculation rather than investment and is based on the hope that share prices will rise irrespec- tive of valuation. Speculators generally regard stocks as pieces of paper to be quickly traded back and forth, foolishly decoupling them from business reality and valuation criteria. Speculative approaches—which pay little or no attention to downside risk—are especially popular in ris- ing markets. In heady times, few are sufficiently disciplined to maintain strict standards of valuation and risk aversion, especially when most of those abandoning such standards are quickly getting rich. After all, it is easy to confuse genius with a bull market. In recent years, some people have attempted to expand the defini- tion of an investment to include any asset that has recently—or might soon—appreciate in price: art, rare stamps, or a wine collection. Because these items have no ascertainable fundamental value, generate no pres- ent or future cash flow, and depend for their value entirely on buyer whim, they clearly constitute speculations rather than investments. In contrast to the speculator’s preoccupation with rapid gain, value investors demonstrate their risk aversion by striving to avoid loss. A risk- averse investor is one for whom the perceived benefit of any gain is out- weighed by the perceived cost of an equivalent loss. Once any of us has accumulated a modicum of capital, the incremental benefit of gaining more is typically eclipsed by the pain of having less.1 Imagine how you would respond to the proposition of a coin flip that would either double your net worth or extinguish it. Being risk averse, nearly all people would respectfully decline such a gamble. Such risk aversion is deeply ingrained in human nature. Yet many unwittingly set aside their risk aversion when the sirens of market speculation call. Value investors regard securities not as speculative instruments but as fractional ownership in, or debt claims on, the underlying businesses. This orientation is key to value investing. When a small slice of a business is offered at a bargain price, it is helpful to evaluate it as if the whole business were offered for sale there. This analytical anchor helps value investors remain focused on the pursuit of long-term results rather than the profitability of their daily trading ledger. At the root of Graham and Dodd’s philosophy is the principle that the financial markets are the ultimate creators of opportunity. Sometimes the markets price securities correctly, other times not. Indeed, in the short run, the market can be quite inefficient, with great deviations between price and underlying value. Unexpected developments, increased uncer- tainty, and capital flows can boost short-term market volatility, with prices overshooting in either direction.2 In the words of Graham and Dodd, “The price [of a security] is frequently an essential element, so that a stock . . . may have investment merit at one price level but not at another.” (p. 106) As Graham has instructed, those who view the market as a weighing machine—a precise and efficient assessor of value—are part of the emo- tionally driven herd. Those who regard the market as a voting machine—a sentiment-driven popularity contest—will be well positioned to take proper advantage of the extremes of market sentiment. While it might seem that anyone can be a value investor, the essential characteristics of this type of investor—patience, discipline, and risk aver- sion—may well be genetically determined. When you first learn of the value approach, it either resonates with you or it doesn’t. Either you are able to remain disciplined and patient, or you aren’t. As Warren Buffett said in his famous article, “The Superinvestors of Graham-and-Doddsville,” “It is extraordinary to me that the idea of buying dollar bills for 40 cents takes immediately with people or it doesn’t take at all. It’s like an inocula- tion. If it doesn’t grab a person right away, I find you can talk to him for years and show him records, and it doesn’t make any difference.” 3,4 If Security Analysis resonates with you—if you can resist speculating and sometimes sit on your hands—perhaps you have a predisposition toward value investing. If not, at least the book will help you understand where you fit into the investing landscape and give you an appreciation for what the value-investing community may be thinking. Just as Relevant Now Perhaps the most exceptional achievement of Security Analysis, first pub- lished in 1934 and revised in the acclaimed 1940 edition, is that its les- sons are timeless. Generations of value investors have adopted the teachings of Graham and Dodd and successfully implemented them across highly varied market environments, countries, and asset classes. 3 “The Superinvestors of Graham-and-Doddsville,” Hermes, the Columbia Business School magazine, 1984. 4 My own experience has been exactly the one that Buffett describes. My 1978 summer job at Mutual Shares, a no-load value-based mutual fund, set the course for my professional career. The planned liquidation of Telecor and spin-off of its Electro Rent subsidiary in 1980 forever imprinted in my mind the merit of fundamental investment analysis. A buyer of Telecor stock was effectively creating an investment in the shares of Electro Rent, a fast-growing equipment rental company, at the giveaway valuation of approximately 1 times the cash flow. You always remember your first value investment.This would delight the authors, who hoped to set forth principles that would “stand the test of the ever enigmatic future.” (p. xliv) In 1992, Tweedy, Browne Company LLC, a well-known value invest- ment firm, published a compilation of 44 research studies entitled, “What Has Worked in Investing.” The study found that what has worked is fairly simple: cheap stocks (measured by price-to-book values, price- to-earnings ratios, or dividend yields) reliably outperform expensive ones, and stocks that have underperformed (over three- and five-year periods) subsequently beat those that have lately performed well. In other words, value investing works! I know of no long-time practitioner who regrets adhering to a value philosophy; few investors who embrace the fundamental principles ever abandon this investment approach for another. Today, when you read Graham and Dodd’s description of how they navigated through the financial markets of the 1930s, it seems as if they were detailing a strange, foreign, and antiquated era of economic depression, extreme risk aversion, and obscure and obsolete businesses. But such an exploration is considerably more valuable than it superfi- cially appears. After all, each new day has the potential to bring with it a strange and foreign environment. Investors tend to assume that tomor- row’s markets will look very much like today’s, and, most of the time, they will. But every once in a while,5 conventional wisdom is turned on its head, circular reasoning is unraveled, prices revert to the mean, and speculative behavior is exposed as such. At those times, when today fails to resemble yesterday, most investors will be paralyzed. In the words of Graham and Dodd, “We have striven throughout to guard the student against overemphasis upon the superficial and the temporary,” which is “at once the delusion and the nemesis of the world of finance.” (p. xliv) It is during periods of tumult that a value-investing philosophy is particu- larly beneficial. In 1934, Graham and Dodd had witnessed over a five-year span the best and the worst of times in the markets—the run-up to the 1929 peak, the October 1929 crash, and the relentless grind of the Great Depression. They laid out a plan for how investors in any environment might sort through hundreds or even thousands of common stocks, pre- ferred shares, and bonds to identify those worthy of investment. Remark- ably, their approach is essentially the same one that value investors employ today. The same principles they applied to the U.S. stock and bond markets of the 1920s and 1930s apply to the global capital markets of the early twenty-first century, to less liquid asset classes like real estate and private equity, and even to derivative instruments that hardly existed when Security Analysis was written. While formulas such as the classic “net working capital” test are nec- essary to support an investment analysis, value investing is not a paint- by-numbers exercise.6 Skepticism and judgment are always required. For one thing, not all elements affecting value are captured in a company’s financial statements—inventories can grow obsolete and receivables uncollectible; liabilities are sometimes unrecorded and property values over- or understated. Second, valuation is an art, not a science. Because the value of a business depends on numerous variables, it can typically be assessed only within a range. Third, the outcomes of all investments depend to some extent on the future, which cannot be predicted with certainty; for this reason, even some carefully analyzed investments fail to achieve profitable outcomes. Sometimes a stock becomes cheap for good reason: a broken business model, hidden liabilities, protracted litigation, or incompetent or corrupt management. Investors must always act with caution and humility, relentlessly searching for additional infor- mation while realizing that they will never know everything about a company. In the end, the most successful value investors combine detailed business research and valuation work with endless discipline and patience, a well-considered sensitivity analysis, intellectual honesty, and years of analytical and investment experience. Interestingly, Graham and Dodd’s value-investing principles apply beyond the financial markets—including, for example, to the market for baseball talent, as eloquently captured in Moneyball, Michael Lewis’s 2003 bestseller. The market for baseball players, like the market for stocks and bonds, is inefficient—and for many of the same reasons. In both investing and baseball, there is no single way to ascertain value, no one metric that tells the whole story. In both, there are mountains of information and no broad consensus on how to assess it. Decision makers in both arenas mis- interpret available data, misdirect their analyses, and reach inaccurate conclusions. In baseball, as in securities, many overpay because they fear standing apart from the crowd and being criticized. They often make decisions for emotional, not rational, reasons. They become exuberant; they panic. Their orientation sometimes becomes overly short term. They fail to understand what is mean reverting and what isn’t. Baseball’s value investors, like financial market value investors, have achieved significant outperformance over time. While Graham and Dodd didn’t apply value principles to baseball, the applicability of their insights to the market for athletic talent attests to the universality and timelessness of this approach. Value Investing Today Amidst the Great Depression, the stock market and the national econ- omy were exceedingly risky. Downward movements in share prices and business activity came suddenly and could be severe and protracted. Optimists were regularly rebuffed by circumstances. Winning, in a sense, was accomplished by not losing. Investors could achieve a margin of safety by buying shares in businesses at a large discount to their under- lying value, and they needed a margin of safety because of all the things that could—and often did—go wrong. Even in the worst of markets, Graham and Dodd remained faithful to their principles, including their view that the economy and markets sometimes go through painful cycles, which must simply be endured. They expressed confidence, in those dark days, that the economy and stock market would eventually rebound: “While we were writing, we had to combat a widespread conviction that financial debacle was to be the permanent order.” (p. xliv) Of course, just as investors must deal with down cycles when busi- ness results deteriorate and cheap stocks become cheaper, they must also endure up cycles when bargains are scarce and investment capital is plentiful. In recent years, the financial markets have performed exceed- ingly well by historic standards, attracting substantial fresh capital in need of managers. Today, a meaningful portion of that capital—likely totaling in the trillions of dollars globally—invests with a value approach. This includes numerous value-based asset management firms and mutual funds, a number of today’s roughly 9,000 hedge funds, and some of the largest and most successful university endowments and family investment offices. It is important to note that not all value investors are alike. In the aforementioned “Superinvestors of Graham-and-Doddsville,” Buffett describes numerous successful value investors who have little portfolio overlap. Some value investors hold obscure, “pink-sheet shares” while others focus on the large-cap universe. Some have gone global, while others focus on a single market sector such as real estate or energy. Some run computer screens to identify statistically inexpensive compa- nies, while others assess “private market value”—the value an industry buyer would pay for the entire company. Some are activists who aggres- sively fight for corporate change, while others seek out undervalued securities with a catalyst already in place—such as a spin-off, asset sale, major share repurchase plan, or new management team—for the partial or full realization of the underlying value. And, of course, as in any pro- fession, some value investors are simply more talented than others. In the aggregate, the value-investing community is no longer the very small group of adherents that it was several decades ago. Competition can have a powerful corrective effect on market inefficiencies and mis- pricings. With today’s many amply capitalized and skilled investors, what are the prospects for a value practitioner? Better than you might expect, for several reasons. First, even with a growing value community, there are far more market participants with little or no value orientation. Most man- agers, including growth and momentum investors and market indexers, pay little or no attention to value criteria. Instead, they concentrate almost single-mindedly on the growth rate of a company’s earnings, the momentum of its share price, or simply its inclusion in a market index. Second, nearly all money managers today, including some hapless value managers, are forced by the (real or imagined) performance pres- sures of the investment business to have an absurdly short investment horizon, sometimes as brief as a calendar quarter, month, or less. A value strategy is of little use to the impatient investor since it usually takes time to pay off. Finally, human nature never changes. Capital market manias regularly occur on a grand scale: Japanese stocks in the late 1980s, Internet and technology stocks in 1999 and 2000, subprime mortgage lending in 2006 and 2007, and alternative investments currently. It is always difficult to take a contrarian approach. Even highly capable investors can wither under the relentless message from the market that they are wrong. The pressures to succumb are enormous; many investment managers fear they’ll lose business if they stand too far apart from the crowd. Some also fail to pursue value because they’ve handcuffed themselves (or been saddled by clients) with constraints preventing them from buying stocks selling at low dollar prices, small-cap stocks, stocks of companies that don’t pay dividends or are losing money, or debt instruments with below investment-grade ratings.7 Many also engage in career manage- ment techniques like “window dressing” their portfolios at the end of cal- endar quarters or selling off losers (even if they are undervalued) while buying more of the winners (even if overvalued). Of course, for those value investors who are truly long term oriented, it is a wonderful thing that many potential competitors are thrown off course by constraints that render them unable or unwilling to effectively compete. Another reason that greater competition may not hinder today’s value investors is the broader and more diverse investment landscape in which they operate. Graham faced a limited lineup of publicly traded U.S. equity and debt securities. Today, there are many thousands of publicly traded stocks in the United States alone, and many tens of thousands worldwide, plus thousands of corporate bonds and asset-backed debt securities. Previously illiquid assets, such as bank loans, now trade regu- larly. Investors may also choose from an almost limitless number of derivative instruments, including customized contracts designed to meet any need or hunch. Nevertheless, 25 years of historically strong stock market perform- ance have left the market far from bargain-priced. High valuations and intensified competition raise the specter of lower returns for value investors generally. Also, some value investment firms have become extremely large, and size can be the enemy of investment performance because decision making is slowed by bureaucracy and smaller opportu- nities cease to move the needle. In addition, because growing numbers of competent buy-side and sell-side analysts are plying their trade with the assistance of sophisti- cated information technology, far fewer securities seem likely to fall through the cracks to become extremely undervalued.8 Today’s value investors are unlikely to find opportunity armed only with a Value Line guide or by thumbing through stock tables. While bargains still occasion- ally hide in plain sight, securities today are most likely to become mis- priced when they are either accidentally overlooked or deliberately avoided. Consequently, value investors have had to become thoughtful about where to focus their analysis. In the early 2000s, for example, investors became so disillusioned with the capital allocation procedures of many South Korean companies that few considered them candidates for worthwhile investment. As a result, the shares of numerous South Korean companies traded at great discounts from prevailing international valuations: at two or three times the cash flow, less than half the underly- ing business value, and, in several cases, less than the cash (net of debt) held on their balance sheets. Bargain issues, such as Posco and SK Tele- com, ultimately attracted many value seekers; Warren Buffett reportedly profited handsomely from a number of South Korean holdings. Today’s value investors also find opportunity in the stocks and bonds of companies stigmatized on Wall Street because of involvement in pro-tracted litigation, scandal, accounting fraud, or financial distress. The securities of such companies sometimes trade down to bargain levels, where they become good investments for those who are able to remain stalwart in the face of bad news. For example, the debt of Enron, per- haps the world’s most stigmatized company after an accounting scandal forced it into bankruptcy in 2001, traded as low as 10 cents on the dollar of claim; ultimate recoveries are expected to be six times that amount. Similarly, companies with tobacco or asbestos exposure have in recent years periodically come under severe selling pressure due to the uncer- tainties surrounding litigation and the resultant risk of corporate finan- cial distress. More generally, companies that disappoint or surprise investors with lower-than-expected results, sudden management changes, accounting problems, or ratings downgrades are more likely than consistently strong performers to be sources of opportunity. When bargains are scarce, value investors must be patient; compro- mising standards is a slippery slope to disaster. New opportunities will emerge, even if we don’t know when or where. In the absence of com- pelling opportunity, holding at least a portion of one’s portfolio in cash equivalents (for example, U.S. Treasury bills) awaiting future deployment will sometimes be the most sensible option. Recently, Warren Buffett stated that he has more cash to invest than he has good investments. As all value investors must do from time to time, Buffett is waiting patiently. Still, value investors are bottom-up analysts, good at assessing securi- ties one at a time based on the fundamentals. They don’t need the entire market to be bargain priced, just 20 or 25 unrelated securities—a num- ber sufficient for diversification of risk. Even in an expensive market, value investors must keep analyzing securities and assessing businesses, gaining knowledge and experience that will be useful in the future. Value investors, therefore, should not try to time the market or guess whether it will rise or fall in the near term. Rather, they should rely on a bottom-up approach, sifting the financial markets for bargains and then buying them, regardless of the level or recent direction of the market or economy. Only when they cannot find bargains should they default to holding cash. A Flexible Approach Because our nation’s founders could not foresee—and knew they could not foresee—technological, social, cultural, and economic changes that the future would bring, they wrote a flexible constitution that still guides us over two centuries later. Similarly, Benjamin Graham and David Dodd acknowledged that they could not anticipate the business, economic, technological, and competitive changes that would sweep through the investment world over the ensuing years. But they, too, wrote a flexible treatise that provides us with the tools to function in an investment landscape that was destined—and remains destined—to undergo pro- found and unpredictable change. For example, companies today sell products that Graham and Dodd could not have imagined. Indeed, there are companies and entire indus- tries that they could not have envisioned. Security Analysis offers no examples of how to value cellular phone carriers, software companies, satellite television providers, or Internet search engines. But the book provides the analytical tools to evaluate almost any company, to assess the value of its marketable securities, and to determine the existence of a margin of safety. Questions of solvency, liquidity, predictability, busi- ness strategy, and risk cut across businesses, nations, and time. Graham and Dodd did not specifically address how to value private businesses or how to determine the value of an entire company rather than the value of a fractional interest through ownership of its shares.9 9 They did consider the relative merits of corporate control enjoyed by a private business owner ver- sus the value of marketability for a listed stock (p. 372). But their analytical principles apply equally well to these different issues. Investors still need to ask, how stable is the enterprise, and what are its future prospects? What are its earnings and cash flow? What is the downside risk of owning it? What is its liquidation value? How capable and honest is its management? What would you pay for the stock of this company if it were public? What factors might cause the owner of this business to sell control at a bargain price? Similarly, the pair never addressed how to analyze the purchase of an office building or apartment complex. Real estate bargains come about for the same reasons as securities bargains—an urgent need for cash, inability to perform proper analysis, a bearish macro view, or investor disfavor or neglect. In a bad real estate climate, tighter lending standards can cause even healthy properties to sell at distressed prices. Graham and Dodd’s principles—such as the stability of cash flow, sufficiency of return, and analysis of downside risk—allow us to identify real estate investments with a margin of safety in any market environment. Even complex derivatives not imagined in an earlier era can be scruti- nized with the value investor’s eye. While traders today typically price put and call options via the Black-Scholes model, one can instead use value-investing precepts—upside potential, downside risk, and the likeli- hood that each of various possible scenarios will occur—to analyze these instruments. An inexpensive option may, in effect, have the favorable risk-return characteristics of a value investment—regardless of what the Black-Scholes model dictates. Institutional Investing Perhaps the most important change in the investment landscape over the past 75 years is the ascendancy of institutional investing. In the 1930s, individual investors dominated the stock market. Today, by contrast, most market activity is driven by institutional investors—large pools of pension, endowment, and aggregated individual capital. While the advent of these large, quasi-permanent capital pools might have resulted in the wide-scale adoption of a long-term value-oriented approach, in fact this has not occurred. Instead, institutional investing has evolved into a short-term performance derby, which makes it diffi- cult for institutional managers to take contrarian or long-term positions. Indeed, rather than standing apart from the crowd and possibly suffering disappointing short-term results that could cause clients to withdraw capital, institutional investors often prefer the safe haven of assured mediocre performance that can be achieved only by closely following the herd. Alternative investments—a catch-all category that includes venture capital, leveraged buyouts, private equity, and hedge funds—are the cur- rent institutional rage. No investment treatise written today could fail to comment on this development. Fueled by performance pressures and a growing expectation of low (and inadequate) returns from traditional equity and debt investments, institutional investors have sought high returns and diversification by allocating a growing portion of their endowments and pension funds to alternatives. Pioneering Portfolio Management, written in 2000 by David Swensen, the groundbreaking head of Yale’s Investment Office, makes a strong case for alternative investments. In it, Swensen points to the historically inefficient pricing of many asset classes,10 the historically high risk-adjusted returns of many alternative managers, and the limited 10 Many investors make the mistake of thinking about returns to asset classes as if they were perma- nent. Returns are not inherent to an asset class; they result from the fundamentals of the underlying businesses and the price paid by investors for the related securities. Capital flowing into an asset class can, reflexively, impair the ability of those investing in that asset class to continue to generate the anticipated, historically attractive returns. He highlights the importance of alternative manager selection by noting the large dispersion of returns achieved between top-quartile and third- quartile performers. A great many endowment managers have emulated Swensen, following him into a large commitment to alternative investments, almost certainly on worse terms and amidst a more competitive environment than when he entered the area. Graham and Dodd would be greatly concerned by the commitment of virtually all major university endowments to one type of alternative investment: venture capital. The authors of the margin-of-safety approach to investing would not find one in the entire venture capital universe.11 While there is often the prospect of substantial upside in ven- ture capital, there is also very high risk of failure. Even with the diversifi- cation provided by a venture fund, it is not clear how to analyze the underlying investments to determine whether the potential return justi- fies the risk. Venture capital investment would, therefore, have to be characterized as pure speculation, with no margin of safety whatsoever. Hedge funds—a burgeoning area of institutional interest with nearly $2 trillion of assets under management—are pools of capital that vary widely in their tactics but have a common fee structure that typically pays the manager 1% to 2% annually of assets under management and 20% (and sometimes more) of any profits generated. They had their start in the 1920s, when Ben Graham himself ran one of the first hedge funds. What would Graham and Dodd say about the hedge funds operating in today’s markets? They would likely disapprove of hedge funds that make investments based on macroeconomic assessments or that pursue 11 Nor would they find one in leveraged buyouts, through which businesses are purchased at lofty prices using mostly debt financing and a thin layer of equity capital. The only value-investing ration- ale for venture capital or leveraged buyouts might be if they were regarded as mispriced call options. Even so, it is not clear that these areas constitute good value. Such funds, by avoiding or even sell- ing undervalued securities to participate in one or another folly, inadver- tently create opportunities for value investors. The illiquidity, lack of transparency, gargantuan size, embedded leverage, and hefty fees of some hedge funds would no doubt raise red flags. But Graham and Dodd would probably approve of hedge funds that practice value-ori- ented investment selection. Importantly, while Graham and Dodd emphasized limiting risk on an investment-by-investment basis, they also believed that diversification and hedging could protect the downside for an entire portfolio. (p. 106) This is what most hedge funds attempt to do. While they hold individual securities that, considered alone, may involve an uncomfortable degree of risk, they attempt to offset the risks for the entire portfolio through the short sale of similar but more highly valued securities, through the purchase of put options on individual securities or market indexes, and through adequate diversification (although many are guilty of overdiver- sification, holding too little of their truly good ideas and too much of their mediocre ones). In this way, a hedge fund portfolio could (in theory, anyway) have characteristics of good potential return with limited risk that its individual components may not have. Modern-day Developments As mentioned, the analysis of businesses and securities has become increasingly sophisticated over the years. Spreadsheet technology, for example, allows for vastly more sophisticated modeling than was possible even one generation ago. Benjamin Graham’s pencil, clearly one of the sharpest of his era, might not be sharp enough today. On the other hand, technology can easily be misused; computer modeling requires making a series of assumptions about the future that can lead to a spurious preci- sion of which Graham would have been quite dubious. While Graham was interested in companies that produced consistent earnings, analysis in his day was less sophisticated regarding why some company’s earnings might be more consistent than others. Analysts today examine businesses but also business models; the bottom-line impact of changes in revenues, profit margins, product mix, and other variables is carefully studied by managements and financial analysts alike. Investors know that businesses do not exist in a vacuum; the actions of competitors, suppliers, and cus- tomers can greatly impact corporate profitability and must be considered.12 Another important change in focus over time is that while Graham looked at corporate earnings and dividend payments as barometers of a company’s health, most value investors today analyze free cash flow. This is the cash generated annually from the operations of a business after all capital expenditures are made and changes in working capital are con- sidered. Investors have increasingly turned to this metric because reported earnings can be an accounting fiction, masking the cash gener- ated by a business or implying positive cash generation when there is none. Today’s investors have rightly concluded that following the cash— as the manager of a business must do—is the most reliable and reveal- ing means of assessing a company. In addition, many value investors today consider balance sheet analy- sis less important than was generally thought a few generations ago. With returns on capital much higher at present than in the past, most stocks trade far above book value; balance sheet analysis is less helpful in understanding upside potential or downside risk of stocks priced at 12 Professor Michael Porter of Harvard Business School, in his seminal book Competitive Strategy (Free Press, 1980), lays out the groundwork for a more intensive, thorough, and dynamic analysis of busi- nesses and industries in the modern economy. A broad industry analysis has become particularly necessary as a result of the passage in 2000 of Regulation FD (Fair Disclosure), which regulates and restricts the communications between a company and its actual or potential shareholders. Wall Street analysts, facing a dearth of information from the companies they cover, have been forced to expand their areas of inquiry. The effects of sustained inflation over time have also wreaked havoc with the accuracy of assets accounted for using historic cost; this means that two companies owning identical assets could report very different book values. Of course, balance sheets must still be carefully scrutinized. Astute observers of corporate balance sheets are often the first to see business deterioration or vulnerability as inventories and receivables build, debt grows, and cash evaporates. And for investors in the equity and debt of underperforming companies, balance sheet analysis remains one generally reliable way of assessing downside protection. Globalization has increasingly affected the investment landscape, with most investors looking beyond their home countries for opportunity and diversification. Graham and Dodd’s principles fully apply to international markets, which are, if anything, even more subject to the vicissitudes of investor sentiment—and thus more inefficiently priced—than the U.S. market is today. Investors must be cognizant of the risks of international investing, including exposure to foreign currencies and the need to consider hedging them. Among the other risks are political instability, different (or absent) securities laws and investor protections, varying accounting standards, and limited availability of information. Oddly enough, despite 75 years of success achieved by value investors, one group of observers largely ignores or dismisses this disci- pline: academics. Academics tend to create elegant theories that purport to explain the real world but in fact oversimplify it. One such theory, the Efficient Market Hypothesis (EMH), holds that security prices always and immediately reflect all available information, an idea deeply at odds with Graham and Dodd’s notion that there is great value to fundamental security analysis. The Capital Asset Pricing Model (CAPM) relates risk to return but always mistakes volatility, or beta, for risk. Modern Portfolio Theory (MPT) applauds the benefits of diversification in constructing an optimal portfolio. But by insisting that higher expected return comes only with greater risk, MPT effectively repudiates the entire value-invest- ing philosophy and its long-term record of risk-adjusted investment out- performance. Value investors have no time for these theories and generally ignore them. The assumptions made by these theories—including continuous markets, perfect information, and low or no transaction costs—are unre- alistic. Academics, broadly speaking, are so entrenched in their theories that they cannot accept that value investing works. Instead of launching a series of studies to understand the remarkable 50-year investment record of Warren Buffett, academics instead explain him away as an aber- ration. Greater attention has been paid recently to behavioral economics, a field recognizing that individuals do not always act rationally and have systematic cognitive biases that contribute to market inefficiencies and security mispricings. These teachings—which would not seem alien to Graham—have not yet entered the academic mainstream, but they are building some momentum. Academics have espoused nuanced permutations of their flawed the- ories for several decades. Countless thousands of their students have been taught that security analysis is worthless, that risk is the same as volatility, and that investors must avoid overconcentration in good ideas (because in efficient markets there can be no good ideas) and thus diver- sify into mediocre or bad ones. Of course, for value investors, the propa- gation of these academic theories has been deeply gratifying: the brainwashing of generations of young investors produces the very ineffi- ciencies that savvy stock pickers can exploit. Another important factor for value investors to take into account is the growing propensity of the Federal Reserve to intervene in financial markets at the first sign of trouble. Amidst severe turbulence, the Fed frequently lowers interest rates to prop up securities prices and restore investor confidence. While the intention of Fed officials is to maintain orderly capital markets, some money managers view Fed intervention as a virtual license to speculate. Aggressive Fed tactics, sometimes referred to as the “Greenspan put” (now the “Bernanke put”), create a moral haz- ard that encourages speculation while prolonging overvaluation. So long as value investors aren’t lured into a false sense of security, so long as they can maintain a long-term horizon and ensure their staying power, market dislocations caused by Fed action (or investor anticipation of it) may ultimately be a source of opportunity. Another modern development of relevance is the ubiquitous cable television coverage of the stock market. This frenetic lunacy exacerbates the already short-term orientation of most investors. It foments the view that it is possible—or even necessary—to have an opinion on everything pertinent to the financial markets, as opposed to the patient and highly selective approach endorsed by Graham and Dodd. This sound-bite cul- ture reinforces the popular impression that investing is easy, not rigorous and painstaking. The daily cheerleading pundits exult at rallies and record highs and commiserate over market reversals; viewers get the impression that up is the only rational market direction and that selling or sitting on the sidelines is almost unpatriotic. The hysterical tenor is exacerbated at every turn. For example, CNBC frequently uses a format- ted screen that constantly updates the level of the major market indexes against a digital clock. Not only is the time displayed in hours, minutes, and seconds but in completely useless hundredths of seconds, the num- bers flashing by so rapidly (like tenths of a cent on the gas pump) as to be completely unreadable. The only conceivable purpose is to grab the viewers’ attention and ratchet their adrenaline to full throttle. Cable business channels bring the herdlike mentality of the crowd into everyone’s living room, thus making it much harder for viewers to stand apart from the masses. Only on financial cable TV would a commentator with a crazed persona become a celebrity whose pronouncements regularly move markets. In a world in which the differences between investing and speculating are frequently blurred, the nonsense on financial cable channels only compounds the problem. Graham would have been appalled. The only saving grace is that value investors prosper at the expense of those who fall under the spell of the cable pundits. Meanwhile, human nature virtually ensures that there will never be a Graham and Dodd channel. Unanswered Questions Today’s investors still wrestle, as Graham and Dodd did in their day, with a number of important investment questions. One is whether to focus on relative or absolute value. Relative value involves the assessment that one security is cheaper than another, that Microsoft is a better bargain than IBM. Relative value is easier to determine than absolute value, the two-dimensional assessment of whether a security is cheaper than other securities and cheap enough to be worth purchasing. The most intrepid investors in relative value manage hedge funds where they purchase the relatively less expensive securities and sell short the relatively more expensive ones. This enables them potentially to profit on both sides of the ledger, long and short. Of course, it also exposes them to double- barreled losses if they are wrong.13 It is harder to think about absolute value than relative value. When is a stock cheap enough to buy and hold without a short sale as a hedge? One standard is to buy when a security trades at an appreciable—say, 30%, 40%, or greater—discount from its underlying value, calculated either as its liquidation value, going-concern value, or private-market 13 Many hedge funds also use significant leverage to goose their returns further, which backfires when analysis is faulty or judgment is flawed. Another standard is to invest when a security offers an acceptably attractive return to a long-term holder, such as a low-risk bond priced to yield 10% or more, or a stock with an 8% to 10% or higher free cash flow yield at a time when “risk-free” U.S. government bonds deliver 4% to 5% nominal and 2% to 3% real returns. Such demanding standards virtually ensure that absolute value will be quite scarce. Another area where investors struggle is trying to define what consti- tutes a good business. Someone once defined the best possible business as a post office box to which people send money. That idea has certainly been eclipsed by the creation of subscription Web sites that accept credit cards. Today’s most profitable businesses are those in which you sell a fixed amount of work product—say, a piece of software or a hit recording—millions and millions of times at very low marginal cost. Good businesses are generally considered those with strong barriers to entry, limited capital requirements, reliable customers, low risk of tech- nological obsolescence, abundant growth possibilities, and thus signifi- cant and growing free cash flow. Businesses are also subject to changes in the technological and com- petitive landscape. Because of the Internet, the competitive moat sur- rounding the newspaper business—which was considered a very good business only a decade ago—has eroded faster than almost anyone anticipated. In an era of rapid technological change, investors must be ever vigilant, even with regard to companies that are not involved in technology but are simply affected by it. In short, today’s good busi- nesses may not be tomorrow’s. Investors also expend considerable effort attempting to assess the quality of a company’s management. Some managers are more capable or scrupulous than others, and some may be able to manage certain businesses and environments better than others. Yet, as Graham and Dodd noted, “Objective tests of managerial ability are few and far from scientific.” (p. 84) Make no mistake about it: a management’s acumen, foresight, integrity, and motivation all make a huge difference in share- holder returns. In the present era of aggressive corporate financial engi- neering, managers have many levers at their disposal to positively impact returns, including share repurchases, prudent use of leverage, and a valuation-based approach to acquisitions. Managers who are unwilling to make shareholder-friendly decisions risk their companies becoming perceived as “value traps”: inexpensively valued, but ulti- mately poor investments, because the assets are underutilized. Such companies often attract activist investors seeking to unlock this trapped value. Even more difficult, investors must decide whether to take the risk of investing—at any price—with management teams that have not always done right by shareholders. Shares of such companies may sell at steeply discounted levels, but perhaps the discount is warranted; value that today belongs to the equity holders may tomorrow have been spir- ited away or squandered. An age-old difficulty for investors is ascertaining the value of future growth. In the preface to the first edition of Security Analysis, the authors said as much: “Some matters of vital significance, e.g., the determination of the future prospects of an enterprise, have received little space, because little of definite value can be said on the subject.” (p. xliii) Clearly, a company that will earn (or have free cash flow of) $1 per share today and $2 per share in five years is worth considerably more than a company with identical current per share earnings and no growth. This is especially true if the growth of the first company is likely to continue and is not subject to great variability. Another complication is that companies can grow in many different ways—for example, selling the same number of units at higher prices; selling more units at the same (or even lower) prices; changing the product mix (selling proportionately more of the higher-profit-margin products); or developing an entirely new product line. Obviously, some forms of growth are worth more than others. There is a significant downside to paying up for growth or, worse, to obsessing over it. Graham and Dodd astutely observed that “analysis is concerned primarily with values which are supported by the facts and not with those which depend largely upon expectations.” (p. 86) Strongly preferring the actual to the possible, they regarded the “future as a haz- ard which his [the analyst’s] conclusions must encounter rather than as the source of his vindication.” (p. 86) Investors should be especially vigi- lant against focusing on growth to the exclusion of all else, including the risk of overpaying. Again, Graham and Dodd were spot on, warning that “carried to its logical extreme, . . . [there is no price] too high for a good stock, and that such an issue was equally ‘safe’ after it had advanced to 200 as it had been at 25.” (p. 105) Precisely this mistake was made when stock prices surged skyward during the Nifty Fifty era of the early 1970s and the dot-com bubble of 1999 to 2000. The flaw in such a growth-at-any-price approach becomes obvious when the anticipated growth fails to materialize. When the future disap- points, what should investors do? Hope growth resumes? Or give up and sell? Indeed, failed growth stocks are often so aggressively dumped by disappointed holders that their price falls to levels at which value investors, who stubbornly pay little or nothing for growth characteristics, become major holders. This was the case with many technology stocks that suffered huge declines after the dot-com bubble burst in the spring of 2000. By 2002, hundreds of fallen tech stocks traded for less than the cash on their balance sheets, a value investor’s dream. One such com- pany was Radvision, an Israeli provider of voice, video, and data products whose stock subsequently rose from under $5 to the mid-$20s after the urgent selling abated and investors refocused on fundamentals. Another conundrum for value investors is knowing when to sell. Buy- ing bargains is the sweet spot of value investors, although how small a discount one might accept can be subject to debate. Selling is more dif- ficult because it involves securities that are closer to fully priced. As with buying, investors need a discipline for selling. First, sell targets, once set, should be regularly adjusted to reflect all currently available information. Second, individual investors must consider tax consequences. Third, whether or not an investor is fully invested may influence the urgency of raising cash from a stockholding as it approaches full valuation. The availability of better bargains might also make one a more eager seller. Finally, value investors should completely exit a security by the time it reaches full value; owning overvalued securities is the realm of specula- tors. Value investors typically begin selling at a 10% to 20% discount to their assessment of underlying value—based on the liquidity of the security, the possible presence of a catalyst for value realization, the quality of management, the riskiness and leverage of the underlying business, and the investors’ confidence level regarding the assumptions underlying the investment. Finally, investors need to deal with the complex subject of risk. As mentioned earlier, academics and many professional investors have come to define risk in terms of the Greek letter beta, which they use as a measure of past share price volatility: a historically more volatile stock is seen as riskier. But value investors, who are inclined to think about risk as the probability and amount of potential loss, find such reasoning absurd. In fact, a volatile stock may become deeply undervalued, rendering it a very low risk investment. One of the most difficult questions for value investors is how much risk to incur. One facet of this question involves position size and its impact on portfolio diversification. How much can you comfortably own of even the most attractive opportunities? Naturally, investors desire to profit fully from their good ideas. Yet this tendency is tempered by the fear of being unlucky or wrong. Nonetheless, value investors should concentrate their holdings in their best ideas; if you can tell a good investment from a bad one, you can also distinguish a great one from a good one. Investors must also ponder the risks of investing in politically unsta- ble countries, as well as the uncertainties involving currency, interest rate, and economic fluctuations. How much of your capital do you want tied up in Argentina or Thailand, or even France or Australia, no matter how undervalued the stocks may be in those markets? Another risk consideration for value investors, as with all investors, is whether or not to use leverage. While some value-oriented hedge funds and even endowments use leverage to enhance their returns, I side with those who are unwilling to incur the added risks that come with margin debt. Just as leverage enhances the return of successful investments, it magnifies the losses from unsuccessful ones. More importantly, nonre- course (margin) debt raises risk to unacceptable levels because it places one’s staying power in jeopardy. One risk-related consideration should be paramount above all others: the ability to sleep well at night, confi- dent that your financial position is secure whatever the future may bring. Final Thoughts In a rising market, everyone makes money and a value philosophy is unnecessary. But because there is no certain way to predict what the market will do, one must follow a value philosophy at all times. By con- trolling risk and limiting loss through extensive fundamental analysis, strict discipline, and endless patience, value investors can expect good results with limited downside. You may not get rich quick, but you will keep what you have, and if the future of value investing resembles its past, you are likely to get rich slowly. As investment strategies go, this is the most that any reasonable investor can hope for. The real secret to investing is that there is no secret to investing. Every important aspect of value investing has been made available to the public many times over, beginning in 1934 with the first edition of Security Analysis. That so many people fail to follow this timeless and almost foolproof approach enables those who adopt it to remain suc- cessful. The foibles of human nature that result in the mass pursuit of instant wealth and effortless gain seem certain to be with us forever. So long as people succumb to this aspect of their natures, value investing will remain, as it has been for 75 years, a sound and low-risk approach to successful long-term investing. SETH A. KLARMAN Boston, Massachusetts, May, 2008 Introduction to the Sixth Edition It was a distracted world before which McGraw-Hill set, with a thud, the first edition of Security Analysis in July 1934. From Berlin dribbled reports of a shake-up at the top of the German government. “It will simplify the Führer’s whole work immensely if he need not first ask some- body if he may do this or that,” the Associated Press quoted an informant on August 1 as saying of Hitler’s ascension from chancellor to dictator. Set against such epochal proceedings, a 727-page textbook on the fine points of value investing must have seemed an unlikely candidate for bestsellerdom, then or later. In his posthumously published autobiography, The Memoirs of the Dean of Wall Street, Graham (1894–1976) thanked his lucky stars that he had entered the investment business when he did. The timing seemed not so propitious in the year of the first edition of Security Analysis, or, indeed, that of the second edition—expanded and revised—six years later. From its 1929 peak to its 1932 trough, the Dow Jones Industrial Average had lost 87% of its value. At cyclical low ebb, in 1933, the national unemployment rate topped 25%. That the Great Depression ended in 1933 was the considered judgment of the timekeepers of the National Bureau of Economic Research. Millions of Americans, however— not least, the relatively few who tried to squeeze a living out of a profit- less Wall Street—had reason to doubt it. The bear market and credit liquidation of the early 1930s gave the institutions of American finance a top-to-bottom scouring. What was left of them presently came in for a rough handling by the first Roosevelt administration. Graham had learned his trade in the Wall Street of the mid–nineteen teens, an era of lightly regulated markets. He began work on Security Analysis as the administration of Herbert Hoover was giving the country its first taste of thoroughgoing federal intervention in a peacetime economy. He was correcting page proofs as the Roosevelt administration was implementing its first radical forays into macroeco- nomic management. By 1934, there were laws to institute federal regula- tion of the securities markets, federal insurance of bank deposits, and federal price controls (not to put a cap on prices, as in later, inflationary times, but rather to put a floor under them). To try to prop up prices, the administration devalued the dollar. It is a testament to the enduring quality of Graham’s thought, not to mention the resiliency of America’s financial markets, that Security Analysis lost none of its relevance even as the economy was being turned upside down and inside out. Five full months elapsed following publication of the first edition before Louis Rich got around to reviewing it in the New York Times. Who knows? Maybe the conscientious critic read every page. In any case, Rich gave the book a rave, albeit a slightly rueful one. “On the assumption,” he wrote, on December 2, 1934, “that despite the debacle of recent history there are still people left whose money burns a hole in their pockets, it is hoped that they will read this book. It is a full-bodied, mature, meticu- lous and wholly meritorious outgrowth of scholarly probing and practi- cal sagacity. Although cast in the form and spirit of a textbook, the presentation is endowed with all the qualities likely to engage the liveli- est interest of the layman.”1 How few laymen seemed to care about investing was brought home to Wall Street more forcefully with every passing year of the unprosperous postcrash era. Just when it seemed that trading volume could get no smaller, or New York Stock Exchange seat prices no lower, or equity valu- ations more absurdly cheap, a new, dispiriting record was set. It required every effort of the editors of the Big Board’s house organ, the Exchange magazine, to keep up a brave face. “Must There Be an End to Progress?” was the inquiring headline over an essay by the Swedish economist Gus- tav Cassel published around the time of the release of Graham and Dodd’s second edition (the professor thought not).2 “Why Do Securities Brokers Stay in Business?” the editors posed and helpfully answered, “Despite wearying lethargy over long periods, confidence abounds that when the public recognizes fully the value of protective measures which lately have been ranged about market procedure, investment interest in securities will increase.” It did not amuse the Exchange that a New York City magistrate, sarcastically addressing in his court a collection of defen- dants hauled in by the police for shooting craps on the sidewalk, had derided the financial profession. “The first thing you know,” the judge had upbraided the suspects, “you’ll wind up as stock brokers in Wall Street with yachts and country homes on Long Island.”3 In ways now difficult to imagine, Murphy’s Law was the order of the day; what could go wrong, did. “Depression” was more than a long-lin- gering state of economic affairs. It had become a worldview. The aca- demic exponents of “secular stagnation,” notably Alvin Hansen and Joseph Schumpeter, each a Harvard economics professor, predicted a long decline in American population growth. This deceleration, Hansen contended in his 1939 essay, “together with the failure of any really important innovations of a magnitude to absorb large capital outlays, weighs very heavily as an explanation for the failure of the recent recov- ery to reach full employment.”4 Neither Hansen nor his readers had any way of knowing that a baby boom was around the corner. Nothing could have seemed more unlikely to a world preoccupied with a new war in Europe and the evident decline and fall of capitalism. Certainly, Hansen’s ideas must have struck a chord with the chronically underemployed brokers and traders in lower Manhat- tan. As a business, the New York Stock Exchange was running at a steady loss. From 1933, the year in which it began to report its financial results, through 1940, the Big Board recorded a profit in only one year, 1935 (and a nominal one, at that). And when, in 1937, Chelcie C. Bosland, an assis- tant professor of economics at Brown University, brought forth a book entitled The Common Stock Theory of Investment, he remarked as if he were repeating a commonplace that the American economy had peaked two decades earlier at about the time of what was not yet called World War I. The professor added, quoting unnamed authorities, that American population growth could be expected to stop in its tracks by 1975.5 Small wonder that Graham was to write that the acid test of a bond issuer was its capacity to meet its obligations not in a time of middling prosperity (which modest test today’s residential mortgage–backed securities strug- gle to meet) but in a depression. Altogether, an investor in those days was well advised to keep up his guard. “The combination of a record high level for bonds,” writes Graham in the 1940 edition, “with a history of two catastrophic price collapses in the preceding 20 years and a major war in progress is not one to justify airy confidence in the future.” (p. 142) Wall Street, not such a big place even during the 1920s’ boom, got considerably smaller in the subsequent bust. Ben Graham, in conjunction with his partner Jerry Newman, made a very small cog of this low-horse- power machine. The two of them conducted a specialty investment busi- ness at 52 Wall Street. Their strong suits were arbitrage, reorganizations, bankruptcies, and other complex matters. A schematic drawing of the financial district published by Fortune in 1937 made no reference to the Graham-Newman offices. Then again, the partnerships and corporate headquarters that did rate a spot on the Wall Street map were them- selves—by the standards of twenty-first-century finance—remarkably compact. One floor at 40 Wall Street was enough to contain the entire office of Merrill Lynch & Co. And a single floor at 2 Wall Street was all the space required to house Morgan Stanley, the hands-down leader in 1936 corporate securities underwriting, with originations of all of $195 million. Compensation was in keeping with the slow pace of business, especially at the bottom of the corporate ladder.6 After a 20% rise in the new fed- eral minimum wage, effective October 1939, brokerage employees could earn no less than 30 cents an hour.7 In March 1940, the Exchange documented in all the detail its readers could want (and possibly then some) the collapse of public participation in the stock market. In the first three decades of the twentieth century, the annual volume of trading had almost invariably exceeded the quantity of listed shares outstanding, sometimes by a wide margin. And in only one year between 1900 and 1930 had annual volume amounted to less than 50% of listed shares—the exception being 1914, the year in which the exchange was closed for 41/2 months to allow for the shock of the out- break of World War I to sink in. Then came the 1930s, and the annual turnover as a percentage of listed shares struggled to reach as high as 50%. In 1939, despite a short-lived surge of trading on the outbreak of World War II in Europe, the turnover ratio had fallen to a shockingly low 18.4%. (For comparison, in 2007, the ratio of trading volume to listed shares amounted to 123%.) “Perhaps,” sighed the author of the study, “it is a fair statement that if the farming industry showed a similar record, government subsidies would have been voted long ago. Unfortunately for Wall Street, it seems to have too little sponsorship in officialdom.”8 If a reader took hope from the idea that things were so bad that they could hardly get worse, he or she was in for yet another disappointment. The second edition of Security Analysis had been published only months earlier when, on August 19, 1940, the stock exchange volume totaled just 129,650 shares. It was one of the sleepiest sessions since the 49,000- share mark set on August 5, 1916. For the entire 1940 calendar year, vol- ume totaled 207,599,749 shares—a not very busy two hours’ turnover at this writing and 18.5% of the turnover of 1929, that year of seemingly irrecoverable prosperity. The cost of a membership, or seat, on the stock exchange sank along with turnover and with the major price indexes. At the nadir in 1942, a seat fetched just $17,000. It was the lowest price since 1897 and 97% below the record high price of $625,000, set—natu- rally—in 1929. “‘The Cleaners,’” quipped Fred Schwed, Jr., in his funny and wise book Where Are the Customers’ Yachts? (which, like Graham’s second edition, appeared in 1940), “was not one of those exclusive clubs; by 1932, every- body who had ever tried speculation had been admitted to membership.”9 And if an investor did, somehow, manage to avoid the cleaner’s during the formally designated Great Depression, he or she was by no means home free. In August 1937, the market began a violent sell-off that would carry the averages down by 50% by March 1938. The nonfinancial portion of the economy fared little better than the financial side. In just nine months, industrial production fell by 34.5%, a sharper contraction even than that in the depression of 1920 to 1921, a slump that, for Graham’s generation, had seemed to set the standard for the most economic damage in the shortest elapsed time.10 The Roosevelt administration insisted that the slump of 1937 to 1938 was no depression but rather a “recession.” The national unemployment rate in 1938 was, on average, 18.8%. In April 1937, four months before the bottom fell out of the stock mar- ket for the second time in 10 years, Robert Lovett, a partner at the invest- ment firm of Brown Brothers Harriman & Co., served warning to the American public in the pages of the weekly Saturday Evening Post. Lovett, a member of the innermost circle of the Wall Street establishment, set out to demonstrate that there is no such thing as financial security—none, at least, to be had in stocks and bonds. The gist of Lovett’s argument was that, in capitalism, capital is consumed and that businesses are just as fragile, and mortal, as the people who own them. He invited his millions of readers to examine the record, as he had done: “If an investor had pur- chased 100 shares of the 20 most popular dividend-paying stocks on December 31, 1901, and held them through 1936, adding, in the mean- time, all the melons in the form of stock dividends, and all the plums in the form of stock split-ups, and had exercised all the valuable rights to subscribe to additional stock, the aggregate market value of his total holdings on December 31, 1936, would have shown a shrinkage of 39% as compared with the cost of his original investment. In plain English, the average investor paid $294,911.90 for things worth $180,072.06 on December 31, 1936. That’s a big disappearance of dollar value in any lan- guage.” In the innocent days before the crash, people had blithely spoken of “permanent investments.” “For our part,” wrote this partner of an emi- nent Wall Street private bank, “we are convinced that the only permanent investment is one which has become a total and irretrievable loss.”11 Lovett turned out to be a prophet. At the nadir of the 1937 to 1938 bear market, one in five NYSE-listed industrial companies was valued in the market for less than its net current assets. Subtract from cash and quick assets all liabilities and the remainder was greater than the company’s market value. That is, business value was negative. The Great Atlantic & Pacific Tea Company (A&P), the Wal-Mart of its day, was one of these corporate castoffs. At the 1938 lows, the market value of the com- mon and preferred shares of A&P at $126 million was less than the value of its cash, inventories, and receivables, conservatively valued at $134 million. In the words of Graham and Dodd, the still-profitable company was selling for “scrap.” (p. 673) A Different Wall Street Few institutional traces of that Wall Street remain. Nowadays, the big broker-dealers keep as much as $1 trillion in securities in inventory; in Graham’s day, they customarily held none. Nowadays, the big broker- dealers are in a perpetual competitive lather to see which can bring the greatest number of initial public offerings (IPOs) to the public market. In Graham’s day, no frontline member firm would stoop to placing an IPO in public hands, the risks and rewards for this kind of offering being reserved for professionals. Federal securities regulation was a new thing in the 1930s. What had preceded the Securities and Exchange Commis- sion (SEC) was a regime of tribal sanction. Some things were simply beyond the pale. Both during and immediately after World War I, no self- respecting NYSE member firm facilitated a client’s switch from Liberty bonds into potentially more lucrative, if less patriotic, alternatives. There was no law against such a business development overture. Rather, according to Graham, it just wasn’t done. A great many things weren’t done in the Wall Street of the 1930s. Newly empowered regulators were resistant to financial innovation, trans- action costs were high, technology was (at least by today’s digital stan- dards) primitive, and investors were demoralized. After the vicious bear market of 1937 to 1938, not a few decided they’d had enough. What was the point of it all? “In June 1939,” writes Graham in a note to a discussion about corporate finance in the second edition, “the S.E.C. set a salutary precedent by refusing to authorize the issuance of ‘Capital Income Debentures’ in the reorganization of the Griess-Pfleger Tanning Company, on the ground that the devising of new types of hybrid issues had gone far enough.” (p. 115, fn. 4) In the same conservative vein, he expresses his approval of the institution of the “legal list,” a document compiled by state banking departments to stipulate which bonds the regulated sav- ings banks could safely own. The very idea of such a list flies in the face of nearly every millennial notion about good regulatory practice. But Gra- ham defends it thus: “Since the selection of high-grade bonds has been shown to be in good part a process of exclusion, it lends itself reasonably well to the application of definite rules and standards designed to dis- qualify unsuitable issues.” (p. 169) No collateralized debt obligations stocked with subprime mortgages for the father of value investing! The 1930s ushered in a revolution in financial disclosure. The new federal securities acts directed investor-owned companies to brief their stockholders once a quarter as well as at year-end. But the new stan- dards were not immediately applicable to all public companies, and more than a few continued doing business the old-fashioned way, with their cards to their chests. One of these informational holdouts was none other than Dun & Bradstreet (D&B), the financial information company. Graham seemed to relish the irony of D&B not revealing “its own earn- ings to its own stockholders.” (p. 92, fn. 4) On the whole, by twenty-first- century standards, information in Graham’s time was as slow moving as it was sparse. There were no conference calls, no automated spread- sheets, and no nonstop news from distant markets—indeed, not much truck with the world outside the 48 states. Security Analysis barely acknowledges the existence of foreign markets. Such an institutional setting was hardly conducive to the develop- ment of “efficient markets,” as the economists today call them—markets in which information is disseminated rapidly, human beings process it flawlessly, and prices incorporate it instantaneously. Graham would have scoffed at such an idea. Equally, he would have smiled at the discovery— so late in the evolution of the human species—that there was a place in economics for a subdiscipline called “behavioral finance.” Reading Security Analysis, one is led to wonder what facet of investing is not behavioral. The stock market, Graham saw, is a source of entertainment value as well as investment value: “Even when the underlying motive of purchase is mere speculative greed, human nature desires to conceal this unlovely impulse behind a screen of apparent logic and good sense. To adapt the aphorism of Voltaire, it may be said that if there were no such thing as common-stock analysis, it would be necessary to counterfeit it.” (p. 348) Anomalies of undervaluation and overvaluation—of underdoing it and overdoing it—fill these pages. It bemused Graham, but did not shock him, that so many businesses could be valued in the stock market for less than their net current assets, even during the late 1920s’ boom, or that, in the dislocations to the bond market immediately following World War I, investors became disoriented enough to assign a higher price and a lower yield to the Union Pacific First Mortgage 4s than they did to the U.S. Treasury’s own Fourth Liberty 41⁄4s. Graham writes of the “inveterate tendency of the stock market to exaggerate.” (p. 679) He would not have exaggerated much if he had written, instead, “all markets.” Though he did not dwell long on the cycles in finance, Graham was certainly aware of them. He could see that ideas, no less than prices and categories of investment assets, had their seasons. The discussion in Security Analysis of the flame-out of the mortgage guarantee business in the early 1930s is a perfect miniature of the often-ruinous competition in which financial institutions periodically engage. “The rise of the newer and more aggressive real estate bond organizations had a most unfortu- nate effect upon the policies of the older concerns,” Graham writes of his time and also of ours. “By force of competition they were led to relax their standards of making loans. New mortgages were granted on an increasingly liberal basis, and when old mortgages matured, they were frequently renewed in a larger sum. Furthermore, the face amount of the mortgages guaranteed rose to so high a multiple of the capital of the guarantor companies that it should have been obvious that the guaranty would afford only the flimsiest of protection in the event of a general decline in values.” (p. 217) Security analysis itself is a cyclical phenomenon; it, too, goes in and out of fashion, Graham observed. It holds a strong, intuitive appeal for the kind of businessperson who thinks about stocks the way he or she thinks about his or her own family business. What would such a fount of com- mon sense care about earnings momentum or Wall Street’s pseudo-scien- tific guesses about the economic future? Such an investor, appraising a common stock, would much rather know what the company behind it is worth. That is, he or she would want to study its balance sheet. Well, Gra- ham relates here, that kind of analysis went out of style when stocks started levitating without reference to anything except hope and prophecy. So, by about 1927, fortune-telling and chart-reading had dis- placed the value discipline by which he and his partner were earning a very good living. It is characteristic of Graham that his critique of the “new era” method of investing is measured and not derisory. The old, conserva- tive approach—his own—had been rather backward looking, Graham admits. It had laid more emphasis on the past than on the future, on sta- ble earning power rather than tomorrow’s earnings prospects. But new technologies, new methods, and new forms of corporate organization had introduced new risks into the post–World War I economy. This fact— “the increasing instability of the typical business”—had blown a small hole in the older analytical approach that emphasized stable earnings power over forecast earnings growth. Beyond that mitigating considera- tion, however, Graham does not go. The new era approach, “which turned upon the earnings trend as the sole criterion of value, . . . was certain to end in an appalling debacle.” (p. 366) Which, of course, it did, and—in the CNBC-driven markets of the twenty-first century—continues to do at intervals today. A Man of Many Talents Benjamin Graham was born Benjamin Grossbaum on May 9, 1894, in London, and sailed to New York with his family before he was two. Young Benjamin was a prodigy in mathematics, classical languages, modern languages, expository writing (as readers of this volume will see for themselves), and anything else that the public schools had to offer. He had a tenacious memory and a love of reading—a certain ticket to aca- demic success, then or later. His father’s death at the age of 35 left him, his two brothers, and their mother in the social and financial lurch. Ben- jamin early learned to work and to do without. No need here for a biographical profile of the principal author of Security Analysis: Graham’s own memoir delightfully covers that ground. Suffice it to say that the high school brainiac entered Columbia College as an Alumni Scholar in September 1911 at the age of 17. So much material had he already absorbed that he began with a semester’s head start, “the highest possible advanced standing.”12 He mixed his academic studies with a grab bag of jobs, part-time and full-time alike. Upon his graduation in 1914, he started work as a runner and board-boy at the New York Stock Exchange member firm of Newberger, Henderson & Loeb. Within a year, the board-boy was playing the liquidation of the Guggenheim Exploration Company by astutely going long the shares of Guggenheim and short the stocks of the companies in which Guggen- heim had made a minority investment, as his no-doubt bemused elders looked on: “The profit was realized exactly as calculated; and everyone was happy, not least myself.”13 Security Analysis did not come out of the blue. Graham had supple- mented his modest salary by contributing articles to the Magazine of Wall Street. His productions are unmistakably those of a self-assured and superbly educated Wall Street moneymaker. There was no need to quote expert opinion. He and the documents he interpreted were all the authority he needed. His favorite topics were the ones that he subse- quently developed in the book you hold in your hands. He was partial to the special situations in which Graham-Newman was to become so suc- cessful. Thus, when a high-flying, and highly complex, American Interna- tional Corp. fell from the sky in 1920, Graham was able to show that the stock was cheap in relation to the evident value of its portfolio of miscel- laneous (and not especially well disclosed) investment assets.14 The shocking insolvency of Goodyear Tire and Rubber attracted his attention in 1921. “The downfall of Goodyear is a remarkable incident even in the present plenitude of business disasters,” he wrote, in a characteristic Gra- ham sentence (how many financial journalists, then or later, had “pleni- tude” on the tips of their tongues?). He shrewdly judged that Goodyear would be a survivor.15 In the summer of 1924, he hit on a theme that would echo through Security Analysis: it was the evident non sequitor of stocks valued in the market at less than the liquidating value of the com- panies that issued them. “Eight Stock Bargains Off the Beaten Track,” said the headline over the Benjamin Graham byline: “Stocks that Are Covered Chiefly by Cash or the Equivalent—No Bonds or Preferred Stock Ahead of These Issues—An Unusually Interesting Group of Securities.” In one case, that of Tonopah Mining, liquid assets of $4.31 per share towered over a market price of just $1.38 a share.16 For Graham, an era of sweet reasonableness in investment thinking seemed to end around 1914. Before that time, the typical investor was a businessman who analyzed a stock or a bond much as he might a claim on a private business. He—it was usually a he—would naturally try to determine what the security-issuing company owned, free and clear of any encumbrances. If the prospective investment was a bond—and it usually was—the businessman-investor would seek assurances that the borrowing company had the financial strength to weather a depression. “It’s not undue modesty,” Graham wrote in his memoir, “to say that I had become something of a smart cookie in my particular field.” His spe- cialty was the carefully analyzed out-of-the-way investment: castaway stocks or bonds, liquidations, bankruptcies, arbitrage. Since at least the early 1920s, Graham had preached the sermon of the “margin of safety.” As the future is a closed book, he urged in his writings, an investor, as a matter of self-defense against the unknown, should contrive to pay less than “intrinsic” value. Intrinsic value, as defined in Security Analysis, is “that value which is justified by the facts, e.g., the assets, earnings, divi- dends, definite prospects, as distinct, let us say, from market quotations established by artificial manipulation or distorted by psychological excesses.” (p. 64) He himself had gone from the ridiculous to the sublime (and some- times back again) in the conduct of his own investment career. His quick and easy grasp of mathematics made him a natural arbitrageur. He would sell one stock and simultaneously buy another. Or he would buy or sell shares of stock against the convertible bonds of the identical issu- ing company. So doing, he would lock in a profit that, if not certain, was as close to guaranteed as the vicissitudes of finance allowed. In one instance, in the early 1920s, he exploited an inefficiency in the relation- ship between DuPont and the then red-hot General Motors (GM). DuPont held a sizable stake in GM. And it was for that interest alone which the market valued the big chemical company. By implication, the rest of the business was worth nothing. To exploit this anomaly, Graham bought shares in DuPont and sold short the hedge-appropriate number of shares in GM. And when the market came to its senses, and the price gap between DuPont and GM widened in the expected direction, Gra- ham took his profit.17 However, Graham, like many another value investors after him, some- times veered from the austere precepts of safe-and-cheap investing. A Graham only slightly younger than the master who sold GM and bought DuPont allowed himself to be hoodwinked by a crooked promoter of a company that seems not actually to have existed—at least, in anything like the state of glowing prosperity described by the manager of the pool to which Graham entrusted his money. An electric sign in Colum- bus Circle, on the upper West Side of Manhattan, did bear the name of the object of Graham’s misplaced confidence, Savold Tire. But, as the author of Security Analysis confessed in his memoir, that could have been the only tangible marker of the company’s existence. “Also, as far as I knew,” Graham added, “nobody complained to the district attorney’s office about the promoter’s bare-faced theft of the public’s money.” Cer- tainly, by his own telling, Graham didn’t.18 By 1929, when he was 35, Graham was well on his way to fame and fortune. His wife and he kept a squadron of servants, including—for the first and only time in his life—a manservant for himself. With JerryNewman, Graham had compiled an investment record so enviable that the great Bernard M. Baruch sought him out. Would Graham wind up his busi- ness to manage Baruch’s money? “I replied,” Graham writes, “that I was highly flattered—flabbergasted, in fact—by his proposal, but I could not end so abruptly the close and highly satisfactory relations I had with my friends and clients.”19 Those relations soon became much less satisfactory. Graham relates that, though he was worried at the top of the market, he failed to act on his bearish hunch. The Graham-Newman partnership went into the 1929 break with $2.5 million of capital. And they con- trolled about $2.5 million in hedged positions—stocks owned long offset by stocks sold short. They had, besides, about $4.5 million in outright long positions. It was bad enough that they were leveraged, as Graham later came to realize. Compounding that tactical error was a deeply rooted conviction that the stocks they owned were cheap enough to withstand any imaginable blow. They came through the crash creditably: down by only 20% was, for the final quarter of 1929, almost heroic. But they gave up 50% in 1930, 16% in 1931, and 3% in 1932 (another relatively excellent showing), for a cumulative loss of 70%.20 “I blamed myself not so much for my failure to protect myself against the disaster I had been predicting,” Graham writes, “as for having slipped into an extravagant way of life which I hadn’t the temperament or capacity to enjoy. I quickly convinced myself that the true key to material happiness lay in a modest standard of living which could be achieved with little difficulty under almost all economic condi- tions”—the margin-of-safety idea applied to personal finance.21 It can’t be said that the academic world immediately clasped Security Analysis to its breast as the definitive elucidation of value investing, or of anything else. The aforementioned survey of the field in which Graham and Dodd made their signal contribution, The Common Stock Theory of Investment, by Chelcie C. Bosland, published three years after the appear- ance of the first edition of Security Analysis, cited 53 different sources and 43 different authors. Not one of them was named Graham or Dodd. Edgar Lawrence Smith, however, did receive Bosland’s full and respectful attention. Smith’s Common Stocks as Long Term Investments, published in 1924, had challenged the long-held view that bonds were innately superior to equities. For one thing, Smith argued, the dollar (even the gold-backed 1924 edition) was inflation-prone, which meant that creditors were inherently disadvantaged. Not so the owners of com- mon stock. If the companies in which they invested earned a profit, and if the managements of those companies retained a portion of that profit in the business, and if those retained earnings, in turn, produced future earnings, the principal value of an investor’s portfolio would tend “to increase in accordance with the operation of compound interest.”22 Smith’s timing was impeccable. Not a year after he published, the great Coolidge bull market erupted. Common Stocks as Long Term Investments, only 129 pages long, provided a handy rationale for chasing the market higher. That stocks do, in fact, tend to excel in the long run has entered the canon of American investment thought as a revealed truth (it looked any- thing but obvious in the 1930s). For his part, Graham entered a strong dis- sent to Smith’s thesis, or, more exactly, its uncritical bullish application. It was one thing to pay 10 times earnings for an equity investment, he notes, quite another to pay 20 to 40 times earnings. Besides, the Smith analysis skirted the important question of what asset values lay behind the stock certificates that people so feverishly and uncritically traded back and forth. Finally, embedded in Smith’s argument was the assumption that common stocks could be counted on to deliver in the future what they had done in the past. Graham was not a believer. (pp. 362–363) If Graham was a hard critic, however, he was also a generous one. In 1939 he was given John Burr Williams’s The Theory of Investment Value to review for the Journal of Political Economy (no small honor for a Wall Street author-practitioner). Williams’s thesis was as important as it was concise. The investment value of a common stock is the present value of all future dividends, he proposed. Williams did not underestimate the significance of these loaded words. Armed with that critical knowledge, the author ventured to hope, investors might restrain themselves from bidding stocks back up to the moon again. Graham, in whose capacious brain dwelled the talents both of the quant and behavioral financier, voiced his doubts about that forecast. The rub, as he pointed out, was that, in order to apply Williams’s method, one needed to make some very large assumptions about the future course of interest rates, the growth of profit, and the terminal value of the shares when growth stops. “One wonders,” Graham mused, “whether there may not be too great a discrepancy between the necessarily hit-or-miss character of these assumptions and the highly refined mathematical treatment to which they are subjected.” Graham closed his essay on a characteristi- cally generous and witty note, commending Williams for the refreshing level-headedness of his approach and adding: “This conservatism is not really implicit in the author’s formulas; but if the investor can be per- suaded by higher algebra to take a sane attitude toward common-stock prices, the reviewer will cast a loud vote for higher algebra.”23 Graham’s technical accomplishments in securities analysis, by them- selves, could hardly have carried Security Analysis through its five edi- tions. It’s the book’s humanity and good humor that, to me, explain its long life and the adoring loyalty of a certain remnant of Graham readers, myself included. Was there ever a Wall Street moneymaker better steeped than Graham in classical languages and literature and in the financial history of his own time? I would bet “no” with all the confidence of a value investor laying down money to buy an especially cheap stock. Yet this great investment philosopher was, to a degree, a prisoner of his own times. He could see that the experiences through which he lived were unique, that the Great Depression was, in fact, a great anomaly. If anyone understood the folly of projecting current experience into the unpredictable future, it was Graham. Yet this investment-philosopher king, having spent 727 pages (not including the gold mine of an appendix) describing how a careful and risk-averse investor could prosper in every kind of macroeconomic conditions, arrives at a remarkable conclusion. What of the institutional investor, he asks. How should he invest? At first, Graham diffidently ducks the question—who is he to prescribe for the experienced financiers at the head of America’s philanthropic and educational institutions? But then he takes the astonishing plunge. “An institution,” he writes, “that can manage to get along on the low income provided by high-grade fixed-value issues should, in our opinion, confine its holdings to this field. We doubt if the better performance of common- stock indexes over past periods will, in itself, warrant the heavy responsi- bilities and the recurring uncertainties that are inseparable from a common-stock investment program.” (pp. 709–710) Could the greatest value investor have meant that? Did the man who stuck it out through ruinous losses in the Depression years and went on to compile a remarkable long-term investment record really mean that common stocks were not worth the bother? In 1940, with a new world war fanning the Roosevelt administration’s fiscal and monetary policies, high-grade corporate bonds yielded just 2.75%, while blue-chip equities yielded 5.1%. Did Graham mean to say that bonds were a safer proposi- tion than stocks? Well, he did say it. If Homer could nod, so could Gra- ham—and so can the rest of us, whoever we are. Let it be a lesson.
+
+USER:
+According to the author of the preface, who cannot accept that value investing works?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,66,14,14534,,760
+"""================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""","I am looking into getting Lasik surgery. However, I'd like to know more about the history of how it came to be. Using the article provided, please explain the accident that caused Lasik to be discovered. Use at least 400 words.","A laboratory accident with a laser more than 30 years ago served as the unlikely first step in the development of an entire industry that has helped more than 30 million people overcome vision problems. In 1993, a graduate student at the University of Michigan's Center for Ultrafast Optical Science (CUOS) suffered an accidental laser injury to his eye. The femtosecond laser, which emits pulses of light with a duration of one-quadrillionth of a second (equivalent to one-millionth of one-billionth of a second), left a series of pinpoint laser burns in the center of the retina without damaging any adjacent tissue. The incident instead sparked a collaboration that would result in a revolutionary approach to corrective eye surgery, commonly known as LASIK. Bladeless LASIK, or laser in situ keratomileusis, uses a femtosecond laser rather than a scalpel to cut into the cornea before it is reshaped to improve the patient's vision. Juhasz with deviceJuhasz, a professor of ophthalmology and biomedical engineering at UC Irvine, won a 2022 Golden Goose Award for helping to develop the widely used LASIK surgery device. Credit: Steve Zylius, UC Irvine The laser technology and surgical procedures were developed by a team of scientists at CUOS, a Science and Technology Center funded by the U.S. National Science Foundation from 1990 to 2001. The path from lab to global use, which included additional support from NSF as well as the Department of Energy, the National Institutes of Health and other agencies, is an example of how federal support for basic and translational research produces new technologies with broad societal benefit. Development and commercialization Tibor Juhasz, then a research associate professor in ophthalmology and biomedical engineering at the university, began working with the research team — led by French physicist Gerard Mourou — to see if the laser, which employs ultrashort pulses, could be used for medical purposes. In 1997, Juhasz and Ron Kurtz, then an assistant professor of ophthalmology, founded IntraLase Corp. to commercialize their approach. At IntraLase, Juhasz and Kurtz developed a shoebox-sized instrument to perform bladeless LASIK cornea surgery. The company also received critical support from NSF's Small Business Innovation Research (SBIR) program, which invests in startups to help them develop their ideas and bring them to the market. Compared to bladed surgery, the laser procedure was painless and reduced recovery time for patients, but it took several years to catch on. Military lasix surgeryIn 2007, an ophthalmology surgeon at National Naval Medical Center Bethesda performs LASIK IntraLase surgery. Credit: U.S. Navy Juhasz, now a biomedical engineering and ophthalmology professor at the University of California, Irvine, described the early stages of commercializing the technology as difficult and highlighted the NSF support as crucial: ""There were some bad examples in ophthalmology of laser companies. There were some failures, and that kind of scared away venture capitalists from the industry. But our center was funded by NSF, and that was a big endorsement."" In 2006, a U.S. Navy study concluded that military pilots who underwent the procedure recovered faster and had better vision than those who had conventional operations, giving the procedure a commercial boost. In 2007, IntraLase was acquired for $808 million. ""The story is that an entire industry developed out of those basic laser-tissue interaction experiments. I think that the initial success of IntraLase created followers, therefore lots of new jobs. I believe that a lot of highly trained scientists are working in these companies as we speak,"" Juhasz said. ""I remember the first steps,"" said Denise Caldwell, acting assistant director of NSF's Directorate for Mathematical and Physical Sciences. In the 1990s, Caldwell was the NSF program director managing the research grants that supported the femtosecond laser research at the University of Michigan. ""One of the things we did in talking with the researchers at Michigan was tell them 'if you think there is promise here, you should follow it. Use the resources you have to pursue it.' Having a creative group of individuals and giving that group the flexibility to pursue new directions as they identify them is very important."" NSF support and global recognition In 2022, Juhasz, Kurtz, Mourou, Strickland and Detao Du — the researcher who had the incident with the laser — received the Golden Goose Award for scientific breakthroughs that led to the development of bladeless LASIK. This award, presented by the American Association for the Advancement of Science, honors scientists whose federally funded research has unexpectedly benefited society. In 2018, Mourou and Donna Strickland were awarded the Nobel Prize in Physics for a ""method of generating high-intensity, ultra-short optical pulses."" Ron Kurtz and Tibor Juhasz with the 1000th LensX FS Laser during the build process. Credit: Tibor Juhasz, UC Irvine Beginning in 1980, NSF supported Mourou with several awards for cross-disciplinary work in physics, materials, electrical engineering and biology. NSF funding helped Mourou establish a biological physics facility at the University of Rochester, and CUOS at the University of Michigan now bears his name. NSF support also helped transition technology developed in Mourou's labs to commercial applications. ""It's fully demonstrated here the importance, particularly for the biomedical area, of bringing the physicists and the engineers together to work with clinicians,"" Caldwell said. ""It's really a joint effort between scientists, engineers and companies to make the necessary fundamental discoveries and early prototypes that can eventually become mature technologies that broadly benefit people and communities."" The future Work based on the initial research continues today as many scientists explore other potential applications of the femtosecond laser. In 2008, Juhasz and Kurtz developed femtosecond laser cataract surgery, and a startup led by Juhasz, ViaLase Inc., is currently conducting clinical trials on new methods to treat glaucoma with femtosecond lasers. Clerio Vision, another small business founded based on NSF-funded basic research and which received SBIR funding from NSF at its inception, is also working on a different approach, based on femtosecond laser pulses, to correct various vision impairments. ViaLase LaserThe ViaLase Laser combines femtosecond laser technology and micron-level image guidance to deliver a noninvasive glaucoma treatment called femtosecond laser image-guided high-precision trabeculotomy (FLigHT). Credit: ViaLase ""We can really say that femtosecond laser technology changed how ophthalmic surgery is done today, and I really need to thank NSF for the initial funding and creating this great journey,"" Juhasz said. ""This story illustrates the importance of foundational science to our society and economy, and also equally importantly, the investments that we make in aiding the translation of research from the lab to the market,"" said Erwin Gianchandani, NSF assistant director for Technology, Innovation and Partnerships. ""That's why NSF established a new directorate for Technology, Innovation and Partnerships in March 2022 — our first new directorate in more than 30 years — to specifically accelerate use-inspired and translational research across all areas of science and engineering.""","""================ <TEXT PASSAGE> ======= A laboratory accident with a laser more than 30 years ago served as the unlikely first step in the development of an entire industry that has helped more than 30 million people overcome vision problems. In 1993, a graduate student at the University of Michigan's Center for Ultrafast Optical Science (CUOS) suffered an accidental laser injury to his eye. The femtosecond laser, which emits pulses of light with a duration of one-quadrillionth of a second (equivalent to one-millionth of one-billionth of a second), left a series of pinpoint laser burns in the center of the retina without damaging any adjacent tissue. The incident instead sparked a collaboration that would result in a revolutionary approach to corrective eye surgery, commonly known as LASIK. Bladeless LASIK, or laser in situ keratomileusis, uses a femtosecond laser rather than a scalpel to cut into the cornea before it is reshaped to improve the patient's vision. Juhasz with deviceJuhasz, a professor of ophthalmology and biomedical engineering at UC Irvine, won a 2022 Golden Goose Award for helping to develop the widely used LASIK surgery device. Credit: Steve Zylius, UC Irvine The laser technology and surgical procedures were developed by a team of scientists at CUOS, a Science and Technology Center funded by the U.S. National Science Foundation from 1990 to 2001. The path from lab to global use, which included additional support from NSF as well as the Department of Energy, the National Institutes of Health and other agencies, is an example of how federal support for basic and translational research produces new technologies with broad societal benefit. Development and commercialization Tibor Juhasz, then a research associate professor in ophthalmology and biomedical engineering at the university, began working with the research team — led by French physicist Gerard Mourou — to see if the laser, which employs ultrashort pulses, could be used for medical purposes. In 1997, Juhasz and Ron Kurtz, then an assistant professor of ophthalmology, founded IntraLase Corp. to commercialize their approach. At IntraLase, Juhasz and Kurtz developed a shoebox-sized instrument to perform bladeless LASIK cornea surgery. The company also received critical support from NSF's Small Business Innovation Research (SBIR) program, which invests in startups to help them develop their ideas and bring them to the market. Compared to bladed surgery, the laser procedure was painless and reduced recovery time for patients, but it took several years to catch on. Military lasix surgeryIn 2007, an ophthalmology surgeon at National Naval Medical Center Bethesda performs LASIK IntraLase surgery. Credit: U.S. Navy Juhasz, now a biomedical engineering and ophthalmology professor at the University of California, Irvine, described the early stages of commercializing the technology as difficult and highlighted the NSF support as crucial: ""There were some bad examples in ophthalmology of laser companies. There were some failures, and that kind of scared away venture capitalists from the industry. But our center was funded by NSF, and that was a big endorsement."" In 2006, a U.S. Navy study concluded that military pilots who underwent the procedure recovered faster and had better vision than those who had conventional operations, giving the procedure a commercial boost. In 2007, IntraLase was acquired for $808 million. ""The story is that an entire industry developed out of those basic laser-tissue interaction experiments. I think that the initial success of IntraLase created followers, therefore lots of new jobs. I believe that a lot of highly trained scientists are working in these companies as we speak,"" Juhasz said. ""I remember the first steps,"" said Denise Caldwell, acting assistant director of NSF's Directorate for Mathematical and Physical Sciences. In the 1990s, Caldwell was the NSF program director managing the research grants that supported the femtosecond laser research at the University of Michigan. ""One of the things we did in talking with the researchers at Michigan was tell them 'if you think there is promise here, you should follow it. Use the resources you have to pursue it.' Having a creative group of individuals and giving that group the flexibility to pursue new directions as they identify them is very important."" NSF support and global recognition In 2022, Juhasz, Kurtz, Mourou, Strickland and Detao Du — the researcher who had the incident with the laser — received the Golden Goose Award for scientific breakthroughs that led to the development of bladeless LASIK. This award, presented by the American Association for the Advancement of Science, honors scientists whose federally funded research has unexpectedly benefited society. In 2018, Mourou and Donna Strickland were awarded the Nobel Prize in Physics for a ""method of generating high-intensity, ultra-short optical pulses."" Ron Kurtz and Tibor Juhasz with the 1000th LensX FS Laser during the build process. Credit: Tibor Juhasz, UC Irvine Beginning in 1980, NSF supported Mourou with several awards for cross-disciplinary work in physics, materials, electrical engineering and biology. NSF funding helped Mourou establish a biological physics facility at the University of Rochester, and CUOS at the University of Michigan now bears his name. NSF support also helped transition technology developed in Mourou's labs to commercial applications. ""It's fully demonstrated here the importance, particularly for the biomedical area, of bringing the physicists and the engineers together to work with clinicians,"" Caldwell said. ""It's really a joint effort between scientists, engineers and companies to make the necessary fundamental discoveries and early prototypes that can eventually become mature technologies that broadly benefit people and communities."" The future Work based on the initial research continues today as many scientists explore other potential applications of the femtosecond laser. In 2008, Juhasz and Kurtz developed femtosecond laser cataract surgery, and a startup led by Juhasz, ViaLase Inc., is currently conducting clinical trials on new methods to treat glaucoma with femtosecond lasers. Clerio Vision, another small business founded based on NSF-funded basic research and which received SBIR funding from NSF at its inception, is also working on a different approach, based on femtosecond laser pulses, to correct various vision impairments. ViaLase LaserThe ViaLase Laser combines femtosecond laser technology and micron-level image guidance to deliver a noninvasive glaucoma treatment called femtosecond laser image-guided high-precision trabeculotomy (FLigHT). Credit: ViaLase ""We can really say that femtosecond laser technology changed how ophthalmic surgery is done today, and I really need to thank NSF for the initial funding and creating this great journey,"" Juhasz said. ""This story illustrates the importance of foundational science to our society and economy, and also equally importantly, the investments that we make in aiding the translation of research from the lab to the market,"" said Erwin Gianchandani, NSF assistant director for Technology, Innovation and Partnerships. ""That's why NSF established a new directorate for Technology, Innovation and Partnerships in March 2022 — our first new directorate in more than 30 years — to specifically accelerate use-inspired and translational research across all areas of science and engineering."" https://new.nsf.gov/science-matters/invention-impact-story-lasik-eye-surgery ================ <QUESTION> ======= I am looking into getting Lasik surgery. However, I'd like to know more about the history of how it came to be. Using the article provided, please explain the accident that caused Lasik to be discovered. Use at least 400 words. ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""","""================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""
+
+EVIDENCE:
+A laboratory accident with a laser more than 30 years ago served as the unlikely first step in the development of an entire industry that has helped more than 30 million people overcome vision problems. In 1993, a graduate student at the University of Michigan's Center for Ultrafast Optical Science (CUOS) suffered an accidental laser injury to his eye. The femtosecond laser, which emits pulses of light with a duration of one-quadrillionth of a second (equivalent to one-millionth of one-billionth of a second), left a series of pinpoint laser burns in the center of the retina without damaging any adjacent tissue. The incident instead sparked a collaboration that would result in a revolutionary approach to corrective eye surgery, commonly known as LASIK. Bladeless LASIK, or laser in situ keratomileusis, uses a femtosecond laser rather than a scalpel to cut into the cornea before it is reshaped to improve the patient's vision. Juhasz with deviceJuhasz, a professor of ophthalmology and biomedical engineering at UC Irvine, won a 2022 Golden Goose Award for helping to develop the widely used LASIK surgery device. Credit: Steve Zylius, UC Irvine The laser technology and surgical procedures were developed by a team of scientists at CUOS, a Science and Technology Center funded by the U.S. National Science Foundation from 1990 to 2001. The path from lab to global use, which included additional support from NSF as well as the Department of Energy, the National Institutes of Health and other agencies, is an example of how federal support for basic and translational research produces new technologies with broad societal benefit. Development and commercialization Tibor Juhasz, then a research associate professor in ophthalmology and biomedical engineering at the university, began working with the research team — led by French physicist Gerard Mourou — to see if the laser, which employs ultrashort pulses, could be used for medical purposes. In 1997, Juhasz and Ron Kurtz, then an assistant professor of ophthalmology, founded IntraLase Corp. to commercialize their approach. At IntraLase, Juhasz and Kurtz developed a shoebox-sized instrument to perform bladeless LASIK cornea surgery. The company also received critical support from NSF's Small Business Innovation Research (SBIR) program, which invests in startups to help them develop their ideas and bring them to the market. Compared to bladed surgery, the laser procedure was painless and reduced recovery time for patients, but it took several years to catch on. Military lasix surgeryIn 2007, an ophthalmology surgeon at National Naval Medical Center Bethesda performs LASIK IntraLase surgery. Credit: U.S. Navy Juhasz, now a biomedical engineering and ophthalmology professor at the University of California, Irvine, described the early stages of commercializing the technology as difficult and highlighted the NSF support as crucial: ""There were some bad examples in ophthalmology of laser companies. There were some failures, and that kind of scared away venture capitalists from the industry. But our center was funded by NSF, and that was a big endorsement."" In 2006, a U.S. Navy study concluded that military pilots who underwent the procedure recovered faster and had better vision than those who had conventional operations, giving the procedure a commercial boost. In 2007, IntraLase was acquired for $808 million. ""The story is that an entire industry developed out of those basic laser-tissue interaction experiments. I think that the initial success of IntraLase created followers, therefore lots of new jobs. I believe that a lot of highly trained scientists are working in these companies as we speak,"" Juhasz said. ""I remember the first steps,"" said Denise Caldwell, acting assistant director of NSF's Directorate for Mathematical and Physical Sciences. In the 1990s, Caldwell was the NSF program director managing the research grants that supported the femtosecond laser research at the University of Michigan. ""One of the things we did in talking with the researchers at Michigan was tell them 'if you think there is promise here, you should follow it. Use the resources you have to pursue it.' Having a creative group of individuals and giving that group the flexibility to pursue new directions as they identify them is very important."" NSF support and global recognition In 2022, Juhasz, Kurtz, Mourou, Strickland and Detao Du — the researcher who had the incident with the laser — received the Golden Goose Award for scientific breakthroughs that led to the development of bladeless LASIK. This award, presented by the American Association for the Advancement of Science, honors scientists whose federally funded research has unexpectedly benefited society. In 2018, Mourou and Donna Strickland were awarded the Nobel Prize in Physics for a ""method of generating high-intensity, ultra-short optical pulses."" Ron Kurtz and Tibor Juhasz with the 1000th LensX FS Laser during the build process. Credit: Tibor Juhasz, UC Irvine Beginning in 1980, NSF supported Mourou with several awards for cross-disciplinary work in physics, materials, electrical engineering and biology. NSF funding helped Mourou establish a biological physics facility at the University of Rochester, and CUOS at the University of Michigan now bears his name. NSF support also helped transition technology developed in Mourou's labs to commercial applications. ""It's fully demonstrated here the importance, particularly for the biomedical area, of bringing the physicists and the engineers together to work with clinicians,"" Caldwell said. ""It's really a joint effort between scientists, engineers and companies to make the necessary fundamental discoveries and early prototypes that can eventually become mature technologies that broadly benefit people and communities."" The future Work based on the initial research continues today as many scientists explore other potential applications of the femtosecond laser. In 2008, Juhasz and Kurtz developed femtosecond laser cataract surgery, and a startup led by Juhasz, ViaLase Inc., is currently conducting clinical trials on new methods to treat glaucoma with femtosecond lasers. Clerio Vision, another small business founded based on NSF-funded basic research and which received SBIR funding from NSF at its inception, is also working on a different approach, based on femtosecond laser pulses, to correct various vision impairments. ViaLase LaserThe ViaLase Laser combines femtosecond laser technology and micron-level image guidance to deliver a noninvasive glaucoma treatment called femtosecond laser image-guided high-precision trabeculotomy (FLigHT). Credit: ViaLase ""We can really say that femtosecond laser technology changed how ophthalmic surgery is done today, and I really need to thank NSF for the initial funding and creating this great journey,"" Juhasz said. ""This story illustrates the importance of foundational science to our society and economy, and also equally importantly, the investments that we make in aiding the translation of research from the lab to the market,"" said Erwin Gianchandani, NSF assistant director for Technology, Innovation and Partnerships. ""That's why NSF established a new directorate for Technology, Innovation and Partnerships in March 2022 — our first new directorate in more than 30 years — to specifically accelerate use-inspired and translational research across all areas of science and engineering.""
+
+USER:
+I am looking into getting Lasik surgery. However, I'd like to know more about the history of how it came to be. Using the article provided, please explain the accident that caused Lasik to be discovered. Use at least 400 words.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,49,41,1130,,742
+Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document],"I've heard that natural deodorant is better for you than regular deodorant. Based on this article, can you explain why? Please used at least 400 words.","Antiperspirants mostly use aluminum-based salts to block the sweat glands from releasing sweat, while deodorants use ingredients that help neutralize odor. Contrary to popular belief, there is no evidence to prove that aluminum can cause Alzheimer’s disease or breast cancer. Deodorants don't have aluminum, but experts say it's still a good idea to opt for natural options because deodorants often contain additives like artificial fragrances or parabens. Many deodorants on the market are now advertised as “natural” and “aluminum-free” because of consumer fears about the health risks associated with aluminum. But there are a lot of details to unpack. Aluminum is only used in antiperspirants, but not in deodorants. And there’s been no evidence to prove that it causes Alzheimer’s disease or breast cancer, the two main concerns about aluminum. Antiperspirants mostly use aluminum-based salts to temporarily block the opening of the sweat glands from releasing sweat, and they usually also include ingredients that help reduce odor, according to Kristina Collins, MD, FAAD, a board-certified dermatologist based in Austin, TX. Deodorants, on the other hand, use ingredients that help neutralize the odor that occurs as bacteria metabolize sweat. Some people prefer using “natural deodorants” to minimize the risk of coming in contact with harmful ingredients, but do these products work? “Natural deodorant reduces the scent of the sweat, but does not reduce the amount of sweat the body produces,” Collins told Verywell. “So if your main concern is the appearance of sweat in the armpit area of your shirt, deodorant will be completely ineffective in reducing the dreaded armpit sweat marks.” The 13 Best Clinical Strength Deodorants and Antiperspirants, Tested and Reviewed Does Aluminum in Antiperspirants Really Cause Alzheimer’s Disease? The theory about aluminum in antiperspirants causing Alzheimer’s disease came about in the ’60s and ’70s, when researchers found increased levels of aluminum in the brains of Alzheimer’s patients, according to Mark Mapstone, PhD, the vice chair for research in neurology at the University of California, Irvine, School of Medicine. “Because aluminum is toxic to brain cells, scientists speculated that the aluminum present in the brains of these people was acquired from the environment and may be responsible for the death of brain cells,” Mapstone told Verywell. While research has found that exposure to aluminum is associated with neurological symptoms, Mapstone said these studies exposed their subjects to much higher concentrations of the metal than what is found in antiperspirants.1 And, according to Collins, there have been no substantiated or randomized studies demonstrating that antiperspirant use specifically causes Alzheimer’s disease. “There is a small amount of absorption of aluminum into the skin and circulation when applied to the skin as an antiperspirant,” Collins said. “However, because of the limited body surface for topical application of these products, that absorption is incredibly small—much smaller, in fact, than the absorption of aluminum in food products.” Do Aluminum-Based Antiperspirants Cause Breast Cancer? Some studies early in this century suggested that an earlier age of breast cancer diagnosis was associated with frequent use of aluminum-based antiperspirants or deodorants, but other studies found no such association. A 2016 study found an apparent association, but only among women who had used antiperspirants or deodorants several times daily before the age of 30. It didn’t provide clear evidence of causation.2 No studies have successfully found a link between an increased risk of breast cancer and antiperspirant use, according to Jennifer Hartman, NP, a nurse practitioner specializing in surgical breast oncology. “It is often mistakenly associated with breast cancer especially because the location of use is close to the location of most breast cancers—upper outer quadrant of the breasts—but products applied anywhere on the body or ingested could impact breast tissue regardless of location,” she said. Should You Use Natural Deodorants? How Do You Pick the Right One? While the evidence about the health risks associated with antiperspirants and deodorants is lacking, Collins said there’s still good reason to opt for the more natural option. Many antiperspirants and some deodorants contain additives like artificial fragrances or parabens that can cause irritation or skin concerns, such as contact dermatitis, she said. Aerosolized spray antiperspirants also sometimes contain a harmful chemical called benzene. What to Know About the Carcinogen Benzene Found in Some Popular Sunscreens “If a person doesn’t sweat very much and they just want to control their body odor, a natural deodorant would be a great choice,” Collins said. The most effective ingredients to look for when selecting a natural deodorant, according to Collins, are ones that help to reduce bacteria on the skin in the armpit. Alpha hydroxy acids (AHAs), such as glycolic acid or mandelic acid, can be used to reduce the dead skin cells in the armpit that bacteria feed off of and encourage healthy cell turnover, Collins said. Tea tree oil is another useful ingredient thanks to its natural antibacterial capabilities, and some deodorants also include probiotics to help boost “good” bacteria and encourage a healthy microbiome balance. Armpit Rash from Deodorant Does Coconut Oil Work as a Natural Deodorant? Coconut oil is another popular choice for those committed to using natural products on their pits, especially on TikTok. Collins said coconut oil contains natural antibacterial properties and is a common ingredient in a variety of natural deodorants, but it’s unlikely to work as effectively on its own. It would also likely rub off faster or absorb faster than an actual deodorant. “It wouldn’t hurt you, but I think this TikTok trend is probably going to leave a lot of people with some stinky armpits,” Collins said. And no matter what ingredients your deodorant includes, it won’t work for an indefinite amount of time. “As the sweat continues to build up, the product is washed away and odor resumes,” Collins said. “The solution for those who are really committed to use of natural deodorants may be to use antibacterial soap in the arm","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. I've heard that natural deodorant is better for you than regular deodorant. Based on this article, can you explain why? Please used at least 400 words. Antiperspirants mostly use aluminum-based salts to block the sweat glands from releasing sweat, while deodorants use ingredients that help neutralize odor. Contrary to popular belief, there is no evidence to prove that aluminum can cause Alzheimer’s disease or breast cancer. Deodorants don't have aluminum, but experts say it's still a good idea to opt for natural options because deodorants often contain additives like artificial fragrances or parabens. Many deodorants on the market are now advertised as “natural” and “aluminum-free” because of consumer fears about the health risks associated with aluminum. But there are a lot of details to unpack. Aluminum is only used in antiperspirants, but not in deodorants. And there’s been no evidence to prove that it causes Alzheimer’s disease or breast cancer, the two main concerns about aluminum. Antiperspirants mostly use aluminum-based salts to temporarily block the opening of the sweat glands from releasing sweat, and they usually also include ingredients that help reduce odor, according to Kristina Collins, MD, FAAD, a board-certified dermatologist based in Austin, TX. Deodorants, on the other hand, use ingredients that help neutralize the odor that occurs as bacteria metabolize sweat. Some people prefer using “natural deodorants” to minimize the risk of coming in contact with harmful ingredients, but do these products work? “Natural deodorant reduces the scent of the sweat, but does not reduce the amount of sweat the body produces,” Collins told Verywell. “So if your main concern is the appearance of sweat in the armpit area of your shirt, deodorant will be completely ineffective in reducing the dreaded armpit sweat marks.” The 13 Best Clinical Strength Deodorants and Antiperspirants, Tested and Reviewed Does Aluminum in Antiperspirants Really Cause Alzheimer’s Disease? The theory about aluminum in antiperspirants causing Alzheimer’s disease came about in the ’60s and ’70s, when researchers found increased levels of aluminum in the brains of Alzheimer’s patients, according to Mark Mapstone, PhD, the vice chair for research in neurology at the University of California, Irvine, School of Medicine. “Because aluminum is toxic to brain cells, scientists speculated that the aluminum present in the brains of these people was acquired from the environment and may be responsible for the death of brain cells,” Mapstone told Verywell. While research has found that exposure to aluminum is associated with neurological symptoms, Mapstone said these studies exposed their subjects to much higher concentrations of the metal than what is found in antiperspirants.1 And, according to Collins, there have been no substantiated or randomized studies demonstrating that antiperspirant use specifically causes Alzheimer’s disease. “There is a small amount of absorption of aluminum into the skin and circulation when applied to the skin as an antiperspirant,” Collins said. “However, because of the limited body surface for topical application of these products, that absorption is incredibly small—much smaller, in fact, than the absorption of aluminum in food products.” Do Aluminum-Based Antiperspirants Cause Breast Cancer? Some studies early in this century suggested that an earlier age of breast cancer diagnosis was associated with frequent use of aluminum-based antiperspirants or deodorants, but other studies found no such association. A 2016 study found an apparent association, but only among women who had used antiperspirants or deodorants several times daily before the age of 30. It didn’t provide clear evidence of causation.2 No studies have successfully found a link between an increased risk of breast cancer and antiperspirant use, according to Jennifer Hartman, NP, a nurse practitioner specializing in surgical breast oncology. “It is often mistakenly associated with breast cancer especially because the location of use is close to the location of most breast cancers—upper outer quadrant of the breasts—but products applied anywhere on the body or ingested could impact breast tissue regardless of location,” she said. Should You Use Natural Deodorants? How Do You Pick the Right One? While the evidence about the health risks associated with antiperspirants and deodorants is lacking, Collins said there’s still good reason to opt for the more natural option. Many antiperspirants and some deodorants contain additives like artificial fragrances or parabens that can cause irritation or skin concerns, such as contact dermatitis, she said. Aerosolized spray antiperspirants also sometimes contain a harmful chemical called benzene. What to Know About the Carcinogen Benzene Found in Some Popular Sunscreens “If a person doesn’t sweat very much and they just want to control their body odor, a natural deodorant would be a great choice,” Collins said. The most effective ingredients to look for when selecting a natural deodorant, according to Collins, are ones that help to reduce bacteria on the skin in the armpit. Alpha hydroxy acids (AHAs), such as glycolic acid or mandelic acid, can be used to reduce the dead skin cells in the armpit that bacteria feed off of and encourage healthy cell turnover, Collins said. Tea tree oil is another useful ingredient thanks to its natural antibacterial capabilities, and some deodorants also include probiotics to help boost “good” bacteria and encourage a healthy microbiome balance. Armpit Rash from Deodorant Does Coconut Oil Work as a Natural Deodorant? Coconut oil is another popular choice for those committed to using natural products on their pits, especially on TikTok. Collins said coconut oil contains natural antibacterial properties and is a common ingredient in a variety of natural deodorants, but it’s unlikely to work as effectively on its own. It would also likely rub off faster or absorb faster than an actual deodorant. “It wouldn’t hurt you, but I think this TikTok trend is probably going to leave a lot of people with some stinky armpits,” Collins said. And no matter what ingredients your deodorant includes, it won’t work for an indefinite amount of time. “As the sweat continues to build up, the product is washed away and odor resumes,” Collins said. “The solution for those who are really committed to use of natural deodorants may be to use antibacterial soap in the arm https://www.verywellhealth.com/do-natural-deodorants-really-work-7255872","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]
+
+EVIDENCE:
+Antiperspirants mostly use aluminum-based salts to block the sweat glands from releasing sweat, while deodorants use ingredients that help neutralize odor. Contrary to popular belief, there is no evidence to prove that aluminum can cause Alzheimer’s disease or breast cancer. Deodorants don't have aluminum, but experts say it's still a good idea to opt for natural options because deodorants often contain additives like artificial fragrances or parabens. Many deodorants on the market are now advertised as “natural” and “aluminum-free” because of consumer fears about the health risks associated with aluminum. But there are a lot of details to unpack. Aluminum is only used in antiperspirants, but not in deodorants. And there’s been no evidence to prove that it causes Alzheimer’s disease or breast cancer, the two main concerns about aluminum. Antiperspirants mostly use aluminum-based salts to temporarily block the opening of the sweat glands from releasing sweat, and they usually also include ingredients that help reduce odor, according to Kristina Collins, MD, FAAD, a board-certified dermatologist based in Austin, TX. Deodorants, on the other hand, use ingredients that help neutralize the odor that occurs as bacteria metabolize sweat. Some people prefer using “natural deodorants” to minimize the risk of coming in contact with harmful ingredients, but do these products work? “Natural deodorant reduces the scent of the sweat, but does not reduce the amount of sweat the body produces,” Collins told Verywell. “So if your main concern is the appearance of sweat in the armpit area of your shirt, deodorant will be completely ineffective in reducing the dreaded armpit sweat marks.” The 13 Best Clinical Strength Deodorants and Antiperspirants, Tested and Reviewed Does Aluminum in Antiperspirants Really Cause Alzheimer’s Disease? The theory about aluminum in antiperspirants causing Alzheimer’s disease came about in the ’60s and ’70s, when researchers found increased levels of aluminum in the brains of Alzheimer’s patients, according to Mark Mapstone, PhD, the vice chair for research in neurology at the University of California, Irvine, School of Medicine. “Because aluminum is toxic to brain cells, scientists speculated that the aluminum present in the brains of these people was acquired from the environment and may be responsible for the death of brain cells,” Mapstone told Verywell. While research has found that exposure to aluminum is associated with neurological symptoms, Mapstone said these studies exposed their subjects to much higher concentrations of the metal than what is found in antiperspirants.1 And, according to Collins, there have been no substantiated or randomized studies demonstrating that antiperspirant use specifically causes Alzheimer’s disease. “There is a small amount of absorption of aluminum into the skin and circulation when applied to the skin as an antiperspirant,” Collins said. “However, because of the limited body surface for topical application of these products, that absorption is incredibly small—much smaller, in fact, than the absorption of aluminum in food products.” Do Aluminum-Based Antiperspirants Cause Breast Cancer? Some studies early in this century suggested that an earlier age of breast cancer diagnosis was associated with frequent use of aluminum-based antiperspirants or deodorants, but other studies found no such association. A 2016 study found an apparent association, but only among women who had used antiperspirants or deodorants several times daily before the age of 30. It didn’t provide clear evidence of causation.2 No studies have successfully found a link between an increased risk of breast cancer and antiperspirant use, according to Jennifer Hartman, NP, a nurse practitioner specializing in surgical breast oncology. “It is often mistakenly associated with breast cancer especially because the location of use is close to the location of most breast cancers—upper outer quadrant of the breasts—but products applied anywhere on the body or ingested could impact breast tissue regardless of location,” she said. Should You Use Natural Deodorants? How Do You Pick the Right One? While the evidence about the health risks associated with antiperspirants and deodorants is lacking, Collins said there’s still good reason to opt for the more natural option. Many antiperspirants and some deodorants contain additives like artificial fragrances or parabens that can cause irritation or skin concerns, such as contact dermatitis, she said. Aerosolized spray antiperspirants also sometimes contain a harmful chemical called benzene. What to Know About the Carcinogen Benzene Found in Some Popular Sunscreens “If a person doesn’t sweat very much and they just want to control their body odor, a natural deodorant would be a great choice,” Collins said. The most effective ingredients to look for when selecting a natural deodorant, according to Collins, are ones that help to reduce bacteria on the skin in the armpit. Alpha hydroxy acids (AHAs), such as glycolic acid or mandelic acid, can be used to reduce the dead skin cells in the armpit that bacteria feed off of and encourage healthy cell turnover, Collins said. Tea tree oil is another useful ingredient thanks to its natural antibacterial capabilities, and some deodorants also include probiotics to help boost “good” bacteria and encourage a healthy microbiome balance. Armpit Rash from Deodorant Does Coconut Oil Work as a Natural Deodorant? Coconut oil is another popular choice for those committed to using natural products on their pits, especially on TikTok. Collins said coconut oil contains natural antibacterial properties and is a common ingredient in a variety of natural deodorants, but it’s unlikely to work as effectively on its own. It would also likely rub off faster or absorb faster than an actual deodorant. “It wouldn’t hurt you, but I think this TikTok trend is probably going to leave a lot of people with some stinky armpits,” Collins said. And no matter what ingredients your deodorant includes, it won’t work for an indefinite amount of time. “As the sweat continues to build up, the product is washed away and odor resumes,” Collins said. “The solution for those who are really committed to use of natural deodorants may be to use antibacterial soap in the arm
+
+USER:
+I've heard that natural deodorant is better for you than regular deodorant. Based on this article, can you explain why? Please used at least 400 words.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,24,26,979,,794
+System Instructions: Do not use any outside sources. Do not use any prior knowledge. Respond using only the provided text.,Question: What is the difference between the sideline and locker room evaluations?,"Context: 2. Game Day Procedures a. Pregame Medical Team Meeting. Sixty (60) minutes prior to kickoff, all medicalstaff will meet in the referees’ locker room. Expected personnel include: Head Team Physician and Head Team Primary Care Sports Medicine Physician, and Head Team ATC from each team and UNCs, both Booth ATC Spotters, lead EMS paramedic for the field,referee, VTML, and the airway management physician. The pregame medical meeting is to be led by the home team Head Team Physician. Items to be covered include: introductions of medicalstaff; location of the ambulance, transport cart,spine board, defibrillator, and advanced airway equipment; review of EAP medical facilities; and location of x-ray equipment. Medicalstaffshall confirm who is responsible for verifying a concussion evaluation of an athlete, i.e., “closing the loop.” Booth ATC spotters shall review the Medical Time-Out procedures with officials. b. “No-Go” Signs and Symptoms. If a player exhibits or reports any of the following signs or symptoms of concussion, he must be removed immediately from the field of play and transported to the locker room. If a neutral sideline observer or a member of the player’s Club’s medical team observes a player exhibit or receives a report that a player has experienced any of the following signs or symptoms, the player shall be considered to have suffered a concussion and may not return to participation (practice or play) on the same day under any circumstances: i. Loss of Consciousness (including Impact Seizure and/or “fencing posture”); ii. Ataxia (abnormality of balance/stability, motor coordination, or dysfunctional speech); Amended As of October 8, 2022 iii. Confusion; or iv. Amnesia c. NFL Sideline Concussion Assessment (Sideline Survey) If a player exhibits or reports a sign or symptom of concussion (defined above), spinal cord neuropraxia or a concern is raised by the Club’s athletic trainer,Club physicians, Booth ATC Spotter, coach, teammate, game official or sideline or Booth UNCs(collectively referredto as “gameday medical personnel”)the player must be immediately removed to the sideline orstabilized on the field, as needed, the player’s helmet must be taken away from him, and the player must undergo the entire NFL Sideline Concussion Assessment1 which, at a minimum, must consist of the following: i. A review of the “No-Go” criteria listed above (Loss of Consciousness (including impact seizure and/or “fencing posture”), Ataxia, Confusion, andAmnesia), which, if present, requires the player to be brought to the lockerroom immediately and he shall not return to play; ii. Inquiry regarding the history of the event, including before, during and after the suspected mechanism of injury; iii. Review of concussion signs and symptoms (See, Section I (C and D)); iv. All Maddocks’ questions; v. Complete Video Review of the injury (detailed below), including discussion with theBooth UNC; and vi. Focused Neurological Exam, inclusive of the following: (A)Cervical Spine Examination (including range of motion and pain); (B) Evaluation of speech; (C) Testing of gait, coordination, and balance; and (D)Eye Movements and Pupillary Exam. The foregoing shall be: (i) conducted inside the medical evaluation tent on the Sideline (or in the Locker Room if the Club medical staff elects to conduct it in the Locker Room); (ii) performed using the tablet or other technology assigned by the NFL, and (iii) completion of each component of the Sideline Survey shall be confirmed using the same. If any elements of the sideline assessment are positive, inconclusive, or suspicious for the presence of a concussion, the player must be escorted to the locker room immediately for the complete NFL Locker Room Comprehensive Concussion Assessment. Also, if the player demonstrates worsening or progressing symptoms at any point, he is to be brought to the 1 The Club physician/sideline UNC unit will be co-located for all concussion evaluates and management both on and off the field. The sideline UNC may present his/her own questions or conduct additional testing and shall assist in the diagnosis and treatment of concussion. Amended As of October 8, 2022 locker room for further evaluation including the complete NFL Locker Room Comprehensive Concussion Assessment unless clinically contraindicated. Only medical personnel deemed essential to the care of the athlete may be present for the tent and/or locker room evaluation. This includes the team physician best qualified to evaluate concussion, the Club athletic trainer, and the sideline UNC. The sideline UNC may present his/her own questions or conduct additional testing and shall not be prevented in from so doing. If, upon completing the Sideline Survey, the Club physician, after consultation with the sideline UNC, concludes that the player did notsustain a concussion, then the playermay return to play. Bestpracticesfor concussion assessment include periodic checks of the player by the Club physician, sideline UNC or other medical personnel to determine whether he has developed any of the signs orsymptoms of concussion that would necessitate a locker room evaluation. UNC Involvement in Sideline Concussion Assessment: 1. The Club physician will consult in private with the members of his/her team’s medical staff designated to identify, diagnose and treat potentially concussed players, the sideline UNC and, as necessary, the Club’s ATC, prior to making his/her decision regarding whether the player will return to the game. 2. If the Club physician determines that the player shall not return to play (based on the criteria listed in Section 2.a. above) and therefore there is no need to complete the SidelineConcussionAssessment, the Club physician and the sideline UNC shall accompany the player to the locker room to evaluate the player using the NFL Locker Room Comprehensive Concussion Evaluation (see below). For more serious injury, the EAP will be activated, if indicated. 3. The Club physician remains responsible for all final decisions regarding Return-to-Play. However, the Club physician will consult with his/her sideline UNC team member prior to reaching his/her decision. If the sideline UNC disagrees with the Club physician’s decision to return the player to play or remove the athlete, the sideline UNC will be given an opportunity to explain the basis of his/her opinion. This will be discussed in a collegial fashion in private as to why the player should or should not be returned to the game. The Club physician will communicate his or her final decision to the player. Amended As of October 8, 2022 10 4. As soon as practical, following the evaluation, the individual designated at the Pregame Medical Team Meeting shall notify the booth medical personnel that an evaluation was conducted (“close the loop”). d. NFL Locker Room Comprehensive Concussion Assessment (Locker Room Exam) The NFL Locker Room Comprehensive Concussion Assessment is the standardized acute evaluation tool that has been developed by the NFL’s Head, Neck and Spine Committee to be used by Clubs’ medical staffs and designated UNCs to evaluate potential concussions during practices and on game day (see Attachment A). This evaluation is based on the Standardized Concussion Assessment Tool (SCAT 5) published by the International Concussion in Sport Group (McCrory, et al., 2017), modified for use in the NFL (Attachment A). The NFL Locker Room Comprehensive Concussion Assessment can be used to aid in the diagnosis of concussion even if there is a delayed onset of symptoms. The ongoing use of the Locker Room Comprehensive Concussion Assessment in conjunction with the preseason baseline and post-injury testing provides detailed data regarding each athlete’s injury and recovery course. Being able to compare the results from the NFL Locker Room Comprehensive Concussion Assessment to the baseline information obtained in the preseason improves the value of this instrument. Clubs shall maintain and upload to the EMR all NFL Locker Room Comprehensive Concussion Assessment exams and a copy of the same shall be given to both the player and the team medical staff. In all circumstances, the Club physician responsible for concussion evaluation shall assess the player in conjunction with the sideline UNC. The Club physician shall be responsible for determining whether the player is diagnosed as having a concussion. The athlete may have a concussion despite being able to complete the NFL Locker Room Comprehensive Concussion Assessment “within normal limits” compared to baseline, due to the potential limitations of the Assessment. Such limitations underscore the importance of knowing the athlete and the subtle deficits in their personality and behaviors that can occur with concussive injury. The signs and symptoms of concussion listed above (Section I, C and D), although frequently observed or reported, are not an exhaustive list. The NFL Locker Room Comprehensive Concussion Assessment is intended to capture these elements in a standardized format. The neurocognitive assessment in the NFL Locker Room Comprehensive Concussion Assessment is brief and does not replace a more comprehensive neurological evaluation or more formal neurocognitive testing. The Amended As of October 8, 2022 11 modified Balance Error Scoring System (mBESS) is an important component of the NFL Locker Room Comprehensive Concussion Assessment and has been validated as a useful adjunct in assessing concussive injury.","System Instructions: Do not use any outside sources. Do not use any prior knowledge. Respond using only the provided text. Question: What is the difference between the sideline and locker room evaluations? Context: 2. Game Day Procedures a. Pregame Medical Team Meeting. Sixty (60) minutes prior to kickoff, all medicalstaff will meet in the referees’ locker room. Expected personnel include: Head Team Physician and Head Team Primary Care Sports Medicine Physician, and Head Team ATC from each team and UNCs, both Booth ATC Spotters, lead EMS paramedic for the field,referee, VTML, and the airway management physician. The pregame medical meeting is to be led by the home team Head Team Physician. Items to be covered include: introductions of medicalstaff; location of the ambulance, transport cart,spine board, defibrillator, and advanced airway equipment; review of EAP medical facilities; and location of x-ray equipment. Medicalstaffshall confirm who is responsible for verifying a concussion evaluation of an athlete, i.e., “closing the loop.” Booth ATC spotters shall review the Medical Time-Out procedures with officials. b. “No-Go” Signs and Symptoms. If a player exhibits or reports any of the following signs or symptoms of concussion, he must be removed immediately from the field of play and transported to the locker room. If a neutral sideline observer or a member of the player’s Club’s medical team observes a player exhibit or receives a report that a player has experienced any of the following signs or symptoms, the player shall be considered to have suffered a concussion and may not return to participation (practice or play) on the same day under any circumstances: i. Loss of Consciousness (including Impact Seizure and/or “fencing posture”); ii. Ataxia (abnormality of balance/stability, motor coordination, or dysfunctional speech); Amended As of October 8, 2022 iii. Confusion; or iv. Amnesia c. NFL Sideline Concussion Assessment (Sideline Survey) If a player exhibits or reports a sign or symptom of concussion (defined above), spinal cord neuropraxia or a concern is raised by the Club’s athletic trainer,Club physicians, Booth ATC Spotter, coach, teammate, game official or sideline or Booth UNCs(collectively referredto as “gameday medical personnel”)the player must be immediately removed to the sideline orstabilized on the field, as needed, the player’s helmet must be taken away from him, and the player must undergo the entire NFL Sideline Concussion Assessment1 which, at a minimum, must consist of the following: i. A review of the “No-Go” criteria listed above (Loss of Consciousness (including impact seizure and/or “fencing posture”), Ataxia, Confusion, andAmnesia), which, if present, requires the player to be brought to the lockerroom immediately and he shall not return to play; ii. Inquiry regarding the history of the event, including before, during and after the suspected mechanism of injury; iii. Review of concussion signs and symptoms (See, Section I (C and D)); iv. All Maddocks’ questions; v. Complete Video Review of the injury (detailed below), including discussion with theBooth UNC; and vi. Focused Neurological Exam, inclusive of the following: (A)Cervical Spine Examination (including range of motion and pain); (B) Evaluation of speech; (C) Testing of gait, coordination, and balance; and (D)Eye Movements and Pupillary Exam. The foregoing shall be: (i) conducted inside the medical evaluation tent on the Sideline (or in the Locker Room if the Club medical staff elects to conduct it in the Locker Room); (ii) performed using the tablet or other technology assigned by the NFL, and (iii) completion of each component of the Sideline Survey shall be confirmed using the same. If any elements of the sideline assessment are positive, inconclusive, or suspicious for the presence of a concussion, the player must be escorted to the locker room immediately for the complete NFL Locker Room Comprehensive Concussion Assessment. Also, if the player demonstrates worsening or progressing symptoms at any point, he is to be brought to the 1 The Club physician/sideline UNC unit will be co-located for all concussion evaluates and management both on and off the field. The sideline UNC may present his/her own questions or conduct additional testing and shall assist in the diagnosis and treatment of concussion. Amended As of October 8, 2022 locker room for further evaluation including the complete NFL Locker Room Comprehensive Concussion Assessment unless clinically contraindicated. Only medical personnel deemed essential to the care of the athlete may be present for the tent and/or locker room evaluation. This includes the team physician best qualified to evaluate concussion, the Club athletic trainer, and the sideline UNC. The sideline UNC may present his/her own questions or conduct additional testing and shall not be prevented in from so doing. If, upon completing the Sideline Survey, the Club physician, after consultation with the sideline UNC, concludes that the player did notsustain a concussion, then the playermay return to play. Bestpracticesfor concussion assessment include periodic checks of the player by the Club physician, sideline UNC or other medical personnel to determine whether he has developed any of the signs orsymptoms of concussion that would necessitate a locker room evaluation. UNC Involvement in Sideline Concussion Assessment: 1. The Club physician will consult in private with the members of his/her team’s medical staff designated to identify, diagnose and treat potentially concussed players, the sideline UNC and, as necessary, the Club’s ATC, prior to making his/her decision regarding whether the player will return to the game. 2. If the Club physician determines that the player shall not return to play (based on the criteria listed in Section 2.a. above) and therefore there is no need to complete the SidelineConcussionAssessment, the Club physician and the sideline UNC shall accompany the player to the locker room to evaluate the player using the NFL Locker Room Comprehensive Concussion Evaluation (see below). For more serious injury, the EAP will be activated, if indicated. 3. The Club physician remains responsible for all final decisions regarding Return-to-Play. However, the Club physician will consult with his/her sideline UNC team member prior to reaching his/her decision. If the sideline UNC disagrees with the Club physician’s decision to return the player to play or remove the athlete, the sideline UNC will be given an opportunity to explain the basis of his/her opinion. This will be discussed in a collegial fashion in private as to why the player should or should not be returned to the game. The Club physician will communicate his or her final decision to the player. Amended As of October 8, 2022 10 4. As soon as practical, following the evaluation, the individual designated at the Pregame Medical Team Meeting shall notify the booth medical personnel that an evaluation was conducted (“close the loop”). d. NFL Locker Room Comprehensive Concussion Assessment (Locker Room Exam) The NFL Locker Room Comprehensive Concussion Assessment is the standardized acute evaluation tool that has been developed by the NFL’s Head, Neck and Spine Committee to be used by Clubs’ medical staffs and designated UNCs to evaluate potential concussions during practices and on game day (see Attachment A). This evaluation is based on the Standardized Concussion Assessment Tool (SCAT 5) published by the International Concussion in Sport Group (McCrory, et al., 2017), modified for use in the NFL (Attachment A). The NFL Locker Room Comprehensive Concussion Assessment can be used to aid in the diagnosis of concussion even if there is a delayed onset of symptoms. The ongoing use of the Locker Room Comprehensive Concussion Assessment in conjunction with the preseason baseline and post-injury testing provides detailed data regarding each athlete’s injury and recovery course. Being able to compare the results from the NFL Locker Room Comprehensive Concussion Assessment to the baseline information obtained in the preseason improves the value of this instrument. Clubs shall maintain and upload to the EMR all NFL Locker Room Comprehensive Concussion Assessment exams and a copy of the same shall be given to both the player and the team medical staff. In all circumstances, the Club physician responsible for concussion evaluation shall assess the player in conjunction with the sideline UNC. The Club physician shall be responsible for determining whether the player is diagnosed as having a concussion. The athlete may have a concussion despite being able to complete the NFL Locker Room Comprehensive Concussion Assessment “within normal limits” compared to baseline, due to the potential limitations of the Assessment. Such limitations underscore the importance of knowing the athlete and the subtle deficits in their personality and behaviors that can occur with concussive injury. The signs and symptoms of concussion listed above (Section I, C and D), although frequently observed or reported, are not an exhaustive list. The NFL Locker Room Comprehensive Concussion Assessment is intended to capture these elements in a standardized format. The neurocognitive assessment in the NFL Locker Room Comprehensive Concussion Assessment is brief and does not replace a more comprehensive neurological evaluation or more formal neurocognitive testing. The Amended As of October 8, 2022 11 modified Balance Error Scoring System (mBESS) is an important component of the NFL Locker Room Comprehensive Concussion Assessment and has been validated as a useful adjunct in assessing concussive injury.","System Instructions: Do not use any outside sources. Do not use any prior knowledge. Respond using only the provided text.
+
+EVIDENCE:
+Context: 2. Game Day Procedures a. Pregame Medical Team Meeting. Sixty (60) minutes prior to kickoff, all medicalstaff will meet in the referees’ locker room. Expected personnel include: Head Team Physician and Head Team Primary Care Sports Medicine Physician, and Head Team ATC from each team and UNCs, both Booth ATC Spotters, lead EMS paramedic for the field,referee, VTML, and the airway management physician. The pregame medical meeting is to be led by the home team Head Team Physician. Items to be covered include: introductions of medicalstaff; location of the ambulance, transport cart,spine board, defibrillator, and advanced airway equipment; review of EAP medical facilities; and location of x-ray equipment. Medicalstaffshall confirm who is responsible for verifying a concussion evaluation of an athlete, i.e., “closing the loop.” Booth ATC spotters shall review the Medical Time-Out procedures with officials. b. “No-Go” Signs and Symptoms. If a player exhibits or reports any of the following signs or symptoms of concussion, he must be removed immediately from the field of play and transported to the locker room. If a neutral sideline observer or a member of the player’s Club’s medical team observes a player exhibit or receives a report that a player has experienced any of the following signs or symptoms, the player shall be considered to have suffered a concussion and may not return to participation (practice or play) on the same day under any circumstances: i. Loss of Consciousness (including Impact Seizure and/or “fencing posture”); ii. Ataxia (abnormality of balance/stability, motor coordination, or dysfunctional speech); Amended As of October 8, 2022 iii. Confusion; or iv. Amnesia c. NFL Sideline Concussion Assessment (Sideline Survey) If a player exhibits or reports a sign or symptom of concussion (defined above), spinal cord neuropraxia or a concern is raised by the Club’s athletic trainer,Club physicians, Booth ATC Spotter, coach, teammate, game official or sideline or Booth UNCs(collectively referredto as “gameday medical personnel”)the player must be immediately removed to the sideline orstabilized on the field, as needed, the player’s helmet must be taken away from him, and the player must undergo the entire NFL Sideline Concussion Assessment1 which, at a minimum, must consist of the following: i. A review of the “No-Go” criteria listed above (Loss of Consciousness (including impact seizure and/or “fencing posture”), Ataxia, Confusion, andAmnesia), which, if present, requires the player to be brought to the lockerroom immediately and he shall not return to play; ii. Inquiry regarding the history of the event, including before, during and after the suspected mechanism of injury; iii. Review of concussion signs and symptoms (See, Section I (C and D)); iv. All Maddocks’ questions; v. Complete Video Review of the injury (detailed below), including discussion with theBooth UNC; and vi. Focused Neurological Exam, inclusive of the following: (A)Cervical Spine Examination (including range of motion and pain); (B) Evaluation of speech; (C) Testing of gait, coordination, and balance; and (D)Eye Movements and Pupillary Exam. The foregoing shall be: (i) conducted inside the medical evaluation tent on the Sideline (or in the Locker Room if the Club medical staff elects to conduct it in the Locker Room); (ii) performed using the tablet or other technology assigned by the NFL, and (iii) completion of each component of the Sideline Survey shall be confirmed using the same. If any elements of the sideline assessment are positive, inconclusive, or suspicious for the presence of a concussion, the player must be escorted to the locker room immediately for the complete NFL Locker Room Comprehensive Concussion Assessment. Also, if the player demonstrates worsening or progressing symptoms at any point, he is to be brought to the 1 The Club physician/sideline UNC unit will be co-located for all concussion evaluates and management both on and off the field. The sideline UNC may present his/her own questions or conduct additional testing and shall assist in the diagnosis and treatment of concussion. Amended As of October 8, 2022 locker room for further evaluation including the complete NFL Locker Room Comprehensive Concussion Assessment unless clinically contraindicated. Only medical personnel deemed essential to the care of the athlete may be present for the tent and/or locker room evaluation. This includes the team physician best qualified to evaluate concussion, the Club athletic trainer, and the sideline UNC. The sideline UNC may present his/her own questions or conduct additional testing and shall not be prevented in from so doing. If, upon completing the Sideline Survey, the Club physician, after consultation with the sideline UNC, concludes that the player did notsustain a concussion, then the playermay return to play. Bestpracticesfor concussion assessment include periodic checks of the player by the Club physician, sideline UNC or other medical personnel to determine whether he has developed any of the signs orsymptoms of concussion that would necessitate a locker room evaluation. UNC Involvement in Sideline Concussion Assessment: 1. The Club physician will consult in private with the members of his/her team’s medical staff designated to identify, diagnose and treat potentially concussed players, the sideline UNC and, as necessary, the Club’s ATC, prior to making his/her decision regarding whether the player will return to the game. 2. If the Club physician determines that the player shall not return to play (based on the criteria listed in Section 2.a. above) and therefore there is no need to complete the SidelineConcussionAssessment, the Club physician and the sideline UNC shall accompany the player to the locker room to evaluate the player using the NFL Locker Room Comprehensive Concussion Evaluation (see below). For more serious injury, the EAP will be activated, if indicated. 3. The Club physician remains responsible for all final decisions regarding Return-to-Play. However, the Club physician will consult with his/her sideline UNC team member prior to reaching his/her decision. If the sideline UNC disagrees with the Club physician’s decision to return the player to play or remove the athlete, the sideline UNC will be given an opportunity to explain the basis of his/her opinion. This will be discussed in a collegial fashion in private as to why the player should or should not be returned to the game. The Club physician will communicate his or her final decision to the player. Amended As of October 8, 2022 10 4. As soon as practical, following the evaluation, the individual designated at the Pregame Medical Team Meeting shall notify the booth medical personnel that an evaluation was conducted (“close the loop”). d. NFL Locker Room Comprehensive Concussion Assessment (Locker Room Exam) The NFL Locker Room Comprehensive Concussion Assessment is the standardized acute evaluation tool that has been developed by the NFL’s Head, Neck and Spine Committee to be used by Clubs’ medical staffs and designated UNCs to evaluate potential concussions during practices and on game day (see Attachment A). This evaluation is based on the Standardized Concussion Assessment Tool (SCAT 5) published by the International Concussion in Sport Group (McCrory, et al., 2017), modified for use in the NFL (Attachment A). The NFL Locker Room Comprehensive Concussion Assessment can be used to aid in the diagnosis of concussion even if there is a delayed onset of symptoms. The ongoing use of the Locker Room Comprehensive Concussion Assessment in conjunction with the preseason baseline and post-injury testing provides detailed data regarding each athlete’s injury and recovery course. Being able to compare the results from the NFL Locker Room Comprehensive Concussion Assessment to the baseline information obtained in the preseason improves the value of this instrument. Clubs shall maintain and upload to the EMR all NFL Locker Room Comprehensive Concussion Assessment exams and a copy of the same shall be given to both the player and the team medical staff. In all circumstances, the Club physician responsible for concussion evaluation shall assess the player in conjunction with the sideline UNC. The Club physician shall be responsible for determining whether the player is diagnosed as having a concussion. The athlete may have a concussion despite being able to complete the NFL Locker Room Comprehensive Concussion Assessment “within normal limits” compared to baseline, due to the potential limitations of the Assessment. Such limitations underscore the importance of knowing the athlete and the subtle deficits in their personality and behaviors that can occur with concussive injury. The signs and symptoms of concussion listed above (Section I, C and D), although frequently observed or reported, are not an exhaustive list. The NFL Locker Room Comprehensive Concussion Assessment is intended to capture these elements in a standardized format. The neurocognitive assessment in the NFL Locker Room Comprehensive Concussion Assessment is brief and does not replace a more comprehensive neurological evaluation or more formal neurocognitive testing. The Amended As of October 8, 2022 11 modified Balance Error Scoring System (mBESS) is an important component of the NFL Locker Room Comprehensive Concussion Assessment and has been validated as a useful adjunct in assessing concussive injury.
+
+USER:
+Question: What is the difference between the sideline and locker room evaluations?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,20,12,1465,,180
+Use only the information given below. Keep your responses concise and use bullet points where appropriate.,"If I'm looking to minimise my tax exposure for my retirement funds, what are some things I should focus on?","So, how do you actually implement the investment plan outlined above? As mentioned in the first section, your biggest priority is to get yourself out of debt; until that point, the only investing you should be doing is with the minimum 401(k) or other defined contribution savings required to “max out” your employer match; beyond that, you should earmark every spare penny to eliminating your student and consumer debt. Next, you’ll need an emergency fund placed in T-bills, CDs, or money market accounts; this should be enough for six months of living expenses, and should be in a taxable account. (Putting your emergency money in a 401(k) or IRA is a terrible idea, since if you need it, you’ll almost certainly have to pay a substantial tax penalty to get it out.) Then, and only then, can you start to save seriously for retirement. For most young people, this will mean some mix of an employer-based plan, such as a 401(k), individual IRA accounts, and taxable accounts. There are two kinds of IRA accounts: traditional and Roth. The main difference between the two comes when you pay taxes on them; with a traditional account, you get a tax deduction on the contributions, and pay taxes when the money is withdrawn, generally after age 59½. (You can withdraw money before 59½, but, with a few important exceptions, you’ll pay a substantial tax penalty for doing so.) With a Roth, it’s the opposite: you contribute with money you’ve already paid taxes on, but pay no taxes on withdrawals in retirement. There’s thus not a lot of difference between a 401(k) and a traditional IRA; in fact, you can seamlessly roll the former into the latter after you leave your employer. In general, the Roth is a better deal than a traditional IRA, since not only can you contribute “more” to the Roth (since $5,500—the current annual contribution limit—of after-tax dollars is worth a lot more than $5,500 in pre-tax dollars), but also you’re hopefully in a higher tax bracket when you retire. Your goal, as mentioned, is to save at least 15 percent of your salary in some combination of 401(k)/IRA/taxable savings. But in reality, the best strategy is to save as much as you can, and don’t stop doing so until the day you die. The optimal strategy for most young people is thus to first max out their 401(k) match, then contribute the maximum to a Roth IRA (assuming they’re not making too much money to qualify for the Roth, approximately $200,000 for a married couple and $120,000 for a single person), then save in a taxable account on top of that. A frequent problem with 401(k) plans is the quality of the fund offerings. You should look carefully at the fund expenses offered in your employer’s plan. If its expense ratios are in general more than 1.0%, then you have a lousy one, and you should contribute only up to the match. If its expenses are in general lower than 0.5%, and particularly if it includes Vanguard’s index funds or Fidelity’s Spartanclass funds (which have fees as low as Vanguard’s), then you might consider making significant voluntary contributions in excess of the match limits. For most young savers, fully maxing out voluntary 401(k) contributions (assuming you have a “good” 401(k) with low expenses) and the annual Roth limit will get them well over the 15 percent savings target. Your contributions to your 401(k), IRA, and taxable accounts should be made equally to the indexed U.S. stock, foreign stock, and bond funds available to you. Once per year, you should “rebalance” them back to equal status. In the good years, this will mean selling some stocks, which you should avoid doing in a taxable account, since this will incur capital gains taxes. In practice, this means keeping a fair amount of your stock holdings in a tax sheltered 401(k) or IRA. This will not be a problem for the typical young investor, since he or she will have a relatively small amount of his or her assets in a taxable account.","If I'm looking to minimise my tax exposure for my retirement funds, what are some things I should focus on? Use only the information given below. Keep your responses concise and use bullet points where appropriate. So, how do you actually implement the investment plan outlined above? As mentioned in the first section, your biggest priority is to get yourself out of debt; until that point, the only investing you should be doing is with the minimum 401(k) or other defined contribution savings required to “max out” your employer match; beyond that, you should earmark every spare penny to eliminating your student and consumer debt. Next, you’ll need an emergency fund placed in T-bills, CDs, or money market accounts; this should be enough for six months of living expenses, and should be in a taxable account. (Putting your emergency money in a 401(k) or IRA is a terrible idea, since if you need it, you’ll almost certainly have to pay a substantial tax penalty to get it out.) Then, and only then, can you start to save seriously for retirement. For most young people, this will mean some mix of an employer-based plan, such as a 401(k), individual IRA accounts, and taxable accounts. There are two kinds of IRA accounts: traditional and Roth. The main difference between the two comes when you pay taxes on them; with a traditional account, you get a tax deduction on the contributions, and pay taxes when the money is withdrawn, generally after age 59½. (You can withdraw money before 59½, but, with a few important exceptions, you’ll pay a substantial tax penalty for doing so.) With a Roth, it’s the opposite: you contribute with money you’ve already paid taxes on, but pay no taxes on withdrawals in retirement. There’s thus not a lot of difference between a 401(k) and a traditional IRA; in fact, you can seamlessly roll the former into the latter after you leave your employer. In general, the Roth is a better deal than a traditional IRA, since not only can you contribute “more” to the Roth (since $5,500—the current annual contribution limit—of after-tax dollars is worth a lot more than $5,500 in pre-tax dollars), but also you’re hopefully in a higher tax bracket when you retire. Your goal, as mentioned, is to save at least 15 percent of your salary in some combination of 401(k)/IRA/taxable savings. But in reality, the best strategy is to save as much as you can, and don’t stop doing so until the day you die. The optimal strategy for most young people is thus to first max out their 401(k) match, then contribute the maximum to a Roth IRA (assuming they’re not making too much money to qualify for the Roth, approximately $200,000 for a married couple and $120,000 for a single person), then save in a taxable account on top of that. A frequent problem with 401(k) plans is the quality of the fund offerings. You should look carefully at the fund expenses offered in your employer’s plan. If its expense ratios are in general more than 1.0%, then you have a lousy one, and you should contribute only up to the match. If its expenses are in general lower than 0.5%, and particularly if it includes Vanguard’s index funds or Fidelity’s Spartanclass funds (which have fees as low as Vanguard’s), then you might consider making significant voluntary contributions in excess of the match limits. For most young savers, fully maxing out voluntary 401(k) contributions (assuming you have a “good” 401(k) with low expenses) and the annual Roth limit will get them well over the 15 percent savings target. Your contributions to your 401(k), IRA, and taxable accounts should be made equally to the indexed U.S. stock, foreign stock, and bond funds available to you. Once per year, you should “rebalance” them back to equal status. In the good years, this will mean selling some stocks, which you should avoid doing in a taxable account, since this will incur capital gains taxes. In practice, this means keeping a fair amount of your stock holdings in a tax sheltered 401(k) or IRA. This will not be a problem for the typical young investor, since he or she will have a relatively small amount of his or her assets in a taxable account.","Use only the information given below. Keep your responses concise and use bullet points where appropriate.
+
+EVIDENCE:
+So, how do you actually implement the investment plan outlined above? As mentioned in the first section, your biggest priority is to get yourself out of debt; until that point, the only investing you should be doing is with the minimum 401(k) or other defined contribution savings required to “max out” your employer match; beyond that, you should earmark every spare penny to eliminating your student and consumer debt. Next, you’ll need an emergency fund placed in T-bills, CDs, or money market accounts; this should be enough for six months of living expenses, and should be in a taxable account. (Putting your emergency money in a 401(k) or IRA is a terrible idea, since if you need it, you’ll almost certainly have to pay a substantial tax penalty to get it out.) Then, and only then, can you start to save seriously for retirement. For most young people, this will mean some mix of an employer-based plan, such as a 401(k), individual IRA accounts, and taxable accounts. There are two kinds of IRA accounts: traditional and Roth. The main difference between the two comes when you pay taxes on them; with a traditional account, you get a tax deduction on the contributions, and pay taxes when the money is withdrawn, generally after age 59½. (You can withdraw money before 59½, but, with a few important exceptions, you’ll pay a substantial tax penalty for doing so.) With a Roth, it’s the opposite: you contribute with money you’ve already paid taxes on, but pay no taxes on withdrawals in retirement. There’s thus not a lot of difference between a 401(k) and a traditional IRA; in fact, you can seamlessly roll the former into the latter after you leave your employer. In general, the Roth is a better deal than a traditional IRA, since not only can you contribute “more” to the Roth (since $5,500—the current annual contribution limit—of after-tax dollars is worth a lot more than $5,500 in pre-tax dollars), but also you’re hopefully in a higher tax bracket when you retire. Your goal, as mentioned, is to save at least 15 percent of your salary in some combination of 401(k)/IRA/taxable savings. But in reality, the best strategy is to save as much as you can, and don’t stop doing so until the day you die. The optimal strategy for most young people is thus to first max out their 401(k) match, then contribute the maximum to a Roth IRA (assuming they’re not making too much money to qualify for the Roth, approximately $200,000 for a married couple and $120,000 for a single person), then save in a taxable account on top of that. A frequent problem with 401(k) plans is the quality of the fund offerings. You should look carefully at the fund expenses offered in your employer’s plan. If its expense ratios are in general more than 1.0%, then you have a lousy one, and you should contribute only up to the match. If its expenses are in general lower than 0.5%, and particularly if it includes Vanguard’s index funds or Fidelity’s Spartanclass funds (which have fees as low as Vanguard’s), then you might consider making significant voluntary contributions in excess of the match limits. For most young savers, fully maxing out voluntary 401(k) contributions (assuming you have a “good” 401(k) with low expenses) and the annual Roth limit will get them well over the 15 percent savings target. Your contributions to your 401(k), IRA, and taxable accounts should be made equally to the indexed U.S. stock, foreign stock, and bond funds available to you. Once per year, you should “rebalance” them back to equal status. In the good years, this will mean selling some stocks, which you should avoid doing in a taxable account, since this will incur capital gains taxes. In practice, this means keeping a fair amount of your stock holdings in a tax sheltered 401(k) or IRA. This will not be a problem for the typical young investor, since he or she will have a relatively small amount of his or her assets in a taxable account.
+
+USER:
+If I'm looking to minimise my tax exposure for my retirement funds, what are some things I should focus on?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,16,20,681,,572
+Do not use external resources for your answer. Only use the provided context block.,What does the book include to help answer important questions about Bitcoin?,"There’s a lot of excitement about Bitcoin and cryptocurrencies. Optimists claim that Bitcoin will fundamentally alter payments, economics, and even politics around the world. Pessimists claim Bitcoin is inherently broken and will suffer an inevitable and spectacular collapse. Underlying these differing views is significant confusion about what Bitcoin is and how it works. We wrote this book to help cut through the hype and get to the core of what makes Bitcoin unique. To really understand what is special about Bitcoin, we need to understand how it works at a technical level. Bitcoin truly is a new technology and we can only get so far by explaining it through simple analogies to past technologies. We’ll assume that you have a basic understanding of computer science — how computers work, data structures and algorithms, and some programming experience. If you’re an undergraduate or graduate student of computer science, a software developer, an entrepreneur, or a technology hobbyist, this textbook is for you. In this book we’ll address the important questions about Bitcoin. How does Bitcoin work? What makes it different? How secure are your bitcoins? How anonymous are Bitcoin users? What applications can we build using Bitcoin as a platform? Can cryptocurrencies be regulated? If we were designing a new cryptocurrency today, what would we change? What might the future hold? Each chapter has a series of homework questions to help you understand these questions at a deeper level. In addition, there is a series of programming assignments in which you’ll implement various components of Bitcoin in simplified models. If you’re an auditory learner, most of the material of this book is available as a series of video lectures. You can find all these on our ​Coursera course.​ You should also supplement your learning with information you can find online including the Bitcoin wiki, forums, and research papers, and by interacting with your peers and the Bitcoin community. After reading this book, you’ll know everything you need to be able to separate fact from fiction when reading claims about Bitcoin and other cryptocurrencies. You’ll have the conceptual foundations you need to engineer secure software that interacts with the Bitcoin network. And you’ll be able to integrate ideas from Bitcoin into your own projects.","Do not use external resources for your answer. Only use the provided context block. What does the book include to help answer important questions about Bitcoin? [There’s a lot of excitement about Bitcoin and cryptocurrencies. Optimists claim that Bitcoin will fundamentally alter payments, economics, and even politics around the world. Pessimists claim Bitcoin is inherently broken and will suffer an inevitable and spectacular collapse. Underlying these differing views is significant confusion about what Bitcoin is and how it works. We wrote this book to help cut through the hype and get to the core of what makes Bitcoin unique. To really understand what is special about Bitcoin, we need to understand how it works at a technical level. Bitcoin truly is a new technology and we can only get so far by explaining it through simple analogies to past technologies. We’ll assume that you have a basic understanding of computer science — how computers work, data structures and algorithms, and some programming experience. If you’re an undergraduate or graduate student of computer science, a software developer, an entrepreneur, or a technology hobbyist, this textbook is for you. In this book we’ll address the important questions about Bitcoin. How does Bitcoin work? What makes it different? How secure are your bitcoins? How anonymous are Bitcoin users? What applications can we build using Bitcoin as a platform? Can cryptocurrencies be regulated? If we were designing a new cryptocurrency today, what would we change? What might the future hold? Each chapter has a series of homework questions to help you understand these questions at a deeper level. In addition, there is a series of programming assignments in which you’ll implement various components of Bitcoin in simplified models. If you’re an auditory learner, most of the material of this book is available as a series of video lectures. You can find all these on our ​Coursera course.​ You should also supplement your learning with information you can find online including the Bitcoin wiki, forums, and research papers, and by interacting with your peers and the Bitcoin community. After reading this book, you’ll know everything you need to be able to separate fact from fiction when reading claims about Bitcoin and other cryptocurrencies. You’ll have the conceptual foundations you need to engineer secure software that interacts with the Bitcoin network. And you’ll be able to integrate ideas from Bitcoin into your own projects.]","Do not use external resources for your answer. Only use the provided context block.
+
+EVIDENCE:
+There’s a lot of excitement about Bitcoin and cryptocurrencies. Optimists claim that Bitcoin will fundamentally alter payments, economics, and even politics around the world. Pessimists claim Bitcoin is inherently broken and will suffer an inevitable and spectacular collapse. Underlying these differing views is significant confusion about what Bitcoin is and how it works. We wrote this book to help cut through the hype and get to the core of what makes Bitcoin unique. To really understand what is special about Bitcoin, we need to understand how it works at a technical level. Bitcoin truly is a new technology and we can only get so far by explaining it through simple analogies to past technologies. We’ll assume that you have a basic understanding of computer science — how computers work, data structures and algorithms, and some programming experience. If you’re an undergraduate or graduate student of computer science, a software developer, an entrepreneur, or a technology hobbyist, this textbook is for you. In this book we’ll address the important questions about Bitcoin. How does Bitcoin work? What makes it different? How secure are your bitcoins? How anonymous are Bitcoin users? What applications can we build using Bitcoin as a platform? Can cryptocurrencies be regulated? If we were designing a new cryptocurrency today, what would we change? What might the future hold? Each chapter has a series of homework questions to help you understand these questions at a deeper level. In addition, there is a series of programming assignments in which you’ll implement various components of Bitcoin in simplified models. If you’re an auditory learner, most of the material of this book is available as a series of video lectures. You can find all these on our ​Coursera course.​ You should also supplement your learning with information you can find online including the Bitcoin wiki, forums, and research papers, and by interacting with your peers and the Bitcoin community. After reading this book, you’ll know everything you need to be able to separate fact from fiction when reading claims about Bitcoin and other cryptocurrencies. You’ll have the conceptual foundations you need to engineer secure software that interacts with the Bitcoin network. And you’ll be able to integrate ideas from Bitcoin into your own projects.
+
+USER:
+What does the book include to help answer important questions about Bitcoin?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,14,12,372,,419
+"Only provide the opinions that were given in the context document. If you cannot answer a question using the provided context alone, then say ""I'm sorry, but I do not have the context to answer this question.""","Using a Chromebook, how do I locate the text app?","Skip to content Tech Time With Timmy logo Home Videos Articles About Us Contact Us SearchSearch Search... How To Create A Text File On A Chromebook August 9, 2022 This Article May Contain Affiliate Links how to create a text file on chromebook Table of Contents How To Create A TXT file On A Chromebook How To Save The TXT File How To Open The TXT File Text files (or .txt files) are useful files that contain plain, unformatted text. And if you ever want to create a new .txt file on your Chromebook, you’re in luck. Because that’s exactly what I’m going to show you how to do in this article. Prefer to watch a video about how to create a text file on a Chromebook? Click here. Before we begin, I’d just like to point out that a .txt file is a very basic file that contains only unformatted plain text. And if you want to create a file with nicer looking formatted text on a Chromebook, I would recommend something like Google Docs. But if you do want to create a .txt file, let’s proceed with the tutorial. How To Create A TXT file On A Chromebook Chrome OS comes with a built in app for creating, saving, opening, and editing .txt files. So to create a text on your Chromebook, you’ll just need to open an app called “Text” which should already be preinstalled on your Chromebook. So just click on the circle in the bottom left hand corner to view all your apps… txt chromebook And you should find the “Text” app somewhere in here. how to create a text file on a chromebook Now you’ll be in the “Text” app, and if you’ve never used the text app before, it will automatically create a new .txt file for you, and you’ll be ready to start typing! how to create a txt file on a chromebook However, if you’ve opened a different .txt file on your Chromebook in the past, it would have opened in the Text app, and now whenever you open the Text app you’ll just be looking at that old file. how to create a txt file on chromebook But don’t worry, if this happens, just click “New” at the top of the left hand menu and it will create a new blank .txt file just like it would if you opened the app for the first time. how to create text file on chromebook But once you’ve got a blank text file like this, you’re ready to type whatever you want in it. how to create txt file on chromebook How To Save The TXT File Once you’ve typed your text into your new text file, all that’s left to do is save it. In the future, when you’re saving changes to an existing text file, you’ll do that by clicking the “Save” button. But, when you’re saving a brand new text file like this one, you’ll need to click “Save As” instead. how to create text file on a chromebook Now, a files window will appear, and you’ll need to name your .txt file, and choose a location for it. how to create txt file on a chromebook By default, the name of the text file will be whatever you typed in the first line of the file, which in my case is “Hello”. If you’re happy with that name, you don’t have to change it, but if you do want to give the file a propper name, you can do that here. (Just make sure you leave .txt on the end of it so that your computer knows it’s a .txt file). how to make a text file on a chromebook And you can also choose where you want the file to be saved. I’m just going to save mine in the “My files” folder to keep things simple, but if you wanted to save your file in Google Drive, or perhaps in a specific folder inside the “My Files” folder, you could do that now by double clicking the folder you want to save it in. But, once you’re happy with both the file name and the location, you can go ahead and click the “Save” button and your .txt file will be saved! how to make a txt file on a chromebook Now that your .txt file is saved, you can safely close the Text app if you want to. And if you open the files app and open the folder where you saved your .txt file, you will see it somewhere there! how to make text file on chromebook How To Open The TXT File Now that you’ve created your text file, if you want to open it in the future, you’ll just need to find it in the files app in the folder you saved it to, and double click on it… how to make text file on chromebook And the file will open up in the Text app. how to make a txt file on chromebook Just remember, if you make any changes to the file while it’s open, you’ll need to click “Save” before you close the Text app to save the changes. how to make text file on a chromebook And because you clicked the “Save” button instead of “Save As”, you won’t have to choose the name and location or anything, it will just update the existing file with the new changes. And that’s all there is to creating and using text files on a Chromebook! But if you want more Chromebook tutorials, you’ll find them all here. Prev Previous How To Crop A Picture On A Chromebook Don't Miss an Episode Email Your Email Address Subscribe Leave a Comment Your email address will not be published. Required fields are marked * Type here.. Type here.. Name* Name* Email* Email* Subscribe On Youtube! Subscribe! Popular Posts How To Delete Files On A Chromebook How To Delete Files On A Chromebook If you have files on your Chromebook that you want to delete, you’re in the right place! Because in this article, I’m going to show Read More » How To Open Zip File In Android How To Unzip Files On An Android Phone If you have a zip file on your Android phone that you want to unzip, you’re in the right place. Because in this article, I’m Read More » google photos change date How To Change The Date Of Photos In Google Photos Google Photos is very useful for storing and organizing all your photos. But if some of your photos say they were taken on the wrong Read More » How To Create A Folder On A Chromebook How To Create A Folder On A Chromebook If you want to create a folder on your Chromebook to keep your files organized, you’re in the right place, because today, that’s exactly what Read More » how to change wallpaper on chromebook How To Change Your Wallpaper On A Chromebook If you want to change the wallpaper on your Chromebook to give it a bit of a different look and feel, you’re in the right Read More » How To Delete Files From Google Drive On Android How To Delete Files From Google Drive On Android If you have files on Google Drive that you want to delete using your Android phone, you’re in the right place, because in this article, Read More » how to open rar files on chromebook How To Open RAR Files On A Chromebook RAR files are a type of file similar to zip files that can store multiple files inside them. They’re quite handy for uploading, downloading, and Read More » How To Change All Caps To Lowercase In Google Docs How To Change All Caps To Lowercase In Google Docs We’ve all been there, you type out an entire sentence in Google docs, and then look up at the screen only to discover that caps Read More » how to open rar file in google drive How To Open A Rar File In Google Drive A RAR file is a cool file that can store multiple files inside it. But if you have a RAR file stored in Google Drive, Read More » Categories All Articles Google Docs Tips Google Drive Tutorials Chrome OS Other Tech Tips And Tutorials Latest Videos How To Log Other Devices Out Of Your Google Account How To Log Other Devices Out Of Your Google Account In this video, Timmy shows you how to log other devices out of your Google account. Whether you’ve logged in to your Google account on a borrowed device… Watch Video » How To Use Floating Windows On A Chromebook How To Use Floating Windows On A Chromebook In this video, Timmy shows you how to use a really handy multitasking feature in Chrome OS called Floating Windows. This allows you to have one… Watch Video » How To Transfer Google Drive Files From One Account To Another How To Transfer Google Drive Files From One Account To Another In this video, Timmy shows you how to move files from one Google Drive to another without having to download and re-upload them! If you have files… Watch Video » how to make chromebook sleep How To Make Your Chromebook Sleep In this video, Timmy shows you all four of the different ways to make your Chromebook go to sleep. So whatever your situation, if you want your… Watch Video » How To Close All Tabs In Chrome How To Close All Tabs In Chrome In this video, Timmy shows you how to easily close all of your open tabs in Google Chrome. Without having to manually click the cross icon on each of them… Watch Video » Tech Time With Timmy logo We are a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for us to earn fees by linking to Amazon.com and affiliated sites. Twitter Facebook Youtube Instagram Search Search... Search Sitemap Privacy Policy Terms And Conditions Affiliate Disclosure Work With Us © Tech Time With Timmy 2016 – 2022","Only provide the opinions that were given in the context document. If you cannot answer a question using the provided context alone, then say ""I'm sorry, but I do not have the context to answer this question."" Using a Chromebook, how do I locate the text app? Skip to content Tech Time With Timmy logo Home Videos Articles About Us Contact Us SearchSearch Search... How To Create A Text File On A Chromebook August 9, 2022 This Article May Contain Affiliate Links how to create a text file on chromebook Table of Contents How To Create A TXT file On A Chromebook How To Save The TXT File How To Open The TXT File Text files (or .txt files) are useful files that contain plain, unformatted text. And if you ever want to create a new .txt file on your Chromebook, you’re in luck. Because that’s exactly what I’m going to show you how to do in this article. Prefer to watch a video about how to create a text file on a Chromebook? Click here. Before we begin, I’d just like to point out that a .txt file is a very basic file that contains only unformatted plain text. And if you want to create a file with nicer looking formatted text on a Chromebook, I would recommend something like Google Docs. But if you do want to create a .txt file, let’s proceed with the tutorial. How To Create A TXT file On A Chromebook Chrome OS comes with a built in app for creating, saving, opening, and editing .txt files. So to create a text on your Chromebook, you’ll just need to open an app called “Text” which should already be preinstalled on your Chromebook. So just click on the circle in the bottom left hand corner to view all your apps… txt chromebook And you should find the “Text” app somewhere in here. how to create a text file on a chromebook Now you’ll be in the “Text” app, and if you’ve never used the text app before, it will automatically create a new .txt file for you, and you’ll be ready to start typing! how to create a txt file on a chromebook However, if you’ve opened a different .txt file on your Chromebook in the past, it would have opened in the Text app, and now whenever you open the Text app you’ll just be looking at that old file. how to create a txt file on chromebook But don’t worry, if this happens, just click “New” at the top of the left hand menu and it will create a new blank .txt file just like it would if you opened the app for the first time. how to create text file on chromebook But once you’ve got a blank text file like this, you’re ready to type whatever you want in it. how to create txt file on chromebook How To Save The TXT File Once you’ve typed your text into your new text file, all that’s left to do is save it. In the future, when you’re saving changes to an existing text file, you’ll do that by clicking the “Save” button. But, when you’re saving a brand new text file like this one, you’ll need to click “Save As” instead. how to create text file on a chromebook Now, a files window will appear, and you’ll need to name your .txt file, and choose a location for it. how to create txt file on a chromebook By default, the name of the text file will be whatever you typed in the first line of the file, which in my case is “Hello”. If you’re happy with that name, you don’t have to change it, but if you do want to give the file a propper name, you can do that here. (Just make sure you leave .txt on the end of it so that your computer knows it’s a .txt file). how to make a text file on a chromebook And you can also choose where you want the file to be saved. I’m just going to save mine in the “My files” folder to keep things simple, but if you wanted to save your file in Google Drive, or perhaps in a specific folder inside the “My Files” folder, you could do that now by double clicking the folder you want to save it in. But, once you’re happy with both the file name and the location, you can go ahead and click the “Save” button and your .txt file will be saved! how to make a txt file on a chromebook Now that your .txt file is saved, you can safely close the Text app if you want to. And if you open the files app and open the folder where you saved your .txt file, you will see it somewhere there! how to make text file on chromebook How To Open The TXT File Now that you’ve created your text file, if you want to open it in the future, you’ll just need to find it in the files app in the folder you saved it to, and double click on it… how to make text file on chromebook And the file will open up in the Text app. how to make a txt file on chromebook Just remember, if you make any changes to the file while it’s open, you’ll need to click “Save” before you close the Text app to save the changes. how to make text file on a chromebook And because you clicked the “Save” button instead of “Save As”, you won’t have to choose the name and location or anything, it will just update the existing file with the new changes. And that’s all there is to creating and using text files on a Chromebook! But if you want more Chromebook tutorials, you’ll find them all here. Prev Previous How To Crop A Picture On A Chromebook Don't Miss an Episode Email Your Email Address Subscribe Leave a Comment Your email address will not be published. Required fields are marked * Type here.. Type here.. Name* Name* Email* Email* Subscribe On Youtube! Subscribe! Popular Posts How To Delete Files On A Chromebook How To Delete Files On A Chromebook If you have files on your Chromebook that you want to delete, you’re in the right place! Because in this article, I’m going to show Read More » How To Open Zip File In Android How To Unzip Files On An Android Phone If you have a zip file on your Android phone that you want to unzip, you’re in the right place. Because in this article, I’m Read More » google photos change date How To Change The Date Of Photos In Google Photos Google Photos is very useful for storing and organizing all your photos. But if some of your photos say they were taken on the wrong Read More » How To Create A Folder On A Chromebook How To Create A Folder On A Chromebook If you want to create a folder on your Chromebook to keep your files organized, you’re in the right place, because today, that’s exactly what Read More » how to change wallpaper on chromebook How To Change Your Wallpaper On A Chromebook If you want to change the wallpaper on your Chromebook to give it a bit of a different look and feel, you’re in the right Read More » How To Delete Files From Google Drive On Android How To Delete Files From Google Drive On Android If you have files on Google Drive that you want to delete using your Android phone, you’re in the right place, because in this article, Read More » how to open rar files on chromebook How To Open RAR Files On A Chromebook RAR files are a type of file similar to zip files that can store multiple files inside them. They’re quite handy for uploading, downloading, and Read More » How To Change All Caps To Lowercase In Google Docs How To Change All Caps To Lowercase In Google Docs We’ve all been there, you type out an entire sentence in Google docs, and then look up at the screen only to discover that caps Read More » how to open rar file in google drive How To Open A Rar File In Google Drive A RAR file is a cool file that can store multiple files inside it. But if you have a RAR file stored in Google Drive, Read More » Categories All Articles Google Docs Tips Google Drive Tutorials Chrome OS Other Tech Tips And Tutorials Latest Videos How To Log Other Devices Out Of Your Google Account How To Log Other Devices Out Of Your Google Account In this video, Timmy shows you how to log other devices out of your Google account. Whether you’ve logged in to your Google account on a borrowed device… Watch Video » How To Use Floating Windows On A Chromebook How To Use Floating Windows On A Chromebook In this video, Timmy shows you how to use a really handy multitasking feature in Chrome OS called Floating Windows. This allows you to have one… Watch Video » How To Transfer Google Drive Files From One Account To Another How To Transfer Google Drive Files From One Account To Another In this video, Timmy shows you how to move files from one Google Drive to another without having to download and re-upload them! If you have files… Watch Video » how to make chromebook sleep How To Make Your Chromebook Sleep In this video, Timmy shows you all four of the different ways to make your Chromebook go to sleep. So whatever your situation, if you want your… Watch Video » How To Close All Tabs In Chrome How To Close All Tabs In Chrome In this video, Timmy shows you how to easily close all of your open tabs in Google Chrome. Without having to manually click the cross icon on each of them… Watch Video » Tech Time With Timmy logo We are a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for us to earn fees by linking to Amazon.com and affiliated sites. Twitter Facebook Youtube Instagram Search Search... Search Sitemap Privacy Policy Terms And Conditions Affiliate Disclosure Work With Us © Tech Time With Timmy 2016 – 2022","Only provide the opinions that were given in the context document. If you cannot answer a question using the provided context alone, then say ""I'm sorry, but I do not have the context to answer this question.""
+
+EVIDENCE:
+Skip to content Tech Time With Timmy logo Home Videos Articles About Us Contact Us SearchSearch Search... How To Create A Text File On A Chromebook August 9, 2022 This Article May Contain Affiliate Links how to create a text file on chromebook Table of Contents How To Create A TXT file On A Chromebook How To Save The TXT File How To Open The TXT File Text files (or .txt files) are useful files that contain plain, unformatted text. And if you ever want to create a new .txt file on your Chromebook, you’re in luck. Because that’s exactly what I’m going to show you how to do in this article. Prefer to watch a video about how to create a text file on a Chromebook? Click here. Before we begin, I’d just like to point out that a .txt file is a very basic file that contains only unformatted plain text. And if you want to create a file with nicer looking formatted text on a Chromebook, I would recommend something like Google Docs. But if you do want to create a .txt file, let’s proceed with the tutorial. How To Create A TXT file On A Chromebook Chrome OS comes with a built in app for creating, saving, opening, and editing .txt files. So to create a text on your Chromebook, you’ll just need to open an app called “Text” which should already be preinstalled on your Chromebook. So just click on the circle in the bottom left hand corner to view all your apps… txt chromebook And you should find the “Text” app somewhere in here. how to create a text file on a chromebook Now you’ll be in the “Text” app, and if you’ve never used the text app before, it will automatically create a new .txt file for you, and you’ll be ready to start typing! how to create a txt file on a chromebook However, if you’ve opened a different .txt file on your Chromebook in the past, it would have opened in the Text app, and now whenever you open the Text app you’ll just be looking at that old file. how to create a txt file on chromebook But don’t worry, if this happens, just click “New” at the top of the left hand menu and it will create a new blank .txt file just like it would if you opened the app for the first time. how to create text file on chromebook But once you’ve got a blank text file like this, you’re ready to type whatever you want in it. how to create txt file on chromebook How To Save The TXT File Once you’ve typed your text into your new text file, all that’s left to do is save it. In the future, when you’re saving changes to an existing text file, you’ll do that by clicking the “Save” button. But, when you’re saving a brand new text file like this one, you’ll need to click “Save As” instead. how to create text file on a chromebook Now, a files window will appear, and you’ll need to name your .txt file, and choose a location for it. how to create txt file on a chromebook By default, the name of the text file will be whatever you typed in the first line of the file, which in my case is “Hello”. If you’re happy with that name, you don’t have to change it, but if you do want to give the file a propper name, you can do that here. (Just make sure you leave .txt on the end of it so that your computer knows it’s a .txt file). how to make a text file on a chromebook And you can also choose where you want the file to be saved. I’m just going to save mine in the “My files” folder to keep things simple, but if you wanted to save your file in Google Drive, or perhaps in a specific folder inside the “My Files” folder, you could do that now by double clicking the folder you want to save it in. But, once you’re happy with both the file name and the location, you can go ahead and click the “Save” button and your .txt file will be saved! how to make a txt file on a chromebook Now that your .txt file is saved, you can safely close the Text app if you want to. And if you open the files app and open the folder where you saved your .txt file, you will see it somewhere there! how to make text file on chromebook How To Open The TXT File Now that you’ve created your text file, if you want to open it in the future, you’ll just need to find it in the files app in the folder you saved it to, and double click on it… how to make text file on chromebook And the file will open up in the Text app. how to make a txt file on chromebook Just remember, if you make any changes to the file while it’s open, you’ll need to click “Save” before you close the Text app to save the changes. how to make text file on a chromebook And because you clicked the “Save” button instead of “Save As”, you won’t have to choose the name and location or anything, it will just update the existing file with the new changes. And that’s all there is to creating and using text files on a Chromebook! But if you want more Chromebook tutorials, you’ll find them all here. Prev Previous How To Crop A Picture On A Chromebook Don't Miss an Episode Email Your Email Address Subscribe Leave a Comment Your email address will not be published. Required fields are marked * Type here.. Type here.. Name* Name* Email* Email* Subscribe On Youtube! Subscribe! Popular Posts How To Delete Files On A Chromebook How To Delete Files On A Chromebook If you have files on your Chromebook that you want to delete, you’re in the right place! Because in this article, I’m going to show Read More » How To Open Zip File In Android How To Unzip Files On An Android Phone If you have a zip file on your Android phone that you want to unzip, you’re in the right place. Because in this article, I’m Read More » google photos change date How To Change The Date Of Photos In Google Photos Google Photos is very useful for storing and organizing all your photos. But if some of your photos say they were taken on the wrong Read More » How To Create A Folder On A Chromebook How To Create A Folder On A Chromebook If you want to create a folder on your Chromebook to keep your files organized, you’re in the right place, because today, that’s exactly what Read More » how to change wallpaper on chromebook How To Change Your Wallpaper On A Chromebook If you want to change the wallpaper on your Chromebook to give it a bit of a different look and feel, you’re in the right Read More » How To Delete Files From Google Drive On Android How To Delete Files From Google Drive On Android If you have files on Google Drive that you want to delete using your Android phone, you’re in the right place, because in this article, Read More » how to open rar files on chromebook How To Open RAR Files On A Chromebook RAR files are a type of file similar to zip files that can store multiple files inside them. They’re quite handy for uploading, downloading, and Read More » How To Change All Caps To Lowercase In Google Docs How To Change All Caps To Lowercase In Google Docs We’ve all been there, you type out an entire sentence in Google docs, and then look up at the screen only to discover that caps Read More » how to open rar file in google drive How To Open A Rar File In Google Drive A RAR file is a cool file that can store multiple files inside it. But if you have a RAR file stored in Google Drive, Read More » Categories All Articles Google Docs Tips Google Drive Tutorials Chrome OS Other Tech Tips And Tutorials Latest Videos How To Log Other Devices Out Of Your Google Account How To Log Other Devices Out Of Your Google Account In this video, Timmy shows you how to log other devices out of your Google account. Whether you’ve logged in to your Google account on a borrowed device… Watch Video » How To Use Floating Windows On A Chromebook How To Use Floating Windows On A Chromebook In this video, Timmy shows you how to use a really handy multitasking feature in Chrome OS called Floating Windows. This allows you to have one… Watch Video » How To Transfer Google Drive Files From One Account To Another How To Transfer Google Drive Files From One Account To Another In this video, Timmy shows you how to move files from one Google Drive to another without having to download and re-upload them! If you have files… Watch Video » how to make chromebook sleep How To Make Your Chromebook Sleep In this video, Timmy shows you all four of the different ways to make your Chromebook go to sleep. So whatever your situation, if you want your… Watch Video » How To Close All Tabs In Chrome How To Close All Tabs In Chrome In this video, Timmy shows you how to easily close all of your open tabs in Google Chrome. 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+
+USER:
+Using a Chromebook, how do I locate the text app?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,37,10,1697,,576
+Use only the provided text to formulate your answer; use no other sources. Answer in a maximum of two short paragraphs.,Why might a ticket be available in the secondary market?,"Each year, millions of Americans purchase tickets for live entertainment events, such as concerts, theatrical performances, and sporting events. In 2023, about 81 million fans in North America and 145 million fans across the world attended events that were produced by Live Nation Entertainment—a firm that promotes events, owns venues, and provides ticketing services through its subsidiary, Ticketmaster.1 IBISWorld, a market research firm, projects revenue for online ticket sales in the United States in 2024 will be $12.7 billion, with $4.2 billion (33.3%) spent on sporting events; $3.9 billion (30.7%) on concerts; and $1.5 billion (11.8%) on dance, opera, and theatrical performances.2 Congress has held hearings, 3 debated bills, and passed legislation4 related to tickets for live events (Appendix). Some Members of the 118th Congress have called attention to event ticketing issues, such as rising ticket prices (potentially due to higher ticketing service fees), and efforts to increase consumer protection (e.g., by requiring full price disclosure for tickets from the beginning of a transaction). 5 Some states have enacted legislation related to event ticketing, including legislation that seeks to address these same concerns. 6 This report provides an overview of event ticketing and actions taken by the federal government related to event ticketing. It also discusses selected legislative proposals from the 118th Congress. Overview of Event Ticketing and Selected Issues Tickets for live events initially are sold in the primary market. In the primary market, firms that provide ticketing services (i.e., ticketers) work directly with venues, promoters, producers, sports teams, and other entities to sell tickets to consumers (see Figure 1). Most tickets in the primary market are sold online,7 although some tickets may be available through other outlets, such as a local box office or call center.8 Events typically have one primary ticketer selling tickets online. For example, the primary ticketer for most Major League Baseball (MLB) teams is Tickets.com 1 Live Nation Entertainment, Inc., Securities and Exchange Commission (SEC) Form 10-K for the year ending December 31, 2023, pp. 30, 36. 2 IBISWorld, Online Event Ticket Sales in the U.S., April 2024, pp. 8-9 (hereinafter IBISWorld, Online Event Ticket Sales in the U.S.). 3 For example, see U.S. Congress, Senate Committee on the Judiciary, That’s the Ticket: Promoting Competition and Protecting Consumers in Live Entertainment, hearing, 118th Cong., 1st sess., January 24, 2023, S.Hrg. 118-31 (Washington, DC: GPO, 2023), https://www.govinfo.gov/content/pkg/CHRG-118shrg52250/pdf/CHRG118shrg52250.pdf (hereinafter Senate Judiciary hearing, That’s the Ticket), and U.S. Congress, House Energy and Commerce Committee, Subcommittee on Oversight and Investigations, In the Dark: Lack of Transparency in the Live Event Ticketing Industry, hearing, 116th Cong., 2nd sess., February 26, 2020, https://docs.house.gov/Committee/ Calendar/ByEvent.aspx?EventId=110588. 4 The 114th Congress passed the Better Online Ticket Sales Act of 2016 (BOTS Act; P.L. 114-274). For more information about the BOTS Act, see “Federal Oversight of Event Ticketing.” 5 Senate Judiciary hearing, That’s the Ticket. 6 For example, some states require the total price of a ticket, including any taxes and fees, to be provided when the price is initially displayed (e.g., Connecticut General Statute §53-289a, Georgia Code Annotated §43-4B-28(a)(3), and New York Arts and Cultural Affairs Law §25.23). 7 For example, in 2022, Live Nation estimated that it sold 56%, 42%, and 2% of its tickets through mobile apps, websites, and ticket outlets, respectively. Live Nation Entertainment, Inc., SEC Form 10-K for the year ending December 31, 2022, p. 11. 8 IBISWorld, Online Event Ticket Sales in the U.S., p. 12; and U.S. Government Accountability Office (GAO), Event Ticket Sales: Market Characteristics and Consumer Protection Issues, April 2018, pp. 4-5, https://www.gao.gov/assets/ 700/691247.pdf (hereinafter GAO, Event Ticket Sales). E Tickets for Live Entertainment Events Congressional Research Service 2 (a subsidiary of MLB Advanced Media),9 and the primary ticketer for most National Football League (NFL) teams is Ticketmaster. 10 A portion of tickets might be sold through presales (e.g., an artist’s fan club or season tickets), bundled together as a package (e.g., group tickets), or held for certain individuals (e.g., sponsors, media, high-profile guests). 11 Some live event tickets might be nontransferable—consumers might be required to show the credit or debit card that was used to make the purchase and a matching photo ID to enter the event.12 Tickets for some live events also are available in the secondary market. In the secondary market, individuals who purchased tickets in the primary market can resell their tickets, typically using ticketers that operate in the secondary market. Individuals selling tickets in the secondary market can include consumers who cannot or no longer wish to attend the event, as well as ticket brokers who purchase tickets in the primary market with the intention of reselling them in the secondary market for a profit. Some event organizers provide tickets directly to ticket brokers. 13 Thus, an event can have multiple individuals using different secondary ticketers.","Use only the provided text to formulate your answer; use no other sources. Answer in a maximum of two short paragraphs. Provided text: Each year, millions of Americans purchase tickets for live entertainment events, such as concerts, theatrical performances, and sporting events. In 2023, about 81 million fans in North America and 145 million fans across the world attended events that were produced by Live Nation Entertainment—a firm that promotes events, owns venues, and provides ticketing services through its subsidiary, Ticketmaster.1 IBISWorld, a market research firm, projects revenue for online ticket sales in the United States in 2024 will be $12.7 billion, with $4.2 billion (33.3%) spent on sporting events; $3.9 billion (30.7%) on concerts; and $1.5 billion (11.8%) on dance, opera, and theatrical performances.2 Congress has held hearings, 3 debated bills, and passed legislation4 related to tickets for live events (Appendix). Some Members of the 118th Congress have called attention to event ticketing issues, such as rising ticket prices (potentially due to higher ticketing service fees), and efforts to increase consumer protection (e.g., by requiring full price disclosure for tickets from the beginning of a transaction). 5 Some states have enacted legislation related to event ticketing, including legislation that seeks to address these same concerns. 6 This report provides an overview of event ticketing and actions taken by the federal government related to event ticketing. It also discusses selected legislative proposals from the 118th Congress. Overview of Event Ticketing and Selected Issues Tickets for live events initially are sold in the primary market. In the primary market, firms that provide ticketing services (i.e., ticketers) work directly with venues, promoters, producers, sports teams, and other entities to sell tickets to consumers (see Figure 1). Most tickets in the primary market are sold online,7 although some tickets may be available through other outlets, such as a local box office or call center.8 Events typically have one primary ticketer selling tickets online. For example, the primary ticketer for most Major League Baseball (MLB) teams is Tickets.com 1 Live Nation Entertainment, Inc., Securities and Exchange Commission (SEC) Form 10-K for the year ending December 31, 2023, pp. 30, 36. 2 IBISWorld, Online Event Ticket Sales in the U.S., April 2024, pp. 8-9 (hereinafter IBISWorld, Online Event Ticket Sales in the U.S.). 3 For example, see U.S. Congress, Senate Committee on the Judiciary, That’s the Ticket: Promoting Competition and Protecting Consumers in Live Entertainment, hearing, 118th Cong., 1st sess., January 24, 2023, S.Hrg. 118-31 (Washington, DC: GPO, 2023), https://www.govinfo.gov/content/pkg/CHRG-118shrg52250/pdf/CHRG118shrg52250.pdf (hereinafter Senate Judiciary hearing, That’s the Ticket), and U.S. Congress, House Energy and Commerce Committee, Subcommittee on Oversight and Investigations, In the Dark: Lack of Transparency in the Live Event Ticketing Industry, hearing, 116th Cong., 2nd sess., February 26, 2020, https://docs.house.gov/Committee/ Calendar/ByEvent.aspx?EventId=110588. 4 The 114th Congress passed the Better Online Ticket Sales Act of 2016 (BOTS Act; P.L. 114-274). For more information about the BOTS Act, see “Federal Oversight of Event Ticketing.” 5 Senate Judiciary hearing, That’s the Ticket. 6 For example, some states require the total price of a ticket, including any taxes and fees, to be provided when the price is initially displayed (e.g., Connecticut General Statute §53-289a, Georgia Code Annotated §43-4B-28(a)(3), and New York Arts and Cultural Affairs Law §25.23). 7 For example, in 2022, Live Nation estimated that it sold 56%, 42%, and 2% of its tickets through mobile apps, websites, and ticket outlets, respectively. Live Nation Entertainment, Inc., SEC Form 10-K for the year ending December 31, 2022, p. 11. 8 IBISWorld, Online Event Ticket Sales in the U.S., p. 12; and U.S. Government Accountability Office (GAO), Event Ticket Sales: Market Characteristics and Consumer Protection Issues, April 2018, pp. 4-5, https://www.gao.gov/assets/ 700/691247.pdf (hereinafter GAO, Event Ticket Sales). E Tickets for Live Entertainment Events Congressional Research Service 2 (a subsidiary of MLB Advanced Media),9 and the primary ticketer for most National Football League (NFL) teams is Ticketmaster. 10 A portion of tickets might be sold through presales (e.g., an artist’s fan club or season tickets), bundled together as a package (e.g., group tickets), or held for certain individuals (e.g., sponsors, media, high-profile guests). 11 Some live event tickets might be nontransferable—consumers might be required to show the credit or debit card that was used to make the purchase and a matching photo ID to enter the event.12 Tickets for some live events also are available in the secondary market. In the secondary market, individuals who purchased tickets in the primary market can resell their tickets, typically using ticketers that operate in the secondary market. Individuals selling tickets in the secondary market can include consumers who cannot or no longer wish to attend the event, as well as ticket brokers who purchase tickets in the primary market with the intention of reselling them in the secondary market for a profit. Some event organizers provide tickets directly to ticket brokers. 13 Thus, an event can have multiple individuals using different secondary ticketers. Why might a ticket be available in the secondary market?","Use only the provided text to formulate your answer; use no other sources. Answer in a maximum of two short paragraphs.
+
+EVIDENCE:
+Each year, millions of Americans purchase tickets for live entertainment events, such as concerts, theatrical performances, and sporting events. In 2023, about 81 million fans in North America and 145 million fans across the world attended events that were produced by Live Nation Entertainment—a firm that promotes events, owns venues, and provides ticketing services through its subsidiary, Ticketmaster.1 IBISWorld, a market research firm, projects revenue for online ticket sales in the United States in 2024 will be $12.7 billion, with $4.2 billion (33.3%) spent on sporting events; $3.9 billion (30.7%) on concerts; and $1.5 billion (11.8%) on dance, opera, and theatrical performances.2 Congress has held hearings, 3 debated bills, and passed legislation4 related to tickets for live events (Appendix). Some Members of the 118th Congress have called attention to event ticketing issues, such as rising ticket prices (potentially due to higher ticketing service fees), and efforts to increase consumer protection (e.g., by requiring full price disclosure for tickets from the beginning of a transaction). 5 Some states have enacted legislation related to event ticketing, including legislation that seeks to address these same concerns. 6 This report provides an overview of event ticketing and actions taken by the federal government related to event ticketing. It also discusses selected legislative proposals from the 118th Congress. Overview of Event Ticketing and Selected Issues Tickets for live events initially are sold in the primary market. In the primary market, firms that provide ticketing services (i.e., ticketers) work directly with venues, promoters, producers, sports teams, and other entities to sell tickets to consumers (see Figure 1). Most tickets in the primary market are sold online,7 although some tickets may be available through other outlets, such as a local box office or call center.8 Events typically have one primary ticketer selling tickets online. For example, the primary ticketer for most Major League Baseball (MLB) teams is Tickets.com 1 Live Nation Entertainment, Inc., Securities and Exchange Commission (SEC) Form 10-K for the year ending December 31, 2023, pp. 30, 36. 2 IBISWorld, Online Event Ticket Sales in the U.S., April 2024, pp. 8-9 (hereinafter IBISWorld, Online Event Ticket Sales in the U.S.). 3 For example, see U.S. Congress, Senate Committee on the Judiciary, That’s the Ticket: Promoting Competition and Protecting Consumers in Live Entertainment, hearing, 118th Cong., 1st sess., January 24, 2023, S.Hrg. 118-31 (Washington, DC: GPO, 2023), https://www.govinfo.gov/content/pkg/CHRG-118shrg52250/pdf/CHRG118shrg52250.pdf (hereinafter Senate Judiciary hearing, That’s the Ticket), and U.S. Congress, House Energy and Commerce Committee, Subcommittee on Oversight and Investigations, In the Dark: Lack of Transparency in the Live Event Ticketing Industry, hearing, 116th Cong., 2nd sess., February 26, 2020, https://docs.house.gov/Committee/ Calendar/ByEvent.aspx?EventId=110588. 4 The 114th Congress passed the Better Online Ticket Sales Act of 2016 (BOTS Act; P.L. 114-274). For more information about the BOTS Act, see “Federal Oversight of Event Ticketing.” 5 Senate Judiciary hearing, That’s the Ticket. 6 For example, some states require the total price of a ticket, including any taxes and fees, to be provided when the price is initially displayed (e.g., Connecticut General Statute §53-289a, Georgia Code Annotated §43-4B-28(a)(3), and New York Arts and Cultural Affairs Law §25.23). 7 For example, in 2022, Live Nation estimated that it sold 56%, 42%, and 2% of its tickets through mobile apps, websites, and ticket outlets, respectively. Live Nation Entertainment, Inc., SEC Form 10-K for the year ending December 31, 2022, p. 11. 8 IBISWorld, Online Event Ticket Sales in the U.S., p. 12; and U.S. Government Accountability Office (GAO), Event Ticket Sales: Market Characteristics and Consumer Protection Issues, April 2018, pp. 4-5, https://www.gao.gov/assets/ 700/691247.pdf (hereinafter GAO, Event Ticket Sales). E Tickets for Live Entertainment Events Congressional Research Service 2 (a subsidiary of MLB Advanced Media),9 and the primary ticketer for most National Football League (NFL) teams is Ticketmaster. 10 A portion of tickets might be sold through presales (e.g., an artist’s fan club or season tickets), bundled together as a package (e.g., group tickets), or held for certain individuals (e.g., sponsors, media, high-profile guests). 11 Some live event tickets might be nontransferable—consumers might be required to show the credit or debit card that was used to make the purchase and a matching photo ID to enter the event.12 Tickets for some live events also are available in the secondary market. In the secondary market, individuals who purchased tickets in the primary market can resell their tickets, typically using ticketers that operate in the secondary market. Individuals selling tickets in the secondary market can include consumers who cannot or no longer wish to attend the event, as well as ticket brokers who purchase tickets in the primary market with the intention of reselling them in the secondary market for a profit. Some event organizers provide tickets directly to ticket brokers. 13 Thus, an event can have multiple individuals using different secondary ticketers.
+
+USER:
+Why might a ticket be available in the secondary market?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",True,21,10,796,,21
+Draw your answer from the passage below only.,Write a short summary about how this acquisition will affect the video game market as a whole.,"On January 18, 2022, Microsoft Corp. announced plans to acquire Activision Blizzard Inc., a video game company, for $68.7 billion.1 The Federal Trade Commission (FTC) is reviewing the acquisition,2 as provided under the Hart-Scott-Rodino Act (HSR),3 to determine whether its effect might be “substantially to lessen competition”—a violation of Section 7 of the Clayton Act. 4 Competition authorities in other countries are reviewing Microsoft’s proposed acquisition as well.5 The companies have said they expect to complete the acquisition before June 30, 2023.6 In recent decades, enforcement of antitrust laws has typically focused on how a proposed merger or acquisition might affect consumers, such as by reducing price competition in relevant product markets. Some of the FTC’s actions and statements over the last two years suggest that in its review of Microsoft’s proposed acquisition, the FTC may be considering other factors that are discussed in this report.7 This report discusses Microsoft’s proposed acquisition of Activision Blizzard, including some of the potential effects on existing product markets, labor markets, and on product markets that do not currently exist but may develop in the future. The report also provides some considerations for Congress, discussing some bills that may affect Microsoft’s proposed acquisition or Microsoft’s future behavior if the acquisition is completed. The Video Game Industry The video game industry can be separated into three components: developers or gaming studios that create and design video games; publishers who market and monetize the video games; and distributors who provide the video games to consumers.8 Video games are most commonly played on game consoles, personal computers (PCs), and mobile devices (Figure 1). Although some retailers sell physical copies of video games for consoles and PCs, the majority of video games are sold in digital format;9 games for mobile devices are sold only in digital format. The extent of competition among distributors depends on the format and device used to play the game. The digital format of video games played on a console generally can only be downloaded from a digital store operated by the producer of the console. Games for PCs can be purchased from a selection of digital stores that are operated by various firms,10 including publishers and developers.11 Some of these firms also provide their games as apps on certain mobile devices;12 these are distributed through app stores, such as Google Play and Apple’s App Store. Consoles are typically sold at a loss; the manufacturers then profit from sales of games and subscription services.13 This can incentivize console producers to acquire developers and publishers and offer exclusive content.14 Technological developments have allowed some PCs and other devices, depending on their hardware capabilities, to compete with game consoles.15 For example, early in 2022, Valve Corp. released a handheld PC—Steam Deck—that resembles the Nintendo Switch console but provides features that are typically available on PCs, such as a web browser, and allows users to download third-party software, including other operating systems.16 Some firms have started offering video game subscription services that provide access to multiple games for a monthly fee, meaning users do not need to purchase each individual game.17 Some firms offer cloud gaming, which allows users to play video games using remote servers in data centers, reducing the hardware requirements needed to play the games and expanding the variety of devices that can be used.18 Cloud gaming, however, requires a high-speed internet connection and is not feasible for potential users who do not have access to sufficiently high broadband speeds.19 Subscription services reportedly provide 4% of total revenue in the North American and European video game markets.20 Some firms backed by venture capitalists and large firms that are primarily known for providing other online services have shown interest in entering the video game industry.21 For example, Netflix started offering games on mobile devices on November 2, 2021, and has acquired video game developers.22 These firms may be able to further expand the selection of distributors available for certain devices and potentially increase competition in the industry.23","Write a short summary about how this acquisition will affect the video game market as a whole. Draw your answer from the passage below only. Use 100 words or less. On January 18, 2022, Microsoft Corp. announced plans to acquire Activision Blizzard Inc., a video game company, for $68.7 billion.1 The Federal Trade Commission (FTC) is reviewing the acquisition,2 as provided under the Hart-Scott-Rodino Act (HSR),3 to determine whether its effect might be “substantially to lessen competition”—a violation of Section 7 of the Clayton Act. 4 Competition authorities in other countries are reviewing Microsoft’s proposed acquisition as well.5 The companies have said they expect to complete the acquisition before June 30, 2023.6 In recent decades, enforcement of antitrust laws has typically focused on how a proposed merger or acquisition might affect consumers, such as by reducing price competition in relevant product markets. Some of the FTC’s actions and statements over the last two years suggest that in its review of Microsoft’s proposed acquisition, the FTC may be considering other factors that are discussed in this report.7 This report discusses Microsoft’s proposed acquisition of Activision Blizzard, including some of the potential effects on existing product markets, labor markets, and on product markets that do not currently exist but may develop in the future. The report also provides some considerations for Congress, discussing some bills that may affect Microsoft’s proposed acquisition or Microsoft’s future behavior if the acquisition is completed. The Video Game Industry The video game industry can be separated into three components: developers or gaming studios that create and design video games; publishers who market and monetize the video games; and distributors who provide the video games to consumers.8 Video games are most commonly played on game consoles, personal computers (PCs), and mobile devices (Figure 1). Although some retailers sell physical copies of video games for consoles and PCs, the majority of video games are sold in digital format;9 games for mobile devices are sold only in digital format. The extent of competition among distributors depends on the format and device used to play the game. The digital format of video games played on a console generally can only be downloaded from a digital store operated by the producer of the console. Games for PCs can be purchased from a selection of digital stores that are operated by various firms,10 including publishers and developers.11 Some of these firms also provide their games as apps on certain mobile devices;12 these are distributed through app stores, such as Google Play and Apple’s App Store. Consoles are typically sold at a loss; the manufacturers then profit from sales of games and subscription services.13 This can incentivize console producers to acquire developers and publishers and offer exclusive content.14 Technological developments have allowed some PCs and other devices, depending on their hardware capabilities, to compete with game consoles.15 For example, early in 2022, Valve Corp. released a handheld PC—Steam Deck—that resembles the Nintendo Switch console but provides features that are typically available on PCs, such as a web browser, and allows users to download third-party software, including other operating systems.16 Some firms have started offering video game subscription services that provide access to multiple games for a monthly fee, meaning users do not need to purchase each individual game.17 Some firms offer cloud gaming, which allows users to play video games using remote servers in data centers, reducing the hardware requirements needed to play the games and expanding the variety of devices that can be used.18 Cloud gaming, however, requires a high-speed internet connection and is not feasible for potential users who do not have access to sufficiently high broadband speeds.19 Subscription services reportedly provide 4% of total revenue in the North American and European video game markets.20 Some firms backed by venture capitalists and large firms that are primarily known for providing other online services have shown interest in entering the video game industry.21 For example, Netflix started offering games on mobile devices on November 2, 2021, and has acquired video game developers.22 These firms may be able to further expand the selection of distributors available for certain devices and potentially increase competition in the industry.23","Draw your answer from the passage below only.
+
+EVIDENCE:
+On January 18, 2022, Microsoft Corp. announced plans to acquire Activision Blizzard Inc., a video game company, for $68.7 billion.1 The Federal Trade Commission (FTC) is reviewing the acquisition,2 as provided under the Hart-Scott-Rodino Act (HSR),3 to determine whether its effect might be “substantially to lessen competition”—a violation of Section 7 of the Clayton Act. 4 Competition authorities in other countries are reviewing Microsoft’s proposed acquisition as well.5 The companies have said they expect to complete the acquisition before June 30, 2023.6 In recent decades, enforcement of antitrust laws has typically focused on how a proposed merger or acquisition might affect consumers, such as by reducing price competition in relevant product markets. Some of the FTC’s actions and statements over the last two years suggest that in its review of Microsoft’s proposed acquisition, the FTC may be considering other factors that are discussed in this report.7 This report discusses Microsoft’s proposed acquisition of Activision Blizzard, including some of the potential effects on existing product markets, labor markets, and on product markets that do not currently exist but may develop in the future. The report also provides some considerations for Congress, discussing some bills that may affect Microsoft’s proposed acquisition or Microsoft’s future behavior if the acquisition is completed. The Video Game Industry The video game industry can be separated into three components: developers or gaming studios that create and design video games; publishers who market and monetize the video games; and distributors who provide the video games to consumers.8 Video games are most commonly played on game consoles, personal computers (PCs), and mobile devices (Figure 1). Although some retailers sell physical copies of video games for consoles and PCs, the majority of video games are sold in digital format;9 games for mobile devices are sold only in digital format. The extent of competition among distributors depends on the format and device used to play the game. The digital format of video games played on a console generally can only be downloaded from a digital store operated by the producer of the console. Games for PCs can be purchased from a selection of digital stores that are operated by various firms,10 including publishers and developers.11 Some of these firms also provide their games as apps on certain mobile devices;12 these are distributed through app stores, such as Google Play and Apple’s App Store. Consoles are typically sold at a loss; the manufacturers then profit from sales of games and subscription services.13 This can incentivize console producers to acquire developers and publishers and offer exclusive content.14 Technological developments have allowed some PCs and other devices, depending on their hardware capabilities, to compete with game consoles.15 For example, early in 2022, Valve Corp. released a handheld PC—Steam Deck—that resembles the Nintendo Switch console but provides features that are typically available on PCs, such as a web browser, and allows users to download third-party software, including other operating systems.16 Some firms have started offering video game subscription services that provide access to multiple games for a monthly fee, meaning users do not need to purchase each individual game.17 Some firms offer cloud gaming, which allows users to play video games using remote servers in data centers, reducing the hardware requirements needed to play the games and expanding the variety of devices that can be used.18 Cloud gaming, however, requires a high-speed internet connection and is not feasible for potential users who do not have access to sufficiently high broadband speeds.19 Subscription services reportedly provide 4% of total revenue in the North American and European video game markets.20 Some firms backed by venture capitalists and large firms that are primarily known for providing other online services have shown interest in entering the video game industry.21 For example, Netflix started offering games on mobile devices on November 2, 2021, and has acquired video game developers.22 These firms may be able to further expand the selection of distributors available for certain devices and potentially increase competition in the industry.23
+
+USER:
+Write a short summary about how this acquisition will affect the video game market as a whole.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,8,17,662,,512
+Only refer to the document for your answer. Do not use outside sources.,Based on the article when might copyrighted works to train AI programs be considered a fair use?,"Congressional Research Service **Generative Artificial Intelligence and Copyright Law** September 29, 2023 Copyright in Works Created with Generative AI A recent lawsuit challenged the human-authorship requirement in the context of works purportedly “authored” by AI. In June 2022, Stephen Thaler sued the Copyright Office for denying his application to register a visual artwork that he claims was authored “autonomously” by an AI program called the Creativity Machine. Dr. Thaler argued that human authorship is not required by the Copyright Act. On August 18, 2023, a federal district court granted summary judgment in favor of the Copyright Office. The court held that “human authorship is an essential part of a valid copyright claim,” reasoning that only human authors need copyright as an incentive to create works. Dr. Thaler has stated that he plans to appeal the decision. Assuming a copyrightable work requires a human author, works created by humans using generative AI could still be entitled to copyright protection, depending on the nature of human involvement in the creative process. However, a recent copyright proceeding and subsequent Copyright Registration Guidance indicate that the Copyright Office is unlikely to find the requisite human authorship where an AI program generates works in response to text prompts. In September 2022, Kris Kashtanova registered a copyright for a graphic novel illustrated with images that Midjourney generated in response to text inputs. In October 2022, the Copyright Office initiated cancellation proceedings, noting that Kashtanova had not disclosed the use of AI. Kashtanova responded by arguing that the images were made via “a creative, iterative process.” On February 21, 2023, the Copyright Office determined that the images were not copyrightable, deciding that Midjourney, rather than Kashtanova, authored the “visual material.” In March 2023, the Copyright Office released guidance stating that, when AI “determines the expressive elements of its output, the generated material is not the product of human authorship.” Some commentators assert that some AI-generated works should receive copyright protection, arguing that AI programs are like other tools that human beings have used to create copyrighted works. For example, the Supreme Court has held since the 1884 case Burrow-Giles Lithographic Co. v. Sarony that photographs can be entitled to copyright protection where the photographer makes decisions regarding creative elements such as composition, arrangement, and lighting. Generative AI programs might be seen as a new tool analogous to the camera, as Kashtanova argued. Other commentators and the Copyright Office dispute the photography analogy and question whether AI users exercise sufficient creative control for AI to be considered merely a tool. In Kashtanova’s case, the Copyright Office reasoned that Midjourney was not “a tool that [] Kashtanova controlled and guided to reach [their] desired image” because it “generates images in an unpredictable way.” The Copyright Office instead compared the AI user to “a client who hires an artist” and gives that artist only “general directions.” The office’s March 2023 guidance similarly claims that “users do not exercise ultimate creative control over how [generative AI] systems interpret prompts and generate materials.” One of Kashtanova’s lawyers, on the other hand, argues that the Copyright Act does not require such exacting creative control, noting that certain photographs and modern art incorporate a degree of happenstance. Some commentators argue that the Copyright Act’s distinction between copyrightable “works” and noncopyrightable “ideas” supplies another reason that copyright should not protect AI-generated works. One law professor has suggested that the human user who enters a text prompt into an AI program—for instance, asking DALL-E “to produce a painting of hedgehogs having a tea party on the beach”—has “contributed nothing more than an idea” to the finished work. According to this argument, the output image lacks a human author and cannot be copyrighted. While the Copyright Office’s actions indicate that it may be challenging to obtain copyright protection for AI-generated works, the issue remains unsettled. Applicants may file suit in U.S. district court to challenge the Copyright Office’s final decisions to refuse to register a copyright (as Dr. Thaler did), and it remains to be seen whether federal courts will agree with all of the office’s decisions. While the Copyright Office notes that courts sometimes give weight to the office’s experience and expertise in this field, courts will not necessarily adopt the office’s interpretations of the Copyright Act. In addition, the Copyright Office’s guidance accepts that works “containing” AI-generated material may be copyrighted under some circumstances, such as “sufficiently creative” human arrangements or modifications of AI-generated material or works that combine AI-generated and human-authored material. The office states that the author may only claim copyright protection “for their own contributions” to such works, and they must identify and disclaim AI-generated parts of the work if they apply to register their copyright. In September 2023, for instance, the Copyright Office Review Board affirmed the office’s refusal to register a copyright for an artwork that was generated by Midjourney and then modified in various ways by the applicant, since the applicant did not disclaim the AI-generated material. Who Owns the Copyright to Generative AI Outputs? Assuming some AI-created works may be eligible for copyright protection, who owns that copyright? In general, the Copyright Act vests ownership “initially in the author or authors of the work.” Given the lack of judicial or Copyright Office decisions recognizing copyright in AI-created works to date, however, no clear rule has emerged identifying who the “author or authors” of these works could be. Returning to the photography analogy, the AI’s creator might be compared to the camera maker, while the AI user who prompts the creation of a specific work might be compared to the photographer who uses that camera to capture a specific image. On this view, the user would be considered the author and, therefore, the initial copyright owner. The creative choices involved in coding and training the AI, on the other hand, might give an AI’s creator a stronger claim to some form of authorship than the manufacturer of a camera. Does the AI Training Process Infringe Copyright in Other Works? AI are “trained” to create literary, visual, and other artistic works by exposing the program to large amounts of data, which may include text, images, and other works downloaded from the internet. This training process involves making digital copies of existing works. As the U.S. Patent and Trademark Office has described, this process “will almost by definition involve the reproduction of entire works or substantial portions thereof.” OpenAI, for example, acknowledges that its programs are trained on “large, publicly available datasets that include copyrighted works” and that this process “involves first making copies of the data to be analyzed” (although it now offers an option to remove images from training future image generation models). Creating such copies without permission may infringe the copyright holders’ exclusive right to make reproductions of their work. AI companies may argue that their training processes constitute fair use and are therefore noninfringing. Whether or not copying constitutes fair use depends on four statutory factors under 17 U.S.C. § 107: 1. the purpose and character of the use, including whether such use is of a commercial nature or is for nonprofit educational purposes; 2. the nature of the copyrighted work; 3. the amount and substantiality of the portion used in relation to the copyrighted work as a whole; and 4. the effect of the use upon the potential market for or value of the copyrighted work. Some stakeholders argue that the use of copyrighted works to train AI programs should be considered a fair use under these factors. Regarding the first factor, OpenAI argues its purpose is “transformative” as opposed to “expressive” because the training process creates “a useful generative AI system.” OpenAI also contends that the third factor supports fair use because the copies are not made available to the public but are used only to train the program. For support, OpenAI cites The Authors Guild, Inc. v. Google, Inc., in which the U.S. Court of Appeals for the Second Circuit held that Google’s copying of entire books to create a searchable database that displayed excerpts of those books constituted fair use. Regarding the fourth fair use factor, some generative AI applications have raised concern that training AI programs on copyrighted works allows them to generate similar works that compete with the originals. For example, an AI-generated song called “Heart on My Sleeve,” made to sound like the artists Drake and The Weeknd, was heard millions of times on streaming services. Universal Music Group, which has deals with both artists, argues that AI companies violate copyright by using these artists’ songs in training data. OpenAI states that its visual art program DALL-E 3 “is designed to decline requests that ask for an image in the style of a living artist.” Plaintiffs have filed multiple lawsuits claiming the training process for AI programs infringed their copyrights in written and visual works. These include lawsuits by the Authors Guild and authors Paul Tremblay, Michael Chabon, Sarah Silverman, and others against OpenAI; separate lawsuits by Michael Chabon, Sarah Silverman, and others against Meta Platforms; proposed class action lawsuits against Alphabet Inc. and Stability AI and Midjourney; and a lawsuit by Getty Images against Stability AI. The Getty Images lawsuit, for instance, alleges that “Stability AI has copied at least 12 million copyrighted images from Getty Images’ websites . . . in order to train its Stable Diffusion model.” This lawsuit appears to dispute any characterization of fair use, arguing that Stable Diffusion is a commercial product, weighing against fair use under the first statutory factor, and that the program undermines the market for the original works, weighing against fair use under the fourth factor. In September 2023, a U.S. district court ruled that a jury trial would be needed to determine whether it was fair use for an AI company to copy case summaries from Westlaw, a legal research platform, to train an AI program to quote pertinent passages from legal opinions in response to questions from a user. The court found that, while the defendant’s use was “undoubtedly commercial,” a jury would need to resolve factual disputes concerning whether the use was “transformative” (factor 1), to what extent the nature of the plaintiff’s work favored fair use (factor 2), whether the defendant copied more than needed to train the AI program (factor 3), and whether the AI program would constitute a “market substitute” for Westlaw (factor 4). While the AI program at issue might not be considered “generative” AI, the same kinds of facts might be relevant to a court’s fair-use analysis of making copies to train generative AI models.","<Context> ======= Congressional Research Service **Generative Artificial Intelligence and Copyright Law** September 29, 2023 Copyright in Works Created with Generative AI A recent lawsuit challenged the human-authorship requirement in the context of works purportedly “authored” by AI. In June 2022, Stephen Thaler sued the Copyright Office for denying his application to register a visual artwork that he claims was authored “autonomously” by an AI program called the Creativity Machine. Dr. Thaler argued that human authorship is not required by the Copyright Act. On August 18, 2023, a federal district court granted summary judgment in favor of the Copyright Office. The court held that “human authorship is an essential part of a valid copyright claim,” reasoning that only human authors need copyright as an incentive to create works. Dr. Thaler has stated that he plans to appeal the decision. Assuming a copyrightable work requires a human author, works created by humans using generative AI could still be entitled to copyright protection, depending on the nature of human involvement in the creative process. However, a recent copyright proceeding and subsequent Copyright Registration Guidance indicate that the Copyright Office is unlikely to find the requisite human authorship where an AI program generates works in response to text prompts. In September 2022, Kris Kashtanova registered a copyright for a graphic novel illustrated with images that Midjourney generated in response to text inputs. In October 2022, the Copyright Office initiated cancellation proceedings, noting that Kashtanova had not disclosed the use of AI. Kashtanova responded by arguing that the images were made via “a creative, iterative process.” On February 21, 2023, the Copyright Office determined that the images were not copyrightable, deciding that Midjourney, rather than Kashtanova, authored the “visual material.” In March 2023, the Copyright Office released guidance stating that, when AI “determines the expressive elements of its output, the generated material is not the product of human authorship.” Some commentators assert that some AI-generated works should receive copyright protection, arguing that AI programs are like other tools that human beings have used to create copyrighted works. For example, the Supreme Court has held since the 1884 case Burrow-Giles Lithographic Co. v. Sarony that photographs can be entitled to copyright protection where the photographer makes decisions regarding creative elements such as composition, arrangement, and lighting. Generative AI programs might be seen as a new tool analogous to the camera, as Kashtanova argued. Other commentators and the Copyright Office dispute the photography analogy and question whether AI users exercise sufficient creative control for AI to be considered merely a tool. In Kashtanova’s case, the Copyright Office reasoned that Midjourney was not “a tool that [] Kashtanova controlled and guided to reach [their] desired image” because it “generates images in an unpredictable way.” The Copyright Office instead compared the AI user to “a client who hires an artist” and gives that artist only “general directions.” The office’s March 2023 guidance similarly claims that “users do not exercise ultimate creative control over how [generative AI] systems interpret prompts and generate materials.” One of Kashtanova’s lawyers, on the other hand, argues that the Copyright Act does not require such exacting creative control, noting that certain photographs and modern art incorporate a degree of happenstance. Some commentators argue that the Copyright Act’s distinction between copyrightable “works” and noncopyrightable “ideas” supplies another reason that copyright should not protect AI-generated works. One law professor has suggested that the human user who enters a text prompt into an AI program—for instance, asking DALL-E “to produce a painting of hedgehogs having a tea party on the beach”—has “contributed nothing more than an idea” to the finished work. According to this argument, the output image lacks a human author and cannot be copyrighted. While the Copyright Office’s actions indicate that it may be challenging to obtain copyright protection for AI-generated works, the issue remains unsettled. Applicants may file suit in U.S. district court to challenge the Copyright Office’s final decisions to refuse to register a copyright (as Dr. Thaler did), and it remains to be seen whether federal courts will agree with all of the office’s decisions. While the Copyright Office notes that courts sometimes give weight to the office’s experience and expertise in this field, courts will not necessarily adopt the office’s interpretations of the Copyright Act. In addition, the Copyright Office’s guidance accepts that works “containing” AI-generated material may be copyrighted under some circumstances, such as “sufficiently creative” human arrangements or modifications of AI-generated material or works that combine AI-generated and human-authored material. The office states that the author may only claim copyright protection “for their own contributions” to such works, and they must identify and disclaim AI-generated parts of the work if they apply to register their copyright. In September 2023, for instance, the Copyright Office Review Board affirmed the office’s refusal to register a copyright for an artwork that was generated by Midjourney and then modified in various ways by the applicant, since the applicant did not disclaim the AI-generated material. Who Owns the Copyright to Generative AI Outputs? Assuming some AI-created works may be eligible for copyright protection, who owns that copyright? In general, the Copyright Act vests ownership “initially in the author or authors of the work.” Given the lack of judicial or Copyright Office decisions recognizing copyright in AI-created works to date, however, no clear rule has emerged identifying who the “author or authors” of these works could be. Returning to the photography analogy, the AI’s creator might be compared to the camera maker, while the AI user who prompts the creation of a specific work might be compared to the photographer who uses that camera to capture a specific image. On this view, the user would be considered the author and, therefore, the initial copyright owner. The creative choices involved in coding and training the AI, on the other hand, might give an AI’s creator a stronger claim to some form of authorship than the manufacturer of a camera. Does the AI Training Process Infringe Copyright in Other Works? AI are “trained” to create literary, visual, and other artistic works by exposing the program to large amounts of data, which may include text, images, and other works downloaded from the internet. This training process involves making digital copies of existing works. As the U.S. Patent and Trademark Office has described, this process “will almost by definition involve the reproduction of entire works or substantial portions thereof.” OpenAI, for example, acknowledges that its programs are trained on “large, publicly available datasets that include copyrighted works” and that this process “involves first making copies of the data to be analyzed” (although it now offers an option to remove images from training future image generation models). Creating such copies without permission may infringe the copyright holders’ exclusive right to make reproductions of their work. AI companies may argue that their training processes constitute fair use and are therefore noninfringing. Whether or not copying constitutes fair use depends on four statutory factors under 17 U.S.C. § 107: 1. the purpose and character of the use, including whether such use is of a commercial nature or is for nonprofit educational purposes; 2. the nature of the copyrighted work; 3. the amount and substantiality of the portion used in relation to the copyrighted work as a whole; and 4. the effect of the use upon the potential market for or value of the copyrighted work. Some stakeholders argue that the use of copyrighted works to train AI programs should be considered a fair use under these factors. Regarding the first factor, OpenAI argues its purpose is “transformative” as opposed to “expressive” because the training process creates “a useful generative AI system.” OpenAI also contends that the third factor supports fair use because the copies are not made available to the public but are used only to train the program. For support, OpenAI cites The Authors Guild, Inc. v. Google, Inc., in which the U.S. Court of Appeals for the Second Circuit held that Google’s copying of entire books to create a searchable database that displayed excerpts of those books constituted fair use. Regarding the fourth fair use factor, some generative AI applications have raised concern that training AI programs on copyrighted works allows them to generate similar works that compete with the originals. For example, an AI-generated song called “Heart on My Sleeve,” made to sound like the artists Drake and The Weeknd, was heard millions of times on streaming services. Universal Music Group, which has deals with both artists, argues that AI companies violate copyright by using these artists’ songs in training data. OpenAI states that its visual art program DALL-E 3 “is designed to decline requests that ask for an image in the style of a living artist.” Plaintiffs have filed multiple lawsuits claiming the training process for AI programs infringed their copyrights in written and visual works. These include lawsuits by the Authors Guild and authors Paul Tremblay, Michael Chabon, Sarah Silverman, and others against OpenAI; separate lawsuits by Michael Chabon, Sarah Silverman, and others against Meta Platforms; proposed class action lawsuits against Alphabet Inc. and Stability AI and Midjourney; and a lawsuit by Getty Images against Stability AI. The Getty Images lawsuit, for instance, alleges that “Stability AI has copied at least 12 million copyrighted images from Getty Images’ websites . . . in order to train its Stable Diffusion model.” This lawsuit appears to dispute any characterization of fair use, arguing that Stable Diffusion is a commercial product, weighing against fair use under the first statutory factor, and that the program undermines the market for the original works, weighing against fair use under the fourth factor. In September 2023, a U.S. district court ruled that a jury trial would be needed to determine whether it was fair use for an AI company to copy case summaries from Westlaw, a legal research platform, to train an AI program to quote pertinent passages from legal opinions in response to questions from a user. The court found that, while the defendant’s use was “undoubtedly commercial,” a jury would need to resolve factual disputes concerning whether the use was “transformative” (factor 1), to what extent the nature of the plaintiff’s work favored fair use (factor 2), whether the defendant copied more than needed to train the AI program (factor 3), and whether the AI program would constitute a “market substitute” for Westlaw (factor 4). While the AI program at issue might not be considered “generative” AI, the same kinds of facts might be relevant to a court’s fair-use analysis of making copies to train generative AI models. <Task> ======= Only refer to the document for your answer. Do not use outside sources. <Query> ======= Based on the article when might copyrighted works to train AI programs be considered a fair use?","Only refer to the document for your answer. Do not use outside sources.
+
+EVIDENCE:
+Congressional Research Service **Generative Artificial Intelligence and Copyright Law** September 29, 2023 Copyright in Works Created with Generative AI A recent lawsuit challenged the human-authorship requirement in the context of works purportedly “authored” by AI. In June 2022, Stephen Thaler sued the Copyright Office for denying his application to register a visual artwork that he claims was authored “autonomously” by an AI program called the Creativity Machine. Dr. Thaler argued that human authorship is not required by the Copyright Act. On August 18, 2023, a federal district court granted summary judgment in favor of the Copyright Office. The court held that “human authorship is an essential part of a valid copyright claim,” reasoning that only human authors need copyright as an incentive to create works. Dr. Thaler has stated that he plans to appeal the decision. Assuming a copyrightable work requires a human author, works created by humans using generative AI could still be entitled to copyright protection, depending on the nature of human involvement in the creative process. However, a recent copyright proceeding and subsequent Copyright Registration Guidance indicate that the Copyright Office is unlikely to find the requisite human authorship where an AI program generates works in response to text prompts. In September 2022, Kris Kashtanova registered a copyright for a graphic novel illustrated with images that Midjourney generated in response to text inputs. In October 2022, the Copyright Office initiated cancellation proceedings, noting that Kashtanova had not disclosed the use of AI. Kashtanova responded by arguing that the images were made via “a creative, iterative process.” On February 21, 2023, the Copyright Office determined that the images were not copyrightable, deciding that Midjourney, rather than Kashtanova, authored the “visual material.” In March 2023, the Copyright Office released guidance stating that, when AI “determines the expressive elements of its output, the generated material is not the product of human authorship.” Some commentators assert that some AI-generated works should receive copyright protection, arguing that AI programs are like other tools that human beings have used to create copyrighted works. For example, the Supreme Court has held since the 1884 case Burrow-Giles Lithographic Co. v. Sarony that photographs can be entitled to copyright protection where the photographer makes decisions regarding creative elements such as composition, arrangement, and lighting. Generative AI programs might be seen as a new tool analogous to the camera, as Kashtanova argued. Other commentators and the Copyright Office dispute the photography analogy and question whether AI users exercise sufficient creative control for AI to be considered merely a tool. In Kashtanova’s case, the Copyright Office reasoned that Midjourney was not “a tool that [] Kashtanova controlled and guided to reach [their] desired image” because it “generates images in an unpredictable way.” The Copyright Office instead compared the AI user to “a client who hires an artist” and gives that artist only “general directions.” The office’s March 2023 guidance similarly claims that “users do not exercise ultimate creative control over how [generative AI] systems interpret prompts and generate materials.” One of Kashtanova’s lawyers, on the other hand, argues that the Copyright Act does not require such exacting creative control, noting that certain photographs and modern art incorporate a degree of happenstance. Some commentators argue that the Copyright Act’s distinction between copyrightable “works” and noncopyrightable “ideas” supplies another reason that copyright should not protect AI-generated works. One law professor has suggested that the human user who enters a text prompt into an AI program—for instance, asking DALL-E “to produce a painting of hedgehogs having a tea party on the beach”—has “contributed nothing more than an idea” to the finished work. According to this argument, the output image lacks a human author and cannot be copyrighted. While the Copyright Office’s actions indicate that it may be challenging to obtain copyright protection for AI-generated works, the issue remains unsettled. Applicants may file suit in U.S. district court to challenge the Copyright Office’s final decisions to refuse to register a copyright (as Dr. Thaler did), and it remains to be seen whether federal courts will agree with all of the office’s decisions. While the Copyright Office notes that courts sometimes give weight to the office’s experience and expertise in this field, courts will not necessarily adopt the office’s interpretations of the Copyright Act. In addition, the Copyright Office’s guidance accepts that works “containing” AI-generated material may be copyrighted under some circumstances, such as “sufficiently creative” human arrangements or modifications of AI-generated material or works that combine AI-generated and human-authored material. The office states that the author may only claim copyright protection “for their own contributions” to such works, and they must identify and disclaim AI-generated parts of the work if they apply to register their copyright. In September 2023, for instance, the Copyright Office Review Board affirmed the office’s refusal to register a copyright for an artwork that was generated by Midjourney and then modified in various ways by the applicant, since the applicant did not disclaim the AI-generated material. Who Owns the Copyright to Generative AI Outputs? Assuming some AI-created works may be eligible for copyright protection, who owns that copyright? In general, the Copyright Act vests ownership “initially in the author or authors of the work.” Given the lack of judicial or Copyright Office decisions recognizing copyright in AI-created works to date, however, no clear rule has emerged identifying who the “author or authors” of these works could be. Returning to the photography analogy, the AI’s creator might be compared to the camera maker, while the AI user who prompts the creation of a specific work might be compared to the photographer who uses that camera to capture a specific image. On this view, the user would be considered the author and, therefore, the initial copyright owner. The creative choices involved in coding and training the AI, on the other hand, might give an AI’s creator a stronger claim to some form of authorship than the manufacturer of a camera. Does the AI Training Process Infringe Copyright in Other Works? AI are “trained” to create literary, visual, and other artistic works by exposing the program to large amounts of data, which may include text, images, and other works downloaded from the internet. This training process involves making digital copies of existing works. As the U.S. Patent and Trademark Office has described, this process “will almost by definition involve the reproduction of entire works or substantial portions thereof.” OpenAI, for example, acknowledges that its programs are trained on “large, publicly available datasets that include copyrighted works” and that this process “involves first making copies of the data to be analyzed” (although it now offers an option to remove images from training future image generation models). Creating such copies without permission may infringe the copyright holders’ exclusive right to make reproductions of their work. AI companies may argue that their training processes constitute fair use and are therefore noninfringing. Whether or not copying constitutes fair use depends on four statutory factors under 17 U.S.C. § 107: 1. the purpose and character of the use, including whether such use is of a commercial nature or is for nonprofit educational purposes; 2. the nature of the copyrighted work; 3. the amount and substantiality of the portion used in relation to the copyrighted work as a whole; and 4. the effect of the use upon the potential market for or value of the copyrighted work. Some stakeholders argue that the use of copyrighted works to train AI programs should be considered a fair use under these factors. Regarding the first factor, OpenAI argues its purpose is “transformative” as opposed to “expressive” because the training process creates “a useful generative AI system.” OpenAI also contends that the third factor supports fair use because the copies are not made available to the public but are used only to train the program. For support, OpenAI cites The Authors Guild, Inc. v. Google, Inc., in which the U.S. Court of Appeals for the Second Circuit held that Google’s copying of entire books to create a searchable database that displayed excerpts of those books constituted fair use. Regarding the fourth fair use factor, some generative AI applications have raised concern that training AI programs on copyrighted works allows them to generate similar works that compete with the originals. For example, an AI-generated song called “Heart on My Sleeve,” made to sound like the artists Drake and The Weeknd, was heard millions of times on streaming services. Universal Music Group, which has deals with both artists, argues that AI companies violate copyright by using these artists’ songs in training data. OpenAI states that its visual art program DALL-E 3 “is designed to decline requests that ask for an image in the style of a living artist.” Plaintiffs have filed multiple lawsuits claiming the training process for AI programs infringed their copyrights in written and visual works. These include lawsuits by the Authors Guild and authors Paul Tremblay, Michael Chabon, Sarah Silverman, and others against OpenAI; separate lawsuits by Michael Chabon, Sarah Silverman, and others against Meta Platforms; proposed class action lawsuits against Alphabet Inc. and Stability AI and Midjourney; and a lawsuit by Getty Images against Stability AI. The Getty Images lawsuit, for instance, alleges that “Stability AI has copied at least 12 million copyrighted images from Getty Images’ websites . . . in order to train its Stable Diffusion model.” This lawsuit appears to dispute any characterization of fair use, arguing that Stable Diffusion is a commercial product, weighing against fair use under the first statutory factor, and that the program undermines the market for the original works, weighing against fair use under the fourth factor. In September 2023, a U.S. district court ruled that a jury trial would be needed to determine whether it was fair use for an AI company to copy case summaries from Westlaw, a legal research platform, to train an AI program to quote pertinent passages from legal opinions in response to questions from a user. The court found that, while the defendant’s use was “undoubtedly commercial,” a jury would need to resolve factual disputes concerning whether the use was “transformative” (factor 1), to what extent the nature of the plaintiff’s work favored fair use (factor 2), whether the defendant copied more than needed to train the AI program (factor 3), and whether the AI program would constitute a “market substitute” for Westlaw (factor 4). While the AI program at issue might not be considered “generative” AI, the same kinds of facts might be relevant to a court’s fair-use analysis of making copies to train generative AI models.
+
+USER:
+Based on the article when might copyrighted works to train AI programs be considered a fair use?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,13,17,1763,,219
+The response should only contain info from this text.,what are the cases where a it comes out the mouth?,"WHILE the occipital and sincipital cerebral hernias form external visible tumors in the occipital and naso-frontal regions respectively, we find no external visible tumors in the basal hernias. As the sincipital hernias, however, leave the cranium in close proximity to the place of exit of the basal hernias, let us first review briefly the various forms of sincipital hernias: 1. The naso-frontal hernias leave the cranium between the frontal and nasal bones and form a tumor in the median line in the region of the glabella. 2. The naso-ethmoidal hernias leave the cranium between the frontal and nasal bones on the one side and the lateral mass or labyrinth on the other, which is forced or displaced downward toward the nasal cavity. The tumor appears externally in the region of the border between the osseous and cartilaginous portions of the nose, hanging down toward the tip or the wing of the nose. 3. The naso-orbital hernias leave the cranium between the frontal, ethmoid and lachrymal bones. In the region of the latter they enter the orbit and present at or near the inner canthus of the eye. All the above-named varieties present external visible tumors. The naso-ethmoidal and naso-orbital varieties are probably not distinguish- able from each other, as they leave the cranium at the same place ; namely, the nasal notch of the frontal and the cribriform plate of the ethmoid bone. Furthermore, the same hernia may divide into two branches, of which the anterior passes downward and forward behind the nasal bone, to protrude in the face at the border of the osseous and cartilaginous part of the nose, and the posterior branch descends into the anterior and medial portion of the orbit between the frontal, eth- moid and lachrymal bones. There is always some defect of the bones in question at the point where the encephalocele leaves the cranium. 4. Basal hernias are, as already stated, distinguished from the other sincipital hernias by not causing a protruding tumor in the face. Heinecke* distinguishes between three forms of these hernias : I. Cephalocele spheno-pharyngea is the most common variety, and leaves the cranium through an opening between the body of the sphenoid bone and the ethmoid bone, or through one of these bones, to come down in the nasal or naso-pharyngeal cavity. Extending from this point they may present in one of the nostrils, as in Czerny’s case; in the naso- pharyngeal cavity as in the cases of Giraldés, Otto, and Klimentowsky, cited from Larger,” and in my case, or come down into the mouth through a cleft palate, as in the cases reported by Virchow, Lichten- berg, Klintosch and Serres, also cited from Larger. II. Cephalocele spheno-orbitalis, which leaves the cranium through the superior orbital fissure to enter the orbit behind the globe of the eye. III. Cephalocele spheno-maxillaris, which, like the second form, leaves the cranium through the superior orbital fissure, but instead of remain- ing in the posterior part of the orbit, descends through the inferior orbital fissure into the spheno-maxillary fossa. The tumor presents, and can be felt in the mouth on the medial side of the ascending ramus of the inferior maxilla, and is visible on the outside of the face, on the cheek below the zygoma, in the same place where the retro-maxillary branches of retro-nasal fibroids present. The two last-named hernias are exceedingly rare, and I have been unable to find all the varieties to which Heinecke’s classification refers. Larger mentions three instances of retro-orbital encephalocele referred to by Spring. In the case published by Walther, the tumor descended through the superior orbital fissure, and caused exophthalmos and destruction of the eye. Spring had seen two similar specimens in the museum at Bonn. The first variety, the spheno-pharyngeal, is less uncommon. I shall mention the more accurately described instances of this variety, as they present more of surgical interest than Heinecke ascribed to them when he said : “Cephalocele basalis is of no surgical importance, as it has been found only in non-viable monsters (nicht lebensfahigen Missbildungen).” Attempts at the removal of encephalocele by operation have been made by Lichtenberg, Czerny and myself. Lichtenberg’s patient died from the operation; Czerny’s patient survived the operation, but died later from apparently independent causes; my patient made a definite recovery. Lichtenberg” reports the case of a newborn girl in whom a large reddish tumor, the size of a small fist, hung out of the mouth, covering the chin, with its base resting on the sternum. On more minute examin- ation it was seen that the patient had a hare-lip situated nearly in the median line of the lip, and complicated with cleft palate. The tumor was divided into two portions by a slight constriction in the middle, was elastic to the touch, and was attached by a pedicle which could be followed up to the right wall of the nasal cavity by opening the mouth, where it was continuous with the nasal mucosa. The patient died from the operation, and the autopsy demonstrated that the tumor was a cere- bral hernia. Klintosch” gives a vague description of an infant in whom a tumor protruded in the mouth. The patient had a hare-lip and cleft palate, some bones of the face were wanting, and the eyes were atrophied. In the sella Turcica was an opening the size of a goose-quill through which the neck of the hernia came down into the mouth, there to form a tumor the size of a hazelnut. This contained the hypophysis, which was hollow and communicated directly with the ventricle. Serres” describes an infant in whom some portions of the brain, with their envelopes, protruded from the cranium in the median line between - the sphenoid and ethmoid bones. The tumor descended into the nasal fossa, almost into the pharynx. Giraldés,’ according to Dupuytren,’ observed an encephalocele which descended into the interior of the nose. Otto,”* cited by Spring, states that he has seen in the museum at Vienna a cerebral tumor which had penetrated into the nasal cavity through the cribriform plate of the ethmoid. Kelsch,’ according to Otto, has seen a case in which the hypophysis was situated in the sphenoidal sinus. Klimentowsky,’ describes an encephalocele in a newborn child, in which the anterior portion of the two frontal lobes descended into the right side of the nasal cavity, as was verified by the autopsy. Rippmann,"" cited by Meyer, found in a foetus of twenty-three weeks, the head of which was double the normal size, and consequently hydro- cephalic, a lobulated tumor having a pedicle three or four lines in thick- ness, which descended through a canal in the body of the sphenoid bone. Virchow ™ describes a specimen in the Berlin museum, of hydrencepha- locele palatina in a newborn child. (See Fig. 1.) From the open mouth protruded an irregular nodulated tumor the size of a small apple. It was apparently adherent to the hard palate, but upon section it was seen that it had pushed both the vomer and the hard palate forward and up- ward, and that it emerged from the cranial cavity through a broad open- ing immediately anterior to the sphenoid bone, and behind the still carti- laginous ethmoid. The anterior portion of the sphenoid was forced downward and backward, and the connection between it and the vomer interrupted by the tumor, so that the vomer was connected only with the ethmoid. The anterior portion of the sac contained a cavity lined with smooth dura mater, below and behind which were several irregular smaller cavities. In the upper portion of the tumor was brain substance which extended from this point up into the cerebral portion of the cranial cavity. The brain was pushed downward toward the base of the cranial cavity, and above it was a large cavity filled with fluid, and surrounded by a thick membrane. In addition to this more or less cursory discussion of cases from the older literature, there has now appeared an accurate and excellent report of a case by Meyer,” from Czerny’s clinic. The case was one of con- genital nasal polypus, and was brought to the Heidelberg clinic for operation. The child died six weeks later, and the diagnosis was made after post-mortem microscopical examination. The patient was a child three days old, well developed, weighing five or six pounds. The left ala nasi was broadened and pushed upward by a soft, elastic, compressible, pedunculated, transparent tumor the size of a hazelnut, half of which protruded through the opening of the nose, and was clad with smooth, yellowish-red mucous membrane, and covered with dried crusts of serous exudate. The tumor did not increase in size when the child cried; it was attached 14 cm. behind the free border of the septum. Upon incision of the tumor bloody serum escaped, and upon pressure puriform mucus was forced out.","WHILE the occipital and sincipital cerebral hernias form external visible tumors in the occipital and naso-frontal regions respectively, we find no external visible tumors in the basal hernias. As the sincipital hernias, however, leave the cranium in close proximity to the place of exit of the basal hernias, let us first review briefly the various forms of sincipital hernias: 1. The naso-frontal hernias leave the cranium between the frontal and nasal bones and form a tumor in the median line in the region of the glabella. 2. The naso-ethmoidal hernias leave the cranium between the frontal and nasal bones on the one side and the lateral mass or labyrinth on the other, which is forced or displaced downward toward the nasal cavity. The tumor appears externally in the region of the border between the osseous and cartilaginous portions of the nose, hanging down toward the tip or the wing of the nose. 3. The naso-orbital hernias leave the cranium between the frontal, ethmoid and lachrymal bones. In the region of the latter they enter the orbit and present at or near the inner canthus of the eye. All the above-named varieties present external visible tumors. The naso-ethmoidal and naso-orbital varieties are probably not distinguish- able from each other, as they leave the cranium at the same place ; namely, the nasal notch of the frontal and the cribriform plate of the ethmoid bone. Furthermore, the same hernia may divide into two branches, of which the anterior passes downward and forward behind the nasal bone, to protrude in the face at the border of the osseous and cartilaginous part of the nose, and the posterior branch descends into the anterior and medial portion of the orbit between the frontal, eth- moid and lachrymal bones. There is always some defect of the bones in question at the point where the encephalocele leaves the cranium. 4. Basal hernias are, as already stated, distinguished from the other sincipital hernias by not causing a protruding tumor in the face. Heinecke* distinguishes between three forms of these hernias : I. Cephalocele spheno-pharyngea is the most common variety, and leaves the cranium through an opening between the body of the sphenoid bone and the ethmoid bone, or through one of these bones, to come down in the nasal or naso-pharyngeal cavity. Extending from this point they may present in one of the nostrils, as in Czerny’s case; in the naso- pharyngeal cavity as in the cases of Giraldés, Otto, and Klimentowsky, cited from Larger,” and in my case, or come down into the mouth through a cleft palate, as in the cases reported by Virchow, Lichten- berg, Klintosch and Serres, also cited from Larger. II. Cephalocele spheno-orbitalis, which leaves the cranium through the superior orbital fissure to enter the orbit behind the globe of the eye. III. Cephalocele spheno-maxillaris, which, like the second form, leaves the cranium through the superior orbital fissure, but instead of remain- ing in the posterior part of the orbit, descends through the inferior orbital fissure into the spheno-maxillary fossa. The tumor presents, and can be felt in the mouth on the medial side of the ascending ramus of the inferior maxilla, and is visible on the outside of the face, on the cheek below the zygoma, in the same place where the retro-maxillary branches of retro-nasal fibroids present. The two last-named hernias are exceedingly rare, and I have been unable to find all the varieties to which Heinecke’s classification refers. Larger mentions three instances of retro-orbital encephalocele referred to by Spring. In the case published by Walther, the tumor descended through the superior orbital fissure, and caused exophthalmos and destruction of the eye. Spring had seen two similar specimens in the museum at Bonn. The first variety, the spheno-pharyngeal, is less uncommon. I shall mention the more accurately described instances of this variety, as they present more of surgical interest than Heinecke ascribed to them when he said : “Cephalocele basalis is of no surgical importance, as it has been found only in non-viable monsters (nicht lebensfahigen Missbildungen).” Attempts at the removal of encephalocele by operation have been made by Lichtenberg, Czerny and myself. Lichtenberg’s patient died from the operation; Czerny’s patient survived the operation, but died later from apparently independent causes; my patient made a definite recovery. Lichtenberg” reports the case of a newborn girl in whom a large reddish tumor, the size of a small fist, hung out of the mouth, covering the chin, with its base resting on the sternum. On more minute examin- ation it was seen that the patient had a hare-lip situated nearly in the median line of the lip, and complicated with cleft palate. The tumor was divided into two portions by a slight constriction in the middle, was elastic to the touch, and was attached by a pedicle which could be followed up to the right wall of the nasal cavity by opening the mouth, where it was continuous with the nasal mucosa. The patient died from the operation, and the autopsy demonstrated that the tumor was a cere- bral hernia. Klintosch” gives a vague description of an infant in whom a tumor protruded in the mouth. The patient had a hare-lip and cleft palate, some bones of the face were wanting, and the eyes were atrophied. In the sella Turcica was an opening the size of a goose-quill through which the neck of the hernia came down into the mouth, there to form a tumor the size of a hazelnut. This contained the hypophysis, which was hollow and communicated directly with the ventricle. Serres” describes an infant in whom some portions of the brain, with their envelopes, protruded from the cranium in the median line between - the sphenoid and ethmoid bones. The tumor descended into the nasal fossa, almost into the pharynx. Giraldés,’ according to Dupuytren,’ observed an encephalocele which descended into the interior of the nose. Otto,”* cited by Spring, states that he has seen in the museum at Vienna a cerebral tumor which had penetrated into the nasal cavity through the cribriform plate of the ethmoid. Kelsch,’ according to Otto, has seen a case in which the hypophysis was situated in the sphenoidal sinus. Klimentowsky,’ describes an encephalocele in a newborn child, in which the anterior portion of the two frontal lobes descended into the right side of the nasal cavity, as was verified by the autopsy. Rippmann,"" cited by Meyer, found in a foetus of twenty-three weeks, the head of which was double the normal size, and consequently hydro- cephalic, a lobulated tumor having a pedicle three or four lines in thick- ness, which descended through a canal in the body of the sphenoid bone. Virchow ™ describes a specimen in the Berlin museum, of hydrencepha- locele palatina in a newborn child. (See Fig. 1.) From the open mouth protruded an irregular nodulated tumor the size of a small apple. It was apparently adherent to the hard palate, but upon section it was seen that it had pushed both the vomer and the hard palate forward and up- ward, and that it emerged from the cranial cavity through a broad open- ing immediately anterior to the sphenoid bone, and behind the still carti- laginous ethmoid. The anterior portion of the sphenoid was forced downward and backward, and the connection between it and the vomer interrupted by the tumor, so that the vomer was connected only with the ethmoid. The anterior portion of the sac contained a cavity lined with smooth dura mater, below and behind which were several irregular smaller cavities. In the upper portion of the tumor was brain substance which extended from this point up into the cerebral portion of the cranial cavity. The brain was pushed downward toward the base of the cranial cavity, and above it was a large cavity filled with fluid, and surrounded by a thick membrane. In addition to this more or less cursory discussion of cases from the older literature, there has now appeared an accurate and excellent report of a case by Meyer,” from Czerny’s clinic. The case was one of con- genital nasal polypus, and was brought to the Heidelberg clinic for operation. The child died six weeks later, and the diagnosis was made after post-mortem microscopical examination. The patient was a child three days old, well developed, weighing five or six pounds. The left ala nasi was broadened and pushed upward by a soft, elastic, compressible, pedunculated, transparent tumor the size of a hazelnut, half of which protruded through the opening of the nose, and was clad with smooth, yellowish-red mucous membrane, and covered with dried crusts of serous exudate. The tumor did not increase in size when the child cried; it was attached 14 cm. behind the free border of the septum. Upon incision of the tumor bloody serum escaped, and upon pressure puriform mucus was forced out. The response should only contain info from this text. what are the cases where a it comes out the mouth?","The response should only contain info from this text.
+
+EVIDENCE:
+WHILE the occipital and sincipital cerebral hernias form external visible tumors in the occipital and naso-frontal regions respectively, we find no external visible tumors in the basal hernias. As the sincipital hernias, however, leave the cranium in close proximity to the place of exit of the basal hernias, let us first review briefly the various forms of sincipital hernias: 1. The naso-frontal hernias leave the cranium between the frontal and nasal bones and form a tumor in the median line in the region of the glabella. 2. The naso-ethmoidal hernias leave the cranium between the frontal and nasal bones on the one side and the lateral mass or labyrinth on the other, which is forced or displaced downward toward the nasal cavity. The tumor appears externally in the region of the border between the osseous and cartilaginous portions of the nose, hanging down toward the tip or the wing of the nose. 3. The naso-orbital hernias leave the cranium between the frontal, ethmoid and lachrymal bones. In the region of the latter they enter the orbit and present at or near the inner canthus of the eye. All the above-named varieties present external visible tumors. The naso-ethmoidal and naso-orbital varieties are probably not distinguish- able from each other, as they leave the cranium at the same place ; namely, the nasal notch of the frontal and the cribriform plate of the ethmoid bone. Furthermore, the same hernia may divide into two branches, of which the anterior passes downward and forward behind the nasal bone, to protrude in the face at the border of the osseous and cartilaginous part of the nose, and the posterior branch descends into the anterior and medial portion of the orbit between the frontal, eth- moid and lachrymal bones. There is always some defect of the bones in question at the point where the encephalocele leaves the cranium. 4. Basal hernias are, as already stated, distinguished from the other sincipital hernias by not causing a protruding tumor in the face. Heinecke* distinguishes between three forms of these hernias : I. Cephalocele spheno-pharyngea is the most common variety, and leaves the cranium through an opening between the body of the sphenoid bone and the ethmoid bone, or through one of these bones, to come down in the nasal or naso-pharyngeal cavity. Extending from this point they may present in one of the nostrils, as in Czerny’s case; in the naso- pharyngeal cavity as in the cases of Giraldés, Otto, and Klimentowsky, cited from Larger,” and in my case, or come down into the mouth through a cleft palate, as in the cases reported by Virchow, Lichten- berg, Klintosch and Serres, also cited from Larger. II. Cephalocele spheno-orbitalis, which leaves the cranium through the superior orbital fissure to enter the orbit behind the globe of the eye. III. Cephalocele spheno-maxillaris, which, like the second form, leaves the cranium through the superior orbital fissure, but instead of remain- ing in the posterior part of the orbit, descends through the inferior orbital fissure into the spheno-maxillary fossa. The tumor presents, and can be felt in the mouth on the medial side of the ascending ramus of the inferior maxilla, and is visible on the outside of the face, on the cheek below the zygoma, in the same place where the retro-maxillary branches of retro-nasal fibroids present. The two last-named hernias are exceedingly rare, and I have been unable to find all the varieties to which Heinecke’s classification refers. Larger mentions three instances of retro-orbital encephalocele referred to by Spring. In the case published by Walther, the tumor descended through the superior orbital fissure, and caused exophthalmos and destruction of the eye. Spring had seen two similar specimens in the museum at Bonn. The first variety, the spheno-pharyngeal, is less uncommon. I shall mention the more accurately described instances of this variety, as they present more of surgical interest than Heinecke ascribed to them when he said : “Cephalocele basalis is of no surgical importance, as it has been found only in non-viable monsters (nicht lebensfahigen Missbildungen).” Attempts at the removal of encephalocele by operation have been made by Lichtenberg, Czerny and myself. Lichtenberg’s patient died from the operation; Czerny’s patient survived the operation, but died later from apparently independent causes; my patient made a definite recovery. Lichtenberg” reports the case of a newborn girl in whom a large reddish tumor, the size of a small fist, hung out of the mouth, covering the chin, with its base resting on the sternum. On more minute examin- ation it was seen that the patient had a hare-lip situated nearly in the median line of the lip, and complicated with cleft palate. The tumor was divided into two portions by a slight constriction in the middle, was elastic to the touch, and was attached by a pedicle which could be followed up to the right wall of the nasal cavity by opening the mouth, where it was continuous with the nasal mucosa. The patient died from the operation, and the autopsy demonstrated that the tumor was a cere- bral hernia. Klintosch” gives a vague description of an infant in whom a tumor protruded in the mouth. The patient had a hare-lip and cleft palate, some bones of the face were wanting, and the eyes were atrophied. In the sella Turcica was an opening the size of a goose-quill through which the neck of the hernia came down into the mouth, there to form a tumor the size of a hazelnut. This contained the hypophysis, which was hollow and communicated directly with the ventricle. Serres” describes an infant in whom some portions of the brain, with their envelopes, protruded from the cranium in the median line between - the sphenoid and ethmoid bones. The tumor descended into the nasal fossa, almost into the pharynx. Giraldés,’ according to Dupuytren,’ observed an encephalocele which descended into the interior of the nose. Otto,”* cited by Spring, states that he has seen in the museum at Vienna a cerebral tumor which had penetrated into the nasal cavity through the cribriform plate of the ethmoid. Kelsch,’ according to Otto, has seen a case in which the hypophysis was situated in the sphenoidal sinus. Klimentowsky,’ describes an encephalocele in a newborn child, in which the anterior portion of the two frontal lobes descended into the right side of the nasal cavity, as was verified by the autopsy. Rippmann,"" cited by Meyer, found in a foetus of twenty-three weeks, the head of which was double the normal size, and consequently hydro- cephalic, a lobulated tumor having a pedicle three or four lines in thick- ness, which descended through a canal in the body of the sphenoid bone. Virchow ™ describes a specimen in the Berlin museum, of hydrencepha- locele palatina in a newborn child. (See Fig. 1.) From the open mouth protruded an irregular nodulated tumor the size of a small apple. It was apparently adherent to the hard palate, but upon section it was seen that it had pushed both the vomer and the hard palate forward and up- ward, and that it emerged from the cranial cavity through a broad open- ing immediately anterior to the sphenoid bone, and behind the still carti- laginous ethmoid. The anterior portion of the sphenoid was forced downward and backward, and the connection between it and the vomer interrupted by the tumor, so that the vomer was connected only with the ethmoid. The anterior portion of the sac contained a cavity lined with smooth dura mater, below and behind which were several irregular smaller cavities. In the upper portion of the tumor was brain substance which extended from this point up into the cerebral portion of the cranial cavity. The brain was pushed downward toward the base of the cranial cavity, and above it was a large cavity filled with fluid, and surrounded by a thick membrane. In addition to this more or less cursory discussion of cases from the older literature, there has now appeared an accurate and excellent report of a case by Meyer,” from Czerny’s clinic. The case was one of con- genital nasal polypus, and was brought to the Heidelberg clinic for operation. The child died six weeks later, and the diagnosis was made after post-mortem microscopical examination. The patient was a child three days old, well developed, weighing five or six pounds. The left ala nasi was broadened and pushed upward by a soft, elastic, compressible, pedunculated, transparent tumor the size of a hazelnut, half of which protruded through the opening of the nose, and was clad with smooth, yellowish-red mucous membrane, and covered with dried crusts of serous exudate. The tumor did not increase in size when the child cried; it was attached 14 cm. behind the free border of the septum. Upon incision of the tumor bloody serum escaped, and upon pressure puriform mucus was forced out.
+
+USER:
+what are the cases where a it comes out the mouth?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,9,11,1481,,691
+Provide your response in a professional and formal tone. Use the information given in the document without referring to external sources or requiring additional context. Avoid using technical jargon or acronyms that are not explained within the document.,What are some tips on saving money?,"Money Management Tips: 55 Ways to Save Money Recreation and Entertainment: 1. Instead of paying for a fitness club membership fee, buy some weights or go to the ARC. 2. Don’t smoke. Cigarettes are expensive and the money adds up quickly. Also you’ll be fined if you smoke near school facilities. 3. Wait until after half-time at sport events and get in for free! 4. When eating out, look for coupons or special deals- many restaurants offer them! Also, order water. Drinks are highly overpriced. 5. At the beginning of the semester, many local businesses give out coupon books. Grab one! 6. There are hundreds of free activities on campus. Join clubs, attend student concerts, or go to church-sponsored events for cheap fun. There is usually food involved, too! 7. Illinites, student activities, happen at the Illini Union every Friday night for free. 8. Experience some more cultures while in college and attend a show at Krannert. Student tickets are $10 or less. It’s FREE sometimes! 9. If you’re throwing a party, have your guests pay a little money or bring things to offset your cost. 10. Don’t purchase a book unless you think you really want to keep it. You can check out books for free at libraries. 11. Rent movies with a group of friends or go to second-run theaters for $1 or $2 a ticket. 12. Bring your student ID when you go out for a movie. Most theaters will give discount for students. Food and Basic Needs: 13. Be a savvy consumer. Before making a major purchase, do some researches on the product quality through Consumer Reports magazine. 14. Sometimes the cheaper product works just as well as the expensive one. 15. Ask for generic medications at the pharmacy. 16. Ladies, ditch the salon and get your hair done at a cosmetology school. 17. Buying in bulk is usually a good option, but try to shop for items by the per unit price. Often times, the biggest options is not the best way to get the most of your money. 18. Scout out garage/yard sales for housewares, furniture, and stuff to decorate your college dorm or apartment. At the beginning of each semester, the YMCA has a dump and run where they sell items collected from various dorms and apartment on campus. 19. Make things for gifts- it’s cheaper and the time you invest shows you care. 20. Take advantage of sales by buying holiday and birthday gifts throughout the year. 21. Get a job at a place where you already spend a lot of money, so you can get employee discounts. 22. Use mail-in rebates or coupons for groceries or health and beauty items. 23. Don’t buy bottled water. Buy a water filtration pitcher. 24. Don’t buy something just because it is one sale. Consider it’s a need for you before buying. 25. If you shop at a favorite store, apply for their discount card if they have one. Modified by Joe Pleshar, Yuanhang Fan, and Maggie Benson, Peer Educators of Spring 2015. University of Illinois Extension Financial Wellness for College Students Program. Source: National Student Loan Program’s Budget Handout #6: “Money Management Options: 75 Ways to Save Money”, 2002. Money Management Tips: 55 Ways to Save Money 26. Make home cooked meals. A home cooked stead dinner is often cheaper than a fast food binge. Eating at home will save you a lot of money! 27. Pack a lunch instead of eating out. Clothing: 28. Buy clothes at the end of the season when they’re on sales. 29. If you don’t wear certain clothes anymore, take them to a consignment shop or sell them online. You can get part of the profit and free up room in your closet. 30. Share dresses and tuxes with friends for special occasions. 31. If you buy more than one of something, like 2 or 3 shirts, always ask for a discount. 32. Invest in durable clothes, shoes, etc. rather than buying many cheap pairs. Budgeting/ Spending Plan: 33. Set goals for your spending and saving. 34. Keep track of your spending to avoid overspent. There are apps for that! 35. Don’t use a credit card if it will lead you to make more purchases! On average, people have credit cards spend 34% more. 36. Before going out to spend, set a limit for yourself and stick to it! 37. Wait at least two hours before making a big purchase to be sure it’s something you really need. Transportation: 38. Obey traffic laws. Speeding tickets will cost more than just the ticket. It will raise your insurance premiums. 39. Keep your tires inflated properly- you’ll get better gas mileage. 40. Get good grades. Insurance companies offer low rates to student with 3.0+ GPA. 41. Carpool with friend! 42. Search for dependable cards that offer good gas mileage. 43. Drive an older car- the insurance payments and taxes will be less. 44. Walk, bike, or ride to school- it’s good for you to saves on gas. 45. Look around for cheapest gas price before filling up. There are apps for that! Savings: 46. Only use ATM’s of your bank. Other bank’s ATM fees add up! 47. Always put part of our paycheck into a savings account. 48. Spare change adds up! Get a piggy bank or change jar and don’t underestimate the value of your spare changes. 49. Volunteer! If you’re busy, you can’t spend month and it’s a resume booster, too! It’s always make you feel good to help and give back to the community. 50. Use plastic grocery bags for trash can liners. Conserving Resources: 51. Turn off the water while brushing your teeth. 52. Unplug electronics when you aren’t using them. Even while turned off, they still use up costly energy. 53. Use items like shampoo, toothpaste, and paper towels sparingly- enough to do the job without waste. 54. Pay your bills online. Save paper and money on stamps. 55. Ask your landlord to seal gaps between door and windows to prevent heat leaks over the winter. Modified by Joe Pleshar, Yuanhang Fan, and Maggie Benson, Peer Educators of Spring 2015. University of Illinois Extension Financial Wellness for College Students Program. Source: National Student Loan Program’s Budget Handout #6: “Money Management Options: 75 Ways to Save Money”, 2002.","Provide your response in a professional and formal tone. Use the information given in the document without referring to external sources or requiring additional context. Avoid using technical jargon or acronyms that are not explained within the document. What are some tips on saving money? Money Management Tips: 55 Ways to Save Money Recreation and Entertainment: 1. Instead of paying for a fitness club membership fee, buy some weights or go to the ARC. 2. Don’t smoke. Cigarettes are expensive and the money adds up quickly. Also you’ll be fined if you smoke near school facilities. 3. Wait until after half-time at sport events and get in for free! 4. When eating out, look for coupons or special deals- many restaurants offer them! Also, order water. Drinks are highly overpriced. 5. At the beginning of the semester, many local businesses give out coupon books. Grab one! 6. There are hundreds of free activities on campus. Join clubs, attend student concerts, or go to church-sponsored events for cheap fun. There is usually food involved, too! 7. Illinites, student activities, happen at the Illini Union every Friday night for free. 8. Experience some more cultures while in college and attend a show at Krannert. Student tickets are $10 or less. It’s FREE sometimes! 9. If you’re throwing a party, have your guests pay a little money or bring things to offset your cost. 10. Don’t purchase a book unless you think you really want to keep it. You can check out books for free at libraries. 11. Rent movies with a group of friends or go to second-run theaters for $1 or $2 a ticket. 12. Bring your student ID when you go out for a movie. Most theaters will give discount for students. Food and Basic Needs: 13. Be a savvy consumer. Before making a major purchase, do some researches on the product quality through Consumer Reports magazine. 14. Sometimes the cheaper product works just as well as the expensive one. 15. Ask for generic medications at the pharmacy. 16. Ladies, ditch the salon and get your hair done at a cosmetology school. 17. Buying in bulk is usually a good option, but try to shop for items by the per unit price. Often times, the biggest options is not the best way to get the most of your money. 18. Scout out garage/yard sales for housewares, furniture, and stuff to decorate your college dorm or apartment. At the beginning of each semester, the YMCA has a dump and run where they sell items collected from various dorms and apartment on campus. 19. Make things for gifts- it’s cheaper and the time you invest shows you care. 20. Take advantage of sales by buying holiday and birthday gifts throughout the year. 21. Get a job at a place where you already spend a lot of money, so you can get employee discounts. 22. Use mail-in rebates or coupons for groceries or health and beauty items. 23. Don’t buy bottled water. Buy a water filtration pitcher. 24. Don’t buy something just because it is one sale. Consider it’s a need for you before buying. 25. If you shop at a favorite store, apply for their discount card if they have one. Modified by Joe Pleshar, Yuanhang Fan, and Maggie Benson, Peer Educators of Spring 2015. University of Illinois Extension Financial Wellness for College Students Program. Source: National Student Loan Program’s Budget Handout #6: “Money Management Options: 75 Ways to Save Money”, 2002. Money Management Tips: 55 Ways to Save Money 26. Make home cooked meals. A home cooked stead dinner is often cheaper than a fast food binge. Eating at home will save you a lot of money! 27. Pack a lunch instead of eating out. Clothing: 28. Buy clothes at the end of the season when they’re on sales. 29. If you don’t wear certain clothes anymore, take them to a consignment shop or sell them online. You can get part of the profit and free up room in your closet. 30. Share dresses and tuxes with friends for special occasions. 31. If you buy more than one of something, like 2 or 3 shirts, always ask for a discount. 32. Invest in durable clothes, shoes, etc. rather than buying many cheap pairs. Budgeting/ Spending Plan: 33. Set goals for your spending and saving. 34. Keep track of your spending to avoid overspent. There are apps for that! 35. Don’t use a credit card if it will lead you to make more purchases! On average, people have credit cards spend 34% more. 36. Before going out to spend, set a limit for yourself and stick to it! 37. Wait at least two hours before making a big purchase to be sure it’s something you really need. Transportation: 38. Obey traffic laws. Speeding tickets will cost more than just the ticket. It will raise your insurance premiums. 39. Keep your tires inflated properly- you’ll get better gas mileage. 40. Get good grades. Insurance companies offer low rates to student with 3.0+ GPA. 41. Carpool with friend! 42. Search for dependable cards that offer good gas mileage. 43. Drive an older car- the insurance payments and taxes will be less. 44. Walk, bike, or ride to school- it’s good for you to saves on gas. 45. Look around for cheapest gas price before filling up. There are apps for that! Savings: 46. Only use ATM’s of your bank. Other bank’s ATM fees add up! 47. Always put part of our paycheck into a savings account. 48. Spare change adds up! Get a piggy bank or change jar and don’t underestimate the value of your spare changes. 49. Volunteer! If you’re busy, you can’t spend month and it’s a resume booster, too! It’s always make you feel good to help and give back to the community. 50. Use plastic grocery bags for trash can liners. Conserving Resources: 51. Turn off the water while brushing your teeth. 52. Unplug electronics when you aren’t using them. Even while turned off, they still use up costly energy. 53. Use items like shampoo, toothpaste, and paper towels sparingly- enough to do the job without waste. 54. Pay your bills online. Save paper and money on stamps. 55. Ask your landlord to seal gaps between door and windows to prevent heat leaks over the winter. Modified by Joe Pleshar, Yuanhang Fan, and Maggie Benson, Peer Educators of Spring 2015. University of Illinois Extension Financial Wellness for College Students Program. Source: National Student Loan Program’s Budget Handout #6: “Money Management Options: 75 Ways to Save Money”, 2002.","Provide your response in a professional and formal tone. Use the information given in the document without referring to external sources or requiring additional context. Avoid using technical jargon or acronyms that are not explained within the document.
+
+EVIDENCE:
+Money Management Tips: 55 Ways to Save Money Recreation and Entertainment: 1. Instead of paying for a fitness club membership fee, buy some weights or go to the ARC. 2. Don’t smoke. Cigarettes are expensive and the money adds up quickly. Also you’ll be fined if you smoke near school facilities. 3. Wait until after half-time at sport events and get in for free! 4. When eating out, look for coupons or special deals- many restaurants offer them! Also, order water. Drinks are highly overpriced. 5. At the beginning of the semester, many local businesses give out coupon books. Grab one! 6. There are hundreds of free activities on campus. Join clubs, attend student concerts, or go to church-sponsored events for cheap fun. There is usually food involved, too! 7. Illinites, student activities, happen at the Illini Union every Friday night for free. 8. Experience some more cultures while in college and attend a show at Krannert. Student tickets are $10 or less. It’s FREE sometimes! 9. If you’re throwing a party, have your guests pay a little money or bring things to offset your cost. 10. Don’t purchase a book unless you think you really want to keep it. You can check out books for free at libraries. 11. Rent movies with a group of friends or go to second-run theaters for $1 or $2 a ticket. 12. Bring your student ID when you go out for a movie. Most theaters will give discount for students. Food and Basic Needs: 13. Be a savvy consumer. Before making a major purchase, do some researches on the product quality through Consumer Reports magazine. 14. Sometimes the cheaper product works just as well as the expensive one. 15. Ask for generic medications at the pharmacy. 16. Ladies, ditch the salon and get your hair done at a cosmetology school. 17. Buying in bulk is usually a good option, but try to shop for items by the per unit price. Often times, the biggest options is not the best way to get the most of your money. 18. Scout out garage/yard sales for housewares, furniture, and stuff to decorate your college dorm or apartment. At the beginning of each semester, the YMCA has a dump and run where they sell items collected from various dorms and apartment on campus. 19. Make things for gifts- it’s cheaper and the time you invest shows you care. 20. Take advantage of sales by buying holiday and birthday gifts throughout the year. 21. Get a job at a place where you already spend a lot of money, so you can get employee discounts. 22. Use mail-in rebates or coupons for groceries or health and beauty items. 23. Don’t buy bottled water. Buy a water filtration pitcher. 24. Don’t buy something just because it is one sale. Consider it’s a need for you before buying. 25. If you shop at a favorite store, apply for their discount card if they have one. Modified by Joe Pleshar, Yuanhang Fan, and Maggie Benson, Peer Educators of Spring 2015. University of Illinois Extension Financial Wellness for College Students Program. Source: National Student Loan Program’s Budget Handout #6: “Money Management Options: 75 Ways to Save Money”, 2002. Money Management Tips: 55 Ways to Save Money 26. Make home cooked meals. A home cooked stead dinner is often cheaper than a fast food binge. Eating at home will save you a lot of money! 27. Pack a lunch instead of eating out. Clothing: 28. Buy clothes at the end of the season when they’re on sales. 29. If you don’t wear certain clothes anymore, take them to a consignment shop or sell them online. You can get part of the profit and free up room in your closet. 30. Share dresses and tuxes with friends for special occasions. 31. If you buy more than one of something, like 2 or 3 shirts, always ask for a discount. 32. Invest in durable clothes, shoes, etc. rather than buying many cheap pairs. Budgeting/ Spending Plan: 33. Set goals for your spending and saving. 34. Keep track of your spending to avoid overspent. There are apps for that! 35. Don’t use a credit card if it will lead you to make more purchases! On average, people have credit cards spend 34% more. 36. Before going out to spend, set a limit for yourself and stick to it! 37. Wait at least two hours before making a big purchase to be sure it’s something you really need. Transportation: 38. Obey traffic laws. Speeding tickets will cost more than just the ticket. It will raise your insurance premiums. 39. Keep your tires inflated properly- you’ll get better gas mileage. 40. Get good grades. Insurance companies offer low rates to student with 3.0+ GPA. 41. Carpool with friend! 42. Search for dependable cards that offer good gas mileage. 43. Drive an older car- the insurance payments and taxes will be less. 44. Walk, bike, or ride to school- it’s good for you to saves on gas. 45. Look around for cheapest gas price before filling up. There are apps for that! Savings: 46. Only use ATM’s of your bank. Other bank’s ATM fees add up! 47. Always put part of our paycheck into a savings account. 48. Spare change adds up! Get a piggy bank or change jar and don’t underestimate the value of your spare changes. 49. Volunteer! If you’re busy, you can’t spend month and it’s a resume booster, too! It’s always make you feel good to help and give back to the community. 50. Use plastic grocery bags for trash can liners. Conserving Resources: 51. Turn off the water while brushing your teeth. 52. Unplug electronics when you aren’t using them. Even while turned off, they still use up costly energy. 53. Use items like shampoo, toothpaste, and paper towels sparingly- enough to do the job without waste. 54. Pay your bills online. Save paper and money on stamps. 55. Ask your landlord to seal gaps between door and windows to prevent heat leaks over the winter. Modified by Joe Pleshar, Yuanhang Fan, and Maggie Benson, Peer Educators of Spring 2015. University of Illinois Extension Financial Wellness for College Students Program. Source: National Student Loan Program’s Budget Handout #6: “Money Management Options: 75 Ways to Save Money”, 2002.
+
+USER:
+What are some tips on saving money?
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+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,38,7,1052,,2
+"<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> [user request] <TEXT> [context document]","Please summarize what Montelukast is used for and tell me if there are any serious side effects. This is important to me, so please be detained and provide your response in two paragraphs.","Why is this medication prescribed? Montelukast is used to prevent wheezing, difficulty breathing, chest tightness, and coughing caused by asthma in adults and children 12 months of age and older. Montelukast is also used to prevent bronchospasm (breathing difficulties) during exercise in adults and children 6 years of age and older. Montelukast is also used to treat the symptoms of seasonal (occurs only at certain times of the year), allergic rhinitis (a condition associated with sneezing and stuffy, runny or itchy nose) in adults and children 2 years of age and older, and perennial (occurs all year round) allergic rhinitis in adults and children 6 months of age and older. Montelukast should be used to treat seasonal or perennial allergic rhinitis only in adults and children who cannot be treated with other medications. Montelukast is in a class of medications called leukotriene receptor antagonists (LTRAs). It works by blocking the action of substances in the body that cause the symptoms of asthma and allergic rhinitis. How should this medicine be used? Montelukast comes as a tablet, a chewable tablet, and granules to take by mouth. Montelukast is usually taken once a day with or without food. When montelukast is used to treat asthma, it should be taken in the evening. When montelukast is used to prevent breathing difficulties during exercise, it should be taken at least 2 hours before exercise. If you are taking montelukast once a day on a regular basis, or if you have taken a dose of montelukast within the past 24 hours, you should not take an additional dose before exercising. When montelukast is used to treat allergic rhinitis, it may be taken at any time of day. Take montelukast at around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take montelukast exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. If you are giving the granules to your child, you should not open the foil pouch until your child is ready to take the medication. You may pour all of the granules directly from the packet into your child's mouth to be swallowed immediately. Do not use montelukast to treat a sudden attack of asthma symptoms. Your doctor will prescribe a short-acting inhaler to use during attacks. Talk to your doctor about how to treat symptoms of a sudden asthma attack. If your asthma symptoms get worse or if you have asthma attacks more often, be sure to call your doctor. If you are taking montelukast to treat asthma, continue to take or use all other medications that your doctor has prescribed to treat your asthma. Do not stop taking any of your medications or change the doses of any of your medications unless your doctor tells you that you should. If your asthma is made worse by aspirin, do not take aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) during your treatment with montelukast. Montelukast controls the symptoms of asthma and allergic rhinitis but does not cure these conditions. Continue to take montelukast even if you feel well. Do not stop taking montelukast without talking to your doctor. Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient. Other uses for this medicine This medication may be prescribed for other uses; ask your doctor or pharmacist for more information. What special precautions should I follow? Before taking montelukast, tell your doctor and pharmacist if you are allergic to montelukast or any other medications, or any of the ingredients in montelukast tablet, chewable tablet, or granules. tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention gemfibrozil (Lopid), phenobarbital and rifampin (Rifadin, Rimactane, in Rifamate, Rifater). Your doctor may need to change the doses of your medications or monitor you more carefully for side effects. tell your doctor if you have or have ever had liver disease. tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while taking montelukast, call your doctor. if you have phenylketonuria (PKU, an inherited condition in which a special diet must be followed to prevent damage to your brain that can cause severe intellectual disability), you should know that the chewable tablets contain aspartame that forms phenylalanine. What special dietary instructions should I follow? Unless your doctor tells you otherwise, continue your normal diet. What should I do if I forget a dose? Skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one. Do not take more than one dose of montelukast in a 24 hour period. What side effects can this medication cause? Montelukast may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: headache heartburn stomach pain tiredness diarrhea","<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> Please summarize what Montelukast is used for and tell me if there are any serious side effects. This is important to me, so please be detained and provide your response in two paragraphs. <TEXT> Why is this medication prescribed? Montelukast is used to prevent wheezing, difficulty breathing, chest tightness, and coughing caused by asthma in adults and children 12 months of age and older. Montelukast is also used to prevent bronchospasm (breathing difficulties) during exercise in adults and children 6 years of age and older. Montelukast is also used to treat the symptoms of seasonal (occurs only at certain times of the year), allergic rhinitis (a condition associated with sneezing and stuffy, runny or itchy nose) in adults and children 2 years of age and older, and perennial (occurs all year round) allergic rhinitis in adults and children 6 months of age and older. Montelukast should be used to treat seasonal or perennial allergic rhinitis only in adults and children who cannot be treated with other medications. Montelukast is in a class of medications called leukotriene receptor antagonists (LTRAs). It works by blocking the action of substances in the body that cause the symptoms of asthma and allergic rhinitis. How should this medicine be used? Montelukast comes as a tablet, a chewable tablet, and granules to take by mouth. Montelukast is usually taken once a day with or without food. When montelukast is used to treat asthma, it should be taken in the evening. When montelukast is used to prevent breathing difficulties during exercise, it should be taken at least 2 hours before exercise. If you are taking montelukast once a day on a regular basis, or if you have taken a dose of montelukast within the past 24 hours, you should not take an additional dose before exercising. When montelukast is used to treat allergic rhinitis, it may be taken at any time of day. Take montelukast at around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take montelukast exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. If you are giving the granules to your child, you should not open the foil pouch until your child is ready to take the medication. You may pour all of the granules directly from the packet into your child's mouth to be swallowed immediately. Do not use montelukast to treat a sudden attack of asthma symptoms. Your doctor will prescribe a short-acting inhaler to use during attacks. Talk to your doctor about how to treat symptoms of a sudden asthma attack. If your asthma symptoms get worse or if you have asthma attacks more often, be sure to call your doctor. If you are taking montelukast to treat asthma, continue to take or use all other medications that your doctor has prescribed to treat your asthma. Do not stop taking any of your medications or change the doses of any of your medications unless your doctor tells you that you should. If your asthma is made worse by aspirin, do not take aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) during your treatment with montelukast. Montelukast controls the symptoms of asthma and allergic rhinitis but does not cure these conditions. Continue to take montelukast even if you feel well. Do not stop taking montelukast without talking to your doctor. Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient. Other uses for this medicine This medication may be prescribed for other uses; ask your doctor or pharmacist for more information. What special precautions should I follow? Before taking montelukast, tell your doctor and pharmacist if you are allergic to montelukast or any other medications, or any of the ingredients in montelukast tablet, chewable tablet, or granules. tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention gemfibrozil (Lopid), phenobarbital and rifampin (Rifadin, Rimactane, in Rifamate, Rifater). Your doctor may need to change the doses of your medications or monitor you more carefully for side effects. tell your doctor if you have or have ever had liver disease. tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while taking montelukast, call your doctor. if you have phenylketonuria (PKU, an inherited condition in which a special diet must be followed to prevent damage to your brain that can cause severe intellectual disability), you should know that the chewable tablets contain aspartame that forms phenylalanine. What special dietary instructions should I follow? Unless your doctor tells you otherwise, continue your normal diet. What should I do if I forget a dose? Skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one. Do not take more than one dose of montelukast in a 24 hour period. What side effects can this medication cause? Montelukast may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: headache heartburn stomach pain tiredness diarrhea https://medlineplus.gov/druginfo/meds/a600014.html","<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> [user request] <TEXT> [context document]
+
+EVIDENCE:
+Why is this medication prescribed? Montelukast is used to prevent wheezing, difficulty breathing, chest tightness, and coughing caused by asthma in adults and children 12 months of age and older. Montelukast is also used to prevent bronchospasm (breathing difficulties) during exercise in adults and children 6 years of age and older. Montelukast is also used to treat the symptoms of seasonal (occurs only at certain times of the year), allergic rhinitis (a condition associated with sneezing and stuffy, runny or itchy nose) in adults and children 2 years of age and older, and perennial (occurs all year round) allergic rhinitis in adults and children 6 months of age and older. Montelukast should be used to treat seasonal or perennial allergic rhinitis only in adults and children who cannot be treated with other medications. Montelukast is in a class of medications called leukotriene receptor antagonists (LTRAs). It works by blocking the action of substances in the body that cause the symptoms of asthma and allergic rhinitis. How should this medicine be used? Montelukast comes as a tablet, a chewable tablet, and granules to take by mouth. Montelukast is usually taken once a day with or without food. When montelukast is used to treat asthma, it should be taken in the evening. When montelukast is used to prevent breathing difficulties during exercise, it should be taken at least 2 hours before exercise. If you are taking montelukast once a day on a regular basis, or if you have taken a dose of montelukast within the past 24 hours, you should not take an additional dose before exercising. When montelukast is used to treat allergic rhinitis, it may be taken at any time of day. Take montelukast at around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take montelukast exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. If you are giving the granules to your child, you should not open the foil pouch until your child is ready to take the medication. You may pour all of the granules directly from the packet into your child's mouth to be swallowed immediately. Do not use montelukast to treat a sudden attack of asthma symptoms. Your doctor will prescribe a short-acting inhaler to use during attacks. Talk to your doctor about how to treat symptoms of a sudden asthma attack. If your asthma symptoms get worse or if you have asthma attacks more often, be sure to call your doctor. If you are taking montelukast to treat asthma, continue to take or use all other medications that your doctor has prescribed to treat your asthma. Do not stop taking any of your medications or change the doses of any of your medications unless your doctor tells you that you should. If your asthma is made worse by aspirin, do not take aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) during your treatment with montelukast. Montelukast controls the symptoms of asthma and allergic rhinitis but does not cure these conditions. Continue to take montelukast even if you feel well. Do not stop taking montelukast without talking to your doctor. Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient. Other uses for this medicine This medication may be prescribed for other uses; ask your doctor or pharmacist for more information. What special precautions should I follow? Before taking montelukast, tell your doctor and pharmacist if you are allergic to montelukast or any other medications, or any of the ingredients in montelukast tablet, chewable tablet, or granules. tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention gemfibrozil (Lopid), phenobarbital and rifampin (Rifadin, Rimactane, in Rifamate, Rifater). Your doctor may need to change the doses of your medications or monitor you more carefully for side effects. tell your doctor if you have or have ever had liver disease. tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while taking montelukast, call your doctor. if you have phenylketonuria (PKU, an inherited condition in which a special diet must be followed to prevent damage to your brain that can cause severe intellectual disability), you should know that the chewable tablets contain aspartame that forms phenylalanine. What special dietary instructions should I follow? Unless your doctor tells you otherwise, continue your normal diet. What should I do if I forget a dose? Skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one. Do not take more than one dose of montelukast in a 24 hour period. What side effects can this medication cause? Montelukast may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: headache heartburn stomach pain tiredness diarrhea
+
+USER:
+Please summarize what Montelukast is used for and tell me if there are any serious side effects. This is important to me, so please be detained and provide your response in two paragraphs.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,20,33,844,,800
+"{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]","How are the current generation of consoles comparing to PCs in terms of raw graphical performance? I want to play games like Cyberpunk and stuff like that, and really value high-quality visuals like ray-tracing and high FPS. Also, how do PC and consoles differ in terms of game availability? And what kind of price point would I be looking at for a solid PC that could keep up with the consoles?","Gaming PC vs. Console: Which Should You Buy in 2024? Ease of Use Let’s get the most obvious point out of the way: a game console is much, much easier to use than a gaming PC. Modern game consoles are a bit more complex than their predecessors, and users do need to know a bit about HDR, resolution, and refresh rate for the best experience. But PC gamers need to know all that, and more. Drivers, BIOS updates, hardware compatibility, software conflicts, Windows Updates...the list goes on. A PC also requires more patience when installing and launching a game. Launching a game on Xbox, PlayStation 5, or Switch usually takes mere seconds. The Xbox Series X|S and PlayStation 5 even have “quick resume” features that let you pick up precisely where you left off without reloading the game (so long as you haven’t played another in the meantime). This is an easy win for consoles. They provide the quickest, simplest path to launching and playing a game. Though some handheld gaming PCs do a decent job as well. Winner: Console Affordability Affordability is another clear win for consoles. It’s possible to buy a gaming PC for the price of an Xbox Series X or PlayStation 5, but you’ll end up with an outdated graphics card that can’t handle games designed for modern game consoles. Gamers that can’t quite afford the Xbox Series X or Playstation 5 will find fine alternatives in the Xbox Series S and Nintendo Switch. PCs sold at prices comparable to entry-level consoles, on the other hand, usually lack a graphics card. They’ll struggle even in games that are five years old, or older. Affordable PC gaming is possible. Handheld gaming PCs like the Steam Deck and AMD Ryzen-based mini-PCs like the Beelink SER6 MAX are surprisingly capable for their size and price. Still, they’re best when playing indie games with 2D graphics or cross-platform titles from the Xbox One / PlayStation 4 era (or older)—and they’re certainly not comparable to a Xbox Series X|S or PlayStation 5. Winner: Console Overall Value Game consoles are less expensive than a gaming PC, but that doesn’t mean they’re a better value. A console is built to handle specific tasks—gaming and media streaming. A PC is as much a tool as an entertainment device and can be used for everything from web browsing to video editing and software development. That’s relevant. Many people who own a game console will also want a computer, so it’s not fair to compare the total cost of a gaming PC against the price of a game console. It’s more sensible to compare the extra cash you paid to purchase a gaming PC (instead of a more barebones computer) against the price of the game console. PC gamers looking for a good mid-range, off-the-shelf desktop or gaming laptop with performance comparable to an Xbox Series X or PlayStation 5 will need to spend $1,500 to $2,000 (depending on whether you’re fine with an basic desktop from Dell or HP, or want something from a boutique like Origin PC or Digital Storm). DIY gamers can build a console-slaying desktop for under $1,500 with an AMD Ryzen 5600X processor and a solid budget GPU, like a Radeon RX 7800 XT graphics card. That’s still a lot of money. But if you need a solid PC for other demanding tasks, you’ll need to budget around $1,000 to buy it, which makes the price difference between the PC and console less extreme. And while new gaming PCs are expensive, many popular PC games aren’t demanding and don’t require expensive hardware. Games like Counter-Strike 2, DOTA 2, Team Fortress 2, Grand Theft Auto V, War Thunder, and Tom Clancy’s Rainbow Six Siege regularly top Steam’s charts. All of these games are playable even on PCs with an ancient video card like the Nvidia GTX 1060 or AMD Radeon RX 570. Winner: Tie Game Library Differences The game library available to modern game consoles is remarkable. Most games are now cross-platform, so the PlayStation 5, Xbox Series X|S, and Nintendo Switch share many titles. The PlayStation 5 and Xbox Series X|S are backwards-compatible with many previous-gen titles, too, which boosts the game library of each console into the thousands. Compared to a gaming PC, however, those numbers look absolutely adorable. The game library available to a modern gaming PC is a mystery, because there’s too many to count. An estimate of over 100,000 titles is safe: over 12,000 games were released to Steam in 2022 alone. A PC can also emulate the game library of most older titles and, in some cases, even modern games—a PC is arguably the best way to enjoy The Legend of Zelda: Tears of the Kingdom, if you can get it working (and buy a copy of the game, as emulating the game without buying it is piracy). A PC is the way to go if you want access to the largest game library on the face of the planet. Winner: PC Performance and Visuals In June of 2019 I found a chair in Los Angeles' Peacock Theater and let Microsoft’s Xbox press conference wash over me. It was an exciting year, as hype was brewing for Sony and Microsoft’s respective next-gen consoles. And that hype included a now long-forgotten promise: 8K resolution at up to 120 frames per second. It wasn’t exactly a lie: the PlayStation 5 and Xbox Series X can technically output a 8K signal, and also output 120 frames per second. But it was marketing bullshit. The most graphically demanding games are lucky to upscale to 4K at a framerate of 60 FPS, with many titles including a 30 FPS “graphics” or “visuals” mode. PC gaming is a different world. 60 FPS is considered the bare minimum for an optimal experience, and a framerate of 120 FPS or greater is preferable. 8K gaming isn’t really a thing even on the PC (though technically possible, I suppose, if you have a rare 8K television), but a native resolution beyond at and beyond 4K is possible. The Samsung Neo G9 57-inch super-ultrawide, which supports a native resolution of 7,680 x 2,160, is arguably the most extreme gaming display available right now—and gaming at its native resolution is only possible on a PC. Console titles also tend to use a lower quality preset than what’s available on PC. The details vary from game to game, with some better optimized than others. Generally speaking, however, most games available on the PlayStation 5 or Xbox Series X|S have visuals similar to the “Medium” or “High” preset in the PC release. Ray-tracing is another win for the PC. The PlayStation 5 and Xbox Series X|S can handle ray-tracing (a feature heavily marketed in the run-up to their release), but game support is underwhelming. Even some big “next-gen” exclusives, like Starfield, fail to include it. Cross-platform titles that support ray-tracing, like Cyberpunk 2077, usually stick to a level of quality that’s a notch or two below the maximum available on PC. It’s not all good news for the PC. Nvidia’s habit of stiffing gamers on video memory is catching up to cards with less than 16GB of video memory—the amount supported by the PlayStation 5 and Xbox Series X. Optimization problems can also cause problems in some PC ports. And, of course, achieving the best possible PC gaming experience can prove extremely expensive. Still, the fact remains that PC gaming beats console gaming on both performance (as measured by framerate) and visual quality. This gap will only increase in the coming years as the current console generation ages relative to new PC graphics cards. Winner: PC","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== How are the current generation of consoles comparing to PCs in terms of raw graphical performance? I want to play games like Cyberpunk and stuff like that, and really value high-quality visuals like ray-tracing and high FPS. Also, how do PC and consoles differ in terms of game availability? And what kind of price point would I be looking at for a solid PC that could keep up with the consoles? {passage 0} ========== Gaming PC vs. Console: Which Should You Buy in 2024? Ease of Use Let’s get the most obvious point out of the way: a game console is much, much easier to use than a gaming PC. Modern game consoles are a bit more complex than their predecessors, and users do need to know a bit about HDR, resolution, and refresh rate for the best experience. But PC gamers need to know all that, and more. Drivers, BIOS updates, hardware compatibility, software conflicts, Windows Updates...the list goes on. A PC also requires more patience when installing and launching a game. Launching a game on Xbox, PlayStation 5, or Switch usually takes mere seconds. The Xbox Series X|S and PlayStation 5 even have “quick resume” features that let you pick up precisely where you left off without reloading the game (so long as you haven’t played another in the meantime). This is an easy win for consoles. They provide the quickest, simplest path to launching and playing a game. Though some handheld gaming PCs do a decent job as well. Winner: Console Affordability Affordability is another clear win for consoles. It’s possible to buy a gaming PC for the price of an Xbox Series X or PlayStation 5, but you’ll end up with an outdated graphics card that can’t handle games designed for modern game consoles. Gamers that can’t quite afford the Xbox Series X or Playstation 5 will find fine alternatives in the Xbox Series S and Nintendo Switch. PCs sold at prices comparable to entry-level consoles, on the other hand, usually lack a graphics card. They’ll struggle even in games that are five years old, or older. Affordable PC gaming is possible. Handheld gaming PCs like the Steam Deck and AMD Ryzen-based mini-PCs like the Beelink SER6 MAX are surprisingly capable for their size and price. Still, they’re best when playing indie games with 2D graphics or cross-platform titles from the Xbox One / PlayStation 4 era (or older)—and they’re certainly not comparable to a Xbox Series X|S or PlayStation 5. Winner: Console Overall Value Game consoles are less expensive than a gaming PC, but that doesn’t mean they’re a better value. A console is built to handle specific tasks—gaming and media streaming. A PC is as much a tool as an entertainment device and can be used for everything from web browsing to video editing and software development. That’s relevant. Many people who own a game console will also want a computer, so it’s not fair to compare the total cost of a gaming PC against the price of a game console. It’s more sensible to compare the extra cash you paid to purchase a gaming PC (instead of a more barebones computer) against the price of the game console. PC gamers looking for a good mid-range, off-the-shelf desktop or gaming laptop with performance comparable to an Xbox Series X or PlayStation 5 will need to spend $1,500 to $2,000 (depending on whether you’re fine with an basic desktop from Dell or HP, or want something from a boutique like Origin PC or Digital Storm). DIY gamers can build a console-slaying desktop for under $1,500 with an AMD Ryzen 5600X processor and a solid budget GPU, like a Radeon RX 7800 XT graphics card. That’s still a lot of money. But if you need a solid PC for other demanding tasks, you’ll need to budget around $1,000 to buy it, which makes the price difference between the PC and console less extreme. And while new gaming PCs are expensive, many popular PC games aren’t demanding and don’t require expensive hardware. Games like Counter-Strike 2, DOTA 2, Team Fortress 2, Grand Theft Auto V, War Thunder, and Tom Clancy’s Rainbow Six Siege regularly top Steam’s charts. All of these games are playable even on PCs with an ancient video card like the Nvidia GTX 1060 or AMD Radeon RX 570. Winner: Tie Game Library Differences The game library available to modern game consoles is remarkable. Most games are now cross-platform, so the PlayStation 5, Xbox Series X|S, and Nintendo Switch share many titles. The PlayStation 5 and Xbox Series X|S are backwards-compatible with many previous-gen titles, too, which boosts the game library of each console into the thousands. Compared to a gaming PC, however, those numbers look absolutely adorable. The game library available to a modern gaming PC is a mystery, because there’s too many to count. An estimate of over 100,000 titles is safe: over 12,000 games were released to Steam in 2022 alone. A PC can also emulate the game library of most older titles and, in some cases, even modern games—a PC is arguably the best way to enjoy The Legend of Zelda: Tears of the Kingdom, if you can get it working (and buy a copy of the game, as emulating the game without buying it is piracy). A PC is the way to go if you want access to the largest game library on the face of the planet. Winner: PC Performance and Visuals In June of 2019 I found a chair in Los Angeles' Peacock Theater and let Microsoft’s Xbox press conference wash over me. It was an exciting year, as hype was brewing for Sony and Microsoft’s respective next-gen consoles. And that hype included a now long-forgotten promise: 8K resolution at up to 120 frames per second. It wasn’t exactly a lie: the PlayStation 5 and Xbox Series X can technically output a 8K signal, and also output 120 frames per second. But it was marketing bullshit. The most graphically demanding games are lucky to upscale to 4K at a framerate of 60 FPS, with many titles including a 30 FPS “graphics” or “visuals” mode. PC gaming is a different world. 60 FPS is considered the bare minimum for an optimal experience, and a framerate of 120 FPS or greater is preferable. 8K gaming isn’t really a thing even on the PC (though technically possible, I suppose, if you have a rare 8K television), but a native resolution beyond at and beyond 4K is possible. The Samsung Neo G9 57-inch super-ultrawide, which supports a native resolution of 7,680 x 2,160, is arguably the most extreme gaming display available right now—and gaming at its native resolution is only possible on a PC. Console titles also tend to use a lower quality preset than what’s available on PC. The details vary from game to game, with some better optimized than others. Generally speaking, however, most games available on the PlayStation 5 or Xbox Series X|S have visuals similar to the “Medium” or “High” preset in the PC release. Ray-tracing is another win for the PC. The PlayStation 5 and Xbox Series X|S can handle ray-tracing (a feature heavily marketed in the run-up to their release), but game support is underwhelming. Even some big “next-gen” exclusives, like Starfield, fail to include it. Cross-platform titles that support ray-tracing, like Cyberpunk 2077, usually stick to a level of quality that’s a notch or two below the maximum available on PC. It’s not all good news for the PC. Nvidia’s habit of stiffing gamers on video memory is catching up to cards with less than 16GB of video memory—the amount supported by the PlayStation 5 and Xbox Series X. Optimization problems can also cause problems in some PC ports. And, of course, achieving the best possible PC gaming experience can prove extremely expensive. Still, the fact remains that PC gaming beats console gaming on both performance (as measured by framerate) and visual quality. This gap will only increase in the coming years as the current console generation ages relative to new PC graphics cards. Winner: PC https://www.ign.com/articles/gaming-pc-vs-console-differences","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]
+
+EVIDENCE:
+Gaming PC vs. Console: Which Should You Buy in 2024? Ease of Use Let’s get the most obvious point out of the way: a game console is much, much easier to use than a gaming PC. Modern game consoles are a bit more complex than their predecessors, and users do need to know a bit about HDR, resolution, and refresh rate for the best experience. But PC gamers need to know all that, and more. Drivers, BIOS updates, hardware compatibility, software conflicts, Windows Updates...the list goes on. A PC also requires more patience when installing and launching a game. Launching a game on Xbox, PlayStation 5, or Switch usually takes mere seconds. The Xbox Series X|S and PlayStation 5 even have “quick resume” features that let you pick up precisely where you left off without reloading the game (so long as you haven’t played another in the meantime). This is an easy win for consoles. They provide the quickest, simplest path to launching and playing a game. Though some handheld gaming PCs do a decent job as well. Winner: Console Affordability Affordability is another clear win for consoles. It’s possible to buy a gaming PC for the price of an Xbox Series X or PlayStation 5, but you’ll end up with an outdated graphics card that can’t handle games designed for modern game consoles. Gamers that can’t quite afford the Xbox Series X or Playstation 5 will find fine alternatives in the Xbox Series S and Nintendo Switch. PCs sold at prices comparable to entry-level consoles, on the other hand, usually lack a graphics card. They’ll struggle even in games that are five years old, or older. Affordable PC gaming is possible. Handheld gaming PCs like the Steam Deck and AMD Ryzen-based mini-PCs like the Beelink SER6 MAX are surprisingly capable for their size and price. Still, they’re best when playing indie games with 2D graphics or cross-platform titles from the Xbox One / PlayStation 4 era (or older)—and they’re certainly not comparable to a Xbox Series X|S or PlayStation 5. Winner: Console Overall Value Game consoles are less expensive than a gaming PC, but that doesn’t mean they’re a better value. A console is built to handle specific tasks—gaming and media streaming. A PC is as much a tool as an entertainment device and can be used for everything from web browsing to video editing and software development. That’s relevant. Many people who own a game console will also want a computer, so it’s not fair to compare the total cost of a gaming PC against the price of a game console. It’s more sensible to compare the extra cash you paid to purchase a gaming PC (instead of a more barebones computer) against the price of the game console. PC gamers looking for a good mid-range, off-the-shelf desktop or gaming laptop with performance comparable to an Xbox Series X or PlayStation 5 will need to spend $1,500 to $2,000 (depending on whether you’re fine with an basic desktop from Dell or HP, or want something from a boutique like Origin PC or Digital Storm). DIY gamers can build a console-slaying desktop for under $1,500 with an AMD Ryzen 5600X processor and a solid budget GPU, like a Radeon RX 7800 XT graphics card. That’s still a lot of money. But if you need a solid PC for other demanding tasks, you’ll need to budget around $1,000 to buy it, which makes the price difference between the PC and console less extreme. And while new gaming PCs are expensive, many popular PC games aren’t demanding and don’t require expensive hardware. Games like Counter-Strike 2, DOTA 2, Team Fortress 2, Grand Theft Auto V, War Thunder, and Tom Clancy’s Rainbow Six Siege regularly top Steam’s charts. All of these games are playable even on PCs with an ancient video card like the Nvidia GTX 1060 or AMD Radeon RX 570. Winner: Tie Game Library Differences The game library available to modern game consoles is remarkable. Most games are now cross-platform, so the PlayStation 5, Xbox Series X|S, and Nintendo Switch share many titles. The PlayStation 5 and Xbox Series X|S are backwards-compatible with many previous-gen titles, too, which boosts the game library of each console into the thousands. Compared to a gaming PC, however, those numbers look absolutely adorable. The game library available to a modern gaming PC is a mystery, because there’s too many to count. An estimate of over 100,000 titles is safe: over 12,000 games were released to Steam in 2022 alone. A PC can also emulate the game library of most older titles and, in some cases, even modern games—a PC is arguably the best way to enjoy The Legend of Zelda: Tears of the Kingdom, if you can get it working (and buy a copy of the game, as emulating the game without buying it is piracy). A PC is the way to go if you want access to the largest game library on the face of the planet. Winner: PC Performance and Visuals In June of 2019 I found a chair in Los Angeles' Peacock Theater and let Microsoft’s Xbox press conference wash over me. It was an exciting year, as hype was brewing for Sony and Microsoft’s respective next-gen consoles. And that hype included a now long-forgotten promise: 8K resolution at up to 120 frames per second. It wasn’t exactly a lie: the PlayStation 5 and Xbox Series X can technically output a 8K signal, and also output 120 frames per second. But it was marketing bullshit. The most graphically demanding games are lucky to upscale to 4K at a framerate of 60 FPS, with many titles including a 30 FPS “graphics” or “visuals” mode. PC gaming is a different world. 60 FPS is considered the bare minimum for an optimal experience, and a framerate of 120 FPS or greater is preferable. 8K gaming isn’t really a thing even on the PC (though technically possible, I suppose, if you have a rare 8K television), but a native resolution beyond at and beyond 4K is possible. The Samsung Neo G9 57-inch super-ultrawide, which supports a native resolution of 7,680 x 2,160, is arguably the most extreme gaming display available right now—and gaming at its native resolution is only possible on a PC. Console titles also tend to use a lower quality preset than what’s available on PC. The details vary from game to game, with some better optimized than others. Generally speaking, however, most games available on the PlayStation 5 or Xbox Series X|S have visuals similar to the “Medium” or “High” preset in the PC release. Ray-tracing is another win for the PC. The PlayStation 5 and Xbox Series X|S can handle ray-tracing (a feature heavily marketed in the run-up to their release), but game support is underwhelming. Even some big “next-gen” exclusives, like Starfield, fail to include it. Cross-platform titles that support ray-tracing, like Cyberpunk 2077, usually stick to a level of quality that’s a notch or two below the maximum available on PC. It’s not all good news for the PC. Nvidia’s habit of stiffing gamers on video memory is catching up to cards with less than 16GB of video memory—the amount supported by the PlayStation 5 and Xbox Series X. Optimization problems can also cause problems in some PC ports. And, of course, achieving the best possible PC gaming experience can prove extremely expensive. Still, the fact remains that PC gaming beats console gaming on both performance (as measured by framerate) and visual quality. This gap will only increase in the coming years as the current console generation ages relative to new PC graphics cards. Winner: PC
+
+USER:
+How are the current generation of consoles comparing to PCs in terms of raw graphical performance? I want to play games like Cyberpunk and stuff like that, and really value high-quality visuals like ray-tracing and high FPS. Also, how do PC and consoles differ in terms of game availability? And what kind of price point would I be looking at for a solid PC that could keep up with the consoles?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,26,71,1277,,368
+"Respond using only the information contained in the prompt. Format the response in bullet points, with two sentences per bullet point.","Based on this report, summarize the details of the Term Loans taken by squarespace.","Indebtedness On December 12, 2019, we entered into a credit agreement with various financial institutions that provided for a $350.0 million term loan (the “2019 Term Loan”) and a $25.0 million revolving credit facility (the “Revolving Credit Facility”), which included a $15.0 million letter of credit sub-facility. On December 11, 2020, we amended the credit agreement (as amended, the “2020 Credit Agreement”) to increase the size of the 2019 Term Loan to $550.0 million (as amended, the “2020 Term Loan”) and extend the maturity date for the 2019 Term Loan and the Revolving Credit Facility to December 11, 2025. On June 15, 2023, we amended the 2020 Credit Agreement (as amended, the “Credit Agreement”) to increase the total size of the 2020 Term Loan to $650.0 million (the “Term Loan”) upon the closing of the Google Domains Asset Acquisition and, effective June 30, 2023, replaced LIBOR as the benchmark rate with SOFR. The borrowings under the 2019 Term Loan were used to provide for the repurchase, and subsequent retirement, of outstanding capital stock. The borrowings under the 2020 Term Loan were used to provide for a dividend on all outstanding capital stock. The additional borrowings of $100.0 million under the Term Loan were used to partially fund the Google Domains Asset Acquisition, together with cash on hand. Borrowings under the 2020 Credit Agreement were subject to an interest rate equal to, at our option, LIBOR or the bank's alternative base rate (the ""ABR""), in either case, plus an applicable margin prior to June 30, 2023. Effective June 30, 2023, under the Credit Agreement, LIBOR as the benchmark rate was replaced with SOFR. The ABR is the greater of the prime rate, the federal funds effective rate plus the applicable margin or the SOFR quoted rate plus the applicable margin. The applicable margin is based on an indebtedness to consolidated EBITDA ratio as prescribed under the Credit Agreement 39 Table of Contents and ranges from 1.25% to 2.25% on applicable SOFR loans and 0.25% to 1.25% on ABR loans. In addition, the Revolving Credit Facility is subject to an unused commitment fee, payable quarterly, of 0.20% to 0.25% of the unutilized commitments (subject to reduction in certain circumstances). Consolidated EBITDA is defined in the Credit Agreement and is not comparable to our definition of adjusted EBITDA used elsewhere in the Quarterly Report on Form 10-Q since the Credit Agreement allows for additional adjustments to net income/(loss) including the exclusion of transaction costs, changes in deferred revenue and other costs that may be considered non-recurring. Further, consolidated EBITDA, as defined in the Credit Agreement, may be different from similarly titled EBITDA financial measures used by other companies. The definition of consolidated EBITDA is contained in Section 1.1 of the Credit Agreement. As of June 30, 2024, $546.9 million was outstanding under the Term Loan. The Term Loan requires scheduled quarterly principal payments in aggregate annual amounts equal to 7.50% for 2023 and 2024, and 10.00% for 2025, in each case, on the Term Loan principal amount, with the balance due at maturity. In addition, the Credit Agreement includes certain customary prepayment requirements for the Term Loan, which are triggered by events such as asset sales, incurrence of indebtedness and sale leasebacks. As of June 30, 2024, $7.3 million was outstanding under the Revolving Credit Facility in the form of outstanding letters of credit and $17.7 million remained available for borrowing by us. The outstanding letters of credit relate to security deposits for certain of our leased locations. The Credit Agreement contains certain customary affirmative covenants and events of default. The negative covenants in the Credit Agreement include, among others, limitations on our ability (subject to negotiated exceptions) to incur additional indebtedness or issue additional preferred stock, incur liens on assets, enter into agreements related to mergers and acquisitions, dispose of assets or pay dividends and distributions. The Credit Agreement contains certain negative covenants for an indebtedness to consolidated EBITDA ratio, as defined by the Credit Agreement, and commencing with December 31, 2020 and all fiscal quarters thereafter through maturity. For the fiscal quarter ended June 30, 2024, and each fiscal quarter thereafter, the Company is required to maintain an indebtedness to consolidated EBITDA ratio of not more than 3.75 (the “Financial Covenant”), subject to customary equity cure rights. The Financial Covenant is subject to a 0.50 step-up in the event of a material permitted acquisition, which we can elect to implement up to two times during the life of the facility. As of June 30, 2024, we have not elected to implement this set-up as a result of any of our acquisitions. If we are not in compliance with the covenants under the Credit Agreement or we otherwise experience an event of default, the lenders would be entitled to take various actions, including acceleration of amounts due under the Credit Agreement. As of June 30, 2024, we were in compliance with all applicable covenants, including the Financial Covenant. The obligations under the Credit Agreement are guaranteed by our wholly-owned domestic subsidiaries and are secured by substantially all of the assets of the guarantors, subject to certain exceptions. Total interest expense related to our indebtedness was $10.1 million and $20.5 million for the three and six months ended June 30, 2024, respectively, and $8.6 million and $16.7 million for the three and six months ended June 30, 2023, respectively. Stock Repurchase Plan On May 10, 2022, the board of directors authorized a general share repurchase program of the Company’s Class A common stock of up to $200.0 million. On February 26, 2024, the board of directors authorized a new general share repurchase program of the Company's Class A common stock of up to $500.0 million with no fixed expiration (the ""Stock Repurchase Plan"") to replace the previous repurchase plan. During the three and six months ended June 30, 2024, the Company repurchased 0.2 million and 0.5 million shares and paid cash of $4.1 million and $16.3 million, under the Stock Repurchase Plan through open market purchases. The weighted-average price per share for the share repurchases was $36.53 and $34.36 during the three and six months ended June 30, 2024. As of June 30, 2024, approximately $483.7 million remained available for stock repurchase pursuant to the Stock Repurchase Plan.","System instruction: Respond using only the information contained in the prompt. Format the response in bullet points, with two sentences per bullet point. question: Based on this report, summarize the details of the Term Loans taken by squarespace. context: Indebtedness On December 12, 2019, we entered into a credit agreement with various financial institutions that provided for a $350.0 million term loan (the “2019 Term Loan”) and a $25.0 million revolving credit facility (the “Revolving Credit Facility”), which included a $15.0 million letter of credit sub-facility. On December 11, 2020, we amended the credit agreement (as amended, the “2020 Credit Agreement”) to increase the size of the 2019 Term Loan to $550.0 million (as amended, the “2020 Term Loan”) and extend the maturity date for the 2019 Term Loan and the Revolving Credit Facility to December 11, 2025. On June 15, 2023, we amended the 2020 Credit Agreement (as amended, the “Credit Agreement”) to increase the total size of the 2020 Term Loan to $650.0 million (the “Term Loan”) upon the closing of the Google Domains Asset Acquisition and, effective June 30, 2023, replaced LIBOR as the benchmark rate with SOFR. The borrowings under the 2019 Term Loan were used to provide for the repurchase, and subsequent retirement, of outstanding capital stock. The borrowings under the 2020 Term Loan were used to provide for a dividend on all outstanding capital stock. The additional borrowings of $100.0 million under the Term Loan were used to partially fund the Google Domains Asset Acquisition, together with cash on hand. Borrowings under the 2020 Credit Agreement were subject to an interest rate equal to, at our option, LIBOR or the bank's alternative base rate (the ""ABR""), in either case, plus an applicable margin prior to June 30, 2023. Effective June 30, 2023, under the Credit Agreement, LIBOR as the benchmark rate was replaced with SOFR. The ABR is the greater of the prime rate, the federal funds effective rate plus the applicable margin or the SOFR quoted rate plus the applicable margin. The applicable margin is based on an indebtedness to consolidated EBITDA ratio as prescribed under the Credit Agreement 39 Table of Contents and ranges from 1.25% to 2.25% on applicable SOFR loans and 0.25% to 1.25% on ABR loans. In addition, the Revolving Credit Facility is subject to an unused commitment fee, payable quarterly, of 0.20% to 0.25% of the unutilized commitments (subject to reduction in certain circumstances). Consolidated EBITDA is defined in the Credit Agreement and is not comparable to our definition of adjusted EBITDA used elsewhere in the Quarterly Report on Form 10-Q since the Credit Agreement allows for additional adjustments to net income/(loss) including the exclusion of transaction costs, changes in deferred revenue and other costs that may be considered non-recurring. Further, consolidated EBITDA, as defined in the Credit Agreement, may be different from similarly titled EBITDA financial measures used by other companies. The definition of consolidated EBITDA is contained in Section 1.1 of the Credit Agreement. As of June 30, 2024, $546.9 million was outstanding under the Term Loan. The Term Loan requires scheduled quarterly principal payments in aggregate annual amounts equal to 7.50% for 2023 and 2024, and 10.00% for 2025, in each case, on the Term Loan principal amount, with the balance due at maturity. In addition, the Credit Agreement includes certain customary prepayment requirements for the Term Loan, which are triggered by events such as asset sales, incurrence of indebtedness and sale leasebacks. As of June 30, 2024, $7.3 million was outstanding under the Revolving Credit Facility in the form of outstanding letters of credit and $17.7 million remained available for borrowing by us. The outstanding letters of credit relate to security deposits for certain of our leased locations. The Credit Agreement contains certain customary affirmative covenants and events of default. The negative covenants in the Credit Agreement include, among others, limitations on our ability (subject to negotiated exceptions) to incur additional indebtedness or issue additional preferred stock, incur liens on assets, enter into agreements related to mergers and acquisitions, dispose of assets or pay dividends and distributions. The Credit Agreement contains certain negative covenants for an indebtedness to consolidated EBITDA ratio, as defined by the Credit Agreement, and commencing with December 31, 2020 and all fiscal quarters thereafter through maturity. For the fiscal quarter ended June 30, 2024, and each fiscal quarter thereafter, the Company is required to maintain an indebtedness to consolidated EBITDA ratio of not more than 3.75 (the “Financial Covenant”), subject to customary equity cure rights. The Financial Covenant is subject to a 0.50 step-up in the event of a material permitted acquisition, which we can elect to implement up to two times during the life of the facility. As of June 30, 2024, we have not elected to implement this set-up as a result of any of our acquisitions. If we are not in compliance with the covenants under the Credit Agreement or we otherwise experience an event of default, the lenders would be entitled to take various actions, including acceleration of amounts due under the Credit Agreement. As of June 30, 2024, we were in compliance with all applicable covenants, including the Financial Covenant. The obligations under the Credit Agreement are guaranteed by our wholly-owned domestic subsidiaries and are secured by substantially all of the assets of the guarantors, subject to certain exceptions. Total interest expense related to our indebtedness was $10.1 million and $20.5 million for the three and six months ended June 30, 2024, respectively, and $8.6 million and $16.7 million for the three and six months ended June 30, 2023, respectively. Stock Repurchase Plan On May 10, 2022, the board of directors authorized a general share repurchase program of the Company’s Class A common stock of up to $200.0 million. On February 26, 2024, the board of directors authorized a new general share repurchase program of the Company's Class A common stock of up to $500.0 million with no fixed expiration (the ""Stock Repurchase Plan"") to replace the previous repurchase plan. During the three and six months ended June 30, 2024, the Company repurchased 0.2 million and 0.5 million shares and paid cash of $4.1 million and $16.3 million, under the Stock Repurchase Plan through open market purchases. The weighted-average price per share for the share repurchases was $36.53 and $34.36 during the three and six months ended June 30, 2024. As of June 30, 2024, approximately $483.7 million remained available for stock repurchase pursuant to the Stock Repurchase Plan.","Respond using only the information contained in the prompt. Format the response in bullet points, with two sentences per bullet point.
+
+EVIDENCE:
+Indebtedness On December 12, 2019, we entered into a credit agreement with various financial institutions that provided for a $350.0 million term loan (the “2019 Term Loan”) and a $25.0 million revolving credit facility (the “Revolving Credit Facility”), which included a $15.0 million letter of credit sub-facility. On December 11, 2020, we amended the credit agreement (as amended, the “2020 Credit Agreement”) to increase the size of the 2019 Term Loan to $550.0 million (as amended, the “2020 Term Loan”) and extend the maturity date for the 2019 Term Loan and the Revolving Credit Facility to December 11, 2025. On June 15, 2023, we amended the 2020 Credit Agreement (as amended, the “Credit Agreement”) to increase the total size of the 2020 Term Loan to $650.0 million (the “Term Loan”) upon the closing of the Google Domains Asset Acquisition and, effective June 30, 2023, replaced LIBOR as the benchmark rate with SOFR. The borrowings under the 2019 Term Loan were used to provide for the repurchase, and subsequent retirement, of outstanding capital stock. The borrowings under the 2020 Term Loan were used to provide for a dividend on all outstanding capital stock. The additional borrowings of $100.0 million under the Term Loan were used to partially fund the Google Domains Asset Acquisition, together with cash on hand. Borrowings under the 2020 Credit Agreement were subject to an interest rate equal to, at our option, LIBOR or the bank's alternative base rate (the ""ABR""), in either case, plus an applicable margin prior to June 30, 2023. Effective June 30, 2023, under the Credit Agreement, LIBOR as the benchmark rate was replaced with SOFR. The ABR is the greater of the prime rate, the federal funds effective rate plus the applicable margin or the SOFR quoted rate plus the applicable margin. The applicable margin is based on an indebtedness to consolidated EBITDA ratio as prescribed under the Credit Agreement 39 Table of Contents and ranges from 1.25% to 2.25% on applicable SOFR loans and 0.25% to 1.25% on ABR loans. In addition, the Revolving Credit Facility is subject to an unused commitment fee, payable quarterly, of 0.20% to 0.25% of the unutilized commitments (subject to reduction in certain circumstances). Consolidated EBITDA is defined in the Credit Agreement and is not comparable to our definition of adjusted EBITDA used elsewhere in the Quarterly Report on Form 10-Q since the Credit Agreement allows for additional adjustments to net income/(loss) including the exclusion of transaction costs, changes in deferred revenue and other costs that may be considered non-recurring. Further, consolidated EBITDA, as defined in the Credit Agreement, may be different from similarly titled EBITDA financial measures used by other companies. The definition of consolidated EBITDA is contained in Section 1.1 of the Credit Agreement. As of June 30, 2024, $546.9 million was outstanding under the Term Loan. The Term Loan requires scheduled quarterly principal payments in aggregate annual amounts equal to 7.50% for 2023 and 2024, and 10.00% for 2025, in each case, on the Term Loan principal amount, with the balance due at maturity. In addition, the Credit Agreement includes certain customary prepayment requirements for the Term Loan, which are triggered by events such as asset sales, incurrence of indebtedness and sale leasebacks. As of June 30, 2024, $7.3 million was outstanding under the Revolving Credit Facility in the form of outstanding letters of credit and $17.7 million remained available for borrowing by us. The outstanding letters of credit relate to security deposits for certain of our leased locations. The Credit Agreement contains certain customary affirmative covenants and events of default. The negative covenants in the Credit Agreement include, among others, limitations on our ability (subject to negotiated exceptions) to incur additional indebtedness or issue additional preferred stock, incur liens on assets, enter into agreements related to mergers and acquisitions, dispose of assets or pay dividends and distributions. The Credit Agreement contains certain negative covenants for an indebtedness to consolidated EBITDA ratio, as defined by the Credit Agreement, and commencing with December 31, 2020 and all fiscal quarters thereafter through maturity. For the fiscal quarter ended June 30, 2024, and each fiscal quarter thereafter, the Company is required to maintain an indebtedness to consolidated EBITDA ratio of not more than 3.75 (the “Financial Covenant”), subject to customary equity cure rights. The Financial Covenant is subject to a 0.50 step-up in the event of a material permitted acquisition, which we can elect to implement up to two times during the life of the facility. As of June 30, 2024, we have not elected to implement this set-up as a result of any of our acquisitions. If we are not in compliance with the covenants under the Credit Agreement or we otherwise experience an event of default, the lenders would be entitled to take various actions, including acceleration of amounts due under the Credit Agreement. As of June 30, 2024, we were in compliance with all applicable covenants, including the Financial Covenant. The obligations under the Credit Agreement are guaranteed by our wholly-owned domestic subsidiaries and are secured by substantially all of the assets of the guarantors, subject to certain exceptions. Total interest expense related to our indebtedness was $10.1 million and $20.5 million for the three and six months ended June 30, 2024, respectively, and $8.6 million and $16.7 million for the three and six months ended June 30, 2023, respectively. Stock Repurchase Plan On May 10, 2022, the board of directors authorized a general share repurchase program of the Company’s Class A common stock of up to $200.0 million. On February 26, 2024, the board of directors authorized a new general share repurchase program of the Company's Class A common stock of up to $500.0 million with no fixed expiration (the ""Stock Repurchase Plan"") to replace the previous repurchase plan. During the three and six months ended June 30, 2024, the Company repurchased 0.2 million and 0.5 million shares and paid cash of $4.1 million and $16.3 million, under the Stock Repurchase Plan through open market purchases. The weighted-average price per share for the share repurchases was $36.53 and $34.36 during the three and six months ended June 30, 2024. As of June 30, 2024, approximately $483.7 million remained available for stock repurchase pursuant to the Stock Repurchase Plan.
+
+USER:
+Based on this report, summarize the details of the Term Loans taken by squarespace.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,21,14,1045,,501
+Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document],"I see that on the new flagship Nvidia models, there is always the designation RTX. What does this mean and why is it important? Explain in under 300 words.","“Ray tracing is the future, and it always will be!” has been the tongue-in-cheek phrase used by graphics developers for decades when asked whether real-time ray tracing will ever be feasible. Everyone seems to agree on the first part: ray tracing is the future. That’s because ray tracing is the only technology we know of that enables the rendering of truly photorealistic images. It’s no coincidence that every offline renderer used in the movie industry, where compromises on image quality are unacceptable, is based on ray tracing. Rasterization has made immense strides over the years, and it is still evolving even today. But it is also fundamentally limited in the type of effects it can compute. Truly taking graphics to the next level requires new underlying technology. This is where ray tracing comes in, and this is why real-time ray tracing has long been the dream of gamers and game developers. So will ray tracing always remain a dream of the future, and never arrive in the present? At GDC 2018, NVIDIA unveiled RTX, a high-performance implementation that will power all ray tracing APIs supported by NVIDIA on Volta and future GPUs. At the same event, Microsoft announced the integration of ray tracing as a first-class citizen into their industry standard DirectX API. Putting these two technologies together forms such a powerful combination that we can confidently answer the above question: the future is here! This is not a hyperbole: leading game studios are developing upcoming titles using RTX through DirectX — today. Ray tracing in games is no longer a pipe dream. It’s happening, and it will usher in a new era of real-time graphics. he API that Microsoft announced, DirectX Raytracing (DXR), is a natural extension of DirectX 12. It fully integrates ray tracing into DirectX, and makes it a companion (as opposed to a replacement) to rasterization and compute. API Overview The DXR API focuses on delivering high performance by giving the application signficant low-level control, as with earlier versions of DirectX 12. Several design decisions reflect this: All ray tracing related GPU work is dispatched via command lists and queues that the application schedules. Ray tracing therefore integrates tightly with other work such as rasterization or compute, and can be enqueued efficiently by a multithreaded application. Ray tracing shaders are dispatched as grids of work items, similar to compute shaders. This lets the implementation utilize the massive parallel processing throughput of GPUs and perform low-level scheduling of work items as appropriate for the given hardware. The application retains the responsibility of explicitly synchronizing GPU work and resources where necessary, as it does with rasterization and compute. This allows developers to optimize for the maximum amount of overlap between ray tracing, rasterization, compute work, and memory transfers. Ray tracing and other dispatch types share all resources such as textures, buffers, and constants. No conversion, duplication, or mapping is required to access a resource from ray tracing shaders. Resources that hold ray tracing specific data, such as acceleration structures and shader tables (see below), are entirely managed by the application. No memory allocations or transfers happen implicitly “under the hood”. Shader compilation is explicit and therefore under full application control. Shaders can be compiled individually or in batch. Compilation can be parallelized across multiple CPU threads if desired. At a high level, DXR introduces three new concepts to DirectX that the application must manage: Ray Tracing Pipeline State Objects contain the compiled shader code that gets executed during a ray tracing dispatch. Acceleration Structures contain the data structures used to accelerate ray tracing itself, i.e. the search for intersections between rays and scene geometry. Shader Tables define the relationship between ray tracing shaders, their resources (textures, constants, etc), and scene geometry. Let’s take a closer look at these. The traditional raster graphics pipeline defines a number of shader types: vertex shader, geometry shader, pixel shader, etc. Analog to that model, a ray tracing pipeline consists of five new shader types which are executed at different stages: The ray generation shader is the first thing invoked in a ray tracing dispatch. Ray generation shaders are comparable to compute shaders, with the added capability of calling the new HLSL function TraceRay(). This function casts a single ray into the scene to search for intersections, triggering other shaders in the process. A ray generation shader may call TraceRay() as many times as it likes. Intersection and any hit shaders are invoked whenever TraceRay() finds a potential intersection between the ray and the scene. The intersection shader determines whether the ray intersects an individual geometric primitive — for example a sphere, a subdivision surface, or really any primitive type you can code up! The most common type is, of course, triangles, for which the API offers special support through a built-in, highly tuned intersection shader. Once an intersection is found, the any hit shader may be used to process it further or potentially discard it. Any hit shaders commonly implement alpha testing by performing a texture lookup and deciding based on the texel’s value whether or not to discard an intersection. Once TraceRay() has completed the search for ray-scene intersections, either a closest hit or a miss shader is invoked, depending on the outcome of the search. The closest hit shader is typically where most shading operations take place: material evaluation, texture lookups, and so on. The miss shader can be used to implement environment lookups, for example. Both closest hit and miss shaders can recursively trace rays by calling TraceRay() themselves. The pipeline constructed from these shaders defines a single-ray programming model. Semantically, each GPU thread handles one ray at a time and cannot communicate with other threads or see other rays currently being processed. This keeps things simple for developers writing shaders, while allowing room for vendor-specific optimizations under the hood of the API. The main way for the different shader types to communicate with each other is the ray payload. The payload is simply a user-defined struct that’s passed as an inout parameter to TraceRay(). Any hit, closest hit, and miss shaders can read and write the payload, and therefore pass back the result of their computations to the caller of TraceRay().","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. I see that on the new flagship Nvidia models, there is always the designation RTX. What does this mean and why is it important? Explain in under 300 words. “Ray tracing is the future, and it always will be!” has been the tongue-in-cheek phrase used by graphics developers for decades when asked whether real-time ray tracing will ever be feasible. Everyone seems to agree on the first part: ray tracing is the future. That’s because ray tracing is the only technology we know of that enables the rendering of truly photorealistic images. It’s no coincidence that every offline renderer used in the movie industry, where compromises on image quality are unacceptable, is based on ray tracing. Rasterization has made immense strides over the years, and it is still evolving even today. But it is also fundamentally limited in the type of effects it can compute. Truly taking graphics to the next level requires new underlying technology. This is where ray tracing comes in, and this is why real-time ray tracing has long been the dream of gamers and game developers. So will ray tracing always remain a dream of the future, and never arrive in the present? At GDC 2018, NVIDIA unveiled RTX, a high-performance implementation that will power all ray tracing APIs supported by NVIDIA on Volta and future GPUs. At the same event, Microsoft announced the integration of ray tracing as a first-class citizen into their industry standard DirectX API. Putting these two technologies together forms such a powerful combination that we can confidently answer the above question: the future is here! This is not a hyperbole: leading game studios are developing upcoming titles using RTX through DirectX — today. Ray tracing in games is no longer a pipe dream. It’s happening, and it will usher in a new era of real-time graphics. he API that Microsoft announced, DirectX Raytracing (DXR), is a natural extension of DirectX 12. It fully integrates ray tracing into DirectX, and makes it a companion (as opposed to a replacement) to rasterization and compute. API Overview The DXR API focuses on delivering high performance by giving the application signficant low-level control, as with earlier versions of DirectX 12. Several design decisions reflect this: All ray tracing related GPU work is dispatched via command lists and queues that the application schedules. Ray tracing therefore integrates tightly with other work such as rasterization or compute, and can be enqueued efficiently by a multithreaded application. Ray tracing shaders are dispatched as grids of work items, similar to compute shaders. This lets the implementation utilize the massive parallel processing throughput of GPUs and perform low-level scheduling of work items as appropriate for the given hardware. The application retains the responsibility of explicitly synchronizing GPU work and resources where necessary, as it does with rasterization and compute. This allows developers to optimize for the maximum amount of overlap between ray tracing, rasterization, compute work, and memory transfers. Ray tracing and other dispatch types share all resources such as textures, buffers, and constants. No conversion, duplication, or mapping is required to access a resource from ray tracing shaders. Resources that hold ray tracing specific data, such as acceleration structures and shader tables (see below), are entirely managed by the application. No memory allocations or transfers happen implicitly “under the hood”. Shader compilation is explicit and therefore under full application control. Shaders can be compiled individually or in batch. Compilation can be parallelized across multiple CPU threads if desired. At a high level, DXR introduces three new concepts to DirectX that the application must manage: Ray Tracing Pipeline State Objects contain the compiled shader code that gets executed during a ray tracing dispatch. Acceleration Structures contain the data structures used to accelerate ray tracing itself, i.e. the search for intersections between rays and scene geometry. Shader Tables define the relationship between ray tracing shaders, their resources (textures, constants, etc), and scene geometry. Let’s take a closer look at these. The traditional raster graphics pipeline defines a number of shader types: vertex shader, geometry shader, pixel shader, etc. Analog to that model, a ray tracing pipeline consists of five new shader types which are executed at different stages: The ray generation shader is the first thing invoked in a ray tracing dispatch. Ray generation shaders are comparable to compute shaders, with the added capability of calling the new HLSL function TraceRay(). This function casts a single ray into the scene to search for intersections, triggering other shaders in the process. A ray generation shader may call TraceRay() as many times as it likes. Intersection and any hit shaders are invoked whenever TraceRay() finds a potential intersection between the ray and the scene. The intersection shader determines whether the ray intersects an individual geometric primitive — for example a sphere, a subdivision surface, or really any primitive type you can code up! The most common type is, of course, triangles, for which the API offers special support through a built-in, highly tuned intersection shader. Once an intersection is found, the any hit shader may be used to process it further or potentially discard it. Any hit shaders commonly implement alpha testing by performing a texture lookup and deciding based on the texel’s value whether or not to discard an intersection. Once TraceRay() has completed the search for ray-scene intersections, either a closest hit or a miss shader is invoked, depending on the outcome of the search. The closest hit shader is typically where most shading operations take place: material evaluation, texture lookups, and so on. The miss shader can be used to implement environment lookups, for example. Both closest hit and miss shaders can recursively trace rays by calling TraceRay() themselves. The pipeline constructed from these shaders defines a single-ray programming model. Semantically, each GPU thread handles one ray at a time and cannot communicate with other threads or see other rays currently being processed. This keeps things simple for developers writing shaders, while allowing room for vendor-specific optimizations under the hood of the API. The main way for the different shader types to communicate with each other is the ray payload. The payload is simply a user-defined struct that’s passed as an inout parameter to TraceRay(). Any hit, closest hit, and miss shaders can read and write the payload, and therefore pass back the result of their computations to the caller of TraceRay(). https://developer.nvidia.com/blog/introduction-nvidia-rtx-directx-ray-tracing/","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]
+
+EVIDENCE:
+“Ray tracing is the future, and it always will be!” has been the tongue-in-cheek phrase used by graphics developers for decades when asked whether real-time ray tracing will ever be feasible. Everyone seems to agree on the first part: ray tracing is the future. That’s because ray tracing is the only technology we know of that enables the rendering of truly photorealistic images. It’s no coincidence that every offline renderer used in the movie industry, where compromises on image quality are unacceptable, is based on ray tracing. Rasterization has made immense strides over the years, and it is still evolving even today. But it is also fundamentally limited in the type of effects it can compute. Truly taking graphics to the next level requires new underlying technology. This is where ray tracing comes in, and this is why real-time ray tracing has long been the dream of gamers and game developers. So will ray tracing always remain a dream of the future, and never arrive in the present? At GDC 2018, NVIDIA unveiled RTX, a high-performance implementation that will power all ray tracing APIs supported by NVIDIA on Volta and future GPUs. At the same event, Microsoft announced the integration of ray tracing as a first-class citizen into their industry standard DirectX API. Putting these two technologies together forms such a powerful combination that we can confidently answer the above question: the future is here! This is not a hyperbole: leading game studios are developing upcoming titles using RTX through DirectX — today. Ray tracing in games is no longer a pipe dream. It’s happening, and it will usher in a new era of real-time graphics. he API that Microsoft announced, DirectX Raytracing (DXR), is a natural extension of DirectX 12. It fully integrates ray tracing into DirectX, and makes it a companion (as opposed to a replacement) to rasterization and compute. API Overview The DXR API focuses on delivering high performance by giving the application signficant low-level control, as with earlier versions of DirectX 12. Several design decisions reflect this: All ray tracing related GPU work is dispatched via command lists and queues that the application schedules. Ray tracing therefore integrates tightly with other work such as rasterization or compute, and can be enqueued efficiently by a multithreaded application. Ray tracing shaders are dispatched as grids of work items, similar to compute shaders. This lets the implementation utilize the massive parallel processing throughput of GPUs and perform low-level scheduling of work items as appropriate for the given hardware. The application retains the responsibility of explicitly synchronizing GPU work and resources where necessary, as it does with rasterization and compute. This allows developers to optimize for the maximum amount of overlap between ray tracing, rasterization, compute work, and memory transfers. Ray tracing and other dispatch types share all resources such as textures, buffers, and constants. No conversion, duplication, or mapping is required to access a resource from ray tracing shaders. Resources that hold ray tracing specific data, such as acceleration structures and shader tables (see below), are entirely managed by the application. No memory allocations or transfers happen implicitly “under the hood”. Shader compilation is explicit and therefore under full application control. Shaders can be compiled individually or in batch. Compilation can be parallelized across multiple CPU threads if desired. At a high level, DXR introduces three new concepts to DirectX that the application must manage: Ray Tracing Pipeline State Objects contain the compiled shader code that gets executed during a ray tracing dispatch. Acceleration Structures contain the data structures used to accelerate ray tracing itself, i.e. the search for intersections between rays and scene geometry. Shader Tables define the relationship between ray tracing shaders, their resources (textures, constants, etc), and scene geometry. Let’s take a closer look at these. The traditional raster graphics pipeline defines a number of shader types: vertex shader, geometry shader, pixel shader, etc. Analog to that model, a ray tracing pipeline consists of five new shader types which are executed at different stages: The ray generation shader is the first thing invoked in a ray tracing dispatch. Ray generation shaders are comparable to compute shaders, with the added capability of calling the new HLSL function TraceRay(). This function casts a single ray into the scene to search for intersections, triggering other shaders in the process. A ray generation shader may call TraceRay() as many times as it likes. Intersection and any hit shaders are invoked whenever TraceRay() finds a potential intersection between the ray and the scene. The intersection shader determines whether the ray intersects an individual geometric primitive — for example a sphere, a subdivision surface, or really any primitive type you can code up! The most common type is, of course, triangles, for which the API offers special support through a built-in, highly tuned intersection shader. Once an intersection is found, the any hit shader may be used to process it further or potentially discard it. Any hit shaders commonly implement alpha testing by performing a texture lookup and deciding based on the texel’s value whether or not to discard an intersection. Once TraceRay() has completed the search for ray-scene intersections, either a closest hit or a miss shader is invoked, depending on the outcome of the search. The closest hit shader is typically where most shading operations take place: material evaluation, texture lookups, and so on. The miss shader can be used to implement environment lookups, for example. Both closest hit and miss shaders can recursively trace rays by calling TraceRay() themselves. The pipeline constructed from these shaders defines a single-ray programming model. Semantically, each GPU thread handles one ray at a time and cannot communicate with other threads or see other rays currently being processed. This keeps things simple for developers writing shaders, while allowing room for vendor-specific optimizations under the hood of the API. The main way for the different shader types to communicate with each other is the ray payload. The payload is simply a user-defined struct that’s passed as an inout parameter to TraceRay(). Any hit, closest hit, and miss shaders can read and write the payload, and therefore pass back the result of their computations to the caller of TraceRay().
+
+USER:
+I see that on the new flagship Nvidia models, there is always the designation RTX. What does this mean and why is it important? Explain in under 300 words.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,24,29,1033,,116
+Do not use any outside resources or knowledge. Only use the information provided in the prompt to answer. Answer in 5 sentences.,How does Alzheimer's treatment work?,"Treatments Progress in Alzheimer’s and dementia research is creating promising treatments for people living with the disease. The U.S. Food and Drug Administration (FDA) has approved medications that fall into two categories: drugs that change disease progression in people living with Alzheimer’s, and drugs that may temporarily mitigate some of the symptoms of the disease. When considering any treatment, it is important to have a conversation with a health care professional to determine whether it is appropriate. A physician who is experienced in using these types of medications should monitor people who are taking them and ensure that the recommended guidelines are strictly observed. Drugs That Change Disease Progression Drugs in this category slow disease progression. They slow the decline of memory and thinking, as well as function, in people living with Alzheimer’s disease. The treatment landscape is rapidly changing. Amyloid-targeting approaches Anti-amyloid treatments work by removing beta-amyloid, a protein that accumulates into plaques, from the brain. Each works differently and targets beta-amyloid at a different stage of plaque formation. These treatments change the course of the disease in a meaningful way for people in the early stages, giving them more time to participate in daily life and live independently. Clinical trial participants who received anti-amyloid treatments experienced reduction in cognitive decline observed through measures of cognition and function. Examples of cognition measures include: ● Memory. ● Orientation. Examples of functional measures include: ● Conducting personal finances. ● Performing household chores such as cleaning. Anti-amyloid treatments do have side effects. These treatments can cause serious allergic reactions. Side effects can also include amyloid-related imaging abnormalities (ARIA), infusion-related reactions, headaches and falls. ARIA is a common side effect that does not usually cause symptoms but can be serious. It is typically a temporary swelling in areas of the brain that usually resolves over time. Some people may also have small spots of bleeding in or on the surface of the brain with the swelling, although most people with swelling in areas of the brain do not have symptoms. Some may have symptoms of ARIA such as headache, dizziness, nausea, confusion and vision changes. Some people have a genetic risk factor (ApoE ε4 gene carriers) that may cause an increased risk for ARIA. The FDA encourages that testing for ApoE ε4 status should be performed prior to initiation of treatment to inform the risk of developing ARIA. Prior to testing, doctors should discuss with patients the risk of ARIA and the implications of genetic testing results. These are not all the possible side effects, and individuals should talk with their doctors to develop a treatment plan that is right for them, including weighing the benefits and risks of all approved therapies. Aducanumab (Aduhelm® ) Aducanumab (Aduhelm) is an anti-amyloid antibody intravenous (IV) infusion therapy that is delivered every four weeks. It has received accelerated approval from the FDA to treat early Alzheimer's disease, including people living with mild cognitive impairment (MCI) or mild dementia due to Alzheimer's disease who have confirmation of elevated beta-amyloid in the brain. Aducanumab was the first therapy to demonstrate that removing beta-amyloid from the brain reduces cognitive and functional decline in people living with early Alzheimer’s. Aducanumab is being discontinued by its manufacturer, Biogen. The company stated that people who are now receiving the drug as part of a clinical trial will continue to have access to it until May 1, 2024, and that people who are now receiving it by prescription will have it available to them until Nov. 1, 2024. Donanemab (Kisunla™) Donanemab (Kisunla) is an anti-amyloid antibody intravenous (IV) infusion therapy delivered every four weeks. It has received traditional approval from the FDA to treat early Alzheimer's disease, including people living with mild cognitive impairment (MCI) or mild dementia due to Alzheimer's disease who have confirmation of elevated beta-amyloid in the brain. There is no safety or effectiveness data on initiating treatment at earlier or later stages of the disease than were studied. Donanemab was the third therapy to demonstrate that removing beta-amyloid from the brain reduces cognitive and functional decline in people living with early Alzheimer's. The drugs currently approved to treat cognitive symptoms are cholinesterase inhibitors and glutamate regulators. Cholinesterase inhibitors Cholinesterase (KOH-luh-NES-ter-ays) inhibitors are prescribed to treat symptoms related to memory, thinking, language, judgment and other thought processes. These medications prevent the breakdown of acetylcholine (a-SEA-til-KOHlean), a chemical messenger important for memory and learning. These drugs support communication between nerve cells. The cholinesterase inhibitors most commonly prescribed are: Donepezil (Aricept® ): approved to treat all stages of Alzheimer’s disease. Galantamine (Razadyne® ): approved for mild-to-moderate stages of Alzheimer’s disease. Rivastigmine (Exelon® ): approved for mild-to-moderate Alzheimer’s as well as mild-to-moderate dementia associated with Parkinson’s disease. Though generally well-tolerated, if side effects occur, they commonly include nausea, vomiting, loss of appetite and increased frequency of bowel movements. Glutamate regulators Glutamate regulators are prescribed to improve memory, attention, reason, language and the ability to perform simple tasks. This type of drug works by regulating the activity of glutamate, a different chemical messenger that helps the brain process information. This drug is known as: Memantine (Namenda® ): approved for moderate-to-severe Alzheimer’s disease. Can cause side effects, including headache, constipation, confusion and dizziness. Cholinesterase inhibitor + glutamate regulator This type of drug is a combination of a cholinesterase inhibitor and a glutamate regulator. Donepezil and memantine (Namzaric® ): approved for moderate-to-severe Alzheimer’s disease. Possible side effects include nausea, vomiting, loss of appetite, increased frequency of bowel movements, headache, constipation, confusion and dizziness. Noncognitive symptoms (behavioral and psychological symptoms) Alzheimer’s affects more than just memory and thinking. A person’s quality of life may be impacted by a variety of behavioral and psychological symptoms that accompany dementia, such as sleep disturbances, agitation, hallucinations and delusions. Some medications focus on treating these noncognitive symptoms for a time, though it is important to try non-drug strategies to manage behaviors before adding medications. The FDA has approved one drug to address symptoms of insomnia that has been tested in people living with dementia and one that treats agitation. Orexin receptor antagonist Prescribed to treat insomnia, this drug inhibits the activity of orexin, a type of neurotransmitter involved in the sleep-wake cycle: Suvorexant (Belsomra® ): approved for treatment of insomnia and has been shown in clinical trials to be effective for people living with mild to moderate Alzheimer’s disease. Possible side effects include, but are not limited to: risk of impaired alertness and motor coordination (including impaired driving), worsening of depression or suicidal thinking, complex sleep behaviors (such as sleep-walking and sleep-driving), sleep paralysis and compromised respiratory function. Atypical antipsychotics are a group of antipsychotic drugs that target the serotonin and dopamine chemical pathways in the brain. These drugs are largely used to treat schizophrenia and bipolar disorder and as add-on therapies for major depressive disorder. The FDA requires that all atypical antipsychotics carry a safety warning that the medication has been associated with an increased risk of death in older patients with dementia-related psychosis. Many atypical antipsychotic medications are used ""off-label"" to treat dementia-related behaviors, and there is currently only one FDA-approved atypical antipsychotic to treat agitation associated with dementia due to Alzheimer's. It is important to try non-drug strategies to manage non-cognitive symptoms — like agitation — before adding medications.","Do not use any outside resources or knowledge. Only use the information provided in the prompt to answer. Answer in 5 sentences. How does Alzheimer's treatment work? Treatments Progress in Alzheimer’s and dementia research is creating promising treatments for people living with the disease. The U.S. Food and Drug Administration (FDA) has approved medications that fall into two categories: drugs that change disease progression in people living with Alzheimer’s, and drugs that may temporarily mitigate some of the symptoms of the disease. When considering any treatment, it is important to have a conversation with a health care professional to determine whether it is appropriate. A physician who is experienced in using these types of medications should monitor people who are taking them and ensure that the recommended guidelines are strictly observed. Drugs That Change Disease Progression Drugs in this category slow disease progression. They slow the decline of memory and thinking, as well as function, in people living with Alzheimer’s disease. The treatment landscape is rapidly changing. Amyloid-targeting approaches Anti-amyloid treatments work by removing beta-amyloid, a protein that accumulates into plaques, from the brain. Each works differently and targets beta-amyloid at a different stage of plaque formation. These treatments change the course of the disease in a meaningful way for people in the early stages, giving them more time to participate in daily life and live independently. Clinical trial participants who received anti-amyloid treatments experienced reduction in cognitive decline observed through measures of cognition and function. Examples of cognition measures include: ● Memory. ● Orientation. Examples of functional measures include: ● Conducting personal finances. ● Performing household chores such as cleaning. Anti-amyloid treatments do have side effects. These treatments can cause serious allergic reactions. Side effects can also include amyloid-related imaging abnormalities (ARIA), infusion-related reactions, headaches and falls. ARIA is a common side effect that does not usually cause symptoms but can be serious. It is typically a temporary swelling in areas of the brain that usually resolves over time. Some people may also have small spots of bleeding in or on the surface of the brain with the swelling, although most people with swelling in areas of the brain do not have symptoms. Some may have symptoms of ARIA such as headache, dizziness, nausea, confusion and vision changes. Some people have a genetic risk factor (ApoE ε4 gene carriers) that may cause an increased risk for ARIA. The FDA encourages that testing for ApoE ε4 status should be performed prior to initiation of treatment to inform the risk of developing ARIA. Prior to testing, doctors should discuss with patients the risk of ARIA and the implications of genetic testing results. These are not all the possible side effects, and individuals should talk with their doctors to develop a treatment plan that is right for them, including weighing the benefits and risks of all approved therapies. Aducanumab (Aduhelm® ) Aducanumab (Aduhelm) is an anti-amyloid antibody intravenous (IV) infusion therapy that is delivered every four weeks. It has received accelerated approval from the FDA to treat early Alzheimer's disease, including people living with mild cognitive impairment (MCI) or mild dementia due to Alzheimer's disease who have confirmation of elevated beta-amyloid in the brain. Aducanumab was the first therapy to demonstrate that removing beta-amyloid from the brain reduces cognitive and functional decline in people living with early Alzheimer’s. Aducanumab is being discontinued by its manufacturer, Biogen. The company stated that people who are now receiving the drug as part of a clinical trial will continue to have access to it until May 1, 2024, and that people who are now receiving it by prescription will have it available to them until Nov. 1, 2024. Donanemab (Kisunla™) Donanemab (Kisunla) is an anti-amyloid antibody intravenous (IV) infusion therapy delivered every four weeks. It has received traditional approval from the FDA to treat early Alzheimer's disease, including people living with mild cognitive impairment (MCI) or mild dementia due to Alzheimer's disease who have confirmation of elevated beta-amyloid in the brain. There is no safety or effectiveness data on initiating treatment at earlier or later stages of the disease than were studied. Donanemab was the third therapy to demonstrate that removing beta-amyloid from the brain reduces cognitive and functional decline in people living with early Alzheimer's. The drugs currently approved to treat cognitive symptoms are cholinesterase inhibitors and glutamate regulators. Cholinesterase inhibitors Cholinesterase (KOH-luh-NES-ter-ays) inhibitors are prescribed to treat symptoms related to memory, thinking, language, judgment and other thought processes. These medications prevent the breakdown of acetylcholine (a-SEA-til-KOHlean), a chemical messenger important for memory and learning. These drugs support communication between nerve cells. The cholinesterase inhibitors most commonly prescribed are: Donepezil (Aricept® ): approved to treat all stages of Alzheimer’s disease. Galantamine (Razadyne® ): approved for mild-to-moderate stages of Alzheimer’s disease. Rivastigmine (Exelon® ): approved for mild-to-moderate Alzheimer’s as well as mild-to-moderate dementia associated with Parkinson’s disease. Though generally well-tolerated, if side effects occur, they commonly include nausea, vomiting, loss of appetite and increased frequency of bowel movements. Glutamate regulators Glutamate regulators are prescribed to improve memory, attention, reason, language and the ability to perform simple tasks. This type of drug works by regulating the activity of glutamate, a different chemical messenger that helps the brain process information. This drug is known as: Memantine (Namenda® ): approved for moderate-to-severe Alzheimer’s disease. Can cause side effects, including headache, constipation, confusion and dizziness. Cholinesterase inhibitor + glutamate regulator This type of drug is a combination of a cholinesterase inhibitor and a glutamate regulator. Donepezil and memantine (Namzaric® ): approved for moderate-to-severe Alzheimer’s disease. Possible side effects include nausea, vomiting, loss of appetite, increased frequency of bowel movements, headache, constipation, confusion and dizziness. Noncognitive symptoms (behavioral and psychological symptoms) Alzheimer’s affects more than just memory and thinking. A person’s quality of life may be impacted by a variety of behavioral and psychological symptoms that accompany dementia, such as sleep disturbances, agitation, hallucinations and delusions. Some medications focus on treating these noncognitive symptoms for a time, though it is important to try non-drug strategies to manage behaviors before adding medications. The FDA has approved one drug to address symptoms of insomnia that has been tested in people living with dementia and one that treats agitation. Orexin receptor antagonist Prescribed to treat insomnia, this drug inhibits the activity of orexin, a type of neurotransmitter involved in the sleep-wake cycle: Suvorexant (Belsomra® ): approved for treatment of insomnia and has been shown in clinical trials to be effective for people living with mild to moderate Alzheimer’s disease. Possible side effects include, but are not limited to: risk of impaired alertness and motor coordination (including impaired driving), worsening of depression or suicidal thinking, complex sleep behaviors (such as sleep-walking and sleep-driving), sleep paralysis and compromised respiratory function. Atypical antipsychotics are a group of antipsychotic drugs that target the serotonin and dopamine chemical pathways in the brain. These drugs are largely used to treat schizophrenia and bipolar disorder and as add-on therapies for major depressive disorder. The FDA requires that all atypical antipsychotics carry a safety warning that the medication has been associated with an increased risk of death in older patients with dementia-related psychosis. Many atypical antipsychotic medications are used ""off-label"" to treat dementia-related behaviors, and there is currently only one FDA-approved atypical antipsychotic to treat agitation associated with dementia due to Alzheimer's. It is important to try non-drug strategies to manage non-cognitive symptoms — like agitation — before adding medications.","Do not use any outside resources or knowledge. Only use the information provided in the prompt to answer. Answer in 5 sentences.
+
+EVIDENCE:
+Treatments Progress in Alzheimer’s and dementia research is creating promising treatments for people living with the disease. The U.S. Food and Drug Administration (FDA) has approved medications that fall into two categories: drugs that change disease progression in people living with Alzheimer’s, and drugs that may temporarily mitigate some of the symptoms of the disease. When considering any treatment, it is important to have a conversation with a health care professional to determine whether it is appropriate. A physician who is experienced in using these types of medications should monitor people who are taking them and ensure that the recommended guidelines are strictly observed. Drugs That Change Disease Progression Drugs in this category slow disease progression. They slow the decline of memory and thinking, as well as function, in people living with Alzheimer’s disease. The treatment landscape is rapidly changing. Amyloid-targeting approaches Anti-amyloid treatments work by removing beta-amyloid, a protein that accumulates into plaques, from the brain. Each works differently and targets beta-amyloid at a different stage of plaque formation. These treatments change the course of the disease in a meaningful way for people in the early stages, giving them more time to participate in daily life and live independently. Clinical trial participants who received anti-amyloid treatments experienced reduction in cognitive decline observed through measures of cognition and function. Examples of cognition measures include: ● Memory. ● Orientation. Examples of functional measures include: ● Conducting personal finances. ● Performing household chores such as cleaning. Anti-amyloid treatments do have side effects. These treatments can cause serious allergic reactions. Side effects can also include amyloid-related imaging abnormalities (ARIA), infusion-related reactions, headaches and falls. ARIA is a common side effect that does not usually cause symptoms but can be serious. It is typically a temporary swelling in areas of the brain that usually resolves over time. Some people may also have small spots of bleeding in or on the surface of the brain with the swelling, although most people with swelling in areas of the brain do not have symptoms. Some may have symptoms of ARIA such as headache, dizziness, nausea, confusion and vision changes. Some people have a genetic risk factor (ApoE ε4 gene carriers) that may cause an increased risk for ARIA. The FDA encourages that testing for ApoE ε4 status should be performed prior to initiation of treatment to inform the risk of developing ARIA. Prior to testing, doctors should discuss with patients the risk of ARIA and the implications of genetic testing results. These are not all the possible side effects, and individuals should talk with their doctors to develop a treatment plan that is right for them, including weighing the benefits and risks of all approved therapies. Aducanumab (Aduhelm® ) Aducanumab (Aduhelm) is an anti-amyloid antibody intravenous (IV) infusion therapy that is delivered every four weeks. It has received accelerated approval from the FDA to treat early Alzheimer's disease, including people living with mild cognitive impairment (MCI) or mild dementia due to Alzheimer's disease who have confirmation of elevated beta-amyloid in the brain. Aducanumab was the first therapy to demonstrate that removing beta-amyloid from the brain reduces cognitive and functional decline in people living with early Alzheimer’s. Aducanumab is being discontinued by its manufacturer, Biogen. The company stated that people who are now receiving the drug as part of a clinical trial will continue to have access to it until May 1, 2024, and that people who are now receiving it by prescription will have it available to them until Nov. 1, 2024. Donanemab (Kisunla™) Donanemab (Kisunla) is an anti-amyloid antibody intravenous (IV) infusion therapy delivered every four weeks. It has received traditional approval from the FDA to treat early Alzheimer's disease, including people living with mild cognitive impairment (MCI) or mild dementia due to Alzheimer's disease who have confirmation of elevated beta-amyloid in the brain. There is no safety or effectiveness data on initiating treatment at earlier or later stages of the disease than were studied. Donanemab was the third therapy to demonstrate that removing beta-amyloid from the brain reduces cognitive and functional decline in people living with early Alzheimer's. The drugs currently approved to treat cognitive symptoms are cholinesterase inhibitors and glutamate regulators. Cholinesterase inhibitors Cholinesterase (KOH-luh-NES-ter-ays) inhibitors are prescribed to treat symptoms related to memory, thinking, language, judgment and other thought processes. These medications prevent the breakdown of acetylcholine (a-SEA-til-KOHlean), a chemical messenger important for memory and learning. These drugs support communication between nerve cells. The cholinesterase inhibitors most commonly prescribed are: Donepezil (Aricept® ): approved to treat all stages of Alzheimer’s disease. Galantamine (Razadyne® ): approved for mild-to-moderate stages of Alzheimer’s disease. Rivastigmine (Exelon® ): approved for mild-to-moderate Alzheimer’s as well as mild-to-moderate dementia associated with Parkinson’s disease. Though generally well-tolerated, if side effects occur, they commonly include nausea, vomiting, loss of appetite and increased frequency of bowel movements. Glutamate regulators Glutamate regulators are prescribed to improve memory, attention, reason, language and the ability to perform simple tasks. This type of drug works by regulating the activity of glutamate, a different chemical messenger that helps the brain process information. This drug is known as: Memantine (Namenda® ): approved for moderate-to-severe Alzheimer’s disease. Can cause side effects, including headache, constipation, confusion and dizziness. Cholinesterase inhibitor + glutamate regulator This type of drug is a combination of a cholinesterase inhibitor and a glutamate regulator. Donepezil and memantine (Namzaric® ): approved for moderate-to-severe Alzheimer’s disease. Possible side effects include nausea, vomiting, loss of appetite, increased frequency of bowel movements, headache, constipation, confusion and dizziness. Noncognitive symptoms (behavioral and psychological symptoms) Alzheimer’s affects more than just memory and thinking. A person’s quality of life may be impacted by a variety of behavioral and psychological symptoms that accompany dementia, such as sleep disturbances, agitation, hallucinations and delusions. Some medications focus on treating these noncognitive symptoms for a time, though it is important to try non-drug strategies to manage behaviors before adding medications. The FDA has approved one drug to address symptoms of insomnia that has been tested in people living with dementia and one that treats agitation. Orexin receptor antagonist Prescribed to treat insomnia, this drug inhibits the activity of orexin, a type of neurotransmitter involved in the sleep-wake cycle: Suvorexant (Belsomra® ): approved for treatment of insomnia and has been shown in clinical trials to be effective for people living with mild to moderate Alzheimer’s disease. Possible side effects include, but are not limited to: risk of impaired alertness and motor coordination (including impaired driving), worsening of depression or suicidal thinking, complex sleep behaviors (such as sleep-walking and sleep-driving), sleep paralysis and compromised respiratory function. Atypical antipsychotics are a group of antipsychotic drugs that target the serotonin and dopamine chemical pathways in the brain. These drugs are largely used to treat schizophrenia and bipolar disorder and as add-on therapies for major depressive disorder. The FDA requires that all atypical antipsychotics carry a safety warning that the medication has been associated with an increased risk of death in older patients with dementia-related psychosis. Many atypical antipsychotic medications are used ""off-label"" to treat dementia-related behaviors, and there is currently only one FDA-approved atypical antipsychotic to treat agitation associated with dementia due to Alzheimer's. It is important to try non-drug strategies to manage non-cognitive symptoms — like agitation — before adding medications.
+
+USER:
+How does Alzheimer's treatment work?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,22,5,1211,,716
+[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.,Why is there such a big difference between the highest and lowest paid rns? surely experience cant make that much of a difference in pay?,"RN salaries increased for most license types, but not by a generous amount, according to the report. The median RN salary reported by survey respondents was $80,000, an increase of $2,000 from the 2022 survey. The median salary for APRNs/ARNPs was $117,300, which is a decrease of $2,700 (about 2%) from the 2022 report. This could be due to the younger average age of respondents in this group of nurses. The report also revealed that the gender pay gap for RNs has narrowed but hasn’t disappeared. The median salary for a male RN is $6,000 higher than the median salary for a female RN (compared with a $14,000 gap in the 2022 survey). Nurses’ responses helped identify some possible explanations for this salary gap, such as the higher percentage of male RNs working night shifts and negotiating their salary. However, the gap in male-female negotiating tendencies is closing, as more female RNs are becoming proactive in asking for higher pay. “These findings surrounding salary negotiation are encouraging,” said Felicia Sadler, MJ, BSN, RN, CPHQ, LSSBB, Vice President of Quality and Partner at Relias, in the report. “But it’s important that organizations commit to structures and processes that ensure continuous process improvements. Despite the shrinking pay gap, ongoing organizational salary reviews and advocacy and awareness campaigns are needed to close the gap and keep it closed.” Our findings also showed that education can positively impact nurse salaries. Across license types, 40% of nurses who earned certification said it resulted in a salary increase. Workplace safety and wellness For the first time, our survey asked nurses about their experiences with workplace violence and how their jobs affect their mental health and wellness, which are crucial factors for job satisfaction and retention. Unfortunately, many nurses said they have either witnessed or directly experienced workplace violence, which can have detrimental effects on their physical and mental health. About 22% of nurses said their organization has either weekly or monthly instances of workplace violence, according to our survey. And that’s not all. Almost one-third (31%) of nurses had been subjected to verbal abuse by a colleague. 64% had been subjected to verbal abuse by a patient or a patient’s family member. 23% had been physically assaulted or abused by a patient or a patient’s family member. In addition, nurses across all licensures and age groups said the profession has affected their mental health and wellness. Nurses ages 18 to 34 were more likely to report experiencing burnout, ethical dilemmas and moral injury, and compassion fatigue than nurses from other age groups. Wellness resources also remain important to nurses. Based on data from our report, the top three wellness resources nurses wanted were: Fitness stipends for memberships, equipment, or athletic wear Reimbursement or stipends for helpful apps for relaxation, fitness, and nutrition Free or reduced-cost mental health counseling services “It’s crucial for nurses to have access to mental health benefits,” said Cat Golden, BSN, RN, Partner at Nurse.com, in the report. “As a pediatric nurse who faced frequent encounters with the untimely death of young patients and their families’ grief, being able to speak with a therapist while on duty was vital for preserving my own mental well-being and played a pivotal role in my effectiveness as a nurse.” Satisfaction and retention Valuable insights into factors that contribute to nurses’ job satisfaction and the outlook for the nursing profession were also captured in the report. The highest percentage of nurses across all licensures (81%) rated regular merit increases as most important to their job satisfaction, followed by manager (62%), and ability to practice to the full scope of nursing practice (62%). However, 23% of nurses across all license types were considering leaving nursing, according to the survey. The top-ranked reasons for leaving nursing were dissatisfaction with management (25%) and better pay (24%). This is a concerning statistic for nurses, patients, and the healthcare system. What could encourage nurses to stay? The Nurse.com report identified the following top factors that could motivate nurses to stay in the profession: Higher pay (66%) Flexible scheduling (33%) Better support for work-life balance (30%) More reasonable workload (28%) Being able to work in a remote role (25%) Some of the revelations in the report may come as a surprise to nurses, while others may mirror how they feel about their careers and workplaces. However, all nurses can use the report to mold a better professional life for themselves. Use the information in this report to: Compare your salary and benefits to peers. Determine when to negotiate salary. Assess if pursuing additional training, a degree, or certification aligns with your career goals. Identify challenges and shortcomings within your organization. Initiate conversations with nursing leaders and advocate for a safer, healthier workplace.","[question] Why is there such a big difference between the highest and lowest paid rns? surely experience cant make that much of a difference in pay? ===================== [text] RN salaries increased for most license types, but not by a generous amount, according to the report. The median RN salary reported by survey respondents was $80,000, an increase of $2,000 from the 2022 survey. The median salary for APRNs/ARNPs was $117,300, which is a decrease of $2,700 (about 2%) from the 2022 report. This could be due to the younger average age of respondents in this group of nurses. The report also revealed that the gender pay gap for RNs has narrowed but hasn’t disappeared. The median salary for a male RN is $6,000 higher than the median salary for a female RN (compared with a $14,000 gap in the 2022 survey). Nurses’ responses helped identify some possible explanations for this salary gap, such as the higher percentage of male RNs working night shifts and negotiating their salary. However, the gap in male-female negotiating tendencies is closing, as more female RNs are becoming proactive in asking for higher pay. “These findings surrounding salary negotiation are encouraging,” said Felicia Sadler, MJ, BSN, RN, CPHQ, LSSBB, Vice President of Quality and Partner at Relias, in the report. “But it’s important that organizations commit to structures and processes that ensure continuous process improvements. Despite the shrinking pay gap, ongoing organizational salary reviews and advocacy and awareness campaigns are needed to close the gap and keep it closed.” Our findings also showed that education can positively impact nurse salaries. Across license types, 40% of nurses who earned certification said it resulted in a salary increase. Workplace safety and wellness For the first time, our survey asked nurses about their experiences with workplace violence and how their jobs affect their mental health and wellness, which are crucial factors for job satisfaction and retention. Unfortunately, many nurses said they have either witnessed or directly experienced workplace violence, which can have detrimental effects on their physical and mental health. About 22% of nurses said their organization has either weekly or monthly instances of workplace violence, according to our survey. And that’s not all. Almost one-third (31%) of nurses had been subjected to verbal abuse by a colleague. 64% had been subjected to verbal abuse by a patient or a patient’s family member. 23% had been physically assaulted or abused by a patient or a patient’s family member. In addition, nurses across all licensures and age groups said the profession has affected their mental health and wellness. Nurses ages 18 to 34 were more likely to report experiencing burnout, ethical dilemmas and moral injury, and compassion fatigue than nurses from other age groups. Wellness resources also remain important to nurses. Based on data from our report, the top three wellness resources nurses wanted were: Fitness stipends for memberships, equipment, or athletic wear Reimbursement or stipends for helpful apps for relaxation, fitness, and nutrition Free or reduced-cost mental health counseling services “It’s crucial for nurses to have access to mental health benefits,” said Cat Golden, BSN, RN, Partner at Nurse.com, in the report. “As a pediatric nurse who faced frequent encounters with the untimely death of young patients and their families’ grief, being able to speak with a therapist while on duty was vital for preserving my own mental well-being and played a pivotal role in my effectiveness as a nurse.” Satisfaction and retention Valuable insights into factors that contribute to nurses’ job satisfaction and the outlook for the nursing profession were also captured in the report. The highest percentage of nurses across all licensures (81%) rated regular merit increases as most important to their job satisfaction, followed by manager (62%), and ability to practice to the full scope of nursing practice (62%). However, 23% of nurses across all license types were considering leaving nursing, according to the survey. The top-ranked reasons for leaving nursing were dissatisfaction with management (25%) and better pay (24%). This is a concerning statistic for nurses, patients, and the healthcare system. What could encourage nurses to stay? The Nurse.com report identified the following top factors that could motivate nurses to stay in the profession: Higher pay (66%) Flexible scheduling (33%) Better support for work-life balance (30%) More reasonable workload (28%) Being able to work in a remote role (25%) Some of the revelations in the report may come as a surprise to nurses, while others may mirror how they feel about their careers and workplaces. However, all nurses can use the report to mold a better professional life for themselves. Use the information in this report to: Compare your salary and benefits to peers. Determine when to negotiate salary. Assess if pursuing additional training, a degree, or certification aligns with your career goals. Identify challenges and shortcomings within your organization. Initiate conversations with nursing leaders and advocate for a safer, healthier workplace. https://www.nurse.com/blog/nurse-salary-and-work-life-reports-revelations/ ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.","[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
+
+EVIDENCE:
+RN salaries increased for most license types, but not by a generous amount, according to the report. The median RN salary reported by survey respondents was $80,000, an increase of $2,000 from the 2022 survey. The median salary for APRNs/ARNPs was $117,300, which is a decrease of $2,700 (about 2%) from the 2022 report. This could be due to the younger average age of respondents in this group of nurses. The report also revealed that the gender pay gap for RNs has narrowed but hasn’t disappeared. The median salary for a male RN is $6,000 higher than the median salary for a female RN (compared with a $14,000 gap in the 2022 survey). Nurses’ responses helped identify some possible explanations for this salary gap, such as the higher percentage of male RNs working night shifts and negotiating their salary. However, the gap in male-female negotiating tendencies is closing, as more female RNs are becoming proactive in asking for higher pay. “These findings surrounding salary negotiation are encouraging,” said Felicia Sadler, MJ, BSN, RN, CPHQ, LSSBB, Vice President of Quality and Partner at Relias, in the report. “But it’s important that organizations commit to structures and processes that ensure continuous process improvements. Despite the shrinking pay gap, ongoing organizational salary reviews and advocacy and awareness campaigns are needed to close the gap and keep it closed.” Our findings also showed that education can positively impact nurse salaries. Across license types, 40% of nurses who earned certification said it resulted in a salary increase. Workplace safety and wellness For the first time, our survey asked nurses about their experiences with workplace violence and how their jobs affect their mental health and wellness, which are crucial factors for job satisfaction and retention. Unfortunately, many nurses said they have either witnessed or directly experienced workplace violence, which can have detrimental effects on their physical and mental health. About 22% of nurses said their organization has either weekly or monthly instances of workplace violence, according to our survey. And that’s not all. Almost one-third (31%) of nurses had been subjected to verbal abuse by a colleague. 64% had been subjected to verbal abuse by a patient or a patient’s family member. 23% had been physically assaulted or abused by a patient or a patient’s family member. In addition, nurses across all licensures and age groups said the profession has affected their mental health and wellness. Nurses ages 18 to 34 were more likely to report experiencing burnout, ethical dilemmas and moral injury, and compassion fatigue than nurses from other age groups. Wellness resources also remain important to nurses. Based on data from our report, the top three wellness resources nurses wanted were: Fitness stipends for memberships, equipment, or athletic wear Reimbursement or stipends for helpful apps for relaxation, fitness, and nutrition Free or reduced-cost mental health counseling services “It’s crucial for nurses to have access to mental health benefits,” said Cat Golden, BSN, RN, Partner at Nurse.com, in the report. “As a pediatric nurse who faced frequent encounters with the untimely death of young patients and their families’ grief, being able to speak with a therapist while on duty was vital for preserving my own mental well-being and played a pivotal role in my effectiveness as a nurse.” Satisfaction and retention Valuable insights into factors that contribute to nurses’ job satisfaction and the outlook for the nursing profession were also captured in the report. The highest percentage of nurses across all licensures (81%) rated regular merit increases as most important to their job satisfaction, followed by manager (62%), and ability to practice to the full scope of nursing practice (62%). However, 23% of nurses across all license types were considering leaving nursing, according to the survey. The top-ranked reasons for leaving nursing were dissatisfaction with management (25%) and better pay (24%). This is a concerning statistic for nurses, patients, and the healthcare system. What could encourage nurses to stay? The Nurse.com report identified the following top factors that could motivate nurses to stay in the profession: Higher pay (66%) Flexible scheduling (33%) Better support for work-life balance (30%) More reasonable workload (28%) Being able to work in a remote role (25%) Some of the revelations in the report may come as a surprise to nurses, while others may mirror how they feel about their careers and workplaces. However, all nurses can use the report to mold a better professional life for themselves. Use the information in this report to: Compare your salary and benefits to peers. Determine when to negotiate salary. Assess if pursuing additional training, a degree, or certification aligns with your career goals. Identify challenges and shortcomings within your organization. Initiate conversations with nursing leaders and advocate for a safer, healthier workplace.
+
+USER:
+Why is there such a big difference between the highest and lowest paid rns? surely experience cant make that much of a difference in pay?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,28,25,789,,248
+Give your answer in a numbered list and give an explanation for each reason. Draw all information from the provided context and do not use any outside knowledge or references.,What are 3 reasons that iPSCs are a better approach for treating diabetes than ESCs?,"Introducing pancreatic β cells, cultivated in vitro from pluripotent stem cells like embryonic stem cells (ESCs) or induced pluripotent stem cells (iPSCs), has been suggested as an alternative therapeutic approach for diabetes. The fundamental protocol for the in vitro differentiation of mouse embryonic stem (ES) cells into insulin-producing cells involves a three-step process. This includes (i) the formation of embryoid bodies, (ii) the spontaneous differentiation of embryoid bodies into progenitor cells representing ecto-, meso-, and endodermal lineages, and (iii) the induction of differentiation of early progenitors into the pancreatic lineage. The differentiated cells can be obtained in approximately 33 days. Transgenic expression of PDX-1 (pancreatic and duodenal homeobox 1) and Nkx6.1 (NK6 homeobox 1) has been demonstrated to prompt the differentiation of ESCs into endocrine cells that express insulin, somatostatin, and glucagon. Incorporating growth factors and extracellular matrix elements, including laminin, nicotinamide, and insulin, facilitates the process The induction of ESC-derived C-peptide/insulin-positive islet-like cell clusters, exhibiting insulin release upon glucose stimulation and expressing Pax4 (paired box gene), represents a significant advancement. Retinoic acid (RA) plays a crucial role in pancreatic development and is commonly employed to prompt pancreatic differentiation of ESCs. Direct addition of RA to activin A-induced human ESCs expressing CXCR4 leads to 95% of cells becoming positive for the pancreatic marker PDX-1H (pancreatic and duodenal homeobox 1). Animal studies have demonstrated that encapsulating human ESC-derived glucose-responsive mature β cells in alginate and transplanting them into a streptozotocin (STZ)-induced diabetic mouse model effectively regulates glycemic control. However, ethical concerns associated with ESCs have restricted their widespread clinical application. As an alternative, induced pluripotent stem cells have been proposed, possessing similar pluripotent characteristics to ESCs, thereby addressing ethical considerations. The primary focus of research on embryonic pancreas development is to enhance our comprehension of the processes involved in the generation of β-cells under normal conditions. This entails not only unravelling the intricate networks of signalling pathways and transcription factors that govern cell-autonomous differentiation but also acquiring insights into epithelial-mesenchymal interactions and the influence of factors secreted by adjacent tissues that guide endocrine and β-cell development. The overarching goal is that, with the accumulation of this comprehensive information, it will be possible to integrate and reconstruct the embryonic differentiation program. This, in turn, could facilitate the ex vivo generation of therapeutic β-cells for potential clinical applications. The pancreas, a sophisticated endoderm-derived organ, encompasses diverse cell types serving both endocrine and exocrine functions. The exocrine component, constituting over 90–95% of the pancreatic mass, houses acinar cells responsible for secreting digestive enzymes such as lipases, carbohydrases, and amylases. Additionally, ductal cells facilitate the transport of these enzymes into the duodenum. Despite comprising only 1–2% of the pancreatic cell International Journal of Science and Research Archive, 2024, 11(01), 1917–1932 1921 population, hormone-secreting endocrine cells play a vital role in maintaining euglycemia. Within the pancreas, the islets of Langerhans host five distinct endocrine cell types, with the insulin-producing β-cell dominating and constituting 60–80% of the islet. In rodents, and to a lesser extent in humans, β-cells are typically positioned at the centre of the islets, surrounded by other endocrine cell types. The proportion and arrangement of these cells in the adult pancreas, along with the morphological changes during pancreas development, have been extensively studied for over a century. More recently, driven by the advancements in transgenic mouse technology, substantial insights have been gained into the molecular mechanisms governing pancreas organogenesis and epithelial cell differentiation. During vertebrate embryogenesis, the three primary germ layers—ectoderm, mesoderm, and endoderm—form through extensive cell migration during gastrulation. In the mouse, a favoured mammalian model for embryogenesis studies, a thin cup-shaped sheet of embryonic endoderm evolves into the primitive gut tube, which can be subdivided into distinct regions along the anterior-posterior axis. Each region possesses distinct developmental potential, typically giving rise to various endodermal organs, including the liver, lung, stomach, and pancreas. Specification of the pancreatic field occurs around embryonic day 8.5 (E8.5) in mice and around 3 weeks in humans. Initially, three pancreatic primordia emerge from the definitive gut epithelium: the first from the dorsal side, followed by two primordia on the ventral side. Due to their independent origin and distinct locations along the primitive gut tube, differences arise in the surrounding environment, timing, specificity of signalling pathways, and gene expression profiles guiding these processes. Shortly after formation, one of the ventral buds regresses, while the remaining ventral bud eventually fuses with the dorsal evagination during the gut tube's rotation around E12.5.Subsequently, the pancreatic epithelium undergoes significant growth and branches into the surrounding mesenchyme. Although glucagon-producing cells and a few cells coexpressing insulin and glucagon can be detected as early as E9.5, fully differentiated β-cells and other hormone-secreting cells become prominently evident around E13. Termed the secondary transition, this stage witnesses a substantial increase in endocrine cell numbers through the proliferation and subsequent differentiation of pancreatic progenitors. The pancreas plays a pivotal role in systematically regulating glucose homeostasis, and its development involves a complex interplay of factors that influence stem cell differentiation into pancreatic progenitor cells, ultimately forming a fully functional organ. Consequently, most stem cell-based differentiation protocols aim to generate mature, single hormone-expressing, glucose-responsive human β-cells, drawing insights from studies on pancreatic development. Specific signals orchestrate the programming of insulin-producing β-cells. Transcription factors such as SRY (sex determining region Y)-box (Sox)17 and homeobox gene HB9 (Hlxb9) play crucial roles in endoderm formation during gastrulation. After foregut formation, fibroblast growth factor (FGF)-10, retinoic acid, SOX9, and hedgehog signalling pathways induce pancreatic development. Pancreatic specification and budding are driven by pancreas-specific transcription factors like pancreatic and duodenal homeobox 1 (Ptf-1a), pancreatic and duodenal homeobox 1, NK6 homeobox 1 (Nkx6.1), neurogenin-3 (Ngn-3), and mafA. These factors enable the endocrine formation and stimulate ISL LIM homeobox 1 (Isl-1), NK2 homeobox 2 (Nkx2.2), neurogenic differentiation factor (NeuroD), paired box gene (Pax)4, and Pax6 signalling, contributing to the formation of the islets of Langerhans. Throughout pancreatic development, transcription factors Sox17, hepatocyte nuclear factor (HNF)-6, and HNF-3beta (also known as forkhead box A2, Foxa2) are consistently expressed. Finally, FGF-10 and notch signaling-induced stem cell and pancreatic progenitor cell differentiation stimulate neogenesis, leading to the creation of β-cells. 1.1.3. Induced Pluripotent Stem Induced pluripotent stem cells (iPS) are adult cells that undergo genetic reprogramming in the laboratory to acquire characteristics similar to embryonic stem cells. iPS cells possess the remarkable ability to differentiate into nearly all specialized cell types found in the body, making them a versatile resource for generating new cells for various organs or tissues. This quality positions them as valuable tools for disease modelling, with researchers globally exploring their potential to develop cures for severe diseases. Notably, iPS cells offer the advantage of being autologous, meaning they originate from the individual's cells, thereby minimizing the risk of immunological reactions or rejection when transplanted tissues derived from iPS cells are used. 1.1.4. Pancreatic Regeneration Through Induced Pluripotent Stem Cell Human induced pluripotent stem cells (iPSCs) are generated by reprogramming human somatic cells to acquire pluripotent properties. These iPSCs have proven to be a valuable source for deriving glucose-responsive β-like cells. Despite the complexity of β cell development, creating an efficient and reproducible β cell differentiation protocol has been challenging. A potential solution involves initiating differentiation from human iPSC-derived pancreatic progenitor cells expressing PDX-1 and SOX9, which exhibit prolonged proliferation potential and the ability to generate C-peptidepositive β cells. Another effective differentiation protocol involves supplementing factors related to epidermal growth factor (EGF), transforming growth factor β (TGF-β), thyroid hormone, retinoic acid (RA) signalling, and γ-secretase inhibition. This approach results in β cells capable of inducing Ca2+ flux in response to glucose, packaging insulin into secretory granules, and secreting insulin. Due to their unlimited replicative capacity (self-renewal) and pluripotency, iPSCs offer a promising avenue for differentiating into pancreatic endocrine lineage cells, specifically functional insulinproducing pancreatic β cells. Research has consistently reported positive outcomes in various in vitro studies using protocols that emulate the mechanisms of in vivo pancreas development to guide iPSC differentiation into functional β cells. The first demonstration of generating functional β cells from induced pluripotent stem (iPS) cells was conducted by Tateishi and colleagues. Their study revealed that human dermal fibroblast-derived iPS cells, subjected to a four-stage serum-free in vitro differentiation process, could differentiate into functional islet-like clusters (ILCs) with mixed Cpeptide+ and glucagon+ cells. Throughout the differentiation, iPS cells underwent stage-specific morphological changes resembling those observed in human embryonic stem cells (ESCs). Functional analysis, employing quantitative reverse transcriptase polymerase chain reaction (RT-PCR) and immunostaining, showed that the differentiated iPS cells expressed stage-specific genes and antigen markers at each developmental stage. These stages included definitive endoderm (Foxa2 and Sox17), pancreatic endoderm (Pdx1), exocrine/endocrine cells (NKX6.1, Ptf1, and Insulin), and insulin-producing cells (Insulin, C-peptide, and glucagon), mirroring the pattern observed in human ESCs.","System Instruction: Give your answer in a numbered list and give an explanation for each reason. Draw all information from the provided context and do not use any outside knowledge or references. Provided Text: Introducing pancreatic β cells, cultivated in vitro from pluripotent stem cells like embryonic stem cells (ESCs) or induced pluripotent stem cells (iPSCs), has been suggested as an alternative therapeutic approach for diabetes. The fundamental protocol for the in vitro differentiation of mouse embryonic stem (ES) cells into insulin-producing cells involves a three-step process. This includes (i) the formation of embryoid bodies, (ii) the spontaneous differentiation of embryoid bodies into progenitor cells representing ecto-, meso-, and endodermal lineages, and (iii) the induction of differentiation of early progenitors into the pancreatic lineage. The differentiated cells can be obtained in approximately 33 days. Transgenic expression of PDX-1 (pancreatic and duodenal homeobox 1) and Nkx6.1 (NK6 homeobox 1) has been demonstrated to prompt the differentiation of ESCs into endocrine cells that express insulin, somatostatin, and glucagon. Incorporating growth factors and extracellular matrix elements, including laminin, nicotinamide, and insulin, facilitates the process The induction of ESC-derived C-peptide/insulin-positive islet-like cell clusters, exhibiting insulin release upon glucose stimulation and expressing Pax4 (paired box gene), represents a significant advancement. Retinoic acid (RA) plays a crucial role in pancreatic development and is commonly employed to prompt pancreatic differentiation of ESCs. Direct addition of RA to activin A-induced human ESCs expressing CXCR4 leads to 95% of cells becoming positive for the pancreatic marker PDX-1H (pancreatic and duodenal homeobox 1). Animal studies have demonstrated that encapsulating human ESC-derived glucose-responsive mature β cells in alginate and transplanting them into a streptozotocin (STZ)-induced diabetic mouse model effectively regulates glycemic control. However, ethical concerns associated with ESCs have restricted their widespread clinical application. As an alternative, induced pluripotent stem cells have been proposed, possessing similar pluripotent characteristics to ESCs, thereby addressing ethical considerations. The primary focus of research on embryonic pancreas development is to enhance our comprehension of the processes involved in the generation of β-cells under normal conditions. This entails not only unravelling the intricate networks of signalling pathways and transcription factors that govern cell-autonomous differentiation but also acquiring insights into epithelial-mesenchymal interactions and the influence of factors secreted by adjacent tissues that guide endocrine and β-cell development. The overarching goal is that, with the accumulation of this comprehensive information, it will be possible to integrate and reconstruct the embryonic differentiation program. This, in turn, could facilitate the ex vivo generation of therapeutic β-cells for potential clinical applications. The pancreas, a sophisticated endoderm-derived organ, encompasses diverse cell types serving both endocrine and exocrine functions. The exocrine component, constituting over 90–95% of the pancreatic mass, houses acinar cells responsible for secreting digestive enzymes such as lipases, carbohydrases, and amylases. Additionally, ductal cells facilitate the transport of these enzymes into the duodenum. Despite comprising only 1–2% of the pancreatic cell International Journal of Science and Research Archive, 2024, 11(01), 1917–1932 1921 population, hormone-secreting endocrine cells play a vital role in maintaining euglycemia. Within the pancreas, the islets of Langerhans host five distinct endocrine cell types, with the insulin-producing β-cell dominating and constituting 60–80% of the islet. In rodents, and to a lesser extent in humans, β-cells are typically positioned at the centre of the islets, surrounded by other endocrine cell types. The proportion and arrangement of these cells in the adult pancreas, along with the morphological changes during pancreas development, have been extensively studied for over a century. More recently, driven by the advancements in transgenic mouse technology, substantial insights have been gained into the molecular mechanisms governing pancreas organogenesis and epithelial cell differentiation. During vertebrate embryogenesis, the three primary germ layers—ectoderm, mesoderm, and endoderm—form through extensive cell migration during gastrulation. In the mouse, a favoured mammalian model for embryogenesis studies, a thin cup-shaped sheet of embryonic endoderm evolves into the primitive gut tube, which can be subdivided into distinct regions along the anterior-posterior axis. Each region possesses distinct developmental potential, typically giving rise to various endodermal organs, including the liver, lung, stomach, and pancreas. Specification of the pancreatic field occurs around embryonic day 8.5 (E8.5) in mice and around 3 weeks in humans. Initially, three pancreatic primordia emerge from the definitive gut epithelium: the first from the dorsal side, followed by two primordia on the ventral side. Due to their independent origin and distinct locations along the primitive gut tube, differences arise in the surrounding environment, timing, specificity of signalling pathways, and gene expression profiles guiding these processes. Shortly after formation, one of the ventral buds regresses, while the remaining ventral bud eventually fuses with the dorsal evagination during the gut tube's rotation around E12.5.Subsequently, the pancreatic epithelium undergoes significant growth and branches into the surrounding mesenchyme. Although glucagon-producing cells and a few cells coexpressing insulin and glucagon can be detected as early as E9.5, fully differentiated β-cells and other hormone-secreting cells become prominently evident around E13. Termed the secondary transition, this stage witnesses a substantial increase in endocrine cell numbers through the proliferation and subsequent differentiation of pancreatic progenitors. The pancreas plays a pivotal role in systematically regulating glucose homeostasis, and its development involves a complex interplay of factors that influence stem cell differentiation into pancreatic progenitor cells, ultimately forming a fully functional organ. Consequently, most stem cell-based differentiation protocols aim to generate mature, single hormone-expressing, glucose-responsive human β-cells, drawing insights from studies on pancreatic development. Specific signals orchestrate the programming of insulin-producing β-cells. Transcription factors such as SRY (sex determining region Y)-box (Sox)17 and homeobox gene HB9 (Hlxb9) play crucial roles in endoderm formation during gastrulation. After foregut formation, fibroblast growth factor (FGF)-10, retinoic acid, SOX9, and hedgehog signalling pathways induce pancreatic development. Pancreatic specification and budding are driven by pancreas-specific transcription factors like pancreatic and duodenal homeobox 1 (Ptf-1a), pancreatic and duodenal homeobox 1, NK6 homeobox 1 (Nkx6.1), neurogenin-3 (Ngn-3), and mafA. These factors enable the endocrine formation and stimulate ISL LIM homeobox 1 (Isl-1), NK2 homeobox 2 (Nkx2.2), neurogenic differentiation factor (NeuroD), paired box gene (Pax)4, and Pax6 signalling, contributing to the formation of the islets of Langerhans. Throughout pancreatic development, transcription factors Sox17, hepatocyte nuclear factor (HNF)-6, and HNF-3beta (also known as forkhead box A2, Foxa2) are consistently expressed. Finally, FGF-10 and notch signaling-induced stem cell and pancreatic progenitor cell differentiation stimulate neogenesis, leading to the creation of β-cells. 1.1.3. Induced Pluripotent Stem Induced pluripotent stem cells (iPS) are adult cells that undergo genetic reprogramming in the laboratory to acquire characteristics similar to embryonic stem cells. iPS cells possess the remarkable ability to differentiate into nearly all specialized cell types found in the body, making them a versatile resource for generating new cells for various organs or tissues. This quality positions them as valuable tools for disease modelling, with researchers globally exploring their potential to develop cures for severe diseases. Notably, iPS cells offer the advantage of being autologous, meaning they originate from the individual's cells, thereby minimizing the risk of immunological reactions or rejection when transplanted tissues derived from iPS cells are used. 1.1.4. Pancreatic Regeneration Through Induced Pluripotent Stem Cell Human induced pluripotent stem cells (iPSCs) are generated by reprogramming human somatic cells to acquire pluripotent properties. These iPSCs have proven to be a valuable source for deriving glucose-responsive β-like cells. Despite the complexity of β cell development, creating an efficient and reproducible β cell differentiation protocol has been challenging. A potential solution involves initiating differentiation from human iPSC-derived pancreatic progenitor cells expressing PDX-1 and SOX9, which exhibit prolonged proliferation potential and the ability to generate C-peptidepositive β cells. Another effective differentiation protocol involves supplementing factors related to epidermal growth factor (EGF), transforming growth factor β (TGF-β), thyroid hormone, retinoic acid (RA) signalling, and γ-secretase inhibition. This approach results in β cells capable of inducing Ca2+ flux in response to glucose, packaging insulin into secretory granules, and secreting insulin. Due to their unlimited replicative capacity (self-renewal) and pluripotency, iPSCs offer a promising avenue for differentiating into pancreatic endocrine lineage cells, specifically functional insulinproducing pancreatic β cells. Research has consistently reported positive outcomes in various in vitro studies using protocols that emulate the mechanisms of in vivo pancreas development to guide iPSC differentiation into functional β cells. The first demonstration of generating functional β cells from induced pluripotent stem (iPS) cells was conducted by Tateishi and colleagues. Their study revealed that human dermal fibroblast-derived iPS cells, subjected to a four-stage serum-free in vitro differentiation process, could differentiate into functional islet-like clusters (ILCs) with mixed Cpeptide+ and glucagon+ cells. Throughout the differentiation, iPS cells underwent stage-specific morphological changes resembling those observed in human embryonic stem cells (ESCs). Functional analysis, employing quantitative reverse transcriptase polymerase chain reaction (RT-PCR) and immunostaining, showed that the differentiated iPS cells expressed stage-specific genes and antigen markers at each developmental stage. These stages included definitive endoderm (Foxa2 and Sox17), pancreatic endoderm (Pdx1), exocrine/endocrine cells (NKX6.1, Ptf1, and Insulin), and insulin-producing cells (Insulin, C-peptide, and glucagon), mirroring the pattern observed in human ESCs. Question: What are 3 reasons that iPSCs are a better approach for treating diabetes than ESCs?","Give your answer in a numbered list and give an explanation for each reason. Draw all information from the provided context and do not use any outside knowledge or references.
+
+EVIDENCE:
+Introducing pancreatic β cells, cultivated in vitro from pluripotent stem cells like embryonic stem cells (ESCs) or induced pluripotent stem cells (iPSCs), has been suggested as an alternative therapeutic approach for diabetes. The fundamental protocol for the in vitro differentiation of mouse embryonic stem (ES) cells into insulin-producing cells involves a three-step process. This includes (i) the formation of embryoid bodies, (ii) the spontaneous differentiation of embryoid bodies into progenitor cells representing ecto-, meso-, and endodermal lineages, and (iii) the induction of differentiation of early progenitors into the pancreatic lineage. The differentiated cells can be obtained in approximately 33 days. Transgenic expression of PDX-1 (pancreatic and duodenal homeobox 1) and Nkx6.1 (NK6 homeobox 1) has been demonstrated to prompt the differentiation of ESCs into endocrine cells that express insulin, somatostatin, and glucagon. Incorporating growth factors and extracellular matrix elements, including laminin, nicotinamide, and insulin, facilitates the process The induction of ESC-derived C-peptide/insulin-positive islet-like cell clusters, exhibiting insulin release upon glucose stimulation and expressing Pax4 (paired box gene), represents a significant advancement. Retinoic acid (RA) plays a crucial role in pancreatic development and is commonly employed to prompt pancreatic differentiation of ESCs. Direct addition of RA to activin A-induced human ESCs expressing CXCR4 leads to 95% of cells becoming positive for the pancreatic marker PDX-1H (pancreatic and duodenal homeobox 1). Animal studies have demonstrated that encapsulating human ESC-derived glucose-responsive mature β cells in alginate and transplanting them into a streptozotocin (STZ)-induced diabetic mouse model effectively regulates glycemic control. However, ethical concerns associated with ESCs have restricted their widespread clinical application. As an alternative, induced pluripotent stem cells have been proposed, possessing similar pluripotent characteristics to ESCs, thereby addressing ethical considerations. The primary focus of research on embryonic pancreas development is to enhance our comprehension of the processes involved in the generation of β-cells under normal conditions. This entails not only unravelling the intricate networks of signalling pathways and transcription factors that govern cell-autonomous differentiation but also acquiring insights into epithelial-mesenchymal interactions and the influence of factors secreted by adjacent tissues that guide endocrine and β-cell development. The overarching goal is that, with the accumulation of this comprehensive information, it will be possible to integrate and reconstruct the embryonic differentiation program. This, in turn, could facilitate the ex vivo generation of therapeutic β-cells for potential clinical applications. The pancreas, a sophisticated endoderm-derived organ, encompasses diverse cell types serving both endocrine and exocrine functions. The exocrine component, constituting over 90–95% of the pancreatic mass, houses acinar cells responsible for secreting digestive enzymes such as lipases, carbohydrases, and amylases. Additionally, ductal cells facilitate the transport of these enzymes into the duodenum. Despite comprising only 1–2% of the pancreatic cell International Journal of Science and Research Archive, 2024, 11(01), 1917–1932 1921 population, hormone-secreting endocrine cells play a vital role in maintaining euglycemia. Within the pancreas, the islets of Langerhans host five distinct endocrine cell types, with the insulin-producing β-cell dominating and constituting 60–80% of the islet. In rodents, and to a lesser extent in humans, β-cells are typically positioned at the centre of the islets, surrounded by other endocrine cell types. The proportion and arrangement of these cells in the adult pancreas, along with the morphological changes during pancreas development, have been extensively studied for over a century. More recently, driven by the advancements in transgenic mouse technology, substantial insights have been gained into the molecular mechanisms governing pancreas organogenesis and epithelial cell differentiation. During vertebrate embryogenesis, the three primary germ layers—ectoderm, mesoderm, and endoderm—form through extensive cell migration during gastrulation. In the mouse, a favoured mammalian model for embryogenesis studies, a thin cup-shaped sheet of embryonic endoderm evolves into the primitive gut tube, which can be subdivided into distinct regions along the anterior-posterior axis. Each region possesses distinct developmental potential, typically giving rise to various endodermal organs, including the liver, lung, stomach, and pancreas. Specification of the pancreatic field occurs around embryonic day 8.5 (E8.5) in mice and around 3 weeks in humans. Initially, three pancreatic primordia emerge from the definitive gut epithelium: the first from the dorsal side, followed by two primordia on the ventral side. Due to their independent origin and distinct locations along the primitive gut tube, differences arise in the surrounding environment, timing, specificity of signalling pathways, and gene expression profiles guiding these processes. Shortly after formation, one of the ventral buds regresses, while the remaining ventral bud eventually fuses with the dorsal evagination during the gut tube's rotation around E12.5.Subsequently, the pancreatic epithelium undergoes significant growth and branches into the surrounding mesenchyme. Although glucagon-producing cells and a few cells coexpressing insulin and glucagon can be detected as early as E9.5, fully differentiated β-cells and other hormone-secreting cells become prominently evident around E13. Termed the secondary transition, this stage witnesses a substantial increase in endocrine cell numbers through the proliferation and subsequent differentiation of pancreatic progenitors. The pancreas plays a pivotal role in systematically regulating glucose homeostasis, and its development involves a complex interplay of factors that influence stem cell differentiation into pancreatic progenitor cells, ultimately forming a fully functional organ. Consequently, most stem cell-based differentiation protocols aim to generate mature, single hormone-expressing, glucose-responsive human β-cells, drawing insights from studies on pancreatic development. Specific signals orchestrate the programming of insulin-producing β-cells. Transcription factors such as SRY (sex determining region Y)-box (Sox)17 and homeobox gene HB9 (Hlxb9) play crucial roles in endoderm formation during gastrulation. After foregut formation, fibroblast growth factor (FGF)-10, retinoic acid, SOX9, and hedgehog signalling pathways induce pancreatic development. Pancreatic specification and budding are driven by pancreas-specific transcription factors like pancreatic and duodenal homeobox 1 (Ptf-1a), pancreatic and duodenal homeobox 1, NK6 homeobox 1 (Nkx6.1), neurogenin-3 (Ngn-3), and mafA. These factors enable the endocrine formation and stimulate ISL LIM homeobox 1 (Isl-1), NK2 homeobox 2 (Nkx2.2), neurogenic differentiation factor (NeuroD), paired box gene (Pax)4, and Pax6 signalling, contributing to the formation of the islets of Langerhans. Throughout pancreatic development, transcription factors Sox17, hepatocyte nuclear factor (HNF)-6, and HNF-3beta (also known as forkhead box A2, Foxa2) are consistently expressed. Finally, FGF-10 and notch signaling-induced stem cell and pancreatic progenitor cell differentiation stimulate neogenesis, leading to the creation of β-cells. 1.1.3. Induced Pluripotent Stem Induced pluripotent stem cells (iPS) are adult cells that undergo genetic reprogramming in the laboratory to acquire characteristics similar to embryonic stem cells. iPS cells possess the remarkable ability to differentiate into nearly all specialized cell types found in the body, making them a versatile resource for generating new cells for various organs or tissues. This quality positions them as valuable tools for disease modelling, with researchers globally exploring their potential to develop cures for severe diseases. Notably, iPS cells offer the advantage of being autologous, meaning they originate from the individual's cells, thereby minimizing the risk of immunological reactions or rejection when transplanted tissues derived from iPS cells are used. 1.1.4. Pancreatic Regeneration Through Induced Pluripotent Stem Cell Human induced pluripotent stem cells (iPSCs) are generated by reprogramming human somatic cells to acquire pluripotent properties. These iPSCs have proven to be a valuable source for deriving glucose-responsive β-like cells. Despite the complexity of β cell development, creating an efficient and reproducible β cell differentiation protocol has been challenging. A potential solution involves initiating differentiation from human iPSC-derived pancreatic progenitor cells expressing PDX-1 and SOX9, which exhibit prolonged proliferation potential and the ability to generate C-peptidepositive β cells. Another effective differentiation protocol involves supplementing factors related to epidermal growth factor (EGF), transforming growth factor β (TGF-β), thyroid hormone, retinoic acid (RA) signalling, and γ-secretase inhibition. This approach results in β cells capable of inducing Ca2+ flux in response to glucose, packaging insulin into secretory granules, and secreting insulin. Due to their unlimited replicative capacity (self-renewal) and pluripotency, iPSCs offer a promising avenue for differentiating into pancreatic endocrine lineage cells, specifically functional insulinproducing pancreatic β cells. Research has consistently reported positive outcomes in various in vitro studies using protocols that emulate the mechanisms of in vivo pancreas development to guide iPSC differentiation into functional β cells. The first demonstration of generating functional β cells from induced pluripotent stem (iPS) cells was conducted by Tateishi and colleagues. Their study revealed that human dermal fibroblast-derived iPS cells, subjected to a four-stage serum-free in vitro differentiation process, could differentiate into functional islet-like clusters (ILCs) with mixed Cpeptide+ and glucagon+ cells. Throughout the differentiation, iPS cells underwent stage-specific morphological changes resembling those observed in human embryonic stem cells (ESCs). Functional analysis, employing quantitative reverse transcriptase polymerase chain reaction (RT-PCR) and immunostaining, showed that the differentiated iPS cells expressed stage-specific genes and antigen markers at each developmental stage. These stages included definitive endoderm (Foxa2 and Sox17), pancreatic endoderm (Pdx1), exocrine/endocrine cells (NKX6.1, Ptf1, and Insulin), and insulin-producing cells (Insulin, C-peptide, and glucagon), mirroring the pattern observed in human ESCs.
+
+USER:
+What are 3 reasons that iPSCs are a better approach for treating diabetes than ESCs?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,30,15,1457,,274
+[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.,"lately I have been trying to learn more about my uncles heart disease issues. Can you tell me what the article says about hypertension? Make it 380-400 words without referencing what it is caused by, or vitamin D","In recent years, researchers and public health programs and practices have focused on preventing, managing, and controlling traditional CVD risk factors by instituting timely intervention programs, identifying social determinants of health (SDOH), examining disparities in CVD risks, assessing the COVID-19 pandemic’s impact on CVD risks, and implementing collective efforts through community-based approaches to achieve population-level improvements in cardiovascular health. This special PCD collection of 20 articles published from January 2020 through November 2022 highlights some of these efforts by using multiple data sources collected before or during the pandemic. For instance, cigarette smoking and risk-enhancing factors related to pregnancy have been shown to increase CVD risks with significant implications (eg, increased infant mortality). Disparities in hypertension, stroke, and stroke mortality exist, exhibiting significant sociodemographic (eg, racial) and geographic (eg, rural–urban, county, zip code) variations. Intervention programs, such as behavioral modifications strengthening chronic disease awareness, use of self-measured blood pressure monitoring, and sodium intake reduction, are evaluated. The impact of COVID-19 on CVD is also explored. Finally, systematic reviews and meta-analyses evaluated the associations of circulating vitamin D levels, vitamin D supplementation, or high-density lipoprotein cholesterol (HDL-C) with blood pressure or stroke. These 20 articles advance our understanding of effective CVD risk management and intervention programs in multiple settings — in the general population and among high-risk groups — with a health equity lens across 3 broad themes further explored in this essay: Examining factors contributing to CVD risk Exploring factors contributing to disparities in CVD Using community-based approaches to decrease CVDExamining the Factors Contributing to CVD Risk The greatest contributors to CVD-related years of life lost globally are tobacco exposure, hypertension, high body mass index (BMI), and high fasting plasma glucose (3). Tobacco exposure, including cigarette smoking, secondhand smoke, and use of smokeless tobacco, contributed to 8.7 million deaths worldwide in 2019, one-third of which were due to CVD (3). Hypertension affects more than 4 billion people worldwide, representing a near doubling in the absolute prevalence of hypertension since 1990 (3). In the US, nearly half of adults (47%) have hypertension, but only about 1 in 4 (24%) have their condition under control (7). Elevated BMI continues to increase globally, with significant effects on death, disability, and quality of life (3). The prevalence of obesity has increased worldwide in the past 50 years, reaching pandemic levels. Obesity represents a major health challenge because it substantially increases the risk of diseases such as hypertension, myocardial infarction, stroke, type 2 diabetes, and dementia, thereby contributing to a decline in both quality of life and life expectancy (8). Furthermore, global increases in high fasting plasma glucose and its sequelae, type 2 diabetes, have mirrored the increases seen in BMI over the past 3 decades (9). Other behavioral risks (eg, unhealthy diet, physical inactivity, inadequate sleep, excessive alcohol use); environmental risks (eg, air pollution, extreme temperatures); and social risks (eg, house and food insecurity) also contribute to increased CVD burden and disparities in cardiovascular morbidity and mortality (10) Several of the contextual risk factors attributed to increased CVD burden are covered in this special collection. Cigarette smoking persists among adults with chronic disease. Using data from the 2019 National Health Interview Survey (NHIS), Loretan and colleagues reported that more than 1 in 4 US adults aged 18 to 64 years with 1 or more chronic diseases associated with smoking were current smokers (11). The current cigarette smoking prevalence in the US reached 51.9% among adults aged 18 to 44 years with 2 or more chronic diseases (11). Furthermore, that study showed that smoking cessation services were not being provided to almost 1 in 3 people who have a chronic disease, leaving important steps to be taken toward successful smoking cessation in this population (11). Also concerning, rates of smoking vary significantly across countries, and approximately 1 billion people smoke globally, with significant negative implications for cardiovascular health (3). Goulding and colleagues used National Health and Nutrition Examination Survey data collected from 2011 through 2018 to provide estimates of the prevalence of high blood pressure among US children aged 8 to 17 years. The authors documented that elevated blood pressure was most prevalent among children who were older, male, or non-Hispanic Black, with factors beyond inequalities in body weight likely contributing to disparities in elevated blood pressure (12). Furthermore, a meta-analysis conducted by Qie and colleagues determined that a high level of HDL-C may provide a protective effect on the risk of total stroke and ischemic stroke but may increase the risk of intracerebral hemorrhage (13). Another meta-analysis by Zhang and colleagues found an L-shaped dose–response relationship between circulating vitamin D levels and the risk of hypertension; however, the pooled results of randomized controlled trials did not show vitamin D supplementation to be effective in preventing hypertension (14). Studies in this collection also identified populations and communities with higher prevalence or at higher risk for CVD. In a cross-sectional study using 2018 NHIS data, Mendez and colleagues documented a higher prevalence of CVD and its risk factors among US adults with vision impairment (15). Salahuddin and colleagues documented zip code variations in infant mortality rates associated with a high prevalence of maternal cardiometabolic high-risk conditions (chronic or gestational diabetes, chronic or gestational hypertension, smoking during pregnancy, and prepregnancy obesity) in 2 counties in Texas (16). Findings from these articles could direct efforts to implement appropriate strategies to prevent, manage, and control CVD in populations at high risk. Top Exploring Factors Contributing to Disparities in CVD CVD and its related risk factors are increasingly recognized as growing indicators of global health disparities (17). Globally, differences in morbidity and mortality from CVD exist among high-, middle-, and low-income countries and across ethnic groups (1,3,5,6,17,18). In the US, disparities in CVD morbidity, mortality, and risk factors have persisted for decades, with concerning stagnation and significant upward trends since the early 2000s (18). Disparities are largely influenced by demographic, socioeconomic, and environmental factors (19,20). For example, African American and American Indian adults experience a higher burden of cardiovascular risk factors and CVD compared with non-Hispanic White adults (18). Unfortunately, structural racism remains a significant cause of poor cardiovascular health, restricting racial and ethnic minority populations from opportunities to live healthier lives, in healthier neighborhoods, and from access to quality education and health care (20).","[question] lately I have been trying to learn more about my uncles heart disease issues. Can you tell me what the article says about hypertension? Make it 380-400 words without referencing what it is caused by, or vitamin D ===================== [text] In recent years, researchers and public health programs and practices have focused on preventing, managing, and controlling traditional CVD risk factors by instituting timely intervention programs, identifying social determinants of health (SDOH), examining disparities in CVD risks, assessing the COVID-19 pandemic’s impact on CVD risks, and implementing collective efforts through community-based approaches to achieve population-level improvements in cardiovascular health. This special PCD collection of 20 articles published from January 2020 through November 2022 highlights some of these efforts by using multiple data sources collected before or during the pandemic. For instance, cigarette smoking and risk-enhancing factors related to pregnancy have been shown to increase CVD risks with significant implications (eg, increased infant mortality). Disparities in hypertension, stroke, and stroke mortality exist, exhibiting significant sociodemographic (eg, racial) and geographic (eg, rural–urban, county, zip code) variations. Intervention programs, such as behavioral modifications strengthening chronic disease awareness, use of self-measured blood pressure monitoring, and sodium intake reduction, are evaluated. The impact of COVID-19 on CVD is also explored. Finally, systematic reviews and meta-analyses evaluated the associations of circulating vitamin D levels, vitamin D supplementation, or high-density lipoprotein cholesterol (HDL-C) with blood pressure or stroke. These 20 articles advance our understanding of effective CVD risk management and intervention programs in multiple settings — in the general population and among high-risk groups — with a health equity lens across 3 broad themes further explored in this essay: Examining factors contributing to CVD risk Exploring factors contributing to disparities in CVD Using community-based approaches to decrease CVDExamining the Factors Contributing to CVD Risk The greatest contributors to CVD-related years of life lost globally are tobacco exposure, hypertension, high body mass index (BMI), and high fasting plasma glucose (3). Tobacco exposure, including cigarette smoking, secondhand smoke, and use of smokeless tobacco, contributed to 8.7 million deaths worldwide in 2019, one-third of which were due to CVD (3). Hypertension affects more than 4 billion people worldwide, representing a near doubling in the absolute prevalence of hypertension since 1990 (3). In the US, nearly half of adults (47%) have hypertension, but only about 1 in 4 (24%) have their condition under control (7). Elevated BMI continues to increase globally, with significant effects on death, disability, and quality of life (3). The prevalence of obesity has increased worldwide in the past 50 years, reaching pandemic levels. Obesity represents a major health challenge because it substantially increases the risk of diseases such as hypertension, myocardial infarction, stroke, type 2 diabetes, and dementia, thereby contributing to a decline in both quality of life and life expectancy (8). Furthermore, global increases in high fasting plasma glucose and its sequelae, type 2 diabetes, have mirrored the increases seen in BMI over the past 3 decades (9). Other behavioral risks (eg, unhealthy diet, physical inactivity, inadequate sleep, excessive alcohol use); environmental risks (eg, air pollution, extreme temperatures); and social risks (eg, house and food insecurity) also contribute to increased CVD burden and disparities in cardiovascular morbidity and mortality (10) Several of the contextual risk factors attributed to increased CVD burden are covered in this special collection. Cigarette smoking persists among adults with chronic disease. Using data from the 2019 National Health Interview Survey (NHIS), Loretan and colleagues reported that more than 1 in 4 US adults aged 18 to 64 years with 1 or more chronic diseases associated with smoking were current smokers (11). The current cigarette smoking prevalence in the US reached 51.9% among adults aged 18 to 44 years with 2 or more chronic diseases (11). Furthermore, that study showed that smoking cessation services were not being provided to almost 1 in 3 people who have a chronic disease, leaving important steps to be taken toward successful smoking cessation in this population (11). Also concerning, rates of smoking vary significantly across countries, and approximately 1 billion people smoke globally, with significant negative implications for cardiovascular health (3). Goulding and colleagues used National Health and Nutrition Examination Survey data collected from 2011 through 2018 to provide estimates of the prevalence of high blood pressure among US children aged 8 to 17 years. The authors documented that elevated blood pressure was most prevalent among children who were older, male, or non-Hispanic Black, with factors beyond inequalities in body weight likely contributing to disparities in elevated blood pressure (12). Furthermore, a meta-analysis conducted by Qie and colleagues determined that a high level of HDL-C may provide a protective effect on the risk of total stroke and ischemic stroke but may increase the risk of intracerebral hemorrhage (13). Another meta-analysis by Zhang and colleagues found an L-shaped dose–response relationship between circulating vitamin D levels and the risk of hypertension; however, the pooled results of randomized controlled trials did not show vitamin D supplementation to be effective in preventing hypertension (14). Studies in this collection also identified populations and communities with higher prevalence or at higher risk for CVD. In a cross-sectional study using 2018 NHIS data, Mendez and colleagues documented a higher prevalence of CVD and its risk factors among US adults with vision impairment (15). Salahuddin and colleagues documented zip code variations in infant mortality rates associated with a high prevalence of maternal cardiometabolic high-risk conditions (chronic or gestational diabetes, chronic or gestational hypertension, smoking during pregnancy, and prepregnancy obesity) in 2 counties in Texas (16). Findings from these articles could direct efforts to implement appropriate strategies to prevent, manage, and control CVD in populations at high risk. Top Exploring Factors Contributing to Disparities in CVD CVD and its related risk factors are increasingly recognized as growing indicators of global health disparities (17). Globally, differences in morbidity and mortality from CVD exist among high-, middle-, and low-income countries and across ethnic groups (1,3,5,6,17,18). In the US, disparities in CVD morbidity, mortality, and risk factors have persisted for decades, with concerning stagnation and significant upward trends since the early 2000s (18). Disparities are largely influenced by demographic, socioeconomic, and environmental factors (19,20). For example, African American and American Indian adults experience a higher burden of cardiovascular risk factors and CVD compared with non-Hispanic White adults (18). Unfortunately, structural racism remains a significant cause of poor cardiovascular health, restricting racial and ethnic minority populations from opportunities to live healthier lives, in healthier neighborhoods, and from access to quality education and health care (20). https://www.cdc.gov/pcd/issues/2022/22_0347.htm ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.","[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
+
+EVIDENCE:
+In recent years, researchers and public health programs and practices have focused on preventing, managing, and controlling traditional CVD risk factors by instituting timely intervention programs, identifying social determinants of health (SDOH), examining disparities in CVD risks, assessing the COVID-19 pandemic’s impact on CVD risks, and implementing collective efforts through community-based approaches to achieve population-level improvements in cardiovascular health. This special PCD collection of 20 articles published from January 2020 through November 2022 highlights some of these efforts by using multiple data sources collected before or during the pandemic. For instance, cigarette smoking and risk-enhancing factors related to pregnancy have been shown to increase CVD risks with significant implications (eg, increased infant mortality). Disparities in hypertension, stroke, and stroke mortality exist, exhibiting significant sociodemographic (eg, racial) and geographic (eg, rural–urban, county, zip code) variations. Intervention programs, such as behavioral modifications strengthening chronic disease awareness, use of self-measured blood pressure monitoring, and sodium intake reduction, are evaluated. The impact of COVID-19 on CVD is also explored. Finally, systematic reviews and meta-analyses evaluated the associations of circulating vitamin D levels, vitamin D supplementation, or high-density lipoprotein cholesterol (HDL-C) with blood pressure or stroke. These 20 articles advance our understanding of effective CVD risk management and intervention programs in multiple settings — in the general population and among high-risk groups — with a health equity lens across 3 broad themes further explored in this essay: Examining factors contributing to CVD risk Exploring factors contributing to disparities in CVD Using community-based approaches to decrease CVDExamining the Factors Contributing to CVD Risk The greatest contributors to CVD-related years of life lost globally are tobacco exposure, hypertension, high body mass index (BMI), and high fasting plasma glucose (3). Tobacco exposure, including cigarette smoking, secondhand smoke, and use of smokeless tobacco, contributed to 8.7 million deaths worldwide in 2019, one-third of which were due to CVD (3). Hypertension affects more than 4 billion people worldwide, representing a near doubling in the absolute prevalence of hypertension since 1990 (3). In the US, nearly half of adults (47%) have hypertension, but only about 1 in 4 (24%) have their condition under control (7). Elevated BMI continues to increase globally, with significant effects on death, disability, and quality of life (3). The prevalence of obesity has increased worldwide in the past 50 years, reaching pandemic levels. Obesity represents a major health challenge because it substantially increases the risk of diseases such as hypertension, myocardial infarction, stroke, type 2 diabetes, and dementia, thereby contributing to a decline in both quality of life and life expectancy (8). Furthermore, global increases in high fasting plasma glucose and its sequelae, type 2 diabetes, have mirrored the increases seen in BMI over the past 3 decades (9). Other behavioral risks (eg, unhealthy diet, physical inactivity, inadequate sleep, excessive alcohol use); environmental risks (eg, air pollution, extreme temperatures); and social risks (eg, house and food insecurity) also contribute to increased CVD burden and disparities in cardiovascular morbidity and mortality (10) Several of the contextual risk factors attributed to increased CVD burden are covered in this special collection. Cigarette smoking persists among adults with chronic disease. Using data from the 2019 National Health Interview Survey (NHIS), Loretan and colleagues reported that more than 1 in 4 US adults aged 18 to 64 years with 1 or more chronic diseases associated with smoking were current smokers (11). The current cigarette smoking prevalence in the US reached 51.9% among adults aged 18 to 44 years with 2 or more chronic diseases (11). Furthermore, that study showed that smoking cessation services were not being provided to almost 1 in 3 people who have a chronic disease, leaving important steps to be taken toward successful smoking cessation in this population (11). Also concerning, rates of smoking vary significantly across countries, and approximately 1 billion people smoke globally, with significant negative implications for cardiovascular health (3). Goulding and colleagues used National Health and Nutrition Examination Survey data collected from 2011 through 2018 to provide estimates of the prevalence of high blood pressure among US children aged 8 to 17 years. The authors documented that elevated blood pressure was most prevalent among children who were older, male, or non-Hispanic Black, with factors beyond inequalities in body weight likely contributing to disparities in elevated blood pressure (12). Furthermore, a meta-analysis conducted by Qie and colleagues determined that a high level of HDL-C may provide a protective effect on the risk of total stroke and ischemic stroke but may increase the risk of intracerebral hemorrhage (13). Another meta-analysis by Zhang and colleagues found an L-shaped dose–response relationship between circulating vitamin D levels and the risk of hypertension; however, the pooled results of randomized controlled trials did not show vitamin D supplementation to be effective in preventing hypertension (14). Studies in this collection also identified populations and communities with higher prevalence or at higher risk for CVD. In a cross-sectional study using 2018 NHIS data, Mendez and colleagues documented a higher prevalence of CVD and its risk factors among US adults with vision impairment (15). Salahuddin and colleagues documented zip code variations in infant mortality rates associated with a high prevalence of maternal cardiometabolic high-risk conditions (chronic or gestational diabetes, chronic or gestational hypertension, smoking during pregnancy, and prepregnancy obesity) in 2 counties in Texas (16). Findings from these articles could direct efforts to implement appropriate strategies to prevent, manage, and control CVD in populations at high risk. Top Exploring Factors Contributing to Disparities in CVD CVD and its related risk factors are increasingly recognized as growing indicators of global health disparities (17). Globally, differences in morbidity and mortality from CVD exist among high-, middle-, and low-income countries and across ethnic groups (1,3,5,6,17,18). In the US, disparities in CVD morbidity, mortality, and risk factors have persisted for decades, with concerning stagnation and significant upward trends since the early 2000s (18). Disparities are largely influenced by demographic, socioeconomic, and environmental factors (19,20). For example, African American and American Indian adults experience a higher burden of cardiovascular risk factors and CVD compared with non-Hispanic White adults (18). Unfortunately, structural racism remains a significant cause of poor cardiovascular health, restricting racial and ethnic minority populations from opportunities to live healthier lives, in healthier neighborhoods, and from access to quality education and health care (20).
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+USER:
+lately I have been trying to learn more about my uncles heart disease issues. Can you tell me what the article says about hypertension? Make it 380-400 words without referencing what it is caused by, or vitamin D
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+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,28,38,1045,,638
+Give an answer using only the context provided.,How are interest rates set?,"NBER WORKING PAPER SERIES HOW DO BANKS SET INTEREST RATES? Leonardo Gambacorta Working Paper 10295 http://www.nber.org/papers/w10295 NATIONAL BUREAU OF ECONOMIC RESEARCH 1050 Massachusetts Avenue Cambridge, MA 02138 February 2004 This research was done during a period as a visiting scholar at the NBER. The views expressed herein are those of the author and not necessarily those of the Banca d’Italia or the National Bureau of Economic Research. ©2004 by Leonardo Gambacorta. All rights reserved. Short sections of text, not to exceed two paragraphs, may be quoted without explicit permission provided that full credit, including © notice, is given to the source. How Do Banks Set Interest Rates? Leonardo Gambacorta NBER Working Paper No. 10295 February 2004 JEL No. E44, E51, E52 ABSTRACT The aim of this paper is to study cross-sectional differences in banks interest rates. It adds to the existing literature in two ways. First, it analyzes in a systematic way both micro and macroeconomic factors that influence the price setting behavior of banks. Second, by using banks’ prices (rather than quantities) it provides an alternative way to disentangle loan supply from loan demand shift in the “bank lending channel” literature. The results, derived from a sample of Italian banks, suggest that heterogeneity in the banking rates pass-through exists only in the short run. Consistently with the literature for Italy, interest rates on short-term lending of liquid and well-capitalized banks react less to a monetary policy shock. Also banks with a high proportion of long-term lending tend to change their prices less. Heterogeneity in the pass-through on the interest rate on current accounts depends mainly on banks’ liability structure. Bank’s size is never relevant. Leonardo Gambacorta Banca d’Italia Research Department Via Nazionale, 91 00184 Rome, Italy gambacorta.leonardo@insedia.interbusiness.it 1. Introduction1 This paper studies cross-sectional differences in the price setting behavior of Italian banks in the last decade. The main motivations of the study are two. First, heterogeneity in the response of bank interest rates to market rates helps in understanding how monetary policy decisions are transmitted through the economy independently of the consequences on bank lending. The analysis of heterogeneous behavior in banks interest setting has been largely neglected by the existing literature. The vast majority of the studies on the “bank lending channel” analyze the response of credit aggregates to a monetary policy impulse, while no attention is paid on the effects on prices. This seems odd because, in practice, when banks interest rates change, real effects on consumption and investment could be produced also if there are no changes in total lending. The scarce evidence on the effects of monetary shocks on banks prices, mainly due to the lack of available long series of micro data on interest rates, contrasts also with some recent works that highlight a different adjustment of retail rates in the euro area (see, amongst others, de Bondt, Mojon and Valla, 2003). Second, this paper wants to add to the “bank lending channel” literature by identifying loan supply shocks via banks’ prices (rather than quantities). So far to solve the “identification problem” it has been claimed that certain bank-specific characteristics (i.e. size, liquidity, capitalization) influence only loan supply movements while banks’ loan demand is independent of them. After a monetary tightening, the drop in the supply of credit should be more important for small banks, which are financed almost exclusively with deposits and equity (Kashyap and Stein, 1995), less liquid banks, that cannot protect their loan portfolio against monetary tightening simply by drawing down cash and securities (Stein, 1998; Kashyap and Stein, 2000) and poorly capitalized banks, that have less access to markets for uninsured funding (Peek and Rosengren, 1995; Kishan and Opiela, 2000; van den Heuvel, 2001a; 2001b).2 The intuition of an identification via prices of loan supply shift is very simple: if loan demand is not perfectly elastic, also the effect of a monetary 1 This study was developed while the author was a visiting scholar at the NBER. The opinions expressed in this paper are those of the author only and in no way involve the responsibility of the Bank of Italy and the NBER. 2 All these studies on cross-sectional differences in the effectiveness of the “bank lending channel” refer to the US. The literature on European countries is instead far from conclusive (see Altunbas et al., 2002; Ehrmann et al., 2003). For the Italian case see Gambacorta (2003) and Gambacorta and Mistrulli (2003). 3 tightening on banks’ interest rate should be more pronounced for small, low-liquid and lowcapitalized banks . Apart from these standard indicators other bank-specific characteristics could influence banks’ price-setting behavior (Weth, 2002). Berlin and Mester (1999) claim that banks which heavily depend upon non-insured funding (i.e. bonds) will adjust their deposit rates more (and more quickly) than banks whose liabilities are less affected by market movements. Berger and Udell (1992) sustain that banks that maintain a close tie with their customers will change their lending rates comparatively less and slowly. In this paper the search for heterogeneity in banks’ behavior is carried out by using a balanced panel of 73 Italian banks that represent more than 70 per cent of the banking system. Heterogeneity is investigated with respect to the interest rate on short-term lending and that on current accounts. The use of microeconomic data is particularly appropriate in this context because aggregation may significantly bias the estimation of dynamic economic relations (Harvey, 1981). Moreover, information at the level of individual banks provides a more precise understanding of their behavioral patterns and should be less prone to structural changes like the formation of EMU. The main conclusions of this paper are two. First, heterogeneity in the banking rates pass-through exists, but it is detected only in the short run: no differences exist in the longrun elasticities of banking rates to money market rates. Second, consistently with the existing literature for Italy, interest rates on short-term lending of liquid and well-capitalized banks react less to a monetary policy shock. Also banks with a high proportion of long-term lending tend to change less their prices. Heterogeneity in the pass-through on the interest rate on current accounts depends mainly on banks’ liability structure. Bank’s size is never relevant. The paper is organized as follows. Section 2 describes some institutional characteristics that help to explain the behavior of banking rates in Italy in the last two decades. Section 3 reviews the main channels that influence banks’ interest rate settings trying to disentangle macro from microeconomic factors. After a description of the econometric model and the data in Section 4, Section 5 shows the empirical results. Robustness checks are presented in Section 6. The last section summarizes the main conclusions. 4 2. Some facts on bank interest rates in Italy Before discussing the main channels that influence banks’ price setting, it is important to analyze the institutional characteristics that have influenced Italian bank interest rates in the last two decades. The scope of this section is therefore to highlight some facts that could help in understanding differences, if any, with the results drawn by the existing literature for the eighties and mid-nineties. For example, there is evidence that in the eighties Italian banks were comparatively slow in adjusting their rates (Verga, 1984; Banca d’Italia, 1986, 1988; Cottarelli and Kourelis, 1994) but important measures of liberalization of the markets and deregulation over the last two decades should have influenced the speed at which changes in the money market conditions are transmitted to lending and deposit rates (Cottarelli et al. 1995; Passacantando, 1996; Ciocca, 2000; Angelini and Cetorelli, 2002). In fact, between the mid-1980s and the early 1990s all restrictions that characterized the Italian banking system in the eighties were gradually removed. In particular: 1) the lending ceiling was definitely abolished in 1985; 2) foreign exchange controls were lifted between 1987 and 1990; 3) branching was liberalized in 1990; 4) the 1993 Banking Law allowed banks and special credit institutions to perform all banking activities. In particular, the 1993 Banking Law (Testo Unico Bancario, hereafter TUB) completed the enactment of the institutional, operational and maturity despecialization of the Italian banking system and ensured the consistency of supervisory controls and intermediaries’ range of operations within the single market framework. The business restriction imposed by the 1936 Banking Law, which distinguished between banks that could raise short-term funds (“aziende di credito”) and those that could not (“Istituti di credito speciale”), was eliminated.3 To avoid criticism of structural breaks, the econometric analysis of this study will be based on the period 1993:03-2001:03, where all the main reforms of the Italian banking system had already taken place. 3 For more details see Banca d’Italia, Annual Report for 1993. 5 The behavior of bank interest rates in Italy reveals some stylized facts (see Figures 1 and 2). First, a remarkable fall in the average rates since the end of 1992. Second a strong and persistent dispersion of rates among banks. These stylized facts suggest that both the time series and the cross sections dimensions are important elements in understanding the behavior of bank interest setting. This justifies the use of panel data techniques. The main reason behind the fall in banking interest rates is probably the successful monetary policy aiming at reducing the inflation rate in the country to reach the Maastricht criteria and the third stage of EMU. As a result, the interbank rate decreased by more than 10 percentage points in the period 1993-1999. Excluding the 1995 episode of the EMS crisis, it is only since the third quarter of 1999 that it started to move upwards until the end of 2000 when it continued a declining trend. From a statistical point of view, this behavior calls for the investigation of a possible structural break in the nineties.4 The second stylized fact is cross-sectional dispersion among interest rates. Figure 2 shows the coefficient of variation for loan and deposit rates both over time and across banks in the period 1987-2001.5 The temporal variation (dotted line) of the two rates show a different behavior from the mid of the nineties when the deposit rate is more variable, probably for a catching-up process of the rate toward a new equilibrium caused by the convergence process. Also the cross-sectional dispersion of the deposit rate is greater than that of the loan rate, especially after the introduction of euro.6 4 In the period 1995-98, that coincides with the convergence process towards stage three of EMU, it will be necessary to allow for a change in the statistical properties of interest rates (see Appendix 2). 5 The coefficient of variation is given by the ratio of the standard errors to the mean. The series that refer to the variability “over time” shows the coefficient of variation in each year of monthly figures. In contrast, the series that capture the variability “across banks” shows the coefficient of variation of annual averages of bankspecific interest rates. 6 In the period before the 1993 Banking Law deposit interest rates were quite sticky to monetary policy changes. Deposit interest rate rigidity in this period has been extensively analyzed also for the US. Among the market factors that have been found to affect the responsiveness of bank deposit rates are the direction of the change in market rates (Ausubel, 1992; Hannan and Berger, 1991), if the bank interest rate is above or below a target rate (Hutchison, 1995; Moore, Porter and Small, 1990; Neumark and Sharpe, 1992) and market concentration in the bank’s deposit market (Hannan and Berger, 1991). Rosen (2001) develops a model of price settings in presence of heterogeneous customers explaining why bank deposits interest rates respond sluggishly to some extended movements in monetary market rates but not to others. Hutchinson (1995) presents a model of bank deposit rates that includes a demand function for customers and predicts a linear (but less than one for one) relationship between market interest rate changes and bank interest rate changes. Green (1998) claims that the rigidity is due to the fact that bank interest rate management is based on a two-tier pricing system; banks offer accounts at market related interest rates and at posted rates that are changed at discrete intervals. 6 3. What does influence banks’ interest rate setting? The literature that studies banks’ interest rate setting behavior generally assumes that banks operate under oligopolistic market conditions.7 This means that a bank does not act as a price-taker but sets its loan rates taking into account the demand for loans and deposits. This section reviews the main channels that influence banks interest rates (see Figure 3). A simple analytical framework is developed in Appendix 1. Loan and deposit demand The interest rate on loans depends positively on real GDP and inflation (y and p). Better economic conditions improve the number of projects becoming profitable in terms of expected net present value and, therefore, increase credit demand (Kashyap, Stein and Wilcox, 1993). As stressed by Melitz and Pardue (1973) only increases in permanent income (yP) have a positive influence on loan demand, while the effect due to the transitory part (yT) could also be associated with a self-financing effect that reduces the proportion of bank debt (Friedman and Kuttner, 1993).8 An increase in the money market rate (iM) raises the opportunity cost of other forms of financing (i.e. bonds), making lending more attractive. This mechanism also boosts loan demand and increases the interest rate on loans. The interest rate on deposits is negatively influenced by real GDP and inflation. A higher level of income increases the demand for deposits9 and reduces therefore the incentive for banks to set higher deposit rates. In this case the shift of deposit demand should be higher if the transitory component of GDP is affected (unexpected income is generally first deposited on current accounts). On the contrary, an increase in the money market rate, ceteris paribus, makes more attractive to invest in risk-free securities that represent an alternative to detain deposits; the subsequent reduction in deposits demand determines an upward pressure on the interest rate on deposits. 7 For a survey on modeling the banking firm see Santomero (1984). Among more recent works see Green (1998) and Lim (2000). 8 Taking this into account, in Section 4 I tried to disentangle the two effects using a Beveridge and Nelson (1981) decomposition. 9 The aim of this paper is not to answer to the question if deposits are input or output for the bank (see Freixas and Rochet, 1997 on this debate). For simplicity here deposits are considered a service supplied by the bank to depositors and are therefore considered an output (Hancock, 1991). 7 Operating cost, credit risk and interest rate volatility The costs of intermediation (screening, monitoring, branching costs, etc.) have a positive effect on the interest rate on loans and a negative effect on that of deposits (efficiency is represented by e). The interest rate on lending also depends on the riskiness of the credit portfolio; banks that invest in riskier project will have a higher rate of return in order to compensate the higher percentage of bad loans that have to be written off (j). Banking interest rates are also influenced by interest rate volatility. A high volatility in the money market rate (σ) should increase lending and deposit rates. Following the dealership model by Ho and Saunders (1981) and its extension by Angbazo (1997) the interest rate on loans should be more affected by interbank interest rate volatility with respect to that on deposits (diL/dσ>diD/dσ). This should reveal a positive correlation between interest rate volatility and the spread. Interest rate channel Banking interest rates are also influenced by monetary policy changes. A monetary tightening (easing) determines a reduction (increase) of reservable deposits and an increase (reduction) of market interest rates. This has a “direct” and positive effect on bank interest rates through the traditional “interest rate channel”. Nevertheless, the increase in the cost of financing could have a different impact on banks depending on their specific characteristics. There are two channels through which heterogeneity among banks may cause a different impact on lending and deposit rates: the “bank lending channel” and the “bank capital channel”. Both mechanisms are based on adverse selection problems that affect banks fundraising but from different perspectives. Bank lending channel According to the “bank lending channel” thesis, a monetary tightening has effect on bank loans because the drop in reservable deposits cannot be completely offset by issuing other forms of funding (i.e. uninsured CDs or bonds; for an opposite view see Romer and Romer, 1990) or liquidating some assets. Kashyap and Stein (1995, 2000), Stein (1998) and Kishan and Opiela (2000) claim that the market for bank debt is imperfect. Since nonreservable liabilities are not insured and there is an asymmetric information problem about 8 the value of banks’ assets, a “lemon’s premium” is paid to investors. According to these authors, small, low-liquid and low-capitalized banks pay a higher premium because the market perceives them more risky. Since these banks are more exposed to asymmetric information problems they have less capacity to shield their credit relationships in case of a monetary tightening and they should cut their supplied loans and raise their interest rate by more. Moreover, these banks have less capacity to issue bonds and CDs and therefore they could try to contain the drain of deposits by raising their rate by more. In Figure 3 three effects are highlighted: the “average” effect due to the increase of the money market rate (which is difficult to disentangle from the “interest rate channel”), the “direct” heterogeneous effect due to bank-specific characteristics (Xt-1) and the “interaction effect” between monetary policy and the bank-specific characteristic (iM Xt-1). These last two effects can genuinely be attributed to the “bank lending channel” because bank-specific characteristics influence only loan supply movements. Two aspects deserve to be stressed. First, to avoid endogeneity problems bank-specific characteristics should refer to the period before banks set their interest rates. Second, heterogeneous effects, if any, should be detected only in the short run while there is no a priori that these effects should influence the long run relationship between interest rates. Apart from the standard indicators of size (logarithm of total assets), liquidity (cash and securities over total assets) and capitalization (excess capital over total assets),10 two other bank-specific characteristics deserve to be investigated: a) the ratio between deposits and bonds plus deposits; b) the ratio between long-term loans and total loans. The first indicator is in line with Berlin and Mester (1999): banks that heavily depend upon non-deposit funding (i.e. bonds) will adjust their deposits rates by more (and more quickly) than banks whose liabilities are less affected by market movements. The intuition of this result is that, other things being equal, it is more likely that a bank will adjust her terms 10 It is important to note that the effect of bank capital on the “bank lending channel” cannot be easily captured by the capital-to-asset ratio. This measure, generally used by the existing literature to analyze the distributional effects of bank capitalization on lending, does not take into account the riskiness of a bank portfolio. A relevant measure is instead the excess capital that is the amount of capital that banks hold in excess of the minimum required to meet prudential regulation standards. Since minimum capital requirements are determined by the quality of bank’s balance sheet activities, the excess capital represents a risk-adjusted measure of bank capitalization that gives more indications on the probability of a bank default. Moreover, the excess capital is a relevant measure of the availability of the bank to expand credit because it directly controls for prudential regulation constraints. For more details see Gambacorta and Mistrulli (2004). 9 for passive deposits if the conditions of her own alternative form of refinancing change. Therefore an important indicator to analyze the pass-through between market and banking rates is the ratio between deposits and bonds plus deposits. Banks which use relatively more bonds than deposits for financing purpose fell more under pressure because their cost increase contemporaneously and to similar extent as market rates. The Berger and Udell (1992) indicator represents a proxy for long-term business; those credit institutions that maintain close ties with their non-bank customers will adjust their lending rates comparatively less and slowly. Banks may offer implicit interest rate insurance to risk-averse borrowers in the form of below-market rates during periods of high market rates, for which the banks are later compensated when market rates are low. Having this in mind, banks that have a higher proportion of long-term loans should be more inclined to split the risk of monetary policy change with their customers and preserve credit relationships. For example, Weth (2002) finds that in Germany those banks with large volumes of longterm business with households and firms change their prices less frequently than the others. Bank capital channel The “bank capital channel” is based on three hypotheses. First, there is an imperfect market for bank equity: banks cannot easily issue new equity for the presence of agency costs and tax disadvantages (Myers and Majluf, 1984; Cornett and Tehranian, 1994; Calomiris and Hubbard, 1995; Stein, 1998). Second, banks are subject to interest rate risk because their assets have typically a higher maturity with respect to liabilities (maturity transformation). Third, regulatory capital requirements limit the supply of credit (Thakor, 1996; Bolton and Freixas, 2001; Van den Heuvel, 2001a; 2001b). The mechanism is the following. After an increase of market interest rates, a lower fraction of loans can be renegotiated with respect to deposits (loans are mainly long term, while deposits are typically short term): banks suffer therefore a cost due to the maturity mismatch that reduces profits and then capital accumulation.11 If equity is sufficiently low and it is too costly to issue new shares, banks reduce lending (otherwise they fail to meet 11 In Figure 3, the cost per unit of asset due to the maturity transformation at time t-1 ( ρit −1 ) is multiplied by the actual change in the money market rate ( ∆iM ). For more details see Appendix 1. 10 regulatory capital requirements) and amplify their interest rate spread. This determines therefore an increase in the interest rates on loans and a decrease in that on deposits:12 in the oligopolistic version of the Monti-Klein model, the maturity transformation cost has the same effect of an increase in operating costs. Industry structure The literature underlines two possible impacts of concentration on pricing behavior of banks (Berger and Hannan, 1989). A first class of models claims that more concentrated banking industry will behave oligopolistically (structure-performance hypothesis), while another class of models stresses that concentration is due to more efficient banks taking over less efficient counterparts (efficient-structure hypothesis). This means that in the first case lower competition should result in higher spreads, while in the second case a decrease in managerial costs due to increased efficiency should have a negative impact on the spread. In the empirical part great care will be given therefore to the treatment of bank mergers (see Appendix 2). Nevertheless, the scope of this paper is not to extract policy implications about this issue, for which a different analysis is needed. The introduction of bank-specific dummy variables (µi) tries to control for this and other missing aspects.13 4. Empirical specification and data The equations described in Figure 3 and derived analytically in Appendix 1 are expressed in levels. Nevertheless, since interest rates are likely to be non-stationary variables, an error correction model has been used to capture bank’s interest rate setting.14 Economic theory on oligopolistic (and perfect) competition suggests that, in the long run, both banking rates (on lending and deposits) should be related to the level of the monetary 12 The “bank capital channel” can also be at work even if capital requirement is not currently binding. Van den Heuvel (2001a) shows that low-capitalized banks may optimally forgo lending opportunities now in order to lower the risk of capital inadequacy in the future. This is interesting because in reality, most banks are not constrained at any given time. 13 In Section 6 this hypothesis will be tested introducing a specific measure of the degree of competition that each banks faces. For a more detailed explanation on the effect of concentration on the pricing behavior of Italian banks see Focarelli and Panetta (2003). 14 This is indeed the standard approach used for interest rate equations (Cottarelli et al. 1995; Lim, 2000; Weth 2002). From a statistical point of view, the error correction representation is adopted because the lending rate and the deposit rate result to be cointegrated with the money market rate. 11 rate, that reflects the marginal yield of a risk-free investment (Klein, 1971). We have: 2 (1) 1 ∆i L k ,t = µ k + å κ j ∆i L k ,t − j + å ( β j + β *j X k ,t −1 ) ∆i M t − j + ϕ p t + δ 1 ∆ ln y tP + δ 2 ∆ ln y tT + λX k ,t −1 + j =1 j =0 φ∆ ( ρ k ,t −1 ∆i M t ) + (α + α X k ,t −1 )i L k ,t −1 + (γ + γ * X k ,t −1 )i M t −1 + θ j k ,t + ξ e k ,t + ψσ t + Φ k ,t + ε k ,t * 1 2 (2) ∆i D k ,t = µ k + å κ j ∆i D k ,t − j + å ( β j + β *j X k ,t −1 )∆i M t − j + ϕ p t + δ 1 ∆ ln y tP + δ 2 ∆ ln y tT + λX k ,t −1 + j =1 j =0 φ∆ ( ρ k ,t −1 ∆i M t ) + (α + α X k ,t −1 )i D k ,t −1 + (γ + γ * X k ,t −1 )i M t −1 + ξ e k ,t + ψσ t + Φ k ,t + ε k ,t * with k=1,…, N (k=number of banks) and t=1, …,T (t= periods). Data are quarterly (1993:032001:03) and not seasonally adjusted. The panel is balanced with N=73 banks. Lags have been selected in order to obtain white noise residuals. The description of the variables is reported in Table 1.15 The model allows for fixed effects across banks, as indicated by the bank-specific intercept µi. The long-run elasticity between each banking rate and the money market rate is given by: (γ + γ * X k ,t −1 ) /(α + α * X k ,t −1 ) . Therefore to test if the pass-through between the money market rate and the banking rate is complete it is necessary to verify that this elasticity is equal to one. If this is the case there is a one-to-one long-run relationship between the lending (deposit) rate and the money market rate, while the individual effect µi influences the bank-specific mark-up (mark-down). The loading coefficient (α + α * X k ,t −1 ) must be significantly negative if the assumption of an equilibrium relationship is correct. In fact, it represents how many percent of an exogenous variation from the steady state between the rates is brought back towards the equilibrium in the next period.16 The degree of banks’ interest rate stickiness in the short run can be analyzed by the impact multiplier ( β 0 + β 0* X k ,t −1 ) and the total effect after three months.17 15 For more details on data sources, variable definitions, merger treatment and trimming of the sample see Appendix 2. 16 Testing for heterogeneity in the loading coefficient means to verify if α * is significant or not. At the same time heterogeneity in the long-run elasticity can be proved if α *γ − αγ * is statistically different from zero. 17 In the first case heterogeneity among banks is simply tested through the significance of β 0 while in the * second case, since the effect is given by a convolution of the structural parameters it is possible to accept the 12 The variable Xk,t-1 represents a bank-specific characteristic that economic theory suggests to influence only loan and deposit supply movements, without affecting loan and deposit demands. In particular, all bank-specific indicators ( χ k ,t ) have been re-parameterized in the following way: N æ ö ç T å χ k ,t ÷ ÷ /T X k ,t = χ k ,t − ç å k =1 ç t =1 N ÷ ç ÷ è ø Each indicator is therefore normalized with respect to the average across all the banks in the respective sample, in order to obtain a variable whose sum over all observations is zero.18 This has two implications. First, the interaction terms between interest rates and X k , t −1 in equations (1) and (2) are zero for the average bank (this because X k ,t −1 =0). Second, the coefficients β0, β1, α and γ are directly interpretable as average effects. To test for the existence of a “bank capital channel” we have introduced the variable ρ k , t −1∆iM that represents the bank-specific cost of monetary policy due to maturity transformation. In particular ρ k , t −1 measures the loss per unit of asset a bank suffers when the monetary policy interest rate is raised of one percent. The cost at time t is influenced by the maturity transformation in t-1. This variable is computed according to supervisory regulation relative to interest rate risk exposure that depends on the maturity mismatch among assets and liabilities (see Appendix 2 for further details). To work out the real cost we have therefore multiplied ρ k , t −1 for the realized change in interest rates. Therefore ρ k , t −1∆iM represents the cost (gain) that a bank suffers (obtain) in each quarter. As formalized in Appendix 1, this measure influences the level of bank interest rates. Since the model is expressed in error correction form we have included this variable in first difference as well. null hypothesis of absence of heterogeneity if and only if éë β 0α * + β 0* (1 + α + κ 1 ) + β1* + γ * ùû X k ,t −1 + α * β 0* X k2,t −1 is equal to zero. The significance of this expression has been checked using the delta method (Rao, 1973). 18 The size indicator has been normalized with respect to the mean on each single period. This procedure removes trends in size (for more details see Ehrmann et al., 2003). 13 4.1 Characteristics of the dataset The dataset includes 73 banks that represent more than 70 per cent of total Italian banking system in term of loans over the whole sample period. Since information on interest rates is not available for Mutual banks, the sample is biased towards large banks. Foreign banks and special credit institution are also excluded. This bias toward large banks has two consequences. First, the distributional effects of the size variable would be treated with extreme cautious because a “small” bank inside this sample could not be considered with the same characteristic using the full population of Italian banks.19 The size grouping in this study mainly controls for variations in scale, technology and scope efficiencies across banks but it is not able to shed light on differences between Mutual and other banks. Second, results for the average bank will provide more “macroeconomic insights” than studies on the whole population (where the average bank dimension is very small). Table 2 gives some basic information on the dataset. Rows are organized dividing the sample with respect to the bank-specific characteristics that are potential candidates to cause heterogeneous shifts in loan supply in case of a monetary policy shock. On the columns, the table reports summary statistics for the two interest rates and for each indicator. Several clear patterns emerge. Considering size, small banks charge higher interest rates on lending but show a lower time variation. This fits with the standard idea of a close customer relationships between small firms and small banks that provides them with an incentive to smooth the effect of a monetary tightening (Angelini, Di Salvo and Ferri, 1998). Moreover, small banks are more liquid and capitalized than average and this should help them to reduce the effect of cyclical variation on supplied credit. On the liability side, the percentage of deposits (overnight deposits, CDs and savings accounts) is greater among small banks, while their bonds issues are more limited than the ones of large banks. Nevertheless, there are no significant differences that emerge in the level and volatility of the interest rate on current accounts. 19 In particular, banks that are considered “small” in this study are labeled as “medium” in other studies for the Italian banking system that analyze quantities (see for example, Gambacorta, 2003; Gambacorta and Mistrulli, 2004). This is clear noting that the average assets of a “small” bank in my data (1.6 billions of euros) over the sample period is very similar to that of the “medium” bank of the total system (1.7 billions of euros). 14 High-liquid banks are smaller than average and are more capitalized. These characteristics should reduce the speed of the “bank lending channel” transmission through interest rates. In particular, since deposits represent a high share of their funding they should have a smoother transmission on passive rates. Well-capitalized banks make relatively more short-term loans. They are in general not listed and issue less subordinated debt to meet the capital requirement. This evidence is consistent with the view that, ceteris paribus, capitalization is higher for those banks that bear more adjustment costs from issuing new (regulatory) capital. Well-capitalized banks charge a higher interest rate on lending; this probably depend upon their higher ratios of bad loans that increase their credit risk. In other words their higher capitalization is necessary to face a riskier portfolio. Moreover, the interest rate on deposit is lower for low-capitalized banks indicating that agents do not perceive these deposits as riskier than those at other banks. This has two main explanations. First, the impact of bank failures has been very small in Italy, especially with respect to deposits.20 Second, the presence of deposit insurance that insulates deposits of less capitalized banks from the risk of default.21 The Berlin-Mester and the Berger-Udell indicators seem to have a high power in explaining heterogeneity in banks’ price setting behavior. Differences in the standard deviations of the two groups are particularly sensitive, calling for a lower interest rates variability of banks with a high percentage of deposits and long-term loans. 20 During our sample period, the share of deposits of failed banks to total deposits approached 1 per cent only twice, namely in 1987 and 1996 (Boccuzzi, 1998). 21 Two explicit limited-coverage deposit insurance schemes (DISs) currently operate in Italy. Both are funded ex-post; that is, member banks have a commitment to make available to the Funds the necessary resources should a bank default. All the banks operating in the country, with the exception of mutual banks, adhere to the main DIS, the ‘Fondo Interbancario di Tutela dei Depositi’ (FITD). Mutual banks (‘Banche di Credito Cooperativo’) adhere to a special Fund (‘Fondo di Garanzia dei Depositanti del Credito Cooperativo’) created for banks belonging to their category. The ‘Fondo Interbancario di Tutela dei Depositi’ (FITD), the main DIS, is a private consortium of banks created in 1987 on a voluntary basis. In 1996, as a consequence of the implementation of European Union Directive 94/19 on deposit guarantee schemes, the Italian Banking Law regulating the DIS was amended, and FITD became a compulsory DIS. FITD performs its tasks under the supervision of and in cooperation with the banking supervision authority, Banca d’Italia. The level of protection granted to each depositor (slightly more than 103,000 euros) is one of the highest in the European Union. FITD does not adopt any form of deposit coinsurance. 15 5. Results The main channels that influence the interest rate on short term lending and that on current accounts are summarized, respectively, in Tables 3 and 4. The first part of each table, show the influence of the permanent and transitory component of real GDP and inflation. These macro variables capture cyclical movements and serves to isolate shifts in loan and deposit demand from monetary policy changes. The second part of the tables presents the effects of bank’s efficiency, credit risk and interest rate volatility. The third part highlights the effects of monetary policy. These are divided into four components: i) the immediate pass-through; ii) the one-quarter pass-through; iii) the long-run elasticity between each banking rate and the monetary policy indicator; iv) the loading coefficient of the cointegrating relationship.22 The last part of the tables shows the significance of the “bank capital channel”. Each table is divided in five columns that highlight, one at the time, heterogeneous behavior of banks with different characteristics in the response to a monetary shock. The existence of distributional effects is tested for all the four components of the monetary policy pass-through. The models have been estimated using the GMM estimator suggested by Arellano and Bond (1991) which ensures efficiency and consistency provided that the models are not subject to serial correlation of order two and that the instruments used are valid (which is tested for with the Sargan test).23 22 The immediate pass-trough is given by the coefficient β 0 + β 0* X k ,t −1 and heterogeneity among banks is simply tested through the significance of β 0* . The effect for a bank with a low value of the characteristic under 0.25 evaluation is worked out through the expression β 0 + β 0* X k0.25 , t −1 , where X k , t −1 is the average for the banks below the first quartile. Vice versa the effect for a bank with a high value of the characteristic is calculated using X k0.75 , t −1 . The total effect after three months for the average bank is given by β 0 (1 + α1 + κ 1 ) + β1 + γ ' while heterogeneity among banks can be accepted if and only if the expression éë β 0α * + β 0* (1 + α + κ 1 ) + β1* + γ * ùû X k ,t −1 + α * β 0* X k2,t −1 is equal to zero. The long run elasticity is given by: (γ + γ * X k ) /(α + α * X k ) , while the loading coefficient is α1 + α1* X k ,t −1 . Standard errors have been approximated with the “delta method” (Rao, 1973). 23 In the GMM estimation, instruments are the second lag of the dependent variable and of the bank-specific characteristics included in each equation. Inflation, GDP growth rate and the monetary policy indicator are considered as exogenous variables. 16 Loan and deposit demand As predicted by theory only changes in permanent income have a positive and significant effect on the interest rate on short term lending while the transitory component is never significant. In fact, as discussed in Section 3, the effect of transitory changes may be also due to a self-financing effect that reduces the proportion of bank debt. On the contrary the interest rate on deposits is negatively influenced by real GDP. In this case the effect is higher when a change in the transitory component occurs because it is directly channeled through current accounts. The effect of inflation is positive on both interest rates but is significantly higher for short-term lending. Operating costs, credit risk and interest rate volatility Bank’s efficiency reduces the interest rate on loans and increase that of deposits. Nevertheless, the effect is not always significant at conventional levels, especially in the equation for the interest rate on current accounts. These results call for further robustness checks using a cost-to-asset ratio (see Section 6). The relative amount of bad loans has a positive and significant effect on the interest rate on loans. This is in line with the standard result that banks that invest in riskier project ask for a higher rate of return to compensate credit risk. Both banking rates are positively correlated with money market rate volatility. The correlation is higher for the interest rate on loans with respect to that of deposits. This is consistent with the prediction of the dealership model by Ho and Saunders (1981) and its extension by Angbazo (1997) where an increase in interbank interest rate volatility is associated with a higher spread. Bank capital channel As expected the “bank capital channel” (based on the maturity mismatch between bank’s assets an liabilities, see Section 3) has a positive effect on the interest rate on shortterm lending and a negative effect on the interest rate on current account. The absolute values of the coefficients are greater in the first case calling for a stronger adjustment on credit contracts than on deposits. Since this channel can be interpreted similarly to a general 17 increase in the costs for the banks, it is worth comparing this result with that obtained for the efficiency indicator. In both cases the effect is strongest for the interest rate on short-term lending and this is consistent with the view that the interest rate on deposit is more sluggish. Interest rate channel A monetary tightening positively influences banks’ interest rate. After a one per cent increase in the monetary policy indicator, interest rate on short term lending are immediately raised of around 0.5 per cent and of around 0.9 per cent after a quarter. Moreover, the passthrough is complete in the long run (the null hypothesis of a unitary elasticity is accepted in all models). The reaction of the short term lending rate is higher with respect to previous studies on the Italian case and this calls for an increase in competition after the introduction of the 1993 Banking Law. Cottarelli et al. (1995), analyzing the period 1986:02-1993:04, find that the immediate pass through is of around 0.2, while the effect after three months is 0.6 per cent. Their long run elasticity is equal to 0.9 per cent but also in their model the null hypothesis of a complete pass-through in the long run is accepted.24 The long run elasticity of the interest rate on current accounts is around 0.7 per cent. This result is in line with the recent findings by de Bondt et al. (2003) under a similar sample period and only a little higher with respect to the long-run elasticity in Angeloni et al. (1995) for the period 1987:1-1993:04.25 The standard answer to the incomplete pass-through of money market changes on the deposit rate is the existence of market power by banks. Another explanation is the presence of compulsory reserves. To analyze this, we can refer to the theoretical elasticity in the case 24 The main differences between Cottarelli et al. (1995) and this paper are three. First, they use the Treasury bill rate as the reference monetary interest rate. However from the early nineties this indicator became less important as “reference rate” because the interbank market became more competitive and efficient (Gaiotti, 1992). This is indeed stated also by Cottarelli et al. (page 19). Second, they do not include macro variables controls in their equation. Third, their dataset is based on monthly data. To allow comparability among the results of this paper and those in Cottarelli et al. (1995) I have: 1) checked the results to different monetary policy indicators (i.e. the interbank rate; see Section 6); 2) excluded the macro variables from equation (1) to verify if the results were sensitive to their inclusion. In all cases the conclusion of an increase of speed in the reaction of short-term interest rate on loans to money market rate resulted unchanged. 25 The VAR model in Angeloni et al. considers the interest rate on total deposits (sight, time deposits and CDs), which is typically more reactive to monetary policy than that on current account because the service component in time deposits and CDs is less important. This means that in comparing our result with Angeloni et al. we are underestimating the potential effect of competition. 18 of perfect competition.26 This benchmark case is very instructive because it allows to analyze what happens if banks are price takers (they take as given not only the monetary market rate but also the interest rate on loans and that on deposits), set the quantity of loans and deposits and obtain a zero profit (the sum of the intermediation margins equals management costs). In this case the long-run elasticities become: ∂iL ∂i = 1 and D = 1 − α where α is the fraction of ∂iM ∂iM deposits invested in risk-free assets (this includes the “compulsory” reserves). Therefore in principle, an incomplete pass-through from market rates to deposits rates is also consistent with the fact that banks decide (or are constrained by regulation) to detain a certain fraction of their deposits in liquid assets. The loading coefficients are significantly negative. It is around –0.4 in the loan equation and –0.6 in the current account equation. This means that if an exogenous shock occurs, respectively 40 and 60 per cent of the deviation is canceled out within the first quarter in each banking rate. Bank lending channel In case of a monetary shock, banks with different characteristics behave differently only in the short run. On the contrary no heterogeneity emerges in the long run relationship between each banking rate and the monetary policy indicator. Considering each bank’s specific characteristic one at the time (Tables 3 and 4), interest rates of small, liquid and well-capitalized banks react less to a monetary policy shock. Also the Berlin-Mester and the Berger-Udell indicators have an high power in explaining heterogeneity in banks’ price setting behavior. Nevertheless, the robustness of these distributional effects has to be checked in a model that takes all these five indicators together into account. In this model, in order to save degrees of freedom, the long-run elasticity between the money market rate and the short- 26 The case of perfect competition can be easily obtained from equation (A1.8) and A1.9) in Appendix 1 considering loan and deposit demand (equations A1.3 and A1.4) infinitely elastic with respect the bank rates (c0→∞, d0→∞). Moreover, we will consider the benchmark case were no heterogeneity emerges in the “bank lending channel” (b1=0) and bonds can be issued at the risk free rate (b0=1). See Freixas and Rochet (1997) for an analogous treatment. 19 term lending rate has been imposed to one; that with the interest rate on current account has been fixed to 0.7. Results are reported in Table 5. Interest rates on short-term lending of liquid and wellcapitalized banks react less to a monetary policy shock. Also banks with a high proportion of long-term lending tend to change less their prices. Size is not significant. This evidence matches with previous results on lending. Liquid banks can protect their loan portfolio against a monetary tightening simply by drawing down cash and securities (Gambacorta, 2003). Well-capitalized banks that are perceived as less risky by the market are better able to raise uninsured funds in order to compensate the drop in deposits (Gambacorta and Mistrulli, 2004). Therefore the effects on lending detected for liquid and well-capitalized banks are mirrored by their higher capacity to insulate the clients also from the effects on interest rates. It is interesting to note that, in contrast with the evidence for the US (Kashyap and Stein; 1995), the interaction terms between size and monetary policy are insignificant. The fact that the interest rate on short term lending of smaller banks is not more sensitive to monetary policy than that of larger banks is well documented in the literature for Italy and reflects the close customer relationship between small banks and small firms (Angeloni et al. 1995; Conigliani et al., 1997; Angelini, Di Salvo and Ferri, 1998; Ferri and Pittaluga, 1996). This result is also consistent with Ehrmann et al. (2003) where size does not emerge as a useful indicator for the distributional effect of monetary policy on lending not only in Italy but also in France, Germany and Spain. As regards the interest rate on current accounts, the Berlin-Mester indicator is the only bank-specific characteristic that explains heterogeneity in banks price setting behavior. In particular, banks that heavily depend upon non-deposit funding (banks with a low BM indicator) will adjust their interest rate on current account by more (and more quickly) than banks whose liabilities are less affected by market movements. As explained in Section 3, the intuition of this result is that, other things being equals, it is more likely that a bank will adjust her terms on deposits if the other conditions of her refinancing change. The liability structure seems to influence not only the short-run adjustment but also the loading coefficient. This implies that banks with a high BM ratio react less when there is a deviation in the long run mark-down: banks with a higher percentage of deposits have more room in adjusting their prices toward the optimal equilibrium. As expected, no cross sectional 20 differences emerges among banks due to size, liquidity and capitalization because current accounts are typically insured. 6. Robustness checks The robustness of the results has been checked in several ways. The first test was to introduce as additional control variable a bank-specific measure of the degree of competition that each bank faces in the market. In particular, the average value of the Herfindahl index in the different “local markets” (corresponding to the administrative provinces of Italy) in which the bank operates was introduced in each equation. The reason of this test is that the fixed effect (that captures also industry structure) remains stable over the whole period while the degree of competition could change over time due to the effect of concentration. Therefore this test allows us also to check if the treatment of bank mergers is carried out properly. The Herfindahl index did not show to be statistically significant and the results of the study did not change. The second test was to use as bank’s efficiency indicator the cost-to-total asset ratio instead than the ratio of total loans and deposits to the number of branches. In all cases the results remained unchanged. The third test was to consider if different fiscal treatments over the sample period could have changed deposit demand (from June 1996 the interest rate on current account is subject to a fiscal deduction of 27 per cent; 12.5 per cent before). However, using the net interest rate on current account instead than the gross rate nothing changed. The fourth robustness check was the introduction of a dummy variables to take into account of the spike in the change of the repo interest rate caused by the EMS crisis in the first quarter of 1995. Also in this case results remained the same. The fifth test was to introduce additional interaction terms combining the bank-specific characteristic with inflation, permanent and transitory changes in real income. The reason for this test is the possible presence of endogeneity between bank characteristics and cyclical factors. Performing the test, however, nothing changed, and the double interactions were almost always not significant (it turned out to be statistically not different from zero in the case of the interaction of capitalization and permanent income). 21 The final robustness check was to introduce a dummy variable that indicates if the bank belongs to a group (1) or not (0). Banks belonging to a group may be less influenced by monetary changes if they can benefit of an internal liquidity management; in other words, bank holding companies establish internal capital markets in an attempt to allocate capital among their various subsidiaries (Houston and James, 1998; Upper and Worms, 2001). The introduction of this dummy did not change the results of the study. 7. Conclusions This paper investigates which factors influence price setting behavior of Italian banks. It adds to the existing literature in two ways. First, it analyzes systematically a wide range of micro and macroeconomic variables that have an effect on bank interest rates: permanent and transitory changes in income, interest and credit risk, interest rate volatility, banks’ efficiency. Second, the analysis of banks’ prices (rather than quantities) provides an alternative way to disentangle loan supply from loan demand shift in the “bank lending channel” literature. The search for heterogeneity in banks’ behavior is carried out by using a balanced panel of 73 Italian banks that represent more than 70 per cent of the banking system. The use of microeconomic data help in reducing the problems of aggregation that may significantly bias the estimation of dynamic economic relations and it is less prone to structural changes like the formation of EMU. The main results of the study are the following. First, heterogeneity in the banking rates pass-through exists, but it is detected only in the short run: no differences exist in the long-run elasticities of banking rates to the money market rate. Second, consistently with the existing literature for Italy, interest rates on short-term lending of liquid and well-capitalized banks react less to a monetary policy shock. Also banks with a high proportion of long-term lending tend to change their prices less. Heterogeneity in the pass-through on the interest rate on current accounts depends on banks’ liability structure. Bank’s size is never relevant. Appendix 1 - A simple theoretical model This Appendix develops a one-period model of a risk neutral bank that operates under oligopolistic market conditions. The balance sheet of the representative bank is as follows: (A1.1) L + S = D + B + K where L stands for loans, S for securities, D for deposits, B for bonds, K for capital. The bank holds securities as a buffer against contingencies. We assume that security holdings are a fixed share of the outstanding deposits (α). They represent a safe asset and fruit the risk-free interest rate.27 We have therefore: (A1.2) S = α D For simplicity, bank capital is exogenously given in the period and greater than capital requirements.28 The bank faces a loan demand and a deposit demand. The first one is given by: (A1.3) Ld = c0 i L + c1 y + c 2 p + c3 i M (c0<0, c1>0, c2>0, c3>0) that is negatively related to the interest rate on loans (il ) and it is positively related to real income (y) and prices (p) and the opportunity cost of self-financing, proxied by the money market interest rate (im).29 Alternatively S can be considered as the total amount of bank’s liquidity, where α is the coefficient of free and compulsory reserves. In this case reserves are remunerated by the money market rate fixed by the Central Bank. This alternative interpretation does not change the results of the model. 27 28 In the spirit of the actual BIS capital adequacy rules, capital requirements on credit risks are given by a fixed amount (k) of loans. If bank capital perfectly meets Basle standard requirement the amount of loans would be L=K/k. We rule out this possibility because banks typically hold a buffer as a cushion against contingencies (Wall and Peterson, 1987; Barrios and Blanco, 2001). Excess capital allows them to face capital adjustment costs and to convey positive information on their economic value (Leland and Pile, 1977; Myers and Majluf, 1984). Another explanation is that banks face a private cost of bankruptcy, which reduces their expected future income (Dewatripont and Tirole, 1994). Van den Heuvel (2001a) argues that even if capital requirement is not currently binding, a low capitalized bank may optimally forego profitable lending opportunities now, in order to lower the risk of future capital inadequacy. A final explanation for the existence of excess capital is given by market discipline; well-capitalized banks obtain a lower cost of uninsured funding, such as bonds or CDs, because they are perceived less risky by the market (Gambacorta and Mistrulli, 2004). 29 As far as the GDP is concerned, there is no clear consensus about how economic activity affects credit demand. Some empirical works underline a positive relation because better economic conditions would 23 The deposit demand is standard. It depends positively on the interest rate on deposits, the level of real income (the scale variable) and the price level and negatively on the interest rate on securities that represent an alternative to the investment to deposits. (A1.4) D d = d 0id + d1 y + d 2 p + d 3im (d0>0, d1>0, d2>0, d3<0) Because banks are risky and bonds are not insured, bond interest rate incorporates a risk premium that we assume depends on specific banks’ characteristics. The latter are balance sheet information or institutional characteristics exogenously given at the end of previous period. (A1.5) ib ( im , xt −1 ) = b0im + b1im xt −1 + b2 xt −1 (b0>1) In other words, this assumption implies that the distributional effects via the bank lending channel depends on some characteristics that allow the bank to substitute insured, typically deposits, with uninsured banks’ debt, like bonds or CDs (Romer and Romer, 1990). For example, theory predicts that big, liquid and well-capitalized banks should be perceived less risky by the market and obtain a lower cost on their uninsured funding (b2<0). Moreover they could react less to monetary change (b1<0) The effects of the so-called “bank capital channel” are captured by the following equation: (A1.6) C MT = ρt −1∆im ( L + S ) (ρ >0) where C MT represents the total cost suffered by the bank in case of a change in monetary policy due to the maturity transformation. Since loans have typically a longer maturity than improve the number of project becoming profitable in terms of expected net present value and, therefore, increase credit demand (Kashyap, Stein and Wilcox, 1993). This is also the hypothesis used in Bernanke and Blinder (1988). On the contrary, other works stress the fact that if expected income and profits increase, the private sector has more internal source of financing and this could reduce the proportion of bank debt (Friedman and Kuttner, 1993). A compromise position is taken by Melitz and Pardue (1973): only increases in permanent income have a positive influence on loan demand, while the effect due to the transitory part could also be associated with a self-financing effect in line with Friedman and Kuttner. Taking this into account, in the econometric part (see Section 4) I will try to disentangle the two effects using a Beveridge and Nelson (1981). For simplicity in the model I assume that the first effect dominates and that a higher income determines an increase in credit demand (c2>0). This is indeed consistent with the evidence provided by Ehrmann et al. (2001) for the four main countries of the euro area. 24 bank fund-raising, the variable ρ represents the cost (gain) per unit of asset that the bank incurs in case of a one per cent increase (decrease) in the monetary policy interest rate. The cost of intermediation is given by: (A1.7) C IN = g1 L + g 2 D (g1>0, g2>0) where the component g1L can be interpreted as screening and monitoring cost while g2D as the cost of the branching.30 Loans are risky and, in each period, a percentage j of them is written off from the balance sheet, therefore reducing bank’s profitability. The representative bank maximizes her profits subject to the balance-sheet constraint. The bank optimally sets the interest rates on loans and deposits (iL, iD), while she takes the money market interest rate (iM) as given (it is fixed by the Central Bank). Max π = (iL − j ) L + im S − iD D − iB B − C MT − C IN il ,id s.t. L+Q = D+ B+ K Solving the maximization problem, the optimal levels of the two interest rates are: (A1.8) iL = Ψ 0 + Ψ1 p + (Ψ 2 + Ψ 3 xt −1 )im + Ψ 4 y P + Ψ 5 ρt −1∆im + Ψ 6 j + Ψ 7 xt −1 (A1.9) id = Φ 0 + Φ1 p + (Φ 2 + Φ 3 xt −1 )im + Φ 4 y P + Φ 5 ρt −1∆im + Φ 6 xt −1 where: g1 c b c c b 1 > 0 ; Ψ1 = 2 > 0 ; Ψ 2 = 0 + 3 > 0 ; Ψ 3 = 1 ; Ψ 4 = 1 > 0 ; Ψ 5 = ; 2 −2c0 2 −2c0 −2c0 2 2 b (1 − α ) −d 3 α g d b 1 Φ0 = − 2 < 0 ; Ψ7 = 2 Φ2 = 0 + + >0; Φ1 = − 2 < 0 ; Ψ6 = ; 2 2d 0 2 2 2d 0 2 2 d b (1 − α ) α b (1 − α ) Φ3 = − 1 ; Φ 4 = − 1 < 0 ; Φ5 = − < 0 ; Φ6 = 2 . 2d 0 2 2d 0 2 Ψ0 = 30 The additive linear form of the management cost simplifies the algebra. The introduction of a quadratic cost function would not have changed the result of the analysis. An interesting consequence of the additive form of the management cost is that bank’s decision problem is separable: the optimal interest rate on deposits is independent of the characteristic of the loan market while the optimal interest rate on loans is independent of the characteristics of the deposit market. For a discussion see Dermine (1991). 25 Equation (A1.8) states that a monetary tightening determines an increase in the interest rate on loans (Ψ2>0): the total effect could be divided into two parts: the “bank lending channel” (b0/2>0) and the “opportunity cost” effect (-c3/2c0>0) The effect of a monetary squeeze is smaller if the bank-specific characteristic reduces the impact of monetary policy on the cost of funding (b1<0 and Ψ3<0). In this case banks have a greater capacity to compensate the deposit drop by issuing uninsured funds at a lower price. Loan interest rate reacts positively to an output expansion (Ψ4>0) and to a raise in prices (Ψ1>0). The effect of the so-called “bank capital channel” is also positive ( Ψ 5 > 0 ); due to the longer maturity of bank assets with respect to liabilities (ρ>0), in case of a monetary tightening ( ∆im >0) the bank suffers a cost and a subsequent reduction in profit; given the capital constraint, this effect determines an increase in loan interest rates (the mirror effect is a decrease in lending). The equation (A1.9) for deposit interest rate is slightly different. Also in this case the impact of a monetary tightening is positive (Φ2>0) but it can now be split in three parts: the “bank lending channel” (b0(1-α)/2>0), the “opportunity cost” (-d3/2d0>0) and the “liquidity buffer”(α/2>0) effects. The intuition of this result is that a monetary squeeze automatically increase the cost of borrowing of bank uninsured fund and the return on securities (the alternative investment for depositors); therefore the first two effects push the bank to increase the interest rate on deposits to raise more insured funds. The percentage of deposits invested in securities (α) act, on the one hand, as a simple “reserve coefficient” that reduces the effectiveness of the “bank lending channel” while, on the other, it increases the revenue on liquid portfolio and the market power of the bank to offset the interest rate on deposits. The distributional effects of monetary policy are equal to the ones described above for the interest rate on loans. The effects on the cost of deposits are smaller for banks with certain characteristics only if b1<0 and Ψ3<0. Deposit interest rate reacts negatively to an output expansion (Φ4<0) and to an increase in prices (Φ1<0). An economic expansion pushes the deposits demand to the left and causes a decrease in cost of deposits (remember that deposit demand is upward sloping with respect to id). The effect should be greater for increases in transitory income. Also the effect of the “bank capital channel” are negative (Φ5<0); as we have seen, in case of a monetary tightening (ρ ∆im >0) the bank suffers a cost and a reduction in profit; this induces the bank to increase her interest rate margin, reducing the interest rates on deposits. 26 Appendix 2 – Technical details on the data The dataset has been constructed using three sources. Interest rates are taken from the 10-day report survey conducted by the Bank of Italy. Bank’s balance sheet information comes from the Banking Supervision Register at the Bank of Italy. Data on macroeconomic variables are taken from the International Financial Statistics. Data on interest rates refer to transactions in euros (Italian lira before 1999). The deposit interest rate is the weighted average rate paid by the single banks on current accounts, which are highly homogenous deposits products.31 The rate on domestic shortterm lending for the single bank is the weighted average of all lending positions. From this computation, overdraft fees are excluded. The choice of the short-term rate as a measure of the bank interest lending pass-through is due to several reasons. First, short-term lending excludes subsidized credit. Second, short-term loans typically are not collateralised and this allows insulating the “bank lending” channel from the “balance sheet” channel. Broadly speaking, the pass-through from market interest rates to the interest rate on loans does not depend upon market price variations that influence the value of collateral. Nearly half of bank’s business is done at this rate. Both interest rates are posted rates that are changed at discrete intervals (often less frequently than weekly, see Green, 1998). In our case, the quarterly frequency of the data is sufficient enough to capture all relevant changes due to a monetary policy shock. Both rates are gross of fiscal deduction. The interest rate taken as monetary policy indicator is that on repurchase agreements between the Bank of Italy and credit institutions in the period 1993-1998, and the interest rates on main refinancing operation of the ECB for the period 1999-2001.32 31 Current accounts are the most common type of deposit (at the end of 2001 they represented around 70 per cent of total bank deposits and passive repos). Current accounts allow unlimited checking for depositor that can close the account without notice. The bank, in turn, can change the remuneration of the account at any point in time. Therefore differences in deposit rates are not influenced by heterogeneity in maturity (see Focarelli and Panetta, 2003). 32 As pointed out by Buttiglione, Del Giovane and Gaiotti (1997), in the period under investigation the repo rate mostly affected the short-term end of the yield curve and, as it represented the cost of banks’ refinancing, it represented the value to which market rates and bank rates eventually tended to converge. The interest rate on main refinancing operation of the ECB does not present any particular break with the repo rate. 27 The cost a bank suffers from her maturity transformation function is due to the different sensitivity of her assets and liabilities to interest rates. Using a maturity ladder, we have: å(χ ⋅ A −ζ P ) *100 ρ = åA j j j j j i j j where Aj (Pj) is the amount of assets (liabilities) of j months-to-maturity and χj (ζj) measures the increase in interest on assets (liabilities) of class j due to a one-per-cent increase in the monetary policy interest rate (∆im=0.01). In other words, if å ( χ ⋅ A − ζ P ) >0, ρ j j j j i j represents the cost per unit of asset bank i suffers in case the monetary policy interest rate is raised of one percentage point. We obtain χi and ζi directly from supervisory regulation on interest rates risk exposure. In particular, the regulation assumes, for any given class j of months-to-maturity: 1) the same sensitivity parameter (χj =ζj) and 2) a non-parallel shift of the yield curve (∆im=0.01 for the first maturity class and then decreasing for longer maturity classes). Then, for each bank, after having classified assets and liabilities according to their months-to-maturity class, we have computed the bank specific variable ρi . This variable has been then multiplied by the change of the monetary policy indicator (∆im) to obtain the realized loss (or gain) per unit of asset in each quarter. In assembling our sample, the so-called special credit institutions (long-term credit banks) have been excluded since they were subject to different supervisory regulations regarding the maturity range of their assets and liabilities. Nevertheless, special long-term credit sections of commercial banks have been considered part of the banks to which they belonged. Particular attention has been paid to the treatment of mergers. In practice, it has been assumed that these have been taken place at the beginning of the sample period, summing the balance-sheet items of the merging parties. For example, if bank A has been incorporated by bank B at time t, bank B has been reconstructed backward as the sum of the 28 merging banks before the merger. Bank interest rates have been reconstructed backwards using as weights short-term loans and current accounts of the merging parties.33 Only banks reporting detailed lending and deposit rates over the whole sample period were considered. I refrain from adopting short time series to ensure sufficient asymptotic in the context of the error correction estimation. Bank observations that were missing or misreported or that constituted clear outliers were excluded from the sample. Bad loans are defined as loans for which legal procedures aimed at their repayment have been started. The permanent component of GDP has been computed using the Beveridge and Nelson (1981) decomposition. An ARIMA model (1,1,1) was applied to the logarithm of the series. Computations have been carried out using the algorithm described in Newbold (1990). Robustness of the results have been checked by means of a statistical analysis of the residuals. The possible presence of structural breaks in interest rates series have been investigated by means of the procedure developed by Banerjee, Lumsdaine and Stock (1992). Figure A1 shows sequential test for changes in the mean of each interest rate series. The hypothesis of this procedure is that, if there is a break, its date is not known a priori but rather is gleaned from the data. The results clearly show that unit-root/no-break null can be rejected at the 2.5 per cent critical value level against the stationarity/mean-shift alternative for the period 1995:03-1998:03. In equation (1) and (2) a convergence dummy, that takes the value of 1 in this period and 0 elsewhere, has been introduced. 33 The same methodology has been used, among others by Peek and Rosengreen (1995), Kishan and Opiela (2000) and Ehrmann et al. (2001). References Altunbas Y., Fazylow O. and Molyneux P. (2002), “Evidence on the Bank Lending Channel in Europe”, Journal of Banking and Finance, forthcoming. Angbazo, L. (1997), “Commercial Bank Net Interest Margins, Default Risk, Interest-rate risk, and Off-balance Sheet Banking”, Journal of Banking and Finance, Vol. 21, pp. 55-87. Angelini P. and Cetorelli N. (2002), ""The effects of regulatory reform on competition in the banking industry"", Journal of Money, Credit and Banking, forthcoming. Angelini, P., P. Di Salvo and G. Ferri (1998), “Availability and Cost of Credit for Small Businesses: Customer Relationships and Credit Cooperatives”, Journal of Banking and Finance, Vol. 22, No. 6-8, pp. 925-54. Angeloni I., Buttiglione L., Ferri G. and Gaiotti E. (1995), “The Credit Channel of Monetary Policy across Heterogeneous Banks: The Case of Italy”, Banca d’Italia, Temi di discussione, No. 256. Ausubel L. M. (1992), Rigidity and Asymmetric Adjustment of Bank Interest Rates, mimeo. Banca d’Italia (1986), Modello trimestrale dell’economia italiana, Banca d’Italia, Temi di discussione, No. 80. Banca d’Italia (1988), Modello mensile del mercato monetario, Banca d’Italia, Temi di discussione, No. 108. Banerjee A., Lumsdaine R.L. and Stock J.H. (1992), “Recursive and Sequential Tests of the UnitRoot and Trend Break Hypotheses: Theory and International Evidence”, Journal of Business and Economic Statistics, Vol. 10, No. 3, pp.271-87. Berger A.N. and Udell G.F. (1992), “Some Evidence on the Empirical Significance of Credit Rationing”, Journal of Political Economy, Vol.100, No. 5, pp. 1047-77. Berlin M. and Mester L.J. (1999), “Deposits and Relationship Lending”, Review of Financial Studies, Vol. 12, No. 3, pp. 579-607. Bernanke B. and Blinder A.S. (1988), “Is it Money or Credit, or Both or Neither? Credit, Money and Aggregate Demand”, American Economic Review, Vol. 78, No. 2, pp. 435-9. Paper and Proceedings of the One-Hundredth Annual Meeting of the American Economic Association. Beveridge S. and Nelson C. (1981), “A New Approach to the Decomposition of Economics Time Series into Permanent and Transitory Components with Particular Attention to Measurement of the ‘Business Cycle’”, Journal of Monetary Economics, Vol. 21, pp. 151-74. Boccuzzi, G. (1998), La crisi dell'impresa bancaria. Profili economici e giuridici, Giuffrè, Milano. Bolton, P. and Freixas X. (2001), “Corporate Finance and the Monetary Transmission Mechanism”, CEPR, Discussion Paper Series, No. 2982. Calomiris C.W. and Hubbard G.R. (1995), “Internal Finance and Investment: Evidence from the Undistributed Profit Tax of 1936-37”, Journal of Business, Vol. 68. No. 4. Ciocca P. (2000), La nuova finanza in Italia. Una difficile metamorfosi (1980-2000), Bollati Boringhieri, Torino. Cornett M. M. and Tehranian H. (1994), “An Examination of Voluntary Versus Involuntary Security Issuances by Commercial Banks: The Impact of Capital Regulations on Common Stock Returns”, Journal of Financial Economics, Vol. 35, pp. 99-122. Cottarelli C. and Kourelis A. (1994), “Financial Structure, Bank Lending Rates and the Transmission Mechanism of Monetary Policy”, IMF Staff Papers, Vol. 41, No. 4, pp.587-623. Cottarelli C., Ferri G. and Generale A. (1995), “Bank Lending Rates and Financial Structure in Italy: A Case Study”, IMF Working Papers, No. 38. 30 de Bondt G., Mojon B. and Valla N. (2003), “The Adjustment of Retail Rates in the Euro Area: Is It (Really) Sluggish?”, European Central Bank, mimeo. Dermine J. (1991), Discussion to Vives. X., “Banking Competition and European Integration”, in Giovannini A. and Mayer C., European Financial Integration, Cambridge, Cambridge University Press. Dewatripont M. and Tirole J. (1994), The Prudential Regulation of Banks, Cambridge, Massachusetts, MIT Press. Ehrmann M., Gambacorta L., Martinez Pagés J., Sevestre P. and Worms A. (2003), “Financial Systems and the Role of Banks in Monetary Policy Transmission in the Euro Area”, in Angeloni I., Kashyap A. and Mojon B., Monetary Policy Transmission in the Euro Area, Cambridge, Cambridge University Press. Focarelli D. and Panetta F. (2003), “Are Merger Beneficial to Consumers? Evidence from the Market for Bank Deposits”, American Economic Review, forthcoming. Friedman B. and Kuttner K. (1993), “Economic Activity and the Short-Term Credit Markets: an Analysis of Prices and Quantities”, Brooking Papers on Economic Activity, Vol. 2, pp. 193-283. Freixas X. and Rochet J. (1997), Microeconomics of Banking, Cambridge, MIT Press. Gaiotti E. (1992), “L’evoluzione delle tecniche di controllo monetario nel modello mensile della Banca d’Italia”, mimeo, Banca d’Italia. Gambacorta L. (2003), “The Italian Banking System and Monetary Policy Transmission: Evidence from Bank Level Data”, in Angeloni, I., A. Kashyap and B. Mojon (eds.), Monetary Policy Transmission in the Euro Area, Cambridge, Cambridge University Press. Gambacorta L. and Mistrulli P. (2004), “Does Bank Capital Affect Lending Behavior?”, Journal of Financial Intermediation, forthcoming. Green C.J. (1998), “Banks as Interest Rate Managers”, Journal of Financial Services Research, Vol. 14, n. 3, pp. 189-208. Hancock D. (1991), A Theory of Production for the Financial Firm, Norwell, Massachusetts, Kluwer Academic Publishers. Hannan T.H. and Berger A.N. (1991), “The Rigidity of Prices: Evidence From Banking Industry”, American Economic Review, Vol. 81, pp.938-45. Harvey (1981), Time Series Models, Oxford, Allan. Ho T.S.Y. and Saunders A. (1981), The Determinants of Bank Interest Margins: Theory and Empirical Evidence”, Journal of Financial and Quantitative Analysis, Vol. 16, No. 2, pp. 581600. Houston J.F. and James C. (1998), “Do Bank Internal Capital Market Promote Lending?”, Journal of Banking and Finance, Vol. 22, pp. 899-918. Hutchison D.E. (1995), “Retail Bank Deposit Pricing: An Intertemporal Asset Pricing Approach”, Journal of Money Credit and Banking, Vol. 27, pp. 217-31. Kashyap A. and Stein J.C. (1995), “The Impact of Monetary Policy on Bank Balance Sheets”, Carnegie Rochester Conference Series on Public Policy, Vol. 42, pp.151-195. Kashyap A. and Stein J.C. (2000), “What Do a Million Observations on Banks Say About the Transmission of Monetary Policy”, American Economic Review, Vol. 90, No. 3, pp. 407-28. Kashyap A., Stein J.C. and Wilcox D. (1993). Monetary Policy and Credit Conditions: Evidence from the Composition of External Finance, American Economic Review, Vol. 83, pp. 78-98. Kishan R.P. and Opiela T.P. (2000), “Bank Size, Bank Capital and the Bank Lending Channel”, Journal of Money, Credit and Banking, Vol. 32, No. 1, pp. 121-41. Klein M. (1971), “A Theory of the Banking Firm”, Journal of Money, Credit and Banking, Vol. 3, No. 2, pp. 205-18. 31 Leland H.E. and Pile D.H. (1977), “Informational Asymmetries, Financial Structures and Financial Intermediation”, The Journal of Finance, Vol. 32, pp. 371-87. Lim G.C. (2000), “Bank Interest Rate Adjustments: Are They Asymmetric?”, The Economic Record, Vol. 77, no. 237, pp.135-147. Melitz J. and Pardue M. (1973), “The Demand and Supply of Commercial Bank Loans”, Journal of Money, Credit and Banking, Vol. 5, No. 2, pp. 669-92. Moore G.R., Porter R.D. and Small D.H. (1990), “Modelling the Disaggregated Demands for M2 and M1: the U.S. Experience in the 1980s”, Proceedings of a Federal Reserve Board Conference on Monetary Aggregates and Financial System Behavior. Myers S.C. and Majluf N.S. (1984), “Corporate Finance and Investment Decisions when Firms Have Information that Investors Do Not Have”, Journal of Financial Economics, Vol. 13, pp.187-221. Neumark D. and Sharpe S.A. (1992), “Market Structure and the Nature of Price Rigidity: Evidence From the Market for Consumer Deposits”, Quarterly Journal of Economics, Vol. 107, pp.65780. Newbold P. (1990), “Precise and Efficient Computation of the Beveridge-Nelson Decomposition of Economic Time Series”, Journal of Monetary Economics, Vol. 26, pp. 453-457. Passacantando F. (1996), “Building an Institutional Framework for Monetary Stability”, BNL Quarterly Review, Vol. 49, No. 196, pp. 83-132. Peek J. and Rosengren E.S. (1995), “Bank Lending and the Transmission of Monetary Policy”; in Peek J. and E.S. Rosengren (eds.), Is Bank Lending Important for the Transmission of Monetary Policy?, Federal Reserve Bank of Boston Conference Series No. 39, pp. 47-68. Petersen M. and Rajan R. (1994), “The Benefits of Lending Relationships: Evidence from Small Business Data”, Journal of Finance, Vol. 49, pp.3-37. Rosen R.J. (2001), What Goes Up Must Come Down? Asymmetries and Persistence in Bank Deposit Rates, Indiana University, mimeo. Santomero A.M. (1984), “Modeling the Banking Firm: A Survey”, Journal of Money Credit and Banking, Vo. 16, n. 4, pp. 576-602. Stein J.C. (1998), “An Adverse-Selection Model of Bank Asset and Liability Management with Implications for the Transmission of Monetary Policy”, RAND Journal of Economics, Vol. 29, No. 3, pp. 466-86. Thakor A.V. (1996), “Capital Requirements, Monetary Policy, and Aggregate Bank Lending: Theory and Empirical Evidence”, The Journal of Finance, Vol. 51, No. 1, pp. 279-324. Upper C. and Worms A. (2001), “Estimating Bilateral Exposures in the German Interbank Market: Is There a Danger of Contagion?”, in BIS (ed.), Marrying the Macro and Microprudential Dimensions of Financial Stability, BIS papers, No. 1, pp. 211-29. Van den Heuvel S.J. (2001a), “The Bank Capital Channel of Monetary Policy”, University of Pennsylvania, mimeo. Van den Heuvel S.J. (2001b), “Banking Conditions and the Effects of Monetary Policy: Evidence from U.S. States”, University of Pennsylvania, mimeo. Van den Heuvel S.J. (2003), “Does Bank Capital Matter for Monetary Transmission?”, FRBNY Economic Policy Review, forthcoming. Verga G. (1984), “La determinazione dei tassi bancari in Italia: un’analisi per gli anni più recenti”, Banca, Impresa, Società, Vol. 3, No. 1, pp.65-84. Weth M.A. (2002), “The Pass-Through from Market Interest Rates to Bank Lending Rates in Germany”, Discussion Paper No 11, Economic Research Center of the Deutsche Bundesbank. Table 1 VARIABLES DESCRIPTION Variables Dependent variables Fixed effects Symbols iLt Interest rate on domestic short term loans iDt Interest rate on current account deposits µi imt Macro variables Description y tP , y Tt pt Bank-specific dummy variable Monetary policy indicator Permanent and transitory components of real GDP computed using the Beveridge and Nelson (1981) decomposition Inflation rate Size: log of total assets (Kashyap and Stein, 1995; Ehrmann et al. 2003) Liquidity: cash and securities over total assets (Stein, 1998; Kashyap and Stein, 2000) Excess capital: difference between regulatory capital and capital requirements (Peek and Rosengren, 1995; Kishan and Opiela, 2000; Gambacorta and Mistrulli, 2004) Deposit strength: ratio between deposits and bonds plus deposits (Berlin and Mester,1999; Weth, 2002) Credit relationship: ratio between long term loans and total loans (Berger and Udell, 1992) Bank-specific characteristics that influence the “bank lending channel” X it −1 Measure for the “bank capital channel” ρit −1 Risk-measure jit Efficiency ratio eit Interest rate volatility σt Cost per unit of asset that the bank incurs in case of a one per cent increase in MP Ratio between bad loans and total loans. This variable captures the riskiness of lending operations and should be offset by a higher expected yield of loans. Management efficiency: ratio of total loans and deposits to the number of branches. Interest rate volatility: coefficient of variation of iM . Control variables Φ it Convergence dummy: step dummy that takes the value of 1 in the period 1995:03-1998:03 and 0 elsewhere. Seasonal dummies. Note: For more information on the definition of the variables see Appendix 2. 18 18 18 18 Big banks Small banks Liquid banks (2) Low liquid banks 18 18 18 18 18 18 Well capitalized banks Low capitalized banks Banks with high BM ratio Banks with low BM ratio (3) (4) Banks with high BU ratio (5) Banks with low BU ratio (1) 73 Number of banks Total sample Bank-characteristics (*) 8.51 10.97 11.78 7.77 9.71 9.42 9.51 9.33 9.28 10.02 9.51 Mean 2.59 2.12 1.49 2.24 2.73 2.81 2.72 2.73 2.81 2.73 2.72 St. dev. 3.69 4.00 4.88 3.69 3.69 4.75 3.69 4.42 3.69 5.03 3.69 Min 15.06 16.12 16.12 15.06 16.12 15.93 15.94 14.86 15.06 16.12 16.12 Max Interest rate on short term lending 2.80 4.68 5.15 2.41 3.68 3.53 3.57 3.61 3.57 3.55 3.58 Mean 1.67 1.44 0.96 1.45 1.80 1.79 1.80 1.71 1.74 1.79 1.79 St. dev. 0.65 0.53 0.74 0.52 0.52 0.74 0.65 0.73 0.73 0.52 0.52 Min 7.36 7.43 8.21 7.35 7.18 8.21 8.21 7.35 7.35 8.21 8.21 Max Interest rate on current accounts definition of the variables see Appendix 2. The sources of the dataset are Bank of Italy supervisory returns and 10-days reports. 21.92 8.51 6.58 27.00 9.66 24.28 4.67 43.75 51.15 1.55 16.20 Size (1) 19.98 28.26 29.69 18.56 26.15 20.82 33.07 14.91 19.01 25.11 24.00 Liq. (2) 3.80 3.95 4.46 3.42 6.86 1.49 4.27 3.13 2.56 4.81 3.91 Cap. (3) 71.84 93.13 98.53 66.10 85.49 78.40 86.27 72.43 77.60 84.40 82.40 BM (4) 53.29 22.46 28.72 45.30 37.22 38.46 36.15 43.66 38.98 41.72 37.66 BU (5) average ratio below the third quartile. Since the characteristics of each bank could change through time, percentiles have been worked out on mean values. For more details on the long-term loans and total loans. A bank with a ""high"" characteristic has the average ratio above the first quartile of the distribution. (*) A bank with a ""low""characteristic has the capital requirements. (4) The Berlin and Mester indicator (BM) is the ratio between deposits and deposits plus bonds. (5) The Berger and Udell indicator (BU) is the ratio between government securities over total assets. (3) The capital ratio is given by excess capital divided by total assets. Excess capital is the difference between regulatory capital and total interest rate are annualized and given in percentages. (1) The size indicator is given by total asset (billions of euros). (2) The liquidity indicator is represented by the sum of cash and Ex special credit institutions, foreign banks and ""banche di credito cooperativo"" are excluded. The sample represents more than 70 per cent of total system in terms of lending. All SUMMARY STATISTICS (1993:03-2001:03) Table 2 Table 3 RESULTS FOR THE EQUATION ON THE INTEREST RATE ON SHORT-TERM LENDING This table shows the results of the equation for the interest rate on short term lending. The model is given by the following equation, which includes interaction terms that are the product of the monetary policy indicator and a bank specific characteristic: ∆ iL k ,t = µ k + 2 1 j =1 j =0 å κ j ∆iL k ,t − j + å ( β j + β *j X k ,t −1 )∆iM t − j + ϕ pt + δ1∆ ln ytP + δ 2∆ ln ytT + λX k ,t −1 + φ∆ ( ρ k ,t −1∆iM t ) + + (α + α X k ,t −1 )iL k ,t −1 + (γ + γ * X k ,t −1 )iM t −1 + θ jk ,t + ξ ek ,t + ψσ t + Φ k ,t + ε k ,t * with k=1,…, N (k=number of banks) and t=1, …,T (t= periods). Data are quarterly (1993:03-2001:03) and not seasonally adjusted. The panel is balanced with N=73 banks. Lags have been selected in order to obtain white noise residuals. The description of the variables is reported in Table 1. The model have been estimated using the GMM estimator suggested by Arellano and Bond (1991) which ensures efficiency and consistency provided that the models are not subject to serial correlation of order two and that the instruments used are valid (which is tested for with the Sargan test). A bank with “low characteristic” has the average ratio of the banks below the first quartile, a bank with ""high characterisic” has the average ratio of the banks above third quartile. For more details on the data see Appendix 2. *=significance at the 10 per cent; **=significance at the 5 per cent; ***=significance at the 1 per cent. Dependent variable: quarterly change of the interest rate on short-term lending (1) Size Coeff. (2) Liquidity (5) Long term loans/ Total loans S.Error Coeff. S.Error (4) Dep./(Bonds+Dep.) S.Error Coeff. S.Error Coeff. 0.017 0.012 0.025 0.145 *** 0.032 ** 0.012 0.015 0.013 0.026 0.149 *** 0.025 ** 0.012 0.018 0.187 *** 0.012 0.043 *** 0.024 0.026 0.015 0.010 0.020 Costs, credit risk and int.rate volatility Bank's efficiency: -0.004 ** 0.002 -0.001 Bad loans: 0.020 *** 0.002 0.016 *** Interest rate volatility: 0.011 *** 0.001 0.012 *** 0.002 -0.006 ** 0.002 0.017 *** 0.001 0.010 *** 0.002 0.001 0.001 -0.001 0.020 *** 0.014 *** 0.001 -0.001 0.002 0.019 *** 0.001 0.012 *** 0.001 0.002 0.001 Immediate pass-through Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.569 *** 0.027 0.003 0.556 *** 0.028 0.586 *** 0.026 0.031 0.018 0.027 0.036 0.023 0.418 0.022 0.026 0.465 *** 0.030 0.497 *** 0.023 0.028 0.529 *** 0.032 0.463 *** 0.034 0.000 0.033 0.035 Pass-through after a quarter Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.938 *** 0.013 0.000 0.913 *** 0.015 0.971 *** 0.014 0.016 0.878 *** 0.159 0.017 0.889 *** 0.016 0.863 *** 0.013 0.000 0.014 0.012 Long run elasticity Average bank: Ho: unitary long run elasticity (p-val.) Ho: no heterogeneity (p-value) Low characteristic High characteristic 1.017 *** 0.014 0.056 0.509 0.996 *** 0.014 1.049 *** 0.016 0.015 1.012 *** 0.235 0.924 0.026 0.992 *** 0.012 1.040 *** 0.018 0.489 0.644 0.016 0.023 Loading of the long run relationship Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.017 0.000 0.017 0.020 Bank capital channel Loan demand Inflation: Permanent Income: Transitory Income: Miss-specification tests MA(1), MA(2) (p-value) Sargan test (p-value) No of banks, no of observations S.Error Coeff. (3) Capitalization 0.159 *** 0.019 0.033 ** 0.015 0.012 0.031 0.145 *** 0.030 *** 0.013 0.403 *** 0.414 *** 0.383 *** 0.941 *** 0.962 *** 0.920 *** 0.954 *** 0.958 *** 0.949 *** 0.869 *** 0.862 *** 0.878 *** -0.477 *** 0.023 -0.422 *** 0.000 -0.505 *** 0.026 -0.391 *** -0.441 *** 0.023 -0.451 *** 0.019 -0.507 *** 0.000 0.023 -0.482 *** 0.019 -0.539 *** 0.023 0.035 0.028 0.026 -0.234 *** -0.519 *** 0.043 -0.382 *** 0.000 0.021 -0.434 *** 0.020 -0.330 *** 0.104 * 0.055 0.409 *** 0.070 0.178 *** 0.051 0.197 *** 0.066 0.109 * 0.066 0.000 0.949 0.087 2336 0.000 0.367 0.099 2336 0.000 0.702 0.088 2336 0.000 0.185 0.000 0.101 2336 73 0.116 0.057 2336 73 1.023 *** 0.012 0.037 0.011 0.015 0.474 *** 0.456 *** 1.031 *** 1.015 *** 0.987 *** 1.005 *** 0.014 0.816 0.822 0.015 0.015 0.536 *** 0.529 *** 0.012 0.047 0.883 0.013 0.012 73 0.996 *** 0.018 0.000 0.018 0.018 0.533 *** 73 0.982 *** 0.990 *** 0.978 *** -0.381 *** 73 Table 4 RESULTS FOR THE EQUATION ON INTEREST RATE ON CURRENT ACCOUNTS This table shows the results of the equation for the interest rate on current accounts. The model is given by the following equation, which includes interaction terms that are the product of the monetary policy indicator and a bank specific characteristic: ∆i D k , t = µ k + 2 1 j =1 j =0 åκ j ∆iD k ,t − j + å ( β j + β *j X k ,t −1)∆iM t − j + ϕ pt + δ1∆ ln ytP + δ 2∆ ln ytT + λX k ,t −1 + φ∆( ρ k ,t −1∆iM t ) + + (α + α X k ,t −1 )iD k ,t −1 + (γ + γ * X k ,t −1 )iM t −1 + ξ ek ,t + ψσ t + Φ k ,t + ε k ,t * with k=1,…, N (k=number of banks) and t=1, …,T (t= periods). Data are quarterly (1993:03-2001:03) and not seasonally adjusted. The panel is balanced with N=73 banks. Lags have been selected in order to obtain white noise residuals. The description of the variables is reported in Table 1. The model have been estimated using the GMM estimator suggested by Arellano and Bond (1991) which ensures efficiency and consistency provided that the models are not subject to serial correlation of order two and that the instruments used are valid (which is tested for with the Sargan test). A bank with “low characteristic” has the average ratio of the banks below the first quartile, a bank with ""high characterisic” has the average ratio of the banks above third quartile. For more details on the data see Appendix 2. *=significance at the 10 per cent; **=significance at the 5 per cent; ***=significance at the 1 per cent. (1) Size Dependent variable: quarterly change of the interest rate on current accounts Coeff. (2) Liquidity S.Error Coeff. (3) Capitalization (5) Long term loans/ Total loans S.Error Coeff. S.Error (4) Dep./(Bonds+Dep.) S.Error Coeff. S.Error Coeff. Deposit demand Inflation: Permanent Income: Transitory Income: 0.049 *** 0.015 0.091 *** -0.058 *** 0.006 -0.048 *** -0.222 *** 0.012 -0.204 *** 0.012 0.058 *** 0.006 -0.058 *** 0.012 -0.223 *** 0.015 0.005 0.011 0.099 *** -0.024 * -0.102 *** 0.008 0.039 *** 0.013 -0.052 *** 0.012 -0.202 *** 0.009 0.004 0.010 Costs, credit risk and int.rate volatility Bank's efficiency: Interest rate volatility: 0.001 0.001 ** 0.001 0.001 0.001 0.002 *** 0.001 0.001 0.001 0.001 *** 0.002 0.001 0.012 *** 0.005 *** 0.001 0.000 0.002 * 0.002 *** 0.001 0.001 Immediate pass-through Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.413 *** 0.013 0.000 0.400 *** 0.015 0.429 *** 0.012 0.411 *** 0.010 0.000 0.010 0.010 0.410 *** 0.008 0.742 0.009 0.009 0.418 *** 0.009 0.000 0.009 0.010 0.388 *** 0.408 *** 0.366 *** 0.008 0.000 0.007 0.010 Pass-through after a quarter Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.546 *** 0.009 0.000 0.512 *** 0.010 0.588 *** 0.008 0.006 0.540 *** 0.000 0.006 0.536 *** 0.008 0.542 *** 0.006 0.776 0.006 0.008 Long run elasticity Average bank: Ho: unitary long run elasticity (p-val.) Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.685 *** 0.013 0.000 0.905 0.688 *** 0.014 0.682 *** 0.013 0.007 0.000 0.444 0.006 0.009 0.675 *** 0.661 *** 0.010 0.000 0.717 0.010 0.011 Loading of the long run relationship Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.016 0.000 0.017 0.017 Bank capital channel Miss-specification tests MA(1), MA(2) (p-value) Sargan test (p-value) No of banks, no of observations 0.431 *** 0.394 *** 0.541 *** 0.551 *** 0.530 *** 0.551 *** 0.535 *** 0.507 *** 0.526 *** 0.493 *** -0.572 *** 0.018 -0.646 *** 0.000 -0.537 *** 0.018 -0.657 *** -0.610 *** 0.023 -0.634 *** 0.018 -0.609 *** 0.016 0.020 -0.645 *** 0.017 -0.564 *** 0.020 0.000 0.019 0.025 -0.725 *** -0.795 *** 0.016 -0.572 *** 0.000 0.019 -0.610 *** 0.017 -0.533 *** -0.055 *** 0.015 -0.036 *** 0.012 -0.049 *** 0.009 -0.039 *** 0.013 -0.034 *** 0.009 0.000 0.976 0.960 2336 0.785 0.094 2336 0.000 0.340 0.092 2336 0.508 0.095 2336 73 0.000 73 0.676 *** 0.007 0.049 0.007 0.009 0.663 *** 0.694 *** 0.670 *** 0.699 *** 0.009 0.000 0.205 0.010 0.009 0.544 *** 0.451 *** 0.387 *** 0.009 0.000 0.463 0.009 0.011 0.953 0.091 2336 0.685 *** 0.008 0.000 0.008 0.008 0.411 *** 0.409 *** 0.000 73 0.643 *** 0.631 *** 0.654 *** -0.760 *** 73 0.669 *** 0.000 73 Table 5 BANK LENDING CHANNEL This table shows the results of the equation for the interest rate on short-term lending (panel A) and current accounts (panel B) when all bank-specific characteristics are taken simultaneously into account. The model is given by the following equation, which includes interaction terms that are the product of the monetary policy indicator and each bank-specific characteristic: ∆iψ k ,t = µ k + 2 5 1 5 å κ j ∆iψ k ,t − j + å å ( β j + β *j X k , m,t −1)∆iM t − j + ϕ pt + δ1∆ ln ytP + δ 2∆ ln ytT + å λm X k , m,t −1 + j =1 m =1 j = 0 + φ∆ ( ρ k ,t −1∆iM t ) + (α + m =1 5 å α m* X k ,m,t −1)(iψ k ,t −1 − γ iM t −1) + θ jk ,t + ξ ek ,t + ψσ t + Φ k ,t + ε k ,t m =1 with i ψ= quarterly change of the interest rate on short-term lending or current accounts k=1,…, N (k=number of banks) and t=1, …,T (t= periods). Bank-specific characteristics are size,liquidity, capitalization, Berlin-Mester and Berger-Udell indicators (m =5). Data are quarterly (1992:032001:03) and not seasonally adjusted. The panel is balanced with N=73 banks. Lags have been selected in order to obtain white noise residuals. The description of the variables is reported in Table 1. The model have been estimated using the GMM estimator suggested by Arellano and Bond (1991) which ensures efficiency and consistency provided that the models are not subject to serial correlation of order two and that the instruments used are valid (which is tested for with the Sargan test). A bank with “low characteristic” has the average ratio of the banks below the first quartile, a bank with ""high characterisic” has the average ratio of the banks above third quartile. For more details on the data see Appendix 2. *=significance at the 10 per cent; **=significance at the 5 per cent; ***=significance at the 1 per cent. (1) Size Coeff. (2) Liquidity S.Error Coeff. (3) Capitalization S.Error Coeff. (5) Long term loans/ Total loans S.Error Coeff. S.Error (4) Dep./(Bonds+Dep.) S.Error Coeff. (A) Dependent variable is the quarterly change of the interest rate on short-term lending Immediate pass-through Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.452 *** 0.062 0.159 0.492 *** 0.064 0.393 *** 0.080 Pass-through after a quarter Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.879 *** 0.039 0.639 0.895 *** 0.058 0.857 *** 0.040 0.891 *** 0.868 *** Long run elasticity All banks: 1.000 1.000 Loading of the long run relationship Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic -0.354 *** 0.050 -0.354 *** 0.681 -0.377 *** 0.072 -0.354 *** -0.324 *** 0.092 -0.354 *** Miss-specification tests MA(1), MA(2) (p-value) Sargan test (p-value) No of banks, no of observations - 0.000 - 0.452 *** 0.476 *** 0.421 *** 0.879 *** - 0.062 0.027 0.058 0.069 0.039 0.317 0.036 0.033 - 0.452 *** 0.558 *** 0.308 *** 0.879 *** 0.914 *** 0.847 *** 1.000 - 0.050 -0.354 *** 0.990 0.063 -0.318 *** 0.046 -0.399 *** 0.062 0.043 0.065 0.110 0.039 0.744 0.082 0.075 0.050 0.536 0.070 0.095 0.452 *** 0.519 *** 0.375 *** 0.062 0.016 0.050 0.084 0.883 *** 0.876 *** 0.039 0.879 *** 0.913 0.050 0.888 *** 0.047 0.873 *** 0.039 0.912 0.039 0.053 1.000 - 0.460 *** 0.437 *** 0.879 *** - -0.354 *** -0.332 *** -0.375 *** 0.062 0.702 0.059 0.077 0.452 *** 1.000 - 0.050 -0.354 *** 0.761 0.089 -0.332 *** 0.085 -0.376 *** 0.050 0.773 0.086 0.095 0.073 0.985 2336 73 (B) Dependent variable is the quarterly change of the interest rate on current accounts Immediate pass-through Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.452 *** 0.042 0.972 0.453 *** 0.043 0.452 *** 0.050 Pass-through after a quarter Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.545 *** 0.033 0.160 0.572 *** 0.032 0.524 *** 0.043 0.546 *** 0.545 *** Long run elasticity Average bank: 0.700 0.700 Loading of the long run relationship Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic -0.570 *** 0.043 -0.570 *** 0.388 -0.537 *** 0.048 -0.565 *** -0.612 *** 0.074 -0.575 *** Miss-specification tests MA(1), MA(2) (p-value) Sargan test (p-value) No of banks, no of observations 0.000 73 - - 0.915 0.180 2336 0.452 *** 0.470 *** 0.434 *** 0.545 *** - 0.042 0.129 0.050 0.037 0.033 0.978 0.038 0.033 - 0.452 *** 0.479 *** 0.419 *** 0.545 *** 0.566 *** 0.517 *** 0.700 - 0.043 -0.570 *** 0.820 0.050 -0.607 *** 0.047 -0.523 *** 0.042 0.529 0.054 0.074 0.033 0.481 0.055 0.045 0.043 0.481 0.019 0.025 0.452 *** 0.497 *** 0.406 *** 0.042 0.112 0.062 0.062 0.590 *** 0.516 *** 0.033 0.545 *** 0.203 0.045 0.563 *** 0.039 0.525 *** 0.033 0.224 0.041 0.034 0.700 - 0.509 *** 0.400 *** 0.545 *** - -0.570 *** -0.452 *** -0.680 *** 0.042 0.032 0.044 0.054 0.452 *** 0.700 - 0.043 -0.570 *** 0.004 0.062 -0.589 *** 0.054 -0.550 *** 0.043 0.575 0.059 0.051 Fig. 1 Banking interest rates (quarterly data, percentage points) 19.0 3-month interbank rate Repo rate 17.0 Interest rate on current accounts Estimation period 1993:03-2001:03 Short term lending rate 15.0 13.0 Euro 11.0 9.0 7.0 5.0 Period before T.U.B. 1987:01-1993:02 3.0 1.0 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 Fig. 2 Cross sectional and time series dispersion of interest rates 0.350 (a) Interest rate on short-term loans 0.300 0.250 0.200 0.150 0.100 0.050 0.000 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 1998 1999 2000 2001 0.350 (b) Interest rate on current accounts 0.300 0.250 0.200 0.150 0.100 0.050 0.000 1987 1988 1989 ACROSS BANKS 1990 1991 1992 OVER TIME 1993 1994 1995 1996 1997 Fig. 3 Determinants of bank’s interest rates i L = f ( y P , y T , p, i M , + ? + + X t −1 , i M X t −1 , ρ t −1 ∆i M , j , costs , σ , µ k ) ? + + + ? + Loan demand Interest rate channel Bank lending channel Cost of intermediation, credit risk and interest rate volatility Bank capital channel Deposit demand i D = f ( y P , y T , p, i M , − − − + Industry structure X t −1 , i M X t −1 , ρ t −1 ∆i M , costs , σ , µ k ) ? − − ? + Note: the meaning of all the symbols is reported in Table 1. Fig. A1 Search for mean shift breaks (monthly data, sequential minimum unit root tests) 0 Dec-87 Dec-88 Dec-89 Dec-90 Dec-91 Dec-92 Dec-93 Dec-94 Dec-95 Dec-96 Dec-97 Dec-98 Dec-99 -1 -2 -3 -4 -5 -6 -7 Interest rate on current accounts -8 Interest rate on short-term loans 3-month interbank market rate -9 10% critical value 2.5% critical value -10 Note: The estimated model tests for a shift in the constant. No trend is included. Sequential statistic are computed using the sample 1984:7-2002:12, sequentially incrementing the date of the hypothetical shift. A fraction equal to 15 per cent of the total sample at the beginning and at the end of the sample is not considered for the test. For more details see Banerjee, Lumsdaine and Stock (1992).","Give an answer using only the context provided. How are interest rates set? NBER WORKING PAPER SERIES HOW DO BANKS SET INTEREST RATES? Leonardo Gambacorta Working Paper 10295 http://www.nber.org/papers/w10295 NATIONAL BUREAU OF ECONOMIC RESEARCH 1050 Massachusetts Avenue Cambridge, MA 02138 February 2004 This research was done during a period as a visiting scholar at the NBER. The views expressed herein are those of the author and not necessarily those of the Banca d’Italia or the National Bureau of Economic Research. ©2004 by Leonardo Gambacorta. All rights reserved. Short sections of text, not to exceed two paragraphs, may be quoted without explicit permission provided that full credit, including © notice, is given to the source. How Do Banks Set Interest Rates? Leonardo Gambacorta NBER Working Paper No. 10295 February 2004 JEL No. E44, E51, E52 ABSTRACT The aim of this paper is to study cross-sectional differences in banks interest rates. It adds to the existing literature in two ways. First, it analyzes in a systematic way both micro and macroeconomic factors that influence the price setting behavior of banks. Second, by using banks’ prices (rather than quantities) it provides an alternative way to disentangle loan supply from loan demand shift in the “bank lending channel” literature. The results, derived from a sample of Italian banks, suggest that heterogeneity in the banking rates pass-through exists only in the short run. Consistently with the literature for Italy, interest rates on short-term lending of liquid and well-capitalized banks react less to a monetary policy shock. Also banks with a high proportion of long-term lending tend to change their prices less. Heterogeneity in the pass-through on the interest rate on current accounts depends mainly on banks’ liability structure. Bank’s size is never relevant. Leonardo Gambacorta Banca d’Italia Research Department Via Nazionale, 91 00184 Rome, Italy gambacorta.leonardo@insedia.interbusiness.it 1. Introduction1 This paper studies cross-sectional differences in the price setting behavior of Italian banks in the last decade. The main motivations of the study are two. First, heterogeneity in the response of bank interest rates to market rates helps in understanding how monetary policy decisions are transmitted through the economy independently of the consequences on bank lending. The analysis of heterogeneous behavior in banks interest setting has been largely neglected by the existing literature. The vast majority of the studies on the “bank lending channel” analyze the response of credit aggregates to a monetary policy impulse, while no attention is paid on the effects on prices. This seems odd because, in practice, when banks interest rates change, real effects on consumption and investment could be produced also if there are no changes in total lending. The scarce evidence on the effects of monetary shocks on banks prices, mainly due to the lack of available long series of micro data on interest rates, contrasts also with some recent works that highlight a different adjustment of retail rates in the euro area (see, amongst others, de Bondt, Mojon and Valla, 2003). Second, this paper wants to add to the “bank lending channel” literature by identifying loan supply shocks via banks’ prices (rather than quantities). So far to solve the “identification problem” it has been claimed that certain bank-specific characteristics (i.e. size, liquidity, capitalization) influence only loan supply movements while banks’ loan demand is independent of them. After a monetary tightening, the drop in the supply of credit should be more important for small banks, which are financed almost exclusively with deposits and equity (Kashyap and Stein, 1995), less liquid banks, that cannot protect their loan portfolio against monetary tightening simply by drawing down cash and securities (Stein, 1998; Kashyap and Stein, 2000) and poorly capitalized banks, that have less access to markets for uninsured funding (Peek and Rosengren, 1995; Kishan and Opiela, 2000; van den Heuvel, 2001a; 2001b).2 The intuition of an identification via prices of loan supply shift is very simple: if loan demand is not perfectly elastic, also the effect of a monetary 1 This study was developed while the author was a visiting scholar at the NBER. The opinions expressed in this paper are those of the author only and in no way involve the responsibility of the Bank of Italy and the NBER. 2 All these studies on cross-sectional differences in the effectiveness of the “bank lending channel” refer to the US. The literature on European countries is instead far from conclusive (see Altunbas et al., 2002; Ehrmann et al., 2003). For the Italian case see Gambacorta (2003) and Gambacorta and Mistrulli (2003). 3 tightening on banks’ interest rate should be more pronounced for small, low-liquid and lowcapitalized banks . Apart from these standard indicators other bank-specific characteristics could influence banks’ price-setting behavior (Weth, 2002). Berlin and Mester (1999) claim that banks which heavily depend upon non-insured funding (i.e. bonds) will adjust their deposit rates more (and more quickly) than banks whose liabilities are less affected by market movements. Berger and Udell (1992) sustain that banks that maintain a close tie with their customers will change their lending rates comparatively less and slowly. In this paper the search for heterogeneity in banks’ behavior is carried out by using a balanced panel of 73 Italian banks that represent more than 70 per cent of the banking system. Heterogeneity is investigated with respect to the interest rate on short-term lending and that on current accounts. The use of microeconomic data is particularly appropriate in this context because aggregation may significantly bias the estimation of dynamic economic relations (Harvey, 1981). Moreover, information at the level of individual banks provides a more precise understanding of their behavioral patterns and should be less prone to structural changes like the formation of EMU. The main conclusions of this paper are two. First, heterogeneity in the banking rates pass-through exists, but it is detected only in the short run: no differences exist in the longrun elasticities of banking rates to money market rates. Second, consistently with the existing literature for Italy, interest rates on short-term lending of liquid and well-capitalized banks react less to a monetary policy shock. Also banks with a high proportion of long-term lending tend to change less their prices. Heterogeneity in the pass-through on the interest rate on current accounts depends mainly on banks’ liability structure. Bank’s size is never relevant. The paper is organized as follows. Section 2 describes some institutional characteristics that help to explain the behavior of banking rates in Italy in the last two decades. Section 3 reviews the main channels that influence banks’ interest rate settings trying to disentangle macro from microeconomic factors. After a description of the econometric model and the data in Section 4, Section 5 shows the empirical results. Robustness checks are presented in Section 6. The last section summarizes the main conclusions. 4 2. Some facts on bank interest rates in Italy Before discussing the main channels that influence banks’ price setting, it is important to analyze the institutional characteristics that have influenced Italian bank interest rates in the last two decades. The scope of this section is therefore to highlight some facts that could help in understanding differences, if any, with the results drawn by the existing literature for the eighties and mid-nineties. For example, there is evidence that in the eighties Italian banks were comparatively slow in adjusting their rates (Verga, 1984; Banca d’Italia, 1986, 1988; Cottarelli and Kourelis, 1994) but important measures of liberalization of the markets and deregulation over the last two decades should have influenced the speed at which changes in the money market conditions are transmitted to lending and deposit rates (Cottarelli et al. 1995; Passacantando, 1996; Ciocca, 2000; Angelini and Cetorelli, 2002). In fact, between the mid-1980s and the early 1990s all restrictions that characterized the Italian banking system in the eighties were gradually removed. In particular: 1) the lending ceiling was definitely abolished in 1985; 2) foreign exchange controls were lifted between 1987 and 1990; 3) branching was liberalized in 1990; 4) the 1993 Banking Law allowed banks and special credit institutions to perform all banking activities. In particular, the 1993 Banking Law (Testo Unico Bancario, hereafter TUB) completed the enactment of the institutional, operational and maturity despecialization of the Italian banking system and ensured the consistency of supervisory controls and intermediaries’ range of operations within the single market framework. The business restriction imposed by the 1936 Banking Law, which distinguished between banks that could raise short-term funds (“aziende di credito”) and those that could not (“Istituti di credito speciale”), was eliminated.3 To avoid criticism of structural breaks, the econometric analysis of this study will be based on the period 1993:03-2001:03, where all the main reforms of the Italian banking system had already taken place. 3 For more details see Banca d’Italia, Annual Report for 1993. 5 The behavior of bank interest rates in Italy reveals some stylized facts (see Figures 1 and 2). First, a remarkable fall in the average rates since the end of 1992. Second a strong and persistent dispersion of rates among banks. These stylized facts suggest that both the time series and the cross sections dimensions are important elements in understanding the behavior of bank interest setting. This justifies the use of panel data techniques. The main reason behind the fall in banking interest rates is probably the successful monetary policy aiming at reducing the inflation rate in the country to reach the Maastricht criteria and the third stage of EMU. As a result, the interbank rate decreased by more than 10 percentage points in the period 1993-1999. Excluding the 1995 episode of the EMS crisis, it is only since the third quarter of 1999 that it started to move upwards until the end of 2000 when it continued a declining trend. From a statistical point of view, this behavior calls for the investigation of a possible structural break in the nineties.4 The second stylized fact is cross-sectional dispersion among interest rates. Figure 2 shows the coefficient of variation for loan and deposit rates both over time and across banks in the period 1987-2001.5 The temporal variation (dotted line) of the two rates show a different behavior from the mid of the nineties when the deposit rate is more variable, probably for a catching-up process of the rate toward a new equilibrium caused by the convergence process. Also the cross-sectional dispersion of the deposit rate is greater than that of the loan rate, especially after the introduction of euro.6 4 In the period 1995-98, that coincides with the convergence process towards stage three of EMU, it will be necessary to allow for a change in the statistical properties of interest rates (see Appendix 2). 5 The coefficient of variation is given by the ratio of the standard errors to the mean. The series that refer to the variability “over time” shows the coefficient of variation in each year of monthly figures. In contrast, the series that capture the variability “across banks” shows the coefficient of variation of annual averages of bankspecific interest rates. 6 In the period before the 1993 Banking Law deposit interest rates were quite sticky to monetary policy changes. Deposit interest rate rigidity in this period has been extensively analyzed also for the US. Among the market factors that have been found to affect the responsiveness of bank deposit rates are the direction of the change in market rates (Ausubel, 1992; Hannan and Berger, 1991), if the bank interest rate is above or below a target rate (Hutchison, 1995; Moore, Porter and Small, 1990; Neumark and Sharpe, 1992) and market concentration in the bank’s deposit market (Hannan and Berger, 1991). Rosen (2001) develops a model of price settings in presence of heterogeneous customers explaining why bank deposits interest rates respond sluggishly to some extended movements in monetary market rates but not to others. Hutchinson (1995) presents a model of bank deposit rates that includes a demand function for customers and predicts a linear (but less than one for one) relationship between market interest rate changes and bank interest rate changes. Green (1998) claims that the rigidity is due to the fact that bank interest rate management is based on a two-tier pricing system; banks offer accounts at market related interest rates and at posted rates that are changed at discrete intervals. 6 3. What does influence banks’ interest rate setting? The literature that studies banks’ interest rate setting behavior generally assumes that banks operate under oligopolistic market conditions.7 This means that a bank does not act as a price-taker but sets its loan rates taking into account the demand for loans and deposits. This section reviews the main channels that influence banks interest rates (see Figure 3). A simple analytical framework is developed in Appendix 1. Loan and deposit demand The interest rate on loans depends positively on real GDP and inflation (y and p). Better economic conditions improve the number of projects becoming profitable in terms of expected net present value and, therefore, increase credit demand (Kashyap, Stein and Wilcox, 1993). As stressed by Melitz and Pardue (1973) only increases in permanent income (yP) have a positive influence on loan demand, while the effect due to the transitory part (yT) could also be associated with a self-financing effect that reduces the proportion of bank debt (Friedman and Kuttner, 1993).8 An increase in the money market rate (iM) raises the opportunity cost of other forms of financing (i.e. bonds), making lending more attractive. This mechanism also boosts loan demand and increases the interest rate on loans. The interest rate on deposits is negatively influenced by real GDP and inflation. A higher level of income increases the demand for deposits9 and reduces therefore the incentive for banks to set higher deposit rates. In this case the shift of deposit demand should be higher if the transitory component of GDP is affected (unexpected income is generally first deposited on current accounts). On the contrary, an increase in the money market rate, ceteris paribus, makes more attractive to invest in risk-free securities that represent an alternative to detain deposits; the subsequent reduction in deposits demand determines an upward pressure on the interest rate on deposits. 7 For a survey on modeling the banking firm see Santomero (1984). Among more recent works see Green (1998) and Lim (2000). 8 Taking this into account, in Section 4 I tried to disentangle the two effects using a Beveridge and Nelson (1981) decomposition. 9 The aim of this paper is not to answer to the question if deposits are input or output for the bank (see Freixas and Rochet, 1997 on this debate). For simplicity here deposits are considered a service supplied by the bank to depositors and are therefore considered an output (Hancock, 1991). 7 Operating cost, credit risk and interest rate volatility The costs of intermediation (screening, monitoring, branching costs, etc.) have a positive effect on the interest rate on loans and a negative effect on that of deposits (efficiency is represented by e). The interest rate on lending also depends on the riskiness of the credit portfolio; banks that invest in riskier project will have a higher rate of return in order to compensate the higher percentage of bad loans that have to be written off (j). Banking interest rates are also influenced by interest rate volatility. A high volatility in the money market rate (σ) should increase lending and deposit rates. Following the dealership model by Ho and Saunders (1981) and its extension by Angbazo (1997) the interest rate on loans should be more affected by interbank interest rate volatility with respect to that on deposits (diL/dσ>diD/dσ). This should reveal a positive correlation between interest rate volatility and the spread. Interest rate channel Banking interest rates are also influenced by monetary policy changes. A monetary tightening (easing) determines a reduction (increase) of reservable deposits and an increase (reduction) of market interest rates. This has a “direct” and positive effect on bank interest rates through the traditional “interest rate channel”. Nevertheless, the increase in the cost of financing could have a different impact on banks depending on their specific characteristics. There are two channels through which heterogeneity among banks may cause a different impact on lending and deposit rates: the “bank lending channel” and the “bank capital channel”. Both mechanisms are based on adverse selection problems that affect banks fundraising but from different perspectives. Bank lending channel According to the “bank lending channel” thesis, a monetary tightening has effect on bank loans because the drop in reservable deposits cannot be completely offset by issuing other forms of funding (i.e. uninsured CDs or bonds; for an opposite view see Romer and Romer, 1990) or liquidating some assets. Kashyap and Stein (1995, 2000), Stein (1998) and Kishan and Opiela (2000) claim that the market for bank debt is imperfect. Since nonreservable liabilities are not insured and there is an asymmetric information problem about 8 the value of banks’ assets, a “lemon’s premium” is paid to investors. According to these authors, small, low-liquid and low-capitalized banks pay a higher premium because the market perceives them more risky. Since these banks are more exposed to asymmetric information problems they have less capacity to shield their credit relationships in case of a monetary tightening and they should cut their supplied loans and raise their interest rate by more. Moreover, these banks have less capacity to issue bonds and CDs and therefore they could try to contain the drain of deposits by raising their rate by more. In Figure 3 three effects are highlighted: the “average” effect due to the increase of the money market rate (which is difficult to disentangle from the “interest rate channel”), the “direct” heterogeneous effect due to bank-specific characteristics (Xt-1) and the “interaction effect” between monetary policy and the bank-specific characteristic (iM Xt-1). These last two effects can genuinely be attributed to the “bank lending channel” because bank-specific characteristics influence only loan supply movements. Two aspects deserve to be stressed. First, to avoid endogeneity problems bank-specific characteristics should refer to the period before banks set their interest rates. Second, heterogeneous effects, if any, should be detected only in the short run while there is no a priori that these effects should influence the long run relationship between interest rates. Apart from the standard indicators of size (logarithm of total assets), liquidity (cash and securities over total assets) and capitalization (excess capital over total assets),10 two other bank-specific characteristics deserve to be investigated: a) the ratio between deposits and bonds plus deposits; b) the ratio between long-term loans and total loans. The first indicator is in line with Berlin and Mester (1999): banks that heavily depend upon non-deposit funding (i.e. bonds) will adjust their deposits rates by more (and more quickly) than banks whose liabilities are less affected by market movements. The intuition of this result is that, other things being equal, it is more likely that a bank will adjust her terms 10 It is important to note that the effect of bank capital on the “bank lending channel” cannot be easily captured by the capital-to-asset ratio. This measure, generally used by the existing literature to analyze the distributional effects of bank capitalization on lending, does not take into account the riskiness of a bank portfolio. A relevant measure is instead the excess capital that is the amount of capital that banks hold in excess of the minimum required to meet prudential regulation standards. Since minimum capital requirements are determined by the quality of bank’s balance sheet activities, the excess capital represents a risk-adjusted measure of bank capitalization that gives more indications on the probability of a bank default. Moreover, the excess capital is a relevant measure of the availability of the bank to expand credit because it directly controls for prudential regulation constraints. For more details see Gambacorta and Mistrulli (2004). 9 for passive deposits if the conditions of her own alternative form of refinancing change. Therefore an important indicator to analyze the pass-through between market and banking rates is the ratio between deposits and bonds plus deposits. Banks which use relatively more bonds than deposits for financing purpose fell more under pressure because their cost increase contemporaneously and to similar extent as market rates. The Berger and Udell (1992) indicator represents a proxy for long-term business; those credit institutions that maintain close ties with their non-bank customers will adjust their lending rates comparatively less and slowly. Banks may offer implicit interest rate insurance to risk-averse borrowers in the form of below-market rates during periods of high market rates, for which the banks are later compensated when market rates are low. Having this in mind, banks that have a higher proportion of long-term loans should be more inclined to split the risk of monetary policy change with their customers and preserve credit relationships. For example, Weth (2002) finds that in Germany those banks with large volumes of longterm business with households and firms change their prices less frequently than the others. Bank capital channel The “bank capital channel” is based on three hypotheses. First, there is an imperfect market for bank equity: banks cannot easily issue new equity for the presence of agency costs and tax disadvantages (Myers and Majluf, 1984; Cornett and Tehranian, 1994; Calomiris and Hubbard, 1995; Stein, 1998). Second, banks are subject to interest rate risk because their assets have typically a higher maturity with respect to liabilities (maturity transformation). Third, regulatory capital requirements limit the supply of credit (Thakor, 1996; Bolton and Freixas, 2001; Van den Heuvel, 2001a; 2001b). The mechanism is the following. After an increase of market interest rates, a lower fraction of loans can be renegotiated with respect to deposits (loans are mainly long term, while deposits are typically short term): banks suffer therefore a cost due to the maturity mismatch that reduces profits and then capital accumulation.11 If equity is sufficiently low and it is too costly to issue new shares, banks reduce lending (otherwise they fail to meet 11 In Figure 3, the cost per unit of asset due to the maturity transformation at time t-1 ( ρit −1 ) is multiplied by the actual change in the money market rate ( ∆iM ). For more details see Appendix 1. 10 regulatory capital requirements) and amplify their interest rate spread. This determines therefore an increase in the interest rates on loans and a decrease in that on deposits:12 in the oligopolistic version of the Monti-Klein model, the maturity transformation cost has the same effect of an increase in operating costs. Industry structure The literature underlines two possible impacts of concentration on pricing behavior of banks (Berger and Hannan, 1989). A first class of models claims that more concentrated banking industry will behave oligopolistically (structure-performance hypothesis), while another class of models stresses that concentration is due to more efficient banks taking over less efficient counterparts (efficient-structure hypothesis). This means that in the first case lower competition should result in higher spreads, while in the second case a decrease in managerial costs due to increased efficiency should have a negative impact on the spread. In the empirical part great care will be given therefore to the treatment of bank mergers (see Appendix 2). Nevertheless, the scope of this paper is not to extract policy implications about this issue, for which a different analysis is needed. The introduction of bank-specific dummy variables (µi) tries to control for this and other missing aspects.13 4. Empirical specification and data The equations described in Figure 3 and derived analytically in Appendix 1 are expressed in levels. Nevertheless, since interest rates are likely to be non-stationary variables, an error correction model has been used to capture bank’s interest rate setting.14 Economic theory on oligopolistic (and perfect) competition suggests that, in the long run, both banking rates (on lending and deposits) should be related to the level of the monetary 12 The “bank capital channel” can also be at work even if capital requirement is not currently binding. Van den Heuvel (2001a) shows that low-capitalized banks may optimally forgo lending opportunities now in order to lower the risk of capital inadequacy in the future. This is interesting because in reality, most banks are not constrained at any given time. 13 In Section 6 this hypothesis will be tested introducing a specific measure of the degree of competition that each banks faces. For a more detailed explanation on the effect of concentration on the pricing behavior of Italian banks see Focarelli and Panetta (2003). 14 This is indeed the standard approach used for interest rate equations (Cottarelli et al. 1995; Lim, 2000; Weth 2002). From a statistical point of view, the error correction representation is adopted because the lending rate and the deposit rate result to be cointegrated with the money market rate. 11 rate, that reflects the marginal yield of a risk-free investment (Klein, 1971). We have: 2 (1) 1 ∆i L k ,t = µ k + å κ j ∆i L k ,t − j + å ( β j + β *j X k ,t −1 ) ∆i M t − j + ϕ p t + δ 1 ∆ ln y tP + δ 2 ∆ ln y tT + λX k ,t −1 + j =1 j =0 φ∆ ( ρ k ,t −1 ∆i M t ) + (α + α X k ,t −1 )i L k ,t −1 + (γ + γ * X k ,t −1 )i M t −1 + θ j k ,t + ξ e k ,t + ψσ t + Φ k ,t + ε k ,t * 1 2 (2) ∆i D k ,t = µ k + å κ j ∆i D k ,t − j + å ( β j + β *j X k ,t −1 )∆i M t − j + ϕ p t + δ 1 ∆ ln y tP + δ 2 ∆ ln y tT + λX k ,t −1 + j =1 j =0 φ∆ ( ρ k ,t −1 ∆i M t ) + (α + α X k ,t −1 )i D k ,t −1 + (γ + γ * X k ,t −1 )i M t −1 + ξ e k ,t + ψσ t + Φ k ,t + ε k ,t * with k=1,…, N (k=number of banks) and t=1, …,T (t= periods). Data are quarterly (1993:032001:03) and not seasonally adjusted. The panel is balanced with N=73 banks. Lags have been selected in order to obtain white noise residuals. The description of the variables is reported in Table 1.15 The model allows for fixed effects across banks, as indicated by the bank-specific intercept µi. The long-run elasticity between each banking rate and the money market rate is given by: (γ + γ * X k ,t −1 ) /(α + α * X k ,t −1 ) . Therefore to test if the pass-through between the money market rate and the banking rate is complete it is necessary to verify that this elasticity is equal to one. If this is the case there is a one-to-one long-run relationship between the lending (deposit) rate and the money market rate, while the individual effect µi influences the bank-specific mark-up (mark-down). The loading coefficient (α + α * X k ,t −1 ) must be significantly negative if the assumption of an equilibrium relationship is correct. In fact, it represents how many percent of an exogenous variation from the steady state between the rates is brought back towards the equilibrium in the next period.16 The degree of banks’ interest rate stickiness in the short run can be analyzed by the impact multiplier ( β 0 + β 0* X k ,t −1 ) and the total effect after three months.17 15 For more details on data sources, variable definitions, merger treatment and trimming of the sample see Appendix 2. 16 Testing for heterogeneity in the loading coefficient means to verify if α * is significant or not. At the same time heterogeneity in the long-run elasticity can be proved if α *γ − αγ * is statistically different from zero. 17 In the first case heterogeneity among banks is simply tested through the significance of β 0 while in the * second case, since the effect is given by a convolution of the structural parameters it is possible to accept the 12 The variable Xk,t-1 represents a bank-specific characteristic that economic theory suggests to influence only loan and deposit supply movements, without affecting loan and deposit demands. In particular, all bank-specific indicators ( χ k ,t ) have been re-parameterized in the following way: N æ ö ç T å χ k ,t ÷ ÷ /T X k ,t = χ k ,t − ç å k =1 ç t =1 N ÷ ç ÷ è ø Each indicator is therefore normalized with respect to the average across all the banks in the respective sample, in order to obtain a variable whose sum over all observations is zero.18 This has two implications. First, the interaction terms between interest rates and X k , t −1 in equations (1) and (2) are zero for the average bank (this because X k ,t −1 =0). Second, the coefficients β0, β1, α and γ are directly interpretable as average effects. To test for the existence of a “bank capital channel” we have introduced the variable ρ k , t −1∆iM that represents the bank-specific cost of monetary policy due to maturity transformation. In particular ρ k , t −1 measures the loss per unit of asset a bank suffers when the monetary policy interest rate is raised of one percent. The cost at time t is influenced by the maturity transformation in t-1. This variable is computed according to supervisory regulation relative to interest rate risk exposure that depends on the maturity mismatch among assets and liabilities (see Appendix 2 for further details). To work out the real cost we have therefore multiplied ρ k , t −1 for the realized change in interest rates. Therefore ρ k , t −1∆iM represents the cost (gain) that a bank suffers (obtain) in each quarter. As formalized in Appendix 1, this measure influences the level of bank interest rates. Since the model is expressed in error correction form we have included this variable in first difference as well. null hypothesis of absence of heterogeneity if and only if éë β 0α * + β 0* (1 + α + κ 1 ) + β1* + γ * ùû X k ,t −1 + α * β 0* X k2,t −1 is equal to zero. The significance of this expression has been checked using the delta method (Rao, 1973). 18 The size indicator has been normalized with respect to the mean on each single period. This procedure removes trends in size (for more details see Ehrmann et al., 2003). 13 4.1 Characteristics of the dataset The dataset includes 73 banks that represent more than 70 per cent of total Italian banking system in term of loans over the whole sample period. Since information on interest rates is not available for Mutual banks, the sample is biased towards large banks. Foreign banks and special credit institution are also excluded. This bias toward large banks has two consequences. First, the distributional effects of the size variable would be treated with extreme cautious because a “small” bank inside this sample could not be considered with the same characteristic using the full population of Italian banks.19 The size grouping in this study mainly controls for variations in scale, technology and scope efficiencies across banks but it is not able to shed light on differences between Mutual and other banks. Second, results for the average bank will provide more “macroeconomic insights” than studies on the whole population (where the average bank dimension is very small). Table 2 gives some basic information on the dataset. Rows are organized dividing the sample with respect to the bank-specific characteristics that are potential candidates to cause heterogeneous shifts in loan supply in case of a monetary policy shock. On the columns, the table reports summary statistics for the two interest rates and for each indicator. Several clear patterns emerge. Considering size, small banks charge higher interest rates on lending but show a lower time variation. This fits with the standard idea of a close customer relationships between small firms and small banks that provides them with an incentive to smooth the effect of a monetary tightening (Angelini, Di Salvo and Ferri, 1998). Moreover, small banks are more liquid and capitalized than average and this should help them to reduce the effect of cyclical variation on supplied credit. On the liability side, the percentage of deposits (overnight deposits, CDs and savings accounts) is greater among small banks, while their bonds issues are more limited than the ones of large banks. Nevertheless, there are no significant differences that emerge in the level and volatility of the interest rate on current accounts. 19 In particular, banks that are considered “small” in this study are labeled as “medium” in other studies for the Italian banking system that analyze quantities (see for example, Gambacorta, 2003; Gambacorta and Mistrulli, 2004). This is clear noting that the average assets of a “small” bank in my data (1.6 billions of euros) over the sample period is very similar to that of the “medium” bank of the total system (1.7 billions of euros). 14 High-liquid banks are smaller than average and are more capitalized. These characteristics should reduce the speed of the “bank lending channel” transmission through interest rates. In particular, since deposits represent a high share of their funding they should have a smoother transmission on passive rates. Well-capitalized banks make relatively more short-term loans. They are in general not listed and issue less subordinated debt to meet the capital requirement. This evidence is consistent with the view that, ceteris paribus, capitalization is higher for those banks that bear more adjustment costs from issuing new (regulatory) capital. Well-capitalized banks charge a higher interest rate on lending; this probably depend upon their higher ratios of bad loans that increase their credit risk. In other words their higher capitalization is necessary to face a riskier portfolio. Moreover, the interest rate on deposit is lower for low-capitalized banks indicating that agents do not perceive these deposits as riskier than those at other banks. This has two main explanations. First, the impact of bank failures has been very small in Italy, especially with respect to deposits.20 Second, the presence of deposit insurance that insulates deposits of less capitalized banks from the risk of default.21 The Berlin-Mester and the Berger-Udell indicators seem to have a high power in explaining heterogeneity in banks’ price setting behavior. Differences in the standard deviations of the two groups are particularly sensitive, calling for a lower interest rates variability of banks with a high percentage of deposits and long-term loans. 20 During our sample period, the share of deposits of failed banks to total deposits approached 1 per cent only twice, namely in 1987 and 1996 (Boccuzzi, 1998). 21 Two explicit limited-coverage deposit insurance schemes (DISs) currently operate in Italy. Both are funded ex-post; that is, member banks have a commitment to make available to the Funds the necessary resources should a bank default. All the banks operating in the country, with the exception of mutual banks, adhere to the main DIS, the ‘Fondo Interbancario di Tutela dei Depositi’ (FITD). Mutual banks (‘Banche di Credito Cooperativo’) adhere to a special Fund (‘Fondo di Garanzia dei Depositanti del Credito Cooperativo’) created for banks belonging to their category. The ‘Fondo Interbancario di Tutela dei Depositi’ (FITD), the main DIS, is a private consortium of banks created in 1987 on a voluntary basis. In 1996, as a consequence of the implementation of European Union Directive 94/19 on deposit guarantee schemes, the Italian Banking Law regulating the DIS was amended, and FITD became a compulsory DIS. FITD performs its tasks under the supervision of and in cooperation with the banking supervision authority, Banca d’Italia. The level of protection granted to each depositor (slightly more than 103,000 euros) is one of the highest in the European Union. FITD does not adopt any form of deposit coinsurance. 15 5. Results The main channels that influence the interest rate on short term lending and that on current accounts are summarized, respectively, in Tables 3 and 4. The first part of each table, show the influence of the permanent and transitory component of real GDP and inflation. These macro variables capture cyclical movements and serves to isolate shifts in loan and deposit demand from monetary policy changes. The second part of the tables presents the effects of bank’s efficiency, credit risk and interest rate volatility. The third part highlights the effects of monetary policy. These are divided into four components: i) the immediate pass-through; ii) the one-quarter pass-through; iii) the long-run elasticity between each banking rate and the monetary policy indicator; iv) the loading coefficient of the cointegrating relationship.22 The last part of the tables shows the significance of the “bank capital channel”. Each table is divided in five columns that highlight, one at the time, heterogeneous behavior of banks with different characteristics in the response to a monetary shock. The existence of distributional effects is tested for all the four components of the monetary policy pass-through. The models have been estimated using the GMM estimator suggested by Arellano and Bond (1991) which ensures efficiency and consistency provided that the models are not subject to serial correlation of order two and that the instruments used are valid (which is tested for with the Sargan test).23 22 The immediate pass-trough is given by the coefficient β 0 + β 0* X k ,t −1 and heterogeneity among banks is simply tested through the significance of β 0* . The effect for a bank with a low value of the characteristic under 0.25 evaluation is worked out through the expression β 0 + β 0* X k0.25 , t −1 , where X k , t −1 is the average for the banks below the first quartile. Vice versa the effect for a bank with a high value of the characteristic is calculated using X k0.75 , t −1 . The total effect after three months for the average bank is given by β 0 (1 + α1 + κ 1 ) + β1 + γ ' while heterogeneity among banks can be accepted if and only if the expression éë β 0α * + β 0* (1 + α + κ 1 ) + β1* + γ * ùû X k ,t −1 + α * β 0* X k2,t −1 is equal to zero. The long run elasticity is given by: (γ + γ * X k ) /(α + α * X k ) , while the loading coefficient is α1 + α1* X k ,t −1 . Standard errors have been approximated with the “delta method” (Rao, 1973). 23 In the GMM estimation, instruments are the second lag of the dependent variable and of the bank-specific characteristics included in each equation. Inflation, GDP growth rate and the monetary policy indicator are considered as exogenous variables. 16 Loan and deposit demand As predicted by theory only changes in permanent income have a positive and significant effect on the interest rate on short term lending while the transitory component is never significant. In fact, as discussed in Section 3, the effect of transitory changes may be also due to a self-financing effect that reduces the proportion of bank debt. On the contrary the interest rate on deposits is negatively influenced by real GDP. In this case the effect is higher when a change in the transitory component occurs because it is directly channeled through current accounts. The effect of inflation is positive on both interest rates but is significantly higher for short-term lending. Operating costs, credit risk and interest rate volatility Bank’s efficiency reduces the interest rate on loans and increase that of deposits. Nevertheless, the effect is not always significant at conventional levels, especially in the equation for the interest rate on current accounts. These results call for further robustness checks using a cost-to-asset ratio (see Section 6). The relative amount of bad loans has a positive and significant effect on the interest rate on loans. This is in line with the standard result that banks that invest in riskier project ask for a higher rate of return to compensate credit risk. Both banking rates are positively correlated with money market rate volatility. The correlation is higher for the interest rate on loans with respect to that of deposits. This is consistent with the prediction of the dealership model by Ho and Saunders (1981) and its extension by Angbazo (1997) where an increase in interbank interest rate volatility is associated with a higher spread. Bank capital channel As expected the “bank capital channel” (based on the maturity mismatch between bank’s assets an liabilities, see Section 3) has a positive effect on the interest rate on shortterm lending and a negative effect on the interest rate on current account. The absolute values of the coefficients are greater in the first case calling for a stronger adjustment on credit contracts than on deposits. Since this channel can be interpreted similarly to a general 17 increase in the costs for the banks, it is worth comparing this result with that obtained for the efficiency indicator. In both cases the effect is strongest for the interest rate on short-term lending and this is consistent with the view that the interest rate on deposit is more sluggish. Interest rate channel A monetary tightening positively influences banks’ interest rate. After a one per cent increase in the monetary policy indicator, interest rate on short term lending are immediately raised of around 0.5 per cent and of around 0.9 per cent after a quarter. Moreover, the passthrough is complete in the long run (the null hypothesis of a unitary elasticity is accepted in all models). The reaction of the short term lending rate is higher with respect to previous studies on the Italian case and this calls for an increase in competition after the introduction of the 1993 Banking Law. Cottarelli et al. (1995), analyzing the period 1986:02-1993:04, find that the immediate pass through is of around 0.2, while the effect after three months is 0.6 per cent. Their long run elasticity is equal to 0.9 per cent but also in their model the null hypothesis of a complete pass-through in the long run is accepted.24 The long run elasticity of the interest rate on current accounts is around 0.7 per cent. This result is in line with the recent findings by de Bondt et al. (2003) under a similar sample period and only a little higher with respect to the long-run elasticity in Angeloni et al. (1995) for the period 1987:1-1993:04.25 The standard answer to the incomplete pass-through of money market changes on the deposit rate is the existence of market power by banks. Another explanation is the presence of compulsory reserves. To analyze this, we can refer to the theoretical elasticity in the case 24 The main differences between Cottarelli et al. (1995) and this paper are three. First, they use the Treasury bill rate as the reference monetary interest rate. However from the early nineties this indicator became less important as “reference rate” because the interbank market became more competitive and efficient (Gaiotti, 1992). This is indeed stated also by Cottarelli et al. (page 19). Second, they do not include macro variables controls in their equation. Third, their dataset is based on monthly data. To allow comparability among the results of this paper and those in Cottarelli et al. (1995) I have: 1) checked the results to different monetary policy indicators (i.e. the interbank rate; see Section 6); 2) excluded the macro variables from equation (1) to verify if the results were sensitive to their inclusion. In all cases the conclusion of an increase of speed in the reaction of short-term interest rate on loans to money market rate resulted unchanged. 25 The VAR model in Angeloni et al. considers the interest rate on total deposits (sight, time deposits and CDs), which is typically more reactive to monetary policy than that on current account because the service component in time deposits and CDs is less important. This means that in comparing our result with Angeloni et al. we are underestimating the potential effect of competition. 18 of perfect competition.26 This benchmark case is very instructive because it allows to analyze what happens if banks are price takers (they take as given not only the monetary market rate but also the interest rate on loans and that on deposits), set the quantity of loans and deposits and obtain a zero profit (the sum of the intermediation margins equals management costs). In this case the long-run elasticities become: ∂iL ∂i = 1 and D = 1 − α where α is the fraction of ∂iM ∂iM deposits invested in risk-free assets (this includes the “compulsory” reserves). Therefore in principle, an incomplete pass-through from market rates to deposits rates is also consistent with the fact that banks decide (or are constrained by regulation) to detain a certain fraction of their deposits in liquid assets. The loading coefficients are significantly negative. It is around –0.4 in the loan equation and –0.6 in the current account equation. This means that if an exogenous shock occurs, respectively 40 and 60 per cent of the deviation is canceled out within the first quarter in each banking rate. Bank lending channel In case of a monetary shock, banks with different characteristics behave differently only in the short run. On the contrary no heterogeneity emerges in the long run relationship between each banking rate and the monetary policy indicator. Considering each bank’s specific characteristic one at the time (Tables 3 and 4), interest rates of small, liquid and well-capitalized banks react less to a monetary policy shock. Also the Berlin-Mester and the Berger-Udell indicators have an high power in explaining heterogeneity in banks’ price setting behavior. Nevertheless, the robustness of these distributional effects has to be checked in a model that takes all these five indicators together into account. In this model, in order to save degrees of freedom, the long-run elasticity between the money market rate and the short- 26 The case of perfect competition can be easily obtained from equation (A1.8) and A1.9) in Appendix 1 considering loan and deposit demand (equations A1.3 and A1.4) infinitely elastic with respect the bank rates (c0→∞, d0→∞). Moreover, we will consider the benchmark case were no heterogeneity emerges in the “bank lending channel” (b1=0) and bonds can be issued at the risk free rate (b0=1). See Freixas and Rochet (1997) for an analogous treatment. 19 term lending rate has been imposed to one; that with the interest rate on current account has been fixed to 0.7. Results are reported in Table 5. Interest rates on short-term lending of liquid and wellcapitalized banks react less to a monetary policy shock. Also banks with a high proportion of long-term lending tend to change less their prices. Size is not significant. This evidence matches with previous results on lending. Liquid banks can protect their loan portfolio against a monetary tightening simply by drawing down cash and securities (Gambacorta, 2003). Well-capitalized banks that are perceived as less risky by the market are better able to raise uninsured funds in order to compensate the drop in deposits (Gambacorta and Mistrulli, 2004). Therefore the effects on lending detected for liquid and well-capitalized banks are mirrored by their higher capacity to insulate the clients also from the effects on interest rates. It is interesting to note that, in contrast with the evidence for the US (Kashyap and Stein; 1995), the interaction terms between size and monetary policy are insignificant. The fact that the interest rate on short term lending of smaller banks is not more sensitive to monetary policy than that of larger banks is well documented in the literature for Italy and reflects the close customer relationship between small banks and small firms (Angeloni et al. 1995; Conigliani et al., 1997; Angelini, Di Salvo and Ferri, 1998; Ferri and Pittaluga, 1996). This result is also consistent with Ehrmann et al. (2003) where size does not emerge as a useful indicator for the distributional effect of monetary policy on lending not only in Italy but also in France, Germany and Spain. As regards the interest rate on current accounts, the Berlin-Mester indicator is the only bank-specific characteristic that explains heterogeneity in banks price setting behavior. In particular, banks that heavily depend upon non-deposit funding (banks with a low BM indicator) will adjust their interest rate on current account by more (and more quickly) than banks whose liabilities are less affected by market movements. As explained in Section 3, the intuition of this result is that, other things being equals, it is more likely that a bank will adjust her terms on deposits if the other conditions of her refinancing change. The liability structure seems to influence not only the short-run adjustment but also the loading coefficient. This implies that banks with a high BM ratio react less when there is a deviation in the long run mark-down: banks with a higher percentage of deposits have more room in adjusting their prices toward the optimal equilibrium. As expected, no cross sectional 20 differences emerges among banks due to size, liquidity and capitalization because current accounts are typically insured. 6. Robustness checks The robustness of the results has been checked in several ways. The first test was to introduce as additional control variable a bank-specific measure of the degree of competition that each bank faces in the market. In particular, the average value of the Herfindahl index in the different “local markets” (corresponding to the administrative provinces of Italy) in which the bank operates was introduced in each equation. The reason of this test is that the fixed effect (that captures also industry structure) remains stable over the whole period while the degree of competition could change over time due to the effect of concentration. Therefore this test allows us also to check if the treatment of bank mergers is carried out properly. The Herfindahl index did not show to be statistically significant and the results of the study did not change. The second test was to use as bank’s efficiency indicator the cost-to-total asset ratio instead than the ratio of total loans and deposits to the number of branches. In all cases the results remained unchanged. The third test was to consider if different fiscal treatments over the sample period could have changed deposit demand (from June 1996 the interest rate on current account is subject to a fiscal deduction of 27 per cent; 12.5 per cent before). However, using the net interest rate on current account instead than the gross rate nothing changed. The fourth robustness check was the introduction of a dummy variables to take into account of the spike in the change of the repo interest rate caused by the EMS crisis in the first quarter of 1995. Also in this case results remained the same. The fifth test was to introduce additional interaction terms combining the bank-specific characteristic with inflation, permanent and transitory changes in real income. The reason for this test is the possible presence of endogeneity between bank characteristics and cyclical factors. Performing the test, however, nothing changed, and the double interactions were almost always not significant (it turned out to be statistically not different from zero in the case of the interaction of capitalization and permanent income). 21 The final robustness check was to introduce a dummy variable that indicates if the bank belongs to a group (1) or not (0). Banks belonging to a group may be less influenced by monetary changes if they can benefit of an internal liquidity management; in other words, bank holding companies establish internal capital markets in an attempt to allocate capital among their various subsidiaries (Houston and James, 1998; Upper and Worms, 2001). The introduction of this dummy did not change the results of the study. 7. Conclusions This paper investigates which factors influence price setting behavior of Italian banks. It adds to the existing literature in two ways. First, it analyzes systematically a wide range of micro and macroeconomic variables that have an effect on bank interest rates: permanent and transitory changes in income, interest and credit risk, interest rate volatility, banks’ efficiency. Second, the analysis of banks’ prices (rather than quantities) provides an alternative way to disentangle loan supply from loan demand shift in the “bank lending channel” literature. The search for heterogeneity in banks’ behavior is carried out by using a balanced panel of 73 Italian banks that represent more than 70 per cent of the banking system. The use of microeconomic data help in reducing the problems of aggregation that may significantly bias the estimation of dynamic economic relations and it is less prone to structural changes like the formation of EMU. The main results of the study are the following. First, heterogeneity in the banking rates pass-through exists, but it is detected only in the short run: no differences exist in the long-run elasticities of banking rates to the money market rate. Second, consistently with the existing literature for Italy, interest rates on short-term lending of liquid and well-capitalized banks react less to a monetary policy shock. Also banks with a high proportion of long-term lending tend to change their prices less. Heterogeneity in the pass-through on the interest rate on current accounts depends on banks’ liability structure. Bank’s size is never relevant. Appendix 1 - A simple theoretical model This Appendix develops a one-period model of a risk neutral bank that operates under oligopolistic market conditions. The balance sheet of the representative bank is as follows: (A1.1) L + S = D + B + K where L stands for loans, S for securities, D for deposits, B for bonds, K for capital. The bank holds securities as a buffer against contingencies. We assume that security holdings are a fixed share of the outstanding deposits (α). They represent a safe asset and fruit the risk-free interest rate.27 We have therefore: (A1.2) S = α D For simplicity, bank capital is exogenously given in the period and greater than capital requirements.28 The bank faces a loan demand and a deposit demand. The first one is given by: (A1.3) Ld = c0 i L + c1 y + c 2 p + c3 i M (c0<0, c1>0, c2>0, c3>0) that is negatively related to the interest rate on loans (il ) and it is positively related to real income (y) and prices (p) and the opportunity cost of self-financing, proxied by the money market interest rate (im).29 Alternatively S can be considered as the total amount of bank’s liquidity, where α is the coefficient of free and compulsory reserves. In this case reserves are remunerated by the money market rate fixed by the Central Bank. This alternative interpretation does not change the results of the model. 27 28 In the spirit of the actual BIS capital adequacy rules, capital requirements on credit risks are given by a fixed amount (k) of loans. If bank capital perfectly meets Basle standard requirement the amount of loans would be L=K/k. We rule out this possibility because banks typically hold a buffer as a cushion against contingencies (Wall and Peterson, 1987; Barrios and Blanco, 2001). Excess capital allows them to face capital adjustment costs and to convey positive information on their economic value (Leland and Pile, 1977; Myers and Majluf, 1984). Another explanation is that banks face a private cost of bankruptcy, which reduces their expected future income (Dewatripont and Tirole, 1994). Van den Heuvel (2001a) argues that even if capital requirement is not currently binding, a low capitalized bank may optimally forego profitable lending opportunities now, in order to lower the risk of future capital inadequacy. A final explanation for the existence of excess capital is given by market discipline; well-capitalized banks obtain a lower cost of uninsured funding, such as bonds or CDs, because they are perceived less risky by the market (Gambacorta and Mistrulli, 2004). 29 As far as the GDP is concerned, there is no clear consensus about how economic activity affects credit demand. Some empirical works underline a positive relation because better economic conditions would 23 The deposit demand is standard. It depends positively on the interest rate on deposits, the level of real income (the scale variable) and the price level and negatively on the interest rate on securities that represent an alternative to the investment to deposits. (A1.4) D d = d 0id + d1 y + d 2 p + d 3im (d0>0, d1>0, d2>0, d3<0) Because banks are risky and bonds are not insured, bond interest rate incorporates a risk premium that we assume depends on specific banks’ characteristics. The latter are balance sheet information or institutional characteristics exogenously given at the end of previous period. (A1.5) ib ( im , xt −1 ) = b0im + b1im xt −1 + b2 xt −1 (b0>1) In other words, this assumption implies that the distributional effects via the bank lending channel depends on some characteristics that allow the bank to substitute insured, typically deposits, with uninsured banks’ debt, like bonds or CDs (Romer and Romer, 1990). For example, theory predicts that big, liquid and well-capitalized banks should be perceived less risky by the market and obtain a lower cost on their uninsured funding (b2<0). Moreover they could react less to monetary change (b1<0) The effects of the so-called “bank capital channel” are captured by the following equation: (A1.6) C MT = ρt −1∆im ( L + S ) (ρ >0) where C MT represents the total cost suffered by the bank in case of a change in monetary policy due to the maturity transformation. Since loans have typically a longer maturity than improve the number of project becoming profitable in terms of expected net present value and, therefore, increase credit demand (Kashyap, Stein and Wilcox, 1993). This is also the hypothesis used in Bernanke and Blinder (1988). On the contrary, other works stress the fact that if expected income and profits increase, the private sector has more internal source of financing and this could reduce the proportion of bank debt (Friedman and Kuttner, 1993). A compromise position is taken by Melitz and Pardue (1973): only increases in permanent income have a positive influence on loan demand, while the effect due to the transitory part could also be associated with a self-financing effect in line with Friedman and Kuttner. Taking this into account, in the econometric part (see Section 4) I will try to disentangle the two effects using a Beveridge and Nelson (1981). For simplicity in the model I assume that the first effect dominates and that a higher income determines an increase in credit demand (c2>0). This is indeed consistent with the evidence provided by Ehrmann et al. (2001) for the four main countries of the euro area. 24 bank fund-raising, the variable ρ represents the cost (gain) per unit of asset that the bank incurs in case of a one per cent increase (decrease) in the monetary policy interest rate. The cost of intermediation is given by: (A1.7) C IN = g1 L + g 2 D (g1>0, g2>0) where the component g1L can be interpreted as screening and monitoring cost while g2D as the cost of the branching.30 Loans are risky and, in each period, a percentage j of them is written off from the balance sheet, therefore reducing bank’s profitability. The representative bank maximizes her profits subject to the balance-sheet constraint. The bank optimally sets the interest rates on loans and deposits (iL, iD), while she takes the money market interest rate (iM) as given (it is fixed by the Central Bank). Max π = (iL − j ) L + im S − iD D − iB B − C MT − C IN il ,id s.t. L+Q = D+ B+ K Solving the maximization problem, the optimal levels of the two interest rates are: (A1.8) iL = Ψ 0 + Ψ1 p + (Ψ 2 + Ψ 3 xt −1 )im + Ψ 4 y P + Ψ 5 ρt −1∆im + Ψ 6 j + Ψ 7 xt −1 (A1.9) id = Φ 0 + Φ1 p + (Φ 2 + Φ 3 xt −1 )im + Φ 4 y P + Φ 5 ρt −1∆im + Φ 6 xt −1 where: g1 c b c c b 1 > 0 ; Ψ1 = 2 > 0 ; Ψ 2 = 0 + 3 > 0 ; Ψ 3 = 1 ; Ψ 4 = 1 > 0 ; Ψ 5 = ; 2 −2c0 2 −2c0 −2c0 2 2 b (1 − α ) −d 3 α g d b 1 Φ0 = − 2 < 0 ; Ψ7 = 2 Φ2 = 0 + + >0; Φ1 = − 2 < 0 ; Ψ6 = ; 2 2d 0 2 2 2d 0 2 2 d b (1 − α ) α b (1 − α ) Φ3 = − 1 ; Φ 4 = − 1 < 0 ; Φ5 = − < 0 ; Φ6 = 2 . 2d 0 2 2d 0 2 Ψ0 = 30 The additive linear form of the management cost simplifies the algebra. The introduction of a quadratic cost function would not have changed the result of the analysis. An interesting consequence of the additive form of the management cost is that bank’s decision problem is separable: the optimal interest rate on deposits is independent of the characteristic of the loan market while the optimal interest rate on loans is independent of the characteristics of the deposit market. For a discussion see Dermine (1991). 25 Equation (A1.8) states that a monetary tightening determines an increase in the interest rate on loans (Ψ2>0): the total effect could be divided into two parts: the “bank lending channel” (b0/2>0) and the “opportunity cost” effect (-c3/2c0>0) The effect of a monetary squeeze is smaller if the bank-specific characteristic reduces the impact of monetary policy on the cost of funding (b1<0 and Ψ3<0). In this case banks have a greater capacity to compensate the deposit drop by issuing uninsured funds at a lower price. Loan interest rate reacts positively to an output expansion (Ψ4>0) and to a raise in prices (Ψ1>0). The effect of the so-called “bank capital channel” is also positive ( Ψ 5 > 0 ); due to the longer maturity of bank assets with respect to liabilities (ρ>0), in case of a monetary tightening ( ∆im >0) the bank suffers a cost and a subsequent reduction in profit; given the capital constraint, this effect determines an increase in loan interest rates (the mirror effect is a decrease in lending). The equation (A1.9) for deposit interest rate is slightly different. Also in this case the impact of a monetary tightening is positive (Φ2>0) but it can now be split in three parts: the “bank lending channel” (b0(1-α)/2>0), the “opportunity cost” (-d3/2d0>0) and the “liquidity buffer”(α/2>0) effects. The intuition of this result is that a monetary squeeze automatically increase the cost of borrowing of bank uninsured fund and the return on securities (the alternative investment for depositors); therefore the first two effects push the bank to increase the interest rate on deposits to raise more insured funds. The percentage of deposits invested in securities (α) act, on the one hand, as a simple “reserve coefficient” that reduces the effectiveness of the “bank lending channel” while, on the other, it increases the revenue on liquid portfolio and the market power of the bank to offset the interest rate on deposits. The distributional effects of monetary policy are equal to the ones described above for the interest rate on loans. The effects on the cost of deposits are smaller for banks with certain characteristics only if b1<0 and Ψ3<0. Deposit interest rate reacts negatively to an output expansion (Φ4<0) and to an increase in prices (Φ1<0). An economic expansion pushes the deposits demand to the left and causes a decrease in cost of deposits (remember that deposit demand is upward sloping with respect to id). The effect should be greater for increases in transitory income. Also the effect of the “bank capital channel” are negative (Φ5<0); as we have seen, in case of a monetary tightening (ρ ∆im >0) the bank suffers a cost and a reduction in profit; this induces the bank to increase her interest rate margin, reducing the interest rates on deposits. 26 Appendix 2 – Technical details on the data The dataset has been constructed using three sources. Interest rates are taken from the 10-day report survey conducted by the Bank of Italy. Bank’s balance sheet information comes from the Banking Supervision Register at the Bank of Italy. Data on macroeconomic variables are taken from the International Financial Statistics. Data on interest rates refer to transactions in euros (Italian lira before 1999). The deposit interest rate is the weighted average rate paid by the single banks on current accounts, which are highly homogenous deposits products.31 The rate on domestic shortterm lending for the single bank is the weighted average of all lending positions. From this computation, overdraft fees are excluded. The choice of the short-term rate as a measure of the bank interest lending pass-through is due to several reasons. First, short-term lending excludes subsidized credit. Second, short-term loans typically are not collateralised and this allows insulating the “bank lending” channel from the “balance sheet” channel. Broadly speaking, the pass-through from market interest rates to the interest rate on loans does not depend upon market price variations that influence the value of collateral. Nearly half of bank’s business is done at this rate. Both interest rates are posted rates that are changed at discrete intervals (often less frequently than weekly, see Green, 1998). In our case, the quarterly frequency of the data is sufficient enough to capture all relevant changes due to a monetary policy shock. Both rates are gross of fiscal deduction. The interest rate taken as monetary policy indicator is that on repurchase agreements between the Bank of Italy and credit institutions in the period 1993-1998, and the interest rates on main refinancing operation of the ECB for the period 1999-2001.32 31 Current accounts are the most common type of deposit (at the end of 2001 they represented around 70 per cent of total bank deposits and passive repos). Current accounts allow unlimited checking for depositor that can close the account without notice. The bank, in turn, can change the remuneration of the account at any point in time. Therefore differences in deposit rates are not influenced by heterogeneity in maturity (see Focarelli and Panetta, 2003). 32 As pointed out by Buttiglione, Del Giovane and Gaiotti (1997), in the period under investigation the repo rate mostly affected the short-term end of the yield curve and, as it represented the cost of banks’ refinancing, it represented the value to which market rates and bank rates eventually tended to converge. The interest rate on main refinancing operation of the ECB does not present any particular break with the repo rate. 27 The cost a bank suffers from her maturity transformation function is due to the different sensitivity of her assets and liabilities to interest rates. Using a maturity ladder, we have: å(χ ⋅ A −ζ P ) *100 ρ = åA j j j j j i j j where Aj (Pj) is the amount of assets (liabilities) of j months-to-maturity and χj (ζj) measures the increase in interest on assets (liabilities) of class j due to a one-per-cent increase in the monetary policy interest rate (∆im=0.01). In other words, if å ( χ ⋅ A − ζ P ) >0, ρ j j j j i j represents the cost per unit of asset bank i suffers in case the monetary policy interest rate is raised of one percentage point. We obtain χi and ζi directly from supervisory regulation on interest rates risk exposure. In particular, the regulation assumes, for any given class j of months-to-maturity: 1) the same sensitivity parameter (χj =ζj) and 2) a non-parallel shift of the yield curve (∆im=0.01 for the first maturity class and then decreasing for longer maturity classes). Then, for each bank, after having classified assets and liabilities according to their months-to-maturity class, we have computed the bank specific variable ρi . This variable has been then multiplied by the change of the monetary policy indicator (∆im) to obtain the realized loss (or gain) per unit of asset in each quarter. In assembling our sample, the so-called special credit institutions (long-term credit banks) have been excluded since they were subject to different supervisory regulations regarding the maturity range of their assets and liabilities. Nevertheless, special long-term credit sections of commercial banks have been considered part of the banks to which they belonged. Particular attention has been paid to the treatment of mergers. In practice, it has been assumed that these have been taken place at the beginning of the sample period, summing the balance-sheet items of the merging parties. For example, if bank A has been incorporated by bank B at time t, bank B has been reconstructed backward as the sum of the 28 merging banks before the merger. Bank interest rates have been reconstructed backwards using as weights short-term loans and current accounts of the merging parties.33 Only banks reporting detailed lending and deposit rates over the whole sample period were considered. I refrain from adopting short time series to ensure sufficient asymptotic in the context of the error correction estimation. Bank observations that were missing or misreported or that constituted clear outliers were excluded from the sample. Bad loans are defined as loans for which legal procedures aimed at their repayment have been started. The permanent component of GDP has been computed using the Beveridge and Nelson (1981) decomposition. An ARIMA model (1,1,1) was applied to the logarithm of the series. Computations have been carried out using the algorithm described in Newbold (1990). Robustness of the results have been checked by means of a statistical analysis of the residuals. The possible presence of structural breaks in interest rates series have been investigated by means of the procedure developed by Banerjee, Lumsdaine and Stock (1992). Figure A1 shows sequential test for changes in the mean of each interest rate series. The hypothesis of this procedure is that, if there is a break, its date is not known a priori but rather is gleaned from the data. The results clearly show that unit-root/no-break null can be rejected at the 2.5 per cent critical value level against the stationarity/mean-shift alternative for the period 1995:03-1998:03. In equation (1) and (2) a convergence dummy, that takes the value of 1 in this period and 0 elsewhere, has been introduced. 33 The same methodology has been used, among others by Peek and Rosengreen (1995), Kishan and Opiela (2000) and Ehrmann et al. (2001). References Altunbas Y., Fazylow O. and Molyneux P. (2002), “Evidence on the Bank Lending Channel in Europe”, Journal of Banking and Finance, forthcoming. Angbazo, L. (1997), “Commercial Bank Net Interest Margins, Default Risk, Interest-rate risk, and Off-balance Sheet Banking”, Journal of Banking and Finance, Vol. 21, pp. 55-87. Angelini P. and Cetorelli N. (2002), ""The effects of regulatory reform on competition in the banking industry"", Journal of Money, Credit and Banking, forthcoming. Angelini, P., P. Di Salvo and G. Ferri (1998), “Availability and Cost of Credit for Small Businesses: Customer Relationships and Credit Cooperatives”, Journal of Banking and Finance, Vol. 22, No. 6-8, pp. 925-54. Angeloni I., Buttiglione L., Ferri G. and Gaiotti E. (1995), “The Credit Channel of Monetary Policy across Heterogeneous Banks: The Case of Italy”, Banca d’Italia, Temi di discussione, No. 256. Ausubel L. M. (1992), Rigidity and Asymmetric Adjustment of Bank Interest Rates, mimeo. Banca d’Italia (1986), Modello trimestrale dell’economia italiana, Banca d’Italia, Temi di discussione, No. 80. Banca d’Italia (1988), Modello mensile del mercato monetario, Banca d’Italia, Temi di discussione, No. 108. Banerjee A., Lumsdaine R.L. and Stock J.H. (1992), “Recursive and Sequential Tests of the UnitRoot and Trend Break Hypotheses: Theory and International Evidence”, Journal of Business and Economic Statistics, Vol. 10, No. 3, pp.271-87. Berger A.N. and Udell G.F. (1992), “Some Evidence on the Empirical Significance of Credit Rationing”, Journal of Political Economy, Vol.100, No. 5, pp. 1047-77. Berlin M. and Mester L.J. (1999), “Deposits and Relationship Lending”, Review of Financial Studies, Vol. 12, No. 3, pp. 579-607. Bernanke B. and Blinder A.S. (1988), “Is it Money or Credit, or Both or Neither? Credit, Money and Aggregate Demand”, American Economic Review, Vol. 78, No. 2, pp. 435-9. Paper and Proceedings of the One-Hundredth Annual Meeting of the American Economic Association. Beveridge S. and Nelson C. (1981), “A New Approach to the Decomposition of Economics Time Series into Permanent and Transitory Components with Particular Attention to Measurement of the ‘Business Cycle’”, Journal of Monetary Economics, Vol. 21, pp. 151-74. Boccuzzi, G. (1998), La crisi dell'impresa bancaria. Profili economici e giuridici, Giuffrè, Milano. Bolton, P. and Freixas X. (2001), “Corporate Finance and the Monetary Transmission Mechanism”, CEPR, Discussion Paper Series, No. 2982. Calomiris C.W. and Hubbard G.R. (1995), “Internal Finance and Investment: Evidence from the Undistributed Profit Tax of 1936-37”, Journal of Business, Vol. 68. No. 4. Ciocca P. (2000), La nuova finanza in Italia. Una difficile metamorfosi (1980-2000), Bollati Boringhieri, Torino. Cornett M. M. and Tehranian H. (1994), “An Examination of Voluntary Versus Involuntary Security Issuances by Commercial Banks: The Impact of Capital Regulations on Common Stock Returns”, Journal of Financial Economics, Vol. 35, pp. 99-122. Cottarelli C. and Kourelis A. (1994), “Financial Structure, Bank Lending Rates and the Transmission Mechanism of Monetary Policy”, IMF Staff Papers, Vol. 41, No. 4, pp.587-623. Cottarelli C., Ferri G. and Generale A. (1995), “Bank Lending Rates and Financial Structure in Italy: A Case Study”, IMF Working Papers, No. 38. 30 de Bondt G., Mojon B. and Valla N. (2003), “The Adjustment of Retail Rates in the Euro Area: Is It (Really) Sluggish?”, European Central Bank, mimeo. Dermine J. (1991), Discussion to Vives. X., “Banking Competition and European Integration”, in Giovannini A. and Mayer C., European Financial Integration, Cambridge, Cambridge University Press. Dewatripont M. and Tirole J. (1994), The Prudential Regulation of Banks, Cambridge, Massachusetts, MIT Press. Ehrmann M., Gambacorta L., Martinez Pagés J., Sevestre P. and Worms A. (2003), “Financial Systems and the Role of Banks in Monetary Policy Transmission in the Euro Area”, in Angeloni I., Kashyap A. and Mojon B., Monetary Policy Transmission in the Euro Area, Cambridge, Cambridge University Press. Focarelli D. and Panetta F. (2003), “Are Merger Beneficial to Consumers? Evidence from the Market for Bank Deposits”, American Economic Review, forthcoming. Friedman B. and Kuttner K. (1993), “Economic Activity and the Short-Term Credit Markets: an Analysis of Prices and Quantities”, Brooking Papers on Economic Activity, Vol. 2, pp. 193-283. Freixas X. and Rochet J. (1997), Microeconomics of Banking, Cambridge, MIT Press. Gaiotti E. (1992), “L’evoluzione delle tecniche di controllo monetario nel modello mensile della Banca d’Italia”, mimeo, Banca d’Italia. Gambacorta L. (2003), “The Italian Banking System and Monetary Policy Transmission: Evidence from Bank Level Data”, in Angeloni, I., A. Kashyap and B. Mojon (eds.), Monetary Policy Transmission in the Euro Area, Cambridge, Cambridge University Press. Gambacorta L. and Mistrulli P. (2004), “Does Bank Capital Affect Lending Behavior?”, Journal of Financial Intermediation, forthcoming. Green C.J. (1998), “Banks as Interest Rate Managers”, Journal of Financial Services Research, Vol. 14, n. 3, pp. 189-208. Hancock D. (1991), A Theory of Production for the Financial Firm, Norwell, Massachusetts, Kluwer Academic Publishers. Hannan T.H. and Berger A.N. (1991), “The Rigidity of Prices: Evidence From Banking Industry”, American Economic Review, Vol. 81, pp.938-45. Harvey (1981), Time Series Models, Oxford, Allan. Ho T.S.Y. and Saunders A. (1981), The Determinants of Bank Interest Margins: Theory and Empirical Evidence”, Journal of Financial and Quantitative Analysis, Vol. 16, No. 2, pp. 581600. Houston J.F. and James C. (1998), “Do Bank Internal Capital Market Promote Lending?”, Journal of Banking and Finance, Vol. 22, pp. 899-918. Hutchison D.E. (1995), “Retail Bank Deposit Pricing: An Intertemporal Asset Pricing Approach”, Journal of Money Credit and Banking, Vol. 27, pp. 217-31. Kashyap A. and Stein J.C. (1995), “The Impact of Monetary Policy on Bank Balance Sheets”, Carnegie Rochester Conference Series on Public Policy, Vol. 42, pp.151-195. Kashyap A. and Stein J.C. (2000), “What Do a Million Observations on Banks Say About the Transmission of Monetary Policy”, American Economic Review, Vol. 90, No. 3, pp. 407-28. Kashyap A., Stein J.C. and Wilcox D. (1993). Monetary Policy and Credit Conditions: Evidence from the Composition of External Finance, American Economic Review, Vol. 83, pp. 78-98. Kishan R.P. and Opiela T.P. (2000), “Bank Size, Bank Capital and the Bank Lending Channel”, Journal of Money, Credit and Banking, Vol. 32, No. 1, pp. 121-41. Klein M. (1971), “A Theory of the Banking Firm”, Journal of Money, Credit and Banking, Vol. 3, No. 2, pp. 205-18. 31 Leland H.E. and Pile D.H. (1977), “Informational Asymmetries, Financial Structures and Financial Intermediation”, The Journal of Finance, Vol. 32, pp. 371-87. Lim G.C. (2000), “Bank Interest Rate Adjustments: Are They Asymmetric?”, The Economic Record, Vol. 77, no. 237, pp.135-147. Melitz J. and Pardue M. (1973), “The Demand and Supply of Commercial Bank Loans”, Journal of Money, Credit and Banking, Vol. 5, No. 2, pp. 669-92. Moore G.R., Porter R.D. and Small D.H. (1990), “Modelling the Disaggregated Demands for M2 and M1: the U.S. Experience in the 1980s”, Proceedings of a Federal Reserve Board Conference on Monetary Aggregates and Financial System Behavior. Myers S.C. and Majluf N.S. (1984), “Corporate Finance and Investment Decisions when Firms Have Information that Investors Do Not Have”, Journal of Financial Economics, Vol. 13, pp.187-221. Neumark D. and Sharpe S.A. (1992), “Market Structure and the Nature of Price Rigidity: Evidence From the Market for Consumer Deposits”, Quarterly Journal of Economics, Vol. 107, pp.65780. Newbold P. (1990), “Precise and Efficient Computation of the Beveridge-Nelson Decomposition of Economic Time Series”, Journal of Monetary Economics, Vol. 26, pp. 453-457. Passacantando F. (1996), “Building an Institutional Framework for Monetary Stability”, BNL Quarterly Review, Vol. 49, No. 196, pp. 83-132. Peek J. and Rosengren E.S. (1995), “Bank Lending and the Transmission of Monetary Policy”; in Peek J. and E.S. Rosengren (eds.), Is Bank Lending Important for the Transmission of Monetary Policy?, Federal Reserve Bank of Boston Conference Series No. 39, pp. 47-68. Petersen M. and Rajan R. (1994), “The Benefits of Lending Relationships: Evidence from Small Business Data”, Journal of Finance, Vol. 49, pp.3-37. Rosen R.J. (2001), What Goes Up Must Come Down? Asymmetries and Persistence in Bank Deposit Rates, Indiana University, mimeo. Santomero A.M. (1984), “Modeling the Banking Firm: A Survey”, Journal of Money Credit and Banking, Vo. 16, n. 4, pp. 576-602. Stein J.C. (1998), “An Adverse-Selection Model of Bank Asset and Liability Management with Implications for the Transmission of Monetary Policy”, RAND Journal of Economics, Vol. 29, No. 3, pp. 466-86. Thakor A.V. (1996), “Capital Requirements, Monetary Policy, and Aggregate Bank Lending: Theory and Empirical Evidence”, The Journal of Finance, Vol. 51, No. 1, pp. 279-324. Upper C. and Worms A. (2001), “Estimating Bilateral Exposures in the German Interbank Market: Is There a Danger of Contagion?”, in BIS (ed.), Marrying the Macro and Microprudential Dimensions of Financial Stability, BIS papers, No. 1, pp. 211-29. Van den Heuvel S.J. (2001a), “The Bank Capital Channel of Monetary Policy”, University of Pennsylvania, mimeo. Van den Heuvel S.J. (2001b), “Banking Conditions and the Effects of Monetary Policy: Evidence from U.S. States”, University of Pennsylvania, mimeo. Van den Heuvel S.J. (2003), “Does Bank Capital Matter for Monetary Transmission?”, FRBNY Economic Policy Review, forthcoming. Verga G. (1984), “La determinazione dei tassi bancari in Italia: un’analisi per gli anni più recenti”, Banca, Impresa, Società, Vol. 3, No. 1, pp.65-84. Weth M.A. (2002), “The Pass-Through from Market Interest Rates to Bank Lending Rates in Germany”, Discussion Paper No 11, Economic Research Center of the Deutsche Bundesbank. Table 1 VARIABLES DESCRIPTION Variables Dependent variables Fixed effects Symbols iLt Interest rate on domestic short term loans iDt Interest rate on current account deposits µi imt Macro variables Description y tP , y Tt pt Bank-specific dummy variable Monetary policy indicator Permanent and transitory components of real GDP computed using the Beveridge and Nelson (1981) decomposition Inflation rate Size: log of total assets (Kashyap and Stein, 1995; Ehrmann et al. 2003) Liquidity: cash and securities over total assets (Stein, 1998; Kashyap and Stein, 2000) Excess capital: difference between regulatory capital and capital requirements (Peek and Rosengren, 1995; Kishan and Opiela, 2000; Gambacorta and Mistrulli, 2004) Deposit strength: ratio between deposits and bonds plus deposits (Berlin and Mester,1999; Weth, 2002) Credit relationship: ratio between long term loans and total loans (Berger and Udell, 1992) Bank-specific characteristics that influence the “bank lending channel” X it −1 Measure for the “bank capital channel” ρit −1 Risk-measure jit Efficiency ratio eit Interest rate volatility σt Cost per unit of asset that the bank incurs in case of a one per cent increase in MP Ratio between bad loans and total loans. This variable captures the riskiness of lending operations and should be offset by a higher expected yield of loans. Management efficiency: ratio of total loans and deposits to the number of branches. Interest rate volatility: coefficient of variation of iM . Control variables Φ it Convergence dummy: step dummy that takes the value of 1 in the period 1995:03-1998:03 and 0 elsewhere. Seasonal dummies. Note: For more information on the definition of the variables see Appendix 2. 18 18 18 18 Big banks Small banks Liquid banks (2) Low liquid banks 18 18 18 18 18 18 Well capitalized banks Low capitalized banks Banks with high BM ratio Banks with low BM ratio (3) (4) Banks with high BU ratio (5) Banks with low BU ratio (1) 73 Number of banks Total sample Bank-characteristics (*) 8.51 10.97 11.78 7.77 9.71 9.42 9.51 9.33 9.28 10.02 9.51 Mean 2.59 2.12 1.49 2.24 2.73 2.81 2.72 2.73 2.81 2.73 2.72 St. dev. 3.69 4.00 4.88 3.69 3.69 4.75 3.69 4.42 3.69 5.03 3.69 Min 15.06 16.12 16.12 15.06 16.12 15.93 15.94 14.86 15.06 16.12 16.12 Max Interest rate on short term lending 2.80 4.68 5.15 2.41 3.68 3.53 3.57 3.61 3.57 3.55 3.58 Mean 1.67 1.44 0.96 1.45 1.80 1.79 1.80 1.71 1.74 1.79 1.79 St. dev. 0.65 0.53 0.74 0.52 0.52 0.74 0.65 0.73 0.73 0.52 0.52 Min 7.36 7.43 8.21 7.35 7.18 8.21 8.21 7.35 7.35 8.21 8.21 Max Interest rate on current accounts definition of the variables see Appendix 2. The sources of the dataset are Bank of Italy supervisory returns and 10-days reports. 21.92 8.51 6.58 27.00 9.66 24.28 4.67 43.75 51.15 1.55 16.20 Size (1) 19.98 28.26 29.69 18.56 26.15 20.82 33.07 14.91 19.01 25.11 24.00 Liq. (2) 3.80 3.95 4.46 3.42 6.86 1.49 4.27 3.13 2.56 4.81 3.91 Cap. (3) 71.84 93.13 98.53 66.10 85.49 78.40 86.27 72.43 77.60 84.40 82.40 BM (4) 53.29 22.46 28.72 45.30 37.22 38.46 36.15 43.66 38.98 41.72 37.66 BU (5) average ratio below the third quartile. Since the characteristics of each bank could change through time, percentiles have been worked out on mean values. For more details on the long-term loans and total loans. A bank with a ""high"" characteristic has the average ratio above the first quartile of the distribution. (*) A bank with a ""low""characteristic has the capital requirements. (4) The Berlin and Mester indicator (BM) is the ratio between deposits and deposits plus bonds. (5) The Berger and Udell indicator (BU) is the ratio between government securities over total assets. (3) The capital ratio is given by excess capital divided by total assets. Excess capital is the difference between regulatory capital and total interest rate are annualized and given in percentages. (1) The size indicator is given by total asset (billions of euros). (2) The liquidity indicator is represented by the sum of cash and Ex special credit institutions, foreign banks and ""banche di credito cooperativo"" are excluded. The sample represents more than 70 per cent of total system in terms of lending. All SUMMARY STATISTICS (1993:03-2001:03) Table 2 Table 3 RESULTS FOR THE EQUATION ON THE INTEREST RATE ON SHORT-TERM LENDING This table shows the results of the equation for the interest rate on short term lending. The model is given by the following equation, which includes interaction terms that are the product of the monetary policy indicator and a bank specific characteristic: ∆ iL k ,t = µ k + 2 1 j =1 j =0 å κ j ∆iL k ,t − j + å ( β j + β *j X k ,t −1 )∆iM t − j + ϕ pt + δ1∆ ln ytP + δ 2∆ ln ytT + λX k ,t −1 + φ∆ ( ρ k ,t −1∆iM t ) + + (α + α X k ,t −1 )iL k ,t −1 + (γ + γ * X k ,t −1 )iM t −1 + θ jk ,t + ξ ek ,t + ψσ t + Φ k ,t + ε k ,t * with k=1,…, N (k=number of banks) and t=1, …,T (t= periods). Data are quarterly (1993:03-2001:03) and not seasonally adjusted. The panel is balanced with N=73 banks. Lags have been selected in order to obtain white noise residuals. The description of the variables is reported in Table 1. The model have been estimated using the GMM estimator suggested by Arellano and Bond (1991) which ensures efficiency and consistency provided that the models are not subject to serial correlation of order two and that the instruments used are valid (which is tested for with the Sargan test). A bank with “low characteristic” has the average ratio of the banks below the first quartile, a bank with ""high characterisic” has the average ratio of the banks above third quartile. For more details on the data see Appendix 2. *=significance at the 10 per cent; **=significance at the 5 per cent; ***=significance at the 1 per cent. Dependent variable: quarterly change of the interest rate on short-term lending (1) Size Coeff. (2) Liquidity (5) Long term loans/ Total loans S.Error Coeff. S.Error (4) Dep./(Bonds+Dep.) S.Error Coeff. S.Error Coeff. 0.017 0.012 0.025 0.145 *** 0.032 ** 0.012 0.015 0.013 0.026 0.149 *** 0.025 ** 0.012 0.018 0.187 *** 0.012 0.043 *** 0.024 0.026 0.015 0.010 0.020 Costs, credit risk and int.rate volatility Bank's efficiency: -0.004 ** 0.002 -0.001 Bad loans: 0.020 *** 0.002 0.016 *** Interest rate volatility: 0.011 *** 0.001 0.012 *** 0.002 -0.006 ** 0.002 0.017 *** 0.001 0.010 *** 0.002 0.001 0.001 -0.001 0.020 *** 0.014 *** 0.001 -0.001 0.002 0.019 *** 0.001 0.012 *** 0.001 0.002 0.001 Immediate pass-through Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.569 *** 0.027 0.003 0.556 *** 0.028 0.586 *** 0.026 0.031 0.018 0.027 0.036 0.023 0.418 0.022 0.026 0.465 *** 0.030 0.497 *** 0.023 0.028 0.529 *** 0.032 0.463 *** 0.034 0.000 0.033 0.035 Pass-through after a quarter Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.938 *** 0.013 0.000 0.913 *** 0.015 0.971 *** 0.014 0.016 0.878 *** 0.159 0.017 0.889 *** 0.016 0.863 *** 0.013 0.000 0.014 0.012 Long run elasticity Average bank: Ho: unitary long run elasticity (p-val.) Ho: no heterogeneity (p-value) Low characteristic High characteristic 1.017 *** 0.014 0.056 0.509 0.996 *** 0.014 1.049 *** 0.016 0.015 1.012 *** 0.235 0.924 0.026 0.992 *** 0.012 1.040 *** 0.018 0.489 0.644 0.016 0.023 Loading of the long run relationship Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.017 0.000 0.017 0.020 Bank capital channel Loan demand Inflation: Permanent Income: Transitory Income: Miss-specification tests MA(1), MA(2) (p-value) Sargan test (p-value) No of banks, no of observations S.Error Coeff. (3) Capitalization 0.159 *** 0.019 0.033 ** 0.015 0.012 0.031 0.145 *** 0.030 *** 0.013 0.403 *** 0.414 *** 0.383 *** 0.941 *** 0.962 *** 0.920 *** 0.954 *** 0.958 *** 0.949 *** 0.869 *** 0.862 *** 0.878 *** -0.477 *** 0.023 -0.422 *** 0.000 -0.505 *** 0.026 -0.391 *** -0.441 *** 0.023 -0.451 *** 0.019 -0.507 *** 0.000 0.023 -0.482 *** 0.019 -0.539 *** 0.023 0.035 0.028 0.026 -0.234 *** -0.519 *** 0.043 -0.382 *** 0.000 0.021 -0.434 *** 0.020 -0.330 *** 0.104 * 0.055 0.409 *** 0.070 0.178 *** 0.051 0.197 *** 0.066 0.109 * 0.066 0.000 0.949 0.087 2336 0.000 0.367 0.099 2336 0.000 0.702 0.088 2336 0.000 0.185 0.000 0.101 2336 73 0.116 0.057 2336 73 1.023 *** 0.012 0.037 0.011 0.015 0.474 *** 0.456 *** 1.031 *** 1.015 *** 0.987 *** 1.005 *** 0.014 0.816 0.822 0.015 0.015 0.536 *** 0.529 *** 0.012 0.047 0.883 0.013 0.012 73 0.996 *** 0.018 0.000 0.018 0.018 0.533 *** 73 0.982 *** 0.990 *** 0.978 *** -0.381 *** 73 Table 4 RESULTS FOR THE EQUATION ON INTEREST RATE ON CURRENT ACCOUNTS This table shows the results of the equation for the interest rate on current accounts. The model is given by the following equation, which includes interaction terms that are the product of the monetary policy indicator and a bank specific characteristic: ∆i D k , t = µ k + 2 1 j =1 j =0 åκ j ∆iD k ,t − j + å ( β j + β *j X k ,t −1)∆iM t − j + ϕ pt + δ1∆ ln ytP + δ 2∆ ln ytT + λX k ,t −1 + φ∆( ρ k ,t −1∆iM t ) + + (α + α X k ,t −1 )iD k ,t −1 + (γ + γ * X k ,t −1 )iM t −1 + ξ ek ,t + ψσ t + Φ k ,t + ε k ,t * with k=1,…, N (k=number of banks) and t=1, …,T (t= periods). Data are quarterly (1993:03-2001:03) and not seasonally adjusted. The panel is balanced with N=73 banks. Lags have been selected in order to obtain white noise residuals. The description of the variables is reported in Table 1. The model have been estimated using the GMM estimator suggested by Arellano and Bond (1991) which ensures efficiency and consistency provided that the models are not subject to serial correlation of order two and that the instruments used are valid (which is tested for with the Sargan test). A bank with “low characteristic” has the average ratio of the banks below the first quartile, a bank with ""high characterisic” has the average ratio of the banks above third quartile. For more details on the data see Appendix 2. *=significance at the 10 per cent; **=significance at the 5 per cent; ***=significance at the 1 per cent. (1) Size Dependent variable: quarterly change of the interest rate on current accounts Coeff. (2) Liquidity S.Error Coeff. (3) Capitalization (5) Long term loans/ Total loans S.Error Coeff. S.Error (4) Dep./(Bonds+Dep.) S.Error Coeff. S.Error Coeff. Deposit demand Inflation: Permanent Income: Transitory Income: 0.049 *** 0.015 0.091 *** -0.058 *** 0.006 -0.048 *** -0.222 *** 0.012 -0.204 *** 0.012 0.058 *** 0.006 -0.058 *** 0.012 -0.223 *** 0.015 0.005 0.011 0.099 *** -0.024 * -0.102 *** 0.008 0.039 *** 0.013 -0.052 *** 0.012 -0.202 *** 0.009 0.004 0.010 Costs, credit risk and int.rate volatility Bank's efficiency: Interest rate volatility: 0.001 0.001 ** 0.001 0.001 0.001 0.002 *** 0.001 0.001 0.001 0.001 *** 0.002 0.001 0.012 *** 0.005 *** 0.001 0.000 0.002 * 0.002 *** 0.001 0.001 Immediate pass-through Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.413 *** 0.013 0.000 0.400 *** 0.015 0.429 *** 0.012 0.411 *** 0.010 0.000 0.010 0.010 0.410 *** 0.008 0.742 0.009 0.009 0.418 *** 0.009 0.000 0.009 0.010 0.388 *** 0.408 *** 0.366 *** 0.008 0.000 0.007 0.010 Pass-through after a quarter Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.546 *** 0.009 0.000 0.512 *** 0.010 0.588 *** 0.008 0.006 0.540 *** 0.000 0.006 0.536 *** 0.008 0.542 *** 0.006 0.776 0.006 0.008 Long run elasticity Average bank: Ho: unitary long run elasticity (p-val.) Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.685 *** 0.013 0.000 0.905 0.688 *** 0.014 0.682 *** 0.013 0.007 0.000 0.444 0.006 0.009 0.675 *** 0.661 *** 0.010 0.000 0.717 0.010 0.011 Loading of the long run relationship Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.016 0.000 0.017 0.017 Bank capital channel Miss-specification tests MA(1), MA(2) (p-value) Sargan test (p-value) No of banks, no of observations 0.431 *** 0.394 *** 0.541 *** 0.551 *** 0.530 *** 0.551 *** 0.535 *** 0.507 *** 0.526 *** 0.493 *** -0.572 *** 0.018 -0.646 *** 0.000 -0.537 *** 0.018 -0.657 *** -0.610 *** 0.023 -0.634 *** 0.018 -0.609 *** 0.016 0.020 -0.645 *** 0.017 -0.564 *** 0.020 0.000 0.019 0.025 -0.725 *** -0.795 *** 0.016 -0.572 *** 0.000 0.019 -0.610 *** 0.017 -0.533 *** -0.055 *** 0.015 -0.036 *** 0.012 -0.049 *** 0.009 -0.039 *** 0.013 -0.034 *** 0.009 0.000 0.976 0.960 2336 0.785 0.094 2336 0.000 0.340 0.092 2336 0.508 0.095 2336 73 0.000 73 0.676 *** 0.007 0.049 0.007 0.009 0.663 *** 0.694 *** 0.670 *** 0.699 *** 0.009 0.000 0.205 0.010 0.009 0.544 *** 0.451 *** 0.387 *** 0.009 0.000 0.463 0.009 0.011 0.953 0.091 2336 0.685 *** 0.008 0.000 0.008 0.008 0.411 *** 0.409 *** 0.000 73 0.643 *** 0.631 *** 0.654 *** -0.760 *** 73 0.669 *** 0.000 73 Table 5 BANK LENDING CHANNEL This table shows the results of the equation for the interest rate on short-term lending (panel A) and current accounts (panel B) when all bank-specific characteristics are taken simultaneously into account. The model is given by the following equation, which includes interaction terms that are the product of the monetary policy indicator and each bank-specific characteristic: ∆iψ k ,t = µ k + 2 5 1 5 å κ j ∆iψ k ,t − j + å å ( β j + β *j X k , m,t −1)∆iM t − j + ϕ pt + δ1∆ ln ytP + δ 2∆ ln ytT + å λm X k , m,t −1 + j =1 m =1 j = 0 + φ∆ ( ρ k ,t −1∆iM t ) + (α + m =1 5 å α m* X k ,m,t −1)(iψ k ,t −1 − γ iM t −1) + θ jk ,t + ξ ek ,t + ψσ t + Φ k ,t + ε k ,t m =1 with i ψ= quarterly change of the interest rate on short-term lending or current accounts k=1,…, N (k=number of banks) and t=1, …,T (t= periods). Bank-specific characteristics are size,liquidity, capitalization, Berlin-Mester and Berger-Udell indicators (m =5). Data are quarterly (1992:032001:03) and not seasonally adjusted. The panel is balanced with N=73 banks. Lags have been selected in order to obtain white noise residuals. The description of the variables is reported in Table 1. The model have been estimated using the GMM estimator suggested by Arellano and Bond (1991) which ensures efficiency and consistency provided that the models are not subject to serial correlation of order two and that the instruments used are valid (which is tested for with the Sargan test). A bank with “low characteristic” has the average ratio of the banks below the first quartile, a bank with ""high characterisic” has the average ratio of the banks above third quartile. For more details on the data see Appendix 2. *=significance at the 10 per cent; **=significance at the 5 per cent; ***=significance at the 1 per cent. (1) Size Coeff. (2) Liquidity S.Error Coeff. (3) Capitalization S.Error Coeff. (5) Long term loans/ Total loans S.Error Coeff. S.Error (4) Dep./(Bonds+Dep.) S.Error Coeff. (A) Dependent variable is the quarterly change of the interest rate on short-term lending Immediate pass-through Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.452 *** 0.062 0.159 0.492 *** 0.064 0.393 *** 0.080 Pass-through after a quarter Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.879 *** 0.039 0.639 0.895 *** 0.058 0.857 *** 0.040 0.891 *** 0.868 *** Long run elasticity All banks: 1.000 1.000 Loading of the long run relationship Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic -0.354 *** 0.050 -0.354 *** 0.681 -0.377 *** 0.072 -0.354 *** -0.324 *** 0.092 -0.354 *** Miss-specification tests MA(1), MA(2) (p-value) Sargan test (p-value) No of banks, no of observations - 0.000 - 0.452 *** 0.476 *** 0.421 *** 0.879 *** - 0.062 0.027 0.058 0.069 0.039 0.317 0.036 0.033 - 0.452 *** 0.558 *** 0.308 *** 0.879 *** 0.914 *** 0.847 *** 1.000 - 0.050 -0.354 *** 0.990 0.063 -0.318 *** 0.046 -0.399 *** 0.062 0.043 0.065 0.110 0.039 0.744 0.082 0.075 0.050 0.536 0.070 0.095 0.452 *** 0.519 *** 0.375 *** 0.062 0.016 0.050 0.084 0.883 *** 0.876 *** 0.039 0.879 *** 0.913 0.050 0.888 *** 0.047 0.873 *** 0.039 0.912 0.039 0.053 1.000 - 0.460 *** 0.437 *** 0.879 *** - -0.354 *** -0.332 *** -0.375 *** 0.062 0.702 0.059 0.077 0.452 *** 1.000 - 0.050 -0.354 *** 0.761 0.089 -0.332 *** 0.085 -0.376 *** 0.050 0.773 0.086 0.095 0.073 0.985 2336 73 (B) Dependent variable is the quarterly change of the interest rate on current accounts Immediate pass-through Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.452 *** 0.042 0.972 0.453 *** 0.043 0.452 *** 0.050 Pass-through after a quarter Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.545 *** 0.033 0.160 0.572 *** 0.032 0.524 *** 0.043 0.546 *** 0.545 *** Long run elasticity Average bank: 0.700 0.700 Loading of the long run relationship Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic -0.570 *** 0.043 -0.570 *** 0.388 -0.537 *** 0.048 -0.565 *** -0.612 *** 0.074 -0.575 *** Miss-specification tests MA(1), MA(2) (p-value) Sargan test (p-value) No of banks, no of observations 0.000 73 - - 0.915 0.180 2336 0.452 *** 0.470 *** 0.434 *** 0.545 *** - 0.042 0.129 0.050 0.037 0.033 0.978 0.038 0.033 - 0.452 *** 0.479 *** 0.419 *** 0.545 *** 0.566 *** 0.517 *** 0.700 - 0.043 -0.570 *** 0.820 0.050 -0.607 *** 0.047 -0.523 *** 0.042 0.529 0.054 0.074 0.033 0.481 0.055 0.045 0.043 0.481 0.019 0.025 0.452 *** 0.497 *** 0.406 *** 0.042 0.112 0.062 0.062 0.590 *** 0.516 *** 0.033 0.545 *** 0.203 0.045 0.563 *** 0.039 0.525 *** 0.033 0.224 0.041 0.034 0.700 - 0.509 *** 0.400 *** 0.545 *** - -0.570 *** -0.452 *** -0.680 *** 0.042 0.032 0.044 0.054 0.452 *** 0.700 - 0.043 -0.570 *** 0.004 0.062 -0.589 *** 0.054 -0.550 *** 0.043 0.575 0.059 0.051 Fig. 1 Banking interest rates (quarterly data, percentage points) 19.0 3-month interbank rate Repo rate 17.0 Interest rate on current accounts Estimation period 1993:03-2001:03 Short term lending rate 15.0 13.0 Euro 11.0 9.0 7.0 5.0 Period before T.U.B. 1987:01-1993:02 3.0 1.0 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 Fig. 2 Cross sectional and time series dispersion of interest rates 0.350 (a) Interest rate on short-term loans 0.300 0.250 0.200 0.150 0.100 0.050 0.000 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 1998 1999 2000 2001 0.350 (b) Interest rate on current accounts 0.300 0.250 0.200 0.150 0.100 0.050 0.000 1987 1988 1989 ACROSS BANKS 1990 1991 1992 OVER TIME 1993 1994 1995 1996 1997 Fig. 3 Determinants of bank’s interest rates i L = f ( y P , y T , p, i M , + ? + + X t −1 , i M X t −1 , ρ t −1 ∆i M , j , costs , σ , µ k ) ? + + + ? + Loan demand Interest rate channel Bank lending channel Cost of intermediation, credit risk and interest rate volatility Bank capital channel Deposit demand i D = f ( y P , y T , p, i M , − − − + Industry structure X t −1 , i M X t −1 , ρ t −1 ∆i M , costs , σ , µ k ) ? − − ? + Note: the meaning of all the symbols is reported in Table 1. Fig. A1 Search for mean shift breaks (monthly data, sequential minimum unit root tests) 0 Dec-87 Dec-88 Dec-89 Dec-90 Dec-91 Dec-92 Dec-93 Dec-94 Dec-95 Dec-96 Dec-97 Dec-98 Dec-99 -1 -2 -3 -4 -5 -6 -7 Interest rate on current accounts -8 Interest rate on short-term loans 3-month interbank market rate -9 10% critical value 2.5% critical value -10 Note: The estimated model tests for a shift in the constant. No trend is included. Sequential statistic are computed using the sample 1984:7-2002:12, sequentially incrementing the date of the hypothetical shift. A fraction equal to 15 per cent of the total sample at the beginning and at the end of the sample is not considered for the test. For more details see Banerjee, Lumsdaine and Stock (1992).","Give an answer using only the context provided.
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+EVIDENCE:
+NBER WORKING PAPER SERIES HOW DO BANKS SET INTEREST RATES? Leonardo Gambacorta Working Paper 10295 http://www.nber.org/papers/w10295 NATIONAL BUREAU OF ECONOMIC RESEARCH 1050 Massachusetts Avenue Cambridge, MA 02138 February 2004 This research was done during a period as a visiting scholar at the NBER. The views expressed herein are those of the author and not necessarily those of the Banca d’Italia or the National Bureau of Economic Research. ©2004 by Leonardo Gambacorta. All rights reserved. Short sections of text, not to exceed two paragraphs, may be quoted without explicit permission provided that full credit, including © notice, is given to the source. How Do Banks Set Interest Rates? Leonardo Gambacorta NBER Working Paper No. 10295 February 2004 JEL No. E44, E51, E52 ABSTRACT The aim of this paper is to study cross-sectional differences in banks interest rates. It adds to the existing literature in two ways. First, it analyzes in a systematic way both micro and macroeconomic factors that influence the price setting behavior of banks. Second, by using banks’ prices (rather than quantities) it provides an alternative way to disentangle loan supply from loan demand shift in the “bank lending channel” literature. The results, derived from a sample of Italian banks, suggest that heterogeneity in the banking rates pass-through exists only in the short run. Consistently with the literature for Italy, interest rates on short-term lending of liquid and well-capitalized banks react less to a monetary policy shock. Also banks with a high proportion of long-term lending tend to change their prices less. Heterogeneity in the pass-through on the interest rate on current accounts depends mainly on banks’ liability structure. Bank’s size is never relevant. Leonardo Gambacorta Banca d’Italia Research Department Via Nazionale, 91 00184 Rome, Italy gambacorta.leonardo@insedia.interbusiness.it 1. Introduction1 This paper studies cross-sectional differences in the price setting behavior of Italian banks in the last decade. The main motivations of the study are two. First, heterogeneity in the response of bank interest rates to market rates helps in understanding how monetary policy decisions are transmitted through the economy independently of the consequences on bank lending. The analysis of heterogeneous behavior in banks interest setting has been largely neglected by the existing literature. The vast majority of the studies on the “bank lending channel” analyze the response of credit aggregates to a monetary policy impulse, while no attention is paid on the effects on prices. This seems odd because, in practice, when banks interest rates change, real effects on consumption and investment could be produced also if there are no changes in total lending. The scarce evidence on the effects of monetary shocks on banks prices, mainly due to the lack of available long series of micro data on interest rates, contrasts also with some recent works that highlight a different adjustment of retail rates in the euro area (see, amongst others, de Bondt, Mojon and Valla, 2003). Second, this paper wants to add to the “bank lending channel” literature by identifying loan supply shocks via banks’ prices (rather than quantities). So far to solve the “identification problem” it has been claimed that certain bank-specific characteristics (i.e. size, liquidity, capitalization) influence only loan supply movements while banks’ loan demand is independent of them. After a monetary tightening, the drop in the supply of credit should be more important for small banks, which are financed almost exclusively with deposits and equity (Kashyap and Stein, 1995), less liquid banks, that cannot protect their loan portfolio against monetary tightening simply by drawing down cash and securities (Stein, 1998; Kashyap and Stein, 2000) and poorly capitalized banks, that have less access to markets for uninsured funding (Peek and Rosengren, 1995; Kishan and Opiela, 2000; van den Heuvel, 2001a; 2001b).2 The intuition of an identification via prices of loan supply shift is very simple: if loan demand is not perfectly elastic, also the effect of a monetary 1 This study was developed while the author was a visiting scholar at the NBER. The opinions expressed in this paper are those of the author only and in no way involve the responsibility of the Bank of Italy and the NBER. 2 All these studies on cross-sectional differences in the effectiveness of the “bank lending channel” refer to the US. The literature on European countries is instead far from conclusive (see Altunbas et al., 2002; Ehrmann et al., 2003). For the Italian case see Gambacorta (2003) and Gambacorta and Mistrulli (2003). 3 tightening on banks’ interest rate should be more pronounced for small, low-liquid and lowcapitalized banks . Apart from these standard indicators other bank-specific characteristics could influence banks’ price-setting behavior (Weth, 2002). Berlin and Mester (1999) claim that banks which heavily depend upon non-insured funding (i.e. bonds) will adjust their deposit rates more (and more quickly) than banks whose liabilities are less affected by market movements. Berger and Udell (1992) sustain that banks that maintain a close tie with their customers will change their lending rates comparatively less and slowly. In this paper the search for heterogeneity in banks’ behavior is carried out by using a balanced panel of 73 Italian banks that represent more than 70 per cent of the banking system. Heterogeneity is investigated with respect to the interest rate on short-term lending and that on current accounts. The use of microeconomic data is particularly appropriate in this context because aggregation may significantly bias the estimation of dynamic economic relations (Harvey, 1981). Moreover, information at the level of individual banks provides a more precise understanding of their behavioral patterns and should be less prone to structural changes like the formation of EMU. The main conclusions of this paper are two. First, heterogeneity in the banking rates pass-through exists, but it is detected only in the short run: no differences exist in the longrun elasticities of banking rates to money market rates. Second, consistently with the existing literature for Italy, interest rates on short-term lending of liquid and well-capitalized banks react less to a monetary policy shock. Also banks with a high proportion of long-term lending tend to change less their prices. Heterogeneity in the pass-through on the interest rate on current accounts depends mainly on banks’ liability structure. Bank’s size is never relevant. The paper is organized as follows. Section 2 describes some institutional characteristics that help to explain the behavior of banking rates in Italy in the last two decades. Section 3 reviews the main channels that influence banks’ interest rate settings trying to disentangle macro from microeconomic factors. After a description of the econometric model and the data in Section 4, Section 5 shows the empirical results. Robustness checks are presented in Section 6. The last section summarizes the main conclusions. 4 2. Some facts on bank interest rates in Italy Before discussing the main channels that influence banks’ price setting, it is important to analyze the institutional characteristics that have influenced Italian bank interest rates in the last two decades. The scope of this section is therefore to highlight some facts that could help in understanding differences, if any, with the results drawn by the existing literature for the eighties and mid-nineties. For example, there is evidence that in the eighties Italian banks were comparatively slow in adjusting their rates (Verga, 1984; Banca d’Italia, 1986, 1988; Cottarelli and Kourelis, 1994) but important measures of liberalization of the markets and deregulation over the last two decades should have influenced the speed at which changes in the money market conditions are transmitted to lending and deposit rates (Cottarelli et al. 1995; Passacantando, 1996; Ciocca, 2000; Angelini and Cetorelli, 2002). In fact, between the mid-1980s and the early 1990s all restrictions that characterized the Italian banking system in the eighties were gradually removed. In particular: 1) the lending ceiling was definitely abolished in 1985; 2) foreign exchange controls were lifted between 1987 and 1990; 3) branching was liberalized in 1990; 4) the 1993 Banking Law allowed banks and special credit institutions to perform all banking activities. In particular, the 1993 Banking Law (Testo Unico Bancario, hereafter TUB) completed the enactment of the institutional, operational and maturity despecialization of the Italian banking system and ensured the consistency of supervisory controls and intermediaries’ range of operations within the single market framework. The business restriction imposed by the 1936 Banking Law, which distinguished between banks that could raise short-term funds (“aziende di credito”) and those that could not (“Istituti di credito speciale”), was eliminated.3 To avoid criticism of structural breaks, the econometric analysis of this study will be based on the period 1993:03-2001:03, where all the main reforms of the Italian banking system had already taken place. 3 For more details see Banca d’Italia, Annual Report for 1993. 5 The behavior of bank interest rates in Italy reveals some stylized facts (see Figures 1 and 2). First, a remarkable fall in the average rates since the end of 1992. Second a strong and persistent dispersion of rates among banks. These stylized facts suggest that both the time series and the cross sections dimensions are important elements in understanding the behavior of bank interest setting. This justifies the use of panel data techniques. The main reason behind the fall in banking interest rates is probably the successful monetary policy aiming at reducing the inflation rate in the country to reach the Maastricht criteria and the third stage of EMU. As a result, the interbank rate decreased by more than 10 percentage points in the period 1993-1999. Excluding the 1995 episode of the EMS crisis, it is only since the third quarter of 1999 that it started to move upwards until the end of 2000 when it continued a declining trend. From a statistical point of view, this behavior calls for the investigation of a possible structural break in the nineties.4 The second stylized fact is cross-sectional dispersion among interest rates. Figure 2 shows the coefficient of variation for loan and deposit rates both over time and across banks in the period 1987-2001.5 The temporal variation (dotted line) of the two rates show a different behavior from the mid of the nineties when the deposit rate is more variable, probably for a catching-up process of the rate toward a new equilibrium caused by the convergence process. Also the cross-sectional dispersion of the deposit rate is greater than that of the loan rate, especially after the introduction of euro.6 4 In the period 1995-98, that coincides with the convergence process towards stage three of EMU, it will be necessary to allow for a change in the statistical properties of interest rates (see Appendix 2). 5 The coefficient of variation is given by the ratio of the standard errors to the mean. The series that refer to the variability “over time” shows the coefficient of variation in each year of monthly figures. In contrast, the series that capture the variability “across banks” shows the coefficient of variation of annual averages of bankspecific interest rates. 6 In the period before the 1993 Banking Law deposit interest rates were quite sticky to monetary policy changes. Deposit interest rate rigidity in this period has been extensively analyzed also for the US. Among the market factors that have been found to affect the responsiveness of bank deposit rates are the direction of the change in market rates (Ausubel, 1992; Hannan and Berger, 1991), if the bank interest rate is above or below a target rate (Hutchison, 1995; Moore, Porter and Small, 1990; Neumark and Sharpe, 1992) and market concentration in the bank’s deposit market (Hannan and Berger, 1991). Rosen (2001) develops a model of price settings in presence of heterogeneous customers explaining why bank deposits interest rates respond sluggishly to some extended movements in monetary market rates but not to others. Hutchinson (1995) presents a model of bank deposit rates that includes a demand function for customers and predicts a linear (but less than one for one) relationship between market interest rate changes and bank interest rate changes. Green (1998) claims that the rigidity is due to the fact that bank interest rate management is based on a two-tier pricing system; banks offer accounts at market related interest rates and at posted rates that are changed at discrete intervals. 6 3. What does influence banks’ interest rate setting? The literature that studies banks’ interest rate setting behavior generally assumes that banks operate under oligopolistic market conditions.7 This means that a bank does not act as a price-taker but sets its loan rates taking into account the demand for loans and deposits. This section reviews the main channels that influence banks interest rates (see Figure 3). A simple analytical framework is developed in Appendix 1. Loan and deposit demand The interest rate on loans depends positively on real GDP and inflation (y and p). Better economic conditions improve the number of projects becoming profitable in terms of expected net present value and, therefore, increase credit demand (Kashyap, Stein and Wilcox, 1993). As stressed by Melitz and Pardue (1973) only increases in permanent income (yP) have a positive influence on loan demand, while the effect due to the transitory part (yT) could also be associated with a self-financing effect that reduces the proportion of bank debt (Friedman and Kuttner, 1993).8 An increase in the money market rate (iM) raises the opportunity cost of other forms of financing (i.e. bonds), making lending more attractive. This mechanism also boosts loan demand and increases the interest rate on loans. The interest rate on deposits is negatively influenced by real GDP and inflation. A higher level of income increases the demand for deposits9 and reduces therefore the incentive for banks to set higher deposit rates. In this case the shift of deposit demand should be higher if the transitory component of GDP is affected (unexpected income is generally first deposited on current accounts). On the contrary, an increase in the money market rate, ceteris paribus, makes more attractive to invest in risk-free securities that represent an alternative to detain deposits; the subsequent reduction in deposits demand determines an upward pressure on the interest rate on deposits. 7 For a survey on modeling the banking firm see Santomero (1984). Among more recent works see Green (1998) and Lim (2000). 8 Taking this into account, in Section 4 I tried to disentangle the two effects using a Beveridge and Nelson (1981) decomposition. 9 The aim of this paper is not to answer to the question if deposits are input or output for the bank (see Freixas and Rochet, 1997 on this debate). For simplicity here deposits are considered a service supplied by the bank to depositors and are therefore considered an output (Hancock, 1991). 7 Operating cost, credit risk and interest rate volatility The costs of intermediation (screening, monitoring, branching costs, etc.) have a positive effect on the interest rate on loans and a negative effect on that of deposits (efficiency is represented by e). The interest rate on lending also depends on the riskiness of the credit portfolio; banks that invest in riskier project will have a higher rate of return in order to compensate the higher percentage of bad loans that have to be written off (j). Banking interest rates are also influenced by interest rate volatility. A high volatility in the money market rate (σ) should increase lending and deposit rates. Following the dealership model by Ho and Saunders (1981) and its extension by Angbazo (1997) the interest rate on loans should be more affected by interbank interest rate volatility with respect to that on deposits (diL/dσ>diD/dσ). This should reveal a positive correlation between interest rate volatility and the spread. Interest rate channel Banking interest rates are also influenced by monetary policy changes. A monetary tightening (easing) determines a reduction (increase) of reservable deposits and an increase (reduction) of market interest rates. This has a “direct” and positive effect on bank interest rates through the traditional “interest rate channel”. Nevertheless, the increase in the cost of financing could have a different impact on banks depending on their specific characteristics. There are two channels through which heterogeneity among banks may cause a different impact on lending and deposit rates: the “bank lending channel” and the “bank capital channel”. Both mechanisms are based on adverse selection problems that affect banks fundraising but from different perspectives. Bank lending channel According to the “bank lending channel” thesis, a monetary tightening has effect on bank loans because the drop in reservable deposits cannot be completely offset by issuing other forms of funding (i.e. uninsured CDs or bonds; for an opposite view see Romer and Romer, 1990) or liquidating some assets. Kashyap and Stein (1995, 2000), Stein (1998) and Kishan and Opiela (2000) claim that the market for bank debt is imperfect. Since nonreservable liabilities are not insured and there is an asymmetric information problem about 8 the value of banks’ assets, a “lemon’s premium” is paid to investors. According to these authors, small, low-liquid and low-capitalized banks pay a higher premium because the market perceives them more risky. Since these banks are more exposed to asymmetric information problems they have less capacity to shield their credit relationships in case of a monetary tightening and they should cut their supplied loans and raise their interest rate by more. Moreover, these banks have less capacity to issue bonds and CDs and therefore they could try to contain the drain of deposits by raising their rate by more. In Figure 3 three effects are highlighted: the “average” effect due to the increase of the money market rate (which is difficult to disentangle from the “interest rate channel”), the “direct” heterogeneous effect due to bank-specific characteristics (Xt-1) and the “interaction effect” between monetary policy and the bank-specific characteristic (iM Xt-1). These last two effects can genuinely be attributed to the “bank lending channel” because bank-specific characteristics influence only loan supply movements. Two aspects deserve to be stressed. First, to avoid endogeneity problems bank-specific characteristics should refer to the period before banks set their interest rates. Second, heterogeneous effects, if any, should be detected only in the short run while there is no a priori that these effects should influence the long run relationship between interest rates. Apart from the standard indicators of size (logarithm of total assets), liquidity (cash and securities over total assets) and capitalization (excess capital over total assets),10 two other bank-specific characteristics deserve to be investigated: a) the ratio between deposits and bonds plus deposits; b) the ratio between long-term loans and total loans. The first indicator is in line with Berlin and Mester (1999): banks that heavily depend upon non-deposit funding (i.e. bonds) will adjust their deposits rates by more (and more quickly) than banks whose liabilities are less affected by market movements. The intuition of this result is that, other things being equal, it is more likely that a bank will adjust her terms 10 It is important to note that the effect of bank capital on the “bank lending channel” cannot be easily captured by the capital-to-asset ratio. This measure, generally used by the existing literature to analyze the distributional effects of bank capitalization on lending, does not take into account the riskiness of a bank portfolio. A relevant measure is instead the excess capital that is the amount of capital that banks hold in excess of the minimum required to meet prudential regulation standards. Since minimum capital requirements are determined by the quality of bank’s balance sheet activities, the excess capital represents a risk-adjusted measure of bank capitalization that gives more indications on the probability of a bank default. Moreover, the excess capital is a relevant measure of the availability of the bank to expand credit because it directly controls for prudential regulation constraints. For more details see Gambacorta and Mistrulli (2004). 9 for passive deposits if the conditions of her own alternative form of refinancing change. Therefore an important indicator to analyze the pass-through between market and banking rates is the ratio between deposits and bonds plus deposits. Banks which use relatively more bonds than deposits for financing purpose fell more under pressure because their cost increase contemporaneously and to similar extent as market rates. The Berger and Udell (1992) indicator represents a proxy for long-term business; those credit institutions that maintain close ties with their non-bank customers will adjust their lending rates comparatively less and slowly. Banks may offer implicit interest rate insurance to risk-averse borrowers in the form of below-market rates during periods of high market rates, for which the banks are later compensated when market rates are low. Having this in mind, banks that have a higher proportion of long-term loans should be more inclined to split the risk of monetary policy change with their customers and preserve credit relationships. For example, Weth (2002) finds that in Germany those banks with large volumes of longterm business with households and firms change their prices less frequently than the others. Bank capital channel The “bank capital channel” is based on three hypotheses. First, there is an imperfect market for bank equity: banks cannot easily issue new equity for the presence of agency costs and tax disadvantages (Myers and Majluf, 1984; Cornett and Tehranian, 1994; Calomiris and Hubbard, 1995; Stein, 1998). Second, banks are subject to interest rate risk because their assets have typically a higher maturity with respect to liabilities (maturity transformation). Third, regulatory capital requirements limit the supply of credit (Thakor, 1996; Bolton and Freixas, 2001; Van den Heuvel, 2001a; 2001b). The mechanism is the following. After an increase of market interest rates, a lower fraction of loans can be renegotiated with respect to deposits (loans are mainly long term, while deposits are typically short term): banks suffer therefore a cost due to the maturity mismatch that reduces profits and then capital accumulation.11 If equity is sufficiently low and it is too costly to issue new shares, banks reduce lending (otherwise they fail to meet 11 In Figure 3, the cost per unit of asset due to the maturity transformation at time t-1 ( ρit −1 ) is multiplied by the actual change in the money market rate ( ∆iM ). For more details see Appendix 1. 10 regulatory capital requirements) and amplify their interest rate spread. This determines therefore an increase in the interest rates on loans and a decrease in that on deposits:12 in the oligopolistic version of the Monti-Klein model, the maturity transformation cost has the same effect of an increase in operating costs. Industry structure The literature underlines two possible impacts of concentration on pricing behavior of banks (Berger and Hannan, 1989). A first class of models claims that more concentrated banking industry will behave oligopolistically (structure-performance hypothesis), while another class of models stresses that concentration is due to more efficient banks taking over less efficient counterparts (efficient-structure hypothesis). This means that in the first case lower competition should result in higher spreads, while in the second case a decrease in managerial costs due to increased efficiency should have a negative impact on the spread. In the empirical part great care will be given therefore to the treatment of bank mergers (see Appendix 2). Nevertheless, the scope of this paper is not to extract policy implications about this issue, for which a different analysis is needed. The introduction of bank-specific dummy variables (µi) tries to control for this and other missing aspects.13 4. Empirical specification and data The equations described in Figure 3 and derived analytically in Appendix 1 are expressed in levels. Nevertheless, since interest rates are likely to be non-stationary variables, an error correction model has been used to capture bank’s interest rate setting.14 Economic theory on oligopolistic (and perfect) competition suggests that, in the long run, both banking rates (on lending and deposits) should be related to the level of the monetary 12 The “bank capital channel” can also be at work even if capital requirement is not currently binding. Van den Heuvel (2001a) shows that low-capitalized banks may optimally forgo lending opportunities now in order to lower the risk of capital inadequacy in the future. This is interesting because in reality, most banks are not constrained at any given time. 13 In Section 6 this hypothesis will be tested introducing a specific measure of the degree of competition that each banks faces. For a more detailed explanation on the effect of concentration on the pricing behavior of Italian banks see Focarelli and Panetta (2003). 14 This is indeed the standard approach used for interest rate equations (Cottarelli et al. 1995; Lim, 2000; Weth 2002). From a statistical point of view, the error correction representation is adopted because the lending rate and the deposit rate result to be cointegrated with the money market rate. 11 rate, that reflects the marginal yield of a risk-free investment (Klein, 1971). We have: 2 (1) 1 ∆i L k ,t = µ k + å κ j ∆i L k ,t − j + å ( β j + β *j X k ,t −1 ) ∆i M t − j + ϕ p t + δ 1 ∆ ln y tP + δ 2 ∆ ln y tT + λX k ,t −1 + j =1 j =0 φ∆ ( ρ k ,t −1 ∆i M t ) + (α + α X k ,t −1 )i L k ,t −1 + (γ + γ * X k ,t −1 )i M t −1 + θ j k ,t + ξ e k ,t + ψσ t + Φ k ,t + ε k ,t * 1 2 (2) ∆i D k ,t = µ k + å κ j ∆i D k ,t − j + å ( β j + β *j X k ,t −1 )∆i M t − j + ϕ p t + δ 1 ∆ ln y tP + δ 2 ∆ ln y tT + λX k ,t −1 + j =1 j =0 φ∆ ( ρ k ,t −1 ∆i M t ) + (α + α X k ,t −1 )i D k ,t −1 + (γ + γ * X k ,t −1 )i M t −1 + ξ e k ,t + ψσ t + Φ k ,t + ε k ,t * with k=1,…, N (k=number of banks) and t=1, …,T (t= periods). Data are quarterly (1993:032001:03) and not seasonally adjusted. The panel is balanced with N=73 banks. Lags have been selected in order to obtain white noise residuals. The description of the variables is reported in Table 1.15 The model allows for fixed effects across banks, as indicated by the bank-specific intercept µi. The long-run elasticity between each banking rate and the money market rate is given by: (γ + γ * X k ,t −1 ) /(α + α * X k ,t −1 ) . Therefore to test if the pass-through between the money market rate and the banking rate is complete it is necessary to verify that this elasticity is equal to one. If this is the case there is a one-to-one long-run relationship between the lending (deposit) rate and the money market rate, while the individual effect µi influences the bank-specific mark-up (mark-down). The loading coefficient (α + α * X k ,t −1 ) must be significantly negative if the assumption of an equilibrium relationship is correct. In fact, it represents how many percent of an exogenous variation from the steady state between the rates is brought back towards the equilibrium in the next period.16 The degree of banks’ interest rate stickiness in the short run can be analyzed by the impact multiplier ( β 0 + β 0* X k ,t −1 ) and the total effect after three months.17 15 For more details on data sources, variable definitions, merger treatment and trimming of the sample see Appendix 2. 16 Testing for heterogeneity in the loading coefficient means to verify if α * is significant or not. At the same time heterogeneity in the long-run elasticity can be proved if α *γ − αγ * is statistically different from zero. 17 In the first case heterogeneity among banks is simply tested through the significance of β 0 while in the * second case, since the effect is given by a convolution of the structural parameters it is possible to accept the 12 The variable Xk,t-1 represents a bank-specific characteristic that economic theory suggests to influence only loan and deposit supply movements, without affecting loan and deposit demands. In particular, all bank-specific indicators ( χ k ,t ) have been re-parameterized in the following way: N æ ö ç T å χ k ,t ÷ ÷ /T X k ,t = χ k ,t − ç å k =1 ç t =1 N ÷ ç ÷ è ø Each indicator is therefore normalized with respect to the average across all the banks in the respective sample, in order to obtain a variable whose sum over all observations is zero.18 This has two implications. First, the interaction terms between interest rates and X k , t −1 in equations (1) and (2) are zero for the average bank (this because X k ,t −1 =0). Second, the coefficients β0, β1, α and γ are directly interpretable as average effects. To test for the existence of a “bank capital channel” we have introduced the variable ρ k , t −1∆iM that represents the bank-specific cost of monetary policy due to maturity transformation. In particular ρ k , t −1 measures the loss per unit of asset a bank suffers when the monetary policy interest rate is raised of one percent. The cost at time t is influenced by the maturity transformation in t-1. This variable is computed according to supervisory regulation relative to interest rate risk exposure that depends on the maturity mismatch among assets and liabilities (see Appendix 2 for further details). To work out the real cost we have therefore multiplied ρ k , t −1 for the realized change in interest rates. Therefore ρ k , t −1∆iM represents the cost (gain) that a bank suffers (obtain) in each quarter. As formalized in Appendix 1, this measure influences the level of bank interest rates. Since the model is expressed in error correction form we have included this variable in first difference as well. null hypothesis of absence of heterogeneity if and only if éë β 0α * + β 0* (1 + α + κ 1 ) + β1* + γ * ùû X k ,t −1 + α * β 0* X k2,t −1 is equal to zero. The significance of this expression has been checked using the delta method (Rao, 1973). 18 The size indicator has been normalized with respect to the mean on each single period. This procedure removes trends in size (for more details see Ehrmann et al., 2003). 13 4.1 Characteristics of the dataset The dataset includes 73 banks that represent more than 70 per cent of total Italian banking system in term of loans over the whole sample period. Since information on interest rates is not available for Mutual banks, the sample is biased towards large banks. Foreign banks and special credit institution are also excluded. This bias toward large banks has two consequences. First, the distributional effects of the size variable would be treated with extreme cautious because a “small” bank inside this sample could not be considered with the same characteristic using the full population of Italian banks.19 The size grouping in this study mainly controls for variations in scale, technology and scope efficiencies across banks but it is not able to shed light on differences between Mutual and other banks. Second, results for the average bank will provide more “macroeconomic insights” than studies on the whole population (where the average bank dimension is very small). Table 2 gives some basic information on the dataset. Rows are organized dividing the sample with respect to the bank-specific characteristics that are potential candidates to cause heterogeneous shifts in loan supply in case of a monetary policy shock. On the columns, the table reports summary statistics for the two interest rates and for each indicator. Several clear patterns emerge. Considering size, small banks charge higher interest rates on lending but show a lower time variation. This fits with the standard idea of a close customer relationships between small firms and small banks that provides them with an incentive to smooth the effect of a monetary tightening (Angelini, Di Salvo and Ferri, 1998). Moreover, small banks are more liquid and capitalized than average and this should help them to reduce the effect of cyclical variation on supplied credit. On the liability side, the percentage of deposits (overnight deposits, CDs and savings accounts) is greater among small banks, while their bonds issues are more limited than the ones of large banks. Nevertheless, there are no significant differences that emerge in the level and volatility of the interest rate on current accounts. 19 In particular, banks that are considered “small” in this study are labeled as “medium” in other studies for the Italian banking system that analyze quantities (see for example, Gambacorta, 2003; Gambacorta and Mistrulli, 2004). This is clear noting that the average assets of a “small” bank in my data (1.6 billions of euros) over the sample period is very similar to that of the “medium” bank of the total system (1.7 billions of euros). 14 High-liquid banks are smaller than average and are more capitalized. These characteristics should reduce the speed of the “bank lending channel” transmission through interest rates. In particular, since deposits represent a high share of their funding they should have a smoother transmission on passive rates. Well-capitalized banks make relatively more short-term loans. They are in general not listed and issue less subordinated debt to meet the capital requirement. This evidence is consistent with the view that, ceteris paribus, capitalization is higher for those banks that bear more adjustment costs from issuing new (regulatory) capital. Well-capitalized banks charge a higher interest rate on lending; this probably depend upon their higher ratios of bad loans that increase their credit risk. In other words their higher capitalization is necessary to face a riskier portfolio. Moreover, the interest rate on deposit is lower for low-capitalized banks indicating that agents do not perceive these deposits as riskier than those at other banks. This has two main explanations. First, the impact of bank failures has been very small in Italy, especially with respect to deposits.20 Second, the presence of deposit insurance that insulates deposits of less capitalized banks from the risk of default.21 The Berlin-Mester and the Berger-Udell indicators seem to have a high power in explaining heterogeneity in banks’ price setting behavior. Differences in the standard deviations of the two groups are particularly sensitive, calling for a lower interest rates variability of banks with a high percentage of deposits and long-term loans. 20 During our sample period, the share of deposits of failed banks to total deposits approached 1 per cent only twice, namely in 1987 and 1996 (Boccuzzi, 1998). 21 Two explicit limited-coverage deposit insurance schemes (DISs) currently operate in Italy. Both are funded ex-post; that is, member banks have a commitment to make available to the Funds the necessary resources should a bank default. All the banks operating in the country, with the exception of mutual banks, adhere to the main DIS, the ‘Fondo Interbancario di Tutela dei Depositi’ (FITD). Mutual banks (‘Banche di Credito Cooperativo’) adhere to a special Fund (‘Fondo di Garanzia dei Depositanti del Credito Cooperativo’) created for banks belonging to their category. The ‘Fondo Interbancario di Tutela dei Depositi’ (FITD), the main DIS, is a private consortium of banks created in 1987 on a voluntary basis. In 1996, as a consequence of the implementation of European Union Directive 94/19 on deposit guarantee schemes, the Italian Banking Law regulating the DIS was amended, and FITD became a compulsory DIS. FITD performs its tasks under the supervision of and in cooperation with the banking supervision authority, Banca d’Italia. The level of protection granted to each depositor (slightly more than 103,000 euros) is one of the highest in the European Union. FITD does not adopt any form of deposit coinsurance. 15 5. Results The main channels that influence the interest rate on short term lending and that on current accounts are summarized, respectively, in Tables 3 and 4. The first part of each table, show the influence of the permanent and transitory component of real GDP and inflation. These macro variables capture cyclical movements and serves to isolate shifts in loan and deposit demand from monetary policy changes. The second part of the tables presents the effects of bank’s efficiency, credit risk and interest rate volatility. The third part highlights the effects of monetary policy. These are divided into four components: i) the immediate pass-through; ii) the one-quarter pass-through; iii) the long-run elasticity between each banking rate and the monetary policy indicator; iv) the loading coefficient of the cointegrating relationship.22 The last part of the tables shows the significance of the “bank capital channel”. Each table is divided in five columns that highlight, one at the time, heterogeneous behavior of banks with different characteristics in the response to a monetary shock. The existence of distributional effects is tested for all the four components of the monetary policy pass-through. The models have been estimated using the GMM estimator suggested by Arellano and Bond (1991) which ensures efficiency and consistency provided that the models are not subject to serial correlation of order two and that the instruments used are valid (which is tested for with the Sargan test).23 22 The immediate pass-trough is given by the coefficient β 0 + β 0* X k ,t −1 and heterogeneity among banks is simply tested through the significance of β 0* . The effect for a bank with a low value of the characteristic under 0.25 evaluation is worked out through the expression β 0 + β 0* X k0.25 , t −1 , where X k , t −1 is the average for the banks below the first quartile. Vice versa the effect for a bank with a high value of the characteristic is calculated using X k0.75 , t −1 . The total effect after three months for the average bank is given by β 0 (1 + α1 + κ 1 ) + β1 + γ ' while heterogeneity among banks can be accepted if and only if the expression éë β 0α * + β 0* (1 + α + κ 1 ) + β1* + γ * ùû X k ,t −1 + α * β 0* X k2,t −1 is equal to zero. The long run elasticity is given by: (γ + γ * X k ) /(α + α * X k ) , while the loading coefficient is α1 + α1* X k ,t −1 . Standard errors have been approximated with the “delta method” (Rao, 1973). 23 In the GMM estimation, instruments are the second lag of the dependent variable and of the bank-specific characteristics included in each equation. Inflation, GDP growth rate and the monetary policy indicator are considered as exogenous variables. 16 Loan and deposit demand As predicted by theory only changes in permanent income have a positive and significant effect on the interest rate on short term lending while the transitory component is never significant. In fact, as discussed in Section 3, the effect of transitory changes may be also due to a self-financing effect that reduces the proportion of bank debt. On the contrary the interest rate on deposits is negatively influenced by real GDP. In this case the effect is higher when a change in the transitory component occurs because it is directly channeled through current accounts. The effect of inflation is positive on both interest rates but is significantly higher for short-term lending. Operating costs, credit risk and interest rate volatility Bank’s efficiency reduces the interest rate on loans and increase that of deposits. Nevertheless, the effect is not always significant at conventional levels, especially in the equation for the interest rate on current accounts. These results call for further robustness checks using a cost-to-asset ratio (see Section 6). The relative amount of bad loans has a positive and significant effect on the interest rate on loans. This is in line with the standard result that banks that invest in riskier project ask for a higher rate of return to compensate credit risk. Both banking rates are positively correlated with money market rate volatility. The correlation is higher for the interest rate on loans with respect to that of deposits. This is consistent with the prediction of the dealership model by Ho and Saunders (1981) and its extension by Angbazo (1997) where an increase in interbank interest rate volatility is associated with a higher spread. Bank capital channel As expected the “bank capital channel” (based on the maturity mismatch between bank’s assets an liabilities, see Section 3) has a positive effect on the interest rate on shortterm lending and a negative effect on the interest rate on current account. The absolute values of the coefficients are greater in the first case calling for a stronger adjustment on credit contracts than on deposits. Since this channel can be interpreted similarly to a general 17 increase in the costs for the banks, it is worth comparing this result with that obtained for the efficiency indicator. In both cases the effect is strongest for the interest rate on short-term lending and this is consistent with the view that the interest rate on deposit is more sluggish. Interest rate channel A monetary tightening positively influences banks’ interest rate. After a one per cent increase in the monetary policy indicator, interest rate on short term lending are immediately raised of around 0.5 per cent and of around 0.9 per cent after a quarter. Moreover, the passthrough is complete in the long run (the null hypothesis of a unitary elasticity is accepted in all models). The reaction of the short term lending rate is higher with respect to previous studies on the Italian case and this calls for an increase in competition after the introduction of the 1993 Banking Law. Cottarelli et al. (1995), analyzing the period 1986:02-1993:04, find that the immediate pass through is of around 0.2, while the effect after three months is 0.6 per cent. Their long run elasticity is equal to 0.9 per cent but also in their model the null hypothesis of a complete pass-through in the long run is accepted.24 The long run elasticity of the interest rate on current accounts is around 0.7 per cent. This result is in line with the recent findings by de Bondt et al. (2003) under a similar sample period and only a little higher with respect to the long-run elasticity in Angeloni et al. (1995) for the period 1987:1-1993:04.25 The standard answer to the incomplete pass-through of money market changes on the deposit rate is the existence of market power by banks. Another explanation is the presence of compulsory reserves. To analyze this, we can refer to the theoretical elasticity in the case 24 The main differences between Cottarelli et al. (1995) and this paper are three. First, they use the Treasury bill rate as the reference monetary interest rate. However from the early nineties this indicator became less important as “reference rate” because the interbank market became more competitive and efficient (Gaiotti, 1992). This is indeed stated also by Cottarelli et al. (page 19). Second, they do not include macro variables controls in their equation. Third, their dataset is based on monthly data. To allow comparability among the results of this paper and those in Cottarelli et al. (1995) I have: 1) checked the results to different monetary policy indicators (i.e. the interbank rate; see Section 6); 2) excluded the macro variables from equation (1) to verify if the results were sensitive to their inclusion. In all cases the conclusion of an increase of speed in the reaction of short-term interest rate on loans to money market rate resulted unchanged. 25 The VAR model in Angeloni et al. considers the interest rate on total deposits (sight, time deposits and CDs), which is typically more reactive to monetary policy than that on current account because the service component in time deposits and CDs is less important. This means that in comparing our result with Angeloni et al. we are underestimating the potential effect of competition. 18 of perfect competition.26 This benchmark case is very instructive because it allows to analyze what happens if banks are price takers (they take as given not only the monetary market rate but also the interest rate on loans and that on deposits), set the quantity of loans and deposits and obtain a zero profit (the sum of the intermediation margins equals management costs). In this case the long-run elasticities become: ∂iL ∂i = 1 and D = 1 − α where α is the fraction of ∂iM ∂iM deposits invested in risk-free assets (this includes the “compulsory” reserves). Therefore in principle, an incomplete pass-through from market rates to deposits rates is also consistent with the fact that banks decide (or are constrained by regulation) to detain a certain fraction of their deposits in liquid assets. The loading coefficients are significantly negative. It is around –0.4 in the loan equation and –0.6 in the current account equation. This means that if an exogenous shock occurs, respectively 40 and 60 per cent of the deviation is canceled out within the first quarter in each banking rate. Bank lending channel In case of a monetary shock, banks with different characteristics behave differently only in the short run. On the contrary no heterogeneity emerges in the long run relationship between each banking rate and the monetary policy indicator. Considering each bank’s specific characteristic one at the time (Tables 3 and 4), interest rates of small, liquid and well-capitalized banks react less to a monetary policy shock. Also the Berlin-Mester and the Berger-Udell indicators have an high power in explaining heterogeneity in banks’ price setting behavior. Nevertheless, the robustness of these distributional effects has to be checked in a model that takes all these five indicators together into account. In this model, in order to save degrees of freedom, the long-run elasticity between the money market rate and the short- 26 The case of perfect competition can be easily obtained from equation (A1.8) and A1.9) in Appendix 1 considering loan and deposit demand (equations A1.3 and A1.4) infinitely elastic with respect the bank rates (c0→∞, d0→∞). Moreover, we will consider the benchmark case were no heterogeneity emerges in the “bank lending channel” (b1=0) and bonds can be issued at the risk free rate (b0=1). See Freixas and Rochet (1997) for an analogous treatment. 19 term lending rate has been imposed to one; that with the interest rate on current account has been fixed to 0.7. Results are reported in Table 5. Interest rates on short-term lending of liquid and wellcapitalized banks react less to a monetary policy shock. Also banks with a high proportion of long-term lending tend to change less their prices. Size is not significant. This evidence matches with previous results on lending. Liquid banks can protect their loan portfolio against a monetary tightening simply by drawing down cash and securities (Gambacorta, 2003). Well-capitalized banks that are perceived as less risky by the market are better able to raise uninsured funds in order to compensate the drop in deposits (Gambacorta and Mistrulli, 2004). Therefore the effects on lending detected for liquid and well-capitalized banks are mirrored by their higher capacity to insulate the clients also from the effects on interest rates. It is interesting to note that, in contrast with the evidence for the US (Kashyap and Stein; 1995), the interaction terms between size and monetary policy are insignificant. The fact that the interest rate on short term lending of smaller banks is not more sensitive to monetary policy than that of larger banks is well documented in the literature for Italy and reflects the close customer relationship between small banks and small firms (Angeloni et al. 1995; Conigliani et al., 1997; Angelini, Di Salvo and Ferri, 1998; Ferri and Pittaluga, 1996). This result is also consistent with Ehrmann et al. (2003) where size does not emerge as a useful indicator for the distributional effect of monetary policy on lending not only in Italy but also in France, Germany and Spain. As regards the interest rate on current accounts, the Berlin-Mester indicator is the only bank-specific characteristic that explains heterogeneity in banks price setting behavior. In particular, banks that heavily depend upon non-deposit funding (banks with a low BM indicator) will adjust their interest rate on current account by more (and more quickly) than banks whose liabilities are less affected by market movements. As explained in Section 3, the intuition of this result is that, other things being equals, it is more likely that a bank will adjust her terms on deposits if the other conditions of her refinancing change. The liability structure seems to influence not only the short-run adjustment but also the loading coefficient. This implies that banks with a high BM ratio react less when there is a deviation in the long run mark-down: banks with a higher percentage of deposits have more room in adjusting their prices toward the optimal equilibrium. As expected, no cross sectional 20 differences emerges among banks due to size, liquidity and capitalization because current accounts are typically insured. 6. Robustness checks The robustness of the results has been checked in several ways. The first test was to introduce as additional control variable a bank-specific measure of the degree of competition that each bank faces in the market. In particular, the average value of the Herfindahl index in the different “local markets” (corresponding to the administrative provinces of Italy) in which the bank operates was introduced in each equation. The reason of this test is that the fixed effect (that captures also industry structure) remains stable over the whole period while the degree of competition could change over time due to the effect of concentration. Therefore this test allows us also to check if the treatment of bank mergers is carried out properly. The Herfindahl index did not show to be statistically significant and the results of the study did not change. The second test was to use as bank’s efficiency indicator the cost-to-total asset ratio instead than the ratio of total loans and deposits to the number of branches. In all cases the results remained unchanged. The third test was to consider if different fiscal treatments over the sample period could have changed deposit demand (from June 1996 the interest rate on current account is subject to a fiscal deduction of 27 per cent; 12.5 per cent before). However, using the net interest rate on current account instead than the gross rate nothing changed. The fourth robustness check was the introduction of a dummy variables to take into account of the spike in the change of the repo interest rate caused by the EMS crisis in the first quarter of 1995. Also in this case results remained the same. The fifth test was to introduce additional interaction terms combining the bank-specific characteristic with inflation, permanent and transitory changes in real income. The reason for this test is the possible presence of endogeneity between bank characteristics and cyclical factors. Performing the test, however, nothing changed, and the double interactions were almost always not significant (it turned out to be statistically not different from zero in the case of the interaction of capitalization and permanent income). 21 The final robustness check was to introduce a dummy variable that indicates if the bank belongs to a group (1) or not (0). Banks belonging to a group may be less influenced by monetary changes if they can benefit of an internal liquidity management; in other words, bank holding companies establish internal capital markets in an attempt to allocate capital among their various subsidiaries (Houston and James, 1998; Upper and Worms, 2001). The introduction of this dummy did not change the results of the study. 7. Conclusions This paper investigates which factors influence price setting behavior of Italian banks. It adds to the existing literature in two ways. First, it analyzes systematically a wide range of micro and macroeconomic variables that have an effect on bank interest rates: permanent and transitory changes in income, interest and credit risk, interest rate volatility, banks’ efficiency. Second, the analysis of banks’ prices (rather than quantities) provides an alternative way to disentangle loan supply from loan demand shift in the “bank lending channel” literature. The search for heterogeneity in banks’ behavior is carried out by using a balanced panel of 73 Italian banks that represent more than 70 per cent of the banking system. The use of microeconomic data help in reducing the problems of aggregation that may significantly bias the estimation of dynamic economic relations and it is less prone to structural changes like the formation of EMU. The main results of the study are the following. First, heterogeneity in the banking rates pass-through exists, but it is detected only in the short run: no differences exist in the long-run elasticities of banking rates to the money market rate. Second, consistently with the existing literature for Italy, interest rates on short-term lending of liquid and well-capitalized banks react less to a monetary policy shock. Also banks with a high proportion of long-term lending tend to change their prices less. Heterogeneity in the pass-through on the interest rate on current accounts depends on banks’ liability structure. Bank’s size is never relevant. Appendix 1 - A simple theoretical model This Appendix develops a one-period model of a risk neutral bank that operates under oligopolistic market conditions. The balance sheet of the representative bank is as follows: (A1.1) L + S = D + B + K where L stands for loans, S for securities, D for deposits, B for bonds, K for capital. The bank holds securities as a buffer against contingencies. We assume that security holdings are a fixed share of the outstanding deposits (α). They represent a safe asset and fruit the risk-free interest rate.27 We have therefore: (A1.2) S = α D For simplicity, bank capital is exogenously given in the period and greater than capital requirements.28 The bank faces a loan demand and a deposit demand. The first one is given by: (A1.3) Ld = c0 i L + c1 y + c 2 p + c3 i M (c0<0, c1>0, c2>0, c3>0) that is negatively related to the interest rate on loans (il ) and it is positively related to real income (y) and prices (p) and the opportunity cost of self-financing, proxied by the money market interest rate (im).29 Alternatively S can be considered as the total amount of bank’s liquidity, where α is the coefficient of free and compulsory reserves. In this case reserves are remunerated by the money market rate fixed by the Central Bank. This alternative interpretation does not change the results of the model. 27 28 In the spirit of the actual BIS capital adequacy rules, capital requirements on credit risks are given by a fixed amount (k) of loans. If bank capital perfectly meets Basle standard requirement the amount of loans would be L=K/k. We rule out this possibility because banks typically hold a buffer as a cushion against contingencies (Wall and Peterson, 1987; Barrios and Blanco, 2001). Excess capital allows them to face capital adjustment costs and to convey positive information on their economic value (Leland and Pile, 1977; Myers and Majluf, 1984). Another explanation is that banks face a private cost of bankruptcy, which reduces their expected future income (Dewatripont and Tirole, 1994). Van den Heuvel (2001a) argues that even if capital requirement is not currently binding, a low capitalized bank may optimally forego profitable lending opportunities now, in order to lower the risk of future capital inadequacy. A final explanation for the existence of excess capital is given by market discipline; well-capitalized banks obtain a lower cost of uninsured funding, such as bonds or CDs, because they are perceived less risky by the market (Gambacorta and Mistrulli, 2004). 29 As far as the GDP is concerned, there is no clear consensus about how economic activity affects credit demand. Some empirical works underline a positive relation because better economic conditions would 23 The deposit demand is standard. It depends positively on the interest rate on deposits, the level of real income (the scale variable) and the price level and negatively on the interest rate on securities that represent an alternative to the investment to deposits. (A1.4) D d = d 0id + d1 y + d 2 p + d 3im (d0>0, d1>0, d2>0, d3<0) Because banks are risky and bonds are not insured, bond interest rate incorporates a risk premium that we assume depends on specific banks’ characteristics. The latter are balance sheet information or institutional characteristics exogenously given at the end of previous period. (A1.5) ib ( im , xt −1 ) = b0im + b1im xt −1 + b2 xt −1 (b0>1) In other words, this assumption implies that the distributional effects via the bank lending channel depends on some characteristics that allow the bank to substitute insured, typically deposits, with uninsured banks’ debt, like bonds or CDs (Romer and Romer, 1990). For example, theory predicts that big, liquid and well-capitalized banks should be perceived less risky by the market and obtain a lower cost on their uninsured funding (b2<0). Moreover they could react less to monetary change (b1<0) The effects of the so-called “bank capital channel” are captured by the following equation: (A1.6) C MT = ρt −1∆im ( L + S ) (ρ >0) where C MT represents the total cost suffered by the bank in case of a change in monetary policy due to the maturity transformation. Since loans have typically a longer maturity than improve the number of project becoming profitable in terms of expected net present value and, therefore, increase credit demand (Kashyap, Stein and Wilcox, 1993). This is also the hypothesis used in Bernanke and Blinder (1988). On the contrary, other works stress the fact that if expected income and profits increase, the private sector has more internal source of financing and this could reduce the proportion of bank debt (Friedman and Kuttner, 1993). A compromise position is taken by Melitz and Pardue (1973): only increases in permanent income have a positive influence on loan demand, while the effect due to the transitory part could also be associated with a self-financing effect in line with Friedman and Kuttner. Taking this into account, in the econometric part (see Section 4) I will try to disentangle the two effects using a Beveridge and Nelson (1981). For simplicity in the model I assume that the first effect dominates and that a higher income determines an increase in credit demand (c2>0). This is indeed consistent with the evidence provided by Ehrmann et al. (2001) for the four main countries of the euro area. 24 bank fund-raising, the variable ρ represents the cost (gain) per unit of asset that the bank incurs in case of a one per cent increase (decrease) in the monetary policy interest rate. The cost of intermediation is given by: (A1.7) C IN = g1 L + g 2 D (g1>0, g2>0) where the component g1L can be interpreted as screening and monitoring cost while g2D as the cost of the branching.30 Loans are risky and, in each period, a percentage j of them is written off from the balance sheet, therefore reducing bank’s profitability. The representative bank maximizes her profits subject to the balance-sheet constraint. The bank optimally sets the interest rates on loans and deposits (iL, iD), while she takes the money market interest rate (iM) as given (it is fixed by the Central Bank). Max π = (iL − j ) L + im S − iD D − iB B − C MT − C IN il ,id s.t. L+Q = D+ B+ K Solving the maximization problem, the optimal levels of the two interest rates are: (A1.8) iL = Ψ 0 + Ψ1 p + (Ψ 2 + Ψ 3 xt −1 )im + Ψ 4 y P + Ψ 5 ρt −1∆im + Ψ 6 j + Ψ 7 xt −1 (A1.9) id = Φ 0 + Φ1 p + (Φ 2 + Φ 3 xt −1 )im + Φ 4 y P + Φ 5 ρt −1∆im + Φ 6 xt −1 where: g1 c b c c b 1 > 0 ; Ψ1 = 2 > 0 ; Ψ 2 = 0 + 3 > 0 ; Ψ 3 = 1 ; Ψ 4 = 1 > 0 ; Ψ 5 = ; 2 −2c0 2 −2c0 −2c0 2 2 b (1 − α ) −d 3 α g d b 1 Φ0 = − 2 < 0 ; Ψ7 = 2 Φ2 = 0 + + >0; Φ1 = − 2 < 0 ; Ψ6 = ; 2 2d 0 2 2 2d 0 2 2 d b (1 − α ) α b (1 − α ) Φ3 = − 1 ; Φ 4 = − 1 < 0 ; Φ5 = − < 0 ; Φ6 = 2 . 2d 0 2 2d 0 2 Ψ0 = 30 The additive linear form of the management cost simplifies the algebra. The introduction of a quadratic cost function would not have changed the result of the analysis. An interesting consequence of the additive form of the management cost is that bank’s decision problem is separable: the optimal interest rate on deposits is independent of the characteristic of the loan market while the optimal interest rate on loans is independent of the characteristics of the deposit market. For a discussion see Dermine (1991). 25 Equation (A1.8) states that a monetary tightening determines an increase in the interest rate on loans (Ψ2>0): the total effect could be divided into two parts: the “bank lending channel” (b0/2>0) and the “opportunity cost” effect (-c3/2c0>0) The effect of a monetary squeeze is smaller if the bank-specific characteristic reduces the impact of monetary policy on the cost of funding (b1<0 and Ψ3<0). In this case banks have a greater capacity to compensate the deposit drop by issuing uninsured funds at a lower price. Loan interest rate reacts positively to an output expansion (Ψ4>0) and to a raise in prices (Ψ1>0). The effect of the so-called “bank capital channel” is also positive ( Ψ 5 > 0 ); due to the longer maturity of bank assets with respect to liabilities (ρ>0), in case of a monetary tightening ( ∆im >0) the bank suffers a cost and a subsequent reduction in profit; given the capital constraint, this effect determines an increase in loan interest rates (the mirror effect is a decrease in lending). The equation (A1.9) for deposit interest rate is slightly different. Also in this case the impact of a monetary tightening is positive (Φ2>0) but it can now be split in three parts: the “bank lending channel” (b0(1-α)/2>0), the “opportunity cost” (-d3/2d0>0) and the “liquidity buffer”(α/2>0) effects. The intuition of this result is that a monetary squeeze automatically increase the cost of borrowing of bank uninsured fund and the return on securities (the alternative investment for depositors); therefore the first two effects push the bank to increase the interest rate on deposits to raise more insured funds. The percentage of deposits invested in securities (α) act, on the one hand, as a simple “reserve coefficient” that reduces the effectiveness of the “bank lending channel” while, on the other, it increases the revenue on liquid portfolio and the market power of the bank to offset the interest rate on deposits. The distributional effects of monetary policy are equal to the ones described above for the interest rate on loans. The effects on the cost of deposits are smaller for banks with certain characteristics only if b1<0 and Ψ3<0. Deposit interest rate reacts negatively to an output expansion (Φ4<0) and to an increase in prices (Φ1<0). An economic expansion pushes the deposits demand to the left and causes a decrease in cost of deposits (remember that deposit demand is upward sloping with respect to id). The effect should be greater for increases in transitory income. Also the effect of the “bank capital channel” are negative (Φ5<0); as we have seen, in case of a monetary tightening (ρ ∆im >0) the bank suffers a cost and a reduction in profit; this induces the bank to increase her interest rate margin, reducing the interest rates on deposits. 26 Appendix 2 – Technical details on the data The dataset has been constructed using three sources. Interest rates are taken from the 10-day report survey conducted by the Bank of Italy. Bank’s balance sheet information comes from the Banking Supervision Register at the Bank of Italy. Data on macroeconomic variables are taken from the International Financial Statistics. Data on interest rates refer to transactions in euros (Italian lira before 1999). The deposit interest rate is the weighted average rate paid by the single banks on current accounts, which are highly homogenous deposits products.31 The rate on domestic shortterm lending for the single bank is the weighted average of all lending positions. From this computation, overdraft fees are excluded. The choice of the short-term rate as a measure of the bank interest lending pass-through is due to several reasons. First, short-term lending excludes subsidized credit. Second, short-term loans typically are not collateralised and this allows insulating the “bank lending” channel from the “balance sheet” channel. Broadly speaking, the pass-through from market interest rates to the interest rate on loans does not depend upon market price variations that influence the value of collateral. Nearly half of bank’s business is done at this rate. Both interest rates are posted rates that are changed at discrete intervals (often less frequently than weekly, see Green, 1998). In our case, the quarterly frequency of the data is sufficient enough to capture all relevant changes due to a monetary policy shock. Both rates are gross of fiscal deduction. The interest rate taken as monetary policy indicator is that on repurchase agreements between the Bank of Italy and credit institutions in the period 1993-1998, and the interest rates on main refinancing operation of the ECB for the period 1999-2001.32 31 Current accounts are the most common type of deposit (at the end of 2001 they represented around 70 per cent of total bank deposits and passive repos). Current accounts allow unlimited checking for depositor that can close the account without notice. The bank, in turn, can change the remuneration of the account at any point in time. Therefore differences in deposit rates are not influenced by heterogeneity in maturity (see Focarelli and Panetta, 2003). 32 As pointed out by Buttiglione, Del Giovane and Gaiotti (1997), in the period under investigation the repo rate mostly affected the short-term end of the yield curve and, as it represented the cost of banks’ refinancing, it represented the value to which market rates and bank rates eventually tended to converge. The interest rate on main refinancing operation of the ECB does not present any particular break with the repo rate. 27 The cost a bank suffers from her maturity transformation function is due to the different sensitivity of her assets and liabilities to interest rates. Using a maturity ladder, we have: å(χ ⋅ A −ζ P ) *100 ρ = åA j j j j j i j j where Aj (Pj) is the amount of assets (liabilities) of j months-to-maturity and χj (ζj) measures the increase in interest on assets (liabilities) of class j due to a one-per-cent increase in the monetary policy interest rate (∆im=0.01). In other words, if å ( χ ⋅ A − ζ P ) >0, ρ j j j j i j represents the cost per unit of asset bank i suffers in case the monetary policy interest rate is raised of one percentage point. We obtain χi and ζi directly from supervisory regulation on interest rates risk exposure. In particular, the regulation assumes, for any given class j of months-to-maturity: 1) the same sensitivity parameter (χj =ζj) and 2) a non-parallel shift of the yield curve (∆im=0.01 for the first maturity class and then decreasing for longer maturity classes). Then, for each bank, after having classified assets and liabilities according to their months-to-maturity class, we have computed the bank specific variable ρi . This variable has been then multiplied by the change of the monetary policy indicator (∆im) to obtain the realized loss (or gain) per unit of asset in each quarter. In assembling our sample, the so-called special credit institutions (long-term credit banks) have been excluded since they were subject to different supervisory regulations regarding the maturity range of their assets and liabilities. Nevertheless, special long-term credit sections of commercial banks have been considered part of the banks to which they belonged. Particular attention has been paid to the treatment of mergers. In practice, it has been assumed that these have been taken place at the beginning of the sample period, summing the balance-sheet items of the merging parties. For example, if bank A has been incorporated by bank B at time t, bank B has been reconstructed backward as the sum of the 28 merging banks before the merger. Bank interest rates have been reconstructed backwards using as weights short-term loans and current accounts of the merging parties.33 Only banks reporting detailed lending and deposit rates over the whole sample period were considered. I refrain from adopting short time series to ensure sufficient asymptotic in the context of the error correction estimation. Bank observations that were missing or misreported or that constituted clear outliers were excluded from the sample. Bad loans are defined as loans for which legal procedures aimed at their repayment have been started. The permanent component of GDP has been computed using the Beveridge and Nelson (1981) decomposition. An ARIMA model (1,1,1) was applied to the logarithm of the series. Computations have been carried out using the algorithm described in Newbold (1990). Robustness of the results have been checked by means of a statistical analysis of the residuals. The possible presence of structural breaks in interest rates series have been investigated by means of the procedure developed by Banerjee, Lumsdaine and Stock (1992). Figure A1 shows sequential test for changes in the mean of each interest rate series. The hypothesis of this procedure is that, if there is a break, its date is not known a priori but rather is gleaned from the data. The results clearly show that unit-root/no-break null can be rejected at the 2.5 per cent critical value level against the stationarity/mean-shift alternative for the period 1995:03-1998:03. In equation (1) and (2) a convergence dummy, that takes the value of 1 in this period and 0 elsewhere, has been introduced. 33 The same methodology has been used, among others by Peek and Rosengreen (1995), Kishan and Opiela (2000) and Ehrmann et al. (2001). References Altunbas Y., Fazylow O. and Molyneux P. (2002), “Evidence on the Bank Lending Channel in Europe”, Journal of Banking and Finance, forthcoming. Angbazo, L. (1997), “Commercial Bank Net Interest Margins, Default Risk, Interest-rate risk, and Off-balance Sheet Banking”, Journal of Banking and Finance, Vol. 21, pp. 55-87. Angelini P. and Cetorelli N. (2002), ""The effects of regulatory reform on competition in the banking industry"", Journal of Money, Credit and Banking, forthcoming. Angelini, P., P. Di Salvo and G. Ferri (1998), “Availability and Cost of Credit for Small Businesses: Customer Relationships and Credit Cooperatives”, Journal of Banking and Finance, Vol. 22, No. 6-8, pp. 925-54. Angeloni I., Buttiglione L., Ferri G. and Gaiotti E. (1995), “The Credit Channel of Monetary Policy across Heterogeneous Banks: The Case of Italy”, Banca d’Italia, Temi di discussione, No. 256. Ausubel L. M. (1992), Rigidity and Asymmetric Adjustment of Bank Interest Rates, mimeo. Banca d’Italia (1986), Modello trimestrale dell’economia italiana, Banca d’Italia, Temi di discussione, No. 80. Banca d’Italia (1988), Modello mensile del mercato monetario, Banca d’Italia, Temi di discussione, No. 108. Banerjee A., Lumsdaine R.L. and Stock J.H. (1992), “Recursive and Sequential Tests of the UnitRoot and Trend Break Hypotheses: Theory and International Evidence”, Journal of Business and Economic Statistics, Vol. 10, No. 3, pp.271-87. Berger A.N. and Udell G.F. (1992), “Some Evidence on the Empirical Significance of Credit Rationing”, Journal of Political Economy, Vol.100, No. 5, pp. 1047-77. Berlin M. and Mester L.J. (1999), “Deposits and Relationship Lending”, Review of Financial Studies, Vol. 12, No. 3, pp. 579-607. Bernanke B. and Blinder A.S. (1988), “Is it Money or Credit, or Both or Neither? Credit, Money and Aggregate Demand”, American Economic Review, Vol. 78, No. 2, pp. 435-9. Paper and Proceedings of the One-Hundredth Annual Meeting of the American Economic Association. Beveridge S. and Nelson C. (1981), “A New Approach to the Decomposition of Economics Time Series into Permanent and Transitory Components with Particular Attention to Measurement of the ‘Business Cycle’”, Journal of Monetary Economics, Vol. 21, pp. 151-74. Boccuzzi, G. (1998), La crisi dell'impresa bancaria. Profili economici e giuridici, Giuffrè, Milano. Bolton, P. and Freixas X. (2001), “Corporate Finance and the Monetary Transmission Mechanism”, CEPR, Discussion Paper Series, No. 2982. Calomiris C.W. and Hubbard G.R. (1995), “Internal Finance and Investment: Evidence from the Undistributed Profit Tax of 1936-37”, Journal of Business, Vol. 68. No. 4. Ciocca P. (2000), La nuova finanza in Italia. Una difficile metamorfosi (1980-2000), Bollati Boringhieri, Torino. Cornett M. M. and Tehranian H. (1994), “An Examination of Voluntary Versus Involuntary Security Issuances by Commercial Banks: The Impact of Capital Regulations on Common Stock Returns”, Journal of Financial Economics, Vol. 35, pp. 99-122. Cottarelli C. and Kourelis A. (1994), “Financial Structure, Bank Lending Rates and the Transmission Mechanism of Monetary Policy”, IMF Staff Papers, Vol. 41, No. 4, pp.587-623. Cottarelli C., Ferri G. and Generale A. (1995), “Bank Lending Rates and Financial Structure in Italy: A Case Study”, IMF Working Papers, No. 38. 30 de Bondt G., Mojon B. and Valla N. (2003), “The Adjustment of Retail Rates in the Euro Area: Is It (Really) Sluggish?”, European Central Bank, mimeo. Dermine J. (1991), Discussion to Vives. X., “Banking Competition and European Integration”, in Giovannini A. and Mayer C., European Financial Integration, Cambridge, Cambridge University Press. Dewatripont M. and Tirole J. (1994), The Prudential Regulation of Banks, Cambridge, Massachusetts, MIT Press. Ehrmann M., Gambacorta L., Martinez Pagés J., Sevestre P. and Worms A. (2003), “Financial Systems and the Role of Banks in Monetary Policy Transmission in the Euro Area”, in Angeloni I., Kashyap A. and Mojon B., Monetary Policy Transmission in the Euro Area, Cambridge, Cambridge University Press. Focarelli D. and Panetta F. (2003), “Are Merger Beneficial to Consumers? Evidence from the Market for Bank Deposits”, American Economic Review, forthcoming. Friedman B. and Kuttner K. (1993), “Economic Activity and the Short-Term Credit Markets: an Analysis of Prices and Quantities”, Brooking Papers on Economic Activity, Vol. 2, pp. 193-283. Freixas X. and Rochet J. (1997), Microeconomics of Banking, Cambridge, MIT Press. Gaiotti E. (1992), “L’evoluzione delle tecniche di controllo monetario nel modello mensile della Banca d’Italia”, mimeo, Banca d’Italia. Gambacorta L. (2003), “The Italian Banking System and Monetary Policy Transmission: Evidence from Bank Level Data”, in Angeloni, I., A. Kashyap and B. Mojon (eds.), Monetary Policy Transmission in the Euro Area, Cambridge, Cambridge University Press. Gambacorta L. and Mistrulli P. (2004), “Does Bank Capital Affect Lending Behavior?”, Journal of Financial Intermediation, forthcoming. Green C.J. (1998), “Banks as Interest Rate Managers”, Journal of Financial Services Research, Vol. 14, n. 3, pp. 189-208. Hancock D. (1991), A Theory of Production for the Financial Firm, Norwell, Massachusetts, Kluwer Academic Publishers. Hannan T.H. and Berger A.N. (1991), “The Rigidity of Prices: Evidence From Banking Industry”, American Economic Review, Vol. 81, pp.938-45. Harvey (1981), Time Series Models, Oxford, Allan. Ho T.S.Y. and Saunders A. (1981), The Determinants of Bank Interest Margins: Theory and Empirical Evidence”, Journal of Financial and Quantitative Analysis, Vol. 16, No. 2, pp. 581600. Houston J.F. and James C. (1998), “Do Bank Internal Capital Market Promote Lending?”, Journal of Banking and Finance, Vol. 22, pp. 899-918. Hutchison D.E. (1995), “Retail Bank Deposit Pricing: An Intertemporal Asset Pricing Approach”, Journal of Money Credit and Banking, Vol. 27, pp. 217-31. Kashyap A. and Stein J.C. (1995), “The Impact of Monetary Policy on Bank Balance Sheets”, Carnegie Rochester Conference Series on Public Policy, Vol. 42, pp.151-195. Kashyap A. and Stein J.C. (2000), “What Do a Million Observations on Banks Say About the Transmission of Monetary Policy”, American Economic Review, Vol. 90, No. 3, pp. 407-28. Kashyap A., Stein J.C. and Wilcox D. (1993). Monetary Policy and Credit Conditions: Evidence from the Composition of External Finance, American Economic Review, Vol. 83, pp. 78-98. Kishan R.P. and Opiela T.P. (2000), “Bank Size, Bank Capital and the Bank Lending Channel”, Journal of Money, Credit and Banking, Vol. 32, No. 1, pp. 121-41. Klein M. (1971), “A Theory of the Banking Firm”, Journal of Money, Credit and Banking, Vol. 3, No. 2, pp. 205-18. 31 Leland H.E. and Pile D.H. (1977), “Informational Asymmetries, Financial Structures and Financial Intermediation”, The Journal of Finance, Vol. 32, pp. 371-87. Lim G.C. (2000), “Bank Interest Rate Adjustments: Are They Asymmetric?”, The Economic Record, Vol. 77, no. 237, pp.135-147. Melitz J. and Pardue M. (1973), “The Demand and Supply of Commercial Bank Loans”, Journal of Money, Credit and Banking, Vol. 5, No. 2, pp. 669-92. Moore G.R., Porter R.D. and Small D.H. (1990), “Modelling the Disaggregated Demands for M2 and M1: the U.S. Experience in the 1980s”, Proceedings of a Federal Reserve Board Conference on Monetary Aggregates and Financial System Behavior. Myers S.C. and Majluf N.S. (1984), “Corporate Finance and Investment Decisions when Firms Have Information that Investors Do Not Have”, Journal of Financial Economics, Vol. 13, pp.187-221. Neumark D. and Sharpe S.A. (1992), “Market Structure and the Nature of Price Rigidity: Evidence From the Market for Consumer Deposits”, Quarterly Journal of Economics, Vol. 107, pp.65780. Newbold P. (1990), “Precise and Efficient Computation of the Beveridge-Nelson Decomposition of Economic Time Series”, Journal of Monetary Economics, Vol. 26, pp. 453-457. Passacantando F. (1996), “Building an Institutional Framework for Monetary Stability”, BNL Quarterly Review, Vol. 49, No. 196, pp. 83-132. Peek J. and Rosengren E.S. (1995), “Bank Lending and the Transmission of Monetary Policy”; in Peek J. and E.S. Rosengren (eds.), Is Bank Lending Important for the Transmission of Monetary Policy?, Federal Reserve Bank of Boston Conference Series No. 39, pp. 47-68. Petersen M. and Rajan R. (1994), “The Benefits of Lending Relationships: Evidence from Small Business Data”, Journal of Finance, Vol. 49, pp.3-37. Rosen R.J. (2001), What Goes Up Must Come Down? Asymmetries and Persistence in Bank Deposit Rates, Indiana University, mimeo. Santomero A.M. (1984), “Modeling the Banking Firm: A Survey”, Journal of Money Credit and Banking, Vo. 16, n. 4, pp. 576-602. Stein J.C. (1998), “An Adverse-Selection Model of Bank Asset and Liability Management with Implications for the Transmission of Monetary Policy”, RAND Journal of Economics, Vol. 29, No. 3, pp. 466-86. Thakor A.V. (1996), “Capital Requirements, Monetary Policy, and Aggregate Bank Lending: Theory and Empirical Evidence”, The Journal of Finance, Vol. 51, No. 1, pp. 279-324. Upper C. and Worms A. (2001), “Estimating Bilateral Exposures in the German Interbank Market: Is There a Danger of Contagion?”, in BIS (ed.), Marrying the Macro and Microprudential Dimensions of Financial Stability, BIS papers, No. 1, pp. 211-29. Van den Heuvel S.J. (2001a), “The Bank Capital Channel of Monetary Policy”, University of Pennsylvania, mimeo. Van den Heuvel S.J. (2001b), “Banking Conditions and the Effects of Monetary Policy: Evidence from U.S. States”, University of Pennsylvania, mimeo. Van den Heuvel S.J. (2003), “Does Bank Capital Matter for Monetary Transmission?”, FRBNY Economic Policy Review, forthcoming. Verga G. (1984), “La determinazione dei tassi bancari in Italia: un’analisi per gli anni più recenti”, Banca, Impresa, Società, Vol. 3, No. 1, pp.65-84. Weth M.A. (2002), “The Pass-Through from Market Interest Rates to Bank Lending Rates in Germany”, Discussion Paper No 11, Economic Research Center of the Deutsche Bundesbank. Table 1 VARIABLES DESCRIPTION Variables Dependent variables Fixed effects Symbols iLt Interest rate on domestic short term loans iDt Interest rate on current account deposits µi imt Macro variables Description y tP , y Tt pt Bank-specific dummy variable Monetary policy indicator Permanent and transitory components of real GDP computed using the Beveridge and Nelson (1981) decomposition Inflation rate Size: log of total assets (Kashyap and Stein, 1995; Ehrmann et al. 2003) Liquidity: cash and securities over total assets (Stein, 1998; Kashyap and Stein, 2000) Excess capital: difference between regulatory capital and capital requirements (Peek and Rosengren, 1995; Kishan and Opiela, 2000; Gambacorta and Mistrulli, 2004) Deposit strength: ratio between deposits and bonds plus deposits (Berlin and Mester,1999; Weth, 2002) Credit relationship: ratio between long term loans and total loans (Berger and Udell, 1992) Bank-specific characteristics that influence the “bank lending channel” X it −1 Measure for the “bank capital channel” ρit −1 Risk-measure jit Efficiency ratio eit Interest rate volatility σt Cost per unit of asset that the bank incurs in case of a one per cent increase in MP Ratio between bad loans and total loans. This variable captures the riskiness of lending operations and should be offset by a higher expected yield of loans. Management efficiency: ratio of total loans and deposits to the number of branches. Interest rate volatility: coefficient of variation of iM . Control variables Φ it Convergence dummy: step dummy that takes the value of 1 in the period 1995:03-1998:03 and 0 elsewhere. Seasonal dummies. Note: For more information on the definition of the variables see Appendix 2. 18 18 18 18 Big banks Small banks Liquid banks (2) Low liquid banks 18 18 18 18 18 18 Well capitalized banks Low capitalized banks Banks with high BM ratio Banks with low BM ratio (3) (4) Banks with high BU ratio (5) Banks with low BU ratio (1) 73 Number of banks Total sample Bank-characteristics (*) 8.51 10.97 11.78 7.77 9.71 9.42 9.51 9.33 9.28 10.02 9.51 Mean 2.59 2.12 1.49 2.24 2.73 2.81 2.72 2.73 2.81 2.73 2.72 St. dev. 3.69 4.00 4.88 3.69 3.69 4.75 3.69 4.42 3.69 5.03 3.69 Min 15.06 16.12 16.12 15.06 16.12 15.93 15.94 14.86 15.06 16.12 16.12 Max Interest rate on short term lending 2.80 4.68 5.15 2.41 3.68 3.53 3.57 3.61 3.57 3.55 3.58 Mean 1.67 1.44 0.96 1.45 1.80 1.79 1.80 1.71 1.74 1.79 1.79 St. dev. 0.65 0.53 0.74 0.52 0.52 0.74 0.65 0.73 0.73 0.52 0.52 Min 7.36 7.43 8.21 7.35 7.18 8.21 8.21 7.35 7.35 8.21 8.21 Max Interest rate on current accounts definition of the variables see Appendix 2. The sources of the dataset are Bank of Italy supervisory returns and 10-days reports. 21.92 8.51 6.58 27.00 9.66 24.28 4.67 43.75 51.15 1.55 16.20 Size (1) 19.98 28.26 29.69 18.56 26.15 20.82 33.07 14.91 19.01 25.11 24.00 Liq. (2) 3.80 3.95 4.46 3.42 6.86 1.49 4.27 3.13 2.56 4.81 3.91 Cap. (3) 71.84 93.13 98.53 66.10 85.49 78.40 86.27 72.43 77.60 84.40 82.40 BM (4) 53.29 22.46 28.72 45.30 37.22 38.46 36.15 43.66 38.98 41.72 37.66 BU (5) average ratio below the third quartile. Since the characteristics of each bank could change through time, percentiles have been worked out on mean values. For more details on the long-term loans and total loans. A bank with a ""high"" characteristic has the average ratio above the first quartile of the distribution. (*) A bank with a ""low""characteristic has the capital requirements. (4) The Berlin and Mester indicator (BM) is the ratio between deposits and deposits plus bonds. (5) The Berger and Udell indicator (BU) is the ratio between government securities over total assets. (3) The capital ratio is given by excess capital divided by total assets. Excess capital is the difference between regulatory capital and total interest rate are annualized and given in percentages. (1) The size indicator is given by total asset (billions of euros). (2) The liquidity indicator is represented by the sum of cash and Ex special credit institutions, foreign banks and ""banche di credito cooperativo"" are excluded. The sample represents more than 70 per cent of total system in terms of lending. All SUMMARY STATISTICS (1993:03-2001:03) Table 2 Table 3 RESULTS FOR THE EQUATION ON THE INTEREST RATE ON SHORT-TERM LENDING This table shows the results of the equation for the interest rate on short term lending. The model is given by the following equation, which includes interaction terms that are the product of the monetary policy indicator and a bank specific characteristic: ∆ iL k ,t = µ k + 2 1 j =1 j =0 å κ j ∆iL k ,t − j + å ( β j + β *j X k ,t −1 )∆iM t − j + ϕ pt + δ1∆ ln ytP + δ 2∆ ln ytT + λX k ,t −1 + φ∆ ( ρ k ,t −1∆iM t ) + + (α + α X k ,t −1 )iL k ,t −1 + (γ + γ * X k ,t −1 )iM t −1 + θ jk ,t + ξ ek ,t + ψσ t + Φ k ,t + ε k ,t * with k=1,…, N (k=number of banks) and t=1, …,T (t= periods). Data are quarterly (1993:03-2001:03) and not seasonally adjusted. The panel is balanced with N=73 banks. Lags have been selected in order to obtain white noise residuals. The description of the variables is reported in Table 1. The model have been estimated using the GMM estimator suggested by Arellano and Bond (1991) which ensures efficiency and consistency provided that the models are not subject to serial correlation of order two and that the instruments used are valid (which is tested for with the Sargan test). A bank with “low characteristic” has the average ratio of the banks below the first quartile, a bank with ""high characterisic” has the average ratio of the banks above third quartile. For more details on the data see Appendix 2. *=significance at the 10 per cent; **=significance at the 5 per cent; ***=significance at the 1 per cent. Dependent variable: quarterly change of the interest rate on short-term lending (1) Size Coeff. (2) Liquidity (5) Long term loans/ Total loans S.Error Coeff. S.Error (4) Dep./(Bonds+Dep.) S.Error Coeff. S.Error Coeff. 0.017 0.012 0.025 0.145 *** 0.032 ** 0.012 0.015 0.013 0.026 0.149 *** 0.025 ** 0.012 0.018 0.187 *** 0.012 0.043 *** 0.024 0.026 0.015 0.010 0.020 Costs, credit risk and int.rate volatility Bank's efficiency: -0.004 ** 0.002 -0.001 Bad loans: 0.020 *** 0.002 0.016 *** Interest rate volatility: 0.011 *** 0.001 0.012 *** 0.002 -0.006 ** 0.002 0.017 *** 0.001 0.010 *** 0.002 0.001 0.001 -0.001 0.020 *** 0.014 *** 0.001 -0.001 0.002 0.019 *** 0.001 0.012 *** 0.001 0.002 0.001 Immediate pass-through Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.569 *** 0.027 0.003 0.556 *** 0.028 0.586 *** 0.026 0.031 0.018 0.027 0.036 0.023 0.418 0.022 0.026 0.465 *** 0.030 0.497 *** 0.023 0.028 0.529 *** 0.032 0.463 *** 0.034 0.000 0.033 0.035 Pass-through after a quarter Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.938 *** 0.013 0.000 0.913 *** 0.015 0.971 *** 0.014 0.016 0.878 *** 0.159 0.017 0.889 *** 0.016 0.863 *** 0.013 0.000 0.014 0.012 Long run elasticity Average bank: Ho: unitary long run elasticity (p-val.) Ho: no heterogeneity (p-value) Low characteristic High characteristic 1.017 *** 0.014 0.056 0.509 0.996 *** 0.014 1.049 *** 0.016 0.015 1.012 *** 0.235 0.924 0.026 0.992 *** 0.012 1.040 *** 0.018 0.489 0.644 0.016 0.023 Loading of the long run relationship Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.017 0.000 0.017 0.020 Bank capital channel Loan demand Inflation: Permanent Income: Transitory Income: Miss-specification tests MA(1), MA(2) (p-value) Sargan test (p-value) No of banks, no of observations S.Error Coeff. (3) Capitalization 0.159 *** 0.019 0.033 ** 0.015 0.012 0.031 0.145 *** 0.030 *** 0.013 0.403 *** 0.414 *** 0.383 *** 0.941 *** 0.962 *** 0.920 *** 0.954 *** 0.958 *** 0.949 *** 0.869 *** 0.862 *** 0.878 *** -0.477 *** 0.023 -0.422 *** 0.000 -0.505 *** 0.026 -0.391 *** -0.441 *** 0.023 -0.451 *** 0.019 -0.507 *** 0.000 0.023 -0.482 *** 0.019 -0.539 *** 0.023 0.035 0.028 0.026 -0.234 *** -0.519 *** 0.043 -0.382 *** 0.000 0.021 -0.434 *** 0.020 -0.330 *** 0.104 * 0.055 0.409 *** 0.070 0.178 *** 0.051 0.197 *** 0.066 0.109 * 0.066 0.000 0.949 0.087 2336 0.000 0.367 0.099 2336 0.000 0.702 0.088 2336 0.000 0.185 0.000 0.101 2336 73 0.116 0.057 2336 73 1.023 *** 0.012 0.037 0.011 0.015 0.474 *** 0.456 *** 1.031 *** 1.015 *** 0.987 *** 1.005 *** 0.014 0.816 0.822 0.015 0.015 0.536 *** 0.529 *** 0.012 0.047 0.883 0.013 0.012 73 0.996 *** 0.018 0.000 0.018 0.018 0.533 *** 73 0.982 *** 0.990 *** 0.978 *** -0.381 *** 73 Table 4 RESULTS FOR THE EQUATION ON INTEREST RATE ON CURRENT ACCOUNTS This table shows the results of the equation for the interest rate on current accounts. The model is given by the following equation, which includes interaction terms that are the product of the monetary policy indicator and a bank specific characteristic: ∆i D k , t = µ k + 2 1 j =1 j =0 åκ j ∆iD k ,t − j + å ( β j + β *j X k ,t −1)∆iM t − j + ϕ pt + δ1∆ ln ytP + δ 2∆ ln ytT + λX k ,t −1 + φ∆( ρ k ,t −1∆iM t ) + + (α + α X k ,t −1 )iD k ,t −1 + (γ + γ * X k ,t −1 )iM t −1 + ξ ek ,t + ψσ t + Φ k ,t + ε k ,t * with k=1,…, N (k=number of banks) and t=1, …,T (t= periods). Data are quarterly (1993:03-2001:03) and not seasonally adjusted. The panel is balanced with N=73 banks. Lags have been selected in order to obtain white noise residuals. The description of the variables is reported in Table 1. The model have been estimated using the GMM estimator suggested by Arellano and Bond (1991) which ensures efficiency and consistency provided that the models are not subject to serial correlation of order two and that the instruments used are valid (which is tested for with the Sargan test). A bank with “low characteristic” has the average ratio of the banks below the first quartile, a bank with ""high characterisic” has the average ratio of the banks above third quartile. For more details on the data see Appendix 2. *=significance at the 10 per cent; **=significance at the 5 per cent; ***=significance at the 1 per cent. (1) Size Dependent variable: quarterly change of the interest rate on current accounts Coeff. (2) Liquidity S.Error Coeff. (3) Capitalization (5) Long term loans/ Total loans S.Error Coeff. S.Error (4) Dep./(Bonds+Dep.) S.Error Coeff. S.Error Coeff. Deposit demand Inflation: Permanent Income: Transitory Income: 0.049 *** 0.015 0.091 *** -0.058 *** 0.006 -0.048 *** -0.222 *** 0.012 -0.204 *** 0.012 0.058 *** 0.006 -0.058 *** 0.012 -0.223 *** 0.015 0.005 0.011 0.099 *** -0.024 * -0.102 *** 0.008 0.039 *** 0.013 -0.052 *** 0.012 -0.202 *** 0.009 0.004 0.010 Costs, credit risk and int.rate volatility Bank's efficiency: Interest rate volatility: 0.001 0.001 ** 0.001 0.001 0.001 0.002 *** 0.001 0.001 0.001 0.001 *** 0.002 0.001 0.012 *** 0.005 *** 0.001 0.000 0.002 * 0.002 *** 0.001 0.001 Immediate pass-through Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.413 *** 0.013 0.000 0.400 *** 0.015 0.429 *** 0.012 0.411 *** 0.010 0.000 0.010 0.010 0.410 *** 0.008 0.742 0.009 0.009 0.418 *** 0.009 0.000 0.009 0.010 0.388 *** 0.408 *** 0.366 *** 0.008 0.000 0.007 0.010 Pass-through after a quarter Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.546 *** 0.009 0.000 0.512 *** 0.010 0.588 *** 0.008 0.006 0.540 *** 0.000 0.006 0.536 *** 0.008 0.542 *** 0.006 0.776 0.006 0.008 Long run elasticity Average bank: Ho: unitary long run elasticity (p-val.) Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.685 *** 0.013 0.000 0.905 0.688 *** 0.014 0.682 *** 0.013 0.007 0.000 0.444 0.006 0.009 0.675 *** 0.661 *** 0.010 0.000 0.717 0.010 0.011 Loading of the long run relationship Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.016 0.000 0.017 0.017 Bank capital channel Miss-specification tests MA(1), MA(2) (p-value) Sargan test (p-value) No of banks, no of observations 0.431 *** 0.394 *** 0.541 *** 0.551 *** 0.530 *** 0.551 *** 0.535 *** 0.507 *** 0.526 *** 0.493 *** -0.572 *** 0.018 -0.646 *** 0.000 -0.537 *** 0.018 -0.657 *** -0.610 *** 0.023 -0.634 *** 0.018 -0.609 *** 0.016 0.020 -0.645 *** 0.017 -0.564 *** 0.020 0.000 0.019 0.025 -0.725 *** -0.795 *** 0.016 -0.572 *** 0.000 0.019 -0.610 *** 0.017 -0.533 *** -0.055 *** 0.015 -0.036 *** 0.012 -0.049 *** 0.009 -0.039 *** 0.013 -0.034 *** 0.009 0.000 0.976 0.960 2336 0.785 0.094 2336 0.000 0.340 0.092 2336 0.508 0.095 2336 73 0.000 73 0.676 *** 0.007 0.049 0.007 0.009 0.663 *** 0.694 *** 0.670 *** 0.699 *** 0.009 0.000 0.205 0.010 0.009 0.544 *** 0.451 *** 0.387 *** 0.009 0.000 0.463 0.009 0.011 0.953 0.091 2336 0.685 *** 0.008 0.000 0.008 0.008 0.411 *** 0.409 *** 0.000 73 0.643 *** 0.631 *** 0.654 *** -0.760 *** 73 0.669 *** 0.000 73 Table 5 BANK LENDING CHANNEL This table shows the results of the equation for the interest rate on short-term lending (panel A) and current accounts (panel B) when all bank-specific characteristics are taken simultaneously into account. The model is given by the following equation, which includes interaction terms that are the product of the monetary policy indicator and each bank-specific characteristic: ∆iψ k ,t = µ k + 2 5 1 5 å κ j ∆iψ k ,t − j + å å ( β j + β *j X k , m,t −1)∆iM t − j + ϕ pt + δ1∆ ln ytP + δ 2∆ ln ytT + å λm X k , m,t −1 + j =1 m =1 j = 0 + φ∆ ( ρ k ,t −1∆iM t ) + (α + m =1 5 å α m* X k ,m,t −1)(iψ k ,t −1 − γ iM t −1) + θ jk ,t + ξ ek ,t + ψσ t + Φ k ,t + ε k ,t m =1 with i ψ= quarterly change of the interest rate on short-term lending or current accounts k=1,…, N (k=number of banks) and t=1, …,T (t= periods). Bank-specific characteristics are size,liquidity, capitalization, Berlin-Mester and Berger-Udell indicators (m =5). Data are quarterly (1992:032001:03) and not seasonally adjusted. The panel is balanced with N=73 banks. Lags have been selected in order to obtain white noise residuals. The description of the variables is reported in Table 1. The model have been estimated using the GMM estimator suggested by Arellano and Bond (1991) which ensures efficiency and consistency provided that the models are not subject to serial correlation of order two and that the instruments used are valid (which is tested for with the Sargan test). A bank with “low characteristic” has the average ratio of the banks below the first quartile, a bank with ""high characterisic” has the average ratio of the banks above third quartile. For more details on the data see Appendix 2. *=significance at the 10 per cent; **=significance at the 5 per cent; ***=significance at the 1 per cent. (1) Size Coeff. (2) Liquidity S.Error Coeff. (3) Capitalization S.Error Coeff. (5) Long term loans/ Total loans S.Error Coeff. S.Error (4) Dep./(Bonds+Dep.) S.Error Coeff. (A) Dependent variable is the quarterly change of the interest rate on short-term lending Immediate pass-through Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.452 *** 0.062 0.159 0.492 *** 0.064 0.393 *** 0.080 Pass-through after a quarter Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.879 *** 0.039 0.639 0.895 *** 0.058 0.857 *** 0.040 0.891 *** 0.868 *** Long run elasticity All banks: 1.000 1.000 Loading of the long run relationship Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic -0.354 *** 0.050 -0.354 *** 0.681 -0.377 *** 0.072 -0.354 *** -0.324 *** 0.092 -0.354 *** Miss-specification tests MA(1), MA(2) (p-value) Sargan test (p-value) No of banks, no of observations - 0.000 - 0.452 *** 0.476 *** 0.421 *** 0.879 *** - 0.062 0.027 0.058 0.069 0.039 0.317 0.036 0.033 - 0.452 *** 0.558 *** 0.308 *** 0.879 *** 0.914 *** 0.847 *** 1.000 - 0.050 -0.354 *** 0.990 0.063 -0.318 *** 0.046 -0.399 *** 0.062 0.043 0.065 0.110 0.039 0.744 0.082 0.075 0.050 0.536 0.070 0.095 0.452 *** 0.519 *** 0.375 *** 0.062 0.016 0.050 0.084 0.883 *** 0.876 *** 0.039 0.879 *** 0.913 0.050 0.888 *** 0.047 0.873 *** 0.039 0.912 0.039 0.053 1.000 - 0.460 *** 0.437 *** 0.879 *** - -0.354 *** -0.332 *** -0.375 *** 0.062 0.702 0.059 0.077 0.452 *** 1.000 - 0.050 -0.354 *** 0.761 0.089 -0.332 *** 0.085 -0.376 *** 0.050 0.773 0.086 0.095 0.073 0.985 2336 73 (B) Dependent variable is the quarterly change of the interest rate on current accounts Immediate pass-through Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.452 *** 0.042 0.972 0.453 *** 0.043 0.452 *** 0.050 Pass-through after a quarter Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.545 *** 0.033 0.160 0.572 *** 0.032 0.524 *** 0.043 0.546 *** 0.545 *** Long run elasticity Average bank: 0.700 0.700 Loading of the long run relationship Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic -0.570 *** 0.043 -0.570 *** 0.388 -0.537 *** 0.048 -0.565 *** -0.612 *** 0.074 -0.575 *** Miss-specification tests MA(1), MA(2) (p-value) Sargan test (p-value) No of banks, no of observations 0.000 73 - - 0.915 0.180 2336 0.452 *** 0.470 *** 0.434 *** 0.545 *** - 0.042 0.129 0.050 0.037 0.033 0.978 0.038 0.033 - 0.452 *** 0.479 *** 0.419 *** 0.545 *** 0.566 *** 0.517 *** 0.700 - 0.043 -0.570 *** 0.820 0.050 -0.607 *** 0.047 -0.523 *** 0.042 0.529 0.054 0.074 0.033 0.481 0.055 0.045 0.043 0.481 0.019 0.025 0.452 *** 0.497 *** 0.406 *** 0.042 0.112 0.062 0.062 0.590 *** 0.516 *** 0.033 0.545 *** 0.203 0.045 0.563 *** 0.039 0.525 *** 0.033 0.224 0.041 0.034 0.700 - 0.509 *** 0.400 *** 0.545 *** - -0.570 *** -0.452 *** -0.680 *** 0.042 0.032 0.044 0.054 0.452 *** 0.700 - 0.043 -0.570 *** 0.004 0.062 -0.589 *** 0.054 -0.550 *** 0.043 0.575 0.059 0.051 Fig. 1 Banking interest rates (quarterly data, percentage points) 19.0 3-month interbank rate Repo rate 17.0 Interest rate on current accounts Estimation period 1993:03-2001:03 Short term lending rate 15.0 13.0 Euro 11.0 9.0 7.0 5.0 Period before T.U.B. 1987:01-1993:02 3.0 1.0 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 Fig. 2 Cross sectional and time series dispersion of interest rates 0.350 (a) Interest rate on short-term loans 0.300 0.250 0.200 0.150 0.100 0.050 0.000 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 1998 1999 2000 2001 0.350 (b) Interest rate on current accounts 0.300 0.250 0.200 0.150 0.100 0.050 0.000 1987 1988 1989 ACROSS BANKS 1990 1991 1992 OVER TIME 1993 1994 1995 1996 1997 Fig. 3 Determinants of bank’s interest rates i L = f ( y P , y T , p, i M , + ? + + X t −1 , i M X t −1 , ρ t −1 ∆i M , j , costs , σ , µ k ) ? + + + ? + Loan demand Interest rate channel Bank lending channel Cost of intermediation, credit risk and interest rate volatility Bank capital channel Deposit demand i D = f ( y P , y T , p, i M , − − − + Industry structure X t −1 , i M X t −1 , ρ t −1 ∆i M , costs , σ , µ k ) ? − − ? + Note: the meaning of all the symbols is reported in Table 1. Fig. A1 Search for mean shift breaks (monthly data, sequential minimum unit root tests) 0 Dec-87 Dec-88 Dec-89 Dec-90 Dec-91 Dec-92 Dec-93 Dec-94 Dec-95 Dec-96 Dec-97 Dec-98 Dec-99 -1 -2 -3 -4 -5 -6 -7 Interest rate on current accounts -8 Interest rate on short-term loans 3-month interbank market rate -9 10% critical value 2.5% critical value -10 Note: The estimated model tests for a shift in the constant. No trend is included. Sequential statistic are computed using the sample 1984:7-2002:12, sequentially incrementing the date of the hypothetical shift. A fraction equal to 15 per cent of the total sample at the beginning and at the end of the sample is not considered for the test. For more details see Banerjee, Lumsdaine and Stock (1992).
+
+USER:
+How are interest rates set?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",True,8,5,16860,,849
+"Answer solely based on the provided text, do not give any additional information or analysis beyond that which is provided in the text. Give your answer in the form of two lists of bullet points.",What are the arguments for and against the Bill?,"The new British Ambassador to the United States, prior to his departure for Washington, perhaps with the idea of propitiating Irish opinion in America, elected to speak on St. Patrick's Day. He wore a green Irish halo for the occasion. He said it had been a labor of love for him during last summer and autumn to assist in reducing to legislative form proposals for ending the Irish question. He said the new Bill for the government of Ireland was ""a sincere attempt to place definitely and finally in the hands of the elected representatives of the Irish people the duty and responsibility of working out their own salvation and the salvation of their country."" No doubt this statement has been cabled to America, and I propose to examine here how far this statement is justified and how Ireland is indebted to Sir Auckland Geddes for his interest in its welfare. I lay this down as a fundamental proposition, which I do not think will be denied, that whoever controls the taxation and trade policy of a country controls its destiny and the entire character of its civilization. The body with control over customs, excise, income tax, supertax, excess profits duty and external trade has it in its power to make that country predominantly industrial or agricultural or to make a balance between urban and rural interests. It can direct the external trade of the country, make it flow into this or that channel. These powers over Irish taxation and trade policy are expressly denied to Ireland. Ireland in fact has less power under this last Bill over its own economic development than it had under the Act of Union. Under that Act, Ireland had one hundred and two members in the Imperial Parliament who could at times hold the balance of power. It was not a very real power, because when the interests of Ireland and Great Britain conflicted, both parties in Great Britain united against Ireland, but still to the leaders of parties Irish votes were worth angling for, for British purposes, and had to be paid for by Land Acts or other measures. The new Bill provides that the Irish representation at Westminster shall be reduced to forty-two members, and so at Westminster Ireland is made practically powerless, while everything which really affects Irish economic interests is still legislated for by the British Parliament.","What are the arguments for and against the Bill? Answer solely based on the provided text, do not give any additional information or analysis beyond that which is provided in the text. Give your answer in the form of two lists of bullet points. ""The new British Ambassador to the United States, prior to his departure for Washington, perhaps with the idea of propitiating Irish opinion in America, elected to speak on St. Patrick's Day. He wore a green Irish halo for the occasion. He said it had been a labor of love for him during last summer and autumn to assist in reducing to legislative form proposals for ending the Irish question. He said the new Bill for the government of Ireland was ""a sincere attempt to place definitely and finally in the hands of the elected representatives of the Irish people the duty and responsibility of working out their own salvation and the salvation of their country."" No doubt this statement has been cabled to America, and I propose to examine here how far this statement is justified and how Ireland is indebted to Sir Auckland Geddes for his interest in its welfare. I lay this down as a fundamental proposition, which I do not think will be denied, that whoever controls the taxation and trade policy of a country controls its destiny and the entire character of its civilization. The body with control over customs, excise, income tax, supertax, excess profits duty and external trade has it in its power to make that country predominantly industrial or agricultural or to make a balance between urban and rural interests. It can direct the external trade of the country, make it flow into this or that channel. These powers over Irish taxation and trade policy are expressly denied to Ireland. Ireland in fact has less power under this last Bill over its own economic development than it had under the Act of Union. Under that Act, Ireland had one hundred and two members in the Imperial Parliament who could at times hold the balance of power. It was not a very real power, because when the interests of Ireland and Great Britain conflicted, both parties in Great Britain united against Ireland, but still to the leaders of parties Irish votes were worth angling for, for British purposes, and had to be paid for by Land Acts or other measures. The new Bill provides that the Irish representation at Westminster shall be reduced to forty-two members, and so at Westminster Ireland is made practically powerless, while everything which really affects Irish economic interests is still legislated for by the British Parliament.""","Answer solely based on the provided text, do not give any additional information or analysis beyond that which is provided in the text. Give your answer in the form of two lists of bullet points.
+
+EVIDENCE:
+The new British Ambassador to the United States, prior to his departure for Washington, perhaps with the idea of propitiating Irish opinion in America, elected to speak on St. Patrick's Day. He wore a green Irish halo for the occasion. He said it had been a labor of love for him during last summer and autumn to assist in reducing to legislative form proposals for ending the Irish question. He said the new Bill for the government of Ireland was ""a sincere attempt to place definitely and finally in the hands of the elected representatives of the Irish people the duty and responsibility of working out their own salvation and the salvation of their country."" No doubt this statement has been cabled to America, and I propose to examine here how far this statement is justified and how Ireland is indebted to Sir Auckland Geddes for his interest in its welfare. I lay this down as a fundamental proposition, which I do not think will be denied, that whoever controls the taxation and trade policy of a country controls its destiny and the entire character of its civilization. The body with control over customs, excise, income tax, supertax, excess profits duty and external trade has it in its power to make that country predominantly industrial or agricultural or to make a balance between urban and rural interests. It can direct the external trade of the country, make it flow into this or that channel. These powers over Irish taxation and trade policy are expressly denied to Ireland. Ireland in fact has less power under this last Bill over its own economic development than it had under the Act of Union. Under that Act, Ireland had one hundred and two members in the Imperial Parliament who could at times hold the balance of power. It was not a very real power, because when the interests of Ireland and Great Britain conflicted, both parties in Great Britain united against Ireland, but still to the leaders of parties Irish votes were worth angling for, for British purposes, and had to be paid for by Land Acts or other measures. The new Bill provides that the Irish representation at Westminster shall be reduced to forty-two members, and so at Westminster Ireland is made practically powerless, while everything which really affects Irish economic interests is still legislated for by the British Parliament.
+
+USER:
+What are the arguments for and against the Bill?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,35,9,397,,424
+Response should not be more than 100 words. Model must only respond using information contained in the context block. Model should not rely on its own knowledge or outside sources of information when responding.,What medications should be prescribed first for adults diagnosed with heart failure with reduced ejection fraction according to the NICE guidelines?,"Chronic heart failure in adults: diagnosis and management NICE guideline Published: 12 September 2018 www.nice.org.uk/guidance/ng106 © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Your responsibility The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian. All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme. Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties. Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 2 of 35 Contents Overview ...................................................................................................................................... 5 Who is it for? .......................................................................................................................................... 5 Recommendations ....................................................................................................................... 6 1.1 Team working in the management of heart failure ....................................................................... 6 1.2 Diagnosing heart failure .................................................................................................................. 9 1.3 Giving information to people with heart failure ............................................................................ 12 1.4 Treating heart failure with reduced ejection fraction .................................................................. 12 1.5 Treating heart failure with reduced ejection fraction in people with chronic kidney disease . 17 1.6 Managing all types of heart failure ................................................................................................ 18 1.7 Monitoring treatment for all types of heart failure ....................................................................... 21 1.8 Interventional procedures ............................................................................................................... 22 1.9 Cardiac rehabilitation ...................................................................................................................... 23 1.10 Palliative care ................................................................................................................................. 24 Terms used in this guideline ................................................................................................................. 24 Putting this guideline into practice ............................................................................................ 26 Recommendations for research ................................................................................................. 28 1 Diuretic therapy for managing fluid overload in people with advanced heart failure in the community ............................................................................................................................................. 28 2 Cardiac MRI versus other imaging techniques for diagnosing heart failure ................................ 28 3 The impact of atrial fibrillation on the natriuretic peptide threshold for diagnosing heart failure ...................................................................................................................................................... 29 4 The impact of advanced kidney disease on the natriuretic peptide threshold for diagnosing heart failure ............................................................................................................................................ 30 5 Risk tools for predicting non-sudden death in heart failure .......................................................... 30 Context ......................................................................................................................................... 31 Key facts and figures ............................................................................................................................ 31 Current practice .................................................................................................................................... 31 Finding more information and committee details .....................................................................32 Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 3 of 35 Update information .....................................................................................................................33 Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 4 of 35 This guideline replaces CG108. This guideline is the basis of QS167, QS9 and QS181. Overview This guideline covers diagnosing and managing chronic heart failure in people aged 18 and over. It aims to improve diagnosis and treatment to increase the length and quality of life for people with heart failure. NICE has also produced a guideline on acute heart failure. Who is it for? • Healthcare professionals • People with heart failure and their families and carers Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 5 of 35 Recommendations People have the right to be involved in discussions and make informed decisions about their care, as described in NICE's information on making decisions about your care. Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off-label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding. 1.1 Team working in the management of heart failure 1.1.1 The core specialist heart failure multidisciplinary team (MDT) should work in collaboration with the primary care team, and should include: • a lead physician with subspecialty training in heart failure (usually a consultant cardiologist) who is responsible for making the clinical diagnosis • a specialist heart failure nurse • a healthcare professional with expertise in specialist prescribing for heart failure. [2018] 1.1.2 The specialist heart failure MDT should: • diagnose heart failure • give information to people newly diagnosed with heart failure (see the section on giving information to people with heart failure) • manage newly diagnosed, recently decompensated or advanced heart failure (NYHA [New York Heart Association] class III to IV) Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 6 of 35 • optimise treatment • start new medicines that need specialist supervision • continue to manage heart failure after an interventional procedure such as implantation of a cardioverter defibrillator or cardiac resynchronisation device • manage heart failure that is not responding to treatment. [2018] 1.1.3 The specialist heart failure MDT should directly involve, or refer people to, other services, including rehabilitation, services for older people and palliative care services, as needed. [2018] 1.1.4 The primary care team should carry out the following for people with heart failure at all times, including periods when the person is also receiving specialist heart failure care from the MDT: • ensure effective communication links between different care settings and clinical services involved in the person's care • lead a full review of the person's heart failure care, which may form part of a long-term conditions review • recall the person at least every 6 months and update the clinical record • ensure that changes to the clinical record are understood and agreed by the person with heart failure and shared with the specialist heart failure MDT • arrange access to specialist heart failure services if needed. [2018] Care after an acute event For recommendations on the diagnosis and management of acute heart failure, see the NICE guideline on acute heart failure. 1.1.5 People with heart failure should generally be discharged from hospital only when their clinical condition is stable and the management plan is optimised. Timing of discharge should take into account the wishes of the person and their family or Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 7 of 35 carer, and the level of care and support that can be provided in the community. [2003] 1.1.6 The primary care team should take over routine management of heart failure as soon as it has been stabilised and its management optimised. [2018] Writing a care plan 1.1.7 The specialist heart failure MDT should write a summary for each person with heart failure that includes: • diagnosis and aetiology • medicines prescribed, monitoring of medicines, when medicines should be reviewed and any support the person needs to take the medicines • functional abilities and any social care needs • social circumstances, including carers' needs. [2018] 1.1.8 The summary should form the basis of a care plan for each person, which should include: • plans for managing the person's heart failure, including follow-up care, rehabilitation and access to social care • symptoms to look out for in case of deterioration • a process for any subsequent access to the specialist heart failure MDT if needed • contact details for － a named healthcare coordinator (usually a specialist heart failure nurse) － alternative local heart failure specialist care providers, for urgent care or review. • additional sources of information for people with heart failure. [2018] Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 8 of 35 1.1.9 Give a copy of the care plan to the person with heart failure, their family or carer if appropriate, and all health and social care professionals involved in their care. [2018] 1.2 Diagnosing heart failure Symptoms, signs and investigations 1.2.1 Take a careful and detailed history, and perform a clinical examination and tests to confirm the presence of heart failure. [2010] 1.2.2 Measure N-terminal pro-B-type natriuretic peptide (NT-proBNP) in people with suspected heart failure. [2018] 1.2.3 Because very high levels of NT-proBNP carry a poor prognosis, refer people with suspected heart failure and an NT-proBNP level above 2,000 ng/litre (236 pmol/ litre) urgently, to have specialist assessment and transthoracic echocardiography within 2 weeks. [2018] 1.2.4 Refer people with suspected heart failure and an NT-proBNP level between 400 and 2,000 ng/litre (47 to 236 pmol/litre) to have specialist assessment and transthoracic echocardiography within 6 weeks. [2018] 1.2.5 Be aware that: • an NT-proBNP level less than 400 ng/litre (47 pmol/litre) in an untreated person makes a diagnosis of heart failure less likely • the level of serum natriuretic peptide does not differentiate between heart failure with reduced ejection fraction and heart failure with preserved ejection fraction. [2018] 1.2.6 Review alternative causes for symptoms of heart failure in people with NTproBNP levels below 400 ng/litre. If there is still concern that the symptoms might be related to heart failure, discuss with a physician with subspeciality training in heart failure. [2018] Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 9 of 35 1.2.7 Be aware that: • obesity, African or African–Caribbean family background, or treatment with diuretics, angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, angiotensin II receptor blockers (ARBs) or mineralocorticoid receptor antagonists (MRAs) can reduce levels of serum natriuretic peptides • high levels of serum natriuretic peptides can have causes other than heart failure (for example, age over 70 years, left ventricular hypertrophy, ischaemia, tachycardia, right ventricular overload, hypoxaemia [including pulmonary embolism], renal dysfunction [eGFR less than 60 ml/minute/ 1.73 m 2 ], sepsis, chronic obstructive pulmonary disease, diabetes, or cirrhosis of the liver). [2010, amended 2018] 1.2.8 Perform transthoracic echocardiography to exclude important valve disease, assess the systolic (and diastolic) function of the (left) ventricle, and detect intracardiac shunts. See the section on referral for echocardiography and specialist assessment in the NICE guideline on heart valve disease. [2003, amended 2018] 1.2.9 Transthoracic echocardiography should be performed on high-resolution equipment by experienced operators trained to the relevant professional standards. Need and demand for these studies should not compromise quality. [2003, amended 2018] 1.2.10 Ensure that those reporting echocardiography are experienced in doing so. [2003] 1.2.11 Consider alternative methods of imaging the heart (for example, radionuclide angiography [multigated acquisition scanning], cardiac MRI or transoesophageal echocardiography) if a poor image is produced by transthoracic echocardiography. [2003, amended 2018] 1.2.12 Perform an ECG and consider the following tests to evaluate possible aggravating factors and/or alternative diagnoses: • chest X-ray • blood tests: Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 10 of 35 － renal function profile － thyroid function profile － liver function profile － lipid profile － glycosylated haemoglobin (HbA1c) － full blood count • urinalysis • peak flow or spirometry. [2010, amended 2018] 1.2.13 Try to exclude other disorders that may present in a similar manner. [2003] 1.2.14 When a diagnosis of heart failure has been made, assess severity, aetiology, precipitating factors, type of cardiac dysfunction and correctable causes. [2010] Heart failure caused by valve disease 1.2.15 Refer people with heart failure caused by valve disease for specialist assessment and advice regarding follow-up. See the section on referral for echocardiography and specialist assessment in the NICE guideline on heart valve disease. [2003] Reviewing existing diagnoses 1.2.16 Review the basis for a historical diagnosis of heart failure, and manage care in accordance with this guideline only if the diagnosis is confirmed. [2003] 1.2.17 If the diagnosis of heart failure is still suspected, but confirmation of the underlying cardiac abnormality has not occurred, then the person should have appropriate further investigation. [2003] Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 11 of 35 1.3 Giving information to people with heart failure 1.3.1 When giving information to people with heart failure, follow the recommendations in the NICE guideline on patient experience in adult NHS services. [2018] 1.3.2 Discuss the person's prognosis in a sensitive, open and honest manner. Be frank about the uncertainty in predicting the course of their heart failure. Revisit this discussion as the person's condition evolves. [2018] 1.3.3 Provide information whenever needed throughout the person's care. [2018] 1.3.4 Consider training in advanced communication skills for all healthcare professionals working with people who have heart failure. [2018] First consultations for people newly diagnosed with heart failure 1.3.5 The specialist heart failure MDT should offer people newly diagnosed with heart failure an extended first consultation, followed by a second consultation to take place within 2 weeks if possible. At each consultation: • discuss the person's diagnosis and prognosis • explain heart failure terminology • discuss treatments • address the risk of sudden death, including any misconceptions about that risk • encourage the person and their family or carers to ask any questions they have. [2018] 1.4 Treating heart failure with reduced ejection fraction See the section on managing all types of heart failure for general recommendations on managing all types of heart failure. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 12 of 35 See NICE's technology appraisal guidance on dapagliflozin and empagliflozin for treating chronic heart failure with reduced ejection fraction. When managing pharmacological treatment, follow the recommendations in the NICE guidelines on medicines adherence and medicines optimisation. First-line treatment 1.4.1 Offer an angiotensin-converting enzyme (ACE) inhibitor and a beta-blocker licensed for heart failure to people who have heart failure with reduced ejection fraction. Use clinical judgement when deciding which drug to start first. [2010] ACE inhibitors 1.4.2 Do not offer ACE inhibitor therapy if there is a clinical suspicion of haemodynamically significant valve disease until the valve disease has been assessed by a specialist. See the section on referral for echocardiography and specialist assessment in the NICE guideline on heart valve disease. [2003] 1.4.3 Start ACE inhibitor therapy at a low dose and titrate upwards at short intervals (for example, every 2 weeks) until the target or maximum tolerated dose is reached. [2010] 1.4.4 Measure serum sodium and potassium, and assess renal function, before and 1 to 2 weeks after starting an ACE inhibitor, and after each dose increment. [2010, amended 2018] 1.4.5 Measure blood pressure before and after each dose increment of an ACE inhibitor. Follow the recommendations on measuring blood pressure, including measurement in people with symptoms of postural hypotension, in the NICE guideline on hypertension in adults. [2018] 1.4.6 Once the target or maximum tolerated dose of an ACE inhibitor is reached, monitor treatment monthly for 3 months and then at least every 6 months, and at any time the person becomes acutely unwell. [2010, amended 2018] Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 13 of 35 Alternative treatments if ACE inhibitors are not tolerated 1.4.7 Consider an ARB licensed for heart failure as an alternative to an ACE inhibitor for people who have heart failure with reduced ejection fraction and intolerable side effects with ACE inhibitors. [2010] 1.4.8 Measure serum sodium and potassium, and assess renal function, before and after starting an ARB and after each dose increment. [2010, amended 2018] 1.4.9 Measure blood pressure after each dose increment of an ARB. Follow the recommendations on measuring blood pressure, including measurement in people with symptoms of postural hypotension, in the NICE guideline on hypertension in adults. [2018] 1.4.10 Once the target or maximum tolerated dose of an ARB is reached, monitor treatment monthly for 3 months and then at least every 6 months, and at any time the person becomes acutely unwell. [2010, amended 2018] 1.4.11 If neither ACE inhibitors nor ARBs are tolerated, seek specialist advice and consider hydralazine in combination with nitrate for people who have heart failure with reduced ejection fraction. [2010] Beta-blockers 1.4.12 Do not withhold treatment with a beta-blocker solely because of age or the presence of peripheral vascular disease, erectile dysfunction, diabetes, interstitial pulmonary disease or chronic obstructive pulmonary disease. [2010] 1.4.13 Introduce beta-blockers in a 'start low, go slow' manner. Assess heart rate and clinical status after each titration. Measure blood pressure before and after each dose increment of a beta-blocker. [2010,amended 2018] 1.4.14 Switch people whose condition is stable and who are already taking a betablocker for a comorbidity (for example, angina or hypertension), and who develop heart failure with reduced ejection fraction, to a beta-blocker licensed for heart failure. [2010] Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 14 of 35 Mineralocorticoid receptor antagonists 1.4.15 Offer an mineralocorticoid receptor antagonists (MRA), in addition to an ACE inhibitor (or ARB) and beta-blocker, to people who have heart failure with reduced ejection fraction if they continue to have symptoms of heart failure. [2018] 1.4.16 Measure serum sodium and potassium, and assess renal function, before and after starting an MRA and after each dose increment. [2018] 1.4.17 Measure blood pressure before and after after each dose increment of an MRA. Follow the recommendations on measuring blood pressure, including measurement in people with symptoms of postural hypotension, in the NICE guideline on hypertension in adults. [2018] 1.4.18 Once the target, or maximum tolerated, dose of an MRA is reached, monitor treatment monthly for 3 months and then at least every 6 months, and at any time the person becomes acutely unwell. [2018] Specialist treatment Ivabradine These recommendations are from the NICE technology appraisal guidance on ivabradine for treating chronic heart failure. 1.4.19 Ivabradine is recommended as an option for treating chronic heart failure for people: • with New York Heart Association (NYHA) class II to IV stable chronic heart failure with systolic dysfunction and • who are in sinus rhythm with a heart rate of 75 beats per minute (bpm) or more and • who are given ivabradine in combination with standard therapy including beta-blocker therapy, angiotensin-converting enzyme (ACE) inhibitors and Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 15 of 35 aldosterone antagonists, or when beta-blocker therapy is contraindicated or not tolerated and • with a left ventricular ejection fraction of 35% or less. [2012] 1.4.20 Ivabradine should only be initiated after a stabilisation period of 4 weeks on optimised standard therapy with ACE inhibitors, beta-blockers and aldosterone antagonists. [2012] 1.4.21 Ivabradine should be initiated by a heart failure specialist with access to a multidisciplinary heart failure team. Dose titration and monitoring should be carried out by a heart failure specialist, or in primary care by either a GP with a special interest in heart failure or a heart failure specialist nurse. [2012] Sacubitril valsartan These recommendations are from the NICE technology appraisal guidance on sacubitril valsartan for treating symptomatic chronic heart failure with reduced ejection fraction. 1.4.22 Sacubitril valsartan is recommended as an option for treating symptomatic chronic heart failure with reduced ejection fraction, only in people: • with New York Heart Association (NYHA) class II to IV symptoms and • with a left ventricular ejection fraction of 35% or less and • who are already taking a stable dose of angiotensin-converting enzyme (ACE) inhibitors or ARBs. [2016] 1.4.23 Treatment with sacubitril valsartan should be started by a heart failure specialist with access to a multidisciplinary heart failure team. Dose titration and monitoring should be performed by the most appropriate team member (see the section on team working in the management of heart failure). [2016] 1.4.24 This guidance is not intended to affect the position of patients whose treatment with sacubitril valsartan was started within the NHS before this guidance was published. Treatment of those patients may continue without change to whatever Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 16 of 35 funding arrangements were in place for them before this guidance was published until they and their NHS clinician consider it appropriate to stop. [2016] Hydralazine in combination with nitrate 1.4.25 Seek specialist advice and consider offering hydralazine in combination with nitrate (especially if the person is of African or Caribbean family origin and has moderate to severe heart failure [NYHA class III/IV] with reduced ejection fraction). [2010] Digoxin For recommendations on digoxin for people with atrial fibrillation see the section on rate and rhythm control in the NICE guideline on atrial fibrillation. 1.4.26 Digoxin is recommended for worsening or severe heart failure with reduced ejection fraction despite first-line treatment for heart failure. Seek specialist advice before initiating. [2010, amended 2018] 1.4.27 Routine monitoring of serum digoxin concentrations is not recommended. A digoxin concentration measured within 8 to 12 hours of the last dose may be useful to confirm a clinical impression of toxicity or non-adherence. [2003] 1.4.28 The serum digoxin concentration should be interpreted in the clinical context as toxicity may occur even when the concentration is within the 'therapeutic range'. [2003] 1.5 Treating heart failure with reduced ejection fraction in people with chronic kidney disease 1.5.1 For people who have heart failure with reduced ejection fraction and chronic kidney disease with an eGFR of 30 ml/min/1.73 m 2 or above: • offer the treatment outlined in the section on treating heart failure with Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 17 of 35 reduced ejection fraction and • if the person's eGFR is 45 ml/min/1.73 m 2 or below, consider lower doses and/ or slower titration of dose of ACE inhibitors or ARBs, MRAs and digoxin. [2018] 1.5.2 For people who have heart failure with reduced ejection fraction and chronic kidney disease with an eGFR below 30 ml/min/1.73 m 2 , the specialist heart failure MDT should consider liaising with a renal physician. [2018] 1.5.3 Monitor the response to titration of medicines closely in people who have heart failure with reduced ejection fraction and chronic kidney disease, taking into account the increased risk of hyperkalaemia. [2018] 1.6 Managing all types of heart failure When managing pharmacological treatment, follow the recommendations in the NICE guidelines on medicines adherence and medicines optimisation. Pharmacological treatment Diuretics 1.6.1 Diuretics should be routinely used for the relief of congestive symptoms and fluid retention in people with heart failure, and titrated (up and down) according to need following the initiation of subsequent heart failure therapies. [2003] 1.6.2 People who have heart failure with preserved ejection fraction should usually be offered a low to medium dose of loop diuretics (for example, less than 80 mg furosemide per day). People whose heart failure does not respond to this treatment will need further specialist advice. [2003, amended 2018] Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 18 of 35 Calcium-channel blockers 1.6.3 Avoid verapamil, diltiazem and short-acting dihydropyridine agents in people who have heart failure with reduced ejection fraction. [2003, amended 2018] Amiodarone 1.6.4 Make the decision to prescribe amiodarone in consultation with a specialist. [2003] 1.6.5 Review the need to continue the amiodarone prescription at the 6-monthly clinical review. [2003, amended 2018] 1.6.6 Offer people taking amiodarone liver and thyroid function tests, and a review of side effects, as part of their routine 6-monthly clinical review. [2003, amended 2018] Anticoagulants 1.6.7 For people who have heart failure and atrial fibrillation, follow the recommendations on anticoagulation in the NICE guideline on atrial fibrillation. Be aware of the effects of impaired renal and liver function on anticoagulant therapies. [2018] 1.6.8 In people with heart failure in sinus rhythm, anticoagulation should be considered for those with a history of thromboembolism, left ventricular aneurysm or intracardiac thrombus. [2003] Vaccinations 1.6.9 Offer people with heart failure an annual vaccination against influenza. [2003] 1.6.10 Offer people with heart failure vaccination against pneumococcal disease (only required once). [2003] Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 19 of 35 Contraception and pregnancy 1.6.11 In women of childbearing potential who have heart failure, contraception and pregnancy should be discussed. If pregnancy is being considered or occurs, specialist advice should be sought. Subsequently, specialist care should be shared between the cardiologist and obstetrician. [2003] Depression See NICE's guideline on depression in adults with a chronic physical health problem. Lifestyle advice Salt and fluid restriction 1.6.12 Do not routinely advise people with heart failure to restrict their sodium or fluid consumption. Ask about salt and fluid consumption and, if needed, advise as follows: • restricting fluids for people with dilutional hyponatraemia • reducing intake for people with high levels of salt and/or fluid consumption. Continue to review the need to restrict salt or fluid. [2018] 1.6.13 Advise people with heart failure to avoid salt substitutes that contain potassium. [2018] Smoking and alcohol See NICE's guidance on smoking and tobacco and alcohol. Air travel 1.6.14 Air travel will be possible for the majority of people with heart failure, depending Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 20 of 35 on their clinical condition at the time of travel. [2003] Driving 1.6.15 Large Goods Vehicle and Passenger Carrying Vehicle licence: physicians should be up to date with the latest Driver and Vehicle Licensing Agency (DVLA) guidelines. Check the DVLA website for regular updates. [2003] 1.7 Monitoring treatment for all types of heart failure See the section on treating heart failure with reduced ejection fraction for specific recommendations on monitoring treatment for heart failure with reduced ejection fraction. Clinical review 1.7.1 All people with chronic heart failure need monitoring. This monitoring should include: • a clinical assessment of functional capacity, fluid status, cardiac rhythm (minimum of examining the pulse), cognitive status and nutritional status • a review of medication, including need for changes and possible side effects • an assessment of renal function. Note: This is a minimum. People with comorbidities or co-prescribed medications will need further monitoring. Monitoring serum potassium is particularly important if a person is taking digoxin or an MRA. [2010, amended 2018] 1.7.2 More detailed monitoring will be needed if the person has significant comorbidity or if their condition has deteriorated since the previous review. [2003] 1.7.3 The frequency of monitoring should depend on the clinical status and stability of Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 21 of 35 the person. The monitoring interval should be short (days to 2 weeks) if the clinical condition or medication has changed, but is needed at least 6-monthly for stable people with proven heart failure. [2003] 1.7.4 People with heart failure who wish to be involved in monitoring of their condition should be provided with sufficient education and support from their healthcare professional to do this, with clear guidelines as to what to do in the event of deterioration. [2003] Measuring NT-proBNP 1.7.5 Consider measuring NT-proBNP (N-terminal pro-B-type natriuretic peptide) as part of a treatment optimisation protocol only in a specialist care setting for people aged under 75 who have heart failure with reduced ejection fraction and an eGFR above 60 ml/min/1.73 m 2 . [2018] 1.8 Interventional procedures Coronary revascularisation 1.8.1 Do not routinely offer coronary revascularisation to people who have heart failure with reduced ejection fraction and coronary artery disease. [2018] Cardiac transplantation 1.8.2 Specialist referral for transplantation should be considered for people with severe refractory symptoms or refractory cardiogenic shock. [2003] Implantable cardioverter defibrillators and cardiac resynchronisation therapy See NICE's technology appraisal guidance on implantable cardioverter defibrillators and cardiac resynchronisation therapy for arrhythmias and heart failure. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 22 of 35 1.8.3 When discussing implantation of a cardioverter defibrillator: • explain the risks, benefits and consequences of cardioverter defibrillator implantation, following the principles on shared decision making in the NICE guideline on patient experience in adult NHS services • ensure the person knows that the defibrillator function can be deactivated without affecting any cardiac resynchronisation or pacing, and reactivated later • explain the circumstances in which deactivation might be offered • discuss and dispel common misconceptions about the function of the device and the consequences of deactivation • provide the person and, if they wish, their family or carers with written information covering the information discussed. [2018] 1.8.4 Review the benefits and potential harms of a cardioverter defibrillator remaining active in a person with heart failure: • at each 6-monthly review of their heart failure care • whenever their care goals change • as part of advance care planning if it is thought they are nearing the end of life. [2018] 1.9 Cardiac rehabilitation 1.9.1 Offer people with heart failure a personalised, exercise-based cardiac rehabilitation programme, unless their condition is unstable. The programme: • should be preceded by an assessment to ensure that it is suitable for the person • should be provided in a format and setting (at home, in the community or in the hospital) that is easily accessible for the person Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 23 of 35 • should include a psychological and educational component • may be incorporated within an existing cardiac rehabilitation programme • should be accompanied by information about support available from healthcare professionals when the person is doing the programme. [2018] 1.10 Palliative care 1.10.1 Do not offer long-term home oxygen therapy for advanced heart failure. Be aware that long-term home oxygen therapy may be offered for comorbidities, such as for some people with chronic obstructive pulmonary disease (see the section on oxygen in the NICE guideline on chronic obstructive pulmonary disease in over 16s). [2018] 1.10.2 Do not use prognostic risk tools to determine whether to refer a person with heart failure to palliative care services. [2018] 1.10.3 If the symptoms of a person with heart failure are worsening despite optimal specialist treatment, discuss their palliative care needs with the specialist heart failure multidisciplinary team and consider a needs assessment for palliative care. [2018] 1.10.4 People with heart failure and their families or carers should have access to professionals with palliative care skills within the heart failure team. [2003] 1.10.5 If it is thought that a person may be entering the last 2 to 3 days of life, follow the NICE guideline on care of dying adults in the last days of life. [2018] Terms used in this guideline Heart failure with preserved ejection fraction This is usually associated with impaired left ventricular relaxation, rather than left ventricular contraction, and is characterised by normal or preserved left ventricular Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 24 of 35 ejection fraction with evidence of diastolic dysfunction . Heart failure with reduced ejection fraction Heart failure with an ejection fraction below 40%. Mineralocorticoid receptor antagonist A drug that antagonises the action of aldosterone at mineralocorticoid receptors. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 25 of 35 Putting this guideline into practice NICE has produced tools and resources to help you put this guideline into practice. Putting recommendations into practice can take time. How long may vary from guideline to guideline, and depends on how much change in practice or services is needed. Implementing change is most effective when aligned with local priorities. Changes recommended for clinical practice that can be done quickly – like changes in prescribing practice – should be shared quickly. This is because healthcare professionals should use guidelines to guide their work – as is required by professional regulating bodies such as the General Medical and Nursing and Midwifery Councils. Changes should be implemented as soon as possible, unless there is a good reason for not doing so (for example, if it would be better value for money if a package of recommendations were all implemented at once). Different organisations may need different approaches to implementation, depending on their size and function. Sometimes individual practitioners may be able to respond to recommendations to improve their practice more quickly than large organisations. Here are some pointers to help organisations put NICE guidelines into practice: 1. Raise awareness through routine communication channels, such as email or newsletters, regular meetings, internal staff briefings and other communications with all relevant partner organisations. Identify things staff can include in their own practice straight away. 2. Identify a lead with an interest in the topic to champion the guideline and motivate others to support its use and make service changes, and to find out any significant issues locally. 3. Carry out a baseline assessment against the recommendations to find out whether there are gaps in current service provision. 4. Think about what data you need to measure improvement and plan how you will collect it. You may want to work with other health and social care organisations and specialist Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 26 of 35 groups to compare current practice with the recommendations. This may also help identify local issues that will slow or prevent implementation. 5. Develop an action plan, with the steps needed to put the guideline into practice, and make sure it is ready as soon as possible. Big, complex changes may take longer to implement, but some may be quick and easy to do. An action plan will help in both cases. 6. For very big changes include milestones and a business case, which will set out additional costs, savings and possible areas for disinvestment. A small project group could develop the action plan. The group might include the guideline champion, a senior organisational sponsor, staff involved in the associated services, finance and information professionals. 7. Implement the action plan with oversight from the lead and the project group. Big projects may also need project management support. 8. Review and monitor how well the guideline is being implemented through the project group. Share progress with those involved in making improvements, as well as relevant boards and local partners. NICE provides a comprehensive programme of support and resources to maximise uptake and use of evidence and guidance. See NICE's into practice pages for more information. Also see Leng G, Moore V, Abraham S, editors (2014) Achieving high quality care – practical experience from NICE. Chichester: Wiley. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 27 of 35 Recommendations for research The guideline committee has made the following key recommendations for research. The committee's full set of research recommendations is detailed in the full guideline. 1 Diuretic therapy for managing fluid overload in people with advanced heart failure in the community In people with advanced heart failure and significant peripheral fluid overload, what is the clinical and cost effectiveness of oral, subcutaneous and intravenous diuretic therapy in the community? Why this is important This research is critical to inform practice of how best to manage people with advanced heart failure in the community if they develop significant peripheral fluid overload. These people are more likely to have multiple admissions that, together with fluid overload, have a negative impact on their quality of life. Management in the community can minimise disruption for the person and reduce costs from hospital admissions. Knowledge of the most clinically and cost-effective routes of administration for diuretic therapy will dictate the level of resource needed to provide the service. Intravenous and subcutaneous diuretics usually need to be administered by nursing or healthcare staff. although a pump for self-administration of subcutaneous diuretics has recently been developed. Oral formulations can be self-administered. 2 Cardiac MRI versus other imaging techniques for diagnosing heart failure What is the optimal imaging technique for the diagnosis of heart failure? Why this is important The role of cardiac MRI in the detection and characterisation of several structural and Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 28 of 35 functional cardiac abnormalities has become well established over the past 25 years. In people with heart failure, cardiac MRI provides reliable and reproducible assessments of the left ventricular (and to a degree the right ventricular) shapes, volumes and ejection fractions. It also provides spatial assessments of the congenital and acquired structural abnormalities of the heart and their interrelationships with the remainder of the heart, as well as functional and haemodynamic assessments of these abnormalities on the heart's performance. Finally, cardiac MRI provides valuable information about the myocardial structure and metabolism, including the presence of inflammation, scarring, fibrosis and infiltration. Cardiac MRI is an expensive form of imaging, and much of this diagnostic information could be provided by less costly non-invasive imaging techniques, chiefly echocardiography. This question aims to find the most clinically and cost-effective imaging technique for the clinical diagnosis of heart failure. 3 The impact of atrial fibrillation on the natriuretic peptide threshold for diagnosing heart failure What is the optimal NT-proBNP threshold for the diagnosis of heart failure in people with atrial fibrillation? Why this is important Atrial fibrillation is a common arrhythmia in the general population, and occurs in 30 to 40% of people with heart failure. Atrial fibrillation can raise the level of serum natriuretic peptides, including NT-proBNP, even in the absence of heart failure. This is complicated further in heart failure with preserved ejection fraction, in which 2 echocardiographic diagnostic criteria become unreliable (the left atrial volume and the tissue doppler imaging assessment of diastolic function). These factors contribute to the complexity of the diagnosis and have a potential impact on the usual thresholds for NT-proBNP in people who have atrial fibrillation. This has been recognised in several ongoing randomised controlled trials of heart failure, which are using higher NT-proBNP thresholds for the diagnosis of heart failure in people with atrial fibrillation. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 29 of 35 4 The impact of advanced kidney disease on the natriuretic peptide threshold for diagnosing heart failure What are the optimal NT-proBNP thresholds for diagnosing heart failure in people with stage IIIb, IV or V chronic kidney disease? Why this is important Heart failure incidence and prevalence increase with age, with the rise starting at age 65 and peaking between 75 and 85. Both advancing age and heart failure are associated with a gradual and progressive decline in renal function. In addition, the progression of heart failure and some treatments for heart failure lead to progressive deterioration of renal function. A decline in renal function is associated with increased fluid retention and a rise in the level of the serum natriuretic peptides, including NT-proBNP, even in the absence of heart failure. There is some evidence that the use of higher NT-proBNP thresholds would improve diagnostic accuracy for heart failure in people with significant deterioration of creatinine clearance. 5 Risk tools for predicting non-sudden death in heart failure What is the most accurate prognostic risk tool in predicting 1-year mortality from heart failure at specific clinically relevant thresholds (for example, sensitivity, specificity, negative predictive value and positive predictive value at a threshold of 50% risk of mortality at 1 year)? Why this is important There are a number of validated prognostic risk tools for heart failure but most do not report sensitivity and specificity at clinically relevant thresholds. This information is crucial to enable accurate prediction of a person's risk of mortality. The ability to accurately predict a person's prognosis would allow clearer communication and timely referral to other services such as palliative care. Inaccurate prediction has the potential to lead to significant psychological harm and increased morbidity. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 30 of 35 Context Key facts and figures Heart failure is a complex clinical syndrome of symptoms and signs that suggest the efficiency of the heart as a pump is impaired. It is caused by structural or functional abnormalities of the heart. Around 920,000 people in the UK today have been diagnosed with heart failure. Both the incidence and prevalence of heart failure increase steeply with age, and the average age at diagnosis is 77. Improvements in care have increased survival for people with ischaemic heart disease, and treatments for heart failure have become more effective. But the overall prevalence of heart failure is rising because of population ageing and increasing rates of obesity. Current practice Uptake of NICE's 2010 guidance on chronic heart failure appears to be good. However, the Department of Health and Social Care's policy paper on improving cardiovascular disease outcomes: strategy noted that prescribing of ACE inhibitors, beta-blockers and aldosterone antagonists remains suboptimal, and that improved use of these drugs has the potential to reduce hospitalisations and deaths caused by heart failure. This update reviewed evidence on the clinical and cost effectiveness of these therapies. Interdisciplinary working has contributed to better outcomes in heart failure but there is further room to improve the provision of multidisciplinary teams (MDTs) and integrate them more fully into healthcare processes. This update highlights and further expands on the roles of the MDT and collaboration between the MDT and the primary care team. The Department of Health and Social Care's policy paper on improving cardiovascular disease outcomes: strategy also noted that the proportion of people with heart failure who have cardiac rehabilitation was around 4%, and that increasing this proportion would reduce mortality and hospitalisation. This update recommends that all people with heart failure are offered an easily accessible, exercise-based cardiac rehabilitation programme, if this is suitable for them. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 31 of 35 Finding more information and committee details To find out what NICE has said on related topics, including guidance in development, see the NICE topic page on cardiovascular conditions. For full details of the evidence and the guideline committee's discussions, see the full guideline. You can also find information about how the guideline was developed, including details of the committee. NICE has produced tools and resources to help you put this guideline into practice. For general help and advice on putting our guidelines into practice, see resources to help you put NICE guidance into practice. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 32 of 35 Update information September 2018: This guideline updates and replaces NICE clinical guideline 108 (published August 2010). NICE clinical guideline 108 updated and replaced NICE clinical guideline 5 (published July 2003). Recommendations are marked as [2018], [2016], [2012], [2010], [2010, amended 2018], [2003], [2003, amended 2018] or [2003, amended 2010], [2018] indicates that the evidence was reviewed and the recommendation added, updated or unchanged in 2018. [2016] refers to NICE technology appraisal guidance published in 2016. [2012] refers to NICE technology appraisal guidance published in 2012. [2010] indicates that the evidence was reviewed in 2010. [2010, amended 2018] indicates that the evidence was reviewed in 2010 but changes were made to the recommendation wording in 2018 that changed the meaning. [2003] indicates that the evidence was reviewed in 2003. [2003, amended 2018] indicates that the evidence was reviewed in 2003 but changes were made to the recommendation wording in 2018 that changed the meaning. [2003, amended 2010] indicates that the evidence was reviewed in 2003 but changes were made to the recommendation wording in 2010 that changed the meaning. • 'Heart failure due to left ventricular systolic dysfunction (LVSD)' has been replaced in all recommendations by 'heart failure with reduced ejection fraction' in line with current terminology and the 2018 guideline scope. • 'Aldosterone antagonists' has been replaced in all recommendations by 'mineralocorticoid receptor antagonists (MRAs') to clarify the function of the receptor, and in line with the 2018 guideline scope. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 33 of 35 • 'African or African-Caribbean family origin' has been added to recommendation 1.2.7 because of the high incidence of heart failure with preserved ejection fraction in these populations. Recent evidence shows that NT-proBNP levels are lower in people of west African family background and are a confounder in the diagnosis of heart failure. • Doppler 2D has been deleted from recommendations 1.2.8, 1.2.9 and 1.2.11 because all transthoracic echocardiography would have doppler 2D as a minimum and it is no longer necessary to specify this. • 'Multigated acquisition scanning' has been added to recommendation 1.2.11 to reflect current imaging technology. • Measurement of urea has been deleted from recommendations 1.2.12, 1.4.8 and 1.7.1 because the guideline committee agreed that it is not needed and is not part of renal function profiles in most centres in the UK. Blood tests for electrolytes, creatinine and eGFR have been grouped together under the term 'renal function profile' because they are provided as a unified set of analyses in the NHS. The term 'profile' is applied to a group of tests (assays). Thus these tests are more accurately described as 'profiles' as they contain multiple individual assays and have replaced thyroid function test, liver function test and lipid measurement. 'Fasting glucose' has been replaced by 'glycosylated haemoglobin (HbA1c)' in line with the NICE guidelines on diabetes. • Measurement of serum urea has been deleted from recommendation 1.4.4 because the guideline committee agreed that it is not needed and is not part of renal function profiles in most centres in the UK. Measurement of potassium has been added to ensure that monitoring is consistent across treatments. • Recommendations 1.4.6 and 1.4.10 have been added to clarify the timing of monitoring after treatment starts. • In recommendation 1.4.8, monitoring for hyperkalaemia has been replaced by potassium measurement for clarity. • Blood pressure measurement has been clarified in recommendation 1.4.13 and made consistent with other treatments. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 34 of 35 • As a result of new evidence the treatment pathway for heart failure with reduced ejection fraction in recommendation 1.4.26 has been amended. Second line treatment has been replaced by specialist treatment. A sentence has been added to clarify that specialist advice should be sought before starting treatment with digoxin. • The first part of recommendation 1.6.2 has been removed because it is now covered in section 1.1 on team working in the management of heart failure. • Amlodipine to treat hypertension has been deleted from recommendation 1.6.3 because it has been superseded by the NICE guideline on hypertension in adults. • 'Regularly' has been replaced by 'at the 6-monthly clinical review' in recommendation 1.6.5 for clarification. • The wording in recommendation 1.6.6 has been amended in line with recommendation 1.6.5. Minor changes since publication April 2022: In section 1.4 we added links to NICE's technology appraisal guidance on dapagliflozin and empagliflozin for treating chronic heart failure with reduced ejection fraction. November 2021: We added a link to the NICE guideline on heart valve disease in recommendations 1.2.8, 1.2.15 and 1.4.2. ISBN: 978-1-4731-3093-7 Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 35 of 35","Response should not be more than 100 words. Model must only respond using information contained in the context block. Model should not rely on its own knowledge or outside sources of information when responding. What medications should be prescribed first for adults diagnosed with heart failure with reduced ejection fraction according to the NICE guidelines? Chronic heart failure in adults: diagnosis and management NICE guideline Published: 12 September 2018 www.nice.org.uk/guidance/ng106 © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Your responsibility The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian. All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme. Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties. Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 2 of 35 Contents Overview ...................................................................................................................................... 5 Who is it for? .......................................................................................................................................... 5 Recommendations ....................................................................................................................... 6 1.1 Team working in the management of heart failure ....................................................................... 6 1.2 Diagnosing heart failure .................................................................................................................. 9 1.3 Giving information to people with heart failure ............................................................................ 12 1.4 Treating heart failure with reduced ejection fraction .................................................................. 12 1.5 Treating heart failure with reduced ejection fraction in people with chronic kidney disease . 17 1.6 Managing all types of heart failure ................................................................................................ 18 1.7 Monitoring treatment for all types of heart failure ....................................................................... 21 1.8 Interventional procedures ............................................................................................................... 22 1.9 Cardiac rehabilitation ...................................................................................................................... 23 1.10 Palliative care ................................................................................................................................. 24 Terms used in this guideline ................................................................................................................. 24 Putting this guideline into practice ............................................................................................ 26 Recommendations for research ................................................................................................. 28 1 Diuretic therapy for managing fluid overload in people with advanced heart failure in the community ............................................................................................................................................. 28 2 Cardiac MRI versus other imaging techniques for diagnosing heart failure ................................ 28 3 The impact of atrial fibrillation on the natriuretic peptide threshold for diagnosing heart failure ...................................................................................................................................................... 29 4 The impact of advanced kidney disease on the natriuretic peptide threshold for diagnosing heart failure ............................................................................................................................................ 30 5 Risk tools for predicting non-sudden death in heart failure .......................................................... 30 Context ......................................................................................................................................... 31 Key facts and figures ............................................................................................................................ 31 Current practice .................................................................................................................................... 31 Finding more information and committee details .....................................................................32 Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 3 of 35 Update information .....................................................................................................................33 Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 4 of 35 This guideline replaces CG108. This guideline is the basis of QS167, QS9 and QS181. Overview This guideline covers diagnosing and managing chronic heart failure in people aged 18 and over. It aims to improve diagnosis and treatment to increase the length and quality of life for people with heart failure. NICE has also produced a guideline on acute heart failure. Who is it for? • Healthcare professionals • People with heart failure and their families and carers Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 5 of 35 Recommendations People have the right to be involved in discussions and make informed decisions about their care, as described in NICE's information on making decisions about your care. Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off-label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding. 1.1 Team working in the management of heart failure 1.1.1 The core specialist heart failure multidisciplinary team (MDT) should work in collaboration with the primary care team, and should include: • a lead physician with subspecialty training in heart failure (usually a consultant cardiologist) who is responsible for making the clinical diagnosis • a specialist heart failure nurse • a healthcare professional with expertise in specialist prescribing for heart failure. [2018] 1.1.2 The specialist heart failure MDT should: • diagnose heart failure • give information to people newly diagnosed with heart failure (see the section on giving information to people with heart failure) • manage newly diagnosed, recently decompensated or advanced heart failure (NYHA [New York Heart Association] class III to IV) Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 6 of 35 • optimise treatment • start new medicines that need specialist supervision • continue to manage heart failure after an interventional procedure such as implantation of a cardioverter defibrillator or cardiac resynchronisation device • manage heart failure that is not responding to treatment. [2018] 1.1.3 The specialist heart failure MDT should directly involve, or refer people to, other services, including rehabilitation, services for older people and palliative care services, as needed. [2018] 1.1.4 The primary care team should carry out the following for people with heart failure at all times, including periods when the person is also receiving specialist heart failure care from the MDT: • ensure effective communication links between different care settings and clinical services involved in the person's care • lead a full review of the person's heart failure care, which may form part of a long-term conditions review • recall the person at least every 6 months and update the clinical record • ensure that changes to the clinical record are understood and agreed by the person with heart failure and shared with the specialist heart failure MDT • arrange access to specialist heart failure services if needed. [2018] Care after an acute event For recommendations on the diagnosis and management of acute heart failure, see the NICE guideline on acute heart failure. 1.1.5 People with heart failure should generally be discharged from hospital only when their clinical condition is stable and the management plan is optimised. Timing of discharge should take into account the wishes of the person and their family or Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 7 of 35 carer, and the level of care and support that can be provided in the community. [2003] 1.1.6 The primary care team should take over routine management of heart failure as soon as it has been stabilised and its management optimised. [2018] Writing a care plan 1.1.7 The specialist heart failure MDT should write a summary for each person with heart failure that includes: • diagnosis and aetiology • medicines prescribed, monitoring of medicines, when medicines should be reviewed and any support the person needs to take the medicines • functional abilities and any social care needs • social circumstances, including carers' needs. [2018] 1.1.8 The summary should form the basis of a care plan for each person, which should include: • plans for managing the person's heart failure, including follow-up care, rehabilitation and access to social care • symptoms to look out for in case of deterioration • a process for any subsequent access to the specialist heart failure MDT if needed • contact details for － a named healthcare coordinator (usually a specialist heart failure nurse) － alternative local heart failure specialist care providers, for urgent care or review. • additional sources of information for people with heart failure. [2018] Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 8 of 35 1.1.9 Give a copy of the care plan to the person with heart failure, their family or carer if appropriate, and all health and social care professionals involved in their care. [2018] 1.2 Diagnosing heart failure Symptoms, signs and investigations 1.2.1 Take a careful and detailed history, and perform a clinical examination and tests to confirm the presence of heart failure. [2010] 1.2.2 Measure N-terminal pro-B-type natriuretic peptide (NT-proBNP) in people with suspected heart failure. [2018] 1.2.3 Because very high levels of NT-proBNP carry a poor prognosis, refer people with suspected heart failure and an NT-proBNP level above 2,000 ng/litre (236 pmol/ litre) urgently, to have specialist assessment and transthoracic echocardiography within 2 weeks. [2018] 1.2.4 Refer people with suspected heart failure and an NT-proBNP level between 400 and 2,000 ng/litre (47 to 236 pmol/litre) to have specialist assessment and transthoracic echocardiography within 6 weeks. [2018] 1.2.5 Be aware that: • an NT-proBNP level less than 400 ng/litre (47 pmol/litre) in an untreated person makes a diagnosis of heart failure less likely • the level of serum natriuretic peptide does not differentiate between heart failure with reduced ejection fraction and heart failure with preserved ejection fraction. [2018] 1.2.6 Review alternative causes for symptoms of heart failure in people with NTproBNP levels below 400 ng/litre. If there is still concern that the symptoms might be related to heart failure, discuss with a physician with subspeciality training in heart failure. [2018] Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 9 of 35 1.2.7 Be aware that: • obesity, African or African–Caribbean family background, or treatment with diuretics, angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, angiotensin II receptor blockers (ARBs) or mineralocorticoid receptor antagonists (MRAs) can reduce levels of serum natriuretic peptides • high levels of serum natriuretic peptides can have causes other than heart failure (for example, age over 70 years, left ventricular hypertrophy, ischaemia, tachycardia, right ventricular overload, hypoxaemia [including pulmonary embolism], renal dysfunction [eGFR less than 60 ml/minute/ 1.73 m 2 ], sepsis, chronic obstructive pulmonary disease, diabetes, or cirrhosis of the liver). [2010, amended 2018] 1.2.8 Perform transthoracic echocardiography to exclude important valve disease, assess the systolic (and diastolic) function of the (left) ventricle, and detect intracardiac shunts. See the section on referral for echocardiography and specialist assessment in the NICE guideline on heart valve disease. [2003, amended 2018] 1.2.9 Transthoracic echocardiography should be performed on high-resolution equipment by experienced operators trained to the relevant professional standards. Need and demand for these studies should not compromise quality. [2003, amended 2018] 1.2.10 Ensure that those reporting echocardiography are experienced in doing so. [2003] 1.2.11 Consider alternative methods of imaging the heart (for example, radionuclide angiography [multigated acquisition scanning], cardiac MRI or transoesophageal echocardiography) if a poor image is produced by transthoracic echocardiography. [2003, amended 2018] 1.2.12 Perform an ECG and consider the following tests to evaluate possible aggravating factors and/or alternative diagnoses: • chest X-ray • blood tests: Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 10 of 35 － renal function profile － thyroid function profile － liver function profile － lipid profile － glycosylated haemoglobin (HbA1c) － full blood count • urinalysis • peak flow or spirometry. [2010, amended 2018] 1.2.13 Try to exclude other disorders that may present in a similar manner. [2003] 1.2.14 When a diagnosis of heart failure has been made, assess severity, aetiology, precipitating factors, type of cardiac dysfunction and correctable causes. [2010] Heart failure caused by valve disease 1.2.15 Refer people with heart failure caused by valve disease for specialist assessment and advice regarding follow-up. See the section on referral for echocardiography and specialist assessment in the NICE guideline on heart valve disease. [2003] Reviewing existing diagnoses 1.2.16 Review the basis for a historical diagnosis of heart failure, and manage care in accordance with this guideline only if the diagnosis is confirmed. [2003] 1.2.17 If the diagnosis of heart failure is still suspected, but confirmation of the underlying cardiac abnormality has not occurred, then the person should have appropriate further investigation. [2003] Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 11 of 35 1.3 Giving information to people with heart failure 1.3.1 When giving information to people with heart failure, follow the recommendations in the NICE guideline on patient experience in adult NHS services. [2018] 1.3.2 Discuss the person's prognosis in a sensitive, open and honest manner. Be frank about the uncertainty in predicting the course of their heart failure. Revisit this discussion as the person's condition evolves. [2018] 1.3.3 Provide information whenever needed throughout the person's care. [2018] 1.3.4 Consider training in advanced communication skills for all healthcare professionals working with people who have heart failure. [2018] First consultations for people newly diagnosed with heart failure 1.3.5 The specialist heart failure MDT should offer people newly diagnosed with heart failure an extended first consultation, followed by a second consultation to take place within 2 weeks if possible. At each consultation: • discuss the person's diagnosis and prognosis • explain heart failure terminology • discuss treatments • address the risk of sudden death, including any misconceptions about that risk • encourage the person and their family or carers to ask any questions they have. [2018] 1.4 Treating heart failure with reduced ejection fraction See the section on managing all types of heart failure for general recommendations on managing all types of heart failure. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 12 of 35 See NICE's technology appraisal guidance on dapagliflozin and empagliflozin for treating chronic heart failure with reduced ejection fraction. When managing pharmacological treatment, follow the recommendations in the NICE guidelines on medicines adherence and medicines optimisation. First-line treatment 1.4.1 Offer an angiotensin-converting enzyme (ACE) inhibitor and a beta-blocker licensed for heart failure to people who have heart failure with reduced ejection fraction. Use clinical judgement when deciding which drug to start first. [2010] ACE inhibitors 1.4.2 Do not offer ACE inhibitor therapy if there is a clinical suspicion of haemodynamically significant valve disease until the valve disease has been assessed by a specialist. See the section on referral for echocardiography and specialist assessment in the NICE guideline on heart valve disease. [2003] 1.4.3 Start ACE inhibitor therapy at a low dose and titrate upwards at short intervals (for example, every 2 weeks) until the target or maximum tolerated dose is reached. [2010] 1.4.4 Measure serum sodium and potassium, and assess renal function, before and 1 to 2 weeks after starting an ACE inhibitor, and after each dose increment. [2010, amended 2018] 1.4.5 Measure blood pressure before and after each dose increment of an ACE inhibitor. Follow the recommendations on measuring blood pressure, including measurement in people with symptoms of postural hypotension, in the NICE guideline on hypertension in adults. [2018] 1.4.6 Once the target or maximum tolerated dose of an ACE inhibitor is reached, monitor treatment monthly for 3 months and then at least every 6 months, and at any time the person becomes acutely unwell. [2010, amended 2018] Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 13 of 35 Alternative treatments if ACE inhibitors are not tolerated 1.4.7 Consider an ARB licensed for heart failure as an alternative to an ACE inhibitor for people who have heart failure with reduced ejection fraction and intolerable side effects with ACE inhibitors. [2010] 1.4.8 Measure serum sodium and potassium, and assess renal function, before and after starting an ARB and after each dose increment. [2010, amended 2018] 1.4.9 Measure blood pressure after each dose increment of an ARB. Follow the recommendations on measuring blood pressure, including measurement in people with symptoms of postural hypotension, in the NICE guideline on hypertension in adults. [2018] 1.4.10 Once the target or maximum tolerated dose of an ARB is reached, monitor treatment monthly for 3 months and then at least every 6 months, and at any time the person becomes acutely unwell. [2010, amended 2018] 1.4.11 If neither ACE inhibitors nor ARBs are tolerated, seek specialist advice and consider hydralazine in combination with nitrate for people who have heart failure with reduced ejection fraction. [2010] Beta-blockers 1.4.12 Do not withhold treatment with a beta-blocker solely because of age or the presence of peripheral vascular disease, erectile dysfunction, diabetes, interstitial pulmonary disease or chronic obstructive pulmonary disease. [2010] 1.4.13 Introduce beta-blockers in a 'start low, go slow' manner. Assess heart rate and clinical status after each titration. Measure blood pressure before and after each dose increment of a beta-blocker. [2010,amended 2018] 1.4.14 Switch people whose condition is stable and who are already taking a betablocker for a comorbidity (for example, angina or hypertension), and who develop heart failure with reduced ejection fraction, to a beta-blocker licensed for heart failure. [2010] Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 14 of 35 Mineralocorticoid receptor antagonists 1.4.15 Offer an mineralocorticoid receptor antagonists (MRA), in addition to an ACE inhibitor (or ARB) and beta-blocker, to people who have heart failure with reduced ejection fraction if they continue to have symptoms of heart failure. [2018] 1.4.16 Measure serum sodium and potassium, and assess renal function, before and after starting an MRA and after each dose increment. [2018] 1.4.17 Measure blood pressure before and after after each dose increment of an MRA. Follow the recommendations on measuring blood pressure, including measurement in people with symptoms of postural hypotension, in the NICE guideline on hypertension in adults. [2018] 1.4.18 Once the target, or maximum tolerated, dose of an MRA is reached, monitor treatment monthly for 3 months and then at least every 6 months, and at any time the person becomes acutely unwell. [2018] Specialist treatment Ivabradine These recommendations are from the NICE technology appraisal guidance on ivabradine for treating chronic heart failure. 1.4.19 Ivabradine is recommended as an option for treating chronic heart failure for people: • with New York Heart Association (NYHA) class II to IV stable chronic heart failure with systolic dysfunction and • who are in sinus rhythm with a heart rate of 75 beats per minute (bpm) or more and • who are given ivabradine in combination with standard therapy including beta-blocker therapy, angiotensin-converting enzyme (ACE) inhibitors and Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 15 of 35 aldosterone antagonists, or when beta-blocker therapy is contraindicated or not tolerated and • with a left ventricular ejection fraction of 35% or less. [2012] 1.4.20 Ivabradine should only be initiated after a stabilisation period of 4 weeks on optimised standard therapy with ACE inhibitors, beta-blockers and aldosterone antagonists. [2012] 1.4.21 Ivabradine should be initiated by a heart failure specialist with access to a multidisciplinary heart failure team. Dose titration and monitoring should be carried out by a heart failure specialist, or in primary care by either a GP with a special interest in heart failure or a heart failure specialist nurse. [2012] Sacubitril valsartan These recommendations are from the NICE technology appraisal guidance on sacubitril valsartan for treating symptomatic chronic heart failure with reduced ejection fraction. 1.4.22 Sacubitril valsartan is recommended as an option for treating symptomatic chronic heart failure with reduced ejection fraction, only in people: • with New York Heart Association (NYHA) class II to IV symptoms and • with a left ventricular ejection fraction of 35% or less and • who are already taking a stable dose of angiotensin-converting enzyme (ACE) inhibitors or ARBs. [2016] 1.4.23 Treatment with sacubitril valsartan should be started by a heart failure specialist with access to a multidisciplinary heart failure team. Dose titration and monitoring should be performed by the most appropriate team member (see the section on team working in the management of heart failure). [2016] 1.4.24 This guidance is not intended to affect the position of patients whose treatment with sacubitril valsartan was started within the NHS before this guidance was published. Treatment of those patients may continue without change to whatever Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 16 of 35 funding arrangements were in place for them before this guidance was published until they and their NHS clinician consider it appropriate to stop. [2016] Hydralazine in combination with nitrate 1.4.25 Seek specialist advice and consider offering hydralazine in combination with nitrate (especially if the person is of African or Caribbean family origin and has moderate to severe heart failure [NYHA class III/IV] with reduced ejection fraction). [2010] Digoxin For recommendations on digoxin for people with atrial fibrillation see the section on rate and rhythm control in the NICE guideline on atrial fibrillation. 1.4.26 Digoxin is recommended for worsening or severe heart failure with reduced ejection fraction despite first-line treatment for heart failure. Seek specialist advice before initiating. [2010, amended 2018] 1.4.27 Routine monitoring of serum digoxin concentrations is not recommended. A digoxin concentration measured within 8 to 12 hours of the last dose may be useful to confirm a clinical impression of toxicity or non-adherence. [2003] 1.4.28 The serum digoxin concentration should be interpreted in the clinical context as toxicity may occur even when the concentration is within the 'therapeutic range'. [2003] 1.5 Treating heart failure with reduced ejection fraction in people with chronic kidney disease 1.5.1 For people who have heart failure with reduced ejection fraction and chronic kidney disease with an eGFR of 30 ml/min/1.73 m 2 or above: • offer the treatment outlined in the section on treating heart failure with Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 17 of 35 reduced ejection fraction and • if the person's eGFR is 45 ml/min/1.73 m 2 or below, consider lower doses and/ or slower titration of dose of ACE inhibitors or ARBs, MRAs and digoxin. [2018] 1.5.2 For people who have heart failure with reduced ejection fraction and chronic kidney disease with an eGFR below 30 ml/min/1.73 m 2 , the specialist heart failure MDT should consider liaising with a renal physician. [2018] 1.5.3 Monitor the response to titration of medicines closely in people who have heart failure with reduced ejection fraction and chronic kidney disease, taking into account the increased risk of hyperkalaemia. [2018] 1.6 Managing all types of heart failure When managing pharmacological treatment, follow the recommendations in the NICE guidelines on medicines adherence and medicines optimisation. Pharmacological treatment Diuretics 1.6.1 Diuretics should be routinely used for the relief of congestive symptoms and fluid retention in people with heart failure, and titrated (up and down) according to need following the initiation of subsequent heart failure therapies. [2003] 1.6.2 People who have heart failure with preserved ejection fraction should usually be offered a low to medium dose of loop diuretics (for example, less than 80 mg furosemide per day). People whose heart failure does not respond to this treatment will need further specialist advice. [2003, amended 2018] Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 18 of 35 Calcium-channel blockers 1.6.3 Avoid verapamil, diltiazem and short-acting dihydropyridine agents in people who have heart failure with reduced ejection fraction. [2003, amended 2018] Amiodarone 1.6.4 Make the decision to prescribe amiodarone in consultation with a specialist. [2003] 1.6.5 Review the need to continue the amiodarone prescription at the 6-monthly clinical review. [2003, amended 2018] 1.6.6 Offer people taking amiodarone liver and thyroid function tests, and a review of side effects, as part of their routine 6-monthly clinical review. [2003, amended 2018] Anticoagulants 1.6.7 For people who have heart failure and atrial fibrillation, follow the recommendations on anticoagulation in the NICE guideline on atrial fibrillation. Be aware of the effects of impaired renal and liver function on anticoagulant therapies. [2018] 1.6.8 In people with heart failure in sinus rhythm, anticoagulation should be considered for those with a history of thromboembolism, left ventricular aneurysm or intracardiac thrombus. [2003] Vaccinations 1.6.9 Offer people with heart failure an annual vaccination against influenza. [2003] 1.6.10 Offer people with heart failure vaccination against pneumococcal disease (only required once). [2003] Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 19 of 35 Contraception and pregnancy 1.6.11 In women of childbearing potential who have heart failure, contraception and pregnancy should be discussed. If pregnancy is being considered or occurs, specialist advice should be sought. Subsequently, specialist care should be shared between the cardiologist and obstetrician. [2003] Depression See NICE's guideline on depression in adults with a chronic physical health problem. Lifestyle advice Salt and fluid restriction 1.6.12 Do not routinely advise people with heart failure to restrict their sodium or fluid consumption. Ask about salt and fluid consumption and, if needed, advise as follows: • restricting fluids for people with dilutional hyponatraemia • reducing intake for people with high levels of salt and/or fluid consumption. Continue to review the need to restrict salt or fluid. [2018] 1.6.13 Advise people with heart failure to avoid salt substitutes that contain potassium. [2018] Smoking and alcohol See NICE's guidance on smoking and tobacco and alcohol. Air travel 1.6.14 Air travel will be possible for the majority of people with heart failure, depending Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 20 of 35 on their clinical condition at the time of travel. [2003] Driving 1.6.15 Large Goods Vehicle and Passenger Carrying Vehicle licence: physicians should be up to date with the latest Driver and Vehicle Licensing Agency (DVLA) guidelines. Check the DVLA website for regular updates. [2003] 1.7 Monitoring treatment for all types of heart failure See the section on treating heart failure with reduced ejection fraction for specific recommendations on monitoring treatment for heart failure with reduced ejection fraction. Clinical review 1.7.1 All people with chronic heart failure need monitoring. This monitoring should include: • a clinical assessment of functional capacity, fluid status, cardiac rhythm (minimum of examining the pulse), cognitive status and nutritional status • a review of medication, including need for changes and possible side effects • an assessment of renal function. Note: This is a minimum. People with comorbidities or co-prescribed medications will need further monitoring. Monitoring serum potassium is particularly important if a person is taking digoxin or an MRA. [2010, amended 2018] 1.7.2 More detailed monitoring will be needed if the person has significant comorbidity or if their condition has deteriorated since the previous review. [2003] 1.7.3 The frequency of monitoring should depend on the clinical status and stability of Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 21 of 35 the person. The monitoring interval should be short (days to 2 weeks) if the clinical condition or medication has changed, but is needed at least 6-monthly for stable people with proven heart failure. [2003] 1.7.4 People with heart failure who wish to be involved in monitoring of their condition should be provided with sufficient education and support from their healthcare professional to do this, with clear guidelines as to what to do in the event of deterioration. [2003] Measuring NT-proBNP 1.7.5 Consider measuring NT-proBNP (N-terminal pro-B-type natriuretic peptide) as part of a treatment optimisation protocol only in a specialist care setting for people aged under 75 who have heart failure with reduced ejection fraction and an eGFR above 60 ml/min/1.73 m 2 . [2018] 1.8 Interventional procedures Coronary revascularisation 1.8.1 Do not routinely offer coronary revascularisation to people who have heart failure with reduced ejection fraction and coronary artery disease. [2018] Cardiac transplantation 1.8.2 Specialist referral for transplantation should be considered for people with severe refractory symptoms or refractory cardiogenic shock. [2003] Implantable cardioverter defibrillators and cardiac resynchronisation therapy See NICE's technology appraisal guidance on implantable cardioverter defibrillators and cardiac resynchronisation therapy for arrhythmias and heart failure. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 22 of 35 1.8.3 When discussing implantation of a cardioverter defibrillator: • explain the risks, benefits and consequences of cardioverter defibrillator implantation, following the principles on shared decision making in the NICE guideline on patient experience in adult NHS services • ensure the person knows that the defibrillator function can be deactivated without affecting any cardiac resynchronisation or pacing, and reactivated later • explain the circumstances in which deactivation might be offered • discuss and dispel common misconceptions about the function of the device and the consequences of deactivation • provide the person and, if they wish, their family or carers with written information covering the information discussed. [2018] 1.8.4 Review the benefits and potential harms of a cardioverter defibrillator remaining active in a person with heart failure: • at each 6-monthly review of their heart failure care • whenever their care goals change • as part of advance care planning if it is thought they are nearing the end of life. [2018] 1.9 Cardiac rehabilitation 1.9.1 Offer people with heart failure a personalised, exercise-based cardiac rehabilitation programme, unless their condition is unstable. The programme: • should be preceded by an assessment to ensure that it is suitable for the person • should be provided in a format and setting (at home, in the community or in the hospital) that is easily accessible for the person Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 23 of 35 • should include a psychological and educational component • may be incorporated within an existing cardiac rehabilitation programme • should be accompanied by information about support available from healthcare professionals when the person is doing the programme. [2018] 1.10 Palliative care 1.10.1 Do not offer long-term home oxygen therapy for advanced heart failure. Be aware that long-term home oxygen therapy may be offered for comorbidities, such as for some people with chronic obstructive pulmonary disease (see the section on oxygen in the NICE guideline on chronic obstructive pulmonary disease in over 16s). [2018] 1.10.2 Do not use prognostic risk tools to determine whether to refer a person with heart failure to palliative care services. [2018] 1.10.3 If the symptoms of a person with heart failure are worsening despite optimal specialist treatment, discuss their palliative care needs with the specialist heart failure multidisciplinary team and consider a needs assessment for palliative care. [2018] 1.10.4 People with heart failure and their families or carers should have access to professionals with palliative care skills within the heart failure team. [2003] 1.10.5 If it is thought that a person may be entering the last 2 to 3 days of life, follow the NICE guideline on care of dying adults in the last days of life. [2018] Terms used in this guideline Heart failure with preserved ejection fraction This is usually associated with impaired left ventricular relaxation, rather than left ventricular contraction, and is characterised by normal or preserved left ventricular Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 24 of 35 ejection fraction with evidence of diastolic dysfunction . Heart failure with reduced ejection fraction Heart failure with an ejection fraction below 40%. Mineralocorticoid receptor antagonist A drug that antagonises the action of aldosterone at mineralocorticoid receptors. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 25 of 35 Putting this guideline into practice NICE has produced tools and resources to help you put this guideline into practice. Putting recommendations into practice can take time. How long may vary from guideline to guideline, and depends on how much change in practice or services is needed. Implementing change is most effective when aligned with local priorities. Changes recommended for clinical practice that can be done quickly – like changes in prescribing practice – should be shared quickly. This is because healthcare professionals should use guidelines to guide their work – as is required by professional regulating bodies such as the General Medical and Nursing and Midwifery Councils. Changes should be implemented as soon as possible, unless there is a good reason for not doing so (for example, if it would be better value for money if a package of recommendations were all implemented at once). Different organisations may need different approaches to implementation, depending on their size and function. Sometimes individual practitioners may be able to respond to recommendations to improve their practice more quickly than large organisations. Here are some pointers to help organisations put NICE guidelines into practice: 1. Raise awareness through routine communication channels, such as email or newsletters, regular meetings, internal staff briefings and other communications with all relevant partner organisations. Identify things staff can include in their own practice straight away. 2. Identify a lead with an interest in the topic to champion the guideline and motivate others to support its use and make service changes, and to find out any significant issues locally. 3. Carry out a baseline assessment against the recommendations to find out whether there are gaps in current service provision. 4. Think about what data you need to measure improvement and plan how you will collect it. You may want to work with other health and social care organisations and specialist Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 26 of 35 groups to compare current practice with the recommendations. This may also help identify local issues that will slow or prevent implementation. 5. Develop an action plan, with the steps needed to put the guideline into practice, and make sure it is ready as soon as possible. Big, complex changes may take longer to implement, but some may be quick and easy to do. An action plan will help in both cases. 6. For very big changes include milestones and a business case, which will set out additional costs, savings and possible areas for disinvestment. A small project group could develop the action plan. The group might include the guideline champion, a senior organisational sponsor, staff involved in the associated services, finance and information professionals. 7. Implement the action plan with oversight from the lead and the project group. Big projects may also need project management support. 8. Review and monitor how well the guideline is being implemented through the project group. Share progress with those involved in making improvements, as well as relevant boards and local partners. NICE provides a comprehensive programme of support and resources to maximise uptake and use of evidence and guidance. See NICE's into practice pages for more information. Also see Leng G, Moore V, Abraham S, editors (2014) Achieving high quality care – practical experience from NICE. Chichester: Wiley. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 27 of 35 Recommendations for research The guideline committee has made the following key recommendations for research. The committee's full set of research recommendations is detailed in the full guideline. 1 Diuretic therapy for managing fluid overload in people with advanced heart failure in the community In people with advanced heart failure and significant peripheral fluid overload, what is the clinical and cost effectiveness of oral, subcutaneous and intravenous diuretic therapy in the community? Why this is important This research is critical to inform practice of how best to manage people with advanced heart failure in the community if they develop significant peripheral fluid overload. These people are more likely to have multiple admissions that, together with fluid overload, have a negative impact on their quality of life. Management in the community can minimise disruption for the person and reduce costs from hospital admissions. Knowledge of the most clinically and cost-effective routes of administration for diuretic therapy will dictate the level of resource needed to provide the service. Intravenous and subcutaneous diuretics usually need to be administered by nursing or healthcare staff. although a pump for self-administration of subcutaneous diuretics has recently been developed. Oral formulations can be self-administered. 2 Cardiac MRI versus other imaging techniques for diagnosing heart failure What is the optimal imaging technique for the diagnosis of heart failure? Why this is important The role of cardiac MRI in the detection and characterisation of several structural and Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 28 of 35 functional cardiac abnormalities has become well established over the past 25 years. In people with heart failure, cardiac MRI provides reliable and reproducible assessments of the left ventricular (and to a degree the right ventricular) shapes, volumes and ejection fractions. It also provides spatial assessments of the congenital and acquired structural abnormalities of the heart and their interrelationships with the remainder of the heart, as well as functional and haemodynamic assessments of these abnormalities on the heart's performance. Finally, cardiac MRI provides valuable information about the myocardial structure and metabolism, including the presence of inflammation, scarring, fibrosis and infiltration. Cardiac MRI is an expensive form of imaging, and much of this diagnostic information could be provided by less costly non-invasive imaging techniques, chiefly echocardiography. This question aims to find the most clinically and cost-effective imaging technique for the clinical diagnosis of heart failure. 3 The impact of atrial fibrillation on the natriuretic peptide threshold for diagnosing heart failure What is the optimal NT-proBNP threshold for the diagnosis of heart failure in people with atrial fibrillation? Why this is important Atrial fibrillation is a common arrhythmia in the general population, and occurs in 30 to 40% of people with heart failure. Atrial fibrillation can raise the level of serum natriuretic peptides, including NT-proBNP, even in the absence of heart failure. This is complicated further in heart failure with preserved ejection fraction, in which 2 echocardiographic diagnostic criteria become unreliable (the left atrial volume and the tissue doppler imaging assessment of diastolic function). These factors contribute to the complexity of the diagnosis and have a potential impact on the usual thresholds for NT-proBNP in people who have atrial fibrillation. This has been recognised in several ongoing randomised controlled trials of heart failure, which are using higher NT-proBNP thresholds for the diagnosis of heart failure in people with atrial fibrillation. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 29 of 35 4 The impact of advanced kidney disease on the natriuretic peptide threshold for diagnosing heart failure What are the optimal NT-proBNP thresholds for diagnosing heart failure in people with stage IIIb, IV or V chronic kidney disease? Why this is important Heart failure incidence and prevalence increase with age, with the rise starting at age 65 and peaking between 75 and 85. Both advancing age and heart failure are associated with a gradual and progressive decline in renal function. In addition, the progression of heart failure and some treatments for heart failure lead to progressive deterioration of renal function. A decline in renal function is associated with increased fluid retention and a rise in the level of the serum natriuretic peptides, including NT-proBNP, even in the absence of heart failure. There is some evidence that the use of higher NT-proBNP thresholds would improve diagnostic accuracy for heart failure in people with significant deterioration of creatinine clearance. 5 Risk tools for predicting non-sudden death in heart failure What is the most accurate prognostic risk tool in predicting 1-year mortality from heart failure at specific clinically relevant thresholds (for example, sensitivity, specificity, negative predictive value and positive predictive value at a threshold of 50% risk of mortality at 1 year)? Why this is important There are a number of validated prognostic risk tools for heart failure but most do not report sensitivity and specificity at clinically relevant thresholds. This information is crucial to enable accurate prediction of a person's risk of mortality. The ability to accurately predict a person's prognosis would allow clearer communication and timely referral to other services such as palliative care. Inaccurate prediction has the potential to lead to significant psychological harm and increased morbidity. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 30 of 35 Context Key facts and figures Heart failure is a complex clinical syndrome of symptoms and signs that suggest the efficiency of the heart as a pump is impaired. It is caused by structural or functional abnormalities of the heart. Around 920,000 people in the UK today have been diagnosed with heart failure. Both the incidence and prevalence of heart failure increase steeply with age, and the average age at diagnosis is 77. Improvements in care have increased survival for people with ischaemic heart disease, and treatments for heart failure have become more effective. But the overall prevalence of heart failure is rising because of population ageing and increasing rates of obesity. Current practice Uptake of NICE's 2010 guidance on chronic heart failure appears to be good. However, the Department of Health and Social Care's policy paper on improving cardiovascular disease outcomes: strategy noted that prescribing of ACE inhibitors, beta-blockers and aldosterone antagonists remains suboptimal, and that improved use of these drugs has the potential to reduce hospitalisations and deaths caused by heart failure. This update reviewed evidence on the clinical and cost effectiveness of these therapies. Interdisciplinary working has contributed to better outcomes in heart failure but there is further room to improve the provision of multidisciplinary teams (MDTs) and integrate them more fully into healthcare processes. This update highlights and further expands on the roles of the MDT and collaboration between the MDT and the primary care team. The Department of Health and Social Care's policy paper on improving cardiovascular disease outcomes: strategy also noted that the proportion of people with heart failure who have cardiac rehabilitation was around 4%, and that increasing this proportion would reduce mortality and hospitalisation. This update recommends that all people with heart failure are offered an easily accessible, exercise-based cardiac rehabilitation programme, if this is suitable for them. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 31 of 35 Finding more information and committee details To find out what NICE has said on related topics, including guidance in development, see the NICE topic page on cardiovascular conditions. For full details of the evidence and the guideline committee's discussions, see the full guideline. You can also find information about how the guideline was developed, including details of the committee. NICE has produced tools and resources to help you put this guideline into practice. For general help and advice on putting our guidelines into practice, see resources to help you put NICE guidance into practice. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 32 of 35 Update information September 2018: This guideline updates and replaces NICE clinical guideline 108 (published August 2010). NICE clinical guideline 108 updated and replaced NICE clinical guideline 5 (published July 2003). Recommendations are marked as [2018], [2016], [2012], [2010], [2010, amended 2018], [2003], [2003, amended 2018] or [2003, amended 2010], [2018] indicates that the evidence was reviewed and the recommendation added, updated or unchanged in 2018. [2016] refers to NICE technology appraisal guidance published in 2016. [2012] refers to NICE technology appraisal guidance published in 2012. [2010] indicates that the evidence was reviewed in 2010. [2010, amended 2018] indicates that the evidence was reviewed in 2010 but changes were made to the recommendation wording in 2018 that changed the meaning. [2003] indicates that the evidence was reviewed in 2003. [2003, amended 2018] indicates that the evidence was reviewed in 2003 but changes were made to the recommendation wording in 2018 that changed the meaning. [2003, amended 2010] indicates that the evidence was reviewed in 2003 but changes were made to the recommendation wording in 2010 that changed the meaning. • 'Heart failure due to left ventricular systolic dysfunction (LVSD)' has been replaced in all recommendations by 'heart failure with reduced ejection fraction' in line with current terminology and the 2018 guideline scope. • 'Aldosterone antagonists' has been replaced in all recommendations by 'mineralocorticoid receptor antagonists (MRAs') to clarify the function of the receptor, and in line with the 2018 guideline scope. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 33 of 35 • 'African or African-Caribbean family origin' has been added to recommendation 1.2.7 because of the high incidence of heart failure with preserved ejection fraction in these populations. Recent evidence shows that NT-proBNP levels are lower in people of west African family background and are a confounder in the diagnosis of heart failure. • Doppler 2D has been deleted from recommendations 1.2.8, 1.2.9 and 1.2.11 because all transthoracic echocardiography would have doppler 2D as a minimum and it is no longer necessary to specify this. • 'Multigated acquisition scanning' has been added to recommendation 1.2.11 to reflect current imaging technology. • Measurement of urea has been deleted from recommendations 1.2.12, 1.4.8 and 1.7.1 because the guideline committee agreed that it is not needed and is not part of renal function profiles in most centres in the UK. Blood tests for electrolytes, creatinine and eGFR have been grouped together under the term 'renal function profile' because they are provided as a unified set of analyses in the NHS. The term 'profile' is applied to a group of tests (assays). Thus these tests are more accurately described as 'profiles' as they contain multiple individual assays and have replaced thyroid function test, liver function test and lipid measurement. 'Fasting glucose' has been replaced by 'glycosylated haemoglobin (HbA1c)' in line with the NICE guidelines on diabetes. • Measurement of serum urea has been deleted from recommendation 1.4.4 because the guideline committee agreed that it is not needed and is not part of renal function profiles in most centres in the UK. Measurement of potassium has been added to ensure that monitoring is consistent across treatments. • Recommendations 1.4.6 and 1.4.10 have been added to clarify the timing of monitoring after treatment starts. • In recommendation 1.4.8, monitoring for hyperkalaemia has been replaced by potassium measurement for clarity. • Blood pressure measurement has been clarified in recommendation 1.4.13 and made consistent with other treatments. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 34 of 35 • As a result of new evidence the treatment pathway for heart failure with reduced ejection fraction in recommendation 1.4.26 has been amended. Second line treatment has been replaced by specialist treatment. A sentence has been added to clarify that specialist advice should be sought before starting treatment with digoxin. • The first part of recommendation 1.6.2 has been removed because it is now covered in section 1.1 on team working in the management of heart failure. • Amlodipine to treat hypertension has been deleted from recommendation 1.6.3 because it has been superseded by the NICE guideline on hypertension in adults. • 'Regularly' has been replaced by 'at the 6-monthly clinical review' in recommendation 1.6.5 for clarification. • The wording in recommendation 1.6.6 has been amended in line with recommendation 1.6.5. Minor changes since publication April 2022: In section 1.4 we added links to NICE's technology appraisal guidance on dapagliflozin and empagliflozin for treating chronic heart failure with reduced ejection fraction. November 2021: We added a link to the NICE guideline on heart valve disease in recommendations 1.2.8, 1.2.15 and 1.4.2. ISBN: 978-1-4731-3093-7 Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 35 of 35","Response should not be more than 100 words. Model must only respond using information contained in the context block. Model should not rely on its own knowledge or outside sources of information when responding.
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+EVIDENCE:
+Chronic heart failure in adults: diagnosis and management NICE guideline Published: 12 September 2018 www.nice.org.uk/guidance/ng106 © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Your responsibility The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian. All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme. Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties. Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 2 of 35 Contents Overview ...................................................................................................................................... 5 Who is it for? .......................................................................................................................................... 5 Recommendations ....................................................................................................................... 6 1.1 Team working in the management of heart failure ....................................................................... 6 1.2 Diagnosing heart failure .................................................................................................................. 9 1.3 Giving information to people with heart failure ............................................................................ 12 1.4 Treating heart failure with reduced ejection fraction .................................................................. 12 1.5 Treating heart failure with reduced ejection fraction in people with chronic kidney disease . 17 1.6 Managing all types of heart failure ................................................................................................ 18 1.7 Monitoring treatment for all types of heart failure ....................................................................... 21 1.8 Interventional procedures ............................................................................................................... 22 1.9 Cardiac rehabilitation ...................................................................................................................... 23 1.10 Palliative care ................................................................................................................................. 24 Terms used in this guideline ................................................................................................................. 24 Putting this guideline into practice ............................................................................................ 26 Recommendations for research ................................................................................................. 28 1 Diuretic therapy for managing fluid overload in people with advanced heart failure in the community ............................................................................................................................................. 28 2 Cardiac MRI versus other imaging techniques for diagnosing heart failure ................................ 28 3 The impact of atrial fibrillation on the natriuretic peptide threshold for diagnosing heart failure ...................................................................................................................................................... 29 4 The impact of advanced kidney disease on the natriuretic peptide threshold for diagnosing heart failure ............................................................................................................................................ 30 5 Risk tools for predicting non-sudden death in heart failure .......................................................... 30 Context ......................................................................................................................................... 31 Key facts and figures ............................................................................................................................ 31 Current practice .................................................................................................................................... 31 Finding more information and committee details .....................................................................32 Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 3 of 35 Update information .....................................................................................................................33 Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 4 of 35 This guideline replaces CG108. This guideline is the basis of QS167, QS9 and QS181. Overview This guideline covers diagnosing and managing chronic heart failure in people aged 18 and over. It aims to improve diagnosis and treatment to increase the length and quality of life for people with heart failure. NICE has also produced a guideline on acute heart failure. Who is it for? • Healthcare professionals • People with heart failure and their families and carers Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 5 of 35 Recommendations People have the right to be involved in discussions and make informed decisions about their care, as described in NICE's information on making decisions about your care. Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off-label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding. 1.1 Team working in the management of heart failure 1.1.1 The core specialist heart failure multidisciplinary team (MDT) should work in collaboration with the primary care team, and should include: • a lead physician with subspecialty training in heart failure (usually a consultant cardiologist) who is responsible for making the clinical diagnosis • a specialist heart failure nurse • a healthcare professional with expertise in specialist prescribing for heart failure. [2018] 1.1.2 The specialist heart failure MDT should: • diagnose heart failure • give information to people newly diagnosed with heart failure (see the section on giving information to people with heart failure) • manage newly diagnosed, recently decompensated or advanced heart failure (NYHA [New York Heart Association] class III to IV) Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 6 of 35 • optimise treatment • start new medicines that need specialist supervision • continue to manage heart failure after an interventional procedure such as implantation of a cardioverter defibrillator or cardiac resynchronisation device • manage heart failure that is not responding to treatment. [2018] 1.1.3 The specialist heart failure MDT should directly involve, or refer people to, other services, including rehabilitation, services for older people and palliative care services, as needed. [2018] 1.1.4 The primary care team should carry out the following for people with heart failure at all times, including periods when the person is also receiving specialist heart failure care from the MDT: • ensure effective communication links between different care settings and clinical services involved in the person's care • lead a full review of the person's heart failure care, which may form part of a long-term conditions review • recall the person at least every 6 months and update the clinical record • ensure that changes to the clinical record are understood and agreed by the person with heart failure and shared with the specialist heart failure MDT • arrange access to specialist heart failure services if needed. [2018] Care after an acute event For recommendations on the diagnosis and management of acute heart failure, see the NICE guideline on acute heart failure. 1.1.5 People with heart failure should generally be discharged from hospital only when their clinical condition is stable and the management plan is optimised. Timing of discharge should take into account the wishes of the person and their family or Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 7 of 35 carer, and the level of care and support that can be provided in the community. [2003] 1.1.6 The primary care team should take over routine management of heart failure as soon as it has been stabilised and its management optimised. [2018] Writing a care plan 1.1.7 The specialist heart failure MDT should write a summary for each person with heart failure that includes: • diagnosis and aetiology • medicines prescribed, monitoring of medicines, when medicines should be reviewed and any support the person needs to take the medicines • functional abilities and any social care needs • social circumstances, including carers' needs. [2018] 1.1.8 The summary should form the basis of a care plan for each person, which should include: • plans for managing the person's heart failure, including follow-up care, rehabilitation and access to social care • symptoms to look out for in case of deterioration • a process for any subsequent access to the specialist heart failure MDT if needed • contact details for － a named healthcare coordinator (usually a specialist heart failure nurse) － alternative local heart failure specialist care providers, for urgent care or review. • additional sources of information for people with heart failure. [2018] Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 8 of 35 1.1.9 Give a copy of the care plan to the person with heart failure, their family or carer if appropriate, and all health and social care professionals involved in their care. [2018] 1.2 Diagnosing heart failure Symptoms, signs and investigations 1.2.1 Take a careful and detailed history, and perform a clinical examination and tests to confirm the presence of heart failure. [2010] 1.2.2 Measure N-terminal pro-B-type natriuretic peptide (NT-proBNP) in people with suspected heart failure. [2018] 1.2.3 Because very high levels of NT-proBNP carry a poor prognosis, refer people with suspected heart failure and an NT-proBNP level above 2,000 ng/litre (236 pmol/ litre) urgently, to have specialist assessment and transthoracic echocardiography within 2 weeks. [2018] 1.2.4 Refer people with suspected heart failure and an NT-proBNP level between 400 and 2,000 ng/litre (47 to 236 pmol/litre) to have specialist assessment and transthoracic echocardiography within 6 weeks. [2018] 1.2.5 Be aware that: • an NT-proBNP level less than 400 ng/litre (47 pmol/litre) in an untreated person makes a diagnosis of heart failure less likely • the level of serum natriuretic peptide does not differentiate between heart failure with reduced ejection fraction and heart failure with preserved ejection fraction. [2018] 1.2.6 Review alternative causes for symptoms of heart failure in people with NTproBNP levels below 400 ng/litre. If there is still concern that the symptoms might be related to heart failure, discuss with a physician with subspeciality training in heart failure. [2018] Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 9 of 35 1.2.7 Be aware that: • obesity, African or African–Caribbean family background, or treatment with diuretics, angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, angiotensin II receptor blockers (ARBs) or mineralocorticoid receptor antagonists (MRAs) can reduce levels of serum natriuretic peptides • high levels of serum natriuretic peptides can have causes other than heart failure (for example, age over 70 years, left ventricular hypertrophy, ischaemia, tachycardia, right ventricular overload, hypoxaemia [including pulmonary embolism], renal dysfunction [eGFR less than 60 ml/minute/ 1.73 m 2 ], sepsis, chronic obstructive pulmonary disease, diabetes, or cirrhosis of the liver). [2010, amended 2018] 1.2.8 Perform transthoracic echocardiography to exclude important valve disease, assess the systolic (and diastolic) function of the (left) ventricle, and detect intracardiac shunts. See the section on referral for echocardiography and specialist assessment in the NICE guideline on heart valve disease. [2003, amended 2018] 1.2.9 Transthoracic echocardiography should be performed on high-resolution equipment by experienced operators trained to the relevant professional standards. Need and demand for these studies should not compromise quality. [2003, amended 2018] 1.2.10 Ensure that those reporting echocardiography are experienced in doing so. [2003] 1.2.11 Consider alternative methods of imaging the heart (for example, radionuclide angiography [multigated acquisition scanning], cardiac MRI or transoesophageal echocardiography) if a poor image is produced by transthoracic echocardiography. [2003, amended 2018] 1.2.12 Perform an ECG and consider the following tests to evaluate possible aggravating factors and/or alternative diagnoses: • chest X-ray • blood tests: Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 10 of 35 － renal function profile － thyroid function profile － liver function profile － lipid profile － glycosylated haemoglobin (HbA1c) － full blood count • urinalysis • peak flow or spirometry. [2010, amended 2018] 1.2.13 Try to exclude other disorders that may present in a similar manner. [2003] 1.2.14 When a diagnosis of heart failure has been made, assess severity, aetiology, precipitating factors, type of cardiac dysfunction and correctable causes. [2010] Heart failure caused by valve disease 1.2.15 Refer people with heart failure caused by valve disease for specialist assessment and advice regarding follow-up. See the section on referral for echocardiography and specialist assessment in the NICE guideline on heart valve disease. [2003] Reviewing existing diagnoses 1.2.16 Review the basis for a historical diagnosis of heart failure, and manage care in accordance with this guideline only if the diagnosis is confirmed. [2003] 1.2.17 If the diagnosis of heart failure is still suspected, but confirmation of the underlying cardiac abnormality has not occurred, then the person should have appropriate further investigation. [2003] Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 11 of 35 1.3 Giving information to people with heart failure 1.3.1 When giving information to people with heart failure, follow the recommendations in the NICE guideline on patient experience in adult NHS services. [2018] 1.3.2 Discuss the person's prognosis in a sensitive, open and honest manner. Be frank about the uncertainty in predicting the course of their heart failure. Revisit this discussion as the person's condition evolves. [2018] 1.3.3 Provide information whenever needed throughout the person's care. [2018] 1.3.4 Consider training in advanced communication skills for all healthcare professionals working with people who have heart failure. [2018] First consultations for people newly diagnosed with heart failure 1.3.5 The specialist heart failure MDT should offer people newly diagnosed with heart failure an extended first consultation, followed by a second consultation to take place within 2 weeks if possible. At each consultation: • discuss the person's diagnosis and prognosis • explain heart failure terminology • discuss treatments • address the risk of sudden death, including any misconceptions about that risk • encourage the person and their family or carers to ask any questions they have. [2018] 1.4 Treating heart failure with reduced ejection fraction See the section on managing all types of heart failure for general recommendations on managing all types of heart failure. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 12 of 35 See NICE's technology appraisal guidance on dapagliflozin and empagliflozin for treating chronic heart failure with reduced ejection fraction. When managing pharmacological treatment, follow the recommendations in the NICE guidelines on medicines adherence and medicines optimisation. First-line treatment 1.4.1 Offer an angiotensin-converting enzyme (ACE) inhibitor and a beta-blocker licensed for heart failure to people who have heart failure with reduced ejection fraction. Use clinical judgement when deciding which drug to start first. [2010] ACE inhibitors 1.4.2 Do not offer ACE inhibitor therapy if there is a clinical suspicion of haemodynamically significant valve disease until the valve disease has been assessed by a specialist. See the section on referral for echocardiography and specialist assessment in the NICE guideline on heart valve disease. [2003] 1.4.3 Start ACE inhibitor therapy at a low dose and titrate upwards at short intervals (for example, every 2 weeks) until the target or maximum tolerated dose is reached. [2010] 1.4.4 Measure serum sodium and potassium, and assess renal function, before and 1 to 2 weeks after starting an ACE inhibitor, and after each dose increment. [2010, amended 2018] 1.4.5 Measure blood pressure before and after each dose increment of an ACE inhibitor. Follow the recommendations on measuring blood pressure, including measurement in people with symptoms of postural hypotension, in the NICE guideline on hypertension in adults. [2018] 1.4.6 Once the target or maximum tolerated dose of an ACE inhibitor is reached, monitor treatment monthly for 3 months and then at least every 6 months, and at any time the person becomes acutely unwell. [2010, amended 2018] Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 13 of 35 Alternative treatments if ACE inhibitors are not tolerated 1.4.7 Consider an ARB licensed for heart failure as an alternative to an ACE inhibitor for people who have heart failure with reduced ejection fraction and intolerable side effects with ACE inhibitors. [2010] 1.4.8 Measure serum sodium and potassium, and assess renal function, before and after starting an ARB and after each dose increment. [2010, amended 2018] 1.4.9 Measure blood pressure after each dose increment of an ARB. Follow the recommendations on measuring blood pressure, including measurement in people with symptoms of postural hypotension, in the NICE guideline on hypertension in adults. [2018] 1.4.10 Once the target or maximum tolerated dose of an ARB is reached, monitor treatment monthly for 3 months and then at least every 6 months, and at any time the person becomes acutely unwell. [2010, amended 2018] 1.4.11 If neither ACE inhibitors nor ARBs are tolerated, seek specialist advice and consider hydralazine in combination with nitrate for people who have heart failure with reduced ejection fraction. [2010] Beta-blockers 1.4.12 Do not withhold treatment with a beta-blocker solely because of age or the presence of peripheral vascular disease, erectile dysfunction, diabetes, interstitial pulmonary disease or chronic obstructive pulmonary disease. [2010] 1.4.13 Introduce beta-blockers in a 'start low, go slow' manner. Assess heart rate and clinical status after each titration. Measure blood pressure before and after each dose increment of a beta-blocker. [2010,amended 2018] 1.4.14 Switch people whose condition is stable and who are already taking a betablocker for a comorbidity (for example, angina or hypertension), and who develop heart failure with reduced ejection fraction, to a beta-blocker licensed for heart failure. [2010] Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 14 of 35 Mineralocorticoid receptor antagonists 1.4.15 Offer an mineralocorticoid receptor antagonists (MRA), in addition to an ACE inhibitor (or ARB) and beta-blocker, to people who have heart failure with reduced ejection fraction if they continue to have symptoms of heart failure. [2018] 1.4.16 Measure serum sodium and potassium, and assess renal function, before and after starting an MRA and after each dose increment. [2018] 1.4.17 Measure blood pressure before and after after each dose increment of an MRA. Follow the recommendations on measuring blood pressure, including measurement in people with symptoms of postural hypotension, in the NICE guideline on hypertension in adults. [2018] 1.4.18 Once the target, or maximum tolerated, dose of an MRA is reached, monitor treatment monthly for 3 months and then at least every 6 months, and at any time the person becomes acutely unwell. [2018] Specialist treatment Ivabradine These recommendations are from the NICE technology appraisal guidance on ivabradine for treating chronic heart failure. 1.4.19 Ivabradine is recommended as an option for treating chronic heart failure for people: • with New York Heart Association (NYHA) class II to IV stable chronic heart failure with systolic dysfunction and • who are in sinus rhythm with a heart rate of 75 beats per minute (bpm) or more and • who are given ivabradine in combination with standard therapy including beta-blocker therapy, angiotensin-converting enzyme (ACE) inhibitors and Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 15 of 35 aldosterone antagonists, or when beta-blocker therapy is contraindicated or not tolerated and • with a left ventricular ejection fraction of 35% or less. [2012] 1.4.20 Ivabradine should only be initiated after a stabilisation period of 4 weeks on optimised standard therapy with ACE inhibitors, beta-blockers and aldosterone antagonists. [2012] 1.4.21 Ivabradine should be initiated by a heart failure specialist with access to a multidisciplinary heart failure team. Dose titration and monitoring should be carried out by a heart failure specialist, or in primary care by either a GP with a special interest in heart failure or a heart failure specialist nurse. [2012] Sacubitril valsartan These recommendations are from the NICE technology appraisal guidance on sacubitril valsartan for treating symptomatic chronic heart failure with reduced ejection fraction. 1.4.22 Sacubitril valsartan is recommended as an option for treating symptomatic chronic heart failure with reduced ejection fraction, only in people: • with New York Heart Association (NYHA) class II to IV symptoms and • with a left ventricular ejection fraction of 35% or less and • who are already taking a stable dose of angiotensin-converting enzyme (ACE) inhibitors or ARBs. [2016] 1.4.23 Treatment with sacubitril valsartan should be started by a heart failure specialist with access to a multidisciplinary heart failure team. Dose titration and monitoring should be performed by the most appropriate team member (see the section on team working in the management of heart failure). [2016] 1.4.24 This guidance is not intended to affect the position of patients whose treatment with sacubitril valsartan was started within the NHS before this guidance was published. Treatment of those patients may continue without change to whatever Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 16 of 35 funding arrangements were in place for them before this guidance was published until they and their NHS clinician consider it appropriate to stop. [2016] Hydralazine in combination with nitrate 1.4.25 Seek specialist advice and consider offering hydralazine in combination with nitrate (especially if the person is of African or Caribbean family origin and has moderate to severe heart failure [NYHA class III/IV] with reduced ejection fraction). [2010] Digoxin For recommendations on digoxin for people with atrial fibrillation see the section on rate and rhythm control in the NICE guideline on atrial fibrillation. 1.4.26 Digoxin is recommended for worsening or severe heart failure with reduced ejection fraction despite first-line treatment for heart failure. Seek specialist advice before initiating. [2010, amended 2018] 1.4.27 Routine monitoring of serum digoxin concentrations is not recommended. A digoxin concentration measured within 8 to 12 hours of the last dose may be useful to confirm a clinical impression of toxicity or non-adherence. [2003] 1.4.28 The serum digoxin concentration should be interpreted in the clinical context as toxicity may occur even when the concentration is within the 'therapeutic range'. [2003] 1.5 Treating heart failure with reduced ejection fraction in people with chronic kidney disease 1.5.1 For people who have heart failure with reduced ejection fraction and chronic kidney disease with an eGFR of 30 ml/min/1.73 m 2 or above: • offer the treatment outlined in the section on treating heart failure with Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 17 of 35 reduced ejection fraction and • if the person's eGFR is 45 ml/min/1.73 m 2 or below, consider lower doses and/ or slower titration of dose of ACE inhibitors or ARBs, MRAs and digoxin. [2018] 1.5.2 For people who have heart failure with reduced ejection fraction and chronic kidney disease with an eGFR below 30 ml/min/1.73 m 2 , the specialist heart failure MDT should consider liaising with a renal physician. [2018] 1.5.3 Monitor the response to titration of medicines closely in people who have heart failure with reduced ejection fraction and chronic kidney disease, taking into account the increased risk of hyperkalaemia. [2018] 1.6 Managing all types of heart failure When managing pharmacological treatment, follow the recommendations in the NICE guidelines on medicines adherence and medicines optimisation. Pharmacological treatment Diuretics 1.6.1 Diuretics should be routinely used for the relief of congestive symptoms and fluid retention in people with heart failure, and titrated (up and down) according to need following the initiation of subsequent heart failure therapies. [2003] 1.6.2 People who have heart failure with preserved ejection fraction should usually be offered a low to medium dose of loop diuretics (for example, less than 80 mg furosemide per day). People whose heart failure does not respond to this treatment will need further specialist advice. [2003, amended 2018] Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 18 of 35 Calcium-channel blockers 1.6.3 Avoid verapamil, diltiazem and short-acting dihydropyridine agents in people who have heart failure with reduced ejection fraction. [2003, amended 2018] Amiodarone 1.6.4 Make the decision to prescribe amiodarone in consultation with a specialist. [2003] 1.6.5 Review the need to continue the amiodarone prescription at the 6-monthly clinical review. [2003, amended 2018] 1.6.6 Offer people taking amiodarone liver and thyroid function tests, and a review of side effects, as part of their routine 6-monthly clinical review. [2003, amended 2018] Anticoagulants 1.6.7 For people who have heart failure and atrial fibrillation, follow the recommendations on anticoagulation in the NICE guideline on atrial fibrillation. Be aware of the effects of impaired renal and liver function on anticoagulant therapies. [2018] 1.6.8 In people with heart failure in sinus rhythm, anticoagulation should be considered for those with a history of thromboembolism, left ventricular aneurysm or intracardiac thrombus. [2003] Vaccinations 1.6.9 Offer people with heart failure an annual vaccination against influenza. [2003] 1.6.10 Offer people with heart failure vaccination against pneumococcal disease (only required once). [2003] Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 19 of 35 Contraception and pregnancy 1.6.11 In women of childbearing potential who have heart failure, contraception and pregnancy should be discussed. If pregnancy is being considered or occurs, specialist advice should be sought. Subsequently, specialist care should be shared between the cardiologist and obstetrician. [2003] Depression See NICE's guideline on depression in adults with a chronic physical health problem. Lifestyle advice Salt and fluid restriction 1.6.12 Do not routinely advise people with heart failure to restrict their sodium or fluid consumption. Ask about salt and fluid consumption and, if needed, advise as follows: • restricting fluids for people with dilutional hyponatraemia • reducing intake for people with high levels of salt and/or fluid consumption. Continue to review the need to restrict salt or fluid. [2018] 1.6.13 Advise people with heart failure to avoid salt substitutes that contain potassium. [2018] Smoking and alcohol See NICE's guidance on smoking and tobacco and alcohol. Air travel 1.6.14 Air travel will be possible for the majority of people with heart failure, depending Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 20 of 35 on their clinical condition at the time of travel. [2003] Driving 1.6.15 Large Goods Vehicle and Passenger Carrying Vehicle licence: physicians should be up to date with the latest Driver and Vehicle Licensing Agency (DVLA) guidelines. Check the DVLA website for regular updates. [2003] 1.7 Monitoring treatment for all types of heart failure See the section on treating heart failure with reduced ejection fraction for specific recommendations on monitoring treatment for heart failure with reduced ejection fraction. Clinical review 1.7.1 All people with chronic heart failure need monitoring. This monitoring should include: • a clinical assessment of functional capacity, fluid status, cardiac rhythm (minimum of examining the pulse), cognitive status and nutritional status • a review of medication, including need for changes and possible side effects • an assessment of renal function. Note: This is a minimum. People with comorbidities or co-prescribed medications will need further monitoring. Monitoring serum potassium is particularly important if a person is taking digoxin or an MRA. [2010, amended 2018] 1.7.2 More detailed monitoring will be needed if the person has significant comorbidity or if their condition has deteriorated since the previous review. [2003] 1.7.3 The frequency of monitoring should depend on the clinical status and stability of Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 21 of 35 the person. The monitoring interval should be short (days to 2 weeks) if the clinical condition or medication has changed, but is needed at least 6-monthly for stable people with proven heart failure. [2003] 1.7.4 People with heart failure who wish to be involved in monitoring of their condition should be provided with sufficient education and support from their healthcare professional to do this, with clear guidelines as to what to do in the event of deterioration. [2003] Measuring NT-proBNP 1.7.5 Consider measuring NT-proBNP (N-terminal pro-B-type natriuretic peptide) as part of a treatment optimisation protocol only in a specialist care setting for people aged under 75 who have heart failure with reduced ejection fraction and an eGFR above 60 ml/min/1.73 m 2 . [2018] 1.8 Interventional procedures Coronary revascularisation 1.8.1 Do not routinely offer coronary revascularisation to people who have heart failure with reduced ejection fraction and coronary artery disease. [2018] Cardiac transplantation 1.8.2 Specialist referral for transplantation should be considered for people with severe refractory symptoms or refractory cardiogenic shock. [2003] Implantable cardioverter defibrillators and cardiac resynchronisation therapy See NICE's technology appraisal guidance on implantable cardioverter defibrillators and cardiac resynchronisation therapy for arrhythmias and heart failure. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 22 of 35 1.8.3 When discussing implantation of a cardioverter defibrillator: • explain the risks, benefits and consequences of cardioverter defibrillator implantation, following the principles on shared decision making in the NICE guideline on patient experience in adult NHS services • ensure the person knows that the defibrillator function can be deactivated without affecting any cardiac resynchronisation or pacing, and reactivated later • explain the circumstances in which deactivation might be offered • discuss and dispel common misconceptions about the function of the device and the consequences of deactivation • provide the person and, if they wish, their family or carers with written information covering the information discussed. [2018] 1.8.4 Review the benefits and potential harms of a cardioverter defibrillator remaining active in a person with heart failure: • at each 6-monthly review of their heart failure care • whenever their care goals change • as part of advance care planning if it is thought they are nearing the end of life. [2018] 1.9 Cardiac rehabilitation 1.9.1 Offer people with heart failure a personalised, exercise-based cardiac rehabilitation programme, unless their condition is unstable. The programme: • should be preceded by an assessment to ensure that it is suitable for the person • should be provided in a format and setting (at home, in the community or in the hospital) that is easily accessible for the person Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 23 of 35 • should include a psychological and educational component • may be incorporated within an existing cardiac rehabilitation programme • should be accompanied by information about support available from healthcare professionals when the person is doing the programme. [2018] 1.10 Palliative care 1.10.1 Do not offer long-term home oxygen therapy for advanced heart failure. Be aware that long-term home oxygen therapy may be offered for comorbidities, such as for some people with chronic obstructive pulmonary disease (see the section on oxygen in the NICE guideline on chronic obstructive pulmonary disease in over 16s). [2018] 1.10.2 Do not use prognostic risk tools to determine whether to refer a person with heart failure to palliative care services. [2018] 1.10.3 If the symptoms of a person with heart failure are worsening despite optimal specialist treatment, discuss their palliative care needs with the specialist heart failure multidisciplinary team and consider a needs assessment for palliative care. [2018] 1.10.4 People with heart failure and their families or carers should have access to professionals with palliative care skills within the heart failure team. [2003] 1.10.5 If it is thought that a person may be entering the last 2 to 3 days of life, follow the NICE guideline on care of dying adults in the last days of life. [2018] Terms used in this guideline Heart failure with preserved ejection fraction This is usually associated with impaired left ventricular relaxation, rather than left ventricular contraction, and is characterised by normal or preserved left ventricular Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 24 of 35 ejection fraction with evidence of diastolic dysfunction . Heart failure with reduced ejection fraction Heart failure with an ejection fraction below 40%. Mineralocorticoid receptor antagonist A drug that antagonises the action of aldosterone at mineralocorticoid receptors. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 25 of 35 Putting this guideline into practice NICE has produced tools and resources to help you put this guideline into practice. Putting recommendations into practice can take time. How long may vary from guideline to guideline, and depends on how much change in practice or services is needed. Implementing change is most effective when aligned with local priorities. Changes recommended for clinical practice that can be done quickly – like changes in prescribing practice – should be shared quickly. This is because healthcare professionals should use guidelines to guide their work – as is required by professional regulating bodies such as the General Medical and Nursing and Midwifery Councils. Changes should be implemented as soon as possible, unless there is a good reason for not doing so (for example, if it would be better value for money if a package of recommendations were all implemented at once). Different organisations may need different approaches to implementation, depending on their size and function. Sometimes individual practitioners may be able to respond to recommendations to improve their practice more quickly than large organisations. Here are some pointers to help organisations put NICE guidelines into practice: 1. Raise awareness through routine communication channels, such as email or newsletters, regular meetings, internal staff briefings and other communications with all relevant partner organisations. Identify things staff can include in their own practice straight away. 2. Identify a lead with an interest in the topic to champion the guideline and motivate others to support its use and make service changes, and to find out any significant issues locally. 3. Carry out a baseline assessment against the recommendations to find out whether there are gaps in current service provision. 4. Think about what data you need to measure improvement and plan how you will collect it. You may want to work with other health and social care organisations and specialist Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 26 of 35 groups to compare current practice with the recommendations. This may also help identify local issues that will slow or prevent implementation. 5. Develop an action plan, with the steps needed to put the guideline into practice, and make sure it is ready as soon as possible. Big, complex changes may take longer to implement, but some may be quick and easy to do. An action plan will help in both cases. 6. For very big changes include milestones and a business case, which will set out additional costs, savings and possible areas for disinvestment. A small project group could develop the action plan. The group might include the guideline champion, a senior organisational sponsor, staff involved in the associated services, finance and information professionals. 7. Implement the action plan with oversight from the lead and the project group. Big projects may also need project management support. 8. Review and monitor how well the guideline is being implemented through the project group. Share progress with those involved in making improvements, as well as relevant boards and local partners. NICE provides a comprehensive programme of support and resources to maximise uptake and use of evidence and guidance. See NICE's into practice pages for more information. Also see Leng G, Moore V, Abraham S, editors (2014) Achieving high quality care – practical experience from NICE. Chichester: Wiley. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 27 of 35 Recommendations for research The guideline committee has made the following key recommendations for research. The committee's full set of research recommendations is detailed in the full guideline. 1 Diuretic therapy for managing fluid overload in people with advanced heart failure in the community In people with advanced heart failure and significant peripheral fluid overload, what is the clinical and cost effectiveness of oral, subcutaneous and intravenous diuretic therapy in the community? Why this is important This research is critical to inform practice of how best to manage people with advanced heart failure in the community if they develop significant peripheral fluid overload. These people are more likely to have multiple admissions that, together with fluid overload, have a negative impact on their quality of life. Management in the community can minimise disruption for the person and reduce costs from hospital admissions. Knowledge of the most clinically and cost-effective routes of administration for diuretic therapy will dictate the level of resource needed to provide the service. Intravenous and subcutaneous diuretics usually need to be administered by nursing or healthcare staff. although a pump for self-administration of subcutaneous diuretics has recently been developed. Oral formulations can be self-administered. 2 Cardiac MRI versus other imaging techniques for diagnosing heart failure What is the optimal imaging technique for the diagnosis of heart failure? Why this is important The role of cardiac MRI in the detection and characterisation of several structural and Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 28 of 35 functional cardiac abnormalities has become well established over the past 25 years. In people with heart failure, cardiac MRI provides reliable and reproducible assessments of the left ventricular (and to a degree the right ventricular) shapes, volumes and ejection fractions. It also provides spatial assessments of the congenital and acquired structural abnormalities of the heart and their interrelationships with the remainder of the heart, as well as functional and haemodynamic assessments of these abnormalities on the heart's performance. Finally, cardiac MRI provides valuable information about the myocardial structure and metabolism, including the presence of inflammation, scarring, fibrosis and infiltration. Cardiac MRI is an expensive form of imaging, and much of this diagnostic information could be provided by less costly non-invasive imaging techniques, chiefly echocardiography. This question aims to find the most clinically and cost-effective imaging technique for the clinical diagnosis of heart failure. 3 The impact of atrial fibrillation on the natriuretic peptide threshold for diagnosing heart failure What is the optimal NT-proBNP threshold for the diagnosis of heart failure in people with atrial fibrillation? Why this is important Atrial fibrillation is a common arrhythmia in the general population, and occurs in 30 to 40% of people with heart failure. Atrial fibrillation can raise the level of serum natriuretic peptides, including NT-proBNP, even in the absence of heart failure. This is complicated further in heart failure with preserved ejection fraction, in which 2 echocardiographic diagnostic criteria become unreliable (the left atrial volume and the tissue doppler imaging assessment of diastolic function). These factors contribute to the complexity of the diagnosis and have a potential impact on the usual thresholds for NT-proBNP in people who have atrial fibrillation. This has been recognised in several ongoing randomised controlled trials of heart failure, which are using higher NT-proBNP thresholds for the diagnosis of heart failure in people with atrial fibrillation. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 29 of 35 4 The impact of advanced kidney disease on the natriuretic peptide threshold for diagnosing heart failure What are the optimal NT-proBNP thresholds for diagnosing heart failure in people with stage IIIb, IV or V chronic kidney disease? Why this is important Heart failure incidence and prevalence increase with age, with the rise starting at age 65 and peaking between 75 and 85. Both advancing age and heart failure are associated with a gradual and progressive decline in renal function. In addition, the progression of heart failure and some treatments for heart failure lead to progressive deterioration of renal function. A decline in renal function is associated with increased fluid retention and a rise in the level of the serum natriuretic peptides, including NT-proBNP, even in the absence of heart failure. There is some evidence that the use of higher NT-proBNP thresholds would improve diagnostic accuracy for heart failure in people with significant deterioration of creatinine clearance. 5 Risk tools for predicting non-sudden death in heart failure What is the most accurate prognostic risk tool in predicting 1-year mortality from heart failure at specific clinically relevant thresholds (for example, sensitivity, specificity, negative predictive value and positive predictive value at a threshold of 50% risk of mortality at 1 year)? Why this is important There are a number of validated prognostic risk tools for heart failure but most do not report sensitivity and specificity at clinically relevant thresholds. This information is crucial to enable accurate prediction of a person's risk of mortality. The ability to accurately predict a person's prognosis would allow clearer communication and timely referral to other services such as palliative care. Inaccurate prediction has the potential to lead to significant psychological harm and increased morbidity. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 30 of 35 Context Key facts and figures Heart failure is a complex clinical syndrome of symptoms and signs that suggest the efficiency of the heart as a pump is impaired. It is caused by structural or functional abnormalities of the heart. Around 920,000 people in the UK today have been diagnosed with heart failure. Both the incidence and prevalence of heart failure increase steeply with age, and the average age at diagnosis is 77. Improvements in care have increased survival for people with ischaemic heart disease, and treatments for heart failure have become more effective. But the overall prevalence of heart failure is rising because of population ageing and increasing rates of obesity. Current practice Uptake of NICE's 2010 guidance on chronic heart failure appears to be good. However, the Department of Health and Social Care's policy paper on improving cardiovascular disease outcomes: strategy noted that prescribing of ACE inhibitors, beta-blockers and aldosterone antagonists remains suboptimal, and that improved use of these drugs has the potential to reduce hospitalisations and deaths caused by heart failure. This update reviewed evidence on the clinical and cost effectiveness of these therapies. Interdisciplinary working has contributed to better outcomes in heart failure but there is further room to improve the provision of multidisciplinary teams (MDTs) and integrate them more fully into healthcare processes. This update highlights and further expands on the roles of the MDT and collaboration between the MDT and the primary care team. The Department of Health and Social Care's policy paper on improving cardiovascular disease outcomes: strategy also noted that the proportion of people with heart failure who have cardiac rehabilitation was around 4%, and that increasing this proportion would reduce mortality and hospitalisation. This update recommends that all people with heart failure are offered an easily accessible, exercise-based cardiac rehabilitation programme, if this is suitable for them. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 31 of 35 Finding more information and committee details To find out what NICE has said on related topics, including guidance in development, see the NICE topic page on cardiovascular conditions. For full details of the evidence and the guideline committee's discussions, see the full guideline. You can also find information about how the guideline was developed, including details of the committee. NICE has produced tools and resources to help you put this guideline into practice. For general help and advice on putting our guidelines into practice, see resources to help you put NICE guidance into practice. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 32 of 35 Update information September 2018: This guideline updates and replaces NICE clinical guideline 108 (published August 2010). NICE clinical guideline 108 updated and replaced NICE clinical guideline 5 (published July 2003). Recommendations are marked as [2018], [2016], [2012], [2010], [2010, amended 2018], [2003], [2003, amended 2018] or [2003, amended 2010], [2018] indicates that the evidence was reviewed and the recommendation added, updated or unchanged in 2018. [2016] refers to NICE technology appraisal guidance published in 2016. [2012] refers to NICE technology appraisal guidance published in 2012. [2010] indicates that the evidence was reviewed in 2010. [2010, amended 2018] indicates that the evidence was reviewed in 2010 but changes were made to the recommendation wording in 2018 that changed the meaning. [2003] indicates that the evidence was reviewed in 2003. [2003, amended 2018] indicates that the evidence was reviewed in 2003 but changes were made to the recommendation wording in 2018 that changed the meaning. [2003, amended 2010] indicates that the evidence was reviewed in 2003 but changes were made to the recommendation wording in 2010 that changed the meaning. • 'Heart failure due to left ventricular systolic dysfunction (LVSD)' has been replaced in all recommendations by 'heart failure with reduced ejection fraction' in line with current terminology and the 2018 guideline scope. • 'Aldosterone antagonists' has been replaced in all recommendations by 'mineralocorticoid receptor antagonists (MRAs') to clarify the function of the receptor, and in line with the 2018 guideline scope. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 33 of 35 • 'African or African-Caribbean family origin' has been added to recommendation 1.2.7 because of the high incidence of heart failure with preserved ejection fraction in these populations. Recent evidence shows that NT-proBNP levels are lower in people of west African family background and are a confounder in the diagnosis of heart failure. • Doppler 2D has been deleted from recommendations 1.2.8, 1.2.9 and 1.2.11 because all transthoracic echocardiography would have doppler 2D as a minimum and it is no longer necessary to specify this. • 'Multigated acquisition scanning' has been added to recommendation 1.2.11 to reflect current imaging technology. • Measurement of urea has been deleted from recommendations 1.2.12, 1.4.8 and 1.7.1 because the guideline committee agreed that it is not needed and is not part of renal function profiles in most centres in the UK. Blood tests for electrolytes, creatinine and eGFR have been grouped together under the term 'renal function profile' because they are provided as a unified set of analyses in the NHS. The term 'profile' is applied to a group of tests (assays). Thus these tests are more accurately described as 'profiles' as they contain multiple individual assays and have replaced thyroid function test, liver function test and lipid measurement. 'Fasting glucose' has been replaced by 'glycosylated haemoglobin (HbA1c)' in line with the NICE guidelines on diabetes. • Measurement of serum urea has been deleted from recommendation 1.4.4 because the guideline committee agreed that it is not needed and is not part of renal function profiles in most centres in the UK. Measurement of potassium has been added to ensure that monitoring is consistent across treatments. • Recommendations 1.4.6 and 1.4.10 have been added to clarify the timing of monitoring after treatment starts. • In recommendation 1.4.8, monitoring for hyperkalaemia has been replaced by potassium measurement for clarity. • Blood pressure measurement has been clarified in recommendation 1.4.13 and made consistent with other treatments. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 34 of 35 • As a result of new evidence the treatment pathway for heart failure with reduced ejection fraction in recommendation 1.4.26 has been amended. Second line treatment has been replaced by specialist treatment. A sentence has been added to clarify that specialist advice should be sought before starting treatment with digoxin. • The first part of recommendation 1.6.2 has been removed because it is now covered in section 1.1 on team working in the management of heart failure. • Amlodipine to treat hypertension has been deleted from recommendation 1.6.3 because it has been superseded by the NICE guideline on hypertension in adults. • 'Regularly' has been replaced by 'at the 6-monthly clinical review' in recommendation 1.6.5 for clarification. • The wording in recommendation 1.6.6 has been amended in line with recommendation 1.6.5. Minor changes since publication April 2022: In section 1.4 we added links to NICE's technology appraisal guidance on dapagliflozin and empagliflozin for treating chronic heart failure with reduced ejection fraction. November 2021: We added a link to the NICE guideline on heart valve disease in recommendations 1.2.8, 1.2.15 and 1.4.2. ISBN: 978-1-4731-3093-7 Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 35 of 35
+
+USER:
+What medications should be prescribed first for adults diagnosed with heart failure with reduced ejection fraction according to the NICE guidelines?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",True,34,21,8148,,244
+You may only respond to the prompt using information provided in the context block.,Can I reuse the OEM hardware for this?,"Before beginning the installation, thoroughly & completely read these instructions. Please refer to the Parts List to insure that all parts & hardware are received prior to the disassembly of the vehicle. If any parts are found to be missing, contact SKYJACKER® Customer Service at 318-388-0816 to obtain the needed items. If you have any questions or reservations about installing this product, contact SKYJACKER® Technical Assistance at 318-388-0816. Installation: 1. Park the vehicle on a flat, level surface & block the front & rear tires. 2. Place the transmission in neutral. 3. Loosen all of the engine mount bolts about ½ turn. 4. Support the transfer case cross member with a transmission or floor jack. Remove the bolts & nuts for each side of the cross member. 5. Slowly lower the cross member, approximately 2"", to allow enough room to install the new Skyjacker tubular spacers. 1994-2001 Jeep Cherokee XJ Install the new Skyjacker transfer case linkage pivot drop bracket to the stock pivot bracket using the OEM hardware. Using the two 1/4"" x 1"" bolts with a flat washer & self locking nut, bolt the ball swivel bracket (See Arrow in Photo # 3) to the new Skyjacker drop bracket. Note: The bracket has two sets of holes. The bottom holes are for a 4"" lift as shown & the upper holes are for a 2 1/2"" lift. 2. Placing the pivot bracket back in location, start the end of the rod through the ball swivel & bolt the bracket in location with the OEM hardware. (See Photo # 4) 3. Check to make sure that the transfer case will fully engage at each end of the shifter travel. If linkage adjustment is required, 4. Check the transfer case shifter to see if it will move to 4L. If not, the linkage will need adjusting as follows. Place the shifter in 4L, loosen the adjustment bolt & push the linkage (""B"" Arrow in Photo # 5) forward until it stops. Now retighten adjustment bolt. Check to be sure the 4WD works properly. 5. On 5 speed models, engage the clutch & check the transmission shifter to see if it will go into 2nd gear. If not, the shifter housing on the floor will need trimming. Remove the center console, pull back the carpet, remove the screws holding the shifter boot to the floor, & trim or grind the floor board until sufficient clearance is obtained. Shift through each gear to check clearance at this time. Now reinstall the shifter boot, carpet, & console.","You may only respond to the prompt using information provided in the context block. Can I reuse the OEM hardware for this? Before beginning the installation, thoroughly & completely read these instructions. Please refer to the Parts List to insure that all parts & hardware are received prior to the disassembly of the vehicle. If any parts are found to be missing, contact SKYJACKER® Customer Service at 318-388-0816 to obtain the needed items. If you have any questions or reservations about installing this product, contact SKYJACKER® Technical Assistance at 318-388-0816. Installation: 1. Park the vehicle on a flat, level surface & block the front & rear tires. 2. Place the transmission in neutral. 3. Loosen all of the engine mount bolts about ½ turn. 4. Support the transfer case cross member with a transmission or floor jack. Remove the bolts & nuts for each side of the cross member. 5. Slowly lower the cross member, approximately 2"", to allow enough room to install the new 6. Install the new Skyjacker tubular spacers between the cross member & frame. Slowly raise the jack to firmly hold the tubular spacers in place. 7. Install the OEM nuts, removed in Step # 4, onto the studs that are protruding out of the frame on each side to hold the top half of the new spacers in place. Note: There is only one stud on each side protruding out of the frame. Next, install the 3/8"" x 1"" bolt on each side through the cross member & the bottom half of the new tubular spacers. Install the 3/8 nut, washer, & hand tighten. 8. Install the new 10mm x 60mm bolt up through the cross member & tubular spacer & tighten to 33 ft. lbs. (See Photo # 2) 9. Tighten the 3/8"" nut down onto the 3/8"" x 1"" bolt from Step # 7 to 33 ft-lbs. Remove the transmission jack & set aside. 10. Re-torque the engine mount bolts loosened in Step # 3. The engine mount to block bolts torque to 45 ft-lbs. The engine mount to frame bolts torque to 30 ft-lbs. The thru bolts torque to 48 ft-lbs. 11. Install the transfer case linkage bracket. (See Steps # 1 thru # 5 Below) Skyjacker tubular spacers. 1994-2001 Jeep Cherokee XJ Install the new Skyjacker transfer case linkage pivot drop bracket to the stock pivot bracket using the OEM hardware. Using the two 1/4"" x 1"" bolts with a flat washer & self locking nut, bolt the ball swivel bracket (See Arrow in Photo # 3) to the new Skyjacker drop bracket. Note: The bracket has two sets of holes. The bottom holes are for a 4"" lift as shown & the upper holes are for a 2 1/2"" lift. 2. Placing the pivot bracket back in location, start the end of the rod through the ball swivel & bolt the bracket in location with the OEM hardware. (See Photo # 4) 3. Check to make sure that the transfer case will fully engage at each end of the shifter travel. If linkage adjustment is required, 4. Check the transfer case shifter to see if it will move to 4L. If not, the linkage will need adjusting as follows. Place the shifter in 4L, loosen the adjustment bolt & push the linkage (""B"" Arrow in Photo # 5) forward until it stops. Now retighten adjustment bolt. Check to be sure the 4WD works properly. 5. On 5 speed models, engage the clutch & check the transmission shifter to see if it will go into 2nd gear. If not, the shifter housing on the floor will need trimming. Remove the center console, pull back the carpet, remove the screws holding the shifter boot to the floor, & trim or grind the floor board until sufficient clearance is obtained. Shift through each gear to check clearance at this time. Now reinstall the shifter boot, carpet, & console.","You may only respond to the prompt using information provided in the context block.
+
+EVIDENCE:
+Before beginning the installation, thoroughly & completely read these instructions. Please refer to the Parts List to insure that all parts & hardware are received prior to the disassembly of the vehicle. If any parts are found to be missing, contact SKYJACKER® Customer Service at 318-388-0816 to obtain the needed items. If you have any questions or reservations about installing this product, contact SKYJACKER® Technical Assistance at 318-388-0816. Installation: 1. Park the vehicle on a flat, level surface & block the front & rear tires. 2. Place the transmission in neutral. 3. Loosen all of the engine mount bolts about ½ turn. 4. Support the transfer case cross member with a transmission or floor jack. Remove the bolts & nuts for each side of the cross member. 5. Slowly lower the cross member, approximately 2"", to allow enough room to install the new Skyjacker tubular spacers. 1994-2001 Jeep Cherokee XJ Install the new Skyjacker transfer case linkage pivot drop bracket to the stock pivot bracket using the OEM hardware. Using the two 1/4"" x 1"" bolts with a flat washer & self locking nut, bolt the ball swivel bracket (See Arrow in Photo # 3) to the new Skyjacker drop bracket. Note: The bracket has two sets of holes. The bottom holes are for a 4"" lift as shown & the upper holes are for a 2 1/2"" lift. 2. Placing the pivot bracket back in location, start the end of the rod through the ball swivel & bolt the bracket in location with the OEM hardware. (See Photo # 4) 3. Check to make sure that the transfer case will fully engage at each end of the shifter travel. If linkage adjustment is required, 4. Check the transfer case shifter to see if it will move to 4L. If not, the linkage will need adjusting as follows. Place the shifter in 4L, loosen the adjustment bolt & push the linkage (""B"" Arrow in Photo # 5) forward until it stops. Now retighten adjustment bolt. Check to be sure the 4WD works properly. 5. On 5 speed models, engage the clutch & check the transmission shifter to see if it will go into 2nd gear. If not, the shifter housing on the floor will need trimming. Remove the center console, pull back the carpet, remove the screws holding the shifter boot to the floor, & trim or grind the floor board until sufficient clearance is obtained. Shift through each gear to check clearance at this time. Now reinstall the shifter boot, carpet, & console.
+
+USER:
+Can I reuse the OEM hardware for this?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,14,8,424,,448
+"You can only answer the prompt using information found in the context block. You can't use information from external sources or rely heavily on your knowledge. You are not an expert in any field, you are simply extracting information from the context block to answer the prompt. Respond in using 100 words or less.",What is the main argument made by scholars like Moringiello and Odinet against considering NFTs as property?,"OVERVIEW OF HOW NFTS HAVE BEEN CHARACTERIZED Property law perspective What rights do owners of NFTs actually own? In this respect, the concept of possession in property law is currently understood to apply only to tangible assets, and hence inapplicable to intangible assets.17 Marinoti explores the possibility of understanding the rights owned in intangibles such as NFTs from a property law perspective.18 He has argued that intangibles such as NFTs can be governed by property law, through reference to the concepts such as ‘possession’ which is often related mainly to tangible property (i.e., things that are usually physical and that you can touch and identify, such as land and equipment, etc.).19 According to Marinoti, the true function of possession is communicative and its purpose is to convey the availability of an object discernible to an audience. He argued further that communities can also give this meaning through conduct and symbolic acts.20 The narrower concept ‘thinghood’, on the other hand, is often subsumed within the discussion on possession. Tinghood is defined by whether there are discernible boundaries around one thing to distinguish it from another. Physical tangibility is said to be only one way in which thinghood delineates boundaries; social practices and norms can similarly indicate boundaries.21 Marinoti also suggested that property law doctrines like conversion and trespass can be extended to apply to digital assets.22 Even concepts such as the relativity of title (ie, wrongful 13 See, eg, Vijayakumaran (n 10) 409. 14 See, eg, Michael D. Murray, ‘NFT Ownership and Copyrights’ (2023) Indiana Law Rev 366. 15 Many popular NFT projects such as CryptoPunks have been released with no explicitly written copyright terms. See, eg, Grimmelman, Yan and Kell (n 9). An instance is that of the popular NFT project CryptoPunks which has been released with no explicitly written copyright terms. 16 Tese are leading NFT marketplaces. See, eg, Bitdeal, ‘Top 7 NFT Marketplaces to look in 2023 and beyond’ (BLOG, 2023) <www.bitdeal.net/top-7-nf-marketplaces-in-2023 -:~:text=Top 7 NFT Marketplaces 2023 1 1. OpenSea,Marketplace... 7 7. Solanart NFT Marketplace > accessed 13 January 2024. 17 See, eg, Marinoti (n 11). 18 Ibid. 19 Ibid 1277. 20 Ibid 1236. 21 Ibid. 22 Ibid 1269. Downloaded from https://academic.oup.com/ijlit/article/32/1/eaae018/7746479 by guest on 17 September 2024 4 • Tan possession can support an interest held by the wrongful possessor which is stronger than that of the world at large, save for the right owner) can arguably apply.23 While protecting wrongful possession may seem unjust, this could help avoid the scenario of having no legal recourse to an endless series of unlawful conversions of ‘NFTs’ after one single wrongful possession.24 To clarify, Marinoti’s reference to property law concepts drew from both real property and personal property laws, although this was not expressly stated. Along the same vein, other scholars such as Trautman and Fairfield have also proposed that the legal system should treat NFTs as digital personal property because NFTs comprise strong property interests through enabling parties to buy, sell, or own digital assets similar to personal property.25 On the other hand, some scholars do not agree that NFTs should be defined as properties. Lee, for example, has analogized NFTs with library catalog cards to illustrate that the value of NFTs is derived from their underlying properties (ie, books) and to highlight that people do not own these properties when they transact in NFTs.26 Further, Moringiello and Odinet rejected the perception of any property rights in NFTs—through comparison of their characteristics with those of negotiable instruments, securities, deeds of real property, bills of lading and other legal tokens—reasoning that NFTs lack the tethering effect that other properties have and that it is meaningless to view them as such, thus NFT holders do not control anything substantive.27","[System Instructions] You can only answer the prompt using information found in the context block. You can't use information from external sources or rely heavily on your knowledge. You are not an expert in any field, you are simply extracting information from the context block to answer the prompt. Respond in using 100 words or less. [Question] What do scholars like Moringiello and Odinet make the main argument against considering NFTs as property? [Context Block] OVERVIEW OF HOW NFTS HAVE BEEN CHARACTERIZED Property law perspective What rights do owners of NFTs actually own? In this respect, the concept of possession in property law is currently understood to apply only to tangible assets, and hence inapplicable to intangible assets.17 Marinoti explores the possibility of understanding the rights owned in intangibles such as NFTs from a property law perspective.18 He has argued that intangibles such as NFTs can be governed by property law, through reference to the concepts such as ‘possession’ which is often related mainly to tangible property (i.e., things that are usually physical and that you can touch and identify, such as land and equipment, etc.).19 According to Marinoti, the true function of possession is communicative and its purpose is to convey the availability of an object discernible to an audience. He argued further that communities can also give this meaning through conduct and symbolic acts.20 The narrower concept ‘thinghood’, on the other hand, is often subsumed within the discussion on possession. Tinghood is defined by whether there are discernible boundaries around one thing to distinguish it from another. Physical tangibility is said to be only one way in which thinghood delineates boundaries; social practices and norms can similarly indicate boundaries.21 Marinoti also suggested that property law doctrines like conversion and trespass can be extended to apply to digital assets.22 Even concepts such as the relativity of title (ie, wrongful 13 See, eg, Vijayakumaran (n 10) 409. 14 See, eg, Michael D. Murray, ‘NFT Ownership and Copyrights’ (2023) Indiana Law Rev 366. 15 Many popular NFT projects such as CryptoPunks have been released with no explicitly written copyright terms. See, eg, Grimmelman, Yan and Kell (n 9). An instance is that of the popular NFT project CryptoPunks which has been released with no explicitly written copyright terms. 16 Tese are leading NFT marketplaces. See, eg, Bitdeal, ‘Top 7 NFT Marketplaces to look in 2023 and beyond’ (BLOG, 2023) <www.bitdeal.net/top-7-nf-marketplaces-in-2023 -:~:text=Top 7 NFT Marketplaces 2023 1 1. OpenSea,Marketplace... 7 7. Solanart NFT Marketplace > accessed 13 January 2024. 17 See, eg, Marinoti (n 11). 18 Ibid. 19 Ibid 1277. 20 Ibid 1236. 21 Ibid. 22 Ibid 1269. Downloaded from https://academic.oup.com/ijlit/article/32/1/eaae018/7746479 by guest on 17 September 2024 4 • Tan possession can support an interest held by the wrongful possessor which is stronger than that of the world at large, save for the right owner) can arguably apply.23 While protecting wrongful possession may seem unjust, this could help avoid the scenario of having no legal recourse to an endless series of unlawful conversions of ‘NFTs’ after one single wrongful possession.24 To clarify, Marinoti’s reference to property law concepts drew from both real property and personal property laws, although this was not expressly stated. Along the same vein, other scholars such as Trautman and Fairfield have also proposed that the legal system should treat NFTs as digital personal property because NFTs comprise strong property interests through enabling parties to buy, sell, or own digital assets similar to personal property.25 On the other hand, some scholars do not agree that NFTs should be defined as properties. Lee, for example, has analogized NFTs with library catalog cards to illustrate that the value of NFTs is derived from their underlying properties (ie, books) and to highlight that people do not own these properties when they transact in NFTs.26 Further, Moringiello and Odinet rejected the perception of any property rights in NFTs—through comparison of their characteristics with those of negotiable instruments, securities, deeds of real property, bills of lading and other legal tokens—reasoning that NFTs lack the tethering effect that other properties have and that it is meaningless to view them as such, thus NFT holders do not control anything substantive.27","You can only answer the prompt using information found in the context block. You can't use information from external sources or rely heavily on your knowledge. You are not an expert in any field, you are simply extracting information from the context block to answer the prompt. Respond in using 100 words or less.
+
+EVIDENCE:
+OVERVIEW OF HOW NFTS HAVE BEEN CHARACTERIZED Property law perspective What rights do owners of NFTs actually own? In this respect, the concept of possession in property law is currently understood to apply only to tangible assets, and hence inapplicable to intangible assets.17 Marinoti explores the possibility of understanding the rights owned in intangibles such as NFTs from a property law perspective.18 He has argued that intangibles such as NFTs can be governed by property law, through reference to the concepts such as ‘possession’ which is often related mainly to tangible property (i.e., things that are usually physical and that you can touch and identify, such as land and equipment, etc.).19 According to Marinoti, the true function of possession is communicative and its purpose is to convey the availability of an object discernible to an audience. He argued further that communities can also give this meaning through conduct and symbolic acts.20 The narrower concept ‘thinghood’, on the other hand, is often subsumed within the discussion on possession. Tinghood is defined by whether there are discernible boundaries around one thing to distinguish it from another. Physical tangibility is said to be only one way in which thinghood delineates boundaries; social practices and norms can similarly indicate boundaries.21 Marinoti also suggested that property law doctrines like conversion and trespass can be extended to apply to digital assets.22 Even concepts such as the relativity of title (ie, wrongful 13 See, eg, Vijayakumaran (n 10) 409. 14 See, eg, Michael D. Murray, ‘NFT Ownership and Copyrights’ (2023) Indiana Law Rev 366. 15 Many popular NFT projects such as CryptoPunks have been released with no explicitly written copyright terms. See, eg, Grimmelman, Yan and Kell (n 9). An instance is that of the popular NFT project CryptoPunks which has been released with no explicitly written copyright terms. 16 Tese are leading NFT marketplaces. See, eg, Bitdeal, ‘Top 7 NFT Marketplaces to look in 2023 and beyond’ (BLOG, 2023) <www.bitdeal.net/top-7-nf-marketplaces-in-2023 -:~:text=Top 7 NFT Marketplaces 2023 1 1. OpenSea,Marketplace... 7 7. Solanart NFT Marketplace > accessed 13 January 2024. 17 See, eg, Marinoti (n 11). 18 Ibid. 19 Ibid 1277. 20 Ibid 1236. 21 Ibid. 22 Ibid 1269. Downloaded from https://academic.oup.com/ijlit/article/32/1/eaae018/7746479 by guest on 17 September 2024 4 • Tan possession can support an interest held by the wrongful possessor which is stronger than that of the world at large, save for the right owner) can arguably apply.23 While protecting wrongful possession may seem unjust, this could help avoid the scenario of having no legal recourse to an endless series of unlawful conversions of ‘NFTs’ after one single wrongful possession.24 To clarify, Marinoti’s reference to property law concepts drew from both real property and personal property laws, although this was not expressly stated. Along the same vein, other scholars such as Trautman and Fairfield have also proposed that the legal system should treat NFTs as digital personal property because NFTs comprise strong property interests through enabling parties to buy, sell, or own digital assets similar to personal property.25 On the other hand, some scholars do not agree that NFTs should be defined as properties. Lee, for example, has analogized NFTs with library catalog cards to illustrate that the value of NFTs is derived from their underlying properties (ie, books) and to highlight that people do not own these properties when they transact in NFTs.26 Further, Moringiello and Odinet rejected the perception of any property rights in NFTs—through comparison of their characteristics with those of negotiable instruments, securities, deeds of real property, bills of lading and other legal tokens—reasoning that NFTs lack the tethering effect that other properties have and that it is meaningless to view them as such, thus NFT holders do not control anything substantive.27
+
+USER:
+What is the main argument made by scholars like Moringiello and Odinet against considering NFTs as property?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",True,54,17,619,,135
+"Find the correct answer from the context, and respond in two sentences. Omit any filler. Respond only using information from the provided context.",Can you explain CAUTION?,"Representative Michael McCaul introduced the Deterring America’s Technological Adversaries (DATA) Act (H.R. 1153, H.Rept. 118-63) on February 24, 2023. Among other provisions, the bill would require federal actions to protect the sensitive personal data of U.S. persons, with a particular focus on prohibiting the transfer of such data to foreign persons influenced by China. It would also require the Department of the Treasury to issue a directive prohibiting U.S. persons from engaging in any transaction with any person who knowingly provides or may transfer sensitive personal data subject to U.S. jurisdiction to any foreign person subject to Chinese influence. The bill was reported by the Committee on Foreign Affairs on May 16, 2023, and placed on the Union Calendar, Calendar No. 43, the same day. Representative Kat Cammack introduced the Chinese-owned Applications Using the Information of Our Nation (CAUTION) Act of 2023 (H.R. 750) on February 2, 2023. The bill would require any person who sells or distributes the social media application TikTok (or any service developed or provided by ByteDance Ltd.) to disclose, prior to download, that the use of the application is prohibited on government-owned devices. The bill was ordered to be reported, amended, on March 9, 2023, by the House Committee on Energy and Commerce. Representative Ken Buck introduced the No TikTok on United States Devices Act (H.R. 503) on January 25, 2023. Among other provisions, the bill would impose sanctions on the parent company of the TikTok social media service, ByteDance Ltd., as long as it is involved with TikTok. Specifically, the President would be required to impose property-blocking sanctions on ByteDance or any successor entity or subsidiary if it is involved in matters relating to (1) TikTok or any successor service; or (2) information, video, or data associated with such a service. Additionally, the bill would require the Office of the Director of National Intelligence (ODNI) to report to Congress on any national security threats posed by TikTok, including the ability of China’s government to access or use the data of U.S. users of TikTok. Within 180 days of the bill’s enactment, ODNI would be required to brief Congress on the implementation of the bill. On February 27, 2023, the bill was referred to the Subcommittee on the National Intelligence Enterprise. Senator Josh Hawley introduced the No TikTok on United States Devices Act (S. 85) on January 25, 2023. The bill is substantially similar to H.R. 503. On January 25, 2023, the bill was referred to the Committee on Banking, Housing, and Urban Affairs.","Can you explain CAUTION? Find the correct answer from the context, and respond in two sentences. Omit any filler. Respond only using information from the provided context. Representative Michael McCaul introduced the Deterring America’s Technological Adversaries (DATA) Act (H.R. 1153, H.Rept. 118-63) on February 24, 2023. Among other provisions, the bill would require federal actions to protect the sensitive personal data of U.S. persons, with a particular focus on prohibiting the transfer of such data to foreign persons influenced by China. It would also require the Department of the Treasury to issue a directive prohibiting U.S. persons from engaging in any transaction with any person who knowingly provides or may transfer sensitive personal data subject to U.S. jurisdiction to any foreign person subject to Chinese influence. The bill was reported by the Committee on Foreign Affairs on May 16, 2023, and placed on the Union Calendar, Calendar No. 43, the same day. Representative Kat Cammack introduced the Chinese-owned Applications Using the Information of Our Nation (CAUTION) Act of 2023 (H.R. 750) on February 2, 2023. The bill would require any person who sells or distributes the social media application TikTok (or any service developed or provided by ByteDance Ltd.) to disclose, prior to download, that the use of the application is prohibited on government-owned devices. The bill was ordered to be reported, amended, on March 9, 2023, by the House Committee on Energy and Commerce. Representative Ken Buck introduced the No TikTok on United States Devices Act (H.R. 503) on January 25, 2023. Among other provisions, the bill would impose sanctions on the parent company of the TikTok social media service, ByteDance Ltd., as long as it is involved with TikTok. Specifically, the President would be required to impose property-blocking sanctions on ByteDance or any successor entity or subsidiary if it is involved in matters relating to (1) TikTok or any successor service; or (2) information, video, or data associated with such a service. Additionally, the bill would require the Office of the Director of National Intelligence (ODNI) to report to Congress on any national security threats posed by TikTok, including the ability of China’s government to access or use the data of U.S. users of TikTok. Within 180 days of the bill’s enactment, ODNI would be required to brief Congress on the implementation of the bill. On February 27, 2023, the bill was referred to the Subcommittee on the National Intelligence Enterprise. Senator Josh Hawley introduced the No TikTok on United States Devices Act (S. 85) on January 25, 2023. The bill is substantially similar to H.R. 503. On January 25, 2023, the bill was referred to the Committee on Banking, Housing, and Urban Affairs.","Find the correct answer from the context, and respond in two sentences. Omit any filler. Respond only using information from the provided context.
+
+EVIDENCE:
+Representative Michael McCaul introduced the Deterring America’s Technological Adversaries (DATA) Act (H.R. 1153, H.Rept. 118-63) on February 24, 2023. Among other provisions, the bill would require federal actions to protect the sensitive personal data of U.S. persons, with a particular focus on prohibiting the transfer of such data to foreign persons influenced by China. It would also require the Department of the Treasury to issue a directive prohibiting U.S. persons from engaging in any transaction with any person who knowingly provides or may transfer sensitive personal data subject to U.S. jurisdiction to any foreign person subject to Chinese influence. The bill was reported by the Committee on Foreign Affairs on May 16, 2023, and placed on the Union Calendar, Calendar No. 43, the same day. Representative Kat Cammack introduced the Chinese-owned Applications Using the Information of Our Nation (CAUTION) Act of 2023 (H.R. 750) on February 2, 2023. The bill would require any person who sells or distributes the social media application TikTok (or any service developed or provided by ByteDance Ltd.) to disclose, prior to download, that the use of the application is prohibited on government-owned devices. The bill was ordered to be reported, amended, on March 9, 2023, by the House Committee on Energy and Commerce. Representative Ken Buck introduced the No TikTok on United States Devices Act (H.R. 503) on January 25, 2023. Among other provisions, the bill would impose sanctions on the parent company of the TikTok social media service, ByteDance Ltd., as long as it is involved with TikTok. Specifically, the President would be required to impose property-blocking sanctions on ByteDance or any successor entity or subsidiary if it is involved in matters relating to (1) TikTok or any successor service; or (2) information, video, or data associated with such a service. Additionally, the bill would require the Office of the Director of National Intelligence (ODNI) to report to Congress on any national security threats posed by TikTok, including the ability of China’s government to access or use the data of U.S. users of TikTok. Within 180 days of the bill’s enactment, ODNI would be required to brief Congress on the implementation of the bill. On February 27, 2023, the bill was referred to the Subcommittee on the National Intelligence Enterprise. Senator Josh Hawley introduced the No TikTok on United States Devices Act (S. 85) on January 25, 2023. The bill is substantially similar to H.R. 503. On January 25, 2023, the bill was referred to the Committee on Banking, Housing, and Urban Affairs.
+
+USER:
+Can you explain CAUTION?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,23,4,419,,666
+System Instructions: Only use the provided text. Do not use any outside sources. Do not use any prior knowledge.,Question: What is the Ghon's complex?,"Context: Tuberculosis (TB), which is a curable and preventable disease, is the second most common infectious cause of mortality after coronavirus disease 2019 (COVID-19). It affects close to 10 million people per year[1].Despite the diagnosis of TB often being a diagnostic dilemma in kidney disease patients, kidney transplant candidates (KTC) and kidney transplant recipients (KTR) have a 3.62- and 11.35 times higher risk of developing TB, respectively, compared to the general population[2]. They also have a higher rate of mortality due to TB. Treatment of TB also poses unique challenges in these patients due to renal dose modifications, drug interactions, and nephrotoxicity of anti-tubercular agents.EPIDEMIOLOGYIncidence of TB in dialysis patients and transplant candidatesThe incidence of TB in patients with chronic kidney disease (CKD) ranges between 60-19, 270 per 100000 population in various countries (highest incidence in the African region and lowest in the Americas), the pooled incidence being 3718 per 100000[3]. In general, extrapulmonary TB is more common than pulmonary TB in this population[2,3]. Amongst patients with CKD, those on dialysis, who are conventionally considered transplant candidates, are at a higher risk of developing TB as compared to earlier stages of CKD. Patients on hemodialysis have a higher incidence than those on peritoneal dialysis (5611/100000 vs 3533/100000 respectively)[3].Incidence of TB in KTRTB incidence is said to be 7-27 times higher than the general population in solid organ transplant recipients[4]. KTR have a 4.59 times higher risk of developing TB compared to the general population[5]. The incidence of TB in KTR was 2700/100000 population in a pooled systemic analysis[3] from across the world with a range of 340-14680/100000[6,7].NATURAL HISTORY OF TB IN TRANSPLANT CANDIDATES AND RECIPIENTSMycobacterium tuberculosis acquisitionThe primary transmission route of Mycobacterium tuberculosis (M. tuberculosis) is through aerosols, with the lungs being the primary site of host-pathogen interaction. The innate immune system tends to clear the M. tuberculosis bacilli immediately through phagocytosis. However, there is a possibility of the following four distinct outcomes because of complex host-pathogen interplay[8]: (1) Immediate clearance of bacilli; (2) Chronic or latent infection; (3) Rapidly progressive TB; or (4) Reactivation after a prolonged period.Granuloma formationIf the bacilli are not removed immediately, granulomas are formed, where inflammatory cells and cytokines come together and generate a localized response, known as the ""Ghon's complex"". It includes organ parenchymal involvement along with regional adenopathy. Effective cell-mediated immunity usually develops in 4-6 weeks and halts further infection progression[8].Progression and disseminationWhen the host cannot produce a sufficient cell-mediated immune response, the infection spreads and destroys the tissue. Arterial erosion promotes hematogenous spread, which results in disseminated TB that eventually affects multiple organs.Reactivation and immunosuppressed statesIn immunocompromised states, there may be a reactivation of M. tuberculosis CKD, specifically kidney failure, is one such condition where reactivation of previous infection is the most common cause of TB. Earlier, this reactivation was typically limited to a single organ, the most common site being the upper lobe of the lung[8]. However, now extrapulmonary TB is seen to be more common in these patients. Extrapulmonary involvement can affect various other organs and appear with a myriad of clinical symptoms. Almost every organ being involved has been described, including the musculoskeletal system, gastrointestinal tract, liver, skin, orbit, genitourinary tract, lymph nodes, pericardium, larynx, kidneys, and adrenal glands[8,9]. Prasad P et al. TB in kidney transplantationWJT https://www.wjgnet.com 3September 18, 2024 Volume 14 Issue 3Natural history in transplant recipientsBecause of the immunosuppression, the natural history of TB infection is more complex in transplant patients. In developing countries, reactivation from previously acquired infections is more common than re-infection[8,9]. With a median time of onset of 9 months, most active TB cases are recognized during the first year post-transplantation[10-13]. Also, although pulmonary TB is the most common presentation in KTR, they are more likely to develop extrapulmonary TB compared to the general population[12,14,15].MODES OF TRANSMISSIONFor primary prevention, early diagnosis, and prompt treatment, understanding the various modes of transmission of TB is crucial. The various modes of transmission among transplant candidates and recipients are illustrated in Figure 1 and enlisted below[16,17]: (1) Airborne transmission: Aerosol transmission remains the predominant mechanism, particularly in enclosed and congested environments; (2) Reactivation from latent infection: In areas where TB is highly prevalent, reactivation of latent TB is a frequent mechanism of transmission; (3) Nosocomial transmission: The possibility of nosocomial transmission is a worry in healthcare environments. Strict infection control procedures are necessary in transplant units, where immunocompromised patients are concentrated, to stop TB from spreading among recipients; (4) Donor-derived transmission: Rarely, transmission can occur directly from the donor organ. Thorough screening of potential organ donors is essential to avoid unintentionally spreading TB during transplant procedures; and (5) Unusual routes of transmission: Environmental sources have been reported to host viable and infectious TB for long periods. These sources include soil, rivers, wastewater, fomites, dust, and even cadavers. There have been reports of TB transmission through topical wound site contamination, aerosolization during surgery, and intake of water tainted with sanatorium effluent. Also, the incidence of pediatric cases due to intestinal TB is showing an increasing trend, probably due to the ingestion of contaminated milk or sputum[16].Factors influencing transmissionThe probability that an individual with TB will transmit M. tuberculosis to others is determined by many factors, including the number and rate of infectious droplet production and virulence of the disease of the original host who transmits the infection[18]. Environmental factors include duration and extent of contact. Better air circulation and increased ultraviolet (UV) light exposure in the space of contact decrease the chances of transmission. Host factors include the type of induction and maintenance immunosuppression among transplant patients[18].","System Instructions: Only use the provided text. Do not use any outside sources. Do not use any prior knowledge. Question: What is the Ghon's complex? Context: Tuberculosis (TB), which is a curable and preventable disease, is the second most common infectious cause of mortality after coronavirus disease 2019 (COVID-19). It affects close to 10 million people per year[1].Despite the diagnosis of TB often being a diagnostic dilemma in kidney disease patients, kidney transplant candidates (KTC) and kidney transplant recipients (KTR) have a 3.62- and 11.35 times higher risk of developing TB, respectively, compared to the general population[2]. They also have a higher rate of mortality due to TB. Treatment of TB also poses unique challenges in these patients due to renal dose modifications, drug interactions, and nephrotoxicity of anti-tubercular agents.EPIDEMIOLOGYIncidence of TB in dialysis patients and transplant candidatesThe incidence of TB in patients with chronic kidney disease (CKD) ranges between 60-19, 270 per 100000 population in various countries (highest incidence in the African region and lowest in the Americas), the pooled incidence being 3718 per 100000[3]. In general, extrapulmonary TB is more common than pulmonary TB in this population[2,3]. Amongst patients with CKD, those on dialysis, who are conventionally considered transplant candidates, are at a higher risk of developing TB as compared to earlier stages of CKD. Patients on hemodialysis have a higher incidence than those on peritoneal dialysis (5611/100000 vs 3533/100000 respectively)[3].Incidence of TB in KTRTB incidence is said to be 7-27 times higher than the general population in solid organ transplant recipients[4]. KTR have a 4.59 times higher risk of developing TB compared to the general population[5]. The incidence of TB in KTR was 2700/100000 population in a pooled systemic analysis[3] from across the world with a range of 340-14680/100000[6,7].NATURAL HISTORY OF TB IN TRANSPLANT CANDIDATES AND RECIPIENTSMycobacterium tuberculosis acquisitionThe primary transmission route of Mycobacterium tuberculosis (M. tuberculosis) is through aerosols, with the lungs being the primary site of host-pathogen interaction. The innate immune system tends to clear the M. tuberculosis bacilli immediately through phagocytosis. However, there is a possibility of the following four distinct outcomes because of complex host-pathogen interplay[8]: (1) Immediate clearance of bacilli; (2) Chronic or latent infection; (3) Rapidly progressive TB; or (4) Reactivation after a prolonged period.Granuloma formationIf the bacilli are not removed immediately, granulomas are formed, where inflammatory cells and cytokines come together and generate a localized response, known as the ""Ghon's complex"". It includes organ parenchymal involvement along with regional adenopathy. Effective cell-mediated immunity usually develops in 4-6 weeks and halts further infection progression[8].Progression and disseminationWhen the host cannot produce a sufficient cell-mediated immune response, the infection spreads and destroys the tissue. Arterial erosion promotes hematogenous spread, which results in disseminated TB that eventually affects multiple organs.Reactivation and immunosuppressed statesIn immunocompromised states, there may be a reactivation of M. tuberculosis CKD, specifically kidney failure, is one such condition where reactivation of previous infection is the most common cause of TB. Earlier, this reactivation was typically limited to a single organ, the most common site being the upper lobe of the lung[8]. However, now extrapulmonary TB is seen to be more common in these patients. Extrapulmonary involvement can affect various other organs and appear with a myriad of clinical symptoms. Almost every organ being involved has been described, including the musculoskeletal system, gastrointestinal tract, liver, skin, orbit, genitourinary tract, lymph nodes, pericardium, larynx, kidneys, and adrenal glands[8,9]. Prasad P et al. TB in kidney transplantationWJT https://www.wjgnet.com 3September 18, 2024 Volume 14 Issue 3Natural history in transplant recipientsBecause of the immunosuppression, the natural history of TB infection is more complex in transplant patients. In developing countries, reactivation from previously acquired infections is more common than re-infection[8,9]. With a median time of onset of 9 months, most active TB cases are recognized during the first year post-transplantation[10-13]. Also, although pulmonary TB is the most common presentation in KTR, they are more likely to develop extrapulmonary TB compared to the general population[12,14,15].MODES OF TRANSMISSIONFor primary prevention, early diagnosis, and prompt treatment, understanding the various modes of transmission of TB is crucial. The various modes of transmission among transplant candidates and recipients are illustrated in Figure 1 and enlisted below[16,17]: (1) Airborne transmission: Aerosol transmission remains the predominant mechanism, particularly in enclosed and congested environments; (2) Reactivation from latent infection: In areas where TB is highly prevalent, reactivation of latent TB is a frequent mechanism of transmission; (3) Nosocomial transmission: The possibility of nosocomial transmission is a worry in healthcare environments. Strict infection control procedures are necessary in transplant units, where immunocompromised patients are concentrated, to stop TB from spreading among recipients; (4) Donor-derived transmission: Rarely, transmission can occur directly from the donor organ. Thorough screening of potential organ donors is essential to avoid unintentionally spreading TB during transplant procedures; and (5) Unusual routes of transmission: Environmental sources have been reported to host viable and infectious TB for long periods. These sources include soil, rivers, wastewater, fomites, dust, and even cadavers. There have been reports of TB transmission through topical wound site contamination, aerosolization during surgery, and intake of water tainted with sanatorium effluent. Also, the incidence of pediatric cases due to intestinal TB is showing an increasing trend, probably due to the ingestion of contaminated milk or sputum[16].Factors influencing transmissionThe probability that an individual with TB will transmit M. tuberculosis to others is determined by many factors, including the number and rate of infectious droplet production and virulence of the disease of the original host who transmits the infection[18]. Environmental factors include duration and extent of contact. Better air circulation and increased ultraviolet (UV) light exposure in the space of contact decrease the chances of transmission. Host factors include the type of induction and maintenance immunosuppression among transplant patients[18].","System Instructions: Only use the provided text. Do not use any outside sources. Do not use any prior knowledge.
+
+EVIDENCE:
+Context: Tuberculosis (TB), which is a curable and preventable disease, is the second most common infectious cause of mortality after coronavirus disease 2019 (COVID-19). It affects close to 10 million people per year[1].Despite the diagnosis of TB often being a diagnostic dilemma in kidney disease patients, kidney transplant candidates (KTC) and kidney transplant recipients (KTR) have a 3.62- and 11.35 times higher risk of developing TB, respectively, compared to the general population[2]. They also have a higher rate of mortality due to TB. Treatment of TB also poses unique challenges in these patients due to renal dose modifications, drug interactions, and nephrotoxicity of anti-tubercular agents.EPIDEMIOLOGYIncidence of TB in dialysis patients and transplant candidatesThe incidence of TB in patients with chronic kidney disease (CKD) ranges between 60-19, 270 per 100000 population in various countries (highest incidence in the African region and lowest in the Americas), the pooled incidence being 3718 per 100000[3]. In general, extrapulmonary TB is more common than pulmonary TB in this population[2,3]. Amongst patients with CKD, those on dialysis, who are conventionally considered transplant candidates, are at a higher risk of developing TB as compared to earlier stages of CKD. Patients on hemodialysis have a higher incidence than those on peritoneal dialysis (5611/100000 vs 3533/100000 respectively)[3].Incidence of TB in KTRTB incidence is said to be 7-27 times higher than the general population in solid organ transplant recipients[4]. KTR have a 4.59 times higher risk of developing TB compared to the general population[5]. The incidence of TB in KTR was 2700/100000 population in a pooled systemic analysis[3] from across the world with a range of 340-14680/100000[6,7].NATURAL HISTORY OF TB IN TRANSPLANT CANDIDATES AND RECIPIENTSMycobacterium tuberculosis acquisitionThe primary transmission route of Mycobacterium tuberculosis (M. tuberculosis) is through aerosols, with the lungs being the primary site of host-pathogen interaction. The innate immune system tends to clear the M. tuberculosis bacilli immediately through phagocytosis. However, there is a possibility of the following four distinct outcomes because of complex host-pathogen interplay[8]: (1) Immediate clearance of bacilli; (2) Chronic or latent infection; (3) Rapidly progressive TB; or (4) Reactivation after a prolonged period.Granuloma formationIf the bacilli are not removed immediately, granulomas are formed, where inflammatory cells and cytokines come together and generate a localized response, known as the ""Ghon's complex"". It includes organ parenchymal involvement along with regional adenopathy. Effective cell-mediated immunity usually develops in 4-6 weeks and halts further infection progression[8].Progression and disseminationWhen the host cannot produce a sufficient cell-mediated immune response, the infection spreads and destroys the tissue. Arterial erosion promotes hematogenous spread, which results in disseminated TB that eventually affects multiple organs.Reactivation and immunosuppressed statesIn immunocompromised states, there may be a reactivation of M. tuberculosis CKD, specifically kidney failure, is one such condition where reactivation of previous infection is the most common cause of TB. Earlier, this reactivation was typically limited to a single organ, the most common site being the upper lobe of the lung[8]. However, now extrapulmonary TB is seen to be more common in these patients. Extrapulmonary involvement can affect various other organs and appear with a myriad of clinical symptoms. Almost every organ being involved has been described, including the musculoskeletal system, gastrointestinal tract, liver, skin, orbit, genitourinary tract, lymph nodes, pericardium, larynx, kidneys, and adrenal glands[8,9]. Prasad P et al. TB in kidney transplantationWJT https://www.wjgnet.com 3September 18, 2024 Volume 14 Issue 3Natural history in transplant recipientsBecause of the immunosuppression, the natural history of TB infection is more complex in transplant patients. In developing countries, reactivation from previously acquired infections is more common than re-infection[8,9]. With a median time of onset of 9 months, most active TB cases are recognized during the first year post-transplantation[10-13]. Also, although pulmonary TB is the most common presentation in KTR, they are more likely to develop extrapulmonary TB compared to the general population[12,14,15].MODES OF TRANSMISSIONFor primary prevention, early diagnosis, and prompt treatment, understanding the various modes of transmission of TB is crucial. The various modes of transmission among transplant candidates and recipients are illustrated in Figure 1 and enlisted below[16,17]: (1) Airborne transmission: Aerosol transmission remains the predominant mechanism, particularly in enclosed and congested environments; (2) Reactivation from latent infection: In areas where TB is highly prevalent, reactivation of latent TB is a frequent mechanism of transmission; (3) Nosocomial transmission: The possibility of nosocomial transmission is a worry in healthcare environments. Strict infection control procedures are necessary in transplant units, where immunocompromised patients are concentrated, to stop TB from spreading among recipients; (4) Donor-derived transmission: Rarely, transmission can occur directly from the donor organ. Thorough screening of potential organ donors is essential to avoid unintentionally spreading TB during transplant procedures; and (5) Unusual routes of transmission: Environmental sources have been reported to host viable and infectious TB for long periods. These sources include soil, rivers, wastewater, fomites, dust, and even cadavers. There have been reports of TB transmission through topical wound site contamination, aerosolization during surgery, and intake of water tainted with sanatorium effluent. Also, the incidence of pediatric cases due to intestinal TB is showing an increasing trend, probably due to the ingestion of contaminated milk or sputum[16].Factors influencing transmissionThe probability that an individual with TB will transmit M. tuberculosis to others is determined by many factors, including the number and rate of infectious droplet production and virulence of the disease of the original host who transmits the infection[18]. Environmental factors include duration and extent of contact. Better air circulation and increased ultraviolet (UV) light exposure in the space of contact decrease the chances of transmission. Host factors include the type of induction and maintenance immunosuppression among transplant patients[18].
+
+USER:
+Question: What is the Ghon's complex?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",True,19,6,929,,11
+"{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]",Why does having an autoimmune disease like lupus make it complicated for woman who have it to have healthy pregnancies and to have healthy babies.,"Lupus tends to appear in women of childbearing age. It can affect pregnancy, however most women with lupus are able to have children. All pregnancies will need careful medical monitoring because of the risk of complications. It’s generally best to wait six months after a flare of symptoms and ideally have no active lupus symptoms prior to conception. How lupus affects pregnancy Lupus is a chronic condition that results from a malfunctioning immune system. The immune system is designed to identify foreign bodies (such as bacteria and viruses) and attack them to keep us healthy. However, in the case of lupus, your immune system mistakenly attacks one or many different types of tissue in the body, such as the skin, joints, muscles, nerves, kidneys, heart or lungs. The result of this damage is ongoing inflammation and pain. For these reasons, it’s important that you plan your pregnancy carefully. The healthier you are before you get pregnant, the greater the chance that you will have a healthy pregnancy and a healthy baby. Aim to have your condition under control and be in the best possible health. Talk with your doctor and specialist before you get pregnant. They may need to make important changes to your medication to ensure a safe pregnancy. Some medications are safe to take while you’re pregnant however others, like methotrexate, shouldn’t be taken. You may need to stop taking some medications months before trying to get pregnant as they can be harmful to your baby. Your doctors will help you plan this. In some cases, there is a reduction in lupus symptoms during pregnancy. Your lupus is more likely to be stable throughout your pregnancy if your condition was stable before conceiving. Complications of pregnancy Most women with lupus are able to have a healthy baby, however sometimes complications can occur. That’s why it’s so important you plan your pregnancy and work closely with your healthcare team to ensure you’re as healthy as possible before, during and after your pregnancy. It’s also important that you know the possible problems that may occur so that you can be treated immediately. Many of these issues can be prevented or treated effectively if they’re dealt with early. Some of the problems that can occur during pregnancy for women with lupus include: flares of your lupus symptoms may occur during pregnancy or immediately after you deliver, however this is less likely if your condition was stable before you became pregnant high blood pressure (hypertension) your baby may be born with low birth weight pre-eclampsia – symptoms include high blood pressure and excessive amounts of protein lost through your urine premature labour increased risk of blood clots in the legs or lungs increased risk of miscarriage increased risk of emergency caesarean section increased risk of excessive bleeding after delivery. Medical care before and during pregnancy It’s important that you have consistent and adequate medical care before and during your pregnancy. Discuss your plans to become pregnant with your doctor and specialist before you conceive. They can advise you of the best time to fall pregnant – it’s advisable to have had no lupus symptoms for at least six months prior to conception. They can also let you know about any particular risks you may face and whether your medication needs to be changed. Some medication taken for lupus can cross the placenta and pose a threat to your baby. Once you have become pregnant, it's vital that you receive proper antenatal care to anticipate, prevent and solve any problems that may occur. You will need to contact your treating doctor in case your treatment needs to be changed or further tests are required. It’s also important that you consult closely with both a rheumatologist and a specialist obstetrician throughout your pregnancy to lessen the risk of complications and monitor your baby's growth. Lupus flares and normal pregnancy symptoms Sometimes, it can be difficult to distinguish between a lupus flare and normal pregnancy symptoms. For this reason it’s important that you work closely with your healthcare team and obstetrician. Some of the symptoms of pregnancy that may mimic those of lupus include: fatigue build-up of fluid in the joints skin changes, such as rashes, flushes or darkening hair loss following childbirth shortness of breath joint pain. Lupus pregnancies and increased rate of premature birth and miscarriage During pregnancy, the growing baby is nourished by the placenta. About one third of women with lupus have antibodies that may cause blood clots and interfere with the proper functioning of the placenta. This is most likely to happen in the second trimester. The placenta isn’t able to supply the baby with sufficient nourishment and the baby’s growth is slowed. This may require early delivery via caesarean section. If the baby is born after 30 weeks’ gestation, or is at least 1.3 kg in weight, its chances of survival are good. Your doctor can screen for antiphospholipid antibodies, and if they are found, may prescribe a blood thinner to help prevent blood clots. This can help prevent miscarriage in many women. Pre-eclampsia is a condition that involves increased blood pressure, fluid retention and protein in the urine. It occurs in one in five women with lupus. If left untreated it can endanger the life of both the woman and her baby. Pre-eclampsia can be treated. However, depending on the severity, it may also require early delivery. Neonatal lupus Around one third of women with lupus have antibodies that may cause lupus-like symptoms in their baby once it‘s born. This is known as neonatal lupus. Symptoms may include skin rash, unusual blood count and, rarely, heartbeat irregularities. This is not SLE. In babies who don’t experience heartbeat irregularities, all symptoms of neonatal lupus usually resolve by three to six months of age. Heartbeat irregularities can be successfully treated. Lupus and pregnancy delay advice Some women with lupus should delay pregnancy and discuss their plan with their treating doctor when they are planning to have a baby. They include: women whose lupus is active women taking medication such as methotrexate, mycophenolate, or cyclophosphamide women with kidney disease women with previous thrombosis or miscarriage. If you have any questions about your condition, medications and pregnancy, talk with your doctor. Where to get help Your GP (doctor) Obstetrician A specialist (often a rheumatologist, nephrologist, immunologist or dermatologist)","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== Why does having an autoimmune disease like lupus make it complicated for woman who have it to have healthy pregnancies and to have healthy babies. {passage 0} ========== Lupus tends to appear in women of childbearing age. It can affect pregnancy, however most women with lupus are able to have children. All pregnancies will need careful medical monitoring because of the risk of complications. It’s generally best to wait six months after a flare of symptoms and ideally have no active lupus symptoms prior to conception. How lupus affects pregnancy Lupus is a chronic condition that results from a malfunctioning immune system. The immune system is designed to identify foreign bodies (such as bacteria and viruses) and attack them to keep us healthy. However, in the case of lupus, your immune system mistakenly attacks one or many different types of tissue in the body, such as the skin, joints, muscles, nerves, kidneys, heart or lungs. The result of this damage is ongoing inflammation and pain. For these reasons, it’s important that you plan your pregnancy carefully. The healthier you are before you get pregnant, the greater the chance that you will have a healthy pregnancy and a healthy baby. Aim to have your condition under control and be in the best possible health. Talk with your doctor and specialist before you get pregnant. They may need to make important changes to your medication to ensure a safe pregnancy. Some medications are safe to take while you’re pregnant however others, like methotrexate, shouldn’t be taken. You may need to stop taking some medications months before trying to get pregnant as they can be harmful to your baby. Your doctors will help you plan this. In some cases, there is a reduction in lupus symptoms during pregnancy. Your lupus is more likely to be stable throughout your pregnancy if your condition was stable before conceiving. Complications of pregnancy Most women with lupus are able to have a healthy baby, however sometimes complications can occur. That’s why it’s so important you plan your pregnancy and work closely with your healthcare team to ensure you’re as healthy as possible before, during and after your pregnancy. It’s also important that you know the possible problems that may occur so that you can be treated immediately. Many of these issues can be prevented or treated effectively if they’re dealt with early. Some of the problems that can occur during pregnancy for women with lupus include: flares of your lupus symptoms may occur during pregnancy or immediately after you deliver, however this is less likely if your condition was stable before you became pregnant high blood pressure (hypertension) your baby may be born with low birth weight pre-eclampsia – symptoms include high blood pressure and excessive amounts of protein lost through your urine premature labour increased risk of blood clots in the legs or lungs increased risk of miscarriage increased risk of emergency caesarean section increased risk of excessive bleeding after delivery. Medical care before and during pregnancy It’s important that you have consistent and adequate medical care before and during your pregnancy. Discuss your plans to become pregnant with your doctor and specialist before you conceive. They can advise you of the best time to fall pregnant – it’s advisable to have had no lupus symptoms for at least six months prior to conception. They can also let you know about any particular risks you may face and whether your medication needs to be changed. Some medication taken for lupus can cross the placenta and pose a threat to your baby. Once you have become pregnant, it's vital that you receive proper antenatal care to anticipate, prevent and solve any problems that may occur. You will need to contact your treating doctor in case your treatment needs to be changed or further tests are required. It’s also important that you consult closely with both a rheumatologist and a specialist obstetrician throughout your pregnancy to lessen the risk of complications and monitor your baby's growth. Lupus flares and normal pregnancy symptoms Sometimes, it can be difficult to distinguish between a lupus flare and normal pregnancy symptoms. For this reason it’s important that you work closely with your healthcare team and obstetrician. Some of the symptoms of pregnancy that may mimic those of lupus include: fatigue build-up of fluid in the joints skin changes, such as rashes, flushes or darkening hair loss following childbirth shortness of breath joint pain. Lupus pregnancies and increased rate of premature birth and miscarriage During pregnancy, the growing baby is nourished by the placenta. About one third of women with lupus have antibodies that may cause blood clots and interfere with the proper functioning of the placenta. This is most likely to happen in the second trimester. The placenta isn’t able to supply the baby with sufficient nourishment and the baby’s growth is slowed. This may require early delivery via caesarean section. If the baby is born after 30 weeks’ gestation, or is at least 1.3 kg in weight, its chances of survival are good. Your doctor can screen for antiphospholipid antibodies, and if they are found, may prescribe a blood thinner to help prevent blood clots. This can help prevent miscarriage in many women. Pre-eclampsia is a condition that involves increased blood pressure, fluid retention and protein in the urine. It occurs in one in five women with lupus. If left untreated it can endanger the life of both the woman and her baby. Pre-eclampsia can be treated. However, depending on the severity, it may also require early delivery. Neonatal lupus Around one third of women with lupus have antibodies that may cause lupus-like symptoms in their baby once it‘s born. This is known as neonatal lupus. Symptoms may include skin rash, unusual blood count and, rarely, heartbeat irregularities. This is not SLE. In babies who don’t experience heartbeat irregularities, all symptoms of neonatal lupus usually resolve by three to six months of age. Heartbeat irregularities can be successfully treated. Lupus and pregnancy delay advice Some women with lupus should delay pregnancy and discuss their plan with their treating doctor when they are planning to have a baby. They include: women whose lupus is active women taking medication such as methotrexate, mycophenolate, or cyclophosphamide women with kidney disease women with previous thrombosis or miscarriage. If you have any questions about your condition, medications and pregnancy, talk with your doctor. Where to get help Your GP (doctor) Obstetrician A specialist (often a rheumatologist, nephrologist, immunologist or dermatologist) https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/lupus-and-pregnancy","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]
+
+EVIDENCE:
+Lupus tends to appear in women of childbearing age. It can affect pregnancy, however most women with lupus are able to have children. All pregnancies will need careful medical monitoring because of the risk of complications. It’s generally best to wait six months after a flare of symptoms and ideally have no active lupus symptoms prior to conception. How lupus affects pregnancy Lupus is a chronic condition that results from a malfunctioning immune system. The immune system is designed to identify foreign bodies (such as bacteria and viruses) and attack them to keep us healthy. However, in the case of lupus, your immune system mistakenly attacks one or many different types of tissue in the body, such as the skin, joints, muscles, nerves, kidneys, heart or lungs. The result of this damage is ongoing inflammation and pain. For these reasons, it’s important that you plan your pregnancy carefully. The healthier you are before you get pregnant, the greater the chance that you will have a healthy pregnancy and a healthy baby. Aim to have your condition under control and be in the best possible health. Talk with your doctor and specialist before you get pregnant. They may need to make important changes to your medication to ensure a safe pregnancy. Some medications are safe to take while you’re pregnant however others, like methotrexate, shouldn’t be taken. You may need to stop taking some medications months before trying to get pregnant as they can be harmful to your baby. Your doctors will help you plan this. In some cases, there is a reduction in lupus symptoms during pregnancy. Your lupus is more likely to be stable throughout your pregnancy if your condition was stable before conceiving. Complications of pregnancy Most women with lupus are able to have a healthy baby, however sometimes complications can occur. That’s why it’s so important you plan your pregnancy and work closely with your healthcare team to ensure you’re as healthy as possible before, during and after your pregnancy. It’s also important that you know the possible problems that may occur so that you can be treated immediately. Many of these issues can be prevented or treated effectively if they’re dealt with early. Some of the problems that can occur during pregnancy for women with lupus include: flares of your lupus symptoms may occur during pregnancy or immediately after you deliver, however this is less likely if your condition was stable before you became pregnant high blood pressure (hypertension) your baby may be born with low birth weight pre-eclampsia – symptoms include high blood pressure and excessive amounts of protein lost through your urine premature labour increased risk of blood clots in the legs or lungs increased risk of miscarriage increased risk of emergency caesarean section increased risk of excessive bleeding after delivery. Medical care before and during pregnancy It’s important that you have consistent and adequate medical care before and during your pregnancy. Discuss your plans to become pregnant with your doctor and specialist before you conceive. They can advise you of the best time to fall pregnant – it’s advisable to have had no lupus symptoms for at least six months prior to conception. They can also let you know about any particular risks you may face and whether your medication needs to be changed. Some medication taken for lupus can cross the placenta and pose a threat to your baby. Once you have become pregnant, it's vital that you receive proper antenatal care to anticipate, prevent and solve any problems that may occur. You will need to contact your treating doctor in case your treatment needs to be changed or further tests are required. It’s also important that you consult closely with both a rheumatologist and a specialist obstetrician throughout your pregnancy to lessen the risk of complications and monitor your baby's growth. Lupus flares and normal pregnancy symptoms Sometimes, it can be difficult to distinguish between a lupus flare and normal pregnancy symptoms. For this reason it’s important that you work closely with your healthcare team and obstetrician. Some of the symptoms of pregnancy that may mimic those of lupus include: fatigue build-up of fluid in the joints skin changes, such as rashes, flushes or darkening hair loss following childbirth shortness of breath joint pain. Lupus pregnancies and increased rate of premature birth and miscarriage During pregnancy, the growing baby is nourished by the placenta. About one third of women with lupus have antibodies that may cause blood clots and interfere with the proper functioning of the placenta. This is most likely to happen in the second trimester. The placenta isn’t able to supply the baby with sufficient nourishment and the baby’s growth is slowed. This may require early delivery via caesarean section. If the baby is born after 30 weeks’ gestation, or is at least 1.3 kg in weight, its chances of survival are good. Your doctor can screen for antiphospholipid antibodies, and if they are found, may prescribe a blood thinner to help prevent blood clots. This can help prevent miscarriage in many women. Pre-eclampsia is a condition that involves increased blood pressure, fluid retention and protein in the urine. It occurs in one in five women with lupus. If left untreated it can endanger the life of both the woman and her baby. Pre-eclampsia can be treated. However, depending on the severity, it may also require early delivery. Neonatal lupus Around one third of women with lupus have antibodies that may cause lupus-like symptoms in their baby once it‘s born. This is known as neonatal lupus. Symptoms may include skin rash, unusual blood count and, rarely, heartbeat irregularities. This is not SLE. In babies who don’t experience heartbeat irregularities, all symptoms of neonatal lupus usually resolve by three to six months of age. Heartbeat irregularities can be successfully treated. Lupus and pregnancy delay advice Some women with lupus should delay pregnancy and discuss their plan with their treating doctor when they are planning to have a baby. They include: women whose lupus is active women taking medication such as methotrexate, mycophenolate, or cyclophosphamide women with kidney disease women with previous thrombosis or miscarriage. If you have any questions about your condition, medications and pregnancy, talk with your doctor. Where to get help Your GP (doctor) Obstetrician A specialist (often a rheumatologist, nephrologist, immunologist or dermatologist)
+
+USER:
+Why does having an autoimmune disease like lupus make it complicated for woman who have it to have healthy pregnancies and to have healthy babies.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,26,25,1056,,236
+"""================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""","My brother and sister in law are considering moving to the west coast and im worried about potential health issues due to wildfires. List health issues associated with wildfire smoke and two ways to prevent them, but don't mention anything about the air quality index","What is the Air Quality Index? The United States Environmental Protection Agency (EPA) established an Air Quality Index (AQI) to measure air pollutants. A higher AQI, with color codes and corresponding numbers (ranging from 0 to 500), means a greater health concern. (Local AQI information is available on various apps and websites, including www.airnow.gov.) Particle pollution, also known as particulate matter (or PM), is a type of air pollutant made up of tiny particles of solids or liquids suspended in the air. It’s one of the main components of wildfire smoke, which is a mix of gases and fine particles from burning vegetation, as well as building and other materials. Particulate matter includes PM10, inhalable particles that are 10 micrometers and smaller in diameter, and PM2.5, inhalable particles with diameters of 2.5 micrometers and smaller. PM2.5 poses a greater health risk than PM10 because the particles are so small (30 times smaller than the diameter of a human hair) and can get deep into the lungs and bloodstream. Although air pollution is not good for anyone, certain groups are more sensitive to it than others, including those with heart or lung disease , older adults, infants and children, and pregnant women. As the AQI levels increase, the risk of health effects increases, especially among these more sensitive groups. “The advice to limit strenuous activities is because when your respiratory rate is higher, you inhale more particulates,” says Dr. Redlich. When the AQI is 201 and higher, everyone should be concerned about health risks and limit physical activity outdoors as much as possible, she adds. For context, with the recent wildfires in Canada, the PM2.5 AQI climbed above 400 for a brief period in New York City in early June. Why is particulate matter dangerous? PM2.5 particles are so tiny that they get through the usual defense mechanisms of the upper airway and can penetrate deep into the lungs, where they can impair lung function, cause illnesses, such as bronchitis, and increase asthma attacks . The particles can also pass into the bloodstream and travel to other organs, where they can cause damage. In addition to respiratory problems, PM2.5 exposure has been linked to an increased risk of heart attack , stroke , lung cancer , and a decline in cognitive function. “The health effects extend beyond respiratory issues and include the cardiovascular system,” Dr. Redlich says. “There is more extensive literature on particulate air pollution, in general, than forest fires specifically, but the indication is that wildfires have similar health effects. And there has been an explosion in research and understanding that even relatively low levels of air pollution can impact your lungs and heart, especially if you have asthma, chronic obstructive pulmonary disease [COPD] , or cardiac disease.” The reason particle pollution has such systemic effects, Dr. Redlich explains, is that when you inhale these tiny particles, “they get everywhere through the bloodstream and trigger inflammatory pathways, which can exacerbate a number of underlying cardiac and respiratory conditions.” Does a mask protect against wildfire smoke? The best type of mask to wear for protection against wildfire smoke is a well-fitted N95 or P100 respirator with two straps that go around your head. The “95” and “100” refer to the percentage of particles filtered out by the mask. They are not specially made for children. “A surgical mask probably does some good, but the N95 or even a KN95 is better,” Dr. Redlich says. “KN95s may be easier to find and may come in sizes that fit children better.” The EPA provides a one-sheet with information on how to choose the right mask for wildfire smoke. Is staying inside always best when the outdoor air quality is poor? When the air quality is poor, the general advice is to go inside, shut the windows, and use an air conditioner (with a clean filter and the fresh-air intake closed). But, not every home has air conditioning or can be tightly sealed to keep the bad air out, Dr. Redlich explains. “It’s not as though you go inside and the level drops to zero. Yes, going inside is usually a good idea, but you can also store poor air quality levels—or even air pollutants—in your home,” she says. “Plus, you can generate air pollutants inside by cooking, smoking cigarettes, and burning candles.” These, Dr. Redlich says, are all things we have control over and can be avoided or mitigated with steps like using a vent over your kitchen stove. Another step people can take to improve particulate air quality or reduce particulate air pollution in their homes is to use a portable air purifier with a HEPA (high efficiency particulate air) filter. The air purifier should be sized appropriately for the size of the room.","""================ <TEXT PASSAGE> ======= What is the Air Quality Index? The United States Environmental Protection Agency (EPA) established an Air Quality Index (AQI) to measure air pollutants. A higher AQI, with color codes and corresponding numbers (ranging from 0 to 500), means a greater health concern. (Local AQI information is available on various apps and websites, including www.airnow.gov.) Particle pollution, also known as particulate matter (or PM), is a type of air pollutant made up of tiny particles of solids or liquids suspended in the air. It’s one of the main components of wildfire smoke, which is a mix of gases and fine particles from burning vegetation, as well as building and other materials. Particulate matter includes PM10, inhalable particles that are 10 micrometers and smaller in diameter, and PM2.5, inhalable particles with diameters of 2.5 micrometers and smaller. PM2.5 poses a greater health risk than PM10 because the particles are so small (30 times smaller than the diameter of a human hair) and can get deep into the lungs and bloodstream. Although air pollution is not good for anyone, certain groups are more sensitive to it than others, including those with heart or lung disease , older adults, infants and children, and pregnant women. As the AQI levels increase, the risk of health effects increases, especially among these more sensitive groups. “The advice to limit strenuous activities is because when your respiratory rate is higher, you inhale more particulates,” says Dr. Redlich. When the AQI is 201 and higher, everyone should be concerned about health risks and limit physical activity outdoors as much as possible, she adds. For context, with the recent wildfires in Canada, the PM2.5 AQI climbed above 400 for a brief period in New York City in early June. Why is particulate matter dangerous? PM2.5 particles are so tiny that they get through the usual defense mechanisms of the upper airway and can penetrate deep into the lungs, where they can impair lung function, cause illnesses, such as bronchitis, and increase asthma attacks . The particles can also pass into the bloodstream and travel to other organs, where they can cause damage. In addition to respiratory problems, PM2.5 exposure has been linked to an increased risk of heart attack , stroke , lung cancer , and a decline in cognitive function. “The health effects extend beyond respiratory issues and include the cardiovascular system,” Dr. Redlich says. “There is more extensive literature on particulate air pollution, in general, than forest fires specifically, but the indication is that wildfires have similar health effects. And there has been an explosion in research and understanding that even relatively low levels of air pollution can impact your lungs and heart, especially if you have asthma, chronic obstructive pulmonary disease [COPD] , or cardiac disease.” The reason particle pollution has such systemic effects, Dr. Redlich explains, is that when you inhale these tiny particles, “they get everywhere through the bloodstream and trigger inflammatory pathways, which can exacerbate a number of underlying cardiac and respiratory conditions.” Does a mask protect against wildfire smoke? The best type of mask to wear for protection against wildfire smoke is a well-fitted N95 or P100 respirator with two straps that go around your head. The “95” and “100” refer to the percentage of particles filtered out by the mask. They are not specially made for children. “A surgical mask probably does some good, but the N95 or even a KN95 is better,” Dr. Redlich says. “KN95s may be easier to find and may come in sizes that fit children better.” The EPA provides a one-sheet with information on how to choose the right mask for wildfire smoke. Is staying inside always best when the outdoor air quality is poor? When the air quality is poor, the general advice is to go inside, shut the windows, and use an air conditioner (with a clean filter and the fresh-air intake closed). But, not every home has air conditioning or can be tightly sealed to keep the bad air out, Dr. Redlich explains. “It’s not as though you go inside and the level drops to zero. Yes, going inside is usually a good idea, but you can also store poor air quality levels—or even air pollutants—in your home,” she says. “Plus, you can generate air pollutants inside by cooking, smoking cigarettes, and burning candles.” These, Dr. Redlich says, are all things we have control over and can be avoided or mitigated with steps like using a vent over your kitchen stove. Another step people can take to improve particulate air quality or reduce particulate air pollution in their homes is to use a portable air purifier with a HEPA (high efficiency particulate air) filter. The air purifier should be sized appropriately for the size of the room. https://www.yalemedicine.org/news/how-bad-is-wildfire-smoke-for-your-health ================ <QUESTION> ======= My brother and sister in law are considering moving to the west coast and im worried about potential health issues due to wildfires. List health issues associated with wildfire smoke and two ways to prevent them, but don't mention anything about the air quality index ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""","""================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""
+
+EVIDENCE:
+What is the Air Quality Index? The United States Environmental Protection Agency (EPA) established an Air Quality Index (AQI) to measure air pollutants. A higher AQI, with color codes and corresponding numbers (ranging from 0 to 500), means a greater health concern. (Local AQI information is available on various apps and websites, including www.airnow.gov.) Particle pollution, also known as particulate matter (or PM), is a type of air pollutant made up of tiny particles of solids or liquids suspended in the air. It’s one of the main components of wildfire smoke, which is a mix of gases and fine particles from burning vegetation, as well as building and other materials. Particulate matter includes PM10, inhalable particles that are 10 micrometers and smaller in diameter, and PM2.5, inhalable particles with diameters of 2.5 micrometers and smaller. PM2.5 poses a greater health risk than PM10 because the particles are so small (30 times smaller than the diameter of a human hair) and can get deep into the lungs and bloodstream. Although air pollution is not good for anyone, certain groups are more sensitive to it than others, including those with heart or lung disease , older adults, infants and children, and pregnant women. As the AQI levels increase, the risk of health effects increases, especially among these more sensitive groups. “The advice to limit strenuous activities is because when your respiratory rate is higher, you inhale more particulates,” says Dr. Redlich. When the AQI is 201 and higher, everyone should be concerned about health risks and limit physical activity outdoors as much as possible, she adds. For context, with the recent wildfires in Canada, the PM2.5 AQI climbed above 400 for a brief period in New York City in early June. Why is particulate matter dangerous? PM2.5 particles are so tiny that they get through the usual defense mechanisms of the upper airway and can penetrate deep into the lungs, where they can impair lung function, cause illnesses, such as bronchitis, and increase asthma attacks . The particles can also pass into the bloodstream and travel to other organs, where they can cause damage. In addition to respiratory problems, PM2.5 exposure has been linked to an increased risk of heart attack , stroke , lung cancer , and a decline in cognitive function. “The health effects extend beyond respiratory issues and include the cardiovascular system,” Dr. Redlich says. “There is more extensive literature on particulate air pollution, in general, than forest fires specifically, but the indication is that wildfires have similar health effects. And there has been an explosion in research and understanding that even relatively low levels of air pollution can impact your lungs and heart, especially if you have asthma, chronic obstructive pulmonary disease [COPD] , or cardiac disease.” The reason particle pollution has such systemic effects, Dr. Redlich explains, is that when you inhale these tiny particles, “they get everywhere through the bloodstream and trigger inflammatory pathways, which can exacerbate a number of underlying cardiac and respiratory conditions.” Does a mask protect against wildfire smoke? The best type of mask to wear for protection against wildfire smoke is a well-fitted N95 or P100 respirator with two straps that go around your head. The “95” and “100” refer to the percentage of particles filtered out by the mask. They are not specially made for children. “A surgical mask probably does some good, but the N95 or even a KN95 is better,” Dr. Redlich says. “KN95s may be easier to find and may come in sizes that fit children better.” The EPA provides a one-sheet with information on how to choose the right mask for wildfire smoke. Is staying inside always best when the outdoor air quality is poor? When the air quality is poor, the general advice is to go inside, shut the windows, and use an air conditioner (with a clean filter and the fresh-air intake closed). But, not every home has air conditioning or can be tightly sealed to keep the bad air out, Dr. Redlich explains. “It’s not as though you go inside and the level drops to zero. Yes, going inside is usually a good idea, but you can also store poor air quality levels—or even air pollutants—in your home,” she says. “Plus, you can generate air pollutants inside by cooking, smoking cigarettes, and burning candles.” These, Dr. Redlich says, are all things we have control over and can be avoided or mitigated with steps like using a vent over your kitchen stove. Another step people can take to improve particulate air quality or reduce particulate air pollution in their homes is to use a portable air purifier with a HEPA (high efficiency particulate air) filter. The air purifier should be sized appropriately for the size of the room.
+
+USER:
+My brother and sister in law are considering moving to the west coast and im worried about potential health issues due to wildfires. List health issues associated with wildfire smoke and two ways to prevent them, but don't mention anything about the air quality index
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,49,45,793,,371
+Draw your answer from the above text.,"According to this document, what is an executer responsible for?","**Texas last will and testament requirements** Here are the requirements for a valid will in Texas: Your will must be “in writing,” meaning it exists in a physical form. For example, a will “in writing” can be one you’ve written by hand, or one you’ve typed on a computer and printed. A digital copy, like a PDF of your will saved on your computer, isn’t considered valid. You must be at least 18 years old. This rule doesn’t apply if you’re married or serve in the military. You must be of sound mind and memory. This means that you: Understand what it means to make a will Understand the nature and extent of your property and relationships Are capable of making reasonable judgments about the matters your will controls (for example, naming a guardian for your minor children) You must make your will freely and voluntarily. This means you shouldn’t be under improper pressure to write your will by someone who has power over you, like a caretaker or family member. This is known as “undue influence.” You must sign your will in the presence of at least two credible witnesses, who also sign. According to the Texas Estates Code, your witnesses must be at least 14 years old. A witness is “credible” when they don’t receive any financial benefit under your will. In other words, your witnesses should be people who aren’t receiving anything from your will. Do you need to notarize your will in Texas? No — in Texas, you don’t need to notarize your will to make it valid. However, a notary is required if you want to make your will self-proving. When a will is self-proving, the court can accept your will without needing to contact your witnesses to prove its validity. This can speed up the probate process. To make your will self-proving, you must include a self-proving affidavit. In it, you and your witnesses state that your will was signed by you in the witnesses’ presence, and that you’ve declared it to be your will. Your self-proving affidavit must be signed (or acknowledged) by both you and your witnesses in front of a notary, who will then notarize the affidavit. Are holographic wills legal in Texas? Holographic wills, also called handwritten wills, are accepted in Texas. To be valid, a holographic will must be written entirely in your handwriting and signed by you. As long as you follow these two requirements, you don’t need witnesses to make your holographic will valid. However, if you think someone could challenge the validity of your will, it’s a good idea to have them anyway. Estate attorneys generally don’t recommend making a holographic will. They can be difficult to prove legally valid in court, and they may contain errors or unclear wishes. Learn more about the pitfalls of holographic wills, and alternative options you can use instead. Texas will executor requirements Your executor is the person responsible for managing your probate estate and carrying out the wishes described in your will. They will work with the probate court to pay your debts and distribute your assets to the beneficiaries of your will. You can use your will to name the person (or people) you’d like to be your executor, but not everyone is qualified to serve. For a person to be accepted by the Texas court as your executor, they must: Be at least 18 years old Be capable of performing their duties as executor Have never been convicted of a felony Be deemed “suitable” by the court It’s often more practical to choose an executor that lives in Texas, and close to you. If you decide to nominate someone who lives out of state, they can only serve as your executor if they appoint a resident agent and notify the court. A resident agent is someone who lives in the state of Texas and accepts legal documentation on behalf of your executor and your estate. Revoking or changing your will in Texas Revoking your will You can generally revoke, or nullify, your will in Texas at any time before your death, unless you’ve committed to an agreement stating you wouldn’t (for example, a joint will). There are a few ways you can nullify your will: Intentionally destroy it. You can burn it, tear it, shred it, or throw it away. Ask someone to destroy it for you in your presence. Create a new one. Generally, a more recent will overrides any previous wills you’ve written. Be sure to include language stating explicitly that your new will is intended to revoke your prior will, and destroy all previous wills and codicils to avoid confusion. Change your will with a codicil If you’d like to make a few changes to your will, rather than revoking it altogether, you may consider writing a codicil. A codicil is a legal document that revises your existing will. To be legally effective, codicils must be executed and witnessed just like a will. In Texas, this means you must be of sound mind to make a codicil, and it must be signed by you and two witnesses. Estate attorneys generally don’t recommend creating a codicil. It can be difficult to keep track of multiple documents, and codicils could make it more difficult to determine the will-maker’s wishes. In most cases, it may be safer to simply create a new will. Probate in Texas Probate is the legal process of gathering the assets of a deceased person and distributing them to that person’s beneficiaries. During probate, your executor will be responsible for preparing an inventory of your estate’s assets and managing those assets until they can be distributed. A court typically oversees the process to resolve any questions and disputes that might arise, make sure your remaining debts are paid, and ensure that your property is passed on to the right people or organizations. Here’s a high-level overview of what happens during the probate process: Someone, usually your executor or a family member, files your will (if you had one). In Texas, they have four years from the date of death to file your will. The court validates your will. The court appoints a representative, or executor, to oversee your estate. Your executor identifies your assets and debts, and contacts your beneficiaries and creditors to notify them of your passing. Your executor pays any of your debts, usually with money from your estate. Your executor distributes assets to your beneficiaries, according to the wishes outlined in your will. If you didn’t have a will, your assets are distributed based on Texas’s intestate laws. Independent administration vs. court-supervised administration Texas’s probate process is known for being quick and simple due to a process called “independent administration.” Independent administration allows executors to take steps to settle the estate — like paying debts, selling property, and distributing assets — with minimal court supervision. Court-supervised administration is also an option, although less common. The probate court is more involved during a court-supervised administration. Its approval is required for more of the proposed actions the executor may wish to take. Although this process takes longer and can be more expensive than an independent administration, it may be useful if the estate is particularly complicated, or if the estate’s beneficiaries don’t get along. In your will, you can indicate which type of administration your estate will receive. Disinheriting an heir In Texas, you can use your will to disinherit an heir, like an adult child or grandchild. This means you can prevent them from having the legal right to your property after you die. However, this doesn’t apply to your spouse. In Texas (and many states), there are laws in place that protect spouses from being disinherited without their consent. You can read more about these laws in the community property section below. Is Texas a community property state? Yes, Texas is a community property state. Community property states consider almost all assets acquired by either spouse during their marriage to belong to both spouses equally. In community property states like Texas, the surviving spouse is entitled to at least half of any community property, even if the deceased spouse wrote something different in their will. To better understand Texas community property laws, it helps to understand the difference between personal and community property. Personal property Personal property is property that belongs to only one spouse. This can include: Any assets or debts you acquire before your marriage Any inheritance you receive during your marriage Any assets specified in a prenuptial or postnuptial agreement Personal property isn’t considered community property. This means you can use your will to leave it to anyone you want. Community property With few exceptions, any assets and debts that either you or your spouse acquire during your marriage are community property under Texas law. For example, this could be a vehicle your spouse purchased that has their name on the title, or the money you earned in your career during the years you were married. Each of you will have a one-half interest in each item of community property, and you will generally only be able to use your will to control who receives your one-half interest in that property — the other one-half interest remains the property of your spouse. Many people choose to leave the majority of their estate to their spouse, regardless of whether they live in a community property state. If you want to leave a significant portion of your estate to someone other than your spouse for any reason, you should consider working with an estate attorney to discuss your situation and create an estate plan to meet your needs.","{CONTEXT} ======= **Texas last will and testament requirements** Here are the requirements for a valid will in Texas: Your will must be “in writing,” meaning it exists in a physical form. For example, a will “in writing” can be one you’ve written by hand, or one you’ve typed on a computer and printed. A digital copy, like a PDF of your will saved on your computer, isn’t considered valid. You must be at least 18 years old. This rule doesn’t apply if you’re married or serve in the military. You must be of sound mind and memory. This means that you: Understand what it means to make a will Understand the nature and extent of your property and relationships Are capable of making reasonable judgments about the matters your will controls (for example, naming a guardian for your minor children) You must make your will freely and voluntarily. This means you shouldn’t be under improper pressure to write your will by someone who has power over you, like a caretaker or family member. This is known as “undue influence.” You must sign your will in the presence of at least two credible witnesses, who also sign. According to the Texas Estates Code, your witnesses must be at least 14 years old. A witness is “credible” when they don’t receive any financial benefit under your will. In other words, your witnesses should be people who aren’t receiving anything from your will. Do you need to notarize your will in Texas? No — in Texas, you don’t need to notarize your will to make it valid. However, a notary is required if you want to make your will self-proving. When a will is self-proving, the court can accept your will without needing to contact your witnesses to prove its validity. This can speed up the probate process. To make your will self-proving, you must include a self-proving affidavit. In it, you and your witnesses state that your will was signed by you in the witnesses’ presence, and that you’ve declared it to be your will. Your self-proving affidavit must be signed (or acknowledged) by both you and your witnesses in front of a notary, who will then notarize the affidavit. Are holographic wills legal in Texas? Holographic wills, also called handwritten wills, are accepted in Texas. To be valid, a holographic will must be written entirely in your handwriting and signed by you. As long as you follow these two requirements, you don’t need witnesses to make your holographic will valid. However, if you think someone could challenge the validity of your will, it’s a good idea to have them anyway. Estate attorneys generally don’t recommend making a holographic will. They can be difficult to prove legally valid in court, and they may contain errors or unclear wishes. Learn more about the pitfalls of holographic wills, and alternative options you can use instead. Texas will executor requirements Your executor is the person responsible for managing your probate estate and carrying out the wishes described in your will. They will work with the probate court to pay your debts and distribute your assets to the beneficiaries of your will. You can use your will to name the person (or people) you’d like to be your executor, but not everyone is qualified to serve. For a person to be accepted by the Texas court as your executor, they must: Be at least 18 years old Be capable of performing their duties as executor Have never been convicted of a felony Be deemed “suitable” by the court It’s often more practical to choose an executor that lives in Texas, and close to you. If you decide to nominate someone who lives out of state, they can only serve as your executor if they appoint a resident agent and notify the court. A resident agent is someone who lives in the state of Texas and accepts legal documentation on behalf of your executor and your estate. Revoking or changing your will in Texas Revoking your will You can generally revoke, or nullify, your will in Texas at any time before your death, unless you’ve committed to an agreement stating you wouldn’t (for example, a joint will). There are a few ways you can nullify your will: Intentionally destroy it. You can burn it, tear it, shred it, or throw it away. Ask someone to destroy it for you in your presence. Create a new one. Generally, a more recent will overrides any previous wills you’ve written. Be sure to include language stating explicitly that your new will is intended to revoke your prior will, and destroy all previous wills and codicils to avoid confusion. Change your will with a codicil If you’d like to make a few changes to your will, rather than revoking it altogether, you may consider writing a codicil. A codicil is a legal document that revises your existing will. To be legally effective, codicils must be executed and witnessed just like a will. In Texas, this means you must be of sound mind to make a codicil, and it must be signed by you and two witnesses. Estate attorneys generally don’t recommend creating a codicil. It can be difficult to keep track of multiple documents, and codicils could make it more difficult to determine the will-maker’s wishes. In most cases, it may be safer to simply create a new will. Probate in Texas Probate is the legal process of gathering the assets of a deceased person and distributing them to that person’s beneficiaries. During probate, your executor will be responsible for preparing an inventory of your estate’s assets and managing those assets until they can be distributed. A court typically oversees the process to resolve any questions and disputes that might arise, make sure your remaining debts are paid, and ensure that your property is passed on to the right people or organizations. Here’s a high-level overview of what happens during the probate process: Someone, usually your executor or a family member, files your will (if you had one). In Texas, they have four years from the date of death to file your will. The court validates your will. The court appoints a representative, or executor, to oversee your estate. Your executor identifies your assets and debts, and contacts your beneficiaries and creditors to notify them of your passing. Your executor pays any of your debts, usually with money from your estate. Your executor distributes assets to your beneficiaries, according to the wishes outlined in your will. If you didn’t have a will, your assets are distributed based on Texas’s intestate laws. Independent administration vs. court-supervised administration Texas’s probate process is known for being quick and simple due to a process called “independent administration.” Independent administration allows executors to take steps to settle the estate — like paying debts, selling property, and distributing assets — with minimal court supervision. Court-supervised administration is also an option, although less common. The probate court is more involved during a court-supervised administration. Its approval is required for more of the proposed actions the executor may wish to take. Although this process takes longer and can be more expensive than an independent administration, it may be useful if the estate is particularly complicated, or if the estate’s beneficiaries don’t get along. In your will, you can indicate which type of administration your estate will receive. Disinheriting an heir In Texas, you can use your will to disinherit an heir, like an adult child or grandchild. This means you can prevent them from having the legal right to your property after you die. However, this doesn’t apply to your spouse. In Texas (and many states), there are laws in place that protect spouses from being disinherited without their consent. You can read more about these laws in the community property section below. Is Texas a community property state? Yes, Texas is a community property state. Community property states consider almost all assets acquired by either spouse during their marriage to belong to both spouses equally. In community property states like Texas, the surviving spouse is entitled to at least half of any community property, even if the deceased spouse wrote something different in their will. To better understand Texas community property laws, it helps to understand the difference between personal and community property. Personal property Personal property is property that belongs to only one spouse. This can include: Any assets or debts you acquire before your marriage Any inheritance you receive during your marriage Any assets specified in a prenuptial or postnuptial agreement Personal property isn’t considered community property. This means you can use your will to leave it to anyone you want. Community property With few exceptions, any assets and debts that either you or your spouse acquire during your marriage are community property under Texas law. For example, this could be a vehicle your spouse purchased that has their name on the title, or the money you earned in your career during the years you were married. Each of you will have a one-half interest in each item of community property, and you will generally only be able to use your will to control who receives your one-half interest in that property — the other one-half interest remains the property of your spouse. Many people choose to leave the majority of their estate to their spouse, regardless of whether they live in a community property state. If you want to leave a significant portion of your estate to someone other than your spouse for any reason, you should consider working with an estate attorney to discuss your situation and create an estate plan to meet your needs. {QUESTION} ======= According to this document, what is an executer responsible for? {INSTRUCTION} ======= Draw your answer from the above text.","Draw your answer from the above text.
+
+EVIDENCE:
+**Texas last will and testament requirements** Here are the requirements for a valid will in Texas: Your will must be “in writing,” meaning it exists in a physical form. For example, a will “in writing” can be one you’ve written by hand, or one you’ve typed on a computer and printed. A digital copy, like a PDF of your will saved on your computer, isn’t considered valid. You must be at least 18 years old. This rule doesn’t apply if you’re married or serve in the military. You must be of sound mind and memory. This means that you: Understand what it means to make a will Understand the nature and extent of your property and relationships Are capable of making reasonable judgments about the matters your will controls (for example, naming a guardian for your minor children) You must make your will freely and voluntarily. This means you shouldn’t be under improper pressure to write your will by someone who has power over you, like a caretaker or family member. This is known as “undue influence.” You must sign your will in the presence of at least two credible witnesses, who also sign. According to the Texas Estates Code, your witnesses must be at least 14 years old. A witness is “credible” when they don’t receive any financial benefit under your will. In other words, your witnesses should be people who aren’t receiving anything from your will. Do you need to notarize your will in Texas? No — in Texas, you don’t need to notarize your will to make it valid. However, a notary is required if you want to make your will self-proving. When a will is self-proving, the court can accept your will without needing to contact your witnesses to prove its validity. This can speed up the probate process. To make your will self-proving, you must include a self-proving affidavit. In it, you and your witnesses state that your will was signed by you in the witnesses’ presence, and that you’ve declared it to be your will. Your self-proving affidavit must be signed (or acknowledged) by both you and your witnesses in front of a notary, who will then notarize the affidavit. Are holographic wills legal in Texas? Holographic wills, also called handwritten wills, are accepted in Texas. To be valid, a holographic will must be written entirely in your handwriting and signed by you. As long as you follow these two requirements, you don’t need witnesses to make your holographic will valid. However, if you think someone could challenge the validity of your will, it’s a good idea to have them anyway. Estate attorneys generally don’t recommend making a holographic will. They can be difficult to prove legally valid in court, and they may contain errors or unclear wishes. Learn more about the pitfalls of holographic wills, and alternative options you can use instead. Texas will executor requirements Your executor is the person responsible for managing your probate estate and carrying out the wishes described in your will. They will work with the probate court to pay your debts and distribute your assets to the beneficiaries of your will. You can use your will to name the person (or people) you’d like to be your executor, but not everyone is qualified to serve. For a person to be accepted by the Texas court as your executor, they must: Be at least 18 years old Be capable of performing their duties as executor Have never been convicted of a felony Be deemed “suitable” by the court It’s often more practical to choose an executor that lives in Texas, and close to you. If you decide to nominate someone who lives out of state, they can only serve as your executor if they appoint a resident agent and notify the court. A resident agent is someone who lives in the state of Texas and accepts legal documentation on behalf of your executor and your estate. Revoking or changing your will in Texas Revoking your will You can generally revoke, or nullify, your will in Texas at any time before your death, unless you’ve committed to an agreement stating you wouldn’t (for example, a joint will). There are a few ways you can nullify your will: Intentionally destroy it. You can burn it, tear it, shred it, or throw it away. Ask someone to destroy it for you in your presence. Create a new one. Generally, a more recent will overrides any previous wills you’ve written. Be sure to include language stating explicitly that your new will is intended to revoke your prior will, and destroy all previous wills and codicils to avoid confusion. Change your will with a codicil If you’d like to make a few changes to your will, rather than revoking it altogether, you may consider writing a codicil. A codicil is a legal document that revises your existing will. To be legally effective, codicils must be executed and witnessed just like a will. In Texas, this means you must be of sound mind to make a codicil, and it must be signed by you and two witnesses. Estate attorneys generally don’t recommend creating a codicil. It can be difficult to keep track of multiple documents, and codicils could make it more difficult to determine the will-maker’s wishes. In most cases, it may be safer to simply create a new will. Probate in Texas Probate is the legal process of gathering the assets of a deceased person and distributing them to that person’s beneficiaries. During probate, your executor will be responsible for preparing an inventory of your estate’s assets and managing those assets until they can be distributed. A court typically oversees the process to resolve any questions and disputes that might arise, make sure your remaining debts are paid, and ensure that your property is passed on to the right people or organizations. Here’s a high-level overview of what happens during the probate process: Someone, usually your executor or a family member, files your will (if you had one). In Texas, they have four years from the date of death to file your will. The court validates your will. The court appoints a representative, or executor, to oversee your estate. Your executor identifies your assets and debts, and contacts your beneficiaries and creditors to notify them of your passing. Your executor pays any of your debts, usually with money from your estate. Your executor distributes assets to your beneficiaries, according to the wishes outlined in your will. If you didn’t have a will, your assets are distributed based on Texas’s intestate laws. Independent administration vs. court-supervised administration Texas’s probate process is known for being quick and simple due to a process called “independent administration.” Independent administration allows executors to take steps to settle the estate — like paying debts, selling property, and distributing assets — with minimal court supervision. Court-supervised administration is also an option, although less common. The probate court is more involved during a court-supervised administration. Its approval is required for more of the proposed actions the executor may wish to take. Although this process takes longer and can be more expensive than an independent administration, it may be useful if the estate is particularly complicated, or if the estate’s beneficiaries don’t get along. In your will, you can indicate which type of administration your estate will receive. Disinheriting an heir In Texas, you can use your will to disinherit an heir, like an adult child or grandchild. This means you can prevent them from having the legal right to your property after you die. However, this doesn’t apply to your spouse. In Texas (and many states), there are laws in place that protect spouses from being disinherited without their consent. You can read more about these laws in the community property section below. Is Texas a community property state? Yes, Texas is a community property state. Community property states consider almost all assets acquired by either spouse during their marriage to belong to both spouses equally. In community property states like Texas, the surviving spouse is entitled to at least half of any community property, even if the deceased spouse wrote something different in their will. To better understand Texas community property laws, it helps to understand the difference between personal and community property. Personal property Personal property is property that belongs to only one spouse. This can include: Any assets or debts you acquire before your marriage Any inheritance you receive during your marriage Any assets specified in a prenuptial or postnuptial agreement Personal property isn’t considered community property. This means you can use your will to leave it to anyone you want. Community property With few exceptions, any assets and debts that either you or your spouse acquire during your marriage are community property under Texas law. For example, this could be a vehicle your spouse purchased that has their name on the title, or the money you earned in your career during the years you were married. Each of you will have a one-half interest in each item of community property, and you will generally only be able to use your will to control who receives your one-half interest in that property — the other one-half interest remains the property of your spouse. Many people choose to leave the majority of their estate to their spouse, regardless of whether they live in a community property state. If you want to leave a significant portion of your estate to someone other than your spouse for any reason, you should consider working with an estate attorney to discuss your situation and create an estate plan to meet your needs.
+
+USER:
+According to this document, what is an executer responsible for?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,7,10,1609,,693
+"""================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Can you summarize the following text in bullet form. Each bullet must contain a quote from the passage supporting the summary point but still describe the points. Don't use the word AI and make sure to talk about all of the points made. PLease provide some specific examples and names/descriptions of organizations and can you describe the code of conduct stuff? Talk about specific acts and list out specific guidelines they are implementing. Limit it to 400 words.,"Abraham Lincoln once observed: “In the world’s history, certain inventions and discoveries occurred of peculiar value . . . in facilitating all other inventions and discoveries.” Lincoln was speaking of the written word and, later, the printing press. But today, we are living through another such invention: artificial intelligence. Powerful generative AI systems like GPT-4 are ushering in a new era of this technology. They’re revolutionising the production of knowledge: vastly increasing the capacity of machines to generate original content, perform complex tasks and solve important problems. They are also dramatically lowering the barriers for people to access AI and its benefits. This new era brings serious potential hazards. These include the risk of AI generating false information, reinforcing bias and discrimination, being misused for repressive or destabilising purposes or proliferating the knowledge to make a bioweapon or conduct a cyber attack. But even with these risks — which we’re determined to minimise — AI holds an exhilarating potential to improve people’s lives and help solve some of the world’s biggest challenges, from curing cancer to mitigating the effects of climate change to solving global food insecurity. The future of AI — whether it makes our societies more or less equitable, unlocks breakthroughs or becomes a tool of authoritarians — is up to us. The question is not whether to use it, but how. The United States, as home to many of the leading companies, technologies and minds driving the AI revolution, has the ability and responsibility to lead on its governance. We are committed to doing so in partnership with others around the world to ensure the future reflects our shared values and vision for this technology. We have already taken action to guide AI’s use. We set out a Blueprint for an AI Bill of Rights with principles for how automated systems are designed and used, and developed an AI Risk Management Framework to help improve user protections. Last week, President Joe Biden announced the next step with a set of commitments from leading companies designed to enhance safety, security and trust. These commitments will mitigate risks of AI including misuse, and support new technologies and standards to distinguish between human and AI-generated content. They will encourage companies and individuals to report on systems’ capabilities and limitations, and facilitate information sharing. And they will promote the development of AI systems designed to address society’s greatest challenges. The commitments offer a starting point for action to limit near-term risks while fostering innovation. They will be complemented by key lines of effort with partners around the world. Over the coming weeks, we will continue to work with the G7 through the Japan-led Hiroshima Process to expand and internationalise these commitments. We want AI governance to be guided by democratic values and those who embrace them, and G7-led action could inform an international code of conduct for private actors and governments, as well as common regulatory principles for states. As we co-ordinate globally, we will also align our domestic approaches in forums like the US-EU Trade and Technology Council. We will work intensively with other governments to build a shared understanding of longer-term AI risks and how to limit them. The US looks forward to participating in the UK’s Global Summit on AI Safety and other opportunities for global engagement to build a more secure future. The US is committed to making AI work for, and designing governance with, developing countries, whose voices are crucial to the global discussion. India will play a critical role, including through the Global Partnership on AI. We are also working on inclusivity for AI through discussions with the UN. We will partner with countries around the world, as well as the private sector and civil society, to advance a key goal of the commitments: creating AI systems that make people’s lives better. Today, we’re on track to meet just 12 per cent of the UN’s Sustainable Development Goals. AI could change that trajectory by accelerating efforts to deliver clean water and sanitation, eliminate poverty, advance public health and further other development goals. To shape the future of AI, we must act quickly. We must also act collectively. No country or company can shape the future of AI alone. The US has taken an important step — but only with the combined focus, ingenuity and co-operation of the international community will we be able to fully and safely harness the potential of AI. The writers are US secretary of state and US secretary of commerce","""================ <TEXT PASSAGE> ======= Abraham Lincoln once observed: “In the world’s history, certain inventions and discoveries occurred of peculiar value . . . in facilitating all other inventions and discoveries.” Lincoln was speaking of the written word and, later, the printing press. But today, we are living through another such invention: artificial intelligence. Powerful generative AI systems like GPT-4 are ushering in a new era of this technology. They’re revolutionising the production of knowledge: vastly increasing the capacity of machines to generate original content, perform complex tasks and solve important problems. They are also dramatically lowering the barriers for people to access AI and its benefits. This new era brings serious potential hazards. These include the risk of AI generating false information, reinforcing bias and discrimination, being misused for repressive or destabilising purposes or proliferating the knowledge to make a bioweapon or conduct a cyber attack. But even with these risks — which we’re determined to minimise — AI holds an exhilarating potential to improve people’s lives and help solve some of the world’s biggest challenges, from curing cancer to mitigating the effects of climate change to solving global food insecurity. The future of AI — whether it makes our societies more or less equitable, unlocks breakthroughs or becomes a tool of authoritarians — is up to us. The question is not whether to use it, but how. The United States, as home to many of the leading companies, technologies and minds driving the AI revolution, has the ability and responsibility to lead on its governance. We are committed to doing so in partnership with others around the world to ensure the future reflects our shared values and vision for this technology. We have already taken action to guide AI’s use. We set out a Blueprint for an AI Bill of Rights with principles for how automated systems are designed and used, and developed an AI Risk Management Framework to help improve user protections. Last week, President Joe Biden announced the next step with a set of commitments from leading companies designed to enhance safety, security and trust. These commitments will mitigate risks of AI including misuse, and support new technologies and standards to distinguish between human and AI-generated content. They will encourage companies and individuals to report on systems’ capabilities and limitations, and facilitate information sharing. And they will promote the development of AI systems designed to address society’s greatest challenges. The commitments offer a starting point for action to limit near-term risks while fostering innovation. They will be complemented by key lines of effort with partners around the world. Over the coming weeks, we will continue to work with the G7 through the Japan-led Hiroshima Process to expand and internationalise these commitments. We want AI governance to be guided by democratic values and those who embrace them, and G7-led action could inform an international code of conduct for private actors and governments, as well as common regulatory principles for states. As we co-ordinate globally, we will also align our domestic approaches in forums like the US-EU Trade and Technology Council. We will work intensively with other governments to build a shared understanding of longer-term AI risks and how to limit them. The US looks forward to participating in the UK’s Global Summit on AI Safety and other opportunities for global engagement to build a more secure future. The US is committed to making AI work for, and designing governance with, developing countries, whose voices are crucial to the global discussion. India will play a critical role, including through the Global Partnership on AI. We are also working on inclusivity for AI through discussions with the UN. We will partner with countries around the world, as well as the private sector and civil society, to advance a key goal of the commitments: creating AI systems that make people’s lives better. Today, we’re on track to meet just 12 per cent of the UN’s Sustainable Development Goals. AI could change that trajectory by accelerating efforts to deliver clean water and sanitation, eliminate poverty, advance public health and further other development goals. To shape the future of AI, we must act quickly. We must also act collectively. No country or company can shape the future of AI alone. The US has taken an important step — but only with the combined focus, ingenuity and co-operation of the international community will we be able to fully and safely harness the potential of AI. The writers are US secretary of state and US secretary of commerce https://www.commerce.gov/news/op-eds/2023/07/op-ed-antony-blinken-gina-raimondo-shape-future-ai-we-must-act-quickly ================ <QUESTION> ======= Can you summarize the following text in bullet form. Each bullet must contain a quote from the passage supporting the summary point but still describe the points. Don't use the word AI and make sure to talk about all of the points made. PLease provide some specific examples and names/descriptions of organizations and can you describe the code of conduct stuff? Talk about specific acts and list out specific guidelines they are implementing. Limit it to 400 words. ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""","""================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""
+
+EVIDENCE:
+Abraham Lincoln once observed: “In the world’s history, certain inventions and discoveries occurred of peculiar value . . . in facilitating all other inventions and discoveries.” Lincoln was speaking of the written word and, later, the printing press. But today, we are living through another such invention: artificial intelligence. Powerful generative AI systems like GPT-4 are ushering in a new era of this technology. They’re revolutionising the production of knowledge: vastly increasing the capacity of machines to generate original content, perform complex tasks and solve important problems. They are also dramatically lowering the barriers for people to access AI and its benefits. This new era brings serious potential hazards. These include the risk of AI generating false information, reinforcing bias and discrimination, being misused for repressive or destabilising purposes or proliferating the knowledge to make a bioweapon or conduct a cyber attack. But even with these risks — which we’re determined to minimise — AI holds an exhilarating potential to improve people’s lives and help solve some of the world’s biggest challenges, from curing cancer to mitigating the effects of climate change to solving global food insecurity. The future of AI — whether it makes our societies more or less equitable, unlocks breakthroughs or becomes a tool of authoritarians — is up to us. The question is not whether to use it, but how. The United States, as home to many of the leading companies, technologies and minds driving the AI revolution, has the ability and responsibility to lead on its governance. We are committed to doing so in partnership with others around the world to ensure the future reflects our shared values and vision for this technology. We have already taken action to guide AI’s use. We set out a Blueprint for an AI Bill of Rights with principles for how automated systems are designed and used, and developed an AI Risk Management Framework to help improve user protections. Last week, President Joe Biden announced the next step with a set of commitments from leading companies designed to enhance safety, security and trust. These commitments will mitigate risks of AI including misuse, and support new technologies and standards to distinguish between human and AI-generated content. They will encourage companies and individuals to report on systems’ capabilities and limitations, and facilitate information sharing. And they will promote the development of AI systems designed to address society’s greatest challenges. The commitments offer a starting point for action to limit near-term risks while fostering innovation. They will be complemented by key lines of effort with partners around the world. Over the coming weeks, we will continue to work with the G7 through the Japan-led Hiroshima Process to expand and internationalise these commitments. We want AI governance to be guided by democratic values and those who embrace them, and G7-led action could inform an international code of conduct for private actors and governments, as well as common regulatory principles for states. As we co-ordinate globally, we will also align our domestic approaches in forums like the US-EU Trade and Technology Council. We will work intensively with other governments to build a shared understanding of longer-term AI risks and how to limit them. The US looks forward to participating in the UK’s Global Summit on AI Safety and other opportunities for global engagement to build a more secure future. The US is committed to making AI work for, and designing governance with, developing countries, whose voices are crucial to the global discussion. India will play a critical role, including through the Global Partnership on AI. We are also working on inclusivity for AI through discussions with the UN. We will partner with countries around the world, as well as the private sector and civil society, to advance a key goal of the commitments: creating AI systems that make people’s lives better. Today, we’re on track to meet just 12 per cent of the UN’s Sustainable Development Goals. AI could change that trajectory by accelerating efforts to deliver clean water and sanitation, eliminate poverty, advance public health and further other development goals. To shape the future of AI, we must act quickly. We must also act collectively. No country or company can shape the future of AI alone. The US has taken an important step — but only with the combined focus, ingenuity and co-operation of the international community will we be able to fully and safely harness the potential of AI. The writers are US secretary of state and US secretary of commerce
+
+USER:
+Can you summarize the following text in bullet form. Each bullet must contain a quote from the passage supporting the summary point but still describe the points. Don't use the word AI and make sure to talk about all of the points made. PLease provide some specific examples and names/descriptions of organizations and can you describe the code of conduct stuff? Talk about specific acts and list out specific guidelines they are implementing. Limit it to 400 words.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,49,78,749,,29
+"Write the answer in one paragraph, using full sentences. Use only the document provided. Use language that is easy to understand.",what are the pros of plastic and plastic bottle use?,"We have all seen the photos: birds nesting in piles of garbage along the shore, fish fatally caught in discarded netting, and huge mosaics of debris floating in the ocean. Even more alarmingly, what we see in these poignant images is only a portion of the problem. Approximately half of all plastic pollution is submerged below the ocean surface, much of it in the form of microplastics so small that we may never be able to clean them up completely. To cut through the enormity of the ocean pollution crisis, one approach is to focus on something recognizable within these images of debris. Identify something you personally have used that may have ended up in the ocean—a water bottle perhaps. Find one in an image and ask yourself, how did it get there? Plastic is a human-made, synthetic material that was first discovered more than one hundred years ago but did not broadly enter the public sphere until the 1950s. While currently a major culprit in ocean pollution, plastics are not inherently bad for humans or the environment. In fact, in a United Nations (UN) report on combatting the negative effects of plastics, the head of the UN Environment Programme Erik Solheim made a point to acknowledge that plastic is in fact a “miracle material.” “Thanks to plastics, countless lives have been saved in the health sector, the growth of clean energy from wind turbines and solar panels has been greatly facilitated, and safe food storage has been revolutionized,” Solheim wrote in his introduction. Yet plastic bottles are one of the most common items within marine debris. So how did such a promising material become a symbol of human environmental desecration? Plastic bottles are a single-use plastic, a product designed to be used only once and then discarded. Single-use plastics also include plastic packaging, for example of meats and fresh produce, which accounts for almost half of all plastic pollution. This type of plastic product is distinct from multi-use plastics, which can also pollute the ocean, but tend to amass less frequently due to their multi-use nature. For example, refillable bottles can store water in a way that does not produce the repeated waste of a single-use plastic water bottle. Refillable bottles can be made of many materials, including plastic, but last much longer than a single-use bottle and can be recycled when they become old or damaged. For both types of bottles, how they are discarded determines their ultimate resting place and whether they become pollutants of the ocean. A single-use plastic water bottle was manufactured, filled with water, and likely transported to a store, where it sat on a shelf waiting for a thirsty purchaser. Many of us drink out of plastic bottles several times during an average day, week, or month. Once we are finished with it, we have a choice where we leave that bottle: Recycling bin: Bottles destined for recycling are unlikely to end up in the ocean, in their current form, unless they are mismanaged or lost in transit to a processing facility. However, due to recent limitations in how recyclables are internationally transferred and accepted for processing, many of these bottles will unfortunately end up in landfills rather than recycling facilities. Trash can: These bottles also will not likely end up, in their current form, in the ocean. However, in areas across the globe with poor waste management or a lack of properly sealed landfills, as a bottle breaks down into microplastic particles over time, some particles may seep into the soil and eventually make their way into our waterways, ultimately entering and polluting the ocean. Litter: These bottles may very well be carried by wind, storm water, or other processes to sewers, rivers, lakes, and other waterways that may ultimately deposit the bottle in the ocean. Multi-use plastic bottles face these same pathways at end of their life—but of course this happens much less frequently since they can be used many times. National Geographic Explorer Heather J. Koldewey works to empower communities around the world to participate in solving the ocean pollution crisis from single-use plastics via incremental individual actions—including a campaign called One Less, which encourages people to stop using single-use plastic water bottles altogether. One Less is currently based in and focused on London, England and its inhabitants, but anyone can make the choice to use one less single-use bottle.","Write the answer in one paragraph, using full sentences. Use only the document provided. Use language that is easy to understand. what are the pros of plastic and plastic bottle use? We have all seen the photos: birds nesting in piles of garbage along the shore, fish fatally caught in discarded netting, and huge mosaics of debris floating in the ocean. Even more alarmingly, what we see in these poignant images is only a portion of the problem. Approximately half of all plastic pollution is submerged below the ocean surface, much of it in the form of microplastics so small that we may never be able to clean them up completely. To cut through the enormity of the ocean pollution crisis, one approach is to focus on something recognizable within these images of debris. Identify something you personally have used that may have ended up in the ocean—a water bottle perhaps. Find one in an image and ask yourself, how did it get there? Plastic is a human-made, synthetic material that was first discovered more than one hundred years ago but did not broadly enter the public sphere until the 1950s. While currently a major culprit in ocean pollution, plastics are not inherently bad for humans or the environment. In fact, in a United Nations (UN) report on combatting the negative effects of plastics, the head of the UN Environment Programme Erik Solheim made a point to acknowledge that plastic is in fact a “miracle material.” “Thanks to plastics, countless lives have been saved in the health sector, the growth of clean energy from wind turbines and solar panels has been greatly facilitated, and safe food storage has been revolutionized,” Solheim wrote in his introduction. Yet plastic bottles are one of the most common items within marine debris. So how did such a promising material become a symbol of human environmental desecration? Plastic bottles are a single-use plastic, a product designed to be used only once and then discarded. Single-use plastics also include plastic packaging, for example of meats and fresh produce, which accounts for almost half of all plastic pollution. This type of plastic product is distinct from multi-use plastics, which can also pollute the ocean, but tend to amass less frequently due to their multi-use nature. For example, refillable bottles can store water in a way that does not produce the repeated waste of a single-use plastic water bottle. Refillable bottles can be made of many materials, including plastic, but last much longer than a single-use bottle and can be recycled when they become old or damaged. For both types of bottles, how they are discarded determines their ultimate resting place and whether they become pollutants of the ocean. A single-use plastic water bottle was manufactured, filled with water, and likely transported to a store, where it sat on a shelf waiting for a thirsty purchaser. Many of us drink out of plastic bottles several times during an average day, week, or month. Once we are finished with it, we have a choice where we leave that bottle: Recycling bin: Bottles destined for recycling are unlikely to end up in the ocean, in their current form, unless they are mismanaged or lost in transit to a processing facility. However, due to recent limitations in how recyclables are internationally transferred and accepted for processing, many of these bottles will unfortunately end up in landfills rather than recycling facilities. Trash can: These bottles also will not likely end up, in their current form, in the ocean. However, in areas across the globe with poor waste management or a lack of properly sealed landfills, as a bottle breaks down into microplastic particles over time, some particles may seep into the soil and eventually make their way into our waterways, ultimately entering and polluting the ocean. Litter: These bottles may very well be carried by wind, storm water, or other processes to sewers, rivers, lakes, and other waterways that may ultimately deposit the bottle in the ocean. Multi-use plastic bottles face these same pathways at end of their life—but of course this happens much less frequently since they can be used many times. National Geographic Explorer Heather J. Koldewey works to empower communities around the world to participate in solving the ocean pollution crisis from single-use plastics via incremental individual actions—including a campaign called One Less, which encourages people to stop using single-use plastic water bottles altogether. One Less is currently based in and focused on London, England and its inhabitants, but anyone can make the choice to use one less single-use bottle.","Write the answer in one paragraph, using full sentences. Use only the document provided. Use language that is easy to understand.
+
+EVIDENCE:
+We have all seen the photos: birds nesting in piles of garbage along the shore, fish fatally caught in discarded netting, and huge mosaics of debris floating in the ocean. Even more alarmingly, what we see in these poignant images is only a portion of the problem. Approximately half of all plastic pollution is submerged below the ocean surface, much of it in the form of microplastics so small that we may never be able to clean them up completely. To cut through the enormity of the ocean pollution crisis, one approach is to focus on something recognizable within these images of debris. Identify something you personally have used that may have ended up in the ocean—a water bottle perhaps. Find one in an image and ask yourself, how did it get there? Plastic is a human-made, synthetic material that was first discovered more than one hundred years ago but did not broadly enter the public sphere until the 1950s. While currently a major culprit in ocean pollution, plastics are not inherently bad for humans or the environment. In fact, in a United Nations (UN) report on combatting the negative effects of plastics, the head of the UN Environment Programme Erik Solheim made a point to acknowledge that plastic is in fact a “miracle material.” “Thanks to plastics, countless lives have been saved in the health sector, the growth of clean energy from wind turbines and solar panels has been greatly facilitated, and safe food storage has been revolutionized,” Solheim wrote in his introduction. Yet plastic bottles are one of the most common items within marine debris. So how did such a promising material become a symbol of human environmental desecration? Plastic bottles are a single-use plastic, a product designed to be used only once and then discarded. Single-use plastics also include plastic packaging, for example of meats and fresh produce, which accounts for almost half of all plastic pollution. This type of plastic product is distinct from multi-use plastics, which can also pollute the ocean, but tend to amass less frequently due to their multi-use nature. For example, refillable bottles can store water in a way that does not produce the repeated waste of a single-use plastic water bottle. Refillable bottles can be made of many materials, including plastic, but last much longer than a single-use bottle and can be recycled when they become old or damaged. For both types of bottles, how they are discarded determines their ultimate resting place and whether they become pollutants of the ocean. A single-use plastic water bottle was manufactured, filled with water, and likely transported to a store, where it sat on a shelf waiting for a thirsty purchaser. Many of us drink out of plastic bottles several times during an average day, week, or month. Once we are finished with it, we have a choice where we leave that bottle: Recycling bin: Bottles destined for recycling are unlikely to end up in the ocean, in their current form, unless they are mismanaged or lost in transit to a processing facility. However, due to recent limitations in how recyclables are internationally transferred and accepted for processing, many of these bottles will unfortunately end up in landfills rather than recycling facilities. Trash can: These bottles also will not likely end up, in their current form, in the ocean. However, in areas across the globe with poor waste management or a lack of properly sealed landfills, as a bottle breaks down into microplastic particles over time, some particles may seep into the soil and eventually make their way into our waterways, ultimately entering and polluting the ocean. Litter: These bottles may very well be carried by wind, storm water, or other processes to sewers, rivers, lakes, and other waterways that may ultimately deposit the bottle in the ocean. Multi-use plastic bottles face these same pathways at end of their life—but of course this happens much less frequently since they can be used many times. National Geographic Explorer Heather J. Koldewey works to empower communities around the world to participate in solving the ocean pollution crisis from single-use plastics via incremental individual actions—including a campaign called One Less, which encourages people to stop using single-use plastic water bottles altogether. One Less is currently based in and focused on London, England and its inhabitants, but anyone can make the choice to use one less single-use bottle.
+
+USER:
+what are the pros of plastic and plastic bottle use?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,21,10,730,,685
+Address the user's request with the information contained within the provided text - Do not draw on external resources or from your base knowledge.,Please present a comprehensive history of polio and its vaccines in bullet-point format.,"1.2 History of poliomyelitis and polio vaccines Poliomyelitis is a disease of great antiquity. Perhaps the earliest description is evident in an Egyptian stele from around 1350 BC depicting a young man with typical asymmetric flaccid paralysis and atrophy of the leg. Several scattered reports of the disease also appear in the literature from the 17th and 18th century. By the mid-19th century, the Industrial Revolution had brought increased urbanization to Europe and North America and, with it, significant changes and improvements in living conditions. Coincident with these massive changes was the advent of larger and more frequent outbreaks of poliomyelitis. From the late 1800s, outbreaks were occurring in several European countries and in the United States, and they remained a dominant public health problem in the developed world for the first half of the 20th century. A major landmark in the study of poliomyelitis was the successful passage of the virus to nonhuman primates by Landsteiner and Popper in 1909. The availability of animal models provided the first opportunity to study the disease outside of human patients and produced important information on the process of infection and the pathophysiology of the disease. Further studies on the infectious agent awaited the crucial development by Enders, Weller, and Robbins in 1949 of tissue culture systems for in vitro propagation of the virus. This advance, and the recognition of three distinct serotypes, opened the way for all subsequent work on vaccines and study of the biochemical and biophysical properties of the polioviruses. By the 1950s, two different approaches to the prevention of poliomyelitis by vaccination were developed. Salk and Younger produced the first successful polio vaccine in 1954 by chemical inactivation of tissue culture-propagated virus using formaldehyde. This vaccine was completely non-infectious, yet, following injection, it elicited an immune response that was protective against paralytic disease. During the same period, many laboratories sought to produce live, attenuated polio vaccines. The OPV strains of Sabin were licensed in 1961 following extensive field trials in the former Soviet Union, Eastern Europe and Latin America. Mass immunization campaigns in many countries began in 1962 and 1963. Both the inactivated polio vaccine (IPV) and OPV contain three components, one for each immunologically distinct serotype of poliovirus. Some countries use enhanced IPV (eIPV) that contains higher D-antigenic units per dose for types 2 and 3 than standard IPV. Widespread immunization with IPV, and since 1963 with OPV, has virtually eliminated poliomyelitis in most developed countries. 1.3 Characterization of the pathogen The polioviruses belong to the genus Enterovirus in the family Picornaviridae. All are small, round 30 nm particles with icosahedral symmetry, and they contain no essential lipid envelope. Polioviruses share most of their biochemical and biophysical characteristics with the other enteroviruses and are different from some of the other picornaviruses. The viral particles have a buoyant density of 1.34 g/ml in caesium chloride and a sedimentation coefficient of approximately 156S. The infectious particles are relatively heat resistant (when stabilized by magnesium cations), resistant to acid pH (pH 3 to 5 for one to three hours), and also resistant to WHO/IVB/04.10 5 many common detergents and disinfectants, including common soap, non-ionic detergents, ether, chloroform, and other lipid solvents. The virus is stable for weeks at 4°C and for days at room temperature. Drying, ultraviolet light, high heat, formaldehyde, and free chlorine, however, readily inactivate the virus. Polioviruses and the enteroviruses are distinguished from the other picornaviruses on the basis of physical properties such as buoyant density in caesium chloride and stability in weak acid. The three poliovirus serotypes are distinguished from the other enteroviruses by neutralization with serotype-specific antisera and the propensity to cause paralytic illness. The Mahoney strain of type 1 poliovirus is the prototype for the polioviruses, the genus enterovirus, and the family Picornaviridae. It is among the most-studied and best-characterized agents of human disease. The poliovirus consists of 60 copies each of four polypeptide chains that form a very highly structured shell. Located inside this shell, the viral genome consists of a single molecule of ribonucleic acid (RNA), which is about 7500 nucleotides long. The four capsid polypeptides are produced by the proteolytic cleavage of a single polyprotein precursor, and are designated VP1 through VP4. Attached covalently to the amino-terminal of the VP4 protein is a single molecule of myristilate. In addition, one small protein, VPg, is covalently attached to the 5'-end of the viral RNA. A major advance in studies on the structure of polioviruses occurred with the solution of the crystal structure to a resolution of 0.29 nm. From the three-dimensional structure of the poliovirus, VP1 contributes the majority of the amino acid residues on the virus surface, VP2 and VP3 are partially exposed on the surface, and VP4 is completely internal. The information concerning the surface of the virus has been particularly useful in understanding the neutralization of poliovirus by antibodies. Studies with monoclonal neutralizing antibodies and mutant viruses resistant to them have revealed four main antigenic sites on the virus. The relative importance of individual sites is different for each of the three serotypes of poliovirus. The X-ray crystal structure has confirmed that the antigenic sites are composed of amino acid residues located on the virus surface and exposed loops of capsid proteins. Adjacent domains of the same and other capsid proteins influence the conformation of the loops. This explains why antigenicity of the virus is destroyed by disruption of the virus structure. In addition, there are other antigenic sites that elicit an immune response that is not neutralizing. The poliovirus-neutralizing antibody response is serotype-specific, with the exception of some minor cross-reaction between poliovirus 1 and 2. Heat-disrupted viruses, particularly those heated in the presence of detergent, induce antibodies that react with many enteroviruses. These broadly reacting antibodies are generally not neutralizing. Antisera raised in animals to each of the viruses are largely type-specific and are used for the determination of serotype in a neutralization assay. Although more than one T-cell epitope has been described in both structural and non-structural viral proteins, the role of cell-mediated immunity in controlling infection has not been determined. 6 Polio laboratory manual Polioviruses are among the simplest viruses in terms of genetic complexity and size. The RNA genomes from all three serotypes of poliovirus have been cloned and sequenced. The genomic RNA is infectious and serves as messenger RNA for viral protein synthesis. The RNA is translated in a single open reading frame into one large polyprotein, which is then processed through proteolytic cleavage by two distinct virus-encoded proteases into the functional viral proteins (Figure 1.2). Despite much research and the simple nature of the virus, several steps of the virus growth cycle have remained elusive, including the site and mode of virus entry and release of the genome into the cytoplasm. Polioviruses initially bind to a specific plasma membrane protein, the poliovirus receptor (PVR; CD155), a member of the immunoglobulin superfamily of proteins. The binding to the receptor triggers conformational changes in the capsid structure that are necessary for the release of the genome into the cytoplasm (uncoating). No other picornaviruses use this protein as their cellular receptor, a fact that has been exploited in the eradication programme by the use of a recombinant murine cell line expressing the human PVR to selectively isolate polioviruses. Once the viral genome has entered the cell, the replication cycle begins when the viral RNA is transcribed by the viral polymerase beginning at the 3'-end of the infecting viral RNA to generate a complementary RNA (cRNA). In the next step, which is dependent on a “host factor”, the progeny viral RNA is synthesized from the cRNA. The newly synthesized viral RNA is covalently linked to the VPg protein at the 5'- end of the RNA, and then only the positive sense strand of RNA is encapsidated in the viral structural proteins to form infectious viral particles. The extensive studies into virus replication and assembly have resulted in the remarkable accomplishment of complete cell-free replication of poliovirus beginning only with the viral RNA.","Address the user's request with the information contained within the provided text - Do not draw on external resources or from your base knowledge. 1.2 History of poliomyelitis and polio vaccines Poliomyelitis is a disease of great antiquity. Perhaps the earliest description is evident in an Egyptian stele from around 1350 BC depicting a young man with typical asymmetric flaccid paralysis and atrophy of the leg. Several scattered reports of the disease also appear in the literature from the 17th and 18th century. By the mid-19th century, the Industrial Revolution had brought increased urbanization to Europe and North America and, with it, significant changes and improvements in living conditions. Coincident with these massive changes was the advent of larger and more frequent outbreaks of poliomyelitis. From the late 1800s, outbreaks were occurring in several European countries and in the United States, and they remained a dominant public health problem in the developed world for the first half of the 20th century. A major landmark in the study of poliomyelitis was the successful passage of the virus to nonhuman primates by Landsteiner and Popper in 1909. The availability of animal models provided the first opportunity to study the disease outside of human patients and produced important information on the process of infection and the pathophysiology of the disease. Further studies on the infectious agent awaited the crucial development by Enders, Weller, and Robbins in 1949 of tissue culture systems for in vitro propagation of the virus. This advance, and the recognition of three distinct serotypes, opened the way for all subsequent work on vaccines and study of the biochemical and biophysical properties of the polioviruses. By the 1950s, two different approaches to the prevention of poliomyelitis by vaccination were developed. Salk and Younger produced the first successful polio vaccine in 1954 by chemical inactivation of tissue culture-propagated virus using formaldehyde. This vaccine was completely non-infectious, yet, following injection, it elicited an immune response that was protective against paralytic disease. During the same period, many laboratories sought to produce live, attenuated polio vaccines. The OPV strains of Sabin were licensed in 1961 following extensive field trials in the former Soviet Union, Eastern Europe and Latin America. Mass immunization campaigns in many countries began in 1962 and 1963. Both the inactivated polio vaccine (IPV) and OPV contain three components, one for each immunologically distinct serotype of poliovirus. Some countries use enhanced IPV (eIPV) that contains higher D-antigenic units per dose for types 2 and 3 than standard IPV. Widespread immunization with IPV, and since 1963 with OPV, has virtually eliminated poliomyelitis in most developed countries. 1.3 Characterization of the pathogen The polioviruses belong to the genus Enterovirus in the family Picornaviridae. All are small, round 30 nm particles with icosahedral symmetry, and they contain no essential lipid envelope. Polioviruses share most of their biochemical and biophysical characteristics with the other enteroviruses and are different from some of the other picornaviruses. The viral particles have a buoyant density of 1.34 g/ml in caesium chloride and a sedimentation coefficient of approximately 156S. The infectious particles are relatively heat resistant (when stabilized by magnesium cations), resistant to acid pH (pH 3 to 5 for one to three hours), and also resistant to WHO/IVB/04.10 5 many common detergents and disinfectants, including common soap, non-ionic detergents, ether, chloroform, and other lipid solvents. The virus is stable for weeks at 4°C and for days at room temperature. Drying, ultraviolet light, high heat, formaldehyde, and free chlorine, however, readily inactivate the virus. Polioviruses and the enteroviruses are distinguished from the other picornaviruses on the basis of physical properties such as buoyant density in caesium chloride and stability in weak acid. The three poliovirus serotypes are distinguished from the other enteroviruses by neutralization with serotype-specific antisera and the propensity to cause paralytic illness. The Mahoney strain of type 1 poliovirus is the prototype for the polioviruses, the genus enterovirus, and the family Picornaviridae. It is among the most-studied and best-characterized agents of human disease. The poliovirus consists of 60 copies each of four polypeptide chains that form a very highly structured shell. Located inside this shell, the viral genome consists of a single molecule of ribonucleic acid (RNA), which is about 7500 nucleotides long. The four capsid polypeptides are produced by the proteolytic cleavage of a single polyprotein precursor, and are designated VP1 through VP4. Attached covalently to the amino-terminal of the VP4 protein is a single molecule of myristilate. In addition, one small protein, VPg, is covalently attached to the 5'-end of the viral RNA. A major advance in studies on the structure of polioviruses occurred with the solution of the crystal structure to a resolution of 0.29 nm. From the three-dimensional structure of the poliovirus, VP1 contributes the majority of the amino acid residues on the virus surface, VP2 and VP3 are partially exposed on the surface, and VP4 is completely internal. The information concerning the surface of the virus has been particularly useful in understanding the neutralization of poliovirus by antibodies. Studies with monoclonal neutralizing antibodies and mutant viruses resistant to them have revealed four main antigenic sites on the virus. The relative importance of individual sites is different for each of the three serotypes of poliovirus. The X-ray crystal structure has confirmed that the antigenic sites are composed of amino acid residues located on the virus surface and exposed loops of capsid proteins. Adjacent domains of the same and other capsid proteins influence the conformation of the loops. This explains why antigenicity of the virus is destroyed by disruption of the virus structure. In addition, there are other antigenic sites that elicit an immune response that is not neutralizing. The poliovirus-neutralizing antibody response is serotype-specific, with the exception of some minor cross-reaction between poliovirus 1 and 2. Heat-disrupted viruses, particularly those heated in the presence of detergent, induce antibodies that react with many enteroviruses. These broadly reacting antibodies are generally not neutralizing. Antisera raised in animals to each of the viruses are largely type-specific and are used for the determination of serotype in a neutralization assay. Although more than one T-cell epitope has been described in both structural and non-structural viral proteins, the role of cell-mediated immunity in controlling infection has not been determined. 6 Polio laboratory manual Polioviruses are among the simplest viruses in terms of genetic complexity and size. The RNA genomes from all three serotypes of poliovirus have been cloned and sequenced. The genomic RNA is infectious and serves as messenger RNA for viral protein synthesis. The RNA is translated in a single open reading frame into one large polyprotein, which is then processed through proteolytic cleavage by two distinct virus-encoded proteases into the functional viral proteins (Figure 1.2). Despite much research and the simple nature of the virus, several steps of the virus growth cycle have remained elusive, including the site and mode of virus entry and release of the genome into the cytoplasm. Polioviruses initially bind to a specific plasma membrane protein, the poliovirus receptor (PVR; CD155), a member of the immunoglobulin superfamily of proteins. The binding to the receptor triggers conformational changes in the capsid structure that are necessary for the release of the genome into the cytoplasm (uncoating). No other picornaviruses use this protein as their cellular receptor, a fact that has been exploited in the eradication programme by the use of a recombinant murine cell line expressing the human PVR to selectively isolate polioviruses. Once the viral genome has entered the cell, the replication cycle begins when the viral RNA is transcribed by the viral polymerase beginning at the 3'-end of the infecting viral RNA to generate a complementary RNA (cRNA). In the next step, which is dependent on a “host factor”, the progeny viral RNA is synthesized from the cRNA. The newly synthesized viral RNA is covalently linked to the VPg protein at the 5'- end of the RNA, and then only the positive sense strand of RNA is encapsidated in the viral structural proteins to form infectious viral particles. The extensive studies into virus replication and assembly have resulted in the remarkable accomplishment of complete cell-free replication of poliovirus beginning only with the viral RNA. Please present a comprehensive history of polio and its vaccines in bullet-point format.","Address the user's request with the information contained within the provided text - Do not draw on external resources or from your base knowledge.
+
+EVIDENCE:
+1.2 History of poliomyelitis and polio vaccines Poliomyelitis is a disease of great antiquity. Perhaps the earliest description is evident in an Egyptian stele from around 1350 BC depicting a young man with typical asymmetric flaccid paralysis and atrophy of the leg. Several scattered reports of the disease also appear in the literature from the 17th and 18th century. By the mid-19th century, the Industrial Revolution had brought increased urbanization to Europe and North America and, with it, significant changes and improvements in living conditions. Coincident with these massive changes was the advent of larger and more frequent outbreaks of poliomyelitis. From the late 1800s, outbreaks were occurring in several European countries and in the United States, and they remained a dominant public health problem in the developed world for the first half of the 20th century. A major landmark in the study of poliomyelitis was the successful passage of the virus to nonhuman primates by Landsteiner and Popper in 1909. The availability of animal models provided the first opportunity to study the disease outside of human patients and produced important information on the process of infection and the pathophysiology of the disease. Further studies on the infectious agent awaited the crucial development by Enders, Weller, and Robbins in 1949 of tissue culture systems for in vitro propagation of the virus. This advance, and the recognition of three distinct serotypes, opened the way for all subsequent work on vaccines and study of the biochemical and biophysical properties of the polioviruses. By the 1950s, two different approaches to the prevention of poliomyelitis by vaccination were developed. Salk and Younger produced the first successful polio vaccine in 1954 by chemical inactivation of tissue culture-propagated virus using formaldehyde. This vaccine was completely non-infectious, yet, following injection, it elicited an immune response that was protective against paralytic disease. During the same period, many laboratories sought to produce live, attenuated polio vaccines. The OPV strains of Sabin were licensed in 1961 following extensive field trials in the former Soviet Union, Eastern Europe and Latin America. Mass immunization campaigns in many countries began in 1962 and 1963. Both the inactivated polio vaccine (IPV) and OPV contain three components, one for each immunologically distinct serotype of poliovirus. Some countries use enhanced IPV (eIPV) that contains higher D-antigenic units per dose for types 2 and 3 than standard IPV. Widespread immunization with IPV, and since 1963 with OPV, has virtually eliminated poliomyelitis in most developed countries. 1.3 Characterization of the pathogen The polioviruses belong to the genus Enterovirus in the family Picornaviridae. All are small, round 30 nm particles with icosahedral symmetry, and they contain no essential lipid envelope. Polioviruses share most of their biochemical and biophysical characteristics with the other enteroviruses and are different from some of the other picornaviruses. The viral particles have a buoyant density of 1.34 g/ml in caesium chloride and a sedimentation coefficient of approximately 156S. The infectious particles are relatively heat resistant (when stabilized by magnesium cations), resistant to acid pH (pH 3 to 5 for one to three hours), and also resistant to WHO/IVB/04.10 5 many common detergents and disinfectants, including common soap, non-ionic detergents, ether, chloroform, and other lipid solvents. The virus is stable for weeks at 4°C and for days at room temperature. Drying, ultraviolet light, high heat, formaldehyde, and free chlorine, however, readily inactivate the virus. Polioviruses and the enteroviruses are distinguished from the other picornaviruses on the basis of physical properties such as buoyant density in caesium chloride and stability in weak acid. The three poliovirus serotypes are distinguished from the other enteroviruses by neutralization with serotype-specific antisera and the propensity to cause paralytic illness. The Mahoney strain of type 1 poliovirus is the prototype for the polioviruses, the genus enterovirus, and the family Picornaviridae. It is among the most-studied and best-characterized agents of human disease. The poliovirus consists of 60 copies each of four polypeptide chains that form a very highly structured shell. Located inside this shell, the viral genome consists of a single molecule of ribonucleic acid (RNA), which is about 7500 nucleotides long. The four capsid polypeptides are produced by the proteolytic cleavage of a single polyprotein precursor, and are designated VP1 through VP4. Attached covalently to the amino-terminal of the VP4 protein is a single molecule of myristilate. In addition, one small protein, VPg, is covalently attached to the 5'-end of the viral RNA. A major advance in studies on the structure of polioviruses occurred with the solution of the crystal structure to a resolution of 0.29 nm. From the three-dimensional structure of the poliovirus, VP1 contributes the majority of the amino acid residues on the virus surface, VP2 and VP3 are partially exposed on the surface, and VP4 is completely internal. The information concerning the surface of the virus has been particularly useful in understanding the neutralization of poliovirus by antibodies. Studies with monoclonal neutralizing antibodies and mutant viruses resistant to them have revealed four main antigenic sites on the virus. The relative importance of individual sites is different for each of the three serotypes of poliovirus. The X-ray crystal structure has confirmed that the antigenic sites are composed of amino acid residues located on the virus surface and exposed loops of capsid proteins. Adjacent domains of the same and other capsid proteins influence the conformation of the loops. This explains why antigenicity of the virus is destroyed by disruption of the virus structure. In addition, there are other antigenic sites that elicit an immune response that is not neutralizing. The poliovirus-neutralizing antibody response is serotype-specific, with the exception of some minor cross-reaction between poliovirus 1 and 2. Heat-disrupted viruses, particularly those heated in the presence of detergent, induce antibodies that react with many enteroviruses. These broadly reacting antibodies are generally not neutralizing. Antisera raised in animals to each of the viruses are largely type-specific and are used for the determination of serotype in a neutralization assay. Although more than one T-cell epitope has been described in both structural and non-structural viral proteins, the role of cell-mediated immunity in controlling infection has not been determined. 6 Polio laboratory manual Polioviruses are among the simplest viruses in terms of genetic complexity and size. The RNA genomes from all three serotypes of poliovirus have been cloned and sequenced. The genomic RNA is infectious and serves as messenger RNA for viral protein synthesis. The RNA is translated in a single open reading frame into one large polyprotein, which is then processed through proteolytic cleavage by two distinct virus-encoded proteases into the functional viral proteins (Figure 1.2). Despite much research and the simple nature of the virus, several steps of the virus growth cycle have remained elusive, including the site and mode of virus entry and release of the genome into the cytoplasm. Polioviruses initially bind to a specific plasma membrane protein, the poliovirus receptor (PVR; CD155), a member of the immunoglobulin superfamily of proteins. The binding to the receptor triggers conformational changes in the capsid structure that are necessary for the release of the genome into the cytoplasm (uncoating). No other picornaviruses use this protein as their cellular receptor, a fact that has been exploited in the eradication programme by the use of a recombinant murine cell line expressing the human PVR to selectively isolate polioviruses. Once the viral genome has entered the cell, the replication cycle begins when the viral RNA is transcribed by the viral polymerase beginning at the 3'-end of the infecting viral RNA to generate a complementary RNA (cRNA). In the next step, which is dependent on a “host factor”, the progeny viral RNA is synthesized from the cRNA. The newly synthesized viral RNA is covalently linked to the VPg protein at the 5'- end of the RNA, and then only the positive sense strand of RNA is encapsidated in the viral structural proteins to form infectious viral particles. The extensive studies into virus replication and assembly have resulted in the remarkable accomplishment of complete cell-free replication of poliovirus beginning only with the viral RNA.
+
+USER:
+Please present a comprehensive history of polio and its vaccines in bullet-point format.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,24,13,1334,,636
+"Fulfill user requests utilizing only the information provided in the prompt. If you cannot answer using the context alone, state that you can't determine the answer due to a lack of context information.",What are the important things to know about partial trisomy 18?,"Trisomy 18 Description Trisomy 18, also called Edwards syndrome, is a chromosomal condition associated with abnormalities in many parts of the body. Individuals with trisomy 18 often have slow growth before birth (intrauterine growth retardation) and a low birth weight. Affected individuals may have heart defects and abnormalities of other organs that develop before birth. Other features of trisomy 18 include a small, abnormally shaped head; a small jaw and mouth; and clenched fists with overlapping fingers. Due to the presence of several life-threatening medical problems, many individuals with trisomy 18 die before birth or within their first month. Five to 10 percent of children with this condition live past their first year, and these children often have severe intellectual disability. Frequency Trisomy 18 occurs in about 1 in 5,000 live-born infants; it is more common in pregnancy, but many affected fetuses do not survive to term. Although women of all ages can have a child with trisomy 18, the chance of having a child with this condition increases as a woman gets older. Causes Most cases of trisomy 18 result from having three copies of chromosome 18 in each cell in the body instead of the usual two copies. The extra genetic material disrupts the normal course of development, causing the characteristic features of trisomy 18. Approximately 5 percent of people with trisomy 18 have an extra copy of chromosome 18 in only some of the body's cells. In these people, the condition is called mosaic trisomy 18. The severity of mosaic trisomy 18 depends on the type and number of cells that have the extra chromosome. The development of individuals with this form of trisomy 18 may range from normal to severely affected. Very rarely, part of the long (q) arm of chromosome 18 becomes attached (translocated) to another chromosome during the formation of reproductive cells (eggs and sperm) or very early in embryonic development. Affected individuals have two copies of chromosome 18, plus the extra material from chromosome 18 attached to another chromosome. People with this genetic change are said to have partial trisomy 18. If only part of the q arm is present in three copies, the physical signs of partial trisomy 18 may be less severe than those typically seen in trisomy 18. If the entire q arm is present in three copies, individuals may be as severely affected as if they had three full copies of chromosome 18. Learn more about the chromosome associated with Trisomy 18 • chromosome 18 Inheritance Most cases of trisomy 18 are not inherited, but occur as random events during the formation of eggs and sperm. An error in cell division called nondisjunction results in a reproductive cell with an abnormal number of chromosomes. For example, an egg or sperm cell may gain an extra copy of chromosome 18. If one of these atypical reproductive cells contributes to the genetic makeup of a child, the child will have an extra chromosome 18 in each of the body's cells. Mosaic trisomy 18 is also not inherited. It occurs as a random event during cell division early in embryonic development. As a result, some of the body's cells have the usual two copies of chromosome 18, and other cells have three copies of this chromosome. Partial trisomy 18 can be inherited. An unaffected person can carry a rearrangement of genetic material between chromosome 18 and another chromosome. This rearrangement is called a balanced translocation because there is no extra material from chromosome 18. Although they do not have signs of trisomy 18, people who carry this type of balanced translocation are at an increased risk of having children with the condition. Other Names for This Condition • Complete trisomy 18 syndrome • Edwards syndrome • Trisomy 18 syndrome • Trisomy E syndrome Additional Information & Resources Genetic Testing Information • Genetic Testing Registry: Complete trisomy 18 (https://www.ncbi.nlm.nih.gov/gtr/co nditions/C0152096/) Genetic and Rare Diseases Information Center • Trisomy 18 (https://rarediseases.info.nih.gov/diseases/6321/index) Patient Support and Advocacy Resources • National Organization for Rare Disorders (NORD) (https://rarediseases.org/) Clinical Trials • ClinicalTrials.gov (https://clinicaltrials.gov/search?cond=%22Trisomy 18%22) Scientific Articles on PubMed • PubMed (https://pubmed.ncbi.nlm.nih.gov/?term=%28%28trisomy+18%5BTIAB%5 D%29+OR+%28Edwards+syndrome%5BTIAB%5D%29%29+AND+english%5Bla% 5D+AND+human%5Bmh%5D+AND+%22last+360+days%22%5Bdp%5D)","System Instructions: Fulfill user requests utilizing only the information provided in the prompt. If you cannot answer using the context alone, state that you can't determine the answer due to a lack of context information. Question: What are the important things to know about partial trisomy 18? Context: Trisomy 18 Description Trisomy 18, also called Edwards syndrome, is a chromosomal condition associated with abnormalities in many parts of the body. Individuals with trisomy 18 often have slow growth before birth (intrauterine growth retardation) and a low birth weight. Affected individuals may have heart defects and abnormalities of other organs that develop before birth. Other features of trisomy 18 include a small, abnormally shaped head; a small jaw and mouth; and clenched fists with overlapping fingers. Due to the presence of several life-threatening medical problems, many individuals with trisomy 18 die before birth or within their first month. Five to 10 percent of children with this condition live past their first year, and these children often have severe intellectual disability. Frequency Trisomy 18 occurs in about 1 in 5,000 live-born infants; it is more common in pregnancy, but many affected fetuses do not survive to term. Although women of all ages can have a child with trisomy 18, the chance of having a child with this condition increases as a woman gets older. Causes Most cases of trisomy 18 result from having three copies of chromosome 18 in each cell in the body instead of the usual two copies. The extra genetic material disrupts the normal course of development, causing the characteristic features of trisomy 18. Approximately 5 percent of people with trisomy 18 have an extra copy of chromosome 18 in only some of the body's cells. In these people, the condition is called mosaic trisomy 18. The severity of mosaic trisomy 18 depends on the type and number of cells that have the extra chromosome. The development of individuals with this form of trisomy 18 may range from normal to severely affected. Very rarely, part of the long (q) arm of chromosome 18 becomes attached (translocated) to another chromosome during the formation of reproductive cells (eggs and sperm) or very early in embryonic development. Affected individuals have two copies of chromosome 18, plus the extra material from chromosome 18 attached to another chromosome. People with this genetic change are said to have partial trisomy 18. If only part of the q arm is present in three copies, the physical signs of partial trisomy 18 may be less severe than those typically seen in trisomy 18. If the entire q arm is present in three copies, individuals may be as severely affected as if they had three full copies of chromosome 18. Learn more about the chromosome associated with Trisomy 18 • chromosome 18 Inheritance Most cases of trisomy 18 are not inherited, but occur as random events during the formation of eggs and sperm. An error in cell division called nondisjunction results in a reproductive cell with an abnormal number of chromosomes. For example, an egg or sperm cell may gain an extra copy of chromosome 18. If one of these atypical reproductive cells contributes to the genetic makeup of a child, the child will have an extra chromosome 18 in each of the body's cells. Mosaic trisomy 18 is also not inherited. It occurs as a random event during cell division early in embryonic development. As a result, some of the body's cells have the usual two copies of chromosome 18, and other cells have three copies of this chromosome. Partial trisomy 18 can be inherited. An unaffected person can carry a rearrangement of genetic material between chromosome 18 and another chromosome. This rearrangement is called a balanced translocation because there is no extra material from chromosome 18. Although they do not have signs of trisomy 18, people who carry this type of balanced translocation are at an increased risk of having children with the condition. Other Names for This Condition • Complete trisomy 18 syndrome • Edwards syndrome • Trisomy 18 syndrome • Trisomy E syndrome Additional Information & Resources Genetic Testing Information • Genetic Testing Registry: Complete trisomy 18 (https://www.ncbi.nlm.nih.gov/gtr/co nditions/C0152096/) Genetic and Rare Diseases Information Center • Trisomy 18 (https://rarediseases.info.nih.gov/diseases/6321/index) Patient Support and Advocacy Resources • National Organization for Rare Disorders (NORD) (https://rarediseases.org/) Clinical Trials • ClinicalTrials.gov (https://clinicaltrials.gov/search?cond=%22Trisomy 18%22) Scientific Articles on PubMed • PubMed (https://pubmed.ncbi.nlm.nih.gov/?term=%28%28trisomy+18%5BTIAB%5 D%29+OR+%28Edwards+syndrome%5BTIAB%5D%29%29+AND+english%5Bla% 5D+AND+human%5Bmh%5D+AND+%22last+360+days%22%5Bdp%5D)","Fulfill user requests utilizing only the information provided in the prompt. If you cannot answer using the context alone, state that you can't determine the answer due to a lack of context information.
+
+EVIDENCE:
+Trisomy 18 Description Trisomy 18, also called Edwards syndrome, is a chromosomal condition associated with abnormalities in many parts of the body. Individuals with trisomy 18 often have slow growth before birth (intrauterine growth retardation) and a low birth weight. Affected individuals may have heart defects and abnormalities of other organs that develop before birth. Other features of trisomy 18 include a small, abnormally shaped head; a small jaw and mouth; and clenched fists with overlapping fingers. Due to the presence of several life-threatening medical problems, many individuals with trisomy 18 die before birth or within their first month. Five to 10 percent of children with this condition live past their first year, and these children often have severe intellectual disability. Frequency Trisomy 18 occurs in about 1 in 5,000 live-born infants; it is more common in pregnancy, but many affected fetuses do not survive to term. Although women of all ages can have a child with trisomy 18, the chance of having a child with this condition increases as a woman gets older. Causes Most cases of trisomy 18 result from having three copies of chromosome 18 in each cell in the body instead of the usual two copies. The extra genetic material disrupts the normal course of development, causing the characteristic features of trisomy 18. Approximately 5 percent of people with trisomy 18 have an extra copy of chromosome 18 in only some of the body's cells. In these people, the condition is called mosaic trisomy 18. The severity of mosaic trisomy 18 depends on the type and number of cells that have the extra chromosome. The development of individuals with this form of trisomy 18 may range from normal to severely affected. Very rarely, part of the long (q) arm of chromosome 18 becomes attached (translocated) to another chromosome during the formation of reproductive cells (eggs and sperm) or very early in embryonic development. Affected individuals have two copies of chromosome 18, plus the extra material from chromosome 18 attached to another chromosome. People with this genetic change are said to have partial trisomy 18. If only part of the q arm is present in three copies, the physical signs of partial trisomy 18 may be less severe than those typically seen in trisomy 18. If the entire q arm is present in three copies, individuals may be as severely affected as if they had three full copies of chromosome 18. Learn more about the chromosome associated with Trisomy 18 • chromosome 18 Inheritance Most cases of trisomy 18 are not inherited, but occur as random events during the formation of eggs and sperm. An error in cell division called nondisjunction results in a reproductive cell with an abnormal number of chromosomes. For example, an egg or sperm cell may gain an extra copy of chromosome 18. If one of these atypical reproductive cells contributes to the genetic makeup of a child, the child will have an extra chromosome 18 in each of the body's cells. Mosaic trisomy 18 is also not inherited. It occurs as a random event during cell division early in embryonic development. As a result, some of the body's cells have the usual two copies of chromosome 18, and other cells have three copies of this chromosome. Partial trisomy 18 can be inherited. An unaffected person can carry a rearrangement of genetic material between chromosome 18 and another chromosome. This rearrangement is called a balanced translocation because there is no extra material from chromosome 18. Although they do not have signs of trisomy 18, people who carry this type of balanced translocation are at an increased risk of having children with the condition. Other Names for This Condition • Complete trisomy 18 syndrome • Edwards syndrome • Trisomy 18 syndrome • Trisomy E syndrome Additional Information & Resources Genetic Testing Information • Genetic Testing Registry: Complete trisomy 18 (https://www.ncbi.nlm.nih.gov/gtr/co nditions/C0152096/) Genetic and Rare Diseases Information Center • Trisomy 18 (https://rarediseases.info.nih.gov/diseases/6321/index) Patient Support and Advocacy Resources • National Organization for Rare Disorders (NORD) (https://rarediseases.org/) Clinical Trials • ClinicalTrials.gov (https://clinicaltrials.gov/search?cond=%22Trisomy 18%22) Scientific Articles on PubMed • PubMed (https://pubmed.ncbi.nlm.nih.gov/?term=%28%28trisomy+18%5BTIAB%5 D%29+OR+%28Edwards+syndrome%5BTIAB%5D%29%29+AND+english%5Bla% 5D+AND+human%5Bmh%5D+AND+%22last+360+days%22%5Bdp%5D)
+
+USER:
+What are the important things to know about partial trisomy 18?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",True,33,11,685,,608
+Use information from the article only to explain your answer. Do not rely on outside knowledge.,What does it mean that the Dept of Labor is hiring for an intermittent employment position?,"EMPLOYEE HANDBOOK Table of Contents Welcome................................................................................................................................................... 5 About the Agency .................................................................................................................................... 6 Mission Statement ................................................................................................................................... 6 Supersedence ........................................................................................................................................... 6 General Highlights .................................................................................................................................. 7 Access Card ............................................................................................................................................. 7 Affirmative Action/Equal Employment Opportunity Employer ....................................................... 7 Americans with Disabilities Act ............................................................................................................ 7 Appearance & Dress Code ..................................................................................................................... 7 Building Security .................................................................................................................................... 7 Code of Ethics ......................................................................................................................................... 7 Collective Bargaining ............................................................................................................................. 7 Email & Internet Use.............................................................................................................................. 8 Employee Assistance Program .............................................................................................................. 8 Employee Background Check ............................................................................................................... 8 Employment Applications ...................................................................................................................... 8 Equal Employment Opportunity........................................................................................................... 8 Immigration Law Compliance............................................................................................................... 8 On-the-Job Accident/Illness ................................................................................................................... 9 Photo Identification ................................................................................................................................ 9 Political Activity ...................................................................................................................................... 9 Rideshare ................................................................................................................................................. 9 Safety ........................................................................................................................................................ 9 Sexual Harassment ................................................................................................................................. 9 Smoking ................................................................................................................................................. 10 Standards of Conduct ........................................................................................................................... 10 Telephones - Cellular Telephones ....................................................................................................... 10 Travel ..................................................................................................................................................... 10 Uniformed Services Employment & Reemployment......................................................................... 10 Violence in the Workplace ................................................................................................................... 10 Visitors ................................................................................................................................................... 11 Weather & Emergency Closings ......................................................................................................... 11 Collective Bargaining ........................................................................................................................... 12 Bargaining Unit Representation .......................................................................................................... 12 Union Contracts .................................................................................................................................... 12 2 Grievance Procedure ............................................................................................................................ 12 Appointment and Promotion ............................................................................................................... 14 Merit System ......................................................................................................................................... 14 Job Classification .................................................................................................................................. 14 Classified & Unclassified Positions ..................................................................................................... 14 Competitive & Non-Competitive Positions ........................................................................................ 14 Scheduled & Continuous Recruitment Job Announcements ........................................................... 14 Job Announcements.............................................................................................................................. 14 Employment Opportunities ................................................................................................................. 15 Application Accommodations for People with Disabilities ............................................................... 15 Rejection from State Application ........................................................................................................ 15 Appointment Types .............................................................................................................................. 15 Working Test Period ............................................................................................................................ 16 Service Ratings ...................................................................................................................................... 17 Promotion & Reclassification .............................................................................................................. 17 Temporary Service in a Higher Class ................................................................................................. 17 Transfers ................................................................................................................................................ 18 Dual Employment ................................................................................................................................. 18 Personnel Records ................................................................................................................................ 19 Personnel Files ...................................................................................................................................... 19 Change of Personal Data ...................................................................................................................... 19 Working Hours ..................................................................................................................................... 19 Meal & Break Periods .......................................................................................................................... 20 Overtime & Compensatory Time ........................................................................................................ 20 Shift Assignments.................................................................................................................................. 20 Attendance ............................................................................................................................................. 20 Paid Leave Time ................................................................................................................................... 21 Holidays ................................................................................................................................................. 21 Sick Leave .............................................................................................................................................. 21 Vacation Leave ...................................................................................................................................... 22 Personal Leave ...................................................................................................................................... 23 Jury Duty ............................................................................................................................................... 23 Military Leave ....................................................................................................................................... 24 Leave Without Pay ............................................................................................................................... 25 Leave of Absence Without Pay (LAW) ............................................................................................... 25 Maternity Leave .................................................................................................................................... 25 3 Medical Leave ....................................................................................................................................... 25 Family Leave ......................................................................................................................................... 26 Salary ..................................................................................................................................................... 27 Payment ................................................................................................................................................. 27 Payday .................................................................................................................................................... 27 Annual Increments ............................................................................................................................... 27 Collective Bargaining & Cost-of-Living Increases ............................................................................ 27 Longevity Pay ........................................................................................................................................ 27 Deductions ............................................................................................................................................. 29 Federal Income Tax & Social Security Tax ....................................................................................... 29 Connecticut Income Tax ...................................................................................................................... 29 Health Insurance ................................................................................................................................... 29 Group Life Insurance ........................................................................................................................... 29 Supplemental Benefits .......................................................................................................................... 29 Direct Deposit ........................................................................................................................................ 30 Deferred Compensation ....................................................................................................................... 30 State Employees Campaign ................................................................................................................. 30 Union Dues ............................................................................................................................................ 30 Credit Unions ........................................................................................................................................ 30 Retirement Tiers ................................................................................................................................... 31 Separation .............................................................................................................................................. 36 Resignation ............................................................................................................................................ 33 Layoff ..................................................................................................................................................... 33 Reemployment Rights .......................................................................................................................... 33 Rescind of Resignation or Retirement ................................................................................................ 33 Exit Interview ........................................................................................................................................ 33 Retirement ............................................................................................................................................. 33 Retirement Types .................................................................................................................................. 36 Pension Payment Options .................................................................................................................... 36 Insurance Benefits ................................................................................................................................ 36 Training and Development .................................................................................................................. 38 In-Service Training ............................................................................................................................... 38 Management Development Courses .................................................................................................... 38 Tuition Reimbursement ....................................................................................................................... 38 Conferences, Workshops & Seminars ................................................................................................ 38 EMPLOYMENT POLICIES ............................................................................................................... 39 4 Welcome Whether you have just joined the agency or have been with us for a while, we are confident that you will or have found our organization to be a dynamic and rewarding place in which to work. We consider the employees of the Department of Labor to be our most valuable resource and we look forward to a productive and successful partnership. This handbook has been prepared for you to serve as a guide for the employer-employee relationship. The topics covered in this handbook apply to all employees of the Department of Labor. It is important to keep the following things in mind about this handbook. First, it contains general information and guidelines. It is not intended to be comprehensive or to address all the possible applications of, or exceptions to, the general policies and procedures described. It is not intended to replace or supersede collective bargaining agreements that may cover many of your terms and conditions of employment. Employees covered by a collective bargaining agreement will receive a copy of their contract at orientation. You should read and become familiar with your collective bargaining agreement, this employee handbook and the agency’s employment policies. If you have any questions concerning eligibility for a particular benefit, or the applicability of a policy or practice, you should address your specific questions to your supervisor or contact your HR Generalist for clarification. Second, neither this handbook nor any other agency document confers any contractual right, either expressed or implied, to remain in the agency’s employ or guarantee any fixed terms and conditions of your employment. Third, the policies, procedures, and benefits described here may be modified or discontinued from time to time. We will try to inform employees of any changes as they occur but cannot guarantee immediate advance notice of changes. Finally, some of the subjects described here are covered in detail elsewhere. The terms of written insurance policies and/or plan documents are controlling for health, life, retirement and deferred or reduced income benefits. You should refer to those documents for specific information since this handbook is only designed as a brief guide and summary of policies and benefits. We are pleased to have you as a member of the Department of Labor and look forward to a successful and beneficial association. 5 About the Agency The Department of Labor handles far more than unemployment insurance benefits. Helping employers and jobseekers with their workforce needs is our goal. An overview of the many programs and public services the agency offers is available on the website (www.ct.gov/dol), which also contains information ranging from upcoming job fairs to wage and workplace guidelines. Mission Statement The Department of Labor is committed to protecting and promoting the interests of Connecticut workers. In order to accomplish this in an ever-changing environment, we assist workers and employers to become competitive in the global economy. We take a comprehensive approach to meeting the needs of workers and employers, and the other agencies that serve them. We ensure the supply of high-quality integrated services that serve the needs of our customer. Supersedence This revised version of the Employee Handbook supersedes all prior versions that have been issued by the Department of Labor and will be effective April 2023. 6 General Highlights Access Card Central Office and Annex employees are issued an access card to enter the building. Should your card be lost, stolen or destroyed, contact Facilities Operations so the card can be deactivated and a replacement issued. Affirmative Action/Equal Employment Opportunity Employer The Department of Labor is committed to affirmative action/equal employment that will build on the strengths of our current workforce and continually enhance the diversity of our organization. The department opposes all forms of discrimination and has developed a set of anti-discriminatory policies. Please direct your questions about affirmative action issues to the AA/EEO Manager at Central Office, 200 Folly Brook Boulevard, Wethersfield, CT 06109; telephone (860) 263-6520. To file a complaint, please click on the link to access the form: Internal Discrimination Complaint Americans with Disabilities Act The Department of Labor complies with all relevant and applicable provisions of the Americans with Disabilities Act (ADA). The agency will not discriminate against any qualified employee or job applicant with respect to any terms, privileges, or conditions of employment because of a person’s physical or mental disability. See the Americans with Disabilities Act Reasonable Accommodation Policy Appearance & Dress Code It is the policy of the agency to project a business-like image to clients, visitors and co-workers. In line with this, you are required to dress appropriately in clothing which is suitable for your job responsibilities and work environment, meets the requirements established for safety reasons, and complies with the agency’s dress code requirements. See Professional Image Policy. Building Security Each and every employee must follow the building security rules and regulations. Employees are not allowed on the property after hours without prior authorization from their supervisor. Code of Ethics The department’s standards of ethical conduct, which all employees are expected to be familiar with and observe, are outlined in the Code of Ethics for Public Officials & State Employees and the Ethical Conduct Policy . Collective Bargaining Your assignment to a collective bargaining unit (union) is based on your job classification. As a bargaining unit member, you will have union dues deducted from your bi-weekly paycheck. You may elect not to join a union. Your union contract governs salary, benefits and hours of work, and other terms and conditions of employment. Collective bargaining agreements are negotiated periodically. 7 Exempt employees are excluded from the collective bargaining process and are not required to pay union dues. Email & Internet Use It is the policy of the agency to provide electronic mail (email) and internet access for work-related purposes. You are required to adhere to this and related policies to ensure proper, legal and effective use of these electronic tools and resources. See Acceptable Use of State Systems Policy. Employee Assistance Program The Employee Assistance Program (EAP) is designed to offer consultation and counseling services for employees and their dependents who are experiencing problems which may be impacting their life at work and/or at home. Some of these problems may include family, marital, alcohol/drugs, emotional distress, and job-related, legal, or financial difficulties. Participation is voluntary and confidential. EAP services are provided by Wheeler EAP. To schedule an appointment or obtain more information, call 1800-252-4555 or 1-800-225-2527, or log on to their website at Wheeler EAP. Employee Background Check Prior to making an offer of employment, Human Resources may conduct a job-related background check. A comprehensive background check may consist of prior employment verification, professional reference check, education confirmation and fingerprinting. Employment Applications We rely upon the accuracy of information contained in an employment application and the accuracy of other data presented throughout the hiring process and employment. Any misrepresentation, falsification or material omission of information or data may result in exclusion of the individual from consideration for employment or, if the person has been hired, termination of employment. Equal Employment Opportunity The Department of Labor is an equal employment opportunity employer. Employment decisions are based on merit and business needs. The Department of Labor does not discriminate on the basis of race, color, citizenship status, national origin, ancestry, gender, sexual orientation, age, religion, creed, physical or mental disability, marital status, veterans’ status, political affiliation, or any other factor protected by law. To file a complaint, please click on the link to access the form: Internal Discrimination Complaint. Immigration Law Compliance All offers of employment are contingent on verification of the candidate’s right to work in the United States. On the first day of work, every new employee will be asked to provide original documents verifying his or her right to work and, as required by federal law, to complete and sign an Employment Eligibility Verification Form I-9. 8 On-the-Job Accident/Illness The agency promotes safety in the workplace. The State of Connecticut also has implemented a Managed Care Program for Workers’ Compensation, administered by Gallagher Bassett Services, Inc. You must report a work-related accident or illness to your supervisor, who is required to call a 24-hour hotline (1-800-828-2717) to report your accident or illness and initiate a claim. If your supervisor is unavailable, you may call or have someone call for you. Your supervisor must also complete the First Report of Injury (Form WC-207) and submit it to DAS_RfaxWCHE@ct.gov or by fax to 959-200-4841, whether or not you seek treatment or lose time from work. To become eligible for workers’ compensation benefits, you must seek treatment from a network physician or medical facility. Forms can be obtained at Workers' Compensation Rights, Responsibilities, and Claims--Documents (ct.gov). In cases of a medical emergency call 911 to seek immediate medical attention. Contact the DAS Workers' Compensation Division at (860) 713-5002 with any questions regarding access. Photo Identification You are required to wear and visibly display a photo identification badge during working hours. If your identification badge is lost, stolen, or destroyed, or you have transferred to a different unit, you must request a replacement through Facilities Operations. Political Activity As a state employee, state statutes govern your involvement in various political activities such as campaigning and running for elective office. Also, if you are working on programs financed in whole or in part by federal funds, you are subject to the provisions of the federal Hatch Act, which is generally more restrictive than state statue. The purpose of these laws is to avoid a conflict of interest between your state job and political activities. Information regarding political activity may be found in DAS General Letter 214D, link to document General Letter 214D – Political Activity. The Ethical Conduct Policy also addressed these issues and you are advised to contact the agency’s Ethics Liaison regarding any political activity. See Ethical Conduct Policy. Rideshare The department promotes the statewide Rideshare Program, an opportunity to reduce your transportation expenses to work. Consider using a ride-sharing mode (carpool, vanpool or bus) as an alternative to driving alone. Ride sharing saves you money, energy and preserves the environment. For information call 800-972-EASY (800-972-3279) or visit the website at www.rideshare.com. Safety The safety and health of employees is our top priority. The agency makes every effort to comply with all federal and state workplace safety requirements. Each employee is expected to obey safety rules and exercise caution and common sense in all work activities. Promptly report safety concerns to your supervisor. Sexual Harassment The Department of Labor does not tolerate sexual harassment. Sexual harassment may include unwelcome sexual advances, requests for sexual favors, or other unwelcome verbal or physical contact 9 of a sexual nature when such conduct creates an offensive, hostile and intimidating work environment and prevents an individual from effectively performing the duties of their position. See Sexual Harassment Policy. Smoking Smoking is prohibited throughout agency buildings and offices, including in rest rooms, private offices, lounges and similar areas. Smoking is permitted only in designated areas outside office buildings and other work locations. The use of smokeless tobacco and e-cigarettes are also prohibited and subject to the same restrictions. Standards of Conduct The work rules and standards of conduct for employees are important and the agency regards them seriously. All employees are urged to become familiar with and must follow these rules and standards. See Employee Conduct Policy. Telephones - Cellular Telephones The agency recognizes that occasionally it is necessary for employees to make or receive personal telephone calls during working hours. You are expected to restrict your personal telephone usage, both on state-owned phones and personally owned cellular phones, to reasonable, incidental calls that do not interfere with your work schedule or the performance of your duties. To avoid being disruptive to others in the workplace, please make certain audible alerts are disabled. Travel Your position may require travel to conduct state business. If you are required to travel for work, you may obtain a state-owned vehicle from a central carpool with a valid driver’s license. Use of your personal vehicle in the performance of Agency duties is allowable only when the use of a State-owned vehicle is not reasonably available for use and request mileage reimbursement. You must present proof of automobile insurance with the minimum coverage requirements. Contact your supervisor or Business Management if you have any questions. Uniformed Services Employment & Reemployment As an equal opportunity employer, the Department of Labor is committed to providing employment and reemployment services and support as set forth in the Uniformed Services and Reemployment Rights Act of 1994 (USERRA). Violence in the Workplace The Department of Labor has a policy prohibiting workplace violence. Consistent with this policy, acts or threats of physical violence, including intimidation, harassment and/or coercion, which involve or affect the organization and its employees will not be tolerated. See Violence in the Workplace Prevention Policy. 10 Visitors To provide for safety and security, only authorized visitors are allowed in the workplace. All visitors must enter through the main reception area, sign-in and sign-out at the front desk and receive a visitor identification to wear while on the premises. Authorized visitors will be escorted to their destination and must be accompanied by an employee at all times. Weather & Emergency Closings At times, emergencies such as severe weather or power failures can disrupt business operations. Everbridge, is a system that the state utilizes to notify enrolled individuals on safety and weather concerns. You can determine by which methods you want to be notified. Sign-up is free. Any personal information provided (such as cell number) will be used for important employee notifications purposes only directed by DAS. Everbridge will never give or sell contact or location information to any vendor or other organization. The Department of Emergency Service & Public Protection website is the official source of information for state employees. Use this page to find any official announcements about closures or delayed openings that have been declared by the Governor. Everbridge system can send alerts to your work phone and email as well as your home phone, cell phone, and home email. The Statewide CT Alert system can also keep you informed of state emergencies and send you emails and text alerts. FEMA’s Ready.gov preparedness site has information on how to keep safe during the winter. 11 Collective Bargaining Bargaining Unit Representation Labor unions and management at times negotiate collective bargaining agreements (union contracts). The contracts govern such areas as salary, benefits, hours of work, and the terms and conditions of employment. Most state job classifications have been assigned to particular bargaining units (unions) and state employees have voted to have unions represent them in the negotiation process. If you are a nonexempt employee, you have been assigned to a bargaining unit based on your job classification and will be represented by that specific union. If you are an exempt employee, you have been excluded from the collective bargaining process. The terms and conditions of your employment will be governed by state statutes, rules and regulations. Union Contracts Union contracts, established through the formal negotiation process, outline the terms and conditions of your employment. You should familiarize yourself with your contract. Benefits and provisions vary between bargaining units. Contract language has been crafted to avoid disputes and eliminate misunderstandings. Contract provisions, however, may be open to interpretation and subject to the grievance and arbitration process. Direct your questions about your union contract to your supervisor, union representative or Human Resources Generalist. Grievance Procedure Your problems or complaints should be resolved quickly and fairly. First, discuss the issue with your supervisor, who may help you find a solution. If your supervisor or another employee in the chain of command cannot resolve your problem or complaint, or if you feel that you have been treated unjustly, contact your union steward or Agency Labor Relations Specialist. If an issue cannot be resolved informally, you may follow the grievance procedure outlined in your union contract. This procedure helps resolve disputes concerning the interpretation and application of a contract. You should, however, make every effort to resolve an issue before filing a grievance. Though specific procedures may vary, your union contract establishes time limits for initiating grievances and obtaining responses. The first steps of the grievance process are informal to encourage quick resolution. If an issue still cannot be resolved, more formal meetings are conducted until the grievance reaches the highest level of the process. Most grievance procedures permit arbitration when an issue cannot be resolved at the highest level. An arbitrator, an impartial party chosen by the union and management, will hear both sides of an issue and render a binding decision. A union normally requests arbitration, but you as an employee may also request it in certain circumstances. Arbitration is permitted only if negotiated as a step in the grievance procedure. You or a group of employees may present a grievance to management for resolution without your union’s participation. However, the resolution must be consistent with your union contract and your union must be given the opportunity to attend all meetings. 12 If you are an exempt classified employee, you may appeal certain actions through the grievance procedure as outlined in Sec. 5-202 of the Connecticut General Statutes. 13 Appointment and Promotion Merit System The appointment and promotion of state employees is based on the merit principles in the State Personnel Act. As with other federal, state and municipal merit systems, this system was established to minimize the influence of electoral politics on the employment and retention of state employees. The system strives to place the best qualified people in state service and to ensure that they are fairly treated in the appointment and promotion process. The merit system is not subject to collective bargaining. Job Classification The state, as an employer of thousands of people, must systematically describe and group jobs to ensure consistent and fair treatment when assigning, compensating and promoting employees. Consequently, it has established a classification plan for all jobs in the executive branch of state service. Individual positions are grouped into job classes, with each class consisting of positions with similar duties, responsibilities and required qualifications. Your job classification is the foundation for the employment process. Classified & Unclassified Positions Most positions in the executive branch of state government are classified. Unclassified positions may be exempt from job announcements. The State Personnel Act lists a number of unclassified categories: agency heads, members of boards and commissions, officers appointed by the governor, deputies and executive assistants to the head of departments, executive secretaries, employees in the Senior Executive Service and professional specialists. Competitive & Non-Competitive Positions Most classified positions are competitive and require an application. The type of experience required depends on the job classification. Applicants must meet minimum general experience and training requirements, however, to be eligible for appointment if a position requires a professional license or degree, there may be no additional requirements beyond possession of the professional license or degree. Scheduled & Continuous Recruitment Job Announcements Most state job opportunities are announced to the general public with a specific closing date. If you apply for a job opening, you will be notified if you are selected for an interview by the hiring agency. When the state considers continuous recruiting necessary, it may postpone the closing date for filing applications until it receives a suitable number of candidates. A job posting will indicate when recruiting is continuous and that applications may be filed until further notice. Job Announcements To meet merit system objectives, the state has developed competitive job classifications to fill many of its positions. They are not used to fill unclassified positions or those in classes designated as noncompetitive. State job announcements fall into the following categories: 14 Open to the Public. If you meet the minimum experience and training qualifications for a position, you may participate in this type of recruitment. Open-competitive job announcements are administered periodically usually when a state agency is recruiting for a vacant position. Statewide & Agency Promotion. If you are a state employee who meets the minimum experience and training qualifications for a position and has completed six months continuous service in a state agency, you may participate in a statewide recruitment. Agency promotional announcements will have the additional requirements that you must be a current agency employee. Employment Opportunities Agency job announcements are posted on the DAS Online Employment Center. You should check regularly for the most up to date information. To apply for employment, you must complete a Master Application on the DAS Website. Check the state employment pages on the Department of Administrative Services website (Job Openings Department of Administrative Services (jobapscloud.com) for information about completing the application form, job opportunities, and to sign up for e-mail notification of current job openings. Application Accommodations for People with Disabilities The state may conduct recruitments in various ways. If you need special accommodations for a particular recruitment, you or someone on your behalf should immediately notify the DAS at (860) 713-7463. You must supply the application title and job number, and a description of your special needs and documentation of the disability. Rejection from State Application Your application for a state job opening may be rejected if (1) your application was received after the closing date, (2) you did not meet the minimum requirements, (3) your years of experience did not match the requirements, (4) specific information was missing from your application, (5) you failed to meet the special requirements for the position, or (6) your years of experience did not match the special requirements. Appointment Types Durational. An employee hired for a specific term, for a reason not provided above, including a grant or specially funded program, not to exceed one year. A durational employee shall become permanent after six months, or the length of the working test period, whichever is longer. Emergency. The state may appoint you to an emergency position to meet short-term agency needs. The appointment may extend for as long as two months but may not be renewed in a fiscal year. Intermittent. Intermittent employment is also work on an ""as needed"" basis. The agency may use intermittent interviewers to supplement permanent staff in times of high unemployment. They are paid an hourly rate for time worked and may receive benefits. They are eligible to apply for agency promotional postings following the completion of 1044 hours of intermittent service. 15 Permanent. The state may appoint you to a permanent competitive position from a certification list. You must successfully complete the working test period to gain permanent status. Provisional. The state may provisionally appoint you to a position that must be filled immediately if no active certification list exists, or an insufficient number of candidates are listed. The appointment may extend for as long as six months or until a job announcement for the position has been held and a certification list promulgated. You may not receive more than one provisional appointment in a fiscal year or serve more than six months as a provisional appointee. Your job performance while a provisional must be satisfactory. To receive a permanent appointment, you must be appointed from a competitive process for the position. If you are not appointed from a competitive process and do not have a permanent position to which you may return, you must be separated from state service. If the competitive process is not completed for a position within six months, an additional temporary or emergency appointment may be authorized. Seasonal. Seasonal employment for a position established for a specific period, usually during summer months. Individuals employed are paid an hourly rate and are not entitled to any fringe benefits. Temporary. Position filled for a short term, seasonal, or an emergency situation, including to cover for a permanent position when the incumbent is on workers’ compensation or other extended leave, not to exceed 6 months. May be extended up to one year. If a temporary employee is retained greater than 12 months, said employee shall be considered durational. Working Test Period The working test period, or probationary period, for a state employee is an extension of the state recruitment process. You must serve this period to gain permanent status following initial appointment or promotion. Your initial test period is generally six months, depending on the applicable contract or state regulation. Your promotional test period is generally four to six months, again depending on the applicable contract or regulation. Exceptions may occur in the length of the trial period for trainee positions. Questions about your working test period may be directed to your supervisor or Human Resources Generalist. During an initial working test period, you are considered a probationary employee and will work closely with supervisors and colleagues to learn your duties. This period also gives your supervisor the opportunity to evaluate your response to training and job requirements. If you demonstrate acceptable performance during your initial test period, you will be given a satisfactory service rating and gain permanent status as a state employee. Your working test period may be extended in certain circumstances. If you do not meet acceptable performance standards during the initial working test period, you will be separated from state service. You may not appeal a dismissal during your initial test period through the contractual grievance procedure, but you may request an administrative review. If you fail to meet acceptable performance standards during a promotional working test period, you will revert to your previous classification. 16 Service Ratings You will receive a service rating for your initial working test period or promotional test period, and at least three months before your annual increase date. Depending on your union contract or state statutes, you may receive a service rating at any time, particularly when your job performance has changed significantly. Service ratings record your progress and performance as training and job experience increase. The state recognizes satisfactory performance by awarding annual salary increases (as negotiated) until reaching the maximum step in a salary group. For employees at the maximum step, some bargaining units award a lump sum payment in lieu of an annual increment. A “less than good” rating may prevent you from receiving an increase. An “unsatisfactory” during the working test period signifies failure. After attaining permanent status, two successive “unsatisfactory” ratings may result in your dismissal. Managers are evaluated in accordance with the provisions of the Performance Assessment and Recognition System (PARS) Program. Promotion & Reclassification Generally, there are two ways in which you may receive an appointment to a higher-level job classification. First, you may compete for a new position or an opening that arises when another employee leaves an existing position. The agency may use a formal state employment application process to obtain a list of candidates to be considered for an opening or it may use a less formal recruitment and selection process. In either event, in order to be considered you must meet the minimum qualifications for the higher classification and comply with the application procedures. Recruitment notices are posted internally on the agency intranet, and at times externally on the Department of Administrative Services website. It is your responsibility to monitor them and respond according to the instructions on the job posting. Additionally, you may progress to a higher level through reclassification. After working for the agency for some time, you may find that your duties have expanded and are more consistent with a higher-level job classification. In such cases, your supervisor will ask you to complete a job duties questionnaire, which will be evaluated by Human Resources. If you are found to be working “out of class,” the agency has the option of either removing the higher-level duties or reclassifying your position to the higher level. Certain conditions must be met for reclassification. You must be in your current position for at least six months, have a rating of “good” or better on your last two performance evaluations and meet the minimum experience and training requirements for the higher class. If you have applied for a job opening and did not qualify for the classification, this is evidence that you do not meet the qualifications for the higher-level class and cannot be considered for reclassification. Temporary Service in a Higher Class When a temporary vacancy occurs in a non-entry level classification, such as the result of an employee being on an extended leave of absence, the agency may fill the opening by temporarily assigning you to a higher level as long as the assignment lasts for more than 30 days and meets any other relevant union contract provisions. You must meet the minimum qualifications of the class. While serving in this type 17 of service, you are paid at the higher level, but you retain status in your permanent (lower) classification. Benefits such as longevity and vacation accrual are based on the permanent class. Transfers You may voluntarily transfer within the agency or to another state agency. To place your name on a Statewide Transfer list, for your current job class in which you hold permanent status, please visit the DAS Website, Freenames - Department of Administrative Services (jobapscloud.com), scroll down and follow the process of Statewide Transfers. If your job classification is unique to the agency, your transfer options will be limited to those classes deemed comparable to the one in which you have permanent status. Consult your union contract for more information. If you are interested in transferring to another work location within the agency and meet the eligibility of the job requirements, Human Resources will send emails periodically with transfer opportunities, to be considered you must follow the procedures noted on the email. The agency may involuntarily transfer you under certain circumstances, generally defined in your union contract or state personnel regulations. Transfers occur for a variety of reasons: when the agency seeks to better use its resources, to avoid layoffs, to meet emergency or seasonal conditions, or to accommodate you. If you are an exempt employee, your transfer is subject to state regulations and the State Personnel Act. Dual Employment You may be authorized to work at a secondary agency subject to the dual employment provisions of the regulations for state agencies. For this to occur, the secondary agency must initiate and complete the appropriate paperwork. The secondary agency will forward a copy of the dual employment request form to the primary agency for completion and return. If all provisions are met, subject to any fair labor standards considerations and the operating needs of the department, you may be eligible for secondary employment. Secondary employment may not pose a conflict of interest or interfere with the performance of your job duties and your approved work schedule for the Department of Labor. 18 Personnel Records Personnel Files The agency maintains a digital personnel file containing information about your employment: service ratings; personnel processing forms; appointment, promotion, and disciplinary letters. The agency also maintains a separate, confidential file that contains your medical documents, including doctor’s notes and medical certificates. You may review your digital personnel file by contacting Human Resources. You may sign a waiver to allow another person, such as a union official, to review your files. The agency must comply with written requests for information about its employees under the state freedom-of-information law. If the agency considers an information request to be a possible invasion of your privacy, you will be notified. Change of Personal Data Whenever you change your name, address, number of dependents, telephone number, or marital status, you must promptly notify Payroll so that agency records and files may be updated. You may also need to complete a new federal or state withholding allowance certificate (W-4 or CT W-4), or various health insurance forms. Working Hours The negotiated workweek for most staff members currently averages 40 hours per week. Some union contracts provide for a 35 or 37.5-hour workweek. Many employees work a standard schedule of 8:00 a.m. to 4:30 p.m. The agency has also established nonstandard work schedules, which are approved in advance by the appointing authority in consultation with the Director of Human Resources. Provision for flex time has been included in some contracts. If your position is covered by flex time or other nonstandard workweek, your supervisor will explain its operation. The Payroll Unit will maintain your attendance record. From time to time and consistent with the terms of the applicable collective bargaining agreement, it may be necessary to temporarily or permanently change your work schedule to meet operational needs. In such a situation you will be given as much notice as possible, at a minimum that is required by your union contract. Regardless of your work schedule, you are expected to arrive at work on time, return from lunch and breaks on time, and not leave your job prior to quitting time. 19 Meal & Break Periods Full-time employees are permitted two 15-minute breaks and a 30-minute unpaid meal period. Longer unpaid meal periods are allowed with supervisory approval. The schedule for all meal and break periods is determined by your supervisor based on business operations and staffing needs. Your supervisor will inform you of your schedule and any required changes. Employees are not permitted to work through lunch to leave early. Breaks do not accumulate, nor may they be used to start late or leave early. Overtime & Compensatory Time Overtime occurs when you work in excess of your regular established weekly schedule. Overtime assignments must be approved in advance, except in extreme emergencies. The Fair Labor Standards Act (FLSA), state statutes and regulations, and your union contract govern your eligibility for overtime and the rate of compensation. Compensatory time is a form of accrued leave time that may be used later; it does not constitute a basis for additional compensation. Compensatory time must be taken in accordance with the provisions of your contract and agency policy. The FLSA may conflict with your union contract regarding compensation for overtime. Generally, you will be paid by the method that provides the greater benefit. Hours worked in excess of 40 in one week are generally compensated at the rate of time-and-one half. The time-and-one-half rate is derived from your basic hourly wage rate. Some employees may be ineligible for the overtime provisions of FLSA. Questions may be directed to Payroll. Shift Assignments Some areas engage in multi-shift operations. Depending on the starting and ending times of your shift and union contract, you may be eligible for shift-differential payments. These usually take the form of additional pay for the hours worked on your assigned shift. Generally, any shift that begins before 6:00 a.m. or after 2:00 p.m. is subject to shift-differential payments. Some employees may not be eligible for these payments, even when assigned to such a shift. Consult your union contract for information regarding eligibility for the shift and weekend differentials, and the applicable pay rate. Attendance You are responsible for maintaining a good attendance record. Frequent absenteeism reduces the level of your service to the agency and the public, increases operational costs, and places a burden on your co-workers. Use your accrued leave in accordance with agency policies and procedures and ensure that you comply with Employee Dependability Policy requirements. You should request leave time as far in advance as possible. Refer to your union contract for additional guidelines. Agency operating needs, the reasonableness of the request, and the specific language contained in the union contract govern the approval or denial of your leave request. Whenever possible, avoid unscheduled leave. 20 Paid Leave Time Holidays The state grants 13 paid holidays per year to permanent, full-time employees: New Year’s Day, Martin Luther King’s Birthday, Lincoln’s Birthday, Washington’s Birthday, Good Friday, Memorial Day, Juneteenth Day, Independence Day, Labor Day, Columbus Day, Veterans’ Day, Thanksgiving Day and Christmas Day. Intermittent and durational employees must work the equivalent of six months (1044 hours) to be eligible for holiday pay. If a holiday falls on a Saturday or Sunday, the state generally designates the Friday preceding or the Monday following as the day it will be observed. A calendar detailing the exact day of holiday observance appears on the Human Resources intranet site. You will be paid for a holiday if you are on the payroll on or immediately before or after the day it is celebrated; you normally will not receive holiday pay if on a leave of absence without pay before and after a scheduled holiday. Consult your union contract for information about compensation for work performed on a state holiday. Sick Leave As a permanent employee, you accrue sick leave from your date of employment for each fully completed calendar month of service, except as otherwise provided in the statutes. You must use sick leave when incapacitated or in the special cases described in your union contract. Upon exhaustion of sick leave, you must use other accrued leave in lieu of sick leave unless FMLA rules dictate otherwise. If an employee is sick while on annual vacation leave, the time will be charged against accrued sick leave if supported by a properly completed medical certificate. Sick leave is not an extension of vacation or personal leave. You should maintain a sick leave balance as a form of insurance in the event of a long-term illness. Accrual. Full-time employees accrue paid sick leave at the rate of 1¼ days per completed month of service or 15 days per year. If you are absent without pay for more than forty hours in any month, you do not accrue sick leave in that month. If you are an eligible part-time employee, you accrue paid sick leave on a pro-rated basis or on the amount of your scheduled hours as a percentage of a full-time schedule. Balances. Payroll records your sick leave balance (time accrued but not used) in hours and minutes. When you retire, the state will compensate you for 25 percent of your accrued sick leave balance (to a maximum of 60 days). Call-In Procedure. If you are unexpectedly absent as a result of injury or illness, you must notify your supervisor or designee as early as possible, but no later than one-half hour before your scheduled reporting time. If your absence is continuous or lengthy and you have not been granted a medical leave 21 of absence, you must notify your supervisor on a daily basis. If you fail to call in, you may be placed on unauthorized leave without pay and subject to corrective action. Medical Documentation. Your physician must complete a medical certificate if you are absent as the result of injury or illness for more than five working days or as otherwise outlined in your union contract or state personnel regulations. If you fail to provide the required medical documentation, you may be placed on unauthorized leave, which can lead to loss of pay and disciplinary action. Medical certification forms should be emailed directly to DAS.BenefitsandLeavesPod4@ct.gov. Any questions must be sent directly to DAS.BenefitsandLeavesPod4@ct.gov. Additional Use of Sick Leave. You may use sick leave for situations other than your own injury or illness (a medical certificate or written statement supporting a request may be required): • • • • • Medical, dental or optical examination or treatment when arrangements cannot be made outside working hours. Death in your immediate family. Illness or injury to a member of your immediate family. Funeral for a person other than an immediate family member. Birth, adoption or taking custody of a child. To determine the exact number of days allowed, refer to your union contract. Extended Illness or Recuperation. If you exhaust your accrued sick leave during a prolonged illness or injury, you may be permitted to use other accrued time. You must obtain approval from your immediate supervisor for use of other accrued leave to cover the remainder of the absence. In certain circumstances, you may be granted an advance of sick leave if you have at least five years of full-time state service. Consult your union contract for information regarding the sick leave bank or donation of leave time. If an employee has no accrued leave time available, a written request for a medical leave without pay must be submitted to DAS.BenefitsandLeavesPod4@ct.gov, and the request must be followed up in writing upon return to work. Failure to do so will result in charging the absence to Sick Leave Without Pay. Illness or Injury While on Vacation. If you become ill or injured while on vacation, you may request that the recovery time be charged to your sick leave rather than to your vacation leave. A medical certificate or documentation support your request will be required. Vacation Leave Usage. As a full-time employee, you may begin taking paid vacation leave after six months of continuous service. Unless otherwise stated in a union contract, a part-time employee may begin taking paid vacation after completing the equivalent of six months of full-time service (1044 hours). Requests for vacation leave are subject to the approval of your supervisor, based on the operating needs of the unit and the seniority provisions of your contract. 22 Accrual. You accrue vacation leave at the end of each full calendar month of service. Absence without pay for more than five days (equivalent to 40 hours) in a month result in the loss of accrual for that month. You accrue vacation leave at the following rate for each completed month of service (prorated, if part-time): • • • 0-5 years of service: 1 day per month (12 days per year). 5-20 years: 1-1/4 days per month (15 days per year). 20 or more years: 1-2/3 days per month (20 days per year) As a manager and confidential employees excluded from collective bargaining, you accrue vacation leave at the rate of 1-1/4 days per completed month of service or 15 days per year. After completing 10 years of service, on January 1 of each subsequent year you will receive the following number of days in addition to the normal accrual: • • • • • 11 years of service: 1 additional day 12 years: 2 additional days 13 years: 3 additional days 14 years: 4 additional days 15 or more years: 5 additional days Balances. Payroll will record your vacation leave balance in hours and minutes. Without agency permission, you cannot carry more than 10 days of accrued vacation leave from one year to the next if you are a nonexempt employee. If you are a nonexempt employee, refer to your bargaining union contract regarding your maximum accrual. If you are a nonexempt employee or a manager, you may accumulate as many as 120 days of vacation time. When separated from state service, if a permanent employee, you will receive a lump-sum payment for your vacation leave balance. Personal Leave As a full-time employee who has attained permanent status, you are credited with three days of personal leave to conduct private affairs, including the observance of religious holidays. On January 1 of each year thereafter, three days of personal leave will be credited to your leave balance. You must request authorization in advance from your supervisor to use personal leave. Personal leave must be used prior to the end of the calendar year or it will be forfeited. You are responsible for monitoring your time charges to ensure that your personal leave is used within the calendar year. Part-time employees generally are entitled to prorated personal leave; consult your union contract for the specifics. Payroll will maintain your balance. Jury Duty If you are summoned for jury duty, you will not lose your regular salary or benefits. You must notify your supervisor immediately and supply the jury notice; your supervisor will forward it along with the reason for your absence to the Payroll Unit. The court will supply you with verification of your attendance; which is then submitted through your supervisor to Payroll. You must return to work 23 whenever not actively serving on jury duty. With the exception of travel allowances, you must return the money received for jury duty to Payroll. Military Leave If you are a member of the National Guard or a reserve component of the U.S. armed forces and a permanent employee, you may apply for leave to attend required training. To verify the leave, you must submit a copy of your military orders to DAS.BenefitsandLeavesPod5@ct.gov or fax to 860-622-4928. The state permits as many as three weeks in a calendar year for field training. Paid leave for military call-ups other than annual training is limited to unscheduled emergencies, subject to the provisions of your union contract. Notify your supervisor as soon as you become aware of your military leave schedule. 24 Leave Without Pay Leave of Absence Without Pay (LAW) Depending on the terms of your union contract, you may be granted a LAW without endangering your status as a state employee. Your benefits, however, may be affected. You will not accrue vacation or sick leave in any month on a LAW for more than five working days (hourly equivalent of) without pay, and service credit toward retirement, seniority and longevity may be suspended. If you are on a LAW for pregnancy, illness, injury, or an FMLA-qualifying reason, the state will continue to pay the same portion of your health insurance as while you were working. You will, however, be billed directly for the amount that you previously paid through payroll deduction. If on a LAW for another reason, you will be billed for the full cost of medical coverage. If possible, submit your LAW request to DAS.BenefitsandLeavesPod4@ct.gov in advance and in writing with appropriate documentation. Your manager may grant a LAW for as many as five consecutive days. A LAW of longer than five days must be authorized by the Benefits and Leaves Pod before the leave, except in extraordinary situations such as emergency medical leave. You may be granted a LAW for a variety of purposes on a position-held or not-held basis. Your LAW must be consistent with the requirements in your union contract or state regulations if you are an exempt employee. If your position is held, you may resume employment on the expiration of the LAW. You must be cleared by a physician to return to normal duties if you are on a medical LAW. This needs to be done before you return to work. If your position is not held, your return to active service depends on the availability of a position. The agency will consider the reason for your request, your work record and agency operating needs when deciding whether to grant you a LAW and to hold your position. Maternity Leave If pregnant, you must use accrued sick leave to cover time before, during or after your delivery when a physician certifies you as “unable to perform the requirements of your job.” You must send a Medical Certificate - P33A to DAS.BenefitsandLeavesPod4@ct.gov to substantiate your disability. When your disability period ends or you have exhausted your sick leave balance prior to the end of your disability period, you may request to use accrued vacation and personal leave. When all your paid leave has been used, you may request a LAW with your position held. Refer to your union contract and the FMLA Policy for further information. Medical Leave You must use accrued sick leave to cover the time which you are unable to work because of illness. If that period extends beyond five days, you will need to supply a Medical Certificate - P33A to DAS.BenefitsandLeavesPod4@ct.gov to substantiate your use of sick time to. When your sick leave balance is exhausted, you must apply vacation or personal leave to cover your absence unless FMLA rules dictate otherwise. Your union contract may contain provisions for advance of sick leave, a sick leave bank, and donation of leave time in cases of prolonged illness. You may also request a leave of absence without pay. Details on the requirements and provisions of such leaves are in your union contract and the FMLA policy. 25 Family Leave You may request a LAW for the birth or adoption of a child; the serious illness or health condition of a child, spouse or parent; your own serious health condition; the placement of a foster child in your care and certain other conditions. A medical certificate must be submitted by email to DAS.BenefitsandLeavesPod4@ct.gov to substantiate a request for leave under the Family and Medical Leave Act (FMLA). You must request forms by sending an email to DAS.BenefitsandLeavesPod4@ct.gov. 26 SALARY Payment Your job classification determines your salary grade. Classifications are assigned to a salary group based on the amount and type of required experience and training, technical complexity, difficulty and level of responsibility. The state establishes a number of steps for salary groups other than managerial and confidential classes. As a new employee, you will generally start at the salary range minimum for your job classification. Payday The state issues salary payments bi-weekly through a checkless system called e-pay. You will receive payment for the work you performed during the previous two weeks. The delay allows for processing. If you are a new employee, you should receive your first salary payment four weeks after your first workday. If you separate from state service, you will receive your last salary payment two weeks following the end of the last pay period worked. Earnings, itemized deductions and leave accruals are viewable online. Questions should be directed to Payroll. Annual Increments Annual increments are based on the terms of your union contract. You may be raised to the next higher step in a salary group on your anniversary date. Consult your union contract for details. If an appointed official or manager, you may be awarded an increase by the governor, usually effective on January 1. The amount of the increase will be based on your goal attainment and performance under PARS, the Performance Appraisal and Recognition System for managers. Collective Bargaining & Cost-of-Living Increases If you are a union member, your increase will result from the collective bargaining process. An increase generally will be calculated as an across-the-board percentage within a negotiated salary structure and payable in July. If you are an appointed official or a manager, the governor may award you a cost-ofliving increase, usually a percentage of your annual salary, also payable in July. When promoted, you will normally receive a salary increase of at least one full step in the salary group, unless you are placed at the maximum step. If promoted to a managerial position, you will receive an increase of five percent or the minimum of the new salary range, whichever is greater. Longevity Pay Employees hired on or after July 1, 2011, shall not be entitled to a longevity payment however, any individual hired on or after said date who shall have military service which would count toward longevity under current rules shall be entitled to longevity if they obtain the requisite service in the future. Employees hired prior to July 1, 2011, are eligible for longevity. For those eligible employees, when you complete the equivalent of 10 years of full-time state service (generally continuous) you will receive a longevity payment. The amount of longevity payment increases when you complete 15, 20, and 25 year years of service. Longevity schedules appear in your union contract and other pay plans. To qualify, you must attain the required years of service by April1 or October 1. Longevity payment are also paid 27 in these months. Employees not included in any collective bargaining unit are no longer eligible for longevity payments. 28 DEDUCTIONS Federal Income Tax & Social Security Tax Federal income and Social Security taxes will be deducted from your paycheck in accordance with federal law. Connecticut Income Tax State income tax will be deducted from your paycheck in accordance with state law. Health Insurance Health insurance coverage for eligible employees who choose to enroll in the state’s health benefit plan will be effective the first of the month immediately following the employee’s hire date or date of eligibility. For example, if you were hired on November 9, you must submit your application within thirty days; your effective date of coverage would be December 1. You may extend health and dental coverage to cover your spouse, dependent children under age 26, and/or disabled children over age 26. Please contact Payroll for enrollment eligibility. Refer to the Office of State Comptroller’s website for a summary of health insurance options and rates. You must remain with your insurance carrier until the next open enrollment period, the one time a year when you can change carriers. You may add a dependent newborn or spouse within one month of the birth or marriage (please note if adding a new spouse, a marriage certificate is required); other dependent changes generally are restricted to the open enrollment period. If your spouse’s insurance was terminated through his/her employer, you may be eligible to add them as a special exception. A letter from the employer stating insurance has been cancelled will be required. All additions, deletions, or other changes must be processed through the Payroll Unit. You must provide documentation of each dependent’s eligibility status at the time of enrollment. It is your responsibility to notify the Payroll Unit when any dependent is no longer eligible for coverage. Group Life Insurance You may purchase term life insurance at group rates. The state pays a portion of this coverage. You may authorize payroll deductions for this insurance after six months of employment. If you waive coverage and later decide to enroll, you must apply with medical evidence of insurability and wait for approval. The amount of life insurance coverage is based on your annual salary and is automatically adjusted on April 1 and October 1 as your salary increases. Contact the Payroll Unit to obtain forms or arrange for beneficiary changes. You may visit the Office of State Comptroller’s website (https://carecompass.ct.gov/supplementalbenefits/) for more information. Supplemental Benefits The state offers various supplemental benefits to qualified employees and retirees, which are designed to complement the benefits provided by the state. These benefits are on a voluntary basis and are paid entirely by the employee through the convenience of payroll deduction. Available supplemental benefits 29 are listed on the OSC website Supplemental Benefits - Care Compass (ct.gov). Contact the authorized vendors for information and assistance with the enrollment process. Direct Deposit You may deposit your paycheck in a checking or savings account in a financial institution that is a member of the automated clearinghouse. Your funds will be electronically transmitted and available to you after 9:00 a.m. on the date of the check. You must complete an authorization form to adjust or cancel direct deposit. Authorization forms can be obtained from Payroll. Deferred Compensation Permanent employees who work more than 20 hours a week are eligible for the state’s deferred compensation plan. Through payroll deduction, you may set aside a portion of your taxable wages (prior to tax deferrals). The minimum contribution is $20 per pay period. Obtain details by contacting the plan administrator. State Employees Campaign Through the state employee campaign, you may contribute to your choice of a range of service organizations via payroll deduction. Union Dues As a member of a collective bargaining unit, you may elect to join the union and have union dues deducted from your check. Your union determines the amount by using a set-rate or sliding-scale formula based on the amount of your salary. Credit Unions As an agency employee, you may join the, CT Labor Department Federal Credit Union, 200 Folly Brook Blvd., Wethersfield, CT 06109 (telephone 860-263-6500). As a State of Connecticut employee, you may also join the CT State Employees Credit Union. Offices are as follow: 84 Wadsworth Street Hartford, CT 06106 860-522-5388 1244 Storrs Road Storrs, CT 06268 860-429-9306 2434 Berlin Turnpike Newington, CT 06111 860-667-7668 401 West Thames Street Southbury Training School Norwich, CT 06360 Southbury, CT 06488 860-889-7378 203-267-7610 1666 Litchfield Turnpike Woodbridge, CT 06525 203-397-2949 Silver & Holmes Street Middletown, CT 06457 860-347-0479 30 Retirement Tiers The state and collective bargaining units negotiate the pension agreement. The retirement system includes five plans: Tier I, II, IIA, III and IV. For details, contact Office of the State Comptroller’s at osc.crsp@ct.gov or consult the specific retirement booklet for which you are a member. Online copies are available at the OSC website Retiree Resources (ct.gov). Tier I. Usually, you are member of this retirement plan if you were hired on or before July 1, 1984 and contribute by payroll deduction to your pension. You may retire at age 55 with 25 years of service, or at age 65 with 10 years of service, or retire early at age 55 with 10 years of service – at a reduced rate. This tier is divided into three plans. Members of Plans A and C contribute five percent of salary toward retirement. Members of Plan A have chosen not to participate in the Social Security plan; Plan C members pay Social Security taxes and are eligible for Social Security benefits. Plan B members contribute two percent of salary toward retirement until they reach the Social Security maximum, and five percent of salary above the maximum; they will receive reduced pensions when Social Security payments begin. You also may purchase periods of service for which you have not made contributions: war service, prior state service, and leaves of absence for medical reasons. Tier II. If you were hired into state service from July 2, 1984 to June 30, 1997, you are automatically covered under this noncontributing plan. If you were employed by the state on or before July 1, 1984, and were not a member of any other state retirement plan, the Tier II plan also covers you. You contribute two percent of your salary towards retirement. You are eligible for normal retirement benefits after you attain: (1) age 60 with at least 25 years of vesting service; (2) age 62 with at least 10, but less than 25 years of vesting service; or (3) age 62 with at least five years of actual state service. If you have at least 10 years of service, you can receive retirement benefits – at a reduced rate – if you retire on the first day of any month following your 55th birthday. Retirements on or after July 1, 2022 are subject to the age and years of service specified in the SEBAC 2011 agreement. Tier IIA. If you entered state service from July 1, 1997 to June 30, 2011, you are covered under this plan as of the date of your employment. You contribute two percent of your salary towards retirement have the same options and benefits as a Tier II employee. If you are not eligible for any retirement benefits when you leave state service, you may withdraw your retirement contributions. You also may purchase periods of service for which you have not made contributions: war service and leaves of absence for medical reasons. Tier III. This plan covers employees hired on or after July 1, 2011 to July 30, 2017. As a Tier III member, you contribute two percent of your total annual salary. Your normal retirement date is the first of any month on or after you reach age 63 if you have at least 25 years of service, or age 65 with at least 10, but less than 25 years of service. If you have 10 years of vesting service, you can receive early retirement benefits on the first of any month following your 58th birthday. If you are not eligible for any retirement benefits when you leave state service, you may withdraw your retirement contributions. 31 Tier IV. This plan covers employees hired on or after July 31, 2017. The Tier IV retirement plan provides elements of both a defined benefit and defined contribution plan. Defined Benefits – Participants that satisfy the minimum eligibility criteria will qualify for a pre-defined monthly retirement income for life, with the amount being determined by years of service, retirement age and Final Average Earnings. You contribute 7% of your annual salary (this rate is for fiscal year July 2023 through June 2024). Defined Contribution – You contribute 1% to a defined contribution plan with a 1% employer match. This plan also has a risk sharing component wherein for any given year the employee contribution can be up to 2% higher depending on the plan’s performance for the previous year. This contribution will be computed by the plan’s actuaries. (You may also contribute to a 457 plan). For additional information please see the State Comptroller’s Retirement Resources website . Please note: If you were a former state employee who contributed to a different state retirement plan, please contact Payroll 860-263-6195 or dol.payroll@ct.gov to see if you qualify to be placed into a different retirement plan. 32 Separation Resignation The personnel regulation on resignation reads: “An employee in the classified service who wishes to voluntarily separate from state service in good standing shall give the appointing authority at least two working weeks written notice of resignation, except that the appointing authority may require as much notification as four weeks if the employee occupies a professional or supervisory position.” If you resign, your written notice must include your last day of work and be submitted to your supervisor at least two weeks before you leave. You will receive a lump-sum payment for unused vacation time if you are a permanent employee. You may arrange to continue your health insurance benefits at the COBRA rate for a specific period of time. Contact Payroll for details on the length of coverage and payment amount. If you are not eligible for any retirement benefits when you leave state service, you may withdraw your retirement contributions. If you do not return to state service within five years and have not withdrawn your contributions, the Retirement Division will send you a refund application. After you complete the form and return it, you will receive your contributions plus interest. If the Retirement Division cannot locate you within 10 years after your employment ends, your contributions will become part of the retirement fund. If you submit your resignation less than two weeks before leaving, your separation may be regarded as not in good standing and may affect your re-employment rights. An unauthorized absence of five or more working days also will be considered as a resignation not in good standing. You will be notified if your resignation is considered as not in good standing and you may file an appeal with the Commissioner of the Department of Administrative Services. Layoff The state defines a layoff as an involuntary, non-disciplinary separation from state service resulting from a lack of work, program cutback or other economic necessity. Consult your union contract for particulars. If you are an exempt employee, consult Sec. 5-241 of the Connecticut General Statutes. Reemployment Rights In an effort to deliver services in a contemporary and cost effective fashion, the State of Connecticut uses a module called Freenames through the Online Employment Center (JobAps) as a platform for processing the following: • • • Mandatory rights for eligible individuals (reemployment/SEBAC/other mandatory rights) Statewide Transfer requests (non-mandatory transfers) Rescind of Resignation or Retirement requests This section applies to: Current or former State Employees who have been affected by the following: • • • Layoffs Noticed for layoff Accepted a demotion in lieu of layoff 33 • • • • • • Notified of eligibility for mandatory rights Recently failed a working test period and has permanent classified status Exercising rights to return to the classified service from the unclassified service Recently separated NP-2 employee with Article 39 Rights Current employees who request to place their names on a Statewide Transfer list Former employees who request to rescind their resignation in good standing or voluntary retirement. If you retire from state service, you are eligible for temporary employment in any class in which you had permanent status. As a re-employed retiree, you may work as many as 120 days per calendar year (bases on 40 hours per week prior to retirement) without adversely affecting your pension. Such appointments are totally at the discretion of the agency. Rescind of Resignation or Retirement If you have permanent status and resign in good standing, you may, within one year of the date of your separation, request to rescind your resignation by completing the Rescind Resignation request via the JobAps, Freenames Application within one year from date of resignation. This will enable you to be considered for any classes in which you had permanent status. Reinstatement is strictly voluntary on the part of the Agency and may occur at any time up to two years from the date of your separation. Former employees shall be fully independent in and responsible for conducting their own search for reinstatement by requesting rescind privileges via the JobAps, Freenames Application. Use the rescind of resignation or retirement option to request to rescind a resignation in good standing, or a retirement from state service in accordance with DAS General Letter 177. Note: There are no reemployment rights associated with a rescind of resignation. The State of Connecticut is not required to rehire individuals who rescind resignation. Rather, certain privileges may be granted depending on the job class and effective date of rehire. Requirements A former State employee must meet the following conditions: • Attained permanent status as a State employee • Separated from state service in good standing from a position in the Classified service or a bargaining unit position in the Unclassified service • You must know the job class you resigned or retired from. To locate this information, contact your former Human Resources Representative or refer to your last paycheck as an active employee. • You must include each job code matching your last held title including different hourly equivalent. For example: 7603EU= Information Technology Analyst 1 (35 hours) 7603FD= Information Technology Analyst 1 (40 hours) DAS will conduct a review and approve or deny all rescind requests for any or all job classes identified. Applicants will be notified of the status of their requests via email. Please be sure to keep your contact information updated and check your email and spam folders often as most communication will occur via email. 34 For detailed instructions to request to rescind a resignation in good standing or retirement, refer to Instructions Rescind Resignation or Retirement. Exit Interview Below you will find the link and QR code to access a confidential exit interview survey. Thank you for taking the time to engage in the exit interview process. This survey will only take approximately three minutes to complete. The information collected will help us evaluate factors like pay, benefits, work environment, and your overall work experience. All your answers are confidential, so please be candid with your responses. The information collected will help us to identify any potential areas where we can implement new strategies to increase the satisfaction of our workforce. Thank you again for your time and atention. Link to survey: Confidential Exit Survey State of Connecticut - DAS (office.com) QR code: 35 Retirement Retirement Types State employees are members of one of several retirement programs. Once an employee has completed the required actual or vesting service required by the retirement system, he/she is eligible for a pension. Retirements are effective on the first of the month following the last working day of the previous month. For retirement purposes, an employee who is on prolonged sick leave will retire the first of the month following the last working day that sick leave was used in the previous month (a medical certificate is required) and may qualify for a disability retirement. Types of retirement include, Normal, Early, Hazardous Duty or Disability. If you plan to retire you must send your Notice of Intent to Retire and Retirement Information Form via fax to 860-622-4928 or via email to DAS.BenefitsandLeavesPod5@ct.gov. Please refer to the Plan Summary which can be found on the Office of the State Comptroller’s website at Retiree Resources (ct.gov). Regardless of the type of separation from service; on the last day of work, the terminating employee must return State property to her or his supervisor. Pension Payment Options Option A - 50% Spouse: This option will pay you a reduced benefit for your lifetime in exchange for the protection that, should you pre-decease your spouse, the state will continue to pay 50% of your reduced benefit for your spouse's lifetime. Option B - 50% or 100% Contingent Annuitant: This option provides you a reduced monthly benefit for your life and allows you to guarantee lifetime payments after your death to a selected beneficiary. After your death, a percentage of your reduced benefit, either 50% or 100%, whichever you choose, will continue for your beneficiary’s life. Option C - 10 Year or 20 Year Period Certain: This option provides you a reduced monthly benefit for your lifetime in exchange for the guarantee that monthly benefits will be paid for at least 10 or 20 years from your retirement date (whichever you choose). Option D - Straight Life Annuity: This option pays you the maximum monthly benefit for your lifetime only. All benefits will end upon your death, including state-sponsored health insurance for any surviving eligible dependents. Insurance Benefits You must meet age and minimum service requirements to be eligible for retiree health coverage. Service requirements vary. For more about eligibility for retiree health benefits, contact the Retiree Health Insurance Unit at 860-702-3533. Regardless of the retirement option you choose, you will receive a monthly pension for the rest of your life, and, if you qualify for health insurance benefits, coverage will extend to your eligible dependents. Once you or your dependents become eligible for Medicare, this is your primary medical plan provider and the state plan is supplementary. 36 If you retire with at least 25 years of service and have state-sponsored life insurance, the state will pay for 50 percent of the amount of coverage (at least $7,500) as when employed. If you retire with less than 25 years of service, the state will pay a prorated amount. The Group Life Insurance Section of the Retirement Division will contact you following your retirement concerning conversion options. Disability retirement and pre-retirement death benefits are a part of your pension agreement. Pensions also are subject to cost-of-living increases as outlined in the agreement. For further information regarding retirement benefits call or email: Office of the State Comptroller Retirement Division 165 Capitol Avenue Hartford, CT 06106 Telephone: (860) 702-3490 Email: osc.rsd@ct.gov 37 TRAINING & DEVELOPMENT In-Service Training You may apply for Department of Administrative Services in-service training courses. Courses should be relevant to your position or career mobility, or to your unit’s operational needs. They are generally held during regular work hours in the spring and fall. Supervisor approval is required. For information, contact Employee and Organizational Development. Management Development Courses A calendar of courses focusing on leadership, supervisory and management development, strategic planning, customer service skills and total quality management techniques is distributed twice a year. Contact Employee and Organizational Development for particulars. Tuition Reimbursement You may seek tuition reimbursement from the state for courses taken during non-working hours at colleges, universities, technical schools or other accredited educational institutions. You do not need supervisory approval. Eligibility and funding provisions are outlined in your union contract if you are a bargaining unit employee. As a non-exempt employee, you may be reimbursed for a non-credited course through your union. Convert course hours to credits. For example, 6-14 hours equal one credit for tuition reimbursement; 15-29 hours, two credits; and 30-44, three credits. As a manager, you are eligible for tuition reimbursement from the State Management Advisory Council or agency funds. As a non-managerial confidential employee, you may apply for reimbursement in accordance with the union contract that would have included your job classification had your class not been excluded. For a fall semester class, you must document by Feb. 1 that you paid for a course and passed it, and by June 1 for a spring semester class. Forms and assistance are available through Employee and Organizational Development. You must submit your application to that unit at Central Office, 200 Folly Brook Blvd., Wethersfield, CT 061091114, at least two weeks before the start of a class. Conferences, Workshops & Seminars Your union contract may pay costs associated with conferences, workshops or seminars such as registration fees, travel expenses and meals. You must receive supervisory approval before processing a payment request. Consult you union contract for details. 38 EMPLOYMENT POLICIES (Ctrl + Click to follow links below) Acceptable Use of State Systems Policy - Statewide (2019) ADA Reasonable Accommodation Policy Affirmative Action Policy Statement – DOL (2023) AIDS Policy – DOL (7/16/2012) Background Check Policy and Procedures – DOL (10/31/2022) Disposition of Public Records Policy – DOL (11/28/2011) Discrimination and Illegal Harassment Prevention Policy – DOL (April 2023) Drug Free Workplace State Policy – DOL (7/16/2012) Employee Conduct Policy – DOL (8/3/2018) Employee Dependability Policy – DOL (7/16/2012) Employee Discipline Policy – DOL (7/16/2012) Ethical Conduct Policy – DOL (8/2013) Family Violence Leave Policy – Statewide GL 34 (1/2022) Federal Family & Medical Leave Act – DOL (7/16/2012) Health and Safety Policy – DOL (7/16/2012) Internal Discrimination Complaint Procedure – DOL (4/18/2023) Internal Security Standards - DOL Office Automation Policy, Standards and Guidelines – DOL (7/16/2012) Personal Wireless Device Policy (Rev. 9/9/2020) Phone Use Policy (Rev. 4/23/2023) Policy for DOL Facility Occupancy – DOL (7/9/2020) Professional Image Policy – DOL (3/1/2023) Prohibition of Weapons in DOL Worksites Policy – DOL (8/10/16) Public Officials and State Employees Guide to the Code of Ethics - Statewide 07/16/2012 Software Anti-Piracy Policy – DOL (7/16/2012) Vehicle-Use-for-State-Business-Policy--DAS-General-Letter-115--April-1-2012.pdf (ct.gov) Violence in the Workplace Prevention – DOL (4/2012) Workers Compensation Rights Responsibilities and Claims (ct.gov) Workplace Incident Report and Footprints Instructions – DOL (2015) **Please refer to online Employee Handbook for link activation. 39","Use information from the article only to explain your answer. Do not rely on outside knowledge. What does it mean that the Dept of Labor is hiring for an intermittent employment position? EMPLOYEE HANDBOOK Table of Contents Welcome................................................................................................................................................... 5 About the Agency .................................................................................................................................... 6 Mission Statement ................................................................................................................................... 6 Supersedence ........................................................................................................................................... 6 General Highlights .................................................................................................................................. 7 Access Card ............................................................................................................................................. 7 Affirmative Action/Equal Employment Opportunity Employer ....................................................... 7 Americans with Disabilities Act ............................................................................................................ 7 Appearance & Dress Code ..................................................................................................................... 7 Building Security .................................................................................................................................... 7 Code of Ethics ......................................................................................................................................... 7 Collective Bargaining ............................................................................................................................. 7 Email & Internet Use.............................................................................................................................. 8 Employee Assistance Program .............................................................................................................. 8 Employee Background Check ............................................................................................................... 8 Employment Applications ...................................................................................................................... 8 Equal Employment Opportunity........................................................................................................... 8 Immigration Law Compliance............................................................................................................... 8 On-the-Job Accident/Illness ................................................................................................................... 9 Photo Identification ................................................................................................................................ 9 Political Activity ...................................................................................................................................... 9 Rideshare ................................................................................................................................................. 9 Safety ........................................................................................................................................................ 9 Sexual Harassment ................................................................................................................................. 9 Smoking ................................................................................................................................................. 10 Standards of Conduct ........................................................................................................................... 10 Telephones - Cellular Telephones ....................................................................................................... 10 Travel ..................................................................................................................................................... 10 Uniformed Services Employment & Reemployment......................................................................... 10 Violence in the Workplace ................................................................................................................... 10 Visitors ................................................................................................................................................... 11 Weather & Emergency Closings ......................................................................................................... 11 Collective Bargaining ........................................................................................................................... 12 Bargaining Unit Representation .......................................................................................................... 12 Union Contracts .................................................................................................................................... 12 2 Grievance Procedure ............................................................................................................................ 12 Appointment and Promotion ............................................................................................................... 14 Merit System ......................................................................................................................................... 14 Job Classification .................................................................................................................................. 14 Classified & Unclassified Positions ..................................................................................................... 14 Competitive & Non-Competitive Positions ........................................................................................ 14 Scheduled & Continuous Recruitment Job Announcements ........................................................... 14 Job Announcements.............................................................................................................................. 14 Employment Opportunities ................................................................................................................. 15 Application Accommodations for People with Disabilities ............................................................... 15 Rejection from State Application ........................................................................................................ 15 Appointment Types .............................................................................................................................. 15 Working Test Period ............................................................................................................................ 16 Service Ratings ...................................................................................................................................... 17 Promotion & Reclassification .............................................................................................................. 17 Temporary Service in a Higher Class ................................................................................................. 17 Transfers ................................................................................................................................................ 18 Dual Employment ................................................................................................................................. 18 Personnel Records ................................................................................................................................ 19 Personnel Files ...................................................................................................................................... 19 Change of Personal Data ...................................................................................................................... 19 Working Hours ..................................................................................................................................... 19 Meal & Break Periods .......................................................................................................................... 20 Overtime & Compensatory Time ........................................................................................................ 20 Shift Assignments.................................................................................................................................. 20 Attendance ............................................................................................................................................. 20 Paid Leave Time ................................................................................................................................... 21 Holidays ................................................................................................................................................. 21 Sick Leave .............................................................................................................................................. 21 Vacation Leave ...................................................................................................................................... 22 Personal Leave ...................................................................................................................................... 23 Jury Duty ............................................................................................................................................... 23 Military Leave ....................................................................................................................................... 24 Leave Without Pay ............................................................................................................................... 25 Leave of Absence Without Pay (LAW) ............................................................................................... 25 Maternity Leave .................................................................................................................................... 25 3 Medical Leave ....................................................................................................................................... 25 Family Leave ......................................................................................................................................... 26 Salary ..................................................................................................................................................... 27 Payment ................................................................................................................................................. 27 Payday .................................................................................................................................................... 27 Annual Increments ............................................................................................................................... 27 Collective Bargaining & Cost-of-Living Increases ............................................................................ 27 Longevity Pay ........................................................................................................................................ 27 Deductions ............................................................................................................................................. 29 Federal Income Tax & Social Security Tax ....................................................................................... 29 Connecticut Income Tax ...................................................................................................................... 29 Health Insurance ................................................................................................................................... 29 Group Life Insurance ........................................................................................................................... 29 Supplemental Benefits .......................................................................................................................... 29 Direct Deposit ........................................................................................................................................ 30 Deferred Compensation ....................................................................................................................... 30 State Employees Campaign ................................................................................................................. 30 Union Dues ............................................................................................................................................ 30 Credit Unions ........................................................................................................................................ 30 Retirement Tiers ................................................................................................................................... 31 Separation .............................................................................................................................................. 36 Resignation ............................................................................................................................................ 33 Layoff ..................................................................................................................................................... 33 Reemployment Rights .......................................................................................................................... 33 Rescind of Resignation or Retirement ................................................................................................ 33 Exit Interview ........................................................................................................................................ 33 Retirement ............................................................................................................................................. 33 Retirement Types .................................................................................................................................. 36 Pension Payment Options .................................................................................................................... 36 Insurance Benefits ................................................................................................................................ 36 Training and Development .................................................................................................................. 38 In-Service Training ............................................................................................................................... 38 Management Development Courses .................................................................................................... 38 Tuition Reimbursement ....................................................................................................................... 38 Conferences, Workshops & Seminars ................................................................................................ 38 EMPLOYMENT POLICIES ............................................................................................................... 39 4 Welcome Whether you have just joined the agency or have been with us for a while, we are confident that you will or have found our organization to be a dynamic and rewarding place in which to work. We consider the employees of the Department of Labor to be our most valuable resource and we look forward to a productive and successful partnership. This handbook has been prepared for you to serve as a guide for the employer-employee relationship. The topics covered in this handbook apply to all employees of the Department of Labor. It is important to keep the following things in mind about this handbook. First, it contains general information and guidelines. It is not intended to be comprehensive or to address all the possible applications of, or exceptions to, the general policies and procedures described. It is not intended to replace or supersede collective bargaining agreements that may cover many of your terms and conditions of employment. Employees covered by a collective bargaining agreement will receive a copy of their contract at orientation. You should read and become familiar with your collective bargaining agreement, this employee handbook and the agency’s employment policies. If you have any questions concerning eligibility for a particular benefit, or the applicability of a policy or practice, you should address your specific questions to your supervisor or contact your HR Generalist for clarification. Second, neither this handbook nor any other agency document confers any contractual right, either expressed or implied, to remain in the agency’s employ or guarantee any fixed terms and conditions of your employment. Third, the policies, procedures, and benefits described here may be modified or discontinued from time to time. We will try to inform employees of any changes as they occur but cannot guarantee immediate advance notice of changes. Finally, some of the subjects described here are covered in detail elsewhere. The terms of written insurance policies and/or plan documents are controlling for health, life, retirement and deferred or reduced income benefits. You should refer to those documents for specific information since this handbook is only designed as a brief guide and summary of policies and benefits. We are pleased to have you as a member of the Department of Labor and look forward to a successful and beneficial association. 5 About the Agency The Department of Labor handles far more than unemployment insurance benefits. Helping employers and jobseekers with their workforce needs is our goal. An overview of the many programs and public services the agency offers is available on the website (www.ct.gov/dol), which also contains information ranging from upcoming job fairs to wage and workplace guidelines. Mission Statement The Department of Labor is committed to protecting and promoting the interests of Connecticut workers. In order to accomplish this in an ever-changing environment, we assist workers and employers to become competitive in the global economy. We take a comprehensive approach to meeting the needs of workers and employers, and the other agencies that serve them. We ensure the supply of high-quality integrated services that serve the needs of our customer. Supersedence This revised version of the Employee Handbook supersedes all prior versions that have been issued by the Department of Labor and will be effective April 2023. 6 General Highlights Access Card Central Office and Annex employees are issued an access card to enter the building. Should your card be lost, stolen or destroyed, contact Facilities Operations so the card can be deactivated and a replacement issued. Affirmative Action/Equal Employment Opportunity Employer The Department of Labor is committed to affirmative action/equal employment that will build on the strengths of our current workforce and continually enhance the diversity of our organization. The department opposes all forms of discrimination and has developed a set of anti-discriminatory policies. Please direct your questions about affirmative action issues to the AA/EEO Manager at Central Office, 200 Folly Brook Boulevard, Wethersfield, CT 06109; telephone (860) 263-6520. To file a complaint, please click on the link to access the form: Internal Discrimination Complaint Americans with Disabilities Act The Department of Labor complies with all relevant and applicable provisions of the Americans with Disabilities Act (ADA). The agency will not discriminate against any qualified employee or job applicant with respect to any terms, privileges, or conditions of employment because of a person’s physical or mental disability. See the Americans with Disabilities Act Reasonable Accommodation Policy Appearance & Dress Code It is the policy of the agency to project a business-like image to clients, visitors and co-workers. In line with this, you are required to dress appropriately in clothing which is suitable for your job responsibilities and work environment, meets the requirements established for safety reasons, and complies with the agency’s dress code requirements. See Professional Image Policy. Building Security Each and every employee must follow the building security rules and regulations. Employees are not allowed on the property after hours without prior authorization from their supervisor. Code of Ethics The department’s standards of ethical conduct, which all employees are expected to be familiar with and observe, are outlined in the Code of Ethics for Public Officials & State Employees and the Ethical Conduct Policy . Collective Bargaining Your assignment to a collective bargaining unit (union) is based on your job classification. As a bargaining unit member, you will have union dues deducted from your bi-weekly paycheck. You may elect not to join a union. Your union contract governs salary, benefits and hours of work, and other terms and conditions of employment. Collective bargaining agreements are negotiated periodically. 7 Exempt employees are excluded from the collective bargaining process and are not required to pay union dues. Email & Internet Use It is the policy of the agency to provide electronic mail (email) and internet access for work-related purposes. You are required to adhere to this and related policies to ensure proper, legal and effective use of these electronic tools and resources. See Acceptable Use of State Systems Policy. Employee Assistance Program The Employee Assistance Program (EAP) is designed to offer consultation and counseling services for employees and their dependents who are experiencing problems which may be impacting their life at work and/or at home. Some of these problems may include family, marital, alcohol/drugs, emotional distress, and job-related, legal, or financial difficulties. Participation is voluntary and confidential. EAP services are provided by Wheeler EAP. To schedule an appointment or obtain more information, call 1800-252-4555 or 1-800-225-2527, or log on to their website at Wheeler EAP. Employee Background Check Prior to making an offer of employment, Human Resources may conduct a job-related background check. A comprehensive background check may consist of prior employment verification, professional reference check, education confirmation and fingerprinting. Employment Applications We rely upon the accuracy of information contained in an employment application and the accuracy of other data presented throughout the hiring process and employment. Any misrepresentation, falsification or material omission of information or data may result in exclusion of the individual from consideration for employment or, if the person has been hired, termination of employment. Equal Employment Opportunity The Department of Labor is an equal employment opportunity employer. Employment decisions are based on merit and business needs. The Department of Labor does not discriminate on the basis of race, color, citizenship status, national origin, ancestry, gender, sexual orientation, age, religion, creed, physical or mental disability, marital status, veterans’ status, political affiliation, or any other factor protected by law. To file a complaint, please click on the link to access the form: Internal Discrimination Complaint. Immigration Law Compliance All offers of employment are contingent on verification of the candidate’s right to work in the United States. On the first day of work, every new employee will be asked to provide original documents verifying his or her right to work and, as required by federal law, to complete and sign an Employment Eligibility Verification Form I-9. 8 On-the-Job Accident/Illness The agency promotes safety in the workplace. The State of Connecticut also has implemented a Managed Care Program for Workers’ Compensation, administered by Gallagher Bassett Services, Inc. You must report a work-related accident or illness to your supervisor, who is required to call a 24-hour hotline (1-800-828-2717) to report your accident or illness and initiate a claim. If your supervisor is unavailable, you may call or have someone call for you. Your supervisor must also complete the First Report of Injury (Form WC-207) and submit it to DAS_RfaxWCHE@ct.gov or by fax to 959-200-4841, whether or not you seek treatment or lose time from work. To become eligible for workers’ compensation benefits, you must seek treatment from a network physician or medical facility. Forms can be obtained at Workers' Compensation Rights, Responsibilities, and Claims--Documents (ct.gov). In cases of a medical emergency call 911 to seek immediate medical attention. Contact the DAS Workers' Compensation Division at (860) 713-5002 with any questions regarding access. Photo Identification You are required to wear and visibly display a photo identification badge during working hours. If your identification badge is lost, stolen, or destroyed, or you have transferred to a different unit, you must request a replacement through Facilities Operations. Political Activity As a state employee, state statutes govern your involvement in various political activities such as campaigning and running for elective office. Also, if you are working on programs financed in whole or in part by federal funds, you are subject to the provisions of the federal Hatch Act, which is generally more restrictive than state statue. The purpose of these laws is to avoid a conflict of interest between your state job and political activities. Information regarding political activity may be found in DAS General Letter 214D, link to document General Letter 214D – Political Activity. The Ethical Conduct Policy also addressed these issues and you are advised to contact the agency’s Ethics Liaison regarding any political activity. See Ethical Conduct Policy. Rideshare The department promotes the statewide Rideshare Program, an opportunity to reduce your transportation expenses to work. Consider using a ride-sharing mode (carpool, vanpool or bus) as an alternative to driving alone. Ride sharing saves you money, energy and preserves the environment. For information call 800-972-EASY (800-972-3279) or visit the website at www.rideshare.com. Safety The safety and health of employees is our top priority. The agency makes every effort to comply with all federal and state workplace safety requirements. Each employee is expected to obey safety rules and exercise caution and common sense in all work activities. Promptly report safety concerns to your supervisor. Sexual Harassment The Department of Labor does not tolerate sexual harassment. Sexual harassment may include unwelcome sexual advances, requests for sexual favors, or other unwelcome verbal or physical contact 9 of a sexual nature when such conduct creates an offensive, hostile and intimidating work environment and prevents an individual from effectively performing the duties of their position. See Sexual Harassment Policy. Smoking Smoking is prohibited throughout agency buildings and offices, including in rest rooms, private offices, lounges and similar areas. Smoking is permitted only in designated areas outside office buildings and other work locations. The use of smokeless tobacco and e-cigarettes are also prohibited and subject to the same restrictions. Standards of Conduct The work rules and standards of conduct for employees are important and the agency regards them seriously. All employees are urged to become familiar with and must follow these rules and standards. See Employee Conduct Policy. Telephones - Cellular Telephones The agency recognizes that occasionally it is necessary for employees to make or receive personal telephone calls during working hours. You are expected to restrict your personal telephone usage, both on state-owned phones and personally owned cellular phones, to reasonable, incidental calls that do not interfere with your work schedule or the performance of your duties. To avoid being disruptive to others in the workplace, please make certain audible alerts are disabled. Travel Your position may require travel to conduct state business. If you are required to travel for work, you may obtain a state-owned vehicle from a central carpool with a valid driver’s license. Use of your personal vehicle in the performance of Agency duties is allowable only when the use of a State-owned vehicle is not reasonably available for use and request mileage reimbursement. You must present proof of automobile insurance with the minimum coverage requirements. Contact your supervisor or Business Management if you have any questions. Uniformed Services Employment & Reemployment As an equal opportunity employer, the Department of Labor is committed to providing employment and reemployment services and support as set forth in the Uniformed Services and Reemployment Rights Act of 1994 (USERRA). Violence in the Workplace The Department of Labor has a policy prohibiting workplace violence. Consistent with this policy, acts or threats of physical violence, including intimidation, harassment and/or coercion, which involve or affect the organization and its employees will not be tolerated. See Violence in the Workplace Prevention Policy. 10 Visitors To provide for safety and security, only authorized visitors are allowed in the workplace. All visitors must enter through the main reception area, sign-in and sign-out at the front desk and receive a visitor identification to wear while on the premises. Authorized visitors will be escorted to their destination and must be accompanied by an employee at all times. Weather & Emergency Closings At times, emergencies such as severe weather or power failures can disrupt business operations. Everbridge, is a system that the state utilizes to notify enrolled individuals on safety and weather concerns. You can determine by which methods you want to be notified. Sign-up is free. Any personal information provided (such as cell number) will be used for important employee notifications purposes only directed by DAS. Everbridge will never give or sell contact or location information to any vendor or other organization. The Department of Emergency Service & Public Protection website is the official source of information for state employees. Use this page to find any official announcements about closures or delayed openings that have been declared by the Governor. Everbridge system can send alerts to your work phone and email as well as your home phone, cell phone, and home email. The Statewide CT Alert system can also keep you informed of state emergencies and send you emails and text alerts. FEMA’s Ready.gov preparedness site has information on how to keep safe during the winter. 11 Collective Bargaining Bargaining Unit Representation Labor unions and management at times negotiate collective bargaining agreements (union contracts). The contracts govern such areas as salary, benefits, hours of work, and the terms and conditions of employment. Most state job classifications have been assigned to particular bargaining units (unions) and state employees have voted to have unions represent them in the negotiation process. If you are a nonexempt employee, you have been assigned to a bargaining unit based on your job classification and will be represented by that specific union. If you are an exempt employee, you have been excluded from the collective bargaining process. The terms and conditions of your employment will be governed by state statutes, rules and regulations. Union Contracts Union contracts, established through the formal negotiation process, outline the terms and conditions of your employment. You should familiarize yourself with your contract. Benefits and provisions vary between bargaining units. Contract language has been crafted to avoid disputes and eliminate misunderstandings. Contract provisions, however, may be open to interpretation and subject to the grievance and arbitration process. Direct your questions about your union contract to your supervisor, union representative or Human Resources Generalist. Grievance Procedure Your problems or complaints should be resolved quickly and fairly. First, discuss the issue with your supervisor, who may help you find a solution. If your supervisor or another employee in the chain of command cannot resolve your problem or complaint, or if you feel that you have been treated unjustly, contact your union steward or Agency Labor Relations Specialist. If an issue cannot be resolved informally, you may follow the grievance procedure outlined in your union contract. This procedure helps resolve disputes concerning the interpretation and application of a contract. You should, however, make every effort to resolve an issue before filing a grievance. Though specific procedures may vary, your union contract establishes time limits for initiating grievances and obtaining responses. The first steps of the grievance process are informal to encourage quick resolution. If an issue still cannot be resolved, more formal meetings are conducted until the grievance reaches the highest level of the process. Most grievance procedures permit arbitration when an issue cannot be resolved at the highest level. An arbitrator, an impartial party chosen by the union and management, will hear both sides of an issue and render a binding decision. A union normally requests arbitration, but you as an employee may also request it in certain circumstances. Arbitration is permitted only if negotiated as a step in the grievance procedure. You or a group of employees may present a grievance to management for resolution without your union’s participation. However, the resolution must be consistent with your union contract and your union must be given the opportunity to attend all meetings. 12 If you are an exempt classified employee, you may appeal certain actions through the grievance procedure as outlined in Sec. 5-202 of the Connecticut General Statutes. 13 Appointment and Promotion Merit System The appointment and promotion of state employees is based on the merit principles in the State Personnel Act. As with other federal, state and municipal merit systems, this system was established to minimize the influence of electoral politics on the employment and retention of state employees. The system strives to place the best qualified people in state service and to ensure that they are fairly treated in the appointment and promotion process. The merit system is not subject to collective bargaining. Job Classification The state, as an employer of thousands of people, must systematically describe and group jobs to ensure consistent and fair treatment when assigning, compensating and promoting employees. Consequently, it has established a classification plan for all jobs in the executive branch of state service. Individual positions are grouped into job classes, with each class consisting of positions with similar duties, responsibilities and required qualifications. Your job classification is the foundation for the employment process. Classified & Unclassified Positions Most positions in the executive branch of state government are classified. Unclassified positions may be exempt from job announcements. The State Personnel Act lists a number of unclassified categories: agency heads, members of boards and commissions, officers appointed by the governor, deputies and executive assistants to the head of departments, executive secretaries, employees in the Senior Executive Service and professional specialists. Competitive & Non-Competitive Positions Most classified positions are competitive and require an application. The type of experience required depends on the job classification. Applicants must meet minimum general experience and training requirements, however, to be eligible for appointment if a position requires a professional license or degree, there may be no additional requirements beyond possession of the professional license or degree. Scheduled & Continuous Recruitment Job Announcements Most state job opportunities are announced to the general public with a specific closing date. If you apply for a job opening, you will be notified if you are selected for an interview by the hiring agency. When the state considers continuous recruiting necessary, it may postpone the closing date for filing applications until it receives a suitable number of candidates. A job posting will indicate when recruiting is continuous and that applications may be filed until further notice. Job Announcements To meet merit system objectives, the state has developed competitive job classifications to fill many of its positions. They are not used to fill unclassified positions or those in classes designated as noncompetitive. State job announcements fall into the following categories: 14 Open to the Public. If you meet the minimum experience and training qualifications for a position, you may participate in this type of recruitment. Open-competitive job announcements are administered periodically usually when a state agency is recruiting for a vacant position. Statewide & Agency Promotion. If you are a state employee who meets the minimum experience and training qualifications for a position and has completed six months continuous service in a state agency, you may participate in a statewide recruitment. Agency promotional announcements will have the additional requirements that you must be a current agency employee. Employment Opportunities Agency job announcements are posted on the DAS Online Employment Center. You should check regularly for the most up to date information. To apply for employment, you must complete a Master Application on the DAS Website. Check the state employment pages on the Department of Administrative Services website (Job Openings Department of Administrative Services (jobapscloud.com) for information about completing the application form, job opportunities, and to sign up for e-mail notification of current job openings. Application Accommodations for People with Disabilities The state may conduct recruitments in various ways. If you need special accommodations for a particular recruitment, you or someone on your behalf should immediately notify the DAS at (860) 713-7463. You must supply the application title and job number, and a description of your special needs and documentation of the disability. Rejection from State Application Your application for a state job opening may be rejected if (1) your application was received after the closing date, (2) you did not meet the minimum requirements, (3) your years of experience did not match the requirements, (4) specific information was missing from your application, (5) you failed to meet the special requirements for the position, or (6) your years of experience did not match the special requirements. Appointment Types Durational. An employee hired for a specific term, for a reason not provided above, including a grant or specially funded program, not to exceed one year. A durational employee shall become permanent after six months, or the length of the working test period, whichever is longer. Emergency. The state may appoint you to an emergency position to meet short-term agency needs. The appointment may extend for as long as two months but may not be renewed in a fiscal year. Intermittent. Intermittent employment is also work on an ""as needed"" basis. The agency may use intermittent interviewers to supplement permanent staff in times of high unemployment. They are paid an hourly rate for time worked and may receive benefits. They are eligible to apply for agency promotional postings following the completion of 1044 hours of intermittent service. 15 Permanent. The state may appoint you to a permanent competitive position from a certification list. You must successfully complete the working test period to gain permanent status. Provisional. The state may provisionally appoint you to a position that must be filled immediately if no active certification list exists, or an insufficient number of candidates are listed. The appointment may extend for as long as six months or until a job announcement for the position has been held and a certification list promulgated. You may not receive more than one provisional appointment in a fiscal year or serve more than six months as a provisional appointee. Your job performance while a provisional must be satisfactory. To receive a permanent appointment, you must be appointed from a competitive process for the position. If you are not appointed from a competitive process and do not have a permanent position to which you may return, you must be separated from state service. If the competitive process is not completed for a position within six months, an additional temporary or emergency appointment may be authorized. Seasonal. Seasonal employment for a position established for a specific period, usually during summer months. Individuals employed are paid an hourly rate and are not entitled to any fringe benefits. Temporary. Position filled for a short term, seasonal, or an emergency situation, including to cover for a permanent position when the incumbent is on workers’ compensation or other extended leave, not to exceed 6 months. May be extended up to one year. If a temporary employee is retained greater than 12 months, said employee shall be considered durational. Working Test Period The working test period, or probationary period, for a state employee is an extension of the state recruitment process. You must serve this period to gain permanent status following initial appointment or promotion. Your initial test period is generally six months, depending on the applicable contract or state regulation. Your promotional test period is generally four to six months, again depending on the applicable contract or regulation. Exceptions may occur in the length of the trial period for trainee positions. Questions about your working test period may be directed to your supervisor or Human Resources Generalist. During an initial working test period, you are considered a probationary employee and will work closely with supervisors and colleagues to learn your duties. This period also gives your supervisor the opportunity to evaluate your response to training and job requirements. If you demonstrate acceptable performance during your initial test period, you will be given a satisfactory service rating and gain permanent status as a state employee. Your working test period may be extended in certain circumstances. If you do not meet acceptable performance standards during the initial working test period, you will be separated from state service. You may not appeal a dismissal during your initial test period through the contractual grievance procedure, but you may request an administrative review. If you fail to meet acceptable performance standards during a promotional working test period, you will revert to your previous classification. 16 Service Ratings You will receive a service rating for your initial working test period or promotional test period, and at least three months before your annual increase date. Depending on your union contract or state statutes, you may receive a service rating at any time, particularly when your job performance has changed significantly. Service ratings record your progress and performance as training and job experience increase. The state recognizes satisfactory performance by awarding annual salary increases (as negotiated) until reaching the maximum step in a salary group. For employees at the maximum step, some bargaining units award a lump sum payment in lieu of an annual increment. A “less than good” rating may prevent you from receiving an increase. An “unsatisfactory” during the working test period signifies failure. After attaining permanent status, two successive “unsatisfactory” ratings may result in your dismissal. Managers are evaluated in accordance with the provisions of the Performance Assessment and Recognition System (PARS) Program. Promotion & Reclassification Generally, there are two ways in which you may receive an appointment to a higher-level job classification. First, you may compete for a new position or an opening that arises when another employee leaves an existing position. The agency may use a formal state employment application process to obtain a list of candidates to be considered for an opening or it may use a less formal recruitment and selection process. In either event, in order to be considered you must meet the minimum qualifications for the higher classification and comply with the application procedures. Recruitment notices are posted internally on the agency intranet, and at times externally on the Department of Administrative Services website. It is your responsibility to monitor them and respond according to the instructions on the job posting. Additionally, you may progress to a higher level through reclassification. After working for the agency for some time, you may find that your duties have expanded and are more consistent with a higher-level job classification. In such cases, your supervisor will ask you to complete a job duties questionnaire, which will be evaluated by Human Resources. If you are found to be working “out of class,” the agency has the option of either removing the higher-level duties or reclassifying your position to the higher level. Certain conditions must be met for reclassification. You must be in your current position for at least six months, have a rating of “good” or better on your last two performance evaluations and meet the minimum experience and training requirements for the higher class. If you have applied for a job opening and did not qualify for the classification, this is evidence that you do not meet the qualifications for the higher-level class and cannot be considered for reclassification. Temporary Service in a Higher Class When a temporary vacancy occurs in a non-entry level classification, such as the result of an employee being on an extended leave of absence, the agency may fill the opening by temporarily assigning you to a higher level as long as the assignment lasts for more than 30 days and meets any other relevant union contract provisions. You must meet the minimum qualifications of the class. While serving in this type 17 of service, you are paid at the higher level, but you retain status in your permanent (lower) classification. Benefits such as longevity and vacation accrual are based on the permanent class. Transfers You may voluntarily transfer within the agency or to another state agency. To place your name on a Statewide Transfer list, for your current job class in which you hold permanent status, please visit the DAS Website, Freenames - Department of Administrative Services (jobapscloud.com), scroll down and follow the process of Statewide Transfers. If your job classification is unique to the agency, your transfer options will be limited to those classes deemed comparable to the one in which you have permanent status. Consult your union contract for more information. If you are interested in transferring to another work location within the agency and meet the eligibility of the job requirements, Human Resources will send emails periodically with transfer opportunities, to be considered you must follow the procedures noted on the email. The agency may involuntarily transfer you under certain circumstances, generally defined in your union contract or state personnel regulations. Transfers occur for a variety of reasons: when the agency seeks to better use its resources, to avoid layoffs, to meet emergency or seasonal conditions, or to accommodate you. If you are an exempt employee, your transfer is subject to state regulations and the State Personnel Act. Dual Employment You may be authorized to work at a secondary agency subject to the dual employment provisions of the regulations for state agencies. For this to occur, the secondary agency must initiate and complete the appropriate paperwork. The secondary agency will forward a copy of the dual employment request form to the primary agency for completion and return. If all provisions are met, subject to any fair labor standards considerations and the operating needs of the department, you may be eligible for secondary employment. Secondary employment may not pose a conflict of interest or interfere with the performance of your job duties and your approved work schedule for the Department of Labor. 18 Personnel Records Personnel Files The agency maintains a digital personnel file containing information about your employment: service ratings; personnel processing forms; appointment, promotion, and disciplinary letters. The agency also maintains a separate, confidential file that contains your medical documents, including doctor’s notes and medical certificates. You may review your digital personnel file by contacting Human Resources. You may sign a waiver to allow another person, such as a union official, to review your files. The agency must comply with written requests for information about its employees under the state freedom-of-information law. If the agency considers an information request to be a possible invasion of your privacy, you will be notified. Change of Personal Data Whenever you change your name, address, number of dependents, telephone number, or marital status, you must promptly notify Payroll so that agency records and files may be updated. You may also need to complete a new federal or state withholding allowance certificate (W-4 or CT W-4), or various health insurance forms. Working Hours The negotiated workweek for most staff members currently averages 40 hours per week. Some union contracts provide for a 35 or 37.5-hour workweek. Many employees work a standard schedule of 8:00 a.m. to 4:30 p.m. The agency has also established nonstandard work schedules, which are approved in advance by the appointing authority in consultation with the Director of Human Resources. Provision for flex time has been included in some contracts. If your position is covered by flex time or other nonstandard workweek, your supervisor will explain its operation. The Payroll Unit will maintain your attendance record. From time to time and consistent with the terms of the applicable collective bargaining agreement, it may be necessary to temporarily or permanently change your work schedule to meet operational needs. In such a situation you will be given as much notice as possible, at a minimum that is required by your union contract. Regardless of your work schedule, you are expected to arrive at work on time, return from lunch and breaks on time, and not leave your job prior to quitting time. 19 Meal & Break Periods Full-time employees are permitted two 15-minute breaks and a 30-minute unpaid meal period. Longer unpaid meal periods are allowed with supervisory approval. The schedule for all meal and break periods is determined by your supervisor based on business operations and staffing needs. Your supervisor will inform you of your schedule and any required changes. Employees are not permitted to work through lunch to leave early. Breaks do not accumulate, nor may they be used to start late or leave early. Overtime & Compensatory Time Overtime occurs when you work in excess of your regular established weekly schedule. Overtime assignments must be approved in advance, except in extreme emergencies. The Fair Labor Standards Act (FLSA), state statutes and regulations, and your union contract govern your eligibility for overtime and the rate of compensation. Compensatory time is a form of accrued leave time that may be used later; it does not constitute a basis for additional compensation. Compensatory time must be taken in accordance with the provisions of your contract and agency policy. The FLSA may conflict with your union contract regarding compensation for overtime. Generally, you will be paid by the method that provides the greater benefit. Hours worked in excess of 40 in one week are generally compensated at the rate of time-and-one half. The time-and-one-half rate is derived from your basic hourly wage rate. Some employees may be ineligible for the overtime provisions of FLSA. Questions may be directed to Payroll. Shift Assignments Some areas engage in multi-shift operations. Depending on the starting and ending times of your shift and union contract, you may be eligible for shift-differential payments. These usually take the form of additional pay for the hours worked on your assigned shift. Generally, any shift that begins before 6:00 a.m. or after 2:00 p.m. is subject to shift-differential payments. Some employees may not be eligible for these payments, even when assigned to such a shift. Consult your union contract for information regarding eligibility for the shift and weekend differentials, and the applicable pay rate. Attendance You are responsible for maintaining a good attendance record. Frequent absenteeism reduces the level of your service to the agency and the public, increases operational costs, and places a burden on your co-workers. Use your accrued leave in accordance with agency policies and procedures and ensure that you comply with Employee Dependability Policy requirements. You should request leave time as far in advance as possible. Refer to your union contract for additional guidelines. Agency operating needs, the reasonableness of the request, and the specific language contained in the union contract govern the approval or denial of your leave request. Whenever possible, avoid unscheduled leave. 20 Paid Leave Time Holidays The state grants 13 paid holidays per year to permanent, full-time employees: New Year’s Day, Martin Luther King’s Birthday, Lincoln’s Birthday, Washington’s Birthday, Good Friday, Memorial Day, Juneteenth Day, Independence Day, Labor Day, Columbus Day, Veterans’ Day, Thanksgiving Day and Christmas Day. Intermittent and durational employees must work the equivalent of six months (1044 hours) to be eligible for holiday pay. If a holiday falls on a Saturday or Sunday, the state generally designates the Friday preceding or the Monday following as the day it will be observed. A calendar detailing the exact day of holiday observance appears on the Human Resources intranet site. You will be paid for a holiday if you are on the payroll on or immediately before or after the day it is celebrated; you normally will not receive holiday pay if on a leave of absence without pay before and after a scheduled holiday. Consult your union contract for information about compensation for work performed on a state holiday. Sick Leave As a permanent employee, you accrue sick leave from your date of employment for each fully completed calendar month of service, except as otherwise provided in the statutes. You must use sick leave when incapacitated or in the special cases described in your union contract. Upon exhaustion of sick leave, you must use other accrued leave in lieu of sick leave unless FMLA rules dictate otherwise. If an employee is sick while on annual vacation leave, the time will be charged against accrued sick leave if supported by a properly completed medical certificate. Sick leave is not an extension of vacation or personal leave. You should maintain a sick leave balance as a form of insurance in the event of a long-term illness. Accrual. Full-time employees accrue paid sick leave at the rate of 1¼ days per completed month of service or 15 days per year. If you are absent without pay for more than forty hours in any month, you do not accrue sick leave in that month. If you are an eligible part-time employee, you accrue paid sick leave on a pro-rated basis or on the amount of your scheduled hours as a percentage of a full-time schedule. Balances. Payroll records your sick leave balance (time accrued but not used) in hours and minutes. When you retire, the state will compensate you for 25 percent of your accrued sick leave balance (to a maximum of 60 days). Call-In Procedure. If you are unexpectedly absent as a result of injury or illness, you must notify your supervisor or designee as early as possible, but no later than one-half hour before your scheduled reporting time. If your absence is continuous or lengthy and you have not been granted a medical leave 21 of absence, you must notify your supervisor on a daily basis. If you fail to call in, you may be placed on unauthorized leave without pay and subject to corrective action. Medical Documentation. Your physician must complete a medical certificate if you are absent as the result of injury or illness for more than five working days or as otherwise outlined in your union contract or state personnel regulations. If you fail to provide the required medical documentation, you may be placed on unauthorized leave, which can lead to loss of pay and disciplinary action. Medical certification forms should be emailed directly to DAS.BenefitsandLeavesPod4@ct.gov. Any questions must be sent directly to DAS.BenefitsandLeavesPod4@ct.gov. Additional Use of Sick Leave. You may use sick leave for situations other than your own injury or illness (a medical certificate or written statement supporting a request may be required): • • • • • Medical, dental or optical examination or treatment when arrangements cannot be made outside working hours. Death in your immediate family. Illness or injury to a member of your immediate family. Funeral for a person other than an immediate family member. Birth, adoption or taking custody of a child. To determine the exact number of days allowed, refer to your union contract. Extended Illness or Recuperation. If you exhaust your accrued sick leave during a prolonged illness or injury, you may be permitted to use other accrued time. You must obtain approval from your immediate supervisor for use of other accrued leave to cover the remainder of the absence. In certain circumstances, you may be granted an advance of sick leave if you have at least five years of full-time state service. Consult your union contract for information regarding the sick leave bank or donation of leave time. If an employee has no accrued leave time available, a written request for a medical leave without pay must be submitted to DAS.BenefitsandLeavesPod4@ct.gov, and the request must be followed up in writing upon return to work. Failure to do so will result in charging the absence to Sick Leave Without Pay. Illness or Injury While on Vacation. If you become ill or injured while on vacation, you may request that the recovery time be charged to your sick leave rather than to your vacation leave. A medical certificate or documentation support your request will be required. Vacation Leave Usage. As a full-time employee, you may begin taking paid vacation leave after six months of continuous service. Unless otherwise stated in a union contract, a part-time employee may begin taking paid vacation after completing the equivalent of six months of full-time service (1044 hours). Requests for vacation leave are subject to the approval of your supervisor, based on the operating needs of the unit and the seniority provisions of your contract. 22 Accrual. You accrue vacation leave at the end of each full calendar month of service. Absence without pay for more than five days (equivalent to 40 hours) in a month result in the loss of accrual for that month. You accrue vacation leave at the following rate for each completed month of service (prorated, if part-time): • • • 0-5 years of service: 1 day per month (12 days per year). 5-20 years: 1-1/4 days per month (15 days per year). 20 or more years: 1-2/3 days per month (20 days per year) As a manager and confidential employees excluded from collective bargaining, you accrue vacation leave at the rate of 1-1/4 days per completed month of service or 15 days per year. After completing 10 years of service, on January 1 of each subsequent year you will receive the following number of days in addition to the normal accrual: • • • • • 11 years of service: 1 additional day 12 years: 2 additional days 13 years: 3 additional days 14 years: 4 additional days 15 or more years: 5 additional days Balances. Payroll will record your vacation leave balance in hours and minutes. Without agency permission, you cannot carry more than 10 days of accrued vacation leave from one year to the next if you are a nonexempt employee. If you are a nonexempt employee, refer to your bargaining union contract regarding your maximum accrual. If you are a nonexempt employee or a manager, you may accumulate as many as 120 days of vacation time. When separated from state service, if a permanent employee, you will receive a lump-sum payment for your vacation leave balance. Personal Leave As a full-time employee who has attained permanent status, you are credited with three days of personal leave to conduct private affairs, including the observance of religious holidays. On January 1 of each year thereafter, three days of personal leave will be credited to your leave balance. You must request authorization in advance from your supervisor to use personal leave. Personal leave must be used prior to the end of the calendar year or it will be forfeited. You are responsible for monitoring your time charges to ensure that your personal leave is used within the calendar year. Part-time employees generally are entitled to prorated personal leave; consult your union contract for the specifics. Payroll will maintain your balance. Jury Duty If you are summoned for jury duty, you will not lose your regular salary or benefits. You must notify your supervisor immediately and supply the jury notice; your supervisor will forward it along with the reason for your absence to the Payroll Unit. The court will supply you with verification of your attendance; which is then submitted through your supervisor to Payroll. You must return to work 23 whenever not actively serving on jury duty. With the exception of travel allowances, you must return the money received for jury duty to Payroll. Military Leave If you are a member of the National Guard or a reserve component of the U.S. armed forces and a permanent employee, you may apply for leave to attend required training. To verify the leave, you must submit a copy of your military orders to DAS.BenefitsandLeavesPod5@ct.gov or fax to 860-622-4928. The state permits as many as three weeks in a calendar year for field training. Paid leave for military call-ups other than annual training is limited to unscheduled emergencies, subject to the provisions of your union contract. Notify your supervisor as soon as you become aware of your military leave schedule. 24 Leave Without Pay Leave of Absence Without Pay (LAW) Depending on the terms of your union contract, you may be granted a LAW without endangering your status as a state employee. Your benefits, however, may be affected. You will not accrue vacation or sick leave in any month on a LAW for more than five working days (hourly equivalent of) without pay, and service credit toward retirement, seniority and longevity may be suspended. If you are on a LAW for pregnancy, illness, injury, or an FMLA-qualifying reason, the state will continue to pay the same portion of your health insurance as while you were working. You will, however, be billed directly for the amount that you previously paid through payroll deduction. If on a LAW for another reason, you will be billed for the full cost of medical coverage. If possible, submit your LAW request to DAS.BenefitsandLeavesPod4@ct.gov in advance and in writing with appropriate documentation. Your manager may grant a LAW for as many as five consecutive days. A LAW of longer than five days must be authorized by the Benefits and Leaves Pod before the leave, except in extraordinary situations such as emergency medical leave. You may be granted a LAW for a variety of purposes on a position-held or not-held basis. Your LAW must be consistent with the requirements in your union contract or state regulations if you are an exempt employee. If your position is held, you may resume employment on the expiration of the LAW. You must be cleared by a physician to return to normal duties if you are on a medical LAW. This needs to be done before you return to work. If your position is not held, your return to active service depends on the availability of a position. The agency will consider the reason for your request, your work record and agency operating needs when deciding whether to grant you a LAW and to hold your position. Maternity Leave If pregnant, you must use accrued sick leave to cover time before, during or after your delivery when a physician certifies you as “unable to perform the requirements of your job.” You must send a Medical Certificate - P33A to DAS.BenefitsandLeavesPod4@ct.gov to substantiate your disability. When your disability period ends or you have exhausted your sick leave balance prior to the end of your disability period, you may request to use accrued vacation and personal leave. When all your paid leave has been used, you may request a LAW with your position held. Refer to your union contract and the FMLA Policy for further information. Medical Leave You must use accrued sick leave to cover the time which you are unable to work because of illness. If that period extends beyond five days, you will need to supply a Medical Certificate - P33A to DAS.BenefitsandLeavesPod4@ct.gov to substantiate your use of sick time to. When your sick leave balance is exhausted, you must apply vacation or personal leave to cover your absence unless FMLA rules dictate otherwise. Your union contract may contain provisions for advance of sick leave, a sick leave bank, and donation of leave time in cases of prolonged illness. You may also request a leave of absence without pay. Details on the requirements and provisions of such leaves are in your union contract and the FMLA policy. 25 Family Leave You may request a LAW for the birth or adoption of a child; the serious illness or health condition of a child, spouse or parent; your own serious health condition; the placement of a foster child in your care and certain other conditions. A medical certificate must be submitted by email to DAS.BenefitsandLeavesPod4@ct.gov to substantiate a request for leave under the Family and Medical Leave Act (FMLA). You must request forms by sending an email to DAS.BenefitsandLeavesPod4@ct.gov. 26 SALARY Payment Your job classification determines your salary grade. Classifications are assigned to a salary group based on the amount and type of required experience and training, technical complexity, difficulty and level of responsibility. The state establishes a number of steps for salary groups other than managerial and confidential classes. As a new employee, you will generally start at the salary range minimum for your job classification. Payday The state issues salary payments bi-weekly through a checkless system called e-pay. You will receive payment for the work you performed during the previous two weeks. The delay allows for processing. If you are a new employee, you should receive your first salary payment four weeks after your first workday. If you separate from state service, you will receive your last salary payment two weeks following the end of the last pay period worked. Earnings, itemized deductions and leave accruals are viewable online. Questions should be directed to Payroll. Annual Increments Annual increments are based on the terms of your union contract. You may be raised to the next higher step in a salary group on your anniversary date. Consult your union contract for details. If an appointed official or manager, you may be awarded an increase by the governor, usually effective on January 1. The amount of the increase will be based on your goal attainment and performance under PARS, the Performance Appraisal and Recognition System for managers. Collective Bargaining & Cost-of-Living Increases If you are a union member, your increase will result from the collective bargaining process. An increase generally will be calculated as an across-the-board percentage within a negotiated salary structure and payable in July. If you are an appointed official or a manager, the governor may award you a cost-ofliving increase, usually a percentage of your annual salary, also payable in July. When promoted, you will normally receive a salary increase of at least one full step in the salary group, unless you are placed at the maximum step. If promoted to a managerial position, you will receive an increase of five percent or the minimum of the new salary range, whichever is greater. Longevity Pay Employees hired on or after July 1, 2011, shall not be entitled to a longevity payment however, any individual hired on or after said date who shall have military service which would count toward longevity under current rules shall be entitled to longevity if they obtain the requisite service in the future. Employees hired prior to July 1, 2011, are eligible for longevity. For those eligible employees, when you complete the equivalent of 10 years of full-time state service (generally continuous) you will receive a longevity payment. The amount of longevity payment increases when you complete 15, 20, and 25 year years of service. Longevity schedules appear in your union contract and other pay plans. To qualify, you must attain the required years of service by April1 or October 1. Longevity payment are also paid 27 in these months. Employees not included in any collective bargaining unit are no longer eligible for longevity payments. 28 DEDUCTIONS Federal Income Tax & Social Security Tax Federal income and Social Security taxes will be deducted from your paycheck in accordance with federal law. Connecticut Income Tax State income tax will be deducted from your paycheck in accordance with state law. Health Insurance Health insurance coverage for eligible employees who choose to enroll in the state’s health benefit plan will be effective the first of the month immediately following the employee’s hire date or date of eligibility. For example, if you were hired on November 9, you must submit your application within thirty days; your effective date of coverage would be December 1. You may extend health and dental coverage to cover your spouse, dependent children under age 26, and/or disabled children over age 26. Please contact Payroll for enrollment eligibility. Refer to the Office of State Comptroller’s website for a summary of health insurance options and rates. You must remain with your insurance carrier until the next open enrollment period, the one time a year when you can change carriers. You may add a dependent newborn or spouse within one month of the birth or marriage (please note if adding a new spouse, a marriage certificate is required); other dependent changes generally are restricted to the open enrollment period. If your spouse’s insurance was terminated through his/her employer, you may be eligible to add them as a special exception. A letter from the employer stating insurance has been cancelled will be required. All additions, deletions, or other changes must be processed through the Payroll Unit. You must provide documentation of each dependent’s eligibility status at the time of enrollment. It is your responsibility to notify the Payroll Unit when any dependent is no longer eligible for coverage. Group Life Insurance You may purchase term life insurance at group rates. The state pays a portion of this coverage. You may authorize payroll deductions for this insurance after six months of employment. If you waive coverage and later decide to enroll, you must apply with medical evidence of insurability and wait for approval. The amount of life insurance coverage is based on your annual salary and is automatically adjusted on April 1 and October 1 as your salary increases. Contact the Payroll Unit to obtain forms or arrange for beneficiary changes. You may visit the Office of State Comptroller’s website (https://carecompass.ct.gov/supplementalbenefits/) for more information. Supplemental Benefits The state offers various supplemental benefits to qualified employees and retirees, which are designed to complement the benefits provided by the state. These benefits are on a voluntary basis and are paid entirely by the employee through the convenience of payroll deduction. Available supplemental benefits 29 are listed on the OSC website Supplemental Benefits - Care Compass (ct.gov). Contact the authorized vendors for information and assistance with the enrollment process. Direct Deposit You may deposit your paycheck in a checking or savings account in a financial institution that is a member of the automated clearinghouse. Your funds will be electronically transmitted and available to you after 9:00 a.m. on the date of the check. You must complete an authorization form to adjust or cancel direct deposit. Authorization forms can be obtained from Payroll. Deferred Compensation Permanent employees who work more than 20 hours a week are eligible for the state’s deferred compensation plan. Through payroll deduction, you may set aside a portion of your taxable wages (prior to tax deferrals). The minimum contribution is $20 per pay period. Obtain details by contacting the plan administrator. State Employees Campaign Through the state employee campaign, you may contribute to your choice of a range of service organizations via payroll deduction. Union Dues As a member of a collective bargaining unit, you may elect to join the union and have union dues deducted from your check. Your union determines the amount by using a set-rate or sliding-scale formula based on the amount of your salary. Credit Unions As an agency employee, you may join the, CT Labor Department Federal Credit Union, 200 Folly Brook Blvd., Wethersfield, CT 06109 (telephone 860-263-6500). As a State of Connecticut employee, you may also join the CT State Employees Credit Union. Offices are as follow: 84 Wadsworth Street Hartford, CT 06106 860-522-5388 1244 Storrs Road Storrs, CT 06268 860-429-9306 2434 Berlin Turnpike Newington, CT 06111 860-667-7668 401 West Thames Street Southbury Training School Norwich, CT 06360 Southbury, CT 06488 860-889-7378 203-267-7610 1666 Litchfield Turnpike Woodbridge, CT 06525 203-397-2949 Silver & Holmes Street Middletown, CT 06457 860-347-0479 30 Retirement Tiers The state and collective bargaining units negotiate the pension agreement. The retirement system includes five plans: Tier I, II, IIA, III and IV. For details, contact Office of the State Comptroller’s at osc.crsp@ct.gov or consult the specific retirement booklet for which you are a member. Online copies are available at the OSC website Retiree Resources (ct.gov). Tier I. Usually, you are member of this retirement plan if you were hired on or before July 1, 1984 and contribute by payroll deduction to your pension. You may retire at age 55 with 25 years of service, or at age 65 with 10 years of service, or retire early at age 55 with 10 years of service – at a reduced rate. This tier is divided into three plans. Members of Plans A and C contribute five percent of salary toward retirement. Members of Plan A have chosen not to participate in the Social Security plan; Plan C members pay Social Security taxes and are eligible for Social Security benefits. Plan B members contribute two percent of salary toward retirement until they reach the Social Security maximum, and five percent of salary above the maximum; they will receive reduced pensions when Social Security payments begin. You also may purchase periods of service for which you have not made contributions: war service, prior state service, and leaves of absence for medical reasons. Tier II. If you were hired into state service from July 2, 1984 to June 30, 1997, you are automatically covered under this noncontributing plan. If you were employed by the state on or before July 1, 1984, and were not a member of any other state retirement plan, the Tier II plan also covers you. You contribute two percent of your salary towards retirement. You are eligible for normal retirement benefits after you attain: (1) age 60 with at least 25 years of vesting service; (2) age 62 with at least 10, but less than 25 years of vesting service; or (3) age 62 with at least five years of actual state service. If you have at least 10 years of service, you can receive retirement benefits – at a reduced rate – if you retire on the first day of any month following your 55th birthday. Retirements on or after July 1, 2022 are subject to the age and years of service specified in the SEBAC 2011 agreement. Tier IIA. If you entered state service from July 1, 1997 to June 30, 2011, you are covered under this plan as of the date of your employment. You contribute two percent of your salary towards retirement have the same options and benefits as a Tier II employee. If you are not eligible for any retirement benefits when you leave state service, you may withdraw your retirement contributions. You also may purchase periods of service for which you have not made contributions: war service and leaves of absence for medical reasons. Tier III. This plan covers employees hired on or after July 1, 2011 to July 30, 2017. As a Tier III member, you contribute two percent of your total annual salary. Your normal retirement date is the first of any month on or after you reach age 63 if you have at least 25 years of service, or age 65 with at least 10, but less than 25 years of service. If you have 10 years of vesting service, you can receive early retirement benefits on the first of any month following your 58th birthday. If you are not eligible for any retirement benefits when you leave state service, you may withdraw your retirement contributions. 31 Tier IV. This plan covers employees hired on or after July 31, 2017. The Tier IV retirement plan provides elements of both a defined benefit and defined contribution plan. Defined Benefits – Participants that satisfy the minimum eligibility criteria will qualify for a pre-defined monthly retirement income for life, with the amount being determined by years of service, retirement age and Final Average Earnings. You contribute 7% of your annual salary (this rate is for fiscal year July 2023 through June 2024). Defined Contribution – You contribute 1% to a defined contribution plan with a 1% employer match. This plan also has a risk sharing component wherein for any given year the employee contribution can be up to 2% higher depending on the plan’s performance for the previous year. This contribution will be computed by the plan’s actuaries. (You may also contribute to a 457 plan). For additional information please see the State Comptroller’s Retirement Resources website . Please note: If you were a former state employee who contributed to a different state retirement plan, please contact Payroll 860-263-6195 or dol.payroll@ct.gov to see if you qualify to be placed into a different retirement plan. 32 Separation Resignation The personnel regulation on resignation reads: “An employee in the classified service who wishes to voluntarily separate from state service in good standing shall give the appointing authority at least two working weeks written notice of resignation, except that the appointing authority may require as much notification as four weeks if the employee occupies a professional or supervisory position.” If you resign, your written notice must include your last day of work and be submitted to your supervisor at least two weeks before you leave. You will receive a lump-sum payment for unused vacation time if you are a permanent employee. You may arrange to continue your health insurance benefits at the COBRA rate for a specific period of time. Contact Payroll for details on the length of coverage and payment amount. If you are not eligible for any retirement benefits when you leave state service, you may withdraw your retirement contributions. If you do not return to state service within five years and have not withdrawn your contributions, the Retirement Division will send you a refund application. After you complete the form and return it, you will receive your contributions plus interest. If the Retirement Division cannot locate you within 10 years after your employment ends, your contributions will become part of the retirement fund. If you submit your resignation less than two weeks before leaving, your separation may be regarded as not in good standing and may affect your re-employment rights. An unauthorized absence of five or more working days also will be considered as a resignation not in good standing. You will be notified if your resignation is considered as not in good standing and you may file an appeal with the Commissioner of the Department of Administrative Services. Layoff The state defines a layoff as an involuntary, non-disciplinary separation from state service resulting from a lack of work, program cutback or other economic necessity. Consult your union contract for particulars. If you are an exempt employee, consult Sec. 5-241 of the Connecticut General Statutes. Reemployment Rights In an effort to deliver services in a contemporary and cost effective fashion, the State of Connecticut uses a module called Freenames through the Online Employment Center (JobAps) as a platform for processing the following: • • • Mandatory rights for eligible individuals (reemployment/SEBAC/other mandatory rights) Statewide Transfer requests (non-mandatory transfers) Rescind of Resignation or Retirement requests This section applies to: Current or former State Employees who have been affected by the following: • • • Layoffs Noticed for layoff Accepted a demotion in lieu of layoff 33 • • • • • • Notified of eligibility for mandatory rights Recently failed a working test period and has permanent classified status Exercising rights to return to the classified service from the unclassified service Recently separated NP-2 employee with Article 39 Rights Current employees who request to place their names on a Statewide Transfer list Former employees who request to rescind their resignation in good standing or voluntary retirement. If you retire from state service, you are eligible for temporary employment in any class in which you had permanent status. As a re-employed retiree, you may work as many as 120 days per calendar year (bases on 40 hours per week prior to retirement) without adversely affecting your pension. Such appointments are totally at the discretion of the agency. Rescind of Resignation or Retirement If you have permanent status and resign in good standing, you may, within one year of the date of your separation, request to rescind your resignation by completing the Rescind Resignation request via the JobAps, Freenames Application within one year from date of resignation. This will enable you to be considered for any classes in which you had permanent status. Reinstatement is strictly voluntary on the part of the Agency and may occur at any time up to two years from the date of your separation. Former employees shall be fully independent in and responsible for conducting their own search for reinstatement by requesting rescind privileges via the JobAps, Freenames Application. Use the rescind of resignation or retirement option to request to rescind a resignation in good standing, or a retirement from state service in accordance with DAS General Letter 177. Note: There are no reemployment rights associated with a rescind of resignation. The State of Connecticut is not required to rehire individuals who rescind resignation. Rather, certain privileges may be granted depending on the job class and effective date of rehire. Requirements A former State employee must meet the following conditions: • Attained permanent status as a State employee • Separated from state service in good standing from a position in the Classified service or a bargaining unit position in the Unclassified service • You must know the job class you resigned or retired from. To locate this information, contact your former Human Resources Representative or refer to your last paycheck as an active employee. • You must include each job code matching your last held title including different hourly equivalent. For example: 7603EU= Information Technology Analyst 1 (35 hours) 7603FD= Information Technology Analyst 1 (40 hours) DAS will conduct a review and approve or deny all rescind requests for any or all job classes identified. Applicants will be notified of the status of their requests via email. Please be sure to keep your contact information updated and check your email and spam folders often as most communication will occur via email. 34 For detailed instructions to request to rescind a resignation in good standing or retirement, refer to Instructions Rescind Resignation or Retirement. Exit Interview Below you will find the link and QR code to access a confidential exit interview survey. Thank you for taking the time to engage in the exit interview process. This survey will only take approximately three minutes to complete. The information collected will help us evaluate factors like pay, benefits, work environment, and your overall work experience. All your answers are confidential, so please be candid with your responses. The information collected will help us to identify any potential areas where we can implement new strategies to increase the satisfaction of our workforce. Thank you again for your time and atention. Link to survey: Confidential Exit Survey State of Connecticut - DAS (office.com) QR code: 35 Retirement Retirement Types State employees are members of one of several retirement programs. Once an employee has completed the required actual or vesting service required by the retirement system, he/she is eligible for a pension. Retirements are effective on the first of the month following the last working day of the previous month. For retirement purposes, an employee who is on prolonged sick leave will retire the first of the month following the last working day that sick leave was used in the previous month (a medical certificate is required) and may qualify for a disability retirement. Types of retirement include, Normal, Early, Hazardous Duty or Disability. If you plan to retire you must send your Notice of Intent to Retire and Retirement Information Form via fax to 860-622-4928 or via email to DAS.BenefitsandLeavesPod5@ct.gov. Please refer to the Plan Summary which can be found on the Office of the State Comptroller’s website at Retiree Resources (ct.gov). Regardless of the type of separation from service; on the last day of work, the terminating employee must return State property to her or his supervisor. Pension Payment Options Option A - 50% Spouse: This option will pay you a reduced benefit for your lifetime in exchange for the protection that, should you pre-decease your spouse, the state will continue to pay 50% of your reduced benefit for your spouse's lifetime. Option B - 50% or 100% Contingent Annuitant: This option provides you a reduced monthly benefit for your life and allows you to guarantee lifetime payments after your death to a selected beneficiary. After your death, a percentage of your reduced benefit, either 50% or 100%, whichever you choose, will continue for your beneficiary’s life. Option C - 10 Year or 20 Year Period Certain: This option provides you a reduced monthly benefit for your lifetime in exchange for the guarantee that monthly benefits will be paid for at least 10 or 20 years from your retirement date (whichever you choose). Option D - Straight Life Annuity: This option pays you the maximum monthly benefit for your lifetime only. All benefits will end upon your death, including state-sponsored health insurance for any surviving eligible dependents. Insurance Benefits You must meet age and minimum service requirements to be eligible for retiree health coverage. Service requirements vary. For more about eligibility for retiree health benefits, contact the Retiree Health Insurance Unit at 860-702-3533. Regardless of the retirement option you choose, you will receive a monthly pension for the rest of your life, and, if you qualify for health insurance benefits, coverage will extend to your eligible dependents. Once you or your dependents become eligible for Medicare, this is your primary medical plan provider and the state plan is supplementary. 36 If you retire with at least 25 years of service and have state-sponsored life insurance, the state will pay for 50 percent of the amount of coverage (at least $7,500) as when employed. If you retire with less than 25 years of service, the state will pay a prorated amount. The Group Life Insurance Section of the Retirement Division will contact you following your retirement concerning conversion options. Disability retirement and pre-retirement death benefits are a part of your pension agreement. Pensions also are subject to cost-of-living increases as outlined in the agreement. For further information regarding retirement benefits call or email: Office of the State Comptroller Retirement Division 165 Capitol Avenue Hartford, CT 06106 Telephone: (860) 702-3490 Email: osc.rsd@ct.gov 37 TRAINING & DEVELOPMENT In-Service Training You may apply for Department of Administrative Services in-service training courses. Courses should be relevant to your position or career mobility, or to your unit’s operational needs. They are generally held during regular work hours in the spring and fall. Supervisor approval is required. For information, contact Employee and Organizational Development. Management Development Courses A calendar of courses focusing on leadership, supervisory and management development, strategic planning, customer service skills and total quality management techniques is distributed twice a year. Contact Employee and Organizational Development for particulars. Tuition Reimbursement You may seek tuition reimbursement from the state for courses taken during non-working hours at colleges, universities, technical schools or other accredited educational institutions. You do not need supervisory approval. Eligibility and funding provisions are outlined in your union contract if you are a bargaining unit employee. As a non-exempt employee, you may be reimbursed for a non-credited course through your union. Convert course hours to credits. For example, 6-14 hours equal one credit for tuition reimbursement; 15-29 hours, two credits; and 30-44, three credits. As a manager, you are eligible for tuition reimbursement from the State Management Advisory Council or agency funds. As a non-managerial confidential employee, you may apply for reimbursement in accordance with the union contract that would have included your job classification had your class not been excluded. For a fall semester class, you must document by Feb. 1 that you paid for a course and passed it, and by June 1 for a spring semester class. Forms and assistance are available through Employee and Organizational Development. You must submit your application to that unit at Central Office, 200 Folly Brook Blvd., Wethersfield, CT 061091114, at least two weeks before the start of a class. Conferences, Workshops & Seminars Your union contract may pay costs associated with conferences, workshops or seminars such as registration fees, travel expenses and meals. You must receive supervisory approval before processing a payment request. Consult you union contract for details. 38 EMPLOYMENT POLICIES (Ctrl + Click to follow links below) Acceptable Use of State Systems Policy - Statewide (2019) ADA Reasonable Accommodation Policy Affirmative Action Policy Statement – DOL (2023) AIDS Policy – DOL (7/16/2012) Background Check Policy and Procedures – DOL (10/31/2022) Disposition of Public Records Policy – DOL (11/28/2011) Discrimination and Illegal Harassment Prevention Policy – DOL (April 2023) Drug Free Workplace State Policy – DOL (7/16/2012) Employee Conduct Policy – DOL (8/3/2018) Employee Dependability Policy – DOL (7/16/2012) Employee Discipline Policy – DOL (7/16/2012) Ethical Conduct Policy – DOL (8/2013) Family Violence Leave Policy – Statewide GL 34 (1/2022) Federal Family & Medical Leave Act – DOL (7/16/2012) Health and Safety Policy – DOL (7/16/2012) Internal Discrimination Complaint Procedure – DOL (4/18/2023) Internal Security Standards - DOL Office Automation Policy, Standards and Guidelines – DOL (7/16/2012) Personal Wireless Device Policy (Rev. 9/9/2020) Phone Use Policy (Rev. 4/23/2023) Policy for DOL Facility Occupancy – DOL (7/9/2020) Professional Image Policy – DOL (3/1/2023) Prohibition of Weapons in DOL Worksites Policy – DOL (8/10/16) Public Officials and State Employees Guide to the Code of Ethics - Statewide 07/16/2012 Software Anti-Piracy Policy – DOL (7/16/2012) Vehicle-Use-for-State-Business-Policy--DAS-General-Letter-115--April-1-2012.pdf (ct.gov) Violence in the Workplace Prevention – DOL (4/2012) Workers Compensation Rights Responsibilities and Claims (ct.gov) Workplace Incident Report and Footprints Instructions – DOL (2015) **Please refer to online Employee Handbook for link activation. 39","Use information from the article only to explain your answer. Do not rely on outside knowledge.
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+EMPLOYEE HANDBOOK Table of Contents Welcome................................................................................................................................................... 5 About the Agency .................................................................................................................................... 6 Mission Statement ................................................................................................................................... 6 Supersedence ........................................................................................................................................... 6 General Highlights .................................................................................................................................. 7 Access Card ............................................................................................................................................. 7 Affirmative Action/Equal Employment Opportunity Employer ....................................................... 7 Americans with Disabilities Act ............................................................................................................ 7 Appearance & Dress Code ..................................................................................................................... 7 Building Security .................................................................................................................................... 7 Code of Ethics ......................................................................................................................................... 7 Collective Bargaining ............................................................................................................................. 7 Email & Internet Use.............................................................................................................................. 8 Employee Assistance Program .............................................................................................................. 8 Employee Background Check ............................................................................................................... 8 Employment Applications ...................................................................................................................... 8 Equal Employment Opportunity........................................................................................................... 8 Immigration Law Compliance............................................................................................................... 8 On-the-Job Accident/Illness ................................................................................................................... 9 Photo Identification ................................................................................................................................ 9 Political Activity ...................................................................................................................................... 9 Rideshare ................................................................................................................................................. 9 Safety ........................................................................................................................................................ 9 Sexual Harassment ................................................................................................................................. 9 Smoking ................................................................................................................................................. 10 Standards of Conduct ........................................................................................................................... 10 Telephones - Cellular Telephones ....................................................................................................... 10 Travel ..................................................................................................................................................... 10 Uniformed Services Employment & Reemployment......................................................................... 10 Violence in the Workplace ................................................................................................................... 10 Visitors ................................................................................................................................................... 11 Weather & Emergency Closings ......................................................................................................... 11 Collective Bargaining ........................................................................................................................... 12 Bargaining Unit Representation .......................................................................................................... 12 Union Contracts .................................................................................................................................... 12 2 Grievance Procedure ............................................................................................................................ 12 Appointment and Promotion ............................................................................................................... 14 Merit System ......................................................................................................................................... 14 Job Classification .................................................................................................................................. 14 Classified & Unclassified Positions ..................................................................................................... 14 Competitive & Non-Competitive Positions ........................................................................................ 14 Scheduled & Continuous Recruitment Job Announcements ........................................................... 14 Job Announcements.............................................................................................................................. 14 Employment Opportunities ................................................................................................................. 15 Application Accommodations for People with Disabilities ............................................................... 15 Rejection from State Application ........................................................................................................ 15 Appointment Types .............................................................................................................................. 15 Working Test Period ............................................................................................................................ 16 Service Ratings ...................................................................................................................................... 17 Promotion & Reclassification .............................................................................................................. 17 Temporary Service in a Higher Class ................................................................................................. 17 Transfers ................................................................................................................................................ 18 Dual Employment ................................................................................................................................. 18 Personnel Records ................................................................................................................................ 19 Personnel Files ...................................................................................................................................... 19 Change of Personal Data ...................................................................................................................... 19 Working Hours ..................................................................................................................................... 19 Meal & Break Periods .......................................................................................................................... 20 Overtime & Compensatory Time ........................................................................................................ 20 Shift Assignments.................................................................................................................................. 20 Attendance ............................................................................................................................................. 20 Paid Leave Time ................................................................................................................................... 21 Holidays ................................................................................................................................................. 21 Sick Leave .............................................................................................................................................. 21 Vacation Leave ...................................................................................................................................... 22 Personal Leave ...................................................................................................................................... 23 Jury Duty ............................................................................................................................................... 23 Military Leave ....................................................................................................................................... 24 Leave Without Pay ............................................................................................................................... 25 Leave of Absence Without Pay (LAW) ............................................................................................... 25 Maternity Leave .................................................................................................................................... 25 3 Medical Leave ....................................................................................................................................... 25 Family Leave ......................................................................................................................................... 26 Salary ..................................................................................................................................................... 27 Payment ................................................................................................................................................. 27 Payday .................................................................................................................................................... 27 Annual Increments ............................................................................................................................... 27 Collective Bargaining & Cost-of-Living Increases ............................................................................ 27 Longevity Pay ........................................................................................................................................ 27 Deductions ............................................................................................................................................. 29 Federal Income Tax & Social Security Tax ....................................................................................... 29 Connecticut Income Tax ...................................................................................................................... 29 Health Insurance ................................................................................................................................... 29 Group Life Insurance ........................................................................................................................... 29 Supplemental Benefits .......................................................................................................................... 29 Direct Deposit ........................................................................................................................................ 30 Deferred Compensation ....................................................................................................................... 30 State Employees Campaign ................................................................................................................. 30 Union Dues ............................................................................................................................................ 30 Credit Unions ........................................................................................................................................ 30 Retirement Tiers ................................................................................................................................... 31 Separation .............................................................................................................................................. 36 Resignation ............................................................................................................................................ 33 Layoff ..................................................................................................................................................... 33 Reemployment Rights .......................................................................................................................... 33 Rescind of Resignation or Retirement ................................................................................................ 33 Exit Interview ........................................................................................................................................ 33 Retirement ............................................................................................................................................. 33 Retirement Types .................................................................................................................................. 36 Pension Payment Options .................................................................................................................... 36 Insurance Benefits ................................................................................................................................ 36 Training and Development .................................................................................................................. 38 In-Service Training ............................................................................................................................... 38 Management Development Courses .................................................................................................... 38 Tuition Reimbursement ....................................................................................................................... 38 Conferences, Workshops & Seminars ................................................................................................ 38 EMPLOYMENT POLICIES ............................................................................................................... 39 4 Welcome Whether you have just joined the agency or have been with us for a while, we are confident that you will or have found our organization to be a dynamic and rewarding place in which to work. We consider the employees of the Department of Labor to be our most valuable resource and we look forward to a productive and successful partnership. This handbook has been prepared for you to serve as a guide for the employer-employee relationship. The topics covered in this handbook apply to all employees of the Department of Labor. It is important to keep the following things in mind about this handbook. First, it contains general information and guidelines. It is not intended to be comprehensive or to address all the possible applications of, or exceptions to, the general policies and procedures described. It is not intended to replace or supersede collective bargaining agreements that may cover many of your terms and conditions of employment. Employees covered by a collective bargaining agreement will receive a copy of their contract at orientation. You should read and become familiar with your collective bargaining agreement, this employee handbook and the agency’s employment policies. If you have any questions concerning eligibility for a particular benefit, or the applicability of a policy or practice, you should address your specific questions to your supervisor or contact your HR Generalist for clarification. Second, neither this handbook nor any other agency document confers any contractual right, either expressed or implied, to remain in the agency’s employ or guarantee any fixed terms and conditions of your employment. Third, the policies, procedures, and benefits described here may be modified or discontinued from time to time. We will try to inform employees of any changes as they occur but cannot guarantee immediate advance notice of changes. Finally, some of the subjects described here are covered in detail elsewhere. The terms of written insurance policies and/or plan documents are controlling for health, life, retirement and deferred or reduced income benefits. You should refer to those documents for specific information since this handbook is only designed as a brief guide and summary of policies and benefits. We are pleased to have you as a member of the Department of Labor and look forward to a successful and beneficial association. 5 About the Agency The Department of Labor handles far more than unemployment insurance benefits. Helping employers and jobseekers with their workforce needs is our goal. An overview of the many programs and public services the agency offers is available on the website (www.ct.gov/dol), which also contains information ranging from upcoming job fairs to wage and workplace guidelines. Mission Statement The Department of Labor is committed to protecting and promoting the interests of Connecticut workers. In order to accomplish this in an ever-changing environment, we assist workers and employers to become competitive in the global economy. We take a comprehensive approach to meeting the needs of workers and employers, and the other agencies that serve them. We ensure the supply of high-quality integrated services that serve the needs of our customer. Supersedence This revised version of the Employee Handbook supersedes all prior versions that have been issued by the Department of Labor and will be effective April 2023. 6 General Highlights Access Card Central Office and Annex employees are issued an access card to enter the building. Should your card be lost, stolen or destroyed, contact Facilities Operations so the card can be deactivated and a replacement issued. Affirmative Action/Equal Employment Opportunity Employer The Department of Labor is committed to affirmative action/equal employment that will build on the strengths of our current workforce and continually enhance the diversity of our organization. The department opposes all forms of discrimination and has developed a set of anti-discriminatory policies. Please direct your questions about affirmative action issues to the AA/EEO Manager at Central Office, 200 Folly Brook Boulevard, Wethersfield, CT 06109; telephone (860) 263-6520. To file a complaint, please click on the link to access the form: Internal Discrimination Complaint Americans with Disabilities Act The Department of Labor complies with all relevant and applicable provisions of the Americans with Disabilities Act (ADA). The agency will not discriminate against any qualified employee or job applicant with respect to any terms, privileges, or conditions of employment because of a person’s physical or mental disability. See the Americans with Disabilities Act Reasonable Accommodation Policy Appearance & Dress Code It is the policy of the agency to project a business-like image to clients, visitors and co-workers. In line with this, you are required to dress appropriately in clothing which is suitable for your job responsibilities and work environment, meets the requirements established for safety reasons, and complies with the agency’s dress code requirements. See Professional Image Policy. Building Security Each and every employee must follow the building security rules and regulations. Employees are not allowed on the property after hours without prior authorization from their supervisor. Code of Ethics The department’s standards of ethical conduct, which all employees are expected to be familiar with and observe, are outlined in the Code of Ethics for Public Officials & State Employees and the Ethical Conduct Policy . Collective Bargaining Your assignment to a collective bargaining unit (union) is based on your job classification. As a bargaining unit member, you will have union dues deducted from your bi-weekly paycheck. You may elect not to join a union. Your union contract governs salary, benefits and hours of work, and other terms and conditions of employment. Collective bargaining agreements are negotiated periodically. 7 Exempt employees are excluded from the collective bargaining process and are not required to pay union dues. Email & Internet Use It is the policy of the agency to provide electronic mail (email) and internet access for work-related purposes. You are required to adhere to this and related policies to ensure proper, legal and effective use of these electronic tools and resources. See Acceptable Use of State Systems Policy. Employee Assistance Program The Employee Assistance Program (EAP) is designed to offer consultation and counseling services for employees and their dependents who are experiencing problems which may be impacting their life at work and/or at home. Some of these problems may include family, marital, alcohol/drugs, emotional distress, and job-related, legal, or financial difficulties. Participation is voluntary and confidential. EAP services are provided by Wheeler EAP. To schedule an appointment or obtain more information, call 1800-252-4555 or 1-800-225-2527, or log on to their website at Wheeler EAP. Employee Background Check Prior to making an offer of employment, Human Resources may conduct a job-related background check. A comprehensive background check may consist of prior employment verification, professional reference check, education confirmation and fingerprinting. Employment Applications We rely upon the accuracy of information contained in an employment application and the accuracy of other data presented throughout the hiring process and employment. Any misrepresentation, falsification or material omission of information or data may result in exclusion of the individual from consideration for employment or, if the person has been hired, termination of employment. Equal Employment Opportunity The Department of Labor is an equal employment opportunity employer. Employment decisions are based on merit and business needs. The Department of Labor does not discriminate on the basis of race, color, citizenship status, national origin, ancestry, gender, sexual orientation, age, religion, creed, physical or mental disability, marital status, veterans’ status, political affiliation, or any other factor protected by law. To file a complaint, please click on the link to access the form: Internal Discrimination Complaint. Immigration Law Compliance All offers of employment are contingent on verification of the candidate’s right to work in the United States. On the first day of work, every new employee will be asked to provide original documents verifying his or her right to work and, as required by federal law, to complete and sign an Employment Eligibility Verification Form I-9. 8 On-the-Job Accident/Illness The agency promotes safety in the workplace. The State of Connecticut also has implemented a Managed Care Program for Workers’ Compensation, administered by Gallagher Bassett Services, Inc. You must report a work-related accident or illness to your supervisor, who is required to call a 24-hour hotline (1-800-828-2717) to report your accident or illness and initiate a claim. If your supervisor is unavailable, you may call or have someone call for you. Your supervisor must also complete the First Report of Injury (Form WC-207) and submit it to DAS_RfaxWCHE@ct.gov or by fax to 959-200-4841, whether or not you seek treatment or lose time from work. To become eligible for workers’ compensation benefits, you must seek treatment from a network physician or medical facility. Forms can be obtained at Workers' Compensation Rights, Responsibilities, and Claims--Documents (ct.gov). In cases of a medical emergency call 911 to seek immediate medical attention. Contact the DAS Workers' Compensation Division at (860) 713-5002 with any questions regarding access. Photo Identification You are required to wear and visibly display a photo identification badge during working hours. If your identification badge is lost, stolen, or destroyed, or you have transferred to a different unit, you must request a replacement through Facilities Operations. Political Activity As a state employee, state statutes govern your involvement in various political activities such as campaigning and running for elective office. Also, if you are working on programs financed in whole or in part by federal funds, you are subject to the provisions of the federal Hatch Act, which is generally more restrictive than state statue. The purpose of these laws is to avoid a conflict of interest between your state job and political activities. Information regarding political activity may be found in DAS General Letter 214D, link to document General Letter 214D – Political Activity. The Ethical Conduct Policy also addressed these issues and you are advised to contact the agency’s Ethics Liaison regarding any political activity. See Ethical Conduct Policy. Rideshare The department promotes the statewide Rideshare Program, an opportunity to reduce your transportation expenses to work. Consider using a ride-sharing mode (carpool, vanpool or bus) as an alternative to driving alone. Ride sharing saves you money, energy and preserves the environment. For information call 800-972-EASY (800-972-3279) or visit the website at www.rideshare.com. Safety The safety and health of employees is our top priority. The agency makes every effort to comply with all federal and state workplace safety requirements. Each employee is expected to obey safety rules and exercise caution and common sense in all work activities. Promptly report safety concerns to your supervisor. Sexual Harassment The Department of Labor does not tolerate sexual harassment. Sexual harassment may include unwelcome sexual advances, requests for sexual favors, or other unwelcome verbal or physical contact 9 of a sexual nature when such conduct creates an offensive, hostile and intimidating work environment and prevents an individual from effectively performing the duties of their position. See Sexual Harassment Policy. Smoking Smoking is prohibited throughout agency buildings and offices, including in rest rooms, private offices, lounges and similar areas. Smoking is permitted only in designated areas outside office buildings and other work locations. The use of smokeless tobacco and e-cigarettes are also prohibited and subject to the same restrictions. Standards of Conduct The work rules and standards of conduct for employees are important and the agency regards them seriously. All employees are urged to become familiar with and must follow these rules and standards. See Employee Conduct Policy. Telephones - Cellular Telephones The agency recognizes that occasionally it is necessary for employees to make or receive personal telephone calls during working hours. You are expected to restrict your personal telephone usage, both on state-owned phones and personally owned cellular phones, to reasonable, incidental calls that do not interfere with your work schedule or the performance of your duties. To avoid being disruptive to others in the workplace, please make certain audible alerts are disabled. Travel Your position may require travel to conduct state business. If you are required to travel for work, you may obtain a state-owned vehicle from a central carpool with a valid driver’s license. Use of your personal vehicle in the performance of Agency duties is allowable only when the use of a State-owned vehicle is not reasonably available for use and request mileage reimbursement. You must present proof of automobile insurance with the minimum coverage requirements. Contact your supervisor or Business Management if you have any questions. Uniformed Services Employment & Reemployment As an equal opportunity employer, the Department of Labor is committed to providing employment and reemployment services and support as set forth in the Uniformed Services and Reemployment Rights Act of 1994 (USERRA). Violence in the Workplace The Department of Labor has a policy prohibiting workplace violence. Consistent with this policy, acts or threats of physical violence, including intimidation, harassment and/or coercion, which involve or affect the organization and its employees will not be tolerated. See Violence in the Workplace Prevention Policy. 10 Visitors To provide for safety and security, only authorized visitors are allowed in the workplace. All visitors must enter through the main reception area, sign-in and sign-out at the front desk and receive a visitor identification to wear while on the premises. Authorized visitors will be escorted to their destination and must be accompanied by an employee at all times. Weather & Emergency Closings At times, emergencies such as severe weather or power failures can disrupt business operations. Everbridge, is a system that the state utilizes to notify enrolled individuals on safety and weather concerns. You can determine by which methods you want to be notified. Sign-up is free. Any personal information provided (such as cell number) will be used for important employee notifications purposes only directed by DAS. Everbridge will never give or sell contact or location information to any vendor or other organization. The Department of Emergency Service & Public Protection website is the official source of information for state employees. Use this page to find any official announcements about closures or delayed openings that have been declared by the Governor. Everbridge system can send alerts to your work phone and email as well as your home phone, cell phone, and home email. The Statewide CT Alert system can also keep you informed of state emergencies and send you emails and text alerts. FEMA’s Ready.gov preparedness site has information on how to keep safe during the winter. 11 Collective Bargaining Bargaining Unit Representation Labor unions and management at times negotiate collective bargaining agreements (union contracts). The contracts govern such areas as salary, benefits, hours of work, and the terms and conditions of employment. Most state job classifications have been assigned to particular bargaining units (unions) and state employees have voted to have unions represent them in the negotiation process. If you are a nonexempt employee, you have been assigned to a bargaining unit based on your job classification and will be represented by that specific union. If you are an exempt employee, you have been excluded from the collective bargaining process. The terms and conditions of your employment will be governed by state statutes, rules and regulations. Union Contracts Union contracts, established through the formal negotiation process, outline the terms and conditions of your employment. You should familiarize yourself with your contract. Benefits and provisions vary between bargaining units. Contract language has been crafted to avoid disputes and eliminate misunderstandings. Contract provisions, however, may be open to interpretation and subject to the grievance and arbitration process. Direct your questions about your union contract to your supervisor, union representative or Human Resources Generalist. Grievance Procedure Your problems or complaints should be resolved quickly and fairly. First, discuss the issue with your supervisor, who may help you find a solution. If your supervisor or another employee in the chain of command cannot resolve your problem or complaint, or if you feel that you have been treated unjustly, contact your union steward or Agency Labor Relations Specialist. If an issue cannot be resolved informally, you may follow the grievance procedure outlined in your union contract. This procedure helps resolve disputes concerning the interpretation and application of a contract. You should, however, make every effort to resolve an issue before filing a grievance. Though specific procedures may vary, your union contract establishes time limits for initiating grievances and obtaining responses. The first steps of the grievance process are informal to encourage quick resolution. If an issue still cannot be resolved, more formal meetings are conducted until the grievance reaches the highest level of the process. Most grievance procedures permit arbitration when an issue cannot be resolved at the highest level. An arbitrator, an impartial party chosen by the union and management, will hear both sides of an issue and render a binding decision. A union normally requests arbitration, but you as an employee may also request it in certain circumstances. Arbitration is permitted only if negotiated as a step in the grievance procedure. You or a group of employees may present a grievance to management for resolution without your union’s participation. However, the resolution must be consistent with your union contract and your union must be given the opportunity to attend all meetings. 12 If you are an exempt classified employee, you may appeal certain actions through the grievance procedure as outlined in Sec. 5-202 of the Connecticut General Statutes. 13 Appointment and Promotion Merit System The appointment and promotion of state employees is based on the merit principles in the State Personnel Act. As with other federal, state and municipal merit systems, this system was established to minimize the influence of electoral politics on the employment and retention of state employees. The system strives to place the best qualified people in state service and to ensure that they are fairly treated in the appointment and promotion process. The merit system is not subject to collective bargaining. Job Classification The state, as an employer of thousands of people, must systematically describe and group jobs to ensure consistent and fair treatment when assigning, compensating and promoting employees. Consequently, it has established a classification plan for all jobs in the executive branch of state service. Individual positions are grouped into job classes, with each class consisting of positions with similar duties, responsibilities and required qualifications. Your job classification is the foundation for the employment process. Classified & Unclassified Positions Most positions in the executive branch of state government are classified. Unclassified positions may be exempt from job announcements. The State Personnel Act lists a number of unclassified categories: agency heads, members of boards and commissions, officers appointed by the governor, deputies and executive assistants to the head of departments, executive secretaries, employees in the Senior Executive Service and professional specialists. Competitive & Non-Competitive Positions Most classified positions are competitive and require an application. The type of experience required depends on the job classification. Applicants must meet minimum general experience and training requirements, however, to be eligible for appointment if a position requires a professional license or degree, there may be no additional requirements beyond possession of the professional license or degree. Scheduled & Continuous Recruitment Job Announcements Most state job opportunities are announced to the general public with a specific closing date. If you apply for a job opening, you will be notified if you are selected for an interview by the hiring agency. When the state considers continuous recruiting necessary, it may postpone the closing date for filing applications until it receives a suitable number of candidates. A job posting will indicate when recruiting is continuous and that applications may be filed until further notice. Job Announcements To meet merit system objectives, the state has developed competitive job classifications to fill many of its positions. They are not used to fill unclassified positions or those in classes designated as noncompetitive. State job announcements fall into the following categories: 14 Open to the Public. If you meet the minimum experience and training qualifications for a position, you may participate in this type of recruitment. Open-competitive job announcements are administered periodically usually when a state agency is recruiting for a vacant position. Statewide & Agency Promotion. If you are a state employee who meets the minimum experience and training qualifications for a position and has completed six months continuous service in a state agency, you may participate in a statewide recruitment. Agency promotional announcements will have the additional requirements that you must be a current agency employee. Employment Opportunities Agency job announcements are posted on the DAS Online Employment Center. You should check regularly for the most up to date information. To apply for employment, you must complete a Master Application on the DAS Website. Check the state employment pages on the Department of Administrative Services website (Job Openings Department of Administrative Services (jobapscloud.com) for information about completing the application form, job opportunities, and to sign up for e-mail notification of current job openings. Application Accommodations for People with Disabilities The state may conduct recruitments in various ways. If you need special accommodations for a particular recruitment, you or someone on your behalf should immediately notify the DAS at (860) 713-7463. You must supply the application title and job number, and a description of your special needs and documentation of the disability. Rejection from State Application Your application for a state job opening may be rejected if (1) your application was received after the closing date, (2) you did not meet the minimum requirements, (3) your years of experience did not match the requirements, (4) specific information was missing from your application, (5) you failed to meet the special requirements for the position, or (6) your years of experience did not match the special requirements. Appointment Types Durational. An employee hired for a specific term, for a reason not provided above, including a grant or specially funded program, not to exceed one year. A durational employee shall become permanent after six months, or the length of the working test period, whichever is longer. Emergency. The state may appoint you to an emergency position to meet short-term agency needs. The appointment may extend for as long as two months but may not be renewed in a fiscal year. Intermittent. Intermittent employment is also work on an ""as needed"" basis. The agency may use intermittent interviewers to supplement permanent staff in times of high unemployment. They are paid an hourly rate for time worked and may receive benefits. They are eligible to apply for agency promotional postings following the completion of 1044 hours of intermittent service. 15 Permanent. The state may appoint you to a permanent competitive position from a certification list. You must successfully complete the working test period to gain permanent status. Provisional. The state may provisionally appoint you to a position that must be filled immediately if no active certification list exists, or an insufficient number of candidates are listed. The appointment may extend for as long as six months or until a job announcement for the position has been held and a certification list promulgated. You may not receive more than one provisional appointment in a fiscal year or serve more than six months as a provisional appointee. Your job performance while a provisional must be satisfactory. To receive a permanent appointment, you must be appointed from a competitive process for the position. If you are not appointed from a competitive process and do not have a permanent position to which you may return, you must be separated from state service. If the competitive process is not completed for a position within six months, an additional temporary or emergency appointment may be authorized. Seasonal. Seasonal employment for a position established for a specific period, usually during summer months. Individuals employed are paid an hourly rate and are not entitled to any fringe benefits. Temporary. Position filled for a short term, seasonal, or an emergency situation, including to cover for a permanent position when the incumbent is on workers’ compensation or other extended leave, not to exceed 6 months. May be extended up to one year. If a temporary employee is retained greater than 12 months, said employee shall be considered durational. Working Test Period The working test period, or probationary period, for a state employee is an extension of the state recruitment process. You must serve this period to gain permanent status following initial appointment or promotion. Your initial test period is generally six months, depending on the applicable contract or state regulation. Your promotional test period is generally four to six months, again depending on the applicable contract or regulation. Exceptions may occur in the length of the trial period for trainee positions. Questions about your working test period may be directed to your supervisor or Human Resources Generalist. During an initial working test period, you are considered a probationary employee and will work closely with supervisors and colleagues to learn your duties. This period also gives your supervisor the opportunity to evaluate your response to training and job requirements. If you demonstrate acceptable performance during your initial test period, you will be given a satisfactory service rating and gain permanent status as a state employee. Your working test period may be extended in certain circumstances. If you do not meet acceptable performance standards during the initial working test period, you will be separated from state service. You may not appeal a dismissal during your initial test period through the contractual grievance procedure, but you may request an administrative review. If you fail to meet acceptable performance standards during a promotional working test period, you will revert to your previous classification. 16 Service Ratings You will receive a service rating for your initial working test period or promotional test period, and at least three months before your annual increase date. Depending on your union contract or state statutes, you may receive a service rating at any time, particularly when your job performance has changed significantly. Service ratings record your progress and performance as training and job experience increase. The state recognizes satisfactory performance by awarding annual salary increases (as negotiated) until reaching the maximum step in a salary group. For employees at the maximum step, some bargaining units award a lump sum payment in lieu of an annual increment. A “less than good” rating may prevent you from receiving an increase. An “unsatisfactory” during the working test period signifies failure. After attaining permanent status, two successive “unsatisfactory” ratings may result in your dismissal. Managers are evaluated in accordance with the provisions of the Performance Assessment and Recognition System (PARS) Program. Promotion & Reclassification Generally, there are two ways in which you may receive an appointment to a higher-level job classification. First, you may compete for a new position or an opening that arises when another employee leaves an existing position. The agency may use a formal state employment application process to obtain a list of candidates to be considered for an opening or it may use a less formal recruitment and selection process. In either event, in order to be considered you must meet the minimum qualifications for the higher classification and comply with the application procedures. Recruitment notices are posted internally on the agency intranet, and at times externally on the Department of Administrative Services website. It is your responsibility to monitor them and respond according to the instructions on the job posting. Additionally, you may progress to a higher level through reclassification. After working for the agency for some time, you may find that your duties have expanded and are more consistent with a higher-level job classification. In such cases, your supervisor will ask you to complete a job duties questionnaire, which will be evaluated by Human Resources. If you are found to be working “out of class,” the agency has the option of either removing the higher-level duties or reclassifying your position to the higher level. Certain conditions must be met for reclassification. You must be in your current position for at least six months, have a rating of “good” or better on your last two performance evaluations and meet the minimum experience and training requirements for the higher class. If you have applied for a job opening and did not qualify for the classification, this is evidence that you do not meet the qualifications for the higher-level class and cannot be considered for reclassification. Temporary Service in a Higher Class When a temporary vacancy occurs in a non-entry level classification, such as the result of an employee being on an extended leave of absence, the agency may fill the opening by temporarily assigning you to a higher level as long as the assignment lasts for more than 30 days and meets any other relevant union contract provisions. You must meet the minimum qualifications of the class. While serving in this type 17 of service, you are paid at the higher level, but you retain status in your permanent (lower) classification. Benefits such as longevity and vacation accrual are based on the permanent class. Transfers You may voluntarily transfer within the agency or to another state agency. To place your name on a Statewide Transfer list, for your current job class in which you hold permanent status, please visit the DAS Website, Freenames - Department of Administrative Services (jobapscloud.com), scroll down and follow the process of Statewide Transfers. If your job classification is unique to the agency, your transfer options will be limited to those classes deemed comparable to the one in which you have permanent status. Consult your union contract for more information. If you are interested in transferring to another work location within the agency and meet the eligibility of the job requirements, Human Resources will send emails periodically with transfer opportunities, to be considered you must follow the procedures noted on the email. The agency may involuntarily transfer you under certain circumstances, generally defined in your union contract or state personnel regulations. Transfers occur for a variety of reasons: when the agency seeks to better use its resources, to avoid layoffs, to meet emergency or seasonal conditions, or to accommodate you. If you are an exempt employee, your transfer is subject to state regulations and the State Personnel Act. Dual Employment You may be authorized to work at a secondary agency subject to the dual employment provisions of the regulations for state agencies. For this to occur, the secondary agency must initiate and complete the appropriate paperwork. The secondary agency will forward a copy of the dual employment request form to the primary agency for completion and return. If all provisions are met, subject to any fair labor standards considerations and the operating needs of the department, you may be eligible for secondary employment. Secondary employment may not pose a conflict of interest or interfere with the performance of your job duties and your approved work schedule for the Department of Labor. 18 Personnel Records Personnel Files The agency maintains a digital personnel file containing information about your employment: service ratings; personnel processing forms; appointment, promotion, and disciplinary letters. The agency also maintains a separate, confidential file that contains your medical documents, including doctor’s notes and medical certificates. You may review your digital personnel file by contacting Human Resources. You may sign a waiver to allow another person, such as a union official, to review your files. The agency must comply with written requests for information about its employees under the state freedom-of-information law. If the agency considers an information request to be a possible invasion of your privacy, you will be notified. Change of Personal Data Whenever you change your name, address, number of dependents, telephone number, or marital status, you must promptly notify Payroll so that agency records and files may be updated. You may also need to complete a new federal or state withholding allowance certificate (W-4 or CT W-4), or various health insurance forms. Working Hours The negotiated workweek for most staff members currently averages 40 hours per week. Some union contracts provide for a 35 or 37.5-hour workweek. Many employees work a standard schedule of 8:00 a.m. to 4:30 p.m. The agency has also established nonstandard work schedules, which are approved in advance by the appointing authority in consultation with the Director of Human Resources. Provision for flex time has been included in some contracts. If your position is covered by flex time or other nonstandard workweek, your supervisor will explain its operation. The Payroll Unit will maintain your attendance record. From time to time and consistent with the terms of the applicable collective bargaining agreement, it may be necessary to temporarily or permanently change your work schedule to meet operational needs. In such a situation you will be given as much notice as possible, at a minimum that is required by your union contract. Regardless of your work schedule, you are expected to arrive at work on time, return from lunch and breaks on time, and not leave your job prior to quitting time. 19 Meal & Break Periods Full-time employees are permitted two 15-minute breaks and a 30-minute unpaid meal period. Longer unpaid meal periods are allowed with supervisory approval. The schedule for all meal and break periods is determined by your supervisor based on business operations and staffing needs. Your supervisor will inform you of your schedule and any required changes. Employees are not permitted to work through lunch to leave early. Breaks do not accumulate, nor may they be used to start late or leave early. Overtime & Compensatory Time Overtime occurs when you work in excess of your regular established weekly schedule. Overtime assignments must be approved in advance, except in extreme emergencies. The Fair Labor Standards Act (FLSA), state statutes and regulations, and your union contract govern your eligibility for overtime and the rate of compensation. Compensatory time is a form of accrued leave time that may be used later; it does not constitute a basis for additional compensation. Compensatory time must be taken in accordance with the provisions of your contract and agency policy. The FLSA may conflict with your union contract regarding compensation for overtime. Generally, you will be paid by the method that provides the greater benefit. Hours worked in excess of 40 in one week are generally compensated at the rate of time-and-one half. The time-and-one-half rate is derived from your basic hourly wage rate. Some employees may be ineligible for the overtime provisions of FLSA. Questions may be directed to Payroll. Shift Assignments Some areas engage in multi-shift operations. Depending on the starting and ending times of your shift and union contract, you may be eligible for shift-differential payments. These usually take the form of additional pay for the hours worked on your assigned shift. Generally, any shift that begins before 6:00 a.m. or after 2:00 p.m. is subject to shift-differential payments. Some employees may not be eligible for these payments, even when assigned to such a shift. Consult your union contract for information regarding eligibility for the shift and weekend differentials, and the applicable pay rate. Attendance You are responsible for maintaining a good attendance record. Frequent absenteeism reduces the level of your service to the agency and the public, increases operational costs, and places a burden on your co-workers. Use your accrued leave in accordance with agency policies and procedures and ensure that you comply with Employee Dependability Policy requirements. You should request leave time as far in advance as possible. Refer to your union contract for additional guidelines. Agency operating needs, the reasonableness of the request, and the specific language contained in the union contract govern the approval or denial of your leave request. Whenever possible, avoid unscheduled leave. 20 Paid Leave Time Holidays The state grants 13 paid holidays per year to permanent, full-time employees: New Year’s Day, Martin Luther King’s Birthday, Lincoln’s Birthday, Washington’s Birthday, Good Friday, Memorial Day, Juneteenth Day, Independence Day, Labor Day, Columbus Day, Veterans’ Day, Thanksgiving Day and Christmas Day. Intermittent and durational employees must work the equivalent of six months (1044 hours) to be eligible for holiday pay. If a holiday falls on a Saturday or Sunday, the state generally designates the Friday preceding or the Monday following as the day it will be observed. A calendar detailing the exact day of holiday observance appears on the Human Resources intranet site. You will be paid for a holiday if you are on the payroll on or immediately before or after the day it is celebrated; you normally will not receive holiday pay if on a leave of absence without pay before and after a scheduled holiday. Consult your union contract for information about compensation for work performed on a state holiday. Sick Leave As a permanent employee, you accrue sick leave from your date of employment for each fully completed calendar month of service, except as otherwise provided in the statutes. You must use sick leave when incapacitated or in the special cases described in your union contract. Upon exhaustion of sick leave, you must use other accrued leave in lieu of sick leave unless FMLA rules dictate otherwise. If an employee is sick while on annual vacation leave, the time will be charged against accrued sick leave if supported by a properly completed medical certificate. Sick leave is not an extension of vacation or personal leave. You should maintain a sick leave balance as a form of insurance in the event of a long-term illness. Accrual. Full-time employees accrue paid sick leave at the rate of 1¼ days per completed month of service or 15 days per year. If you are absent without pay for more than forty hours in any month, you do not accrue sick leave in that month. If you are an eligible part-time employee, you accrue paid sick leave on a pro-rated basis or on the amount of your scheduled hours as a percentage of a full-time schedule. Balances. Payroll records your sick leave balance (time accrued but not used) in hours and minutes. When you retire, the state will compensate you for 25 percent of your accrued sick leave balance (to a maximum of 60 days). Call-In Procedure. If you are unexpectedly absent as a result of injury or illness, you must notify your supervisor or designee as early as possible, but no later than one-half hour before your scheduled reporting time. If your absence is continuous or lengthy and you have not been granted a medical leave 21 of absence, you must notify your supervisor on a daily basis. If you fail to call in, you may be placed on unauthorized leave without pay and subject to corrective action. Medical Documentation. Your physician must complete a medical certificate if you are absent as the result of injury or illness for more than five working days or as otherwise outlined in your union contract or state personnel regulations. If you fail to provide the required medical documentation, you may be placed on unauthorized leave, which can lead to loss of pay and disciplinary action. Medical certification forms should be emailed directly to DAS.BenefitsandLeavesPod4@ct.gov. Any questions must be sent directly to DAS.BenefitsandLeavesPod4@ct.gov. Additional Use of Sick Leave. You may use sick leave for situations other than your own injury or illness (a medical certificate or written statement supporting a request may be required): • • • • • Medical, dental or optical examination or treatment when arrangements cannot be made outside working hours. Death in your immediate family. Illness or injury to a member of your immediate family. Funeral for a person other than an immediate family member. Birth, adoption or taking custody of a child. To determine the exact number of days allowed, refer to your union contract. Extended Illness or Recuperation. If you exhaust your accrued sick leave during a prolonged illness or injury, you may be permitted to use other accrued time. You must obtain approval from your immediate supervisor for use of other accrued leave to cover the remainder of the absence. In certain circumstances, you may be granted an advance of sick leave if you have at least five years of full-time state service. Consult your union contract for information regarding the sick leave bank or donation of leave time. If an employee has no accrued leave time available, a written request for a medical leave without pay must be submitted to DAS.BenefitsandLeavesPod4@ct.gov, and the request must be followed up in writing upon return to work. Failure to do so will result in charging the absence to Sick Leave Without Pay. Illness or Injury While on Vacation. If you become ill or injured while on vacation, you may request that the recovery time be charged to your sick leave rather than to your vacation leave. A medical certificate or documentation support your request will be required. Vacation Leave Usage. As a full-time employee, you may begin taking paid vacation leave after six months of continuous service. Unless otherwise stated in a union contract, a part-time employee may begin taking paid vacation after completing the equivalent of six months of full-time service (1044 hours). Requests for vacation leave are subject to the approval of your supervisor, based on the operating needs of the unit and the seniority provisions of your contract. 22 Accrual. You accrue vacation leave at the end of each full calendar month of service. Absence without pay for more than five days (equivalent to 40 hours) in a month result in the loss of accrual for that month. You accrue vacation leave at the following rate for each completed month of service (prorated, if part-time): • • • 0-5 years of service: 1 day per month (12 days per year). 5-20 years: 1-1/4 days per month (15 days per year). 20 or more years: 1-2/3 days per month (20 days per year) As a manager and confidential employees excluded from collective bargaining, you accrue vacation leave at the rate of 1-1/4 days per completed month of service or 15 days per year. After completing 10 years of service, on January 1 of each subsequent year you will receive the following number of days in addition to the normal accrual: • • • • • 11 years of service: 1 additional day 12 years: 2 additional days 13 years: 3 additional days 14 years: 4 additional days 15 or more years: 5 additional days Balances. Payroll will record your vacation leave balance in hours and minutes. Without agency permission, you cannot carry more than 10 days of accrued vacation leave from one year to the next if you are a nonexempt employee. If you are a nonexempt employee, refer to your bargaining union contract regarding your maximum accrual. If you are a nonexempt employee or a manager, you may accumulate as many as 120 days of vacation time. When separated from state service, if a permanent employee, you will receive a lump-sum payment for your vacation leave balance. Personal Leave As a full-time employee who has attained permanent status, you are credited with three days of personal leave to conduct private affairs, including the observance of religious holidays. On January 1 of each year thereafter, three days of personal leave will be credited to your leave balance. You must request authorization in advance from your supervisor to use personal leave. Personal leave must be used prior to the end of the calendar year or it will be forfeited. You are responsible for monitoring your time charges to ensure that your personal leave is used within the calendar year. Part-time employees generally are entitled to prorated personal leave; consult your union contract for the specifics. Payroll will maintain your balance. Jury Duty If you are summoned for jury duty, you will not lose your regular salary or benefits. You must notify your supervisor immediately and supply the jury notice; your supervisor will forward it along with the reason for your absence to the Payroll Unit. The court will supply you with verification of your attendance; which is then submitted through your supervisor to Payroll. You must return to work 23 whenever not actively serving on jury duty. With the exception of travel allowances, you must return the money received for jury duty to Payroll. Military Leave If you are a member of the National Guard or a reserve component of the U.S. armed forces and a permanent employee, you may apply for leave to attend required training. To verify the leave, you must submit a copy of your military orders to DAS.BenefitsandLeavesPod5@ct.gov or fax to 860-622-4928. The state permits as many as three weeks in a calendar year for field training. Paid leave for military call-ups other than annual training is limited to unscheduled emergencies, subject to the provisions of your union contract. Notify your supervisor as soon as you become aware of your military leave schedule. 24 Leave Without Pay Leave of Absence Without Pay (LAW) Depending on the terms of your union contract, you may be granted a LAW without endangering your status as a state employee. Your benefits, however, may be affected. You will not accrue vacation or sick leave in any month on a LAW for more than five working days (hourly equivalent of) without pay, and service credit toward retirement, seniority and longevity may be suspended. If you are on a LAW for pregnancy, illness, injury, or an FMLA-qualifying reason, the state will continue to pay the same portion of your health insurance as while you were working. You will, however, be billed directly for the amount that you previously paid through payroll deduction. If on a LAW for another reason, you will be billed for the full cost of medical coverage. If possible, submit your LAW request to DAS.BenefitsandLeavesPod4@ct.gov in advance and in writing with appropriate documentation. Your manager may grant a LAW for as many as five consecutive days. A LAW of longer than five days must be authorized by the Benefits and Leaves Pod before the leave, except in extraordinary situations such as emergency medical leave. You may be granted a LAW for a variety of purposes on a position-held or not-held basis. Your LAW must be consistent with the requirements in your union contract or state regulations if you are an exempt employee. If your position is held, you may resume employment on the expiration of the LAW. You must be cleared by a physician to return to normal duties if you are on a medical LAW. This needs to be done before you return to work. If your position is not held, your return to active service depends on the availability of a position. The agency will consider the reason for your request, your work record and agency operating needs when deciding whether to grant you a LAW and to hold your position. Maternity Leave If pregnant, you must use accrued sick leave to cover time before, during or after your delivery when a physician certifies you as “unable to perform the requirements of your job.” You must send a Medical Certificate - P33A to DAS.BenefitsandLeavesPod4@ct.gov to substantiate your disability. When your disability period ends or you have exhausted your sick leave balance prior to the end of your disability period, you may request to use accrued vacation and personal leave. When all your paid leave has been used, you may request a LAW with your position held. Refer to your union contract and the FMLA Policy for further information. Medical Leave You must use accrued sick leave to cover the time which you are unable to work because of illness. If that period extends beyond five days, you will need to supply a Medical Certificate - P33A to DAS.BenefitsandLeavesPod4@ct.gov to substantiate your use of sick time to. When your sick leave balance is exhausted, you must apply vacation or personal leave to cover your absence unless FMLA rules dictate otherwise. Your union contract may contain provisions for advance of sick leave, a sick leave bank, and donation of leave time in cases of prolonged illness. You may also request a leave of absence without pay. Details on the requirements and provisions of such leaves are in your union contract and the FMLA policy. 25 Family Leave You may request a LAW for the birth or adoption of a child; the serious illness or health condition of a child, spouse or parent; your own serious health condition; the placement of a foster child in your care and certain other conditions. A medical certificate must be submitted by email to DAS.BenefitsandLeavesPod4@ct.gov to substantiate a request for leave under the Family and Medical Leave Act (FMLA). You must request forms by sending an email to DAS.BenefitsandLeavesPod4@ct.gov. 26 SALARY Payment Your job classification determines your salary grade. Classifications are assigned to a salary group based on the amount and type of required experience and training, technical complexity, difficulty and level of responsibility. The state establishes a number of steps for salary groups other than managerial and confidential classes. As a new employee, you will generally start at the salary range minimum for your job classification. Payday The state issues salary payments bi-weekly through a checkless system called e-pay. You will receive payment for the work you performed during the previous two weeks. The delay allows for processing. If you are a new employee, you should receive your first salary payment four weeks after your first workday. If you separate from state service, you will receive your last salary payment two weeks following the end of the last pay period worked. Earnings, itemized deductions and leave accruals are viewable online. Questions should be directed to Payroll. Annual Increments Annual increments are based on the terms of your union contract. You may be raised to the next higher step in a salary group on your anniversary date. Consult your union contract for details. If an appointed official or manager, you may be awarded an increase by the governor, usually effective on January 1. The amount of the increase will be based on your goal attainment and performance under PARS, the Performance Appraisal and Recognition System for managers. Collective Bargaining & Cost-of-Living Increases If you are a union member, your increase will result from the collective bargaining process. An increase generally will be calculated as an across-the-board percentage within a negotiated salary structure and payable in July. If you are an appointed official or a manager, the governor may award you a cost-ofliving increase, usually a percentage of your annual salary, also payable in July. When promoted, you will normally receive a salary increase of at least one full step in the salary group, unless you are placed at the maximum step. If promoted to a managerial position, you will receive an increase of five percent or the minimum of the new salary range, whichever is greater. Longevity Pay Employees hired on or after July 1, 2011, shall not be entitled to a longevity payment however, any individual hired on or after said date who shall have military service which would count toward longevity under current rules shall be entitled to longevity if they obtain the requisite service in the future. Employees hired prior to July 1, 2011, are eligible for longevity. For those eligible employees, when you complete the equivalent of 10 years of full-time state service (generally continuous) you will receive a longevity payment. The amount of longevity payment increases when you complete 15, 20, and 25 year years of service. Longevity schedules appear in your union contract and other pay plans. To qualify, you must attain the required years of service by April1 or October 1. Longevity payment are also paid 27 in these months. Employees not included in any collective bargaining unit are no longer eligible for longevity payments. 28 DEDUCTIONS Federal Income Tax & Social Security Tax Federal income and Social Security taxes will be deducted from your paycheck in accordance with federal law. Connecticut Income Tax State income tax will be deducted from your paycheck in accordance with state law. Health Insurance Health insurance coverage for eligible employees who choose to enroll in the state’s health benefit plan will be effective the first of the month immediately following the employee’s hire date or date of eligibility. For example, if you were hired on November 9, you must submit your application within thirty days; your effective date of coverage would be December 1. You may extend health and dental coverage to cover your spouse, dependent children under age 26, and/or disabled children over age 26. Please contact Payroll for enrollment eligibility. Refer to the Office of State Comptroller’s website for a summary of health insurance options and rates. You must remain with your insurance carrier until the next open enrollment period, the one time a year when you can change carriers. You may add a dependent newborn or spouse within one month of the birth or marriage (please note if adding a new spouse, a marriage certificate is required); other dependent changes generally are restricted to the open enrollment period. If your spouse’s insurance was terminated through his/her employer, you may be eligible to add them as a special exception. A letter from the employer stating insurance has been cancelled will be required. All additions, deletions, or other changes must be processed through the Payroll Unit. You must provide documentation of each dependent’s eligibility status at the time of enrollment. It is your responsibility to notify the Payroll Unit when any dependent is no longer eligible for coverage. Group Life Insurance You may purchase term life insurance at group rates. The state pays a portion of this coverage. You may authorize payroll deductions for this insurance after six months of employment. If you waive coverage and later decide to enroll, you must apply with medical evidence of insurability and wait for approval. The amount of life insurance coverage is based on your annual salary and is automatically adjusted on April 1 and October 1 as your salary increases. Contact the Payroll Unit to obtain forms or arrange for beneficiary changes. You may visit the Office of State Comptroller’s website (https://carecompass.ct.gov/supplementalbenefits/) for more information. Supplemental Benefits The state offers various supplemental benefits to qualified employees and retirees, which are designed to complement the benefits provided by the state. These benefits are on a voluntary basis and are paid entirely by the employee through the convenience of payroll deduction. Available supplemental benefits 29 are listed on the OSC website Supplemental Benefits - Care Compass (ct.gov). Contact the authorized vendors for information and assistance with the enrollment process. Direct Deposit You may deposit your paycheck in a checking or savings account in a financial institution that is a member of the automated clearinghouse. Your funds will be electronically transmitted and available to you after 9:00 a.m. on the date of the check. You must complete an authorization form to adjust or cancel direct deposit. Authorization forms can be obtained from Payroll. Deferred Compensation Permanent employees who work more than 20 hours a week are eligible for the state’s deferred compensation plan. Through payroll deduction, you may set aside a portion of your taxable wages (prior to tax deferrals). The minimum contribution is $20 per pay period. Obtain details by contacting the plan administrator. State Employees Campaign Through the state employee campaign, you may contribute to your choice of a range of service organizations via payroll deduction. Union Dues As a member of a collective bargaining unit, you may elect to join the union and have union dues deducted from your check. Your union determines the amount by using a set-rate or sliding-scale formula based on the amount of your salary. Credit Unions As an agency employee, you may join the, CT Labor Department Federal Credit Union, 200 Folly Brook Blvd., Wethersfield, CT 06109 (telephone 860-263-6500). As a State of Connecticut employee, you may also join the CT State Employees Credit Union. Offices are as follow: 84 Wadsworth Street Hartford, CT 06106 860-522-5388 1244 Storrs Road Storrs, CT 06268 860-429-9306 2434 Berlin Turnpike Newington, CT 06111 860-667-7668 401 West Thames Street Southbury Training School Norwich, CT 06360 Southbury, CT 06488 860-889-7378 203-267-7610 1666 Litchfield Turnpike Woodbridge, CT 06525 203-397-2949 Silver & Holmes Street Middletown, CT 06457 860-347-0479 30 Retirement Tiers The state and collective bargaining units negotiate the pension agreement. The retirement system includes five plans: Tier I, II, IIA, III and IV. For details, contact Office of the State Comptroller’s at osc.crsp@ct.gov or consult the specific retirement booklet for which you are a member. Online copies are available at the OSC website Retiree Resources (ct.gov). Tier I. Usually, you are member of this retirement plan if you were hired on or before July 1, 1984 and contribute by payroll deduction to your pension. You may retire at age 55 with 25 years of service, or at age 65 with 10 years of service, or retire early at age 55 with 10 years of service – at a reduced rate. This tier is divided into three plans. Members of Plans A and C contribute five percent of salary toward retirement. Members of Plan A have chosen not to participate in the Social Security plan; Plan C members pay Social Security taxes and are eligible for Social Security benefits. Plan B members contribute two percent of salary toward retirement until they reach the Social Security maximum, and five percent of salary above the maximum; they will receive reduced pensions when Social Security payments begin. You also may purchase periods of service for which you have not made contributions: war service, prior state service, and leaves of absence for medical reasons. Tier II. If you were hired into state service from July 2, 1984 to June 30, 1997, you are automatically covered under this noncontributing plan. If you were employed by the state on or before July 1, 1984, and were not a member of any other state retirement plan, the Tier II plan also covers you. You contribute two percent of your salary towards retirement. You are eligible for normal retirement benefits after you attain: (1) age 60 with at least 25 years of vesting service; (2) age 62 with at least 10, but less than 25 years of vesting service; or (3) age 62 with at least five years of actual state service. If you have at least 10 years of service, you can receive retirement benefits – at a reduced rate – if you retire on the first day of any month following your 55th birthday. Retirements on or after July 1, 2022 are subject to the age and years of service specified in the SEBAC 2011 agreement. Tier IIA. If you entered state service from July 1, 1997 to June 30, 2011, you are covered under this plan as of the date of your employment. You contribute two percent of your salary towards retirement have the same options and benefits as a Tier II employee. If you are not eligible for any retirement benefits when you leave state service, you may withdraw your retirement contributions. You also may purchase periods of service for which you have not made contributions: war service and leaves of absence for medical reasons. Tier III. This plan covers employees hired on or after July 1, 2011 to July 30, 2017. As a Tier III member, you contribute two percent of your total annual salary. Your normal retirement date is the first of any month on or after you reach age 63 if you have at least 25 years of service, or age 65 with at least 10, but less than 25 years of service. If you have 10 years of vesting service, you can receive early retirement benefits on the first of any month following your 58th birthday. If you are not eligible for any retirement benefits when you leave state service, you may withdraw your retirement contributions. 31 Tier IV. This plan covers employees hired on or after July 31, 2017. The Tier IV retirement plan provides elements of both a defined benefit and defined contribution plan. Defined Benefits – Participants that satisfy the minimum eligibility criteria will qualify for a pre-defined monthly retirement income for life, with the amount being determined by years of service, retirement age and Final Average Earnings. You contribute 7% of your annual salary (this rate is for fiscal year July 2023 through June 2024). Defined Contribution – You contribute 1% to a defined contribution plan with a 1% employer match. This plan also has a risk sharing component wherein for any given year the employee contribution can be up to 2% higher depending on the plan’s performance for the previous year. This contribution will be computed by the plan’s actuaries. (You may also contribute to a 457 plan). For additional information please see the State Comptroller’s Retirement Resources website . Please note: If you were a former state employee who contributed to a different state retirement plan, please contact Payroll 860-263-6195 or dol.payroll@ct.gov to see if you qualify to be placed into a different retirement plan. 32 Separation Resignation The personnel regulation on resignation reads: “An employee in the classified service who wishes to voluntarily separate from state service in good standing shall give the appointing authority at least two working weeks written notice of resignation, except that the appointing authority may require as much notification as four weeks if the employee occupies a professional or supervisory position.” If you resign, your written notice must include your last day of work and be submitted to your supervisor at least two weeks before you leave. You will receive a lump-sum payment for unused vacation time if you are a permanent employee. You may arrange to continue your health insurance benefits at the COBRA rate for a specific period of time. Contact Payroll for details on the length of coverage and payment amount. If you are not eligible for any retirement benefits when you leave state service, you may withdraw your retirement contributions. If you do not return to state service within five years and have not withdrawn your contributions, the Retirement Division will send you a refund application. After you complete the form and return it, you will receive your contributions plus interest. If the Retirement Division cannot locate you within 10 years after your employment ends, your contributions will become part of the retirement fund. If you submit your resignation less than two weeks before leaving, your separation may be regarded as not in good standing and may affect your re-employment rights. An unauthorized absence of five or more working days also will be considered as a resignation not in good standing. You will be notified if your resignation is considered as not in good standing and you may file an appeal with the Commissioner of the Department of Administrative Services. Layoff The state defines a layoff as an involuntary, non-disciplinary separation from state service resulting from a lack of work, program cutback or other economic necessity. Consult your union contract for particulars. If you are an exempt employee, consult Sec. 5-241 of the Connecticut General Statutes. Reemployment Rights In an effort to deliver services in a contemporary and cost effective fashion, the State of Connecticut uses a module called Freenames through the Online Employment Center (JobAps) as a platform for processing the following: • • • Mandatory rights for eligible individuals (reemployment/SEBAC/other mandatory rights) Statewide Transfer requests (non-mandatory transfers) Rescind of Resignation or Retirement requests This section applies to: Current or former State Employees who have been affected by the following: • • • Layoffs Noticed for layoff Accepted a demotion in lieu of layoff 33 • • • • • • Notified of eligibility for mandatory rights Recently failed a working test period and has permanent classified status Exercising rights to return to the classified service from the unclassified service Recently separated NP-2 employee with Article 39 Rights Current employees who request to place their names on a Statewide Transfer list Former employees who request to rescind their resignation in good standing or voluntary retirement. If you retire from state service, you are eligible for temporary employment in any class in which you had permanent status. As a re-employed retiree, you may work as many as 120 days per calendar year (bases on 40 hours per week prior to retirement) without adversely affecting your pension. Such appointments are totally at the discretion of the agency. Rescind of Resignation or Retirement If you have permanent status and resign in good standing, you may, within one year of the date of your separation, request to rescind your resignation by completing the Rescind Resignation request via the JobAps, Freenames Application within one year from date of resignation. This will enable you to be considered for any classes in which you had permanent status. Reinstatement is strictly voluntary on the part of the Agency and may occur at any time up to two years from the date of your separation. Former employees shall be fully independent in and responsible for conducting their own search for reinstatement by requesting rescind privileges via the JobAps, Freenames Application. Use the rescind of resignation or retirement option to request to rescind a resignation in good standing, or a retirement from state service in accordance with DAS General Letter 177. Note: There are no reemployment rights associated with a rescind of resignation. The State of Connecticut is not required to rehire individuals who rescind resignation. Rather, certain privileges may be granted depending on the job class and effective date of rehire. Requirements A former State employee must meet the following conditions: • Attained permanent status as a State employee • Separated from state service in good standing from a position in the Classified service or a bargaining unit position in the Unclassified service • You must know the job class you resigned or retired from. To locate this information, contact your former Human Resources Representative or refer to your last paycheck as an active employee. • You must include each job code matching your last held title including different hourly equivalent. For example: 7603EU= Information Technology Analyst 1 (35 hours) 7603FD= Information Technology Analyst 1 (40 hours) DAS will conduct a review and approve or deny all rescind requests for any or all job classes identified. Applicants will be notified of the status of their requests via email. Please be sure to keep your contact information updated and check your email and spam folders often as most communication will occur via email. 34 For detailed instructions to request to rescind a resignation in good standing or retirement, refer to Instructions Rescind Resignation or Retirement. Exit Interview Below you will find the link and QR code to access a confidential exit interview survey. Thank you for taking the time to engage in the exit interview process. This survey will only take approximately three minutes to complete. The information collected will help us evaluate factors like pay, benefits, work environment, and your overall work experience. All your answers are confidential, so please be candid with your responses. The information collected will help us to identify any potential areas where we can implement new strategies to increase the satisfaction of our workforce. Thank you again for your time and atention. Link to survey: Confidential Exit Survey State of Connecticut - DAS (office.com) QR code: 35 Retirement Retirement Types State employees are members of one of several retirement programs. Once an employee has completed the required actual or vesting service required by the retirement system, he/she is eligible for a pension. Retirements are effective on the first of the month following the last working day of the previous month. For retirement purposes, an employee who is on prolonged sick leave will retire the first of the month following the last working day that sick leave was used in the previous month (a medical certificate is required) and may qualify for a disability retirement. Types of retirement include, Normal, Early, Hazardous Duty or Disability. If you plan to retire you must send your Notice of Intent to Retire and Retirement Information Form via fax to 860-622-4928 or via email to DAS.BenefitsandLeavesPod5@ct.gov. Please refer to the Plan Summary which can be found on the Office of the State Comptroller’s website at Retiree Resources (ct.gov). Regardless of the type of separation from service; on the last day of work, the terminating employee must return State property to her or his supervisor. Pension Payment Options Option A - 50% Spouse: This option will pay you a reduced benefit for your lifetime in exchange for the protection that, should you pre-decease your spouse, the state will continue to pay 50% of your reduced benefit for your spouse's lifetime. Option B - 50% or 100% Contingent Annuitant: This option provides you a reduced monthly benefit for your life and allows you to guarantee lifetime payments after your death to a selected beneficiary. After your death, a percentage of your reduced benefit, either 50% or 100%, whichever you choose, will continue for your beneficiary’s life. Option C - 10 Year or 20 Year Period Certain: This option provides you a reduced monthly benefit for your lifetime in exchange for the guarantee that monthly benefits will be paid for at least 10 or 20 years from your retirement date (whichever you choose). Option D - Straight Life Annuity: This option pays you the maximum monthly benefit for your lifetime only. All benefits will end upon your death, including state-sponsored health insurance for any surviving eligible dependents. Insurance Benefits You must meet age and minimum service requirements to be eligible for retiree health coverage. Service requirements vary. For more about eligibility for retiree health benefits, contact the Retiree Health Insurance Unit at 860-702-3533. Regardless of the retirement option you choose, you will receive a monthly pension for the rest of your life, and, if you qualify for health insurance benefits, coverage will extend to your eligible dependents. Once you or your dependents become eligible for Medicare, this is your primary medical plan provider and the state plan is supplementary. 36 If you retire with at least 25 years of service and have state-sponsored life insurance, the state will pay for 50 percent of the amount of coverage (at least $7,500) as when employed. If you retire with less than 25 years of service, the state will pay a prorated amount. The Group Life Insurance Section of the Retirement Division will contact you following your retirement concerning conversion options. Disability retirement and pre-retirement death benefits are a part of your pension agreement. Pensions also are subject to cost-of-living increases as outlined in the agreement. For further information regarding retirement benefits call or email: Office of the State Comptroller Retirement Division 165 Capitol Avenue Hartford, CT 06106 Telephone: (860) 702-3490 Email: osc.rsd@ct.gov 37 TRAINING & DEVELOPMENT In-Service Training You may apply for Department of Administrative Services in-service training courses. Courses should be relevant to your position or career mobility, or to your unit’s operational needs. They are generally held during regular work hours in the spring and fall. Supervisor approval is required. For information, contact Employee and Organizational Development. Management Development Courses A calendar of courses focusing on leadership, supervisory and management development, strategic planning, customer service skills and total quality management techniques is distributed twice a year. Contact Employee and Organizational Development for particulars. Tuition Reimbursement You may seek tuition reimbursement from the state for courses taken during non-working hours at colleges, universities, technical schools or other accredited educational institutions. You do not need supervisory approval. Eligibility and funding provisions are outlined in your union contract if you are a bargaining unit employee. As a non-exempt employee, you may be reimbursed for a non-credited course through your union. Convert course hours to credits. For example, 6-14 hours equal one credit for tuition reimbursement; 15-29 hours, two credits; and 30-44, three credits. As a manager, you are eligible for tuition reimbursement from the State Management Advisory Council or agency funds. As a non-managerial confidential employee, you may apply for reimbursement in accordance with the union contract that would have included your job classification had your class not been excluded. For a fall semester class, you must document by Feb. 1 that you paid for a course and passed it, and by June 1 for a spring semester class. Forms and assistance are available through Employee and Organizational Development. You must submit your application to that unit at Central Office, 200 Folly Brook Blvd., Wethersfield, CT 061091114, at least two weeks before the start of a class. Conferences, Workshops & Seminars Your union contract may pay costs associated with conferences, workshops or seminars such as registration fees, travel expenses and meals. You must receive supervisory approval before processing a payment request. Consult you union contract for details. 38 EMPLOYMENT POLICIES (Ctrl + Click to follow links below) Acceptable Use of State Systems Policy - Statewide (2019) ADA Reasonable Accommodation Policy Affirmative Action Policy Statement – DOL (2023) AIDS Policy – DOL (7/16/2012) Background Check Policy and Procedures – DOL (10/31/2022) Disposition of Public Records Policy – DOL (11/28/2011) Discrimination and Illegal Harassment Prevention Policy – DOL (April 2023) Drug Free Workplace State Policy – DOL (7/16/2012) Employee Conduct Policy – DOL (8/3/2018) Employee Dependability Policy – DOL (7/16/2012) Employee Discipline Policy – DOL (7/16/2012) Ethical Conduct Policy – DOL (8/2013) Family Violence Leave Policy – Statewide GL 34 (1/2022) Federal Family & Medical Leave Act – DOL (7/16/2012) Health and Safety Policy – DOL (7/16/2012) Internal Discrimination Complaint Procedure – DOL (4/18/2023) Internal Security Standards - DOL Office Automation Policy, Standards and Guidelines – DOL (7/16/2012) Personal Wireless Device Policy (Rev. 9/9/2020) Phone Use Policy (Rev. 4/23/2023) Policy for DOL Facility Occupancy – DOL (7/9/2020) Professional Image Policy – DOL (3/1/2023) Prohibition of Weapons in DOL Worksites Policy – DOL (8/10/16) Public Officials and State Employees Guide to the Code of Ethics - Statewide 07/16/2012 Software Anti-Piracy Policy – DOL (7/16/2012) Vehicle-Use-for-State-Business-Policy--DAS-General-Letter-115--April-1-2012.pdf (ct.gov) Violence in the Workplace Prevention – DOL (4/2012) Workers Compensation Rights Responsibilities and Claims (ct.gov) Workplace Incident Report and Footprints Instructions – DOL (2015) **Please refer to online Employee Handbook for link activation. 39
+
+USER:
+What does it mean that the Dept of Labor is hiring for an intermittent employment position?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",True,16,16,12815,,697
+Only consider the following text in your answer. Format your answer into between 10 and 15 bullet points.,Please summarize this information for a person not familiar with advertising or business models.,"In this paper, we provide a generalizable distribution of television advertising elasticities for established products that can serve as a prior distribution for firms and researchers. Providing generalizable estimates of TV advertising effects necessitates transparent and replicable estimation methods and an a priori relevant population of products. Our analy- sis is based on a sample of 288 large, national CPG brands that are selected using a clear research protocol, and our data sources (Nielsen Ad Intel and RMS scanner data) are widely used by marketing managers and academic researchers. We find that the median of the distribution of estimated long-run advertising elasticities is between 0.0085 and 0.0142, and the corresponding mean is between 0.0098 and 0.0261. We draw two main lessons from these results. First, the estimated advertising elastic- ities are small, and two thirds of the estimates are not statistically distinguishable from zero. The estimates are also economically small, in the sense that more than 80% of all brands have a negative ROI of advertising at the margin. The estimates are roughly half the size of the most comparable prior study, Lodish et al. (1995), which used data from the 1980s. This difference is consistent with an overall decline in TV advertising effectiveness over the last three decades. Second, our results are robust. In particular, across a wide range of specifications, the overall distribution of advertising elasticities is stable. Due to this fact, together with the institutional details of the ad buying process that underlie our identification strategy, it appears implausible that our results are affected by any remaining confounds. Our results have important positive and normative implications. A central finding is the over-investment in advertising for more than 80% of brands, a significant misalloca- tion of resources by firms. Our data are identical to the commercially available data used by firms, and hence it is unlikely that firms observe larger advertising effects because of access to alternative data sources. This raises an economic puzzle. Why do firms spend billions of dollars on TV advertising each year if the return is negative? There are sev- eral possible explanations. First, agency issues, in particular career concerns, may lead managers (or consultants) to overstate the effectiveness of advertising if they expect to lose their jobs if their advertising campaigns are revealed to be unprofitable. Second, an incorrect prior (i.e. conventional wisdom that advertising is typically effective) may lead a decision maker to rationally shrink the estimated advertising effect from their data to an incorrect, inflated prior mean. Third, the estimated advertising effects may be inflated if confounding factors are not adequately adjusted for. The last two explanations do not as- sume irrational behavior, but may simply represent a cost of conducting causal inference 23 to acquire accurate information on the effect of advertising. We view this explanation as plausible given that unified, formal approaches to causal inference have only recently been widely adopted. These proposed explanations are not mutually exclusive. In par- ticular, agency issues may be exacerbated if the general effectiveness of advertising or a specific advertising effect estimate is overstated.13 While we cannot conclusively point to these explanations as the source of the documented over-investment in advertising, our discussions with managers and industry insiders suggest that these may be contributing factors. This brings us back to a key motivating question for this research, the long-run viabil- ity of traditional media markets. The documented over-investment in advertising suggests a threat to the survival of media markets in their current form, once knowledge about the small degree of TV advertising effectiveness becomes common knowledge. But our results also indicate that for a substantial number of brands (34% based on the point estimates), the observed advertising schedules are valuable compared to the counterfactual of no ad- vertising. There is a large degree of statistical uncertainty about the exact ROIs, and only for 12% of brands the predicted ROIs from the observed advertising schedules are positive and statistically different from zero. This suggests a large option value from adopting im- proved methods or research designs, such as A/B tests, to estimate the causal effect and ROI of advertising. Our results also do not foreclose the possibility that advertising can be profitable with alternative scheduling, targeting, or advertising copy strategies. The rise of addressable television, in particular, should allow advertisers and researchers to experiment with individual level targeting in the future. These approaches for improving advertising measurement, scheduling, and targeting may well ensure the long-run viability of media markets. While improvements in targeting technology may theoretically increase the potential for higher advertising returns, they do not solve the underlying agency problems that allow sub-optimal advertising decisions to persist in the traditional TV advertising model we evaluate in this paper. Together with past research documenting similar results in digital advertising markets (Blake et al. 2015; Lewis and Rao 2015), our work should motivate economists to further study the managerial and agency issues in advertising markets.","Only consider the following text in your answer. Format your answer into between 10 and 15 bullet points. In this paper, we provide a generalizable distribution of television advertising elasticities for established products that can serve as a prior distribution for firms and researchers. Providing generalizable estimates of TV advertising effects necessitates transparent and replicable estimation methods and an a priori relevant population of products. Our analy- sis is based on a sample of 288 large, national CPG brands that are selected using a clear research protocol, and our data sources (Nielsen Ad Intel and RMS scanner data) are widely used by marketing managers and academic researchers. We find that the median of the distribution of estimated long-run advertising elasticities is between 0.0085 and 0.0142, and the corresponding mean is between 0.0098 and 0.0261. We draw two main lessons from these results. First, the estimated advertising elastic- ities are small, and two thirds of the estimates are not statistically distinguishable from zero. The estimates are also economically small, in the sense that more than 80% of all brands have a negative ROI of advertising at the margin. The estimates are roughly half the size of the most comparable prior study, Lodish et al. (1995), which used data from the 1980s. This difference is consistent with an overall decline in TV advertising effectiveness over the last three decades. Second, our results are robust. In particular, across a wide range of specifications, the overall distribution of advertising elasticities is stable. Due to this fact, together with the institutional details of the ad buying process that underlie our identification strategy, it appears implausible that our results are affected by any remaining confounds. Our results have important positive and normative implications. A central finding is the over-investment in advertising for more than 80% of brands, a significant misalloca- tion of resources by firms. Our data are identical to the commercially available data used by firms, and hence it is unlikely that firms observe larger advertising effects because of access to alternative data sources. This raises an economic puzzle. Why do firms spend billions of dollars on TV advertising each year if the return is negative? There are sev- eral possible explanations. First, agency issues, in particular career concerns, may lead managers (or consultants) to overstate the effectiveness of advertising if they expect to lose their jobs if their advertising campaigns are revealed to be unprofitable. Second, an incorrect prior (i.e. conventional wisdom that advertising is typically effective) may lead a decision maker to rationally shrink the estimated advertising effect from their data to an incorrect, inflated prior mean. Third, the estimated advertising effects may be inflated if confounding factors are not adequately adjusted for. The last two explanations do not as- sume irrational behavior, but may simply represent a cost of conducting causal inference 23 to acquire accurate information on the effect of advertising. We view this explanation as plausible given that unified, formal approaches to causal inference have only recently been widely adopted. These proposed explanations are not mutually exclusive. In par- ticular, agency issues may be exacerbated if the general effectiveness of advertising or a specific advertising effect estimate is overstated.13 While we cannot conclusively point to these explanations as the source of the documented over-investment in advertising, our discussions with managers and industry insiders suggest that these may be contributing factors. This brings us back to a key motivating question for this research, the long-run viabil- ity of traditional media markets. The documented over-investment in advertising suggests a threat to the survival of media markets in their current form, once knowledge about the small degree of TV advertising effectiveness becomes common knowledge. But our results also indicate that for a substantial number of brands (34% based on the point estimates), the observed advertising schedules are valuable compared to the counterfactual of no ad- vertising. There is a large degree of statistical uncertainty about the exact ROIs, and only for 12% of brands the predicted ROIs from the observed advertising schedules are positive and statistically different from zero. This suggests a large option value from adopting im- proved methods or research designs, such as A/B tests, to estimate the causal effect and ROI of advertising. Our results also do not foreclose the possibility that advertising can be profitable with alternative scheduling, targeting, or advertising copy strategies. The rise of addressable television, in particular, should allow advertisers and researchers to experiment with individual level targeting in the future. These approaches for improving advertising measurement, scheduling, and targeting may well ensure the long-run viability of media markets. While improvements in targeting technology may theoretically increase the potential for higher advertising returns, they do not solve the underlying agency problems that allow sub-optimal advertising decisions to persist in the traditional TV advertising model we evaluate in this paper. Together with past research documenting similar results in digital advertising markets (Blake et al. 2015; Lewis and Rao 2015), our work should motivate economists to further study the managerial and agency issues in advertising markets. Please summarize this information for a person not familiar with advertising or business models.","Only consider the following text in your answer. Format your answer into between 10 and 15 bullet points.
+
+EVIDENCE:
+In this paper, we provide a generalizable distribution of television advertising elasticities for established products that can serve as a prior distribution for firms and researchers. Providing generalizable estimates of TV advertising effects necessitates transparent and replicable estimation methods and an a priori relevant population of products. Our analy- sis is based on a sample of 288 large, national CPG brands that are selected using a clear research protocol, and our data sources (Nielsen Ad Intel and RMS scanner data) are widely used by marketing managers and academic researchers. We find that the median of the distribution of estimated long-run advertising elasticities is between 0.0085 and 0.0142, and the corresponding mean is between 0.0098 and 0.0261. We draw two main lessons from these results. First, the estimated advertising elastic- ities are small, and two thirds of the estimates are not statistically distinguishable from zero. The estimates are also economically small, in the sense that more than 80% of all brands have a negative ROI of advertising at the margin. The estimates are roughly half the size of the most comparable prior study, Lodish et al. (1995), which used data from the 1980s. This difference is consistent with an overall decline in TV advertising effectiveness over the last three decades. Second, our results are robust. In particular, across a wide range of specifications, the overall distribution of advertising elasticities is stable. Due to this fact, together with the institutional details of the ad buying process that underlie our identification strategy, it appears implausible that our results are affected by any remaining confounds. Our results have important positive and normative implications. A central finding is the over-investment in advertising for more than 80% of brands, a significant misalloca- tion of resources by firms. Our data are identical to the commercially available data used by firms, and hence it is unlikely that firms observe larger advertising effects because of access to alternative data sources. This raises an economic puzzle. Why do firms spend billions of dollars on TV advertising each year if the return is negative? There are sev- eral possible explanations. First, agency issues, in particular career concerns, may lead managers (or consultants) to overstate the effectiveness of advertising if they expect to lose their jobs if their advertising campaigns are revealed to be unprofitable. Second, an incorrect prior (i.e. conventional wisdom that advertising is typically effective) may lead a decision maker to rationally shrink the estimated advertising effect from their data to an incorrect, inflated prior mean. Third, the estimated advertising effects may be inflated if confounding factors are not adequately adjusted for. The last two explanations do not as- sume irrational behavior, but may simply represent a cost of conducting causal inference 23 to acquire accurate information on the effect of advertising. We view this explanation as plausible given that unified, formal approaches to causal inference have only recently been widely adopted. These proposed explanations are not mutually exclusive. In par- ticular, agency issues may be exacerbated if the general effectiveness of advertising or a specific advertising effect estimate is overstated.13 While we cannot conclusively point to these explanations as the source of the documented over-investment in advertising, our discussions with managers and industry insiders suggest that these may be contributing factors. This brings us back to a key motivating question for this research, the long-run viabil- ity of traditional media markets. The documented over-investment in advertising suggests a threat to the survival of media markets in their current form, once knowledge about the small degree of TV advertising effectiveness becomes common knowledge. But our results also indicate that for a substantial number of brands (34% based on the point estimates), the observed advertising schedules are valuable compared to the counterfactual of no ad- vertising. There is a large degree of statistical uncertainty about the exact ROIs, and only for 12% of brands the predicted ROIs from the observed advertising schedules are positive and statistically different from zero. This suggests a large option value from adopting im- proved methods or research designs, such as A/B tests, to estimate the causal effect and ROI of advertising. Our results also do not foreclose the possibility that advertising can be profitable with alternative scheduling, targeting, or advertising copy strategies. The rise of addressable television, in particular, should allow advertisers and researchers to experiment with individual level targeting in the future. These approaches for improving advertising measurement, scheduling, and targeting may well ensure the long-run viability of media markets. While improvements in targeting technology may theoretically increase the potential for higher advertising returns, they do not solve the underlying agency problems that allow sub-optimal advertising decisions to persist in the traditional TV advertising model we evaluate in this paper. Together with past research documenting similar results in digital advertising markets (Blake et al. 2015; Lewis and Rao 2015), our work should motivate economists to further study the managerial and agency issues in advertising markets.
+
+USER:
+Please summarize this information for a person not familiar with advertising or business models.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,18,14,820,,463
+"Only use this document as a source, do not use any outside knowledge.",What was the outcome of this study?,"**Weight gain among US adults during the COVID‐19 pandemic** Although the COVID‐19 pandemic and the subsequent mitigation strategies have had a significant impact on the lives and behaviors of many individuals, the effects of the pandemic on weight gain among adults in the United States are uncertain. A widely publicized study [1] reported a 0.7‐kg increase in weight per month (February through June 2020), which would equal 18.5 lb if extrapolated to 12 months, but these findings were based on 269 participants with a Bluetooth‐connected scale. A meta‐analysis [2] of 35 cross‐sectional studies and 1 cohort study among adults and older adolescents in various countries found an average 1.6‐kg increase in (self‐reported) weight from March to May 2020. An American Psychological Association press release [3] in March 2021 also indicated that among the 42% of adults who reported that they had gained weight during the pandemic, the mean weight increase was 29 lb (13 kg). Other studies have indicated that pandemic‐related weight increases may be smaller than suggested by these reports. A longitudinal study without formal peer review, based on the electronic health records (EHR) of about 15 million adults in the United States, for example, concluded that the mean weight gain during the 12 months of the pandemic (through March 2021) was less than 0.5 kg [4]; this increase was similar to the annual increase before the pandemic. In addition, a large study of self‐reported, longitudinal data among adults in the United Kingdom found no change in mean weight after February 2020 [5]. Studies among children and adolescents may also be relevant, and four studies [6, 7, 8, 9] have found that BMI increases were larger during the pandemic than in previous years. For example, Lange et al. [7] reported that the rate of BMI increase was 0.05 kg/m2 per month before the pandemic and 0.1 kg/m2 per month during the pandemic. These increases, however, were most pronounced among 6‐ to 11‐year‐olds, with 18‐ to 20‐year‐olds showing a smaller increase in BMI during the pandemic than before the pandemic. Somewhat similar age interactions have been seen by others [6, 8]. Although increases in the prevalence of obesity were also reported in cross‐sectional analyses [9], this result may have been influenced by an ascertainment bias [10] because heavier children and adolescents may have been more likely to be examined during the pandemic. It has been suggested that further studies are needed to assess potential group‐specific impacts of the COVID‐19 epidemic on body weight [2]. Therefore, we examine changes in weight among 18‐ to 84‐year‐olds from January 2019 through May 2021 among 4.24 million adults in a large EHR database to determine whether weight gain increased during the pandemic. We focus on differences in weight gain from January 2019 to February 2020 with those after March 2020. Data were obtained from IQVIA's Ambulatory Electronic Medical Records database (Version Q3, May 2021 data release), containing deidentified information recorded during outpatient encounters for a geographically diverse US patient population. This database contains the clinical data of approximately 80 million patients from January 2006 through May 2021 from all 50 states recorded by more than 100,000 providers affiliated with over 800 ambulatory large practices and physician networks. The data set contains key clinical variables, including laboratory values, patient vitals, health behaviors, diagnoses, and procedures. All data were extracted using the E360 Software‐as‐a‐Service Platform [11]. The extracted data comprises 43.7 million adults with weight and height measurements from 2009 through 2021. Overall, there are 360 million recorded weights and 297 million heights among these participants. We calculated age at the examination as the difference between the examination date and year of birth. To preserve confidentiality, years of birth before 1936 were re‐coded by IQVIA as 1936 so that the maximum age in 2021 would be 85 years. As the 1936 birth year contains several actual years of birth (e.g., 1936, 1935, 1934), we included only participants born in 1937 or later. The maximum age in the current study in 2021 is therefore 84 years. These data were cleaned using the growthcleanr algorithm for adult data developed to accompany the growthcleanr pediatric algorithm [12, 13] used in previous studies [7, 14, 15]. This algorithm is designed to clean clinically obtained longitudinal weights and heights in EHR databases [16]. Many steps in both the pediatric and adult algorithms are similar and they rely on the deviation of a value from an exponentially weighted moving average (EWMA) of a participant's other weights and heights. There are, however, several differences between adult and pediatric algorithms. Although the EWMA in the pediatric algorithm uses SD scores to account for the expected changes in weight and height with sex and age, the adult algorithm uses the actual weight and height values. The height algorithm for adults differs from the children's algorithm because little change is expected among adults. Furthermore, most repeated values are retained in the adult data but are coded as “carried forwards” in the pediatric algorithm. Of the 360 million weights, 2.1% were excluded based on the growthcleanr algorithm. The largest exclusion categories were (a) identical same day (0.9%), (b) different values on same day (0.7%), (c) biologically implausible (0.2%), and (d) EWMA (0.2%). About 2.9% of the 297 million heights were excluded, with the largest categories being (1) heights of a participant that differed by more than 2 inches (1.3%), (2) identical same day (1.1%), and (3) different values on the same day (0.3%). The adult algorithm limits the weight range from 20 to 500 kg and the height range from 50 to 244 cm. We restricted the analyses to the 16.1 million people examined after January 1, 2019, who were at least 18 years of age at their first examination. We also required participants to have (1) two or more visits in the pre‐pandemic period (January 1, 2019, through February 28, 2020) and (2) one or more visits after June 1, 2020. We chose the latter date as there was an approximately 50% decrease in the number of examinations conducted in the first few months of the pandemic, which could introduce a selection bias. For participants with more than one weight or height measurement in a given month, we selected one value at random. These criteria reduced the sample to 4.25 million participants with 30.1 million examinations. For weights (14%) without a recorded height on the same day, we used the median height of the participant (based on all height measurements) to calculate BMI. The median number of visits in this sample was three in the pre‐pandemic period and two in the postpandemic period. Information on race and ethnicity was optionally reported in a single composite variable in the database. About 75% of the sample was White, and 8% was Black, but race/ethnicity was unknown for about 12% of the sample, and < 1% of the participants indicated that they were Hispanic. As the collection of race/ethnicity data in EHR can be inaccurate [17], we do not focus on this characteristic. All analyses were performed in R.4.1.2 (R Foundation for Statistical Computing), and they are based on 4,246,001 participants examined from January 2019 through May 2021. After showing descriptive characteristics of the participants at their first and last examinations, we examined the mean monthly weights in 2020 and 2021 relative to those in 2019. These differences were calculated as the mean monthly weights in 2020 and 2021 minus the mean weight in the same month in 2019. Because the number of monthly examinations substantially decreased in April and May 2020, we also examined the possibility of a selection bias. This sensitivity analysis was limited to the 1 million 18‐ Compared with the pre‐pandemic weight trend, there was a small increase (0.1 kg) in weight in the first year of the pandemic (March 2020 through March 2021). Weight changes during the pandemic varied by sex, age, and initial BMI, but the largest mean increase across these characteristics was < 1.3 kg. Weight increases were generally greatest among women, adults with BMI of 30 or 35 kg/m2, and younger adults.to 59‐year‐olds examined in April and May 2019. We contrasted the mean 2019 weights between those reexamined in April and May 2020 (26%) and those not reexamined (74%). We then used mixed‐effects models [18, 19], which use all of the intercorrelated, serial data from a person, to examine the difference in the rate of weight change between the pre‐pandemic (before March 2020) and pandemic (after March 2020) periods in the cohort. These sex‐specific models included a random‐intercepts term to account for individual‐level heterogeneity, initial BMI, initial age, time (in years) relative to March 1, 2020, and pandemic period. The difference in the rate of weight change during the pandemic was assessed using an interaction term between the pandemic period (coded as 0 or 1) and time relative to March 1, 2020. These models allowed the weight change between the two periods to vary by sex, age, and BMI. We modeled BMI and age using natural splines [20] to account for nonlinearity. The results of these models are displayed graphically for various combinations of sex, initial age (25, 40, 60, and 75 years), and initial BMI (25, 30, and 35 kg/m2). We also summarize the differences calculated from this model between the pre‐pandemic and pandemic changes in weight over 1 year. We refer to the difference in weight change during the pandemic and the weight change before the pandemic from these models as the excess weight gain during the pandemic. This is the weight gain during the pandemic in excess of that predicted by the pre‐pandemic trend in weight.","<Instruction> ========== Only use this document as a source, do not use any outside knowledge. ---------------- <Text Passage> ========== **Weight gain among US adults during the COVID‐19 pandemic** Although the COVID‐19 pandemic and the subsequent mitigation strategies have had a significant impact on the lives and behaviors of many individuals, the effects of the pandemic on weight gain among adults in the United States are uncertain. A widely publicized study [1] reported a 0.7‐kg increase in weight per month (February through June 2020), which would equal 18.5 lb if extrapolated to 12 months, but these findings were based on 269 participants with a Bluetooth‐connected scale. A meta‐analysis [2] of 35 cross‐sectional studies and 1 cohort study among adults and older adolescents in various countries found an average 1.6‐kg increase in (self‐reported) weight from March to May 2020. An American Psychological Association press release [3] in March 2021 also indicated that among the 42% of adults who reported that they had gained weight during the pandemic, the mean weight increase was 29 lb (13 kg). Other studies have indicated that pandemic‐related weight increases may be smaller than suggested by these reports. A longitudinal study without formal peer review, based on the electronic health records (EHR) of about 15 million adults in the United States, for example, concluded that the mean weight gain during the 12 months of the pandemic (through March 2021) was less than 0.5 kg [4]; this increase was similar to the annual increase before the pandemic. In addition, a large study of self‐reported, longitudinal data among adults in the United Kingdom found no change in mean weight after February 2020 [5]. Studies among children and adolescents may also be relevant, and four studies [6, 7, 8, 9] have found that BMI increases were larger during the pandemic than in previous years. For example, Lange et al. [7] reported that the rate of BMI increase was 0.05 kg/m2 per month before the pandemic and 0.1 kg/m2 per month during the pandemic. These increases, however, were most pronounced among 6‐ to 11‐year‐olds, with 18‐ to 20‐year‐olds showing a smaller increase in BMI during the pandemic than before the pandemic. Somewhat similar age interactions have been seen by others [6, 8]. Although increases in the prevalence of obesity were also reported in cross‐sectional analyses [9], this result may have been influenced by an ascertainment bias [10] because heavier children and adolescents may have been more likely to be examined during the pandemic. It has been suggested that further studies are needed to assess potential group‐specific impacts of the COVID‐19 epidemic on body weight [2]. Therefore, we examine changes in weight among 18‐ to 84‐year‐olds from January 2019 through May 2021 among 4.24 million adults in a large EHR database to determine whether weight gain increased during the pandemic. We focus on differences in weight gain from January 2019 to February 2020 with those after March 2020. Data were obtained from IQVIA's Ambulatory Electronic Medical Records database (Version Q3, May 2021 data release), containing deidentified information recorded during outpatient encounters for a geographically diverse US patient population. This database contains the clinical data of approximately 80 million patients from January 2006 through May 2021 from all 50 states recorded by more than 100,000 providers affiliated with over 800 ambulatory large practices and physician networks. The data set contains key clinical variables, including laboratory values, patient vitals, health behaviors, diagnoses, and procedures. All data were extracted using the E360 Software‐as‐a‐Service Platform [11]. The extracted data comprises 43.7 million adults with weight and height measurements from 2009 through 2021. Overall, there are 360 million recorded weights and 297 million heights among these participants. We calculated age at the examination as the difference between the examination date and year of birth. To preserve confidentiality, years of birth before 1936 were re‐coded by IQVIA as 1936 so that the maximum age in 2021 would be 85 years. As the 1936 birth year contains several actual years of birth (e.g., 1936, 1935, 1934), we included only participants born in 1937 or later. The maximum age in the current study in 2021 is therefore 84 years. These data were cleaned using the growthcleanr algorithm for adult data developed to accompany the growthcleanr pediatric algorithm [12, 13] used in previous studies [7, 14, 15]. This algorithm is designed to clean clinically obtained longitudinal weights and heights in EHR databases [16]. Many steps in both the pediatric and adult algorithms are similar and they rely on the deviation of a value from an exponentially weighted moving average (EWMA) of a participant's other weights and heights. There are, however, several differences between adult and pediatric algorithms. Although the EWMA in the pediatric algorithm uses SD scores to account for the expected changes in weight and height with sex and age, the adult algorithm uses the actual weight and height values. The height algorithm for adults differs from the children's algorithm because little change is expected among adults. Furthermore, most repeated values are retained in the adult data but are coded as “carried forwards” in the pediatric algorithm. Of the 360 million weights, 2.1% were excluded based on the growthcleanr algorithm. The largest exclusion categories were (a) identical same day (0.9%), (b) different values on same day (0.7%), (c) biologically implausible (0.2%), and (d) EWMA (0.2%). About 2.9% of the 297 million heights were excluded, with the largest categories being (1) heights of a participant that differed by more than 2 inches (1.3%), (2) identical same day (1.1%), and (3) different values on the same day (0.3%). The adult algorithm limits the weight range from 20 to 500 kg and the height range from 50 to 244 cm. We restricted the analyses to the 16.1 million people examined after January 1, 2019, who were at least 18 years of age at their first examination. We also required participants to have (1) two or more visits in the pre‐pandemic period (January 1, 2019, through February 28, 2020) and (2) one or more visits after June 1, 2020. We chose the latter date as there was an approximately 50% decrease in the number of examinations conducted in the first few months of the pandemic, which could introduce a selection bias. For participants with more than one weight or height measurement in a given month, we selected one value at random. These criteria reduced the sample to 4.25 million participants with 30.1 million examinations. For weights (14%) without a recorded height on the same day, we used the median height of the participant (based on all height measurements) to calculate BMI. The median number of visits in this sample was three in the pre‐pandemic period and two in the postpandemic period. Information on race and ethnicity was optionally reported in a single composite variable in the database. About 75% of the sample was White, and 8% was Black, but race/ethnicity was unknown for about 12% of the sample, and < 1% of the participants indicated that they were Hispanic. As the collection of race/ethnicity data in EHR can be inaccurate [17], we do not focus on this characteristic. All analyses were performed in R.4.1.2 (R Foundation for Statistical Computing), and they are based on 4,246,001 participants examined from January 2019 through May 2021. After showing descriptive characteristics of the participants at their first and last examinations, we examined the mean monthly weights in 2020 and 2021 relative to those in 2019. These differences were calculated as the mean monthly weights in 2020 and 2021 minus the mean weight in the same month in 2019. Because the number of monthly examinations substantially decreased in April and May 2020, we also examined the possibility of a selection bias. This sensitivity analysis was limited to the 1 million 18‐ Compared with the pre‐pandemic weight trend, there was a small increase (0.1 kg) in weight in the first year of the pandemic (March 2020 through March 2021). Weight changes during the pandemic varied by sex, age, and initial BMI, but the largest mean increase across these characteristics was < 1.3 kg. Weight increases were generally greatest among women, adults with BMI of 30 or 35 kg/m2, and younger adults.to 59‐year‐olds examined in April and May 2019. We contrasted the mean 2019 weights between those reexamined in April and May 2020 (26%) and those not reexamined (74%). We then used mixed‐effects models [18, 19], which use all of the intercorrelated, serial data from a person, to examine the difference in the rate of weight change between the pre‐pandemic (before March 2020) and pandemic (after March 2020) periods in the cohort. These sex‐specific models included a random‐intercepts term to account for individual‐level heterogeneity, initial BMI, initial age, time (in years) relative to March 1, 2020, and pandemic period. The difference in the rate of weight change during the pandemic was assessed using an interaction term between the pandemic period (coded as 0 or 1) and time relative to March 1, 2020. These models allowed the weight change between the two periods to vary by sex, age, and BMI. We modeled BMI and age using natural splines [20] to account for nonlinearity. The results of these models are displayed graphically for various combinations of sex, initial age (25, 40, 60, and 75 years), and initial BMI (25, 30, and 35 kg/m2). We also summarize the differences calculated from this model between the pre‐pandemic and pandemic changes in weight over 1 year. We refer to the difference in weight change during the pandemic and the weight change before the pandemic from these models as the excess weight gain during the pandemic. This is the weight gain during the pandemic in excess of that predicted by the pre‐pandemic trend in weight. ---------------- <Question> ========== What was the outcome of this study?","Only use this document as a source, do not use any outside knowledge.
+
+EVIDENCE:
+**Weight gain among US adults during the COVID‐19 pandemic** Although the COVID‐19 pandemic and the subsequent mitigation strategies have had a significant impact on the lives and behaviors of many individuals, the effects of the pandemic on weight gain among adults in the United States are uncertain. A widely publicized study [1] reported a 0.7‐kg increase in weight per month (February through June 2020), which would equal 18.5 lb if extrapolated to 12 months, but these findings were based on 269 participants with a Bluetooth‐connected scale. A meta‐analysis [2] of 35 cross‐sectional studies and 1 cohort study among adults and older adolescents in various countries found an average 1.6‐kg increase in (self‐reported) weight from March to May 2020. An American Psychological Association press release [3] in March 2021 also indicated that among the 42% of adults who reported that they had gained weight during the pandemic, the mean weight increase was 29 lb (13 kg). Other studies have indicated that pandemic‐related weight increases may be smaller than suggested by these reports. A longitudinal study without formal peer review, based on the electronic health records (EHR) of about 15 million adults in the United States, for example, concluded that the mean weight gain during the 12 months of the pandemic (through March 2021) was less than 0.5 kg [4]; this increase was similar to the annual increase before the pandemic. In addition, a large study of self‐reported, longitudinal data among adults in the United Kingdom found no change in mean weight after February 2020 [5]. Studies among children and adolescents may also be relevant, and four studies [6, 7, 8, 9] have found that BMI increases were larger during the pandemic than in previous years. For example, Lange et al. [7] reported that the rate of BMI increase was 0.05 kg/m2 per month before the pandemic and 0.1 kg/m2 per month during the pandemic. These increases, however, were most pronounced among 6‐ to 11‐year‐olds, with 18‐ to 20‐year‐olds showing a smaller increase in BMI during the pandemic than before the pandemic. Somewhat similar age interactions have been seen by others [6, 8]. Although increases in the prevalence of obesity were also reported in cross‐sectional analyses [9], this result may have been influenced by an ascertainment bias [10] because heavier children and adolescents may have been more likely to be examined during the pandemic. It has been suggested that further studies are needed to assess potential group‐specific impacts of the COVID‐19 epidemic on body weight [2]. Therefore, we examine changes in weight among 18‐ to 84‐year‐olds from January 2019 through May 2021 among 4.24 million adults in a large EHR database to determine whether weight gain increased during the pandemic. We focus on differences in weight gain from January 2019 to February 2020 with those after March 2020. Data were obtained from IQVIA's Ambulatory Electronic Medical Records database (Version Q3, May 2021 data release), containing deidentified information recorded during outpatient encounters for a geographically diverse US patient population. This database contains the clinical data of approximately 80 million patients from January 2006 through May 2021 from all 50 states recorded by more than 100,000 providers affiliated with over 800 ambulatory large practices and physician networks. The data set contains key clinical variables, including laboratory values, patient vitals, health behaviors, diagnoses, and procedures. All data were extracted using the E360 Software‐as‐a‐Service Platform [11]. The extracted data comprises 43.7 million adults with weight and height measurements from 2009 through 2021. Overall, there are 360 million recorded weights and 297 million heights among these participants. We calculated age at the examination as the difference between the examination date and year of birth. To preserve confidentiality, years of birth before 1936 were re‐coded by IQVIA as 1936 so that the maximum age in 2021 would be 85 years. As the 1936 birth year contains several actual years of birth (e.g., 1936, 1935, 1934), we included only participants born in 1937 or later. The maximum age in the current study in 2021 is therefore 84 years. These data were cleaned using the growthcleanr algorithm for adult data developed to accompany the growthcleanr pediatric algorithm [12, 13] used in previous studies [7, 14, 15]. This algorithm is designed to clean clinically obtained longitudinal weights and heights in EHR databases [16]. Many steps in both the pediatric and adult algorithms are similar and they rely on the deviation of a value from an exponentially weighted moving average (EWMA) of a participant's other weights and heights. There are, however, several differences between adult and pediatric algorithms. Although the EWMA in the pediatric algorithm uses SD scores to account for the expected changes in weight and height with sex and age, the adult algorithm uses the actual weight and height values. The height algorithm for adults differs from the children's algorithm because little change is expected among adults. Furthermore, most repeated values are retained in the adult data but are coded as “carried forwards” in the pediatric algorithm. Of the 360 million weights, 2.1% were excluded based on the growthcleanr algorithm. The largest exclusion categories were (a) identical same day (0.9%), (b) different values on same day (0.7%), (c) biologically implausible (0.2%), and (d) EWMA (0.2%). About 2.9% of the 297 million heights were excluded, with the largest categories being (1) heights of a participant that differed by more than 2 inches (1.3%), (2) identical same day (1.1%), and (3) different values on the same day (0.3%). The adult algorithm limits the weight range from 20 to 500 kg and the height range from 50 to 244 cm. We restricted the analyses to the 16.1 million people examined after January 1, 2019, who were at least 18 years of age at their first examination. We also required participants to have (1) two or more visits in the pre‐pandemic period (January 1, 2019, through February 28, 2020) and (2) one or more visits after June 1, 2020. We chose the latter date as there was an approximately 50% decrease in the number of examinations conducted in the first few months of the pandemic, which could introduce a selection bias. For participants with more than one weight or height measurement in a given month, we selected one value at random. These criteria reduced the sample to 4.25 million participants with 30.1 million examinations. For weights (14%) without a recorded height on the same day, we used the median height of the participant (based on all height measurements) to calculate BMI. The median number of visits in this sample was three in the pre‐pandemic period and two in the postpandemic period. Information on race and ethnicity was optionally reported in a single composite variable in the database. About 75% of the sample was White, and 8% was Black, but race/ethnicity was unknown for about 12% of the sample, and < 1% of the participants indicated that they were Hispanic. As the collection of race/ethnicity data in EHR can be inaccurate [17], we do not focus on this characteristic. All analyses were performed in R.4.1.2 (R Foundation for Statistical Computing), and they are based on 4,246,001 participants examined from January 2019 through May 2021. After showing descriptive characteristics of the participants at their first and last examinations, we examined the mean monthly weights in 2020 and 2021 relative to those in 2019. These differences were calculated as the mean monthly weights in 2020 and 2021 minus the mean weight in the same month in 2019. Because the number of monthly examinations substantially decreased in April and May 2020, we also examined the possibility of a selection bias. This sensitivity analysis was limited to the 1 million 18‐ Compared with the pre‐pandemic weight trend, there was a small increase (0.1 kg) in weight in the first year of the pandemic (March 2020 through March 2021). Weight changes during the pandemic varied by sex, age, and initial BMI, but the largest mean increase across these characteristics was < 1.3 kg. Weight increases were generally greatest among women, adults with BMI of 30 or 35 kg/m2, and younger adults.to 59‐year‐olds examined in April and May 2019. We contrasted the mean 2019 weights between those reexamined in April and May 2020 (26%) and those not reexamined (74%). We then used mixed‐effects models [18, 19], which use all of the intercorrelated, serial data from a person, to examine the difference in the rate of weight change between the pre‐pandemic (before March 2020) and pandemic (after March 2020) periods in the cohort. These sex‐specific models included a random‐intercepts term to account for individual‐level heterogeneity, initial BMI, initial age, time (in years) relative to March 1, 2020, and pandemic period. The difference in the rate of weight change during the pandemic was assessed using an interaction term between the pandemic period (coded as 0 or 1) and time relative to March 1, 2020. These models allowed the weight change between the two periods to vary by sex, age, and BMI. We modeled BMI and age using natural splines [20] to account for nonlinearity. The results of these models are displayed graphically for various combinations of sex, initial age (25, 40, 60, and 75 years), and initial BMI (25, 30, and 35 kg/m2). We also summarize the differences calculated from this model between the pre‐pandemic and pandemic changes in weight over 1 year. We refer to the difference in weight change during the pandemic and the weight change before the pandemic from these models as the excess weight gain during the pandemic. This is the weight gain during the pandemic in excess of that predicted by the pre‐pandemic trend in weight.
+
+USER:
+What was the outcome of this study?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,13,7,1598,,326
+"{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]","What are key changes to the Social Security program for 2024, related to the cost-of-living adjustments(COLA), taxable earning limit, and disability benefits, and how do they impact recipients?","7 New Social Security Changes for 2024 The 3.2% COLA for 2024 reflects a drop in inflation—and the 2025 COLA is expected soon By Rebecca Rosenberg Updated September 13, 2024 Reviewed by Charlene Rhinehart Fact checked by Rebecca McClay Part of the Series Understanding Social Security Every October, the U.S. Social Security Administration (SSA) announces its annual changes to the Social Security program for the following year. For 2024, the changes consist of a 3.2% cost-of-living adjustment (COLA) to the monthly benefit amount, an increase in the maximum earnings subject to the Social Security tax, a rise in disability benefits, and more. 1 Key Takeaways Those who are receiving Social Security benefits got a 3.2% raise in 2024. Social Security tax rates for 2024 are 6.2% for employees and 12.4% for the self-employed. In 2024, it takes $1,730 to earn a Social Security credit. The Social Security Administration is expected to release the 2025 COLA soon. 1. COLA Increase While we don't yet know what the cost-of-living adjustment (COLA) will be for 2025, more than 71 million Social Security recipients received a COLA increase to their monthly benefits of 3.2% in 2024. 1 The adjustment helps benefits keep pace with inflation and is based on the Consumer Price Index for Urban Wage Earners and Clerical Workers (CPI-W) calculated by the U.S. Bureau of Labor Statistics (BLS). Based on the increase for 2024, the average monthly benefit for all retired workers is $1,907, up from $1,848. 2 2. Higher Maximum Monthly Payout The earliest individuals can claim Social Security retirement benefits is age 62. However, claiming before full retirement age (FRA) will result in a permanently reduced payout. 3 In 1983, Congress passed a law increasing the full retirement age by two months each year from 2000 to 2022, until it hit 67. In 2024, anyone born in 1960 or later will not reach full retirement age until they are 67. 4 3 Those who earn delayed retirement credits—that is, waiting to claim Social Security past full (or normal) retirement age—can collect more than their full, or normal, payout. In 2024, the maximum payout of a worker retiring at full retirement age is $3,822. Retiring at age 70 means a maximum payout of $4,873. 5 Take the Next Step to Invest Advertiser Disclosure Earning retirement income above a certain threshold—$22,320 in 2024—will temporarily reduce your benefits before your full retirement age. Once you reach full retirement age, you can work as much as you want and your benefits won't be reduced. You'll still receive your full Social Security benefits. 6 Individuals can earn an additional 8% of their benefit per year up until age 70 by delaying retirement. 7 Custom illustration shows a woman stands at a table looking at a cake with the number 62 on top A woman stands at a table looking at a cake with the number 62 on it. You can claim Social Security benefits as early as age 62, but you won’t receive your maximum benefit. Xiaojie Liu / Investopedia 3. Earnings Limits Increased For recipients who work while collecting Social Security benefits, all or part of their benefits may be temporarily withheld, depending on how much they earn. Before reaching full retirement age, recipients can earn up to $22,320 in 2024. After that, $1 will be deducted from their payment for every $2 that exceeds the limit. 8 Individuals who reach full retirement age in 2024 can earn $59,520, up $3,000 from the 2023 limit of $56,520. For every $3 you earn over the limit, your Social Security benefits will be reduced by $1 for money earned in the months before full retirement age. Once full retirement age is reached, no benefits will be withheld if recipients continue to work. 2 4. Taxable Earnings Rose Employees paid the 6.2% Social Security tax, with their employer matching that payment, on income of up to $160,200 in 2023. In 2024, the maximum taxable earnings increased to $168,600. The Social Security tax rate remains at 6.2% and 12.4% for the self-employed. 2 5. Disability Benefits and Income Thresholds Increased Social Security Disability Insurance (SSDI) provides income for those who can no longer work due to a disability. More than 8.9 million people in the United States who are receiving Social Security disability benefits received a 3.2% increase in 2024. 1 Disabled workers receive on average $1,537 per month in 2024, up from $1,489 in 2023. Disabled workers with a spouse and one or more children can expect an average of $2,720. 2 Blind workers have a cap of $2,590 per month in 2024. 2 6. Higher Credit Earning Threshold Those born in 1929 or later must earn at least 40 credits (maximum of four per year) over their working life to qualify for Social Security benefits. The amount it takes to earn a single credit goes up each year. 9 For 2024, it will take $1,730 in earnings per credit. 2 The number of credits needed for SSDI depends on the age when the recipient becomes disabled. 7. Increase in Medicare Part B Premiums Premiums for Medicare Part B, determined according to the Social Security Act, rose in 2024. The standard monthly premium for Medicare Part B is $174.70 for 2024, up from $164.90 in 2023. The annual deductible for Medicare Part B is $240 in 2024. 10 Program Funding Through 2035 According to the 2024 Social Security and Medicare Boards of Trustees annual report, Social Security and Medicare programs face future financing issues. The Old-Age and Survivors Insurance (OASI) Trust Fund and the Disability Insurance (DI) Trust Fund are combined to create the OASDI, used to indicate the status of the Social Security program. 11 As of 2024, OASDI is projected to pay 100% of total scheduled benefits until 2035, At that point, the projected fund's reserves will be depleted and the continuing total fund income will pay 83% of expected benefits. 11 The Old-Age and Survivors Insurance (OASI) Trust Fund is projected to pay 100% of scheduled benefits until 2033. The fund's reserves will be depleted and continuing program income will be able to pay 79% of benefits. The Disability Insurance (DI) Trust Fund is projected to support 100% of benefits through 2098. 11 What Is the Highest Social Security Benefit in 2024? The maximum Social Security benefit for a worker retiring at full retirement age in 2024 is $3,822 monthly. Though uncommon, it's possible to be eligible for triple the Social Security benefits: Social Security retirement benefits, Social Security Disability Insurance (SSDI), and Supplemental Security Income (SSI). Individuals can check their full retirement age on the Social Security Administration’s Retirement Age Calculator. 2 12 What Is the Cost-of-Living Adjustment (COLA) for the Military in 2024? Cost-of-living adjustments (COLAs) for pay for retired military members increased to 3.2% in 2024, depending on the time of retirement. 13 Can a Divorced Person Collect Their Ex-Spouse’s Social Security? Individuals who divorced but were married to a spouse for more than 10 years can likely claim some portion of their spouse’s Social Security benefits. They must be unmarried when collecting Social Security benefits. The widow’s benefit is 71% to 100% of what a spouse received before they died. 14 The Bottom Line Social Security benefits increased in 2024 with a COLA based on inflation. The ideal time to take retirement benefits depends on an individual's financial situation and retirement goals.","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== What are key changes to the Social Security program for 2024, related to the cost-of-living adjustments(COLA), taxable earning limit, and disability benefits, and how do they impact recipients? {passage 0} ========== 7 New Social Security Changes for 2024 The 3.2% COLA for 2024 reflects a drop in inflation—and the 2025 COLA is expected soon By Rebecca Rosenberg Updated September 13, 2024 Reviewed by Charlene Rhinehart Fact checked by Rebecca McClay Part of the Series Understanding Social Security Every October, the U.S. Social Security Administration (SSA) announces its annual changes to the Social Security program for the following year. For 2024, the changes consist of a 3.2% cost-of-living adjustment (COLA) to the monthly benefit amount, an increase in the maximum earnings subject to the Social Security tax, a rise in disability benefits, and more. 1 Key Takeaways Those who are receiving Social Security benefits got a 3.2% raise in 2024. Social Security tax rates for 2024 are 6.2% for employees and 12.4% for the self-employed. In 2024, it takes $1,730 to earn a Social Security credit. The Social Security Administration is expected to release the 2025 COLA soon. 1. COLA Increase While we don't yet know what the cost-of-living adjustment (COLA) will be for 2025, more than 71 million Social Security recipients received a COLA increase to their monthly benefits of 3.2% in 2024. 1 The adjustment helps benefits keep pace with inflation and is based on the Consumer Price Index for Urban Wage Earners and Clerical Workers (CPI-W) calculated by the U.S. Bureau of Labor Statistics (BLS). Based on the increase for 2024, the average monthly benefit for all retired workers is $1,907, up from $1,848. 2 2. Higher Maximum Monthly Payout The earliest individuals can claim Social Security retirement benefits is age 62. However, claiming before full retirement age (FRA) will result in a permanently reduced payout. 3 In 1983, Congress passed a law increasing the full retirement age by two months each year from 2000 to 2022, until it hit 67. In 2024, anyone born in 1960 or later will not reach full retirement age until they are 67. 4 3 Those who earn delayed retirement credits—that is, waiting to claim Social Security past full (or normal) retirement age—can collect more than their full, or normal, payout. In 2024, the maximum payout of a worker retiring at full retirement age is $3,822. Retiring at age 70 means a maximum payout of $4,873. 5 Take the Next Step to Invest Advertiser Disclosure Earning retirement income above a certain threshold—$22,320 in 2024—will temporarily reduce your benefits before your full retirement age. Once you reach full retirement age, you can work as much as you want and your benefits won't be reduced. You'll still receive your full Social Security benefits. 6 Individuals can earn an additional 8% of their benefit per year up until age 70 by delaying retirement. 7 Custom illustration shows a woman stands at a table looking at a cake with the number 62 on top A woman stands at a table looking at a cake with the number 62 on it. You can claim Social Security benefits as early as age 62, but you won’t receive your maximum benefit. Xiaojie Liu / Investopedia 3. Earnings Limits Increased For recipients who work while collecting Social Security benefits, all or part of their benefits may be temporarily withheld, depending on how much they earn. Before reaching full retirement age, recipients can earn up to $22,320 in 2024. After that, $1 will be deducted from their payment for every $2 that exceeds the limit. 8 Individuals who reach full retirement age in 2024 can earn $59,520, up $3,000 from the 2023 limit of $56,520. For every $3 you earn over the limit, your Social Security benefits will be reduced by $1 for money earned in the months before full retirement age. Once full retirement age is reached, no benefits will be withheld if recipients continue to work. 2 4. Taxable Earnings Rose Employees paid the 6.2% Social Security tax, with their employer matching that payment, on income of up to $160,200 in 2023. In 2024, the maximum taxable earnings increased to $168,600. The Social Security tax rate remains at 6.2% and 12.4% for the self-employed. 2 5. Disability Benefits and Income Thresholds Increased Social Security Disability Insurance (SSDI) provides income for those who can no longer work due to a disability. More than 8.9 million people in the United States who are receiving Social Security disability benefits received a 3.2% increase in 2024. 1 Disabled workers receive on average $1,537 per month in 2024, up from $1,489 in 2023. Disabled workers with a spouse and one or more children can expect an average of $2,720. 2 Blind workers have a cap of $2,590 per month in 2024. 2 6. Higher Credit Earning Threshold Those born in 1929 or later must earn at least 40 credits (maximum of four per year) over their working life to qualify for Social Security benefits. The amount it takes to earn a single credit goes up each year. 9 For 2024, it will take $1,730 in earnings per credit. 2 The number of credits needed for SSDI depends on the age when the recipient becomes disabled. 7. Increase in Medicare Part B Premiums Premiums for Medicare Part B, determined according to the Social Security Act, rose in 2024. The standard monthly premium for Medicare Part B is $174.70 for 2024, up from $164.90 in 2023. The annual deductible for Medicare Part B is $240 in 2024. 10 Program Funding Through 2035 According to the 2024 Social Security and Medicare Boards of Trustees annual report, Social Security and Medicare programs face future financing issues. The Old-Age and Survivors Insurance (OASI) Trust Fund and the Disability Insurance (DI) Trust Fund are combined to create the OASDI, used to indicate the status of the Social Security program. 11 As of 2024, OASDI is projected to pay 100% of total scheduled benefits until 2035, At that point, the projected fund's reserves will be depleted and the continuing total fund income will pay 83% of expected benefits. 11 The Old-Age and Survivors Insurance (OASI) Trust Fund is projected to pay 100% of scheduled benefits until 2033. The fund's reserves will be depleted and continuing program income will be able to pay 79% of benefits. The Disability Insurance (DI) Trust Fund is projected to support 100% of benefits through 2098. 11 What Is the Highest Social Security Benefit in 2024? The maximum Social Security benefit for a worker retiring at full retirement age in 2024 is $3,822 monthly. Though uncommon, it's possible to be eligible for triple the Social Security benefits: Social Security retirement benefits, Social Security Disability Insurance (SSDI), and Supplemental Security Income (SSI). Individuals can check their full retirement age on the Social Security Administration’s Retirement Age Calculator. 2 12 What Is the Cost-of-Living Adjustment (COLA) for the Military in 2024? Cost-of-living adjustments (COLAs) for pay for retired military members increased to 3.2% in 2024, depending on the time of retirement. 13 Can a Divorced Person Collect Their Ex-Spouse’s Social Security? Individuals who divorced but were married to a spouse for more than 10 years can likely claim some portion of their spouse’s Social Security benefits. They must be unmarried when collecting Social Security benefits. The widow’s benefit is 71% to 100% of what a spouse received before they died. 14 The Bottom Line Social Security benefits increased in 2024 with a COLA based on inflation. The ideal time to take retirement benefits depends on an individual's financial situation and retirement goals. https://www.investopedia.com/retirement/social-security-changes/","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]
+
+EVIDENCE:
+7 New Social Security Changes for 2024 The 3.2% COLA for 2024 reflects a drop in inflation—and the 2025 COLA is expected soon By Rebecca Rosenberg Updated September 13, 2024 Reviewed by Charlene Rhinehart Fact checked by Rebecca McClay Part of the Series Understanding Social Security Every October, the U.S. Social Security Administration (SSA) announces its annual changes to the Social Security program for the following year. For 2024, the changes consist of a 3.2% cost-of-living adjustment (COLA) to the monthly benefit amount, an increase in the maximum earnings subject to the Social Security tax, a rise in disability benefits, and more. 1 Key Takeaways Those who are receiving Social Security benefits got a 3.2% raise in 2024. Social Security tax rates for 2024 are 6.2% for employees and 12.4% for the self-employed. In 2024, it takes $1,730 to earn a Social Security credit. The Social Security Administration is expected to release the 2025 COLA soon. 1. COLA Increase While we don't yet know what the cost-of-living adjustment (COLA) will be for 2025, more than 71 million Social Security recipients received a COLA increase to their monthly benefits of 3.2% in 2024. 1 The adjustment helps benefits keep pace with inflation and is based on the Consumer Price Index for Urban Wage Earners and Clerical Workers (CPI-W) calculated by the U.S. Bureau of Labor Statistics (BLS). Based on the increase for 2024, the average monthly benefit for all retired workers is $1,907, up from $1,848. 2 2. Higher Maximum Monthly Payout The earliest individuals can claim Social Security retirement benefits is age 62. However, claiming before full retirement age (FRA) will result in a permanently reduced payout. 3 In 1983, Congress passed a law increasing the full retirement age by two months each year from 2000 to 2022, until it hit 67. In 2024, anyone born in 1960 or later will not reach full retirement age until they are 67. 4 3 Those who earn delayed retirement credits—that is, waiting to claim Social Security past full (or normal) retirement age—can collect more than their full, or normal, payout. In 2024, the maximum payout of a worker retiring at full retirement age is $3,822. Retiring at age 70 means a maximum payout of $4,873. 5 Take the Next Step to Invest Advertiser Disclosure Earning retirement income above a certain threshold—$22,320 in 2024—will temporarily reduce your benefits before your full retirement age. Once you reach full retirement age, you can work as much as you want and your benefits won't be reduced. You'll still receive your full Social Security benefits. 6 Individuals can earn an additional 8% of their benefit per year up until age 70 by delaying retirement. 7 Custom illustration shows a woman stands at a table looking at a cake with the number 62 on top A woman stands at a table looking at a cake with the number 62 on it. You can claim Social Security benefits as early as age 62, but you won’t receive your maximum benefit. Xiaojie Liu / Investopedia 3. Earnings Limits Increased For recipients who work while collecting Social Security benefits, all or part of their benefits may be temporarily withheld, depending on how much they earn. Before reaching full retirement age, recipients can earn up to $22,320 in 2024. After that, $1 will be deducted from their payment for every $2 that exceeds the limit. 8 Individuals who reach full retirement age in 2024 can earn $59,520, up $3,000 from the 2023 limit of $56,520. For every $3 you earn over the limit, your Social Security benefits will be reduced by $1 for money earned in the months before full retirement age. Once full retirement age is reached, no benefits will be withheld if recipients continue to work. 2 4. Taxable Earnings Rose Employees paid the 6.2% Social Security tax, with their employer matching that payment, on income of up to $160,200 in 2023. In 2024, the maximum taxable earnings increased to $168,600. The Social Security tax rate remains at 6.2% and 12.4% for the self-employed. 2 5. Disability Benefits and Income Thresholds Increased Social Security Disability Insurance (SSDI) provides income for those who can no longer work due to a disability. More than 8.9 million people in the United States who are receiving Social Security disability benefits received a 3.2% increase in 2024. 1 Disabled workers receive on average $1,537 per month in 2024, up from $1,489 in 2023. Disabled workers with a spouse and one or more children can expect an average of $2,720. 2 Blind workers have a cap of $2,590 per month in 2024. 2 6. Higher Credit Earning Threshold Those born in 1929 or later must earn at least 40 credits (maximum of four per year) over their working life to qualify for Social Security benefits. The amount it takes to earn a single credit goes up each year. 9 For 2024, it will take $1,730 in earnings per credit. 2 The number of credits needed for SSDI depends on the age when the recipient becomes disabled. 7. Increase in Medicare Part B Premiums Premiums for Medicare Part B, determined according to the Social Security Act, rose in 2024. The standard monthly premium for Medicare Part B is $174.70 for 2024, up from $164.90 in 2023. The annual deductible for Medicare Part B is $240 in 2024. 10 Program Funding Through 2035 According to the 2024 Social Security and Medicare Boards of Trustees annual report, Social Security and Medicare programs face future financing issues. The Old-Age and Survivors Insurance (OASI) Trust Fund and the Disability Insurance (DI) Trust Fund are combined to create the OASDI, used to indicate the status of the Social Security program. 11 As of 2024, OASDI is projected to pay 100% of total scheduled benefits until 2035, At that point, the projected fund's reserves will be depleted and the continuing total fund income will pay 83% of expected benefits. 11 The Old-Age and Survivors Insurance (OASI) Trust Fund is projected to pay 100% of scheduled benefits until 2033. The fund's reserves will be depleted and continuing program income will be able to pay 79% of benefits. The Disability Insurance (DI) Trust Fund is projected to support 100% of benefits through 2098. 11 What Is the Highest Social Security Benefit in 2024? The maximum Social Security benefit for a worker retiring at full retirement age in 2024 is $3,822 monthly. Though uncommon, it's possible to be eligible for triple the Social Security benefits: Social Security retirement benefits, Social Security Disability Insurance (SSDI), and Supplemental Security Income (SSI). Individuals can check their full retirement age on the Social Security Administration’s Retirement Age Calculator. 2 12 What Is the Cost-of-Living Adjustment (COLA) for the Military in 2024? Cost-of-living adjustments (COLAs) for pay for retired military members increased to 3.2% in 2024, depending on the time of retirement. 13 Can a Divorced Person Collect Their Ex-Spouse’s Social Security? Individuals who divorced but were married to a spouse for more than 10 years can likely claim some portion of their spouse’s Social Security benefits. They must be unmarried when collecting Social Security benefits. The widow’s benefit is 71% to 100% of what a spouse received before they died. 14 The Bottom Line Social Security benefits increased in 2024 with a COLA based on inflation. The ideal time to take retirement benefits depends on an individual's financial situation and retirement goals.
+
+USER:
+What are key changes to the Social Security program for 2024, related to the cost-of-living adjustments(COLA), taxable earning limit, and disability benefits, and how do they impact recipients?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,26,28,1232,,627
+"In developing a response, draw solely from information given in the prompt or provided context.","A lender applied a lien on a customer's house due to non-payment under their credit terms for a 100k loan (the lien was for the outstanding balance, around 80k). The property was inherited, so the customer paid nothing for the property (now worth more than a million AUD). Is this unfair, or predatory lending?","2.2.2 Harsh and unfair consumer credit contract terms 130. Consumer credit contracts (loans) may include all kinds of harsh and unfair terms. These may include-  allowance for the lender to repossess property without sufficient warning or time to remedy a default;  large early termination fees if a loan is repaid early or the borrower is late in paying the loan instalments; or  placing security over property with greater value than the borrower‘s liability under the consumer credit contract. 131. Laws in some countries allow a borrower to apply to a court or tribunal to ask them to strike out the harsh and unfair contract terms. 132. The Malaysian Financial Services Act and the Islamic Financial Services Act prohibit lenders (ie Financial Service Providers) from engaging in conduct that is deemed to be inherently unfair to financial consumers. The types of prohibited business conduct are set out in Schedule 7 of the two Acts. The types of conduct that are prohibited include-  providing borrowers with misleading or deceptive information;  intimidating or exploiting borrowers;  restricting the freedom of borrowers to choose between financial services or products available to them;  engaging in collusive business practices Schedule 7 Malaysian Financial Services Act and Islamic Financial Services Act Prohibited business conduct includes: 1. Engaging in conduct that is misleading or deceptive, or is likely to mislead or deceive in relation to the nature, features, terms or price of any financial service or product. 2. Inducing or attempting to induce a financial consumer to do an act or omit to do an act in relation to any financial service or product by—  making a statement, illustration, promise, forecast or comparison which is misleading, false or deceptive;  dishonestly concealing, omitting or providing material facts in a manner which is ambiguous; or  recklessly making any statement, illustration, promise, forecast or comparison which is misleading, false or deceptive. 49 133. In Australia, a court can reopen a contract that is ‗unjust‘. ‗Unjust‘ conduct means conduct that is ‗unconscionable, harsh or oppressive‘. This includes circumstances in which the terms of the document are unjust, or the lender‘s conduct is unjust. 134. In determining whether the contract was unjust, the court may take into account:  whether the lender or any other person used unfair pressure;  whether, at the time the contract was entered into, the lender knew or should have known that the borrower would be unable to pay; or  the annual percentage interest rates charged in comparable cases. 135. If the court decides that the contract is unjust, then it can make order a number of remedies, including:  reopening an account already taken between the parties;  relieving the borrower and any guarantor from payment of any amount that the court considers to be excessive;  setting aside either wholly or in part or revise or alter an agreement made or mortgage given in connection with the transaction; or  ordering that the mortgagee takes such steps as are necessary to discharge the mortgage.","<System> In developing a response, draw solely from information given in the prompt or provided context. <Request> A lender applied a lien on a customer's house due to non-payment under their credit terms for a 100k loan (the lien was for the outstanding balance, around 80k). The property was inherited, so the customer paid nothing for the property (now worth more than a million AUD). Is this unfair, or predatory lending? <Context> 2.2.2 Harsh and unfair consumer credit contract terms 130. Consumer credit contracts (loans) may include all kinds of harsh and unfair terms. These may include-  allowance for the lender to repossess property without sufficient warning or time to remedy a default;  large early termination fees if a loan is repaid early or the borrower is late in paying the loan instalments; or  placing security over property with greater value than the borrower‘s liability under the consumer credit contract. 131. Laws in some countries allow a borrower to apply to a court or tribunal to ask them to strike out the harsh and unfair contract terms. 132. The Malaysian Financial Services Act and the Islamic Financial Services Act prohibit lenders (ie Financial Service Providers) from engaging in conduct that is deemed to be inherently unfair to financial consumers. The types of prohibited business conduct are set out in Schedule 7 of the two Acts. The types of conduct that are prohibited include-  providing borrowers with misleading or deceptive information;  intimidating or exploiting borrowers;  restricting the freedom of borrowers to choose between financial services or products available to them;  engaging in collusive business practices Schedule 7 Malaysian Financial Services Act and Islamic Financial Services Act Prohibited business conduct includes: 1. Engaging in conduct that is misleading or deceptive, or is likely to mislead or deceive in relation to the nature, features, terms or price of any financial service or product. 2. Inducing or attempting to induce a financial consumer to do an act or omit to do an act in relation to any financial service or product by—  making a statement, illustration, promise, forecast or comparison which is misleading, false or deceptive;  dishonestly concealing, omitting or providing material facts in a manner which is ambiguous; or  recklessly making any statement, illustration, promise, forecast or comparison which is misleading, false or deceptive. 49 133. In Australia, a court can reopen a contract that is ‗unjust‘. ‗Unjust‘ conduct means conduct that is ‗unconscionable, harsh or oppressive‘. This includes circumstances in which the terms of the document are unjust, or the lender‘s conduct is unjust. 134. In determining whether the contract was unjust, the court may take into account:  whether the lender or any other person used unfair pressure;  whether, at the time the contract was entered into, the lender knew or should have known that the borrower would be unable to pay; or  the annual percentage interest rates charged in comparable cases. 135. If the court decides that the contract is unjust, then it can make order a number of remedies, including:  reopening an account already taken between the parties;  relieving the borrower and any guarantor from payment of any amount that the court considers to be excessive;  setting aside either wholly or in part or revise or alter an agreement made or mortgage given in connection with the transaction; or  ordering that the mortgagee takes such steps as are necessary to discharge the mortgage.","In developing a response, draw solely from information given in the prompt or provided context.
+
+EVIDENCE:
+2.2.2 Harsh and unfair consumer credit contract terms 130. Consumer credit contracts (loans) may include all kinds of harsh and unfair terms. These may include-  allowance for the lender to repossess property without sufficient warning or time to remedy a default;  large early termination fees if a loan is repaid early or the borrower is late in paying the loan instalments; or  placing security over property with greater value than the borrower‘s liability under the consumer credit contract. 131. Laws in some countries allow a borrower to apply to a court or tribunal to ask them to strike out the harsh and unfair contract terms. 132. The Malaysian Financial Services Act and the Islamic Financial Services Act prohibit lenders (ie Financial Service Providers) from engaging in conduct that is deemed to be inherently unfair to financial consumers. The types of prohibited business conduct are set out in Schedule 7 of the two Acts. The types of conduct that are prohibited include-  providing borrowers with misleading or deceptive information;  intimidating or exploiting borrowers;  restricting the freedom of borrowers to choose between financial services or products available to them;  engaging in collusive business practices Schedule 7 Malaysian Financial Services Act and Islamic Financial Services Act Prohibited business conduct includes: 1. Engaging in conduct that is misleading or deceptive, or is likely to mislead or deceive in relation to the nature, features, terms or price of any financial service or product. 2. Inducing or attempting to induce a financial consumer to do an act or omit to do an act in relation to any financial service or product by—  making a statement, illustration, promise, forecast or comparison which is misleading, false or deceptive;  dishonestly concealing, omitting or providing material facts in a manner which is ambiguous; or  recklessly making any statement, illustration, promise, forecast or comparison which is misleading, false or deceptive. 49 133. In Australia, a court can reopen a contract that is ‗unjust‘. ‗Unjust‘ conduct means conduct that is ‗unconscionable, harsh or oppressive‘. This includes circumstances in which the terms of the document are unjust, or the lender‘s conduct is unjust. 134. In determining whether the contract was unjust, the court may take into account:  whether the lender or any other person used unfair pressure;  whether, at the time the contract was entered into, the lender knew or should have known that the borrower would be unable to pay; or  the annual percentage interest rates charged in comparable cases. 135. If the court decides that the contract is unjust, then it can make order a number of remedies, including:  reopening an account already taken between the parties;  relieving the borrower and any guarantor from payment of any amount that the court considers to be excessive;  setting aside either wholly or in part or revise or alter an agreement made or mortgage given in connection with the transaction; or  ordering that the mortgagee takes such steps as are necessary to discharge the mortgage.
+
+USER:
+A lender applied a lien on a customer's house due to non-payment under their credit terms for a 100k loan (the lien was for the outstanding balance, around 80k). The property was inherited, so the customer paid nothing for the property (now worth more than a million AUD). Is this unfair, or predatory lending?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,15,54,508,,91
+[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.,"Explain the difference between the Somogyi phenomenon and the dawn phenomenon, how each can be avoided, and why each happens at night. Use a maximum of 500 words.","Definition/Introduction The Somogyi effect, also known as the ""chronic Somogyi rebound"" or ""posthypoglycemic hyperglycemia,"" was a theory proposed in the 1930s by Dr. Michael Somogyi, a Hungarian-born professor at Washington University, St. Louis, MO, United States.[1] He described the paradoxical tendency of the body to react to hypoglycemia by producing hyperglycemia. Somogyi proposed that when blood glucose levels drop too low during the late evening, activation of counterregulatory hormones such as adrenaline, corticosteroids, growth hormone, and glucagon may be observed, leading to activation of gluconeogenesis and resultant hyperglycemia in the early morning.[2] However, more recent studies involving continuous glucose monitoring (CGM) have disputed this theory. Also, clinicians have observed that patients with early morning hyperglycemia tend to have high blood glucose measurements at night rather than low.[1] As a result, the debate continues in the scientific community regarding Somogyi's theory. Moreover, recently proposed mechanisms of morning hyperglycemia include nocturnal growth hormone secretion, hypoinsulinemia, and insulin resistance associated with metabolic syndrome.[3] A phenomenon known as the dawn phenomenon was introduced by Dr. Schimdt in the 1980s, stating that morning hyperglycemia is due to the decreased levels of endogenous insulin secreted at night.[1] The dawn phenomenon also contributes to morning hyperglycemia to increased concentrations of insulin-antagonist hormones. The dawn phenomenon is comparable to the Somogyi phenomenon, which attributes morning hyperglycemia to counterregulatory hormones from low glucose. The dawn phenomenon has been noted to occur more commonly than the Somogyi phenomenon.[1] While the two theories are not seen in all cases of insulin-dependent diabetics, it is important to note that the best way to prevent either is optimal diabetes control with the proper insulin therapy.[1] The Somogyi phenomenon states that early morning hyperglycemia occurs due to a rebound effect from late-night hypoglycemia. However, the dawn phenomenon does not include hypoglycemic episodes to be a factor. Insulin Release and Insulin Resistance With recent studies attributing early morning hyperglycemia to hypoinsulinemia, there is an observable pattern in which the body secretes insulin. The theory is insulin gets secreted in a circadian pattern, with the lowest concentrations between midnight and 6 AM and the highest concentrations between noon and 6 PM.[4] This pattern of insulin secretion is the opposite of melatonin from the pineal gland. The circadian pattern of insulin secretion provides evidence for the dawn phenomenon. The Somogyi phenomenon has been a proposed phenomenon in insulin-dependent diabetic patients. The thinking is that these patients should monitor their blood glucose levels and adjust insulin dosages as necessary to prevent hypo- or hyperglycemic episodes. In an individual that does not have diabetes, the blood glucose and insulin concentrations stay flat and constant throughout the night, with a transient increase in insulin just before dawn to prevent hepatic glucose production through gluconeogenesis and prevent hyperglycemia.[5] This explains why non-diabetic patients do not exhibit the dawn phenomenon, as their insulin levels follow the circadian pattern necessary for optimal glucose control. Insulin resistance, seen in diabetes or metabolic syndrome, has been associated with constant exposure to high insulin levels.[6] As patients get diagnosed with diabetes or metabolic syndrome at an earlier age, there is more exogenous insulin exposure that leads to this resistance. Because of this, the normal regulation and pattern of insulin levels make it difficult for insulin-dependent diabetics to control their blood glucose levels during their sleep. Not only is insulin necessary to regulate glucose levels, but it is also the primary hormone that inhibits gluconeogenesis.[7] Gluconeogenesis in the morning gets inhibited in a non-diabetic due to the transient increase in insulin right before dawn. As a patient becomes more and more resistant to insulin, the key inhibitor of gluconeogenesis is no longer working; this allows the body to produce more glucose, leading to a hyperglycemic state. Clinical Significance The Somogyi phenomenon had been considered in the past; an essential consideration for the proper diagnosis and management of blood glucose levels is vital for the body’s metabolic demands. The post-hypoglycemic hyperglycemia raises the question of whether a patient’s insulin levels should be adjusted in the evening to prevent hyperglycemia in the morning. As this is something ideally avoided, the Somogyi phenomenon occurs too infrequently to make this standardized practice.","[question] Explain the difference between the Somogyi phenomenon and the dawn phenomenon, how each can be avoided, and why each happens at night. Use a maximum of 500 words. ===================== [text] Definition/Introduction The Somogyi effect, also known as the ""chronic Somogyi rebound"" or ""posthypoglycemic hyperglycemia,"" was a theory proposed in the 1930s by Dr. Michael Somogyi, a Hungarian-born professor at Washington University, St. Louis, MO, United States.[1] He described the paradoxical tendency of the body to react to hypoglycemia by producing hyperglycemia. Somogyi proposed that when blood glucose levels drop too low during the late evening, activation of counterregulatory hormones such as adrenaline, corticosteroids, growth hormone, and glucagon may be observed, leading to activation of gluconeogenesis and resultant hyperglycemia in the early morning.[2] However, more recent studies involving continuous glucose monitoring (CGM) have disputed this theory. Also, clinicians have observed that patients with early morning hyperglycemia tend to have high blood glucose measurements at night rather than low.[1] As a result, the debate continues in the scientific community regarding Somogyi's theory. Moreover, recently proposed mechanisms of morning hyperglycemia include nocturnal growth hormone secretion, hypoinsulinemia, and insulin resistance associated with metabolic syndrome.[3] A phenomenon known as the dawn phenomenon was introduced by Dr. Schimdt in the 1980s, stating that morning hyperglycemia is due to the decreased levels of endogenous insulin secreted at night.[1] The dawn phenomenon also contributes to morning hyperglycemia to increased concentrations of insulin-antagonist hormones. The dawn phenomenon is comparable to the Somogyi phenomenon, which attributes morning hyperglycemia to counterregulatory hormones from low glucose. The dawn phenomenon has been noted to occur more commonly than the Somogyi phenomenon.[1] While the two theories are not seen in all cases of insulin-dependent diabetics, it is important to note that the best way to prevent either is optimal diabetes control with the proper insulin therapy.[1] The Somogyi phenomenon states that early morning hyperglycemia occurs due to a rebound effect from late-night hypoglycemia. However, the dawn phenomenon does not include hypoglycemic episodes to be a factor. Insulin Release and Insulin Resistance With recent studies attributing early morning hyperglycemia to hypoinsulinemia, there is an observable pattern in which the body secretes insulin. The theory is insulin gets secreted in a circadian pattern, with the lowest concentrations between midnight and 6 AM and the highest concentrations between noon and 6 PM.[4] This pattern of insulin secretion is the opposite of melatonin from the pineal gland. The circadian pattern of insulin secretion provides evidence for the dawn phenomenon. The Somogyi phenomenon has been a proposed phenomenon in insulin-dependent diabetic patients. The thinking is that these patients should monitor their blood glucose levels and adjust insulin dosages as necessary to prevent hypo- or hyperglycemic episodes. In an individual that does not have diabetes, the blood glucose and insulin concentrations stay flat and constant throughout the night, with a transient increase in insulin just before dawn to prevent hepatic glucose production through gluconeogenesis and prevent hyperglycemia.[5] This explains why non-diabetic patients do not exhibit the dawn phenomenon, as their insulin levels follow the circadian pattern necessary for optimal glucose control. Insulin resistance, seen in diabetes or metabolic syndrome, has been associated with constant exposure to high insulin levels.[6] As patients get diagnosed with diabetes or metabolic syndrome at an earlier age, there is more exogenous insulin exposure that leads to this resistance. Because of this, the normal regulation and pattern of insulin levels make it difficult for insulin-dependent diabetics to control their blood glucose levels during their sleep. Not only is insulin necessary to regulate glucose levels, but it is also the primary hormone that inhibits gluconeogenesis.[7] Gluconeogenesis in the morning gets inhibited in a non-diabetic due to the transient increase in insulin right before dawn. As a patient becomes more and more resistant to insulin, the key inhibitor of gluconeogenesis is no longer working; this allows the body to produce more glucose, leading to a hyperglycemic state. Clinical Significance The Somogyi phenomenon had been considered in the past; an essential consideration for the proper diagnosis and management of blood glucose levels is vital for the body’s metabolic demands. The post-hypoglycemic hyperglycemia raises the question of whether a patient’s insulin levels should be adjusted in the evening to prevent hyperglycemia in the morning. As this is something ideally avoided, the Somogyi phenomenon occurs too infrequently to make this standardized practice. https://www.ncbi.nlm.nih.gov/books/NBK551525/ ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.","[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
+
+EVIDENCE:
+Definition/Introduction The Somogyi effect, also known as the ""chronic Somogyi rebound"" or ""posthypoglycemic hyperglycemia,"" was a theory proposed in the 1930s by Dr. Michael Somogyi, a Hungarian-born professor at Washington University, St. Louis, MO, United States.[1] He described the paradoxical tendency of the body to react to hypoglycemia by producing hyperglycemia. Somogyi proposed that when blood glucose levels drop too low during the late evening, activation of counterregulatory hormones such as adrenaline, corticosteroids, growth hormone, and glucagon may be observed, leading to activation of gluconeogenesis and resultant hyperglycemia in the early morning.[2] However, more recent studies involving continuous glucose monitoring (CGM) have disputed this theory. Also, clinicians have observed that patients with early morning hyperglycemia tend to have high blood glucose measurements at night rather than low.[1] As a result, the debate continues in the scientific community regarding Somogyi's theory. Moreover, recently proposed mechanisms of morning hyperglycemia include nocturnal growth hormone secretion, hypoinsulinemia, and insulin resistance associated with metabolic syndrome.[3] A phenomenon known as the dawn phenomenon was introduced by Dr. Schimdt in the 1980s, stating that morning hyperglycemia is due to the decreased levels of endogenous insulin secreted at night.[1] The dawn phenomenon also contributes to morning hyperglycemia to increased concentrations of insulin-antagonist hormones. The dawn phenomenon is comparable to the Somogyi phenomenon, which attributes morning hyperglycemia to counterregulatory hormones from low glucose. The dawn phenomenon has been noted to occur more commonly than the Somogyi phenomenon.[1] While the two theories are not seen in all cases of insulin-dependent diabetics, it is important to note that the best way to prevent either is optimal diabetes control with the proper insulin therapy.[1] The Somogyi phenomenon states that early morning hyperglycemia occurs due to a rebound effect from late-night hypoglycemia. However, the dawn phenomenon does not include hypoglycemic episodes to be a factor. Insulin Release and Insulin Resistance With recent studies attributing early morning hyperglycemia to hypoinsulinemia, there is an observable pattern in which the body secretes insulin. The theory is insulin gets secreted in a circadian pattern, with the lowest concentrations between midnight and 6 AM and the highest concentrations between noon and 6 PM.[4] This pattern of insulin secretion is the opposite of melatonin from the pineal gland. The circadian pattern of insulin secretion provides evidence for the dawn phenomenon. The Somogyi phenomenon has been a proposed phenomenon in insulin-dependent diabetic patients. The thinking is that these patients should monitor their blood glucose levels and adjust insulin dosages as necessary to prevent hypo- or hyperglycemic episodes. In an individual that does not have diabetes, the blood glucose and insulin concentrations stay flat and constant throughout the night, with a transient increase in insulin just before dawn to prevent hepatic glucose production through gluconeogenesis and prevent hyperglycemia.[5] This explains why non-diabetic patients do not exhibit the dawn phenomenon, as their insulin levels follow the circadian pattern necessary for optimal glucose control. Insulin resistance, seen in diabetes or metabolic syndrome, has been associated with constant exposure to high insulin levels.[6] As patients get diagnosed with diabetes or metabolic syndrome at an earlier age, there is more exogenous insulin exposure that leads to this resistance. Because of this, the normal regulation and pattern of insulin levels make it difficult for insulin-dependent diabetics to control their blood glucose levels during their sleep. Not only is insulin necessary to regulate glucose levels, but it is also the primary hormone that inhibits gluconeogenesis.[7] Gluconeogenesis in the morning gets inhibited in a non-diabetic due to the transient increase in insulin right before dawn. As a patient becomes more and more resistant to insulin, the key inhibitor of gluconeogenesis is no longer working; this allows the body to produce more glucose, leading to a hyperglycemic state. Clinical Significance The Somogyi phenomenon had been considered in the past; an essential consideration for the proper diagnosis and management of blood glucose levels is vital for the body’s metabolic demands. The post-hypoglycemic hyperglycemia raises the question of whether a patient’s insulin levels should be adjusted in the evening to prevent hyperglycemia in the morning. As this is something ideally avoided, the Somogyi phenomenon occurs too infrequently to make this standardized practice.
+
+USER:
+Explain the difference between the Somogyi phenomenon and the dawn phenomenon, how each can be avoided, and why each happens at night. Use a maximum of 500 words.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,28,28,691,,328
+Only use information from the context in your response.,In what ways can technology affect my child?,"The Impact of Technology on Children Parenting children of today’s generation comes with a unique set of challenges due to the many recent advancements in technology. There is no denying the reach technology has in our lives, as well as the lives of our children. Technology is virtually in every home in one way or another: about 96% of Americans have a TV and 94% of children ages 3 to 18 have internet access either through a computer or smartphone. According to a national survey done by Common Sense Media in 2019, 53% of children have a smartphone by the time they turn 11. Therefore, it’s important for parents to be mindful of how their children use technology and the potential effects—both positive and negative. Negative Impacts Technology can negatively affect children’s developing social skills, relationships, health, and overall ability to focus. • Social skills: With the increased use of technology, children might not be adequately developing their social skills. This can lead to more children being socially awkward, withdrawn, shy, or intimidated by social situations. They might not know how to engage with other children or adults. Developing social skills takes practice, and if technology is often in the way, there are fewer opportunities for kids to develop these skills. • Relationships: Children might get used to being alone and lose the desire to engage with their parents or even friends, outside of the internet. Often the virtual reality of their devices is more appealing and entertaining than the physical reality. • Health problems: Technology can potentially influence the child’s developing brain and problem-solving skills. For instance, the child might be reliant on a device to solve problems for them rather than using brain connections to work through a problem and find a solution. There could also be a lack of exercise due to being inside, which can cause weight gain. If kids use their devices before bedtime, this could lead to reduced sleep quality, affecting their overall wellbeing and immune system. • Ability to focus: Children who spend a lot of time using devices might have a reduced attention span and ability to focus due to their reliance on technology to pay attention for them. This is evident in classrooms, where teachers are opting for shorter lesson plans to accommodate students becoming easily distracted. • Dangers of browsing: With so much information available on the internet, it’s difficult for parents to monitor what their children are exposed to, including inappropriate content or interactions with strangers. Positive Impacts There are also many ways in which technology can positively impact our lives and those of our children—it all depends on how the technology is being used. • Organization: Technology can be beneficial to organization and planning. For example, families can keep an online calendar to make it easier to stay updated on each other’s schedules. Group text messaging is also convenient for streamlining communication and keeping everyone in the loop. Lastly, technology also makes budgeting easier with different apps, which can help parents teach children about money management. • Research and critical thinking: The internet provides access to a great deal of information and resources to help children learn about different topics. This is helpful for school projects or for researching areas of interest. This can also be a teachable moment, by showing children how to sift through information to find reliable sources. • Bonding and community: Technology can foster connection by allowing kids to stay in touch with family members or friends who do not live close by. Also, kids can interact with others in their age group while playing games online and learn to play as a team. • Self-expression: Children can learn how to share their thoughts online, which is a powerful tool that can build confidence. They can learn how to connect with others and be exposed to other viewpoints or perspectives. • Creativity and exploring interests: In many ways, technology fosters creativity and learning new skills through various apps for all different ages. Children can explore different areas they have an interest in, such as learning to play an instrument, creative writing, or beginner programs related to various subjects.","Only use information from the context in your response. In what ways can technology affect my child? The Impact of Technology on Children Parenting children of today’s generation comes with a unique set of challenges due to the many recent advancements in technology. There is no denying the reach technology has in our lives, as well as the lives of our children. Technology is virtually in every home in one way or another: about 96% of Americans have a TV and 94% of children ages 3 to 18 have internet access either through a computer or smartphone. According to a national survey done by Common Sense Media in 2019, 53% of children have a smartphone by the time they turn 11. Therefore, it’s important for parents to be mindful of how their children use technology and the potential effects—both positive and negative. Negative Impacts Technology can negatively affect children’s developing social skills, relationships, health, and overall ability to focus. • Social skills: With the increased use of technology, children might not be adequately developing their social skills. This can lead to more children being socially awkward, withdrawn, shy, or intimidated by social situations. They might not know how to engage with other children or adults. Developing social skills takes practice, and if technology is often in the way, there are fewer opportunities for kids to develop these skills. • Relationships: Children might get used to being alone and lose the desire to engage with their parents or even friends, outside of the internet. Often the virtual reality of their devices is more appealing and entertaining than the physical reality. • Health problems: Technology can potentially influence the child’s developing brain and problem-solving skills. For instance, the child might be reliant on a device to solve problems for them rather than using brain connections to work through a problem and find a solution. There could also be a lack of exercise due to being inside, which can cause weight gain. If kids use their devices before bedtime, this could lead to reduced sleep quality, affecting their overall wellbeing and immune system. • Ability to focus: Children who spend a lot of time using devices might have a reduced attention span and ability to focus due to their reliance on technology to pay attention for them. This is evident in classrooms, where teachers are opting for shorter lesson plans to accommodate students becoming easily distracted. • Dangers of browsing: With so much information available on the internet, it’s difficult for parents to monitor what their children are exposed to, including inappropriate content or interactions with strangers. Positive Impacts There are also many ways in which technology can positively impact our lives and those of our children—it all depends on how the technology is being used. • Organization: Technology can be beneficial to organization and planning. For example, families can keep an online calendar to make it easier to stay updated on each other’s schedules. Group text messaging is also convenient for streamlining communication and keeping everyone in the loop. Lastly, technology also makes budgeting easier with different apps, which can help parents teach children about money management. • Research and critical thinking: The internet provides access to a great deal of information and resources to help children learn about different topics. This is helpful for school projects or for researching areas of interest. This can also be a teachable moment, by showing children how to sift through information to find reliable sources. • Bonding and community: Technology can foster connection by allowing kids to stay in touch with family members or friends who do not live close by. Also, kids can interact with others in their age group while playing games online and learn to play as a team. • Self-expression: Children can learn how to share their thoughts online, which is a powerful tool that can build confidence. They can learn how to connect with others and be exposed to other viewpoints or perspectives. • Creativity and exploring interests: In many ways, technology fosters creativity and learning new skills through various apps for all different ages. Children can explore different areas they have an interest in, such as learning to play an instrument, creative writing, or beginner programs related to various subjects.","Only use information from the context in your response.
+
+EVIDENCE:
+The Impact of Technology on Children Parenting children of today’s generation comes with a unique set of challenges due to the many recent advancements in technology. There is no denying the reach technology has in our lives, as well as the lives of our children. Technology is virtually in every home in one way or another: about 96% of Americans have a TV and 94% of children ages 3 to 18 have internet access either through a computer or smartphone. According to a national survey done by Common Sense Media in 2019, 53% of children have a smartphone by the time they turn 11. Therefore, it’s important for parents to be mindful of how their children use technology and the potential effects—both positive and negative. Negative Impacts Technology can negatively affect children’s developing social skills, relationships, health, and overall ability to focus. • Social skills: With the increased use of technology, children might not be adequately developing their social skills. This can lead to more children being socially awkward, withdrawn, shy, or intimidated by social situations. They might not know how to engage with other children or adults. Developing social skills takes practice, and if technology is often in the way, there are fewer opportunities for kids to develop these skills. • Relationships: Children might get used to being alone and lose the desire to engage with their parents or even friends, outside of the internet. Often the virtual reality of their devices is more appealing and entertaining than the physical reality. • Health problems: Technology can potentially influence the child’s developing brain and problem-solving skills. For instance, the child might be reliant on a device to solve problems for them rather than using brain connections to work through a problem and find a solution. There could also be a lack of exercise due to being inside, which can cause weight gain. If kids use their devices before bedtime, this could lead to reduced sleep quality, affecting their overall wellbeing and immune system. • Ability to focus: Children who spend a lot of time using devices might have a reduced attention span and ability to focus due to their reliance on technology to pay attention for them. This is evident in classrooms, where teachers are opting for shorter lesson plans to accommodate students becoming easily distracted. • Dangers of browsing: With so much information available on the internet, it’s difficult for parents to monitor what their children are exposed to, including inappropriate content or interactions with strangers. Positive Impacts There are also many ways in which technology can positively impact our lives and those of our children—it all depends on how the technology is being used. • Organization: Technology can be beneficial to organization and planning. For example, families can keep an online calendar to make it easier to stay updated on each other’s schedules. Group text messaging is also convenient for streamlining communication and keeping everyone in the loop. Lastly, technology also makes budgeting easier with different apps, which can help parents teach children about money management. • Research and critical thinking: The internet provides access to a great deal of information and resources to help children learn about different topics. This is helpful for school projects or for researching areas of interest. This can also be a teachable moment, by showing children how to sift through information to find reliable sources. • Bonding and community: Technology can foster connection by allowing kids to stay in touch with family members or friends who do not live close by. Also, kids can interact with others in their age group while playing games online and learn to play as a team. • Self-expression: Children can learn how to share their thoughts online, which is a powerful tool that can build confidence. They can learn how to connect with others and be exposed to other viewpoints or perspectives. • Creativity and exploring interests: In many ways, technology fosters creativity and learning new skills through various apps for all different ages. Children can explore different areas they have an interest in, such as learning to play an instrument, creative writing, or beginner programs related to various subjects.
+
+USER:
+In what ways can technology affect my child?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,9,8,694,,422
+Only provide commentary from the context included.,"How, if at all, does the owner of this business respond to negative reviews?","&Pizza Google Reviews Josh Local Guide·316 reviews·113 photos a month ago Ordered online and my receipt had no details confirming my items. I text them like they said and they never responded. Then they have Uber do the order delivery but I didn't know that before putting the tip in and then the driver said he … More Photo 1 in review by Josh Photo 2 in review by Josh &pizza - Dupont (Owner) a month ago We regret to hear about your experience with the online ordering and delivery process. Your response is important to us as we strive to improve our services. We will address the issues you've mentioned with our team to ensure a better experience for all our customers. Thank you for bringing this to our attention. Gine “Gine The Mae Nai's Winery” MaeNaiWinery Local Guide·369 reviews·5043 photos 3 months ago Dine in | Dinner | $10–20 Such a lovely freshly made pizza with various options, really hard time to decide which one to order lol. Very fast and nice service. Pizza just got ready in 8mins. Have two long tables to enjoy, or take away. … More Photo 1 in review by Gine “Gine The Mae Nai's Winery” MaeNaiWinery Photo 2 in review by Gine “Gine The Mae Nai's Winery” MaeNaiWinery Photo 3 in review by Gine “Gine The Mae Nai's Winery” MaeNaiWinery Photo 4 in review by Gine “Gine The Mae Nai's Winery” MaeNaiWinery Photo 5 in review by Gine “Gine The Mae Nai's Winery” MaeNaiWinery Photo 6 in review by Gine “Gine The Mae Nai's Winery” MaeNaiWinery Photo 7 in review by Gine “Gine The Mae Nai's Winery” MaeNaiWinery Photo 8 in review by Gine “Gine The Mae Nai's Winery” MaeNaiWinery Photo 9 in review by Gine “Gine The Mae Nai's Winery” MaeNaiWinery &pizza - Dupont (Owner) a month ago Thank you for your 5-star rating! We're thrilled to hear that you enjoyed our freshly made pizza and fast service. Your response is important to us as we strive to improve our services. We hope to see you again soon for another delicious experience! Torianna Todd 3 reviews·2 photos a week ago NEW Take out | Dinner | $10–20 Super friendly staff and the food was really good! We got 2 pizzas- one cheese and one margarita with some extra toppings, and garlic knots. … More Photo 1 in review by Torianna Todd Photo 2 in review by Torianna Todd Addison Hosner Local Guide·100 reviews·141 photos a month ago Never had pizza from here before but ordered online for pickup during lunch. Showed up on time and the order was ready without delay. The pizza is a great serving size and depending on your appetite and what you get this could be two meals … More &pizza - Dupont (Owner) a month ago Thank you for taking the time to share your experience with us! We are thrilled to hear that you enjoyed our pizza and that your order was ready on time. Your response is important to us as we strive to improve our services. We look forward to serving you again soon! Allen Nuccio Local Guide·297 reviews·380 photos a week ago NEW Dine in | Lunch | $10–20 If you're not familiar, &pizza is like Fancy Pizza Hut in flatbread form. Their pies are pretty good and their garlic knots are delicious. This location has fantastic customer service, but also smells heavily of a bathroom for whatever reason. Anyway, pretty good all-in-all. … More Alma Local Guide·147 reviews·278 photos 7 months ago Take out | Dinner | $10–20 Pizza is good and doesn't take long from ordering to paying so it's fast and convenient. Staff is super friendly and nice … More Photo 1 in review by Alma Photo 2 in review by Alma Photo 3 in review by Alma Photo 4 in review by Alma Photo 5 in review by Alma Lizzy Amirana Local Guide·146 reviews·224 photos 4 months ago Smells like mold in the place but wonderful pizza! Their gluten free pizza with vegan cheese and meat substitute is 💣 … More Photo 1 in review by Lizzy Amirana 1 &pizza - Dupont (Owner) a month ago We regret to hear about the issue you encountered during your visit. Your response is important to us as we strive to improve our services. We're glad you enjoyed the gluten free pizza with vegan cheese and meat substitute. Thank you for sharing your experience. Emma Fan Local Guide·28 reviews·20 photos a month ago We ordered 8 pizzas (menu items) and 4 of them was made incorrectly - missing all the meat, missing veggies & pineapple, wrong sauce, missing spices. They weren’t just missing one or two ingredients, they were made into something completely … More &pizza - Dupont (Owner) a month ago We regret to hear about your experience and the incorrect pizza orders. Your response is important to us as we strive to improve our services. We will address this with our kitchen staff to ensure such mistakes are not repeated. Thank you for bringing this to our attention. Aban Koprulu 74 reviews·3 photos 3 weeks ago NEW The pizza is good but omg the sewage smell was unbearable. I tried to hold my breath and breathe through my mouth. I almost passed out. I don’t think this place is safe according USDA food and safety inspection. I will have to report it … More 1 &pizza - Dupont (Owner) 3 weeks ago We regret to hear about your experience. Your response is important to us as we strive to improve our services. We will investigate the issue immediately to ensure a safe and pleasant dining experience for all our customers. Thank you for bringing this to our attention. Jacob Fix Local Guide·22 reviews·12 photos 4 months ago Take out | Lunch | $10–20 Very fast, affordable, and huge portions. Great deal and great pizza. … More Photo 1 in review by Jacob Fix Jason A 4 reviews·2 photos 2 years ago Take out | Lunch | $10–20 Great pizza in Dupont! Walking distance from the Mayflower hotel. Fast friendly service. The Maverick is my favorite and garlic knots are a nice add on. Photo 1 in review by Jason A Photo 2 in review by Jason A Mehrnoosh Kh Local Guide·245 reviews·1644 photos 6 months ago Take out | Dinner It is a good pizza place for late night bites. … More Photo 1 in review by Mehrnoosh Kh Photo 2 in review by Mehrnoosh Kh Photo 3 in review by Mehrnoosh Kh Photo 4 in review by Mehrnoosh Kh Photo 5 in review by Mehrnoosh Kh Photo 6 in review by Mehrnoosh Kh Photo 7 in review by Mehrnoosh Kh Photo 8 in review by Mehrnoosh Kh Ryan Griffith 11 reviews 4 months ago Don't bother ordering Uber Eats here because they won't make the food and you'll have to cancel the order. And if you dine in apparently it smells like piss. … More Samuel Davie 37 reviews·102 photos a year ago Take out | Dinner | $10–20 Delicious pizza and the perfect serving for 1 person. I always get the pineapple jacked and take my Tour de Pizza cutter for a ride. Going for a pizza ride #tourdepizzacutter 🚴🏼🍕😊 Photo 2 in review by Samuel Davie 3 Alan Marrero Local Guide·215 reviews·2873 photos 5 months ago Nasty piss smell, we had to leave in an instant. No wonder the place was empty. The pizzas looked great in the pictures, if you want to eat a pizza in smelly atmosphere THIS IS IT! … More 2 Henry Kloepper Local Guide·121 reviews·77 photos 7 years ago Was quite decent. Fast, reasonable price, good taste. Though I just had Pizza Paradiso and if you have some extra time it's well worth it over &pizza, especially if you are interested in having an alcoholic drink with your pizza. If you're in a rush this works better. Photo 1 in review by Henry Kloepper Damien Shaner Local Guide·30 reviews·140 photos 3 weeks ago NEW They are so ghetto they have a security guard that locks the door and doesn't let people inside after the place fills full of ""dangerous people""...well before the actual closing time. &pizza - Dupont (Owner) 2 weeks ago We regret to hear about your experience at our restaurant. Your response is important to us as we strive to improve our services. We take the safety of our customers seriously and will address this issue with our security team. Thank you for bringing this to our attention. Diana Marquez 2 reviews 9 months ago Dine in | $10–20 My sister and I came in to grab some food after a night out it was very busy but the team was very efficient and Luis definitely made sure we had a great experience. He has exceptional customer service skills, very out going and just great at what he does and overall takes great care of guests. Will definitely be coming back soon ! Matthew Rice Local Guide·14 reviews·54 photos 4 months ago Take out | Dinner | $10–20 Pizza was decent, but as other reviews have noted, the restaurant had an unbearable stench. The owner needs to call a plumber or an exterminator (or both). … More Elizabeth Dapper 8 reviews·4 photos 3 months ago Dine in | Dinner | $10–20 Good place, good service, loud music which is always a little hard when talking with friends... but the food and the employees never disappoint! … More &pizza - Dupont (Owner) a month ago Thank you for taking the time to share your experience with us. We're glad to hear that you enjoyed the food and service, but we understand that the loud music can be a challenge. Your response is important to us as we strive to improve our services. We hope to have the opportunity to serve you again in the future. D C 8 reviews·2 photos 6 months ago Take out | Dinner I just have to add to the other reviews about the absolutely putrid horrifying smell in here, which hits you upon entering. I had ordered Uber Eats, otherwise I would have immediately left. This place most likely has an ongoing sewage issue that is not being addressed properly. No place that sells food should smell like this. … More 2 Andy Jovel 11 reviews·1 photo a year ago Take out | Lunch | $10–20 Sorry, but the pizza was cold and there was little to none chicken mostly just blue cheese crumbles. There were none jalapenos at all either. Photo 1 in review by Andy Jovel Brei Evans 4 reviews·11 photos 3 days ago NEW This locations stinks so bad. The people are nice here though. … More Cedar Baltz 7 reviews 7 months ago Take out | Dinner | $30–50 I got take out and the guy gave me 1 correct pizza I ordered and gave me a completely different order for the 2nd pizza. He showed me the first pizza with the correct toppings on it. I assumed the 2nd pizza he handed me was the right order … More Nathan Sellers Local Guide·90 reviews·323 photos 4 years ago This is really good pizza. The manager was super friendly and helpful too. My son begged to go back the whole trip and said it was the best pizza he'd ever had. Photo 1 in review by Nathan Sellers Kelli Roberts Local Guide·349 reviews·305 photos 6 years ago Second &pizza today. This location is even bigger! Food was delicious, but I would advise going light on the toppings if you choose a gluten free pizza. Too many toppings can make the pizza heavy and messy. Photo 1 in review by Kelli Roberts Photo 2 in review by Kelli Roberts 2 Jahanna Reese 13 reviews·1 photo 11 months ago This is My favorite & pizza Location, great service and they don’t rush you . 5 stars out of 5 Photo 1 in review by Jahanna Reese Josh Griswell Local Guide·26 reviews·21 photos 5 years ago Great food, good price, friendly staff! I ordered the vegan pizza and it was awesome! Their craft soda fountain has some great selections as well. Food was cooked quickly and tasted great! Photo 1 in review by Josh Griswell 1 David Zaga Local Guide·48 reviews·83 photos 6 months ago I mean the price was ok. The place smelled, clearly not very well maintained. And the pizza was ok. The guys working the counter, although dealing with a lot of customers were working hard and gave good service … More 2 Samim zamiri 1 review a month ago You gotta taste their pizza and you’ll definitely like it … More &pizza - Dupont (Owner) a month ago Thank you for your 5-star rating! We're thrilled to hear that you enjoyed our pizza. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Sabrina Lisenby 3 reviews·1 photo 2 years ago Amazing staff, great service, and was so fast. Oh by the way they have amazing pizza and garlic knots. If this isn’t enough to make you try them out, do it anyway lol 😂🤣 Photo 1 in review by Sabrina Lisenby &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We're thrilled to hear that you had an amazing experience with our staff and enjoyed our pizza and garlic knots. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Ashllyn Silva Local Guide·64 reviews·63 photos a year ago Dine in | Lunch | $10–20 Actually so obsessed with this pizza. So glad to find out they have multiple locations in my home city. Photo 1 in review by Ashllyn Silva Zhuoran Li 7 reviews·6 photos a year ago The guy is super nice. He is friendly. The pizza is so good. It is really a top place for some pizza quick bite Photo 1 in review by Zhuoran Li J Foodgeek Local Guide·715 reviews·732 photos 2 years ago So earlier today I got I texted coupon for a $5 pizza, so I walk in to dupont S location and I figure I'll just make the order in the place, and I look at the places where the ingredients are, and see slimy rod and spinach and black basil, … More Photo 1 in review by J Foodgeek 1 HoneyD 11 reviews 6 months ago Why does this place stink? Walked up expecting smell of fresh pizza but smells like dirty sewage, smells better outside. Couldn't imagine sitting down in here to eat. … More 2 Sarah Jackson Local Guide·81 reviews·2 photos 4 years ago Pizza flavor is good & could have been a 5 star. Delivery wAs about 30 mins on Fri Evening. ..but it was delivered COLD,,,,!.to order is difficult, forget calling you will only get voicemail tell you they only text or order online. They … More Photo 1 in review by Sarah Jackson 1 &pizza - Dupont (Owner) 4 years ago Hey Sarah, thanks for the review and sorry your pies didnt arrive to you in a state we're proud of. If you're up for it, feel free to reach back out and we'd be happy to make it up to you Daniel Ruiz Local Guide·49 reviews·200 photos 4 years ago Great place to eat pizza, fast service, prices are okay, each style is around $10, not so crowed and staff is friendly, very reccomended if you are hungry and looking for something quick. Photo 1 in review by Daniel Ruiz John Yeung Local Guide·130 reviews·151 photos 7 years ago How can you not like &pizza? I come here all the time. Overall it is really good but sometimes the quality is inconsistent. The pizza might be slightly burnt on the edges. The few times I want to buy soda, their machine does not have all the flavors. Photo 1 in review by John Yeung Liam Amiri Local Guide·377 reviews·2368 photos a year ago Decent pizza but don't expect some authentic NYC style pizza. … More Photo 1 in review by Liam Amiri Eddie Hoss Local Guide·268 reviews·74 photos a year ago Dine in | Dinner Oddly enough, some of the best pizza I've had in some time. Visited during the Halloween bar crawl and the three employees were overwhelmed but kept at it. Waited around 45 min for my pizza, but it was worth it. Decent prices and when … More David Dotson Local Guide·146 reviews·574 photos 2 years ago Dine in | Dinner | $10–20 Great pizza & excellent service Both Gluten Free crust & Vegan protein options available (vegan cheese, vegan sausage & chickpeas) … More Photo 1 in review by David Dotson 1 &pizza - Dupont (Owner) 2 years ago Thank you so much for the review David! We're so glad you were able to use our loyalty coupon as well! Ishmael Kamara Local Guide·117 reviews·649 photos a year ago Take out | Dinner | $20–30 &pizza is always great. Went there late on Friday for something to eat. With the crowd from the clubs be prepared to wait and they don't have any indoor seating at that time. Overall you can't go wrong with a personalized pizza from here. … More tshirt tae 7 reviews·6 photos a year ago Pizza was banging line was fast great place custom Pizza Photo 1 in review by tshirt tae Niggle W 14 reviews 6 months ago The store is quiet but the staff is very polite, clean and the pizza came out good. … More Anthony Ayo 4 reviews·1 photo a year ago Lunch | $30–50 Pizza was great! Service was just as awesome! We brought a group of 13 people and Terrence and the crew were happy and helpful. Can’t wait to come back when I’m back in town. … More williampiedra100 3 reviews·1 photo 3 weeks ago NEW Dine in | $10–20 Bryan attended us with great care. … More &pizza - Dupont (Owner) 2 weeks ago Thank you for the 5-star rating! We're thrilled to hear that Bryan took great care of you. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Vannessa Rodello Local Guide·129 reviews·103 photos 4 years ago All the toppings you want and so many options! My only criticism is the crust wasn't as crispy as I'd like. Photo 1 in review by Vannessa Rodello Photo 2 in review by Vannessa Rodello R Bakshi Local Guide·65 reviews·166 photos 6 years ago Excellent pizza and super friendly staff! Photo 1 in review by R Bakshi Photo 2 in review by R Bakshi Krystle Local Guide·107 reviews·224 photos 4 years ago It was really good. But it was sooooo hot in there and took foreverrrrrrr. Pepperoni and bacon. I'm basic lol Photo 1 in review by Krystle Leah Trunsky (raindropAuxilitrix) 1 review 11 months ago Went here with my friends—the pizza was great and the server Chris was super cool! Super friendly. Whoever made the pizza was patient with our orders too. :) Destine Jones 5 reviews 11 months ago Take out | Dinner | $10–20 I came into &Pizza today for lunch and the the staffAndre and Terrace was very helpful polite service was great clean environment fast service I was surprise to see no line so the pizza came out quick and I was able to enjoy it and get … More 1 &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We're thrilled to hear that Andre and Terrace provided helpful and polite service, and that you enjoyed a quick and delicious lunch. Your response is important to us as we strive to improve our services. We appreciate your kind words and hope to see you again soon! Roberts Brian 1 review a year ago I went through this pizza shop last night the service was amazing they were really on point, making sure the customers got everything they needed and more this will definitely be my go to pizza place yours truly Mr.Roberts.. James Drosin 2 reviews 9 months ago Dine in Luis the Manager gave me the best guest experience! Food was amazing definitely recommend. S/O to them! I will definitely be back! Heather Dorsey Local Guide·130 reviews·393 photos 4 years ago The American honey pizza is really good. And the cereal milk soda tastes exactly like cereal milk. So. Service with a snarl. Photo 1 in review by Heather Dorsey &pizza - Dupont (Owner) 4 years ago Thanks for the review Heather! :) Kate Farrell Stanford 4 reviews·2 photos 11 months ago When I walked in, no one was in there and it smelled terrible, as if the floor had been mopped with dirty toilet water. We couldn't imagine staying in there long enough to order, let alone eat. … More 2 &pizza - Dupont (Owner) 11 months ago We apologize that our service did not satisfy your expectations. We set a high standard for ourselves and are truly sorry to hear that standard was not met in your interaction with our business. Your happiness is our number one priority. We well take your feedback into consideration. Jason Miller Local Guide·401 reviews·14 photos 2 years ago Take out | Lunch | $30–50 I love &pizza and usually get awesome service however, this visit to this location was lagging. The 2 staff were seemingly working against each other and they burnt mine and my other 2 family members pizzas. I … More Michael Green Local Guide·113 reviews·665 photos a year ago Dine in | Dinner | $10–20 Flat bread pizza made your way. Staff was fun and engaging. Food was great and was more than enough. Large enough to share but on a hungry day good enough to keep it for yourself. … More Nadia M 8 reviews·4 photos a year ago Normally I’m a huge fan of &Pizza, but this location is so severely understaffed during rush hours that it has proven actually impossible to get the pizzas we ordered. The &pizza website said our order would be ready within 15-20 minutes, … More 1 Chandrell Christopher 7 reviews·3 photos 2 years ago Service was great! Really nice employees, loved syncere and lavell were amazing! Photo 1 in review by Chandrell Christopher Jlyne B Local Guide·63 reviews·14 photos 4 years ago Got a gluten free American honey and oh my goodness I wish there was one closer to where I live. Incredible tasting food and the soda was really good as well. I gave it four because a few of the toppings didn't look very fresh (wilted … More 1 &pizza - Dupont (Owner) 4 years ago Thanks for the review! :) Jamon Pulliam 2 reviews 2 years ago This location is hands down the best! I was visiting from Los Angeles and the service here was impeccable! And don’t get me started on the pizza! They took their time and put nothing but ingredients and love in that one. Would definitely recommend Dean Albrecht 3 reviews a year ago Take out | Dinner | $10–20 Excellent food with great service. Andre helped me make the right choice. Would recommend to anyone who’s in DC and wants something quick to eat. 1 Esse Darden Local Guide·287 reviews·551 photos 2 years ago Take out | Dinner | $10–20 Ordered the Manhattan, while waiting for my personalized order being made - which I received after noticing a distinctive stinginess with every topping that was applied before it was put in the oven, an excessive prolonged period of time; … More 1 &pizza - Dupont (Owner) 2 years ago Thank you for taking the time to share your feedback. We set a high standard for ourselves, and we’re so sorry to hear that this was not displayed during your visit at our location. Your feedback is important to us and we’ll make sure to make the proper adjustments for next time. I’m also going to send this feedback to the shop and district leader to address with the team there because this isn’t what we want our guests to experience at all. We hope that your next visit with us is nothing like what you experienced recently! Scott C Local Guide·33 reviews·9 photos 3 years ago Great pizza and garlic knots! Not your typical style but still quite special and worth trying...over and over again! The dough and toppings are always on point! I also appreciated their program to help frontline workers. Highly highly recommended! 1 &pizza - Dupont (Owner) 3 years ago Thanks for the review Scott! We had to try something different this time. We hope you enjoyed it though! Sean Local Guide·61 reviews·42 photos 2 years ago Take out | Dinner | $30–50 We got delivery. Late night. Pizzas were not good. Got It for a party and we all laughed at how bad it was, and how small they were in the box. (And they forgot one of our items.) all that and only a 1.5 hour wait. Haha. Only reason for the extra star (instead of just 1) was the cookies were really good! … More 1 Kiran Singh Local Guide·70 reviews·66 photos 4 years ago The pizza here is so delicious! The crust is flavorful and tasty and the tomato sauce is so deliciously tangy. I was really blown away by the quality & taste of the pizza! Their ingredients taste fresh and you can add as many toppings as … More &pizza - Dupont (Owner) 4 years ago Thank you so much!🖤🍕🖤 Michael Cupertino Local Guide·106 reviews·163 photos 4 years ago I don't know if it was an ""off day"" here, but service was so slow we had to leave. There were 3 people in front of us and we waited 20 minutes before we left. The employee was more concerned about cutting a 1/4 of an inch of crust off of … More Jessica Peters 12 reviews·6 photos 5 years ago The pizza at & pizza is great. That’s why I have been coming back for years. However beware of the customer service. Recently at the DuPont location, I enjoyed a great pizza and needed to use the restroom. When I asked an employee who was … More 2 Alok Sinha Local Guide·58 reviews a year ago Stopped by here and this is a great place for pizza. I ordered the new G and added some spicy honey and it was delicious. Would definitely recommend stopping by here if you have a chance. &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We're thrilled to hear that you enjoyed the new G pizza with added spicy honey. Your response is important to us as we strive to improve our services. We appreciate your recommendation and look forward to serving you again soon! S G Local Guide·12 reviews a year ago Amazing pizza and unique experience. Build your own pizza to a new level. Fresh toppings and an amazing taste. The place is small but the tastw is huge. Loved the food and the service. A definite must. Claire Mizutani Local Guide·54 reviews·374 photos a year ago Take out I got four pizzas to take back to my family:The Maverick, CBR, Billie, and Kalamata Harris. Two of them were on gluten-free crust. Ordering was pretty hectic because there were many young people coming to eat between going to different bars … More 2 Wanda Murphy 33 reviews 2 years ago This was the worst pizza I have ever purchased from & Pizza. The person in front of me, ordered four pizzas. They should have removed my pizza promptly. Instead, the crust is burnt, the spinach dry and the other vegetables dried out. … More &pizza - Dupont (Owner) 2 years ago Terribly sorry to hear about your experience Wanda! We have reported this information to our senior management to resolve and to take the proper measure for quality control. You can send us an additional message at 200-03 or send us an email at digitalshop@andpizza.com. Thank you again for bringing this to our attention. Robyn J Local Guide·54 reviews 5 years ago Absolutely the best pizza I have every eaten. The bread was amazingly light and doughy. I didn't have the disgustingly full feeling after eating an entire pizza. The toppings were fresh and delicious and unlimited. Love the healthy choices and sauce variety. 1 &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We're thrilled to hear that you enjoyed our pizza, especially the light and doughy crust and fresh, unlimited toppings. We're glad you appreciate our healthy choices and sauce variety. Your response is important to us as we strive to improve our services. A G 10 reviews a year ago I’m literally in this place as of 06/06/22 and it just took me a whole hour to get a pizza which is ridiculous! Low staff and no sense if urgency. Felt bad for the employee up front who seemed suer overwhelmed, pizza is good usually but won’t be back at this location. &pizza - Dupont (Owner) a year ago Hey Andy! Thanks for you review. We are sorry to hear that we did not provide the best experience! Please reach out to us at 200-03 so we can make this right. 🍕 Timur Plavan Local Guide·97 reviews·278 photos a year ago Dine in | $20–30 The most inefficient &pizza I've ever tried in my life. Ordered online, came 30 mins later and waited for another 50 minutes. Order was missing things in both pizzas. &pizza is great but I would avoid this location. … More Natalia Diaz Torres 1 review·1 photo 2 years ago If I could give 0 stars, I would. This review is based on an UberEats order. I ordered 4 pizzas and an order of … More Photo 1 in review by Natalia Diaz Torres Rishi M Local Guide·9 reviews·22 photos 2 years ago Visited late September 2021 for an online pickup order. Waited 2 hours for my order. … More 1 Michel Louis Local Guide·16 reviews·2 photos 2 years ago Take out | Dinner | $10–20 One of the best pizza I ever tried Photo 1 in review by Michel Louis Rachel Wortmann Local Guide·61 reviews·173 photos 2 years ago Ordered online and waited 45 min for my pizza. App had said it would take 10 min so was quite frustrating … More Kristen Eggleston Local Guide·50 reviews·8 photos 4 years ago The pizza is great but the service here could be a bit better. I went at a time where it wasn't busy at all. The woman who made my order was friendly and helpful and while my order was cooking, I sat at a table nearby. The woman who was at … More Jéssica Bittencourt 1 review·1 photo 2 years ago Lavelle great service, thank you! Photo 1 in review by Jéssica Bittencourt 1 Matt Ramey 3 reviews 11 months ago Dine in | Dinner | $1–10 We went in to have wholesome family dinner experience but quickly exited upon my initial smell test which returned a result consisting of bathroom juices/putrid garbage. 2 Matthew Cantisani 2 reviews a year ago Dine in | Dinner | $10–20 Excellent service!! Food was delicious and made quickly. I will definitely come back to this &pizza location! De Wheeler-Chopan 10 reviews 7 months ago Worst experience ever! Pizza wasn't ready to order. The servers states they didn't care that we waited! … More Stefan Hovy 5 reviews 6 years ago Incredible! Was in DC for a long weekend and ended up going to &pizza 3 times! Twice at this location where the staff and manager were very friendly and open for a chat. Not to mention the delicious pizza with equally delicious vegan options. Would recommend this to anyone visiting DC! 1 Joey Norris 4 reviews a year ago Take out | Dinner | $10–20 Andre was such a great help and made sure to treat us right with amazing pizza. Appreciate the amazing service and will gladly go again. S. T. Grandy 19 reviews·6 photos 4 years ago The pizza is good but I was a bit disappointed to see that the employee who made my pizza only put a racing stripe of sauce right down the middle of the dough. Literally a line down...not spread at all. Also, they may need to turn the ovens … More 1 Monte' Kent 2 reviews a year ago Andre at &pizza DuPont south was amazing.. helped me with my gift card at this location. He service and attention to detail was great. Must go location. Thanks Andre! Sameer Singhal Local Guide·41 reviews·8 photos 7 years ago Great at any time of day. This is a unique pizza experience, and I love the fact that you can customize your pizza to your liking for one flat price. Definitely a place to try, and you'll most likely want to keep coming back Cecilia Demoski 1 review 11 months ago Take out | Dinner | $10–20 This is a great place to grab some great pizza! Amazing service and good quality pizza. Miracle Parish Local Guide·75 reviews·6 photos a year ago I will be filing a police report against the fair skinned man with dreads. He put his hands on me multiple times when I was trying to exit the building. The entire line saw it and they were appalled. I was trying to get to my Uber and he … More Ali A Local Guide·691 reviews·435 photos 4 years ago Delicious, but higher prices than their quality. Crowded around noon time, my experience of course. Employees are ok, but they can be much better. … More Brie Morgan 5 reviews 2 years ago I been coming to this pizza spot for a few months and their always respectful and clean They have awesome pizza and the best customer service the manager always takes care of me and makes sure my pizza is hot and ready to go no complaints will continue to send friends and family India Marshall 28 reviews 2 years ago Employees are nice but mangers need to do a better job with organizing during rush hour. Bathrooms are never available for customers. This has been the case for over 5 years. Luis Miron 3 reviews 11 months ago Dine in | Dinner | $10–20 Amazing service by Andre! and delicious pizza. Definitely the place to eat before a night out of drinking. Breanna Duff 9 reviews·1 photo a year ago the security card told me I could not sit down even though I have a disability. There is no rule to this. He was being very rude for no reason. 1 Katie Kennedy 21 reviews 6 years ago The service was terrible here. We were there for the first time and clearly confused but rather than offering help to us, the staff ignored us. They offered no help when we had questions about some dietary restrictions either. And you can't … More 2 Evan Farrara 12 reviews·1 photo 7 years ago Incredibly loud inside to the point that the employees couldn't hear me correctly when ordering. As a result, when asked if I wanted spicy or non-spicy sauce, I replied ""non-spicy"" and got spicy anyways. That being said, it ended up being … More Mohammed Yahia Local Guide·384 reviews·1524 photos 5 years ago &pizza is a good, simple pizza place. They don't have many choices, just pizzas, but they are awesome. They have a few set pizzas you can order or a make-your-own-pizza option. They also have the option for gluten-free dough which is $3 … More 1 Jobina Beale 3 reviews a year ago Went in there today for lunch and Tay was awesome. Amazing, courteous and good customer service. I walk from Farragut West Metro to get my pizza all because of him. Gideon Tong Local Guide·155 reviews·233 photos 4 years ago Great pizza! Fast service, would go again. As someone from the west coast we also have build your own pizza places like Pieology and Blaze Pizza but this style of ""shoebox pizza"" is pretty unique and you can definitely eat a whole pizza on your own even if you don't usually eat that much. &pizza - Dupont (Owner) 4 years ago Great to hear. Thanks! Sara R. Local Guide·144 reviews·305 photos a year ago Dine in | Dinner | $10–20 Vegan-friendly, they even gave vegan pizza. I would like to see more filling vegan toppings options like some Beyond Meat or something. The service was quick and friendly. … More 1 cy mcfadgion 3 reviews 3 months ago Quan, cam and bre were amazing … More &pizza - Dupont (Owner) a month ago Thank you for your 5-star rating! We're thrilled to hear that Quan, Cam, and Bre provided amazing service. Your response is important to us as we strive to improve our services. We look forward to serving you again soon! Khaleel Johns-Watts 58 reviews 10 months ago Best late night dc spot call ahead after 3am if ur with a group and just order all the pizza Emma C Local Guide·83 reviews·85 photos 5 years ago Of all the made-to-order personalized pizza places out there, &pizza has my heart. They offer several delicious dough options including gluten free. All of the toppings are very high quality (get the meatballs!!). After topping, they put it … More 2 A “2Freckles” Oz Local Guide·15 reviews·2 photos 5 years ago I really liked this place, however my second experience here was not like my first. Took me 30 mins to get my order. The cashier was very stressed maybe it was his first day on the job because he did not know how to run the register. The … More Ada Rebecca Smith Local Guide·447 reviews·165 photos a year ago Dine in | Dinner | $10–20 The service was not great, the guy making the pizzas was very slow and wasn't able to find items that should have been easily located(the spinach was empty, he took several minutes looking for it and they were out of spinach). … More Ian Winbrock Local Guide·131 reviews·14 photos 7 years ago I love &pizza. I'm from the West Coast and we have ""cook as you wait"" pizza places, but nothing on the same level as &pizza. This place is superb. Always greeted by some friendly folks behind the counter and then I either complete one of … More Bill Hipsher Local Guide·41 reviews·987 photos 7 years ago Staff was very nice and pizza we got as ordered was great. The fountain machine was broken so your drink options were limited to can/bottle options for tea/lemonade that they had in a fridge. Ordered a Hawaiian style pizza that was supposed … More 1 Scott Dwyer 12 reviews·1 photo a year ago Great place to get a bite when you out drinking in depot circle. The pizza is awesome, and the prices are better than at the bar. … More Justin Andersen Local Guide·15 reviews a year ago Take out This was the most frustrating experience I've ever been in. Our take out order was over an hour late. And that's the least frustrating part of the night... I don't know if I have the energy to explain everything. Andrea M Local Guide·69 reviews·46 photos a year ago They gave me the wrong pizza. I texted customer service and they said they needed a picture in order to issue a refund. I told them my camera was broken and was not able to take a picture. They told me I couldn't get a full refund without a photograph but they could offer me $5 for a new pizza. Josh Higham Local Guide·148 reviews·84 photos 6 years ago Co-workers had talked this place up, but I found it only decent. I definitely enjoyed the unique soda fountain more than the pizza. Great variety of unique flavors. Pizza was fine but unremarkable. Ariel Holmes 2 reviews 4 years ago James and Deon made my night. I would have been left hungry if it was for the girl up front. But thank you 2 for the lovely service much appreciated. I will remember it & I will be back (during opening hours) thanks again! &pizza - Dupont (Owner) 4 years ago Glad to hear our team solidified your evening (and future visits) with great service. We will be sure share with both James and Deon your kind words! Thanks for stopping by, Ariel! Leanne Quinn 1 review·1 photo 2 years ago Great service and fantastic pizza! Photo 1 in review by Leanne Quinn &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We are thrilled to hear that you enjoyed our fantastic pizza and great service. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Tracey N Local Guide·87 reviews·70 photos 5 years ago Pizza would have been better if it was warmer, but their service was shorthanded..... they had one person taking out the pizza from the oven, boxing it, putting on the finishing garnishes AND ringing up the customers...... that's too … More Theresa Kemp 5 reviews a year ago Dine in | Dinner | $1–10 Andre was fantastic! He served our party fresh, hot, pizza. Thank you for the great customer service. Diana Martinez 3 reviews·2 photos 2 years ago I work nearby and I appreciate that my orders are always done right away and I can quickly just pick up. Great customer service. Very strict on covid regulations. Key 2 reviews 2 years ago Customer service was excellent upon arrival. Store was clean and needs were met in a timely fashion. Very friendly and patient staff. 5 Stars to Terence!! Greg Smith 14 reviews·2 photos 10 months ago Delivery | Lunch | $10–20 Did carry out. Pizza was good, but not great. Strange beverage options … More Bali Adawal Local Guide·203 reviews·1637 photos 4 years ago I have always liked the concept of a highly customized pizza and the overall product turns out to be quite appealing. … More 2 Aleks Nekrasov 91 reviews·67 photos 11 months ago As far as GOOD pizza goes, this place completed my order in 8 minutes. &pizza - Dupont (Owner) 11 months ago Thanks for the awesome review! Hope to see you soon. Gnelossi Hamadou Local Guide·6 reviews·7 photos a year ago Visited this place yesterday for my first time , just wanna say thank you for the entire team that work yesterday night. They were patient and friendly specially the manager Andre Cecilia Local Guide·80 reviews·2 photos 5 years ago We had a pleasant experience at a different branch of &pizza so we tried this branch. This branch was stingy on the toppings and the dining area was not wiped down after customers have eaten there. All 3 of us felt queasy after eating here... Josh Eid-Ries 10 reviews·3 photos 6 years ago Delish, super affordable and very easy to customize your order with no upcharges. The staff are a delight and the food is superb. The drink offerings are also wonderful. I'd recommend the 11 grain crust(ask for it) the mango passion fruit soda and root beer. Vegan cheese and veggie based protein options were a lovely bonus! Pradipto Banerjee Local Guide·29 reviews·96 photos 7 years ago Their pizzas are the best value for money. Unlimited toppings on a big flat bread for just $10. And they're open till 4 am, which is great when you're leaving the bars at 2 and want to get some food. NAI- NAI 3 reviews 2 years ago Dupont is awesome. The place is clean and the pizza is great! One of the workers Decostia provided excellent customer service! I definitely recommend this store! Jaqueline Veltri 2 reviews 4 years ago The pizza here is delicious but it is the second time in a row that I find a long black hair in my pizza. It’s so frustrating and disgusting! I hope management finds a way to keep the employees hair out of the food. F.A. B Local Guide·39 reviews·15 photos 4 years ago James was an amazing manager. My card wasn't working for some reason and he still made my pizza and gave it to me for free. Absolutely amazing customer service! Thank you James! &pizza - Dupont (Owner) 4 years ago Hey there! Thanks so much for the love. We always appreciate our loyal fans. Sunil Singh Local Guide·183 reviews·134 photos 5 years ago &Pizza is something like Blaze Pizza. You pick your dough, then the sauces, and then all your toppings. It's unlimited sauces, and unlimited toppings. And after the pizza is baked, you can add any other sauces, or other toppings. And … More breathemusic94 2 reviews a year ago I love coming to this &pizza, Tay is always a welcome face at this establishment, he is extremely helpful and all around fun to talk to. The food is always amazing here. Crystal 1 review·1 photo 2 years ago &pizza Great good and atmosphere, staff was friendly Photo 1 in review by Crystal Thomas Scheurich Local Guide·33 reviews·1 photo 6 years ago I really like the new fast casual trend. Others may complain about it, but it matches my lifestyle and sets a good middle ground on price. &pizza is the best example of fast casual in this region. Really awesome and ultra customizable food … More Oliver Borg 11 reviews a year ago Andre was super helpful! Fantastic late night spot, quick service, friendly staff, and good food. What more could you want. Dale L. Roberts Local Guide·52 reviews·118 photos 6 years ago This is the second &pizza I've gone to today and wow! This place is even better. There's more seating and it's not even busy. Well worth it! And the staff was friendly and attentive. 5+ stars Nibha Rastogi 7 reviews·2 photos 5 years ago ordered a craft your own... SO GOOD!!! The tribe were super courteous and I got what I wanted. Got a traditional with mushrooms, spicy Italian sausage, onions, pesto finish. Jordi Segura Local Guide·115 reviews·366 photos 7 years ago We ate in this pizza shop during our trip to Washington, and we found the pizza and drinks tasty and original. You can make your own pizza or order one of the existing recipes. I would recommend it for take out or a quick bite. Brandon Boone Local Guide·377 reviews·1050 photos 4 years ago Quick and delicious lunch, very filling and I'm a big guy. Definitely mix it up don't settle for cheese and pepperoni... Never thought I'd have honey on a pizza. &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We're thrilled to hear that you enjoyed our unique pizza options. Your response is important to us as we strive to improve our services. We hope to serve you again soon with more delicious and filling options! ROBIN THOMPSON Local Guide·94 reviews·221 photos 6 years ago I love this place! They have a great pizza selection . I love their specialty sodas. Try the cream soda. There is a wait though due to their being only one person to ring up your order and box your pizza. T Williams 9 reviews 4 years ago Best way to order a to go pizza is on their website. After a long day of sightseeing, a couple of their ""oblong"" pizzas was just right. Thin crust was great, toppings good. Prepared quickly. &pizza - Dupont (Owner) 4 years ago Thanks for the review and for stopping by, T! Ashley Craft 4 reviews 2 years ago I love The Dupont Team everyone is so nice Tay always goes above and beyond for the customers amazing customer service!! DuPont Team keep up the great work!! Jelani Phipps 8 reviews 2 years ago Food is so delicious. The manager Delonta gave me supervisor service. I would definitely go back again. You won't be disappointed!!! Nely Hernández 2 reviews·1 photo 10 months ago Love this late location . Super busy They are still very patient with customers. Lance Porciuncula 1 review 2 years ago The workers there are super friendly and nice. The service was also pretty great. Got my pizza with little wait. Ismail Gomaa Local Guide·364 reviews·1240 photos 7 years ago Some of the best pizza I've ever had. Any combination worked because their ingredients are absolutely perfect. I enjoyed everything I've tried there, even the stuff I don't usually like. Sarah Semlear Local Guide·154 reviews·1292 photos 5 years ago The gluten free crust is pretty good! It's not a completely gf environment so they can't guarantee there is no cross contamination, but they are careful and change gloves when handling the gf crust. The options are fun and there is a good amount of toping choices for build your own. 1 &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We understand the importance of providing a safe environment for our gluten-free customers and we're glad to hear that you appreciated our efforts. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Michael williamson 9 reviews a year ago Take out | Lunch | $10–20 Pizzas are not that good and one of the workers not that friendly pizza crust had sir burnt from dirty oven … More Jennifer Telfort 4 reviews 2 years ago The service is great! Thank you so much for making my pizza just the way I like it!! I will be back again!!! Hailey Gruch 7 reviews a year ago Take out Wonderful experience... it was busy but they made me feel at ease... wonderful service... thanks to Quan, Malik, Justin and faith William Minter Local Guide·85 reviews·79 photos 7 years ago Thin crunchy crust that isn't overcooked. Awesome fresh toppings and sauce. Perfect for lunch or later night special. Not the best place to sit and eat as space is limited inside(20-25 at best) Cameron Asgharpour 1 review 2 years ago Great customer service and staff is very attentive. Pizza was awesome LadyLewis 2u Local Guide·17 reviews·15 photos 5 years ago &pizza is my fav pizza, but unfortunately, I experienced the WORST, not just customer service, but attitudes EVER! When I asked for assistance, I was only given the 202 number they have taped on the glass display. It was weird bc 2 … More Angel Aguiluz 1 review a year ago Tay is a hell of a entrepreneur! A lovely lad, Marcia also made an astonishing pizza with Nikko. 10/10 if you’re near Faragut North Rakia Pinkney 3 reviews 2 years ago The staff are very friendly and the food came out great and in a timely manner. I will be back, this is the best &pizza location! Dante Gardner 1 review 2 years ago I had an amazing experience. Antonio, and Roshan were very accommodating to my child who is particular about his pizza topping’s . 1 Scott Jason Local Guide·38 reviews·46 photos 4 years ago Thin crust pizza was very tasty and filling. I had red sauce with fresh mozzarella, tomatoes and onions. They do have a gluten free crust for $3 extra. 1 Chris Morris Local Guide·49 reviews·25 photos 4 years ago Pizza was way better than expected. Really nice staff. They were able to get people in and out quickly. I will definitely be returning. 1 &pizza - Dupont (Owner) 4 years ago Thanks for the review :) Raynell Jackson 26 reviews·26 photos 4 years ago I pizza and staff are wonderful Photo 1 in review by Raynell Jackson Photo 2 in review by Raynell Jackson Killian Devitt Local Guide·128 reviews·541 photos 8 years ago What's not to like about this place? It's just great, simple pizza. Tried the Maverick the first time I went and I haven't ordered anything else since. Perfect for lunch if you can avoid the rush. &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We're thrilled to hear that you enjoyed our Maverick pizza and that it's become your go-to choice. We appreciate your support and hope to serve you again soon. Your response is important to us as we strive to improve our services. taliyah hughes 4 reviews 2 years ago Great customer service, quick service! FOOD IS AMAZING! My favorite spot to come after a drunk night 🤪. Highly recommended Mo Love 38 reviews 3 years ago I went in there for the first time a couple of weeks ago. The restaurant had a really foul odor and I could smell it through my mask. Although, I ordered a pizza online and picked it up, I did not eat it and I will never go back to that pizzeria. 1 &pizza - Dupont (Owner) 3 years ago Thank you for taking the time to share your feedback Mo. Our management team will be looking into the odor that you are referring to for the Dupont location. I'm sorry to hear that the experience did not meet your expectations and I would like to apologize for this. Chris Oliver Local Guide·17 reviews·1 photo 8 years ago Great customisable pizza in a relaxed atmosphere. Their home made cola is to die for and so much tastier than coke or Pepsi. Only criticism is that the music was way too loud. Amanda Neilson 6 reviews 2 years ago Great experience! We had a large group and they were fast and efficient. Love the pizza! Breasia Lawson 5 reviews·1 photo 2 years ago Labella made my pizza so good and had the best costumer service ever, he was very bubbly and pleasant and Met all of my demands because I’m a very picky eater lol he’s the best Adriana Lopez 5 reviews 11 months ago Great service! Everything was on point! Andrew was very attentive and polite! Thank you 😃 Merlin Tondji 2 reviews 2 years ago This place is great . Unfortunately last night we couldn't custom the pizza however the team still amazing Briana McKellery 9 reviews·5 photos 2 years ago Beat servers best pizzas and my fav location but all are great. Definitely suggest stopping here for a late night craving after a night out! Tiffany Dendy 3 reviews a year ago Dine in | Dinner | $20–30 Wave and Twan provided excellent customer service on my visit. Gloves were changed prior to assisting us Thanks guys ! Micheal Stone 2 reviews 2 years ago Team was friendly with great service. Pizza came out great! Will continue to come back Forrice Brunson 1 review a year ago Courteous and professional staff members. My order was completed without issues. It was fresh, hot, and the toppings were 🤌🏽. Saee’Rozay 1 review a year ago Take out | Dinner | $10–20 First Time At &Pizza . Great Service By Andre ! Respectful & Kind . Will Definitely Be Back Especially At This Location Medachi 509 16 reviews 4 years ago This is the worst & pizza that I’ve ever been they don’t change their gloves. They got nasty attitude they should reconsider on hiring people there. If I’m paying $11 for pizza I should be treated with respect the customer service is terrible I can’t even tell them how I want my pizza to get done. 1 &pizza - Dupont (Owner) 4 years ago Hi Questa, thanks for the feedback. We'll be sure to address this promptly with the shop. Angel Angelov Local Guide·159 reviews·920 photos 4 years ago A bit dodgy place but pizza was perfect. They offer you to choose from anything you want to add to it and can make it as you like. Was really delicious. Not beer or any liquor though 1 Nataliya Kostiw 2 reviews a year ago Alonzo was amazing, he helped us with everything and was very polite and informative! Would definitely recommend! Simply, Tasha. Local Guide·130 reviews·244 photos 5 years ago Idk what the rating I'm assuming it must be great for I'm too drunk to realize food but let me tell you...today I walked in and walked out....the stench was crazy...it smelled like a dirty barn...or zoo...sewage...idk but I couldn't even order to go and I was just dissappointed... it is a super rainy day today.... 2 Kylie Gilbert Local Guide·19 reviews 7 years ago Could eat this every day for the rest of my life. Not a lot of seating inside though. Also check out ordering ahead, it's much faster. The sodas are good too! Josh Robichaud Local Guide·93 reviews·123 photos 8 years ago Great custom pizza at a reasonable price. Either the preset menu or build your own, can't go wrong. Plenty of seating and fast service. Andrew Isett Local Guide·185 reviews·230 photos 7 years ago Good pizza custom made the way you like. Similar to Chipotle with a burrito, &pizza allows for any toppings they have and different sauces. Always some left over too!! Ethan Granetz 3 reviews a year ago Take out | Dinner | $10–20 Andre got us food real late. He made an awesome pizza. 10/10 service J 4 Local Guide·131 reviews·64 photos 7 years ago Oh yes lawd. This pizza is so good and u dictate the toppings. Yum. Decent price for DC and a food serving size. Not glutinous but more than sufficient. Arely Castro 1 review 2 years ago Amazing service ! & the pizza was so delicious that I will come back again! Jimmy DeVault 15 reviews·1 photo 5 years ago Great food, concept and atmosphere. First time at this location and this may just be this location but service was super slow! The team here also seemed very disorganized, there was no designated cashier which caused a bottleneck at the register where everyone just stood. Maybe they were short staffed? 1 Destiny Cruz 3 reviews 2 years ago GREAT service! And even better pizza! This is my regular location Bc they never disappoint 😉 Punky Banks 1 review 4 years ago I had a great experience. Our cashier Diamond was kind, courteous, and offered great recommendations. I’ll be back soon. Overall great food and great service! &pizza - Dupont (Owner) 4 years ago Thank you so much for the great review Punky! We look forward to seeing you agin soon. Kevin S 3 reviews 2 years ago This is specifically for the website ordering experience. I typically pick up but I needed delivery and my nearby &pizza store was temporarily closed. The problem is that it is impossible to switch the store you're getting delivery from, or … More 1 &pizza - Dupont (Owner) 2 years ago Thank you for your feedback Kevin! I'm sorry to hear that this was your experience trying to order online. We'll flag this information over to our development team to fix. Najm Aldin 9 reviews 9 months ago Luis is very professional and he took care of me. Very nice guy Samantha Zarrilli Local Guide·25 reviews·2 photos 2 years ago Amazing service! So great. Lavelle went above and beyond to make us feel welcome. Promote him!! . Jeremy R. Stinson Local Guide·178 reviews·293 photos 4 years ago &Pizza is one of my favorite pizza joints in DC. Not all locations are created equal, but this particular location is always clean, the staff is friendly and helpful, and I never have to wait too long. &pizza - Dupont (Owner) 4 years ago Hey, Jeremy. Thanks so much for review! руня 11 reviews 7 years ago Great vegan options, (they have mozzarella daiya and veg meat crumbles)! Lots of fresh veggies, good unique gourmet choices of sauce too. The pesto is delicious. The price is reasonable for a vegan pizza, compared to zpizza which recently … More 1 Fabian Meneses 5 reviews a year ago Staying at a hotel close by this place has been our stop daily! From the friendly staff to the delicious food, you have to try this pizza! Mouhamadou Thioune 4 reviews a year ago I like eating at &pizza Dupont. The pizza is always on point. The place is always clean and Tay always provides good customer service. Reilly Sheehy 1 review a year ago They were so lovely - they gave me free water when my friend and I needed it most. 10/10 Ryan Norton 7 reviews 7 years ago I tried calling multiple times to have a question about their menu answered. Each time it automatically goes to a recording and it gives you the option to press ""2"" to speak to an employee. However when you choose that option the phone … More Geneva Kropper 4 reviews 4 years ago The pizza here is fine, but the staff is very rude and will let you stand at the counter without asking how they can help you. Very poor standard of hospitality and out of place in DC. nate porter 2 reviews a year ago Tay is the best. I love the customer service. He should be promoted. Nikko & Marciara are amazing and should also be promoted!! Isaiah Benjamin 3 reviews 2 years ago I always have a great experience, I work in the area the workers are always fantastic to chat with. Food is always delicious, my go to spot for lunch. Angelica Martinez Local Guide·54 reviews·115 photos 4 years ago Stopped by this place when in the area. Design your own pizza from scratch, and then customize it. The staff assemble your pizza as you watch ... you get to decide everything which goes on the pizza as you follow it down the line. We … More 1 Ariana Brown 3 reviews 2 years ago Very professional clean and made my pizza in a timely manner. Staff was perfect Levon Akopian 8 reviews a year ago Dine in | Other | $10–20 It was amazing and tasty Perfect pizzas, friendly crew … More Jamie Sneed 1 review 2 years ago Outstanding place, great service, Terrence was a huge help and help me build the perfect pizza for my first time!! Teezy Teez 2 reviews a year ago The establishment was amazing, Tay was very kind and ensured we were okay during our time at the restaurant. &pizza - Dupont (Owner) 2 months ago We're thrilled to hear that you had an amazing experience at our restaurant and that Tay took great care of you. Your response is important to us as we strive to improve our services. Thank you for the 5-star rating! We hope to welcome you back soon. kiara cooper 1 review 2 years ago I experience the best customer service with an employee name Lavelle! Definitely would recommend. The pizza was amazing !! Lisa Smith 5 reviews 2 years ago They have an excellent menu selection and you can add anything else you desire... or you can build your pizza from scratch... all at one reasonable price! Delightfully Delicious 👍 2 &pizza - Dupont (Owner) 4 years ago Thanks for the review! :) M A Local Guide·31 reviews·16 photos a year ago The vegan mozzarella and vegan sausage are amazing. To &pizza: please bring back the vegan chicken. Chris Anderson Local Guide·36 reviews·182 photos a year ago Not extremely friendly but excellent excellent pizza. The dough is the best part. 1 Sachin Bhattiprolu 2 reviews a year ago They take orders beyond 10pm but you cannot eat there because they close at 10pm. People here were incredibly rude and forcibly removed chairs WHILE 10+ people were trying to sit and eat. Incredibly rude place. Blue Moon 4 reviews 7 years ago literally the best pizza i've ever eaten. i had the vegan options. they were incredible.staff was really nice. would recommend to everyone. It’s Me Local Guide·381 reviews·169 photos 7 years ago As usual, friendly staff. First time at Dupont location, but just as good as the H St one. … More &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We regret that we no longer offer San Pellegrino and apologize for any inconvenience caused. Your response is important to us as we strive to improve our services. We appreciate your feedback and hope to see you again soon! Quennitta Winzor 1 review 2 years ago The manager is wonderful and fast. But I feel like they were catering to the white people. I almost felt invisible. Darlene Craft 4 reviews 2 years ago I love coming here the manager Tay always knows exactly what the customer service at DuPont is beyond amazing :) Sinceree Stewart 2 reviews·1 photo 2 years ago Great customer service and very patient. Photo 1 in review by Sinceree Stewart lizzle thrvxxx 2 reviews a year ago Andre was very helpful I been goin here for about and year and the customer service is great 10/10 Jas 3 reviews 2 years ago Best pizza I’ve ever had and the workers are the nicest people ever!!!! Come here for a quick bite! &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We're thrilled to hear that you enjoyed our pizza and had a great experience with our staff. Your response is important to us as we strive to improve our services. We hope to see you again soon for another quick bite! Jalen Dixon 1 review a year ago Great service and very reasonable prices! The pizza is also prepared very quickly! Candice Mulholland 4 reviews 2 years ago Terence was awesome! They are always quick and so friendly when I’m in there. 10/10 on the pizza too 😊 Tim Larkin Local Guide·72 reviews·226 photos 5 years ago Damn, this is good pizza Photo 1 in review by Tim Larkin Ron Hagage Local Guide·87 reviews·83 photos 5 years ago Subpar and overpriced pizza place. Compared to u street pizza joints, this place is trendy, hipster and serves mediocre pizza at best. … More 1 Dj Teck Entertainment 1 review 2 years ago Quick and easy. Best pizza I’ve every had. Especially after the club. Will be back Adam Christensen Local Guide·71 reviews·326 photos 8 months ago No way to reach the store and UberEats never delivered my food. … More Erika R. Local Guide·50 reviews·18 photos 5 years ago Reminds me if Blaze. Make your own pizza and craft soda, but some of those toppings should. DEFINITELY go on the pizza as it's being cooked not at the end. Beyond the Clubhouse 1 review a year ago The staff here did a great job, very attentive and engaging. Especially Antonio. A wonferful customer experience! Ryan Local Guide·12 reviews 2 years ago Take out | Dinner | $10–20 Made a mistake when placing my order online and Antonio was awesome helping me get it corrected quickly and courteously. Will Return! … More Alfredo Schonborn 3 reviews a year ago Dine in | Dinner | $10–20 This place was a fantastic establishment to eat with quality food. A recommendation to everyone Ryan Dudrow 1 review 2 years ago Great service for an amazing price for a whole pizza awesome employees 10/10 would recommend Briana Jones 1 review 2 years ago I go to this location all the time! Great customer service and the pizza is always perfect! Haylee Smith 1 review a year ago Awesome pizza & employees. Has original drinks that all taste good! Justin Adams 8 reviews 4 years ago 1st time here. The food was great and the price was right. No complaints. Wish I had found this place sooner. Trip Taker 117 reviews·58 photos 2 years ago I'd like to give it a .5 star. Says that it's open but door is locked, lights are on and you can see employees inside working. Stephen Oliver Local Guide·13 reviews·17 photos 6 years ago Greeted by smells of rancid food or trash when entering. Smell intensifies as you walk further in. Trash everywhere and dirty tables. Bathrooms out of order. … More William Nelson 2 reviews 2 years ago great location! everyone here had great service and the pizza was good! 🙌🏽 Clementina Fernandez Valle 4 reviews·7 photos 2 years ago Great service and really quick. The pizza was delicious and the place is really nice. Jade Boone 2 reviews 2 years ago Staff was very friendly and efficient with taking customers orders in a timely manner! Will definitely visit again Quita11 2 reviews a year ago Terrence was awesome!!! He answered any question I had and did it with a great sense of humor. Marcus Smith Local Guide·115 reviews·5 photos 3 years ago The staff was polite, and efficient this staff is prepared for lunch rush, I even got a bottle of water Since I do a lot of delivery work, I really appreciate these things. 1 &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating and positive feedback! We're glad to hear that you had a great experience with our staff and that the service was efficient. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Marissa Amore Local Guide·57 reviews·13 photos 5 years ago It’s pizza & it’s good. Need I say more? Great location by clubs and night life. Great place to grab a bite on the late night Michael Smalls 2 reviews 2 years ago Fantastic experience! The service was excellent and I love their pizza. &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We're thrilled to hear about your fantastic experience and love for our pizza. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Hycent Nwaneri 1 review 2 years ago Great service!! Antonio really helped me and made sure everything was taken care of for me! Definitely will be back. &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We're thrilled to hear that Antonio provided great service and made sure everything was taken care of for you. Your response is important to us as we strive to improve our services. We look forward to welcoming you back soon! Alan Harris Local Guide·151 reviews·259 photos 6 years ago It was late when I went but it was still a great pizza. I could tell the associates were ready to go but appreciated the pizza. Will come again. Isaiah “Zay” West 1 review 2 years ago We came on Christmas Eve and the service was phenomenal! Antonio and Brian were great! Thank you &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We're thrilled to hear that Antonio and Brian provided phenomenal service on Christmas Eve. Your response is important to us as we strive to improve our services. We hope to have the pleasure of serving you again soon. Ryan Stevens 10 reviews 4 years ago Truly the worst experience . The all male staff associated with the shift on December 6th, at 12:22 am was extremely rude. Customer service was just extremely poor. &pizza - Dupont (Owner) 4 years ago Hey Ryan, I'm really sorry about your experience. We'd love to hear some more details about it if you can reach out to us on our text line, 200-03. Aja Clark 11 reviews 2 years ago Service was excellent! Came to this one because the one in Georgetown was closed. Brian and Antonio were really helpful and pleasant. Beverly Barber 4 reviews·2 photos 2 years ago The staff was very helpful with everything I needed and also made sure I was safe by giving me a mask to protect myself❤️ Patricia Babb 7 reviews 2 years ago Staff was very friendly and accommodating and the pizza was exceptional. Great location :) stefanie riggins 5 reviews 7 years ago Amazingly friendly staff! Our first dining experience in DC and we plan to hit them up again!!! Fresh deliciousness! LynDale Lewis Local Guide·159 reviews·358 photos 4 years ago Good pizza... one size, so be prepared to share if you don't easy a small pizza yourself. Simple menu. &pizza - Dupont (Owner) 4 years ago Hey there! Thanks so much for the love. We always appreciate our loyal fans. Renuka Joshi 3 reviews a year ago Dine in | Dinner | $10–20 Great pizza made quickly. The team working here is super nice. tomas moser 2 reviews 2 years ago Wonderful pizza great especially after a night out. Definitely recommend. &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We're glad to hear that you enjoyed the pizza, especially after a night out. Your response is important to us as we strive to improve our services. We hope to serve you again soon. Vanessa Jimenez Local Guide·49 reviews·8 photos 7 years ago Add your favorite toppings to an amazing crust with eclectic soda flavors for a good price. Comfortable, casual atmosphere. Nista Bob-Grey 1 review 2 years ago This &pizza location is great , the staff was super friendly and I got helped really quick! Stephanie Becker Local Guide·70 reviews·76 photos 5 years ago Different pizza place. Still liked it, one pie can feed 2 people if your not real hungry. Unique combinations. 1 Richo Local Guide·18 reviews·24 photos 4 years ago Delicious pizza, Maverick with extra cheese wont dissapoint any meat lover. Open until late is very helpful. &pizza - Dupont (Owner) 4 years ago Good choice with the Maverick Ricardo! Definitely a fan favorite. Thanks for the great review too! Chris Meaclem 4 reviews·1 photo 7 years ago Only $10 for any pizza, custom made. Basically the subway of pizza - choose your base and any toppings. They charge a flat rate, not per topping. Alex B. Local Guide·190 reviews·277 photos 7 years ago Love &pizza. This place stays open late on the weekends but is pretty full of drunk club goers. Still, it hits the spot after some dancing. robert brown 1 review 2 years ago Service at this location was the best I’ve had at any in the DMV area! Definitely will be going again. Amir Ghasdi 11 reviews·15 photos 5 years ago I built my own Pizza: pesto and spicy tomato, mushroom and Tomato, whole mozzarella, Italian sausages, beef, and finishing with goat cheese and arugula and for sure garlic oil!!! Tenija Livingston 1 review 11 months ago Dine in | Lunch | $1–10 Amazing!!! The workers were welcoming and very cheerful. 10/10 Kalaa 3 reviews 2 years ago Very fast pace store love how my pizza tastes perfect every single time. Brendan M. Local Guide·95 reviews·31 photos 5 years ago The pizza is fantastic. the employees are not. I got the feeling they didn't not care about the job or product they were giving customers. Allen Local Guide·288 reviews·819 photos a year ago Very poor service here. I was the only person in line and the employees did not even acknowledge me. They were having a conversation amongst themselves. Dog Matic 1 review a year ago Fast Great service from the two brother working feb 4 at 6pm Danielle Carr 2 reviews 2 years ago The guy who made my pizza made sure it was done right like forreal lol didn’t skimp me and it looks delicious Halio J 16 reviews 5 years ago Terrible customer service. Staf will rush you and slap together a terrible job of a pizza. Management no better. No wonder employees are terrible, management is even worse. Nadeen Siddiqui 6 reviews 5 years ago Terrible service. They just threw toppings without caring about making it tasty. Don’t waste your time and money here. Chose a place that actually tries. 1 Cory Simmons 1 review 2 years ago I got food poisoning. No disrespect to the workers, but my stomach hurts so much and I’m so mad lol. Thompson Hangen Local Guide·36 reviews·9 photos 4 years ago Fast and great pizza! What's not to love about &pizza? The staff here are friendly and accommodating! Christy McCann Local Guide·48 reviews·18 photos 2 years ago Food was not made correctly and a bit late, the secjrry staff is super rude, but employees were nice. Cavin Ward-Caviness Local Guide·319 reviews·769 photos 6 years ago Fresh, quick, tons of toppings, and most importantly tasty. If you have the chance definitely go to one of the many locations and see why all the hype is deserved Esprit Cha 2 reviews a year ago Amazing pizza, amazing service, awesome experience as a whole m g 11 reviews a year ago We bought a pizza and we’re immediately screamed at and tossed out for eating it inside. Like what? The moment I hand you cash you throw me out. I can’t eat my pizza inside? &pizza - Dupont (Owner) a year ago Hi Max. Sorry to read about your experience. Can you text us at 200-03 to provide more detail. Edwin Lopez 5 reviews·2 photos a year ago &pizza is my all-time favorite for a fast casual -- and delicious -- pizza. This location is a mainstay, too! R. T. Local Guide·16 reviews 7 years ago This place was gross!!! Trash everywhere and it smelled pretty bad. There's definitely better &pizza's to go to in DC. I went in and came right back out! 1 Rebecca Schick 32 reviews a year ago Take out | Dinner | $10–20 Very tasty pizza. Staff were great JED CREEK 8 reviews 7 years ago Do not ever go here it's terrible. My friend got food poisoning, so it's not safe to go here. And the management and the staff are terrible and refuse to take responsibility. Avoid this place at all costs! Monae' Bailey 4 reviews 2 years ago Antonio was very helpful, assisted me with ordering my meal. 10/10 would recommend! Kelli Smith 3 reviews 2 years ago I always get the best service here. I live &Pizza and Terrence is great!!! Emily Nelson 1 review 4 years ago Amazing, charismatic staff and even better pizza!! Very creative and innovative pizza and drink choices :-) Josiah Tomes 4 reviews·2 photos a year ago Staff is very nice! Photo 1 in review by Josiah Tomes GLENN EVANS Local Guide·41 reviews 4 years ago DONT WAIST YOUR TIME.OR.MONEY. PLACE WOULDN'T LAST A WEEK IN JERSEY. FIRST I TRIED TO CALL AND THEY DONT TAKE CALLS U HAVE TO ORDER ONLINE OR … More 2 Gucci simon Local Guide·64 reviews·4 photos 4 years ago Food was great. The service was horrible. Only 2 ppl in the store had some manners. The REST HORRIBLE. &pizza - Dupont (Owner) 4 years ago Hi Gucci. Thanks for the feedback. We're sorry that your experience was below expectation. We'll be sure to relay this message to the Shop Lead so that improvements can be made asap. Alyse Edwards 2 reviews 2 years ago Friendly, polite and helpful staff. Pizza is good too duh! C Michele 1 review a year ago Staff is dope. Pizza is delicious. Big fan! Lauren Prather 2 reviews 2 years ago Friendly and helpful! Quick service and the food is 🔥🔥! Lavelle was amazing and super helpful! Amazing customer service! Austin Zielman Local Guide·437 reviews·1539 photos 7 years ago Great pizza served super fast! Downside is that it's directly next to/under sa club, and the constant thumping is quite disturbing. Billy Local Guide·207 reviews·404 photos 7 years ago Cool spot for a flat bread pizza. You make your own pizza which is pretty cool. The price is reasonable one pizza is good for 2ppl. Kenny Culver Local Guide·14 reviews·1 photo 4 years ago pizza was so spicy I couldn't eat it I took it back in I said hey I need a new one I don't know why it's spicy they said tough s*** bounce &pizza - Dupont (Owner) 4 years ago Hey there! I'm so sorry to hear about your bad experience. If you get a chance, please text us on our customer service line at 200-03 and we will make this right. Priya Patel 2 reviews 2 years ago Loved it! Everyone was so accommodating and understanding! Great pizza! Emir Yılkıcı 5 reviews·3 photos 7 years ago They simply blend some cheap ingredients. The food tasted not that good. I don't recommend unless everywhere else is closed. Johnny Neilson 2 reviews 2 years ago Dine in my family loves this place! very good food and friendly staff! Luis Medina (COACHMETONY) Local Guide·97 reviews·324 photos 6 years ago Great food! I'm vegetarian and I had a lot of options here. Only thing is that serving sizes are really small. Chiquita Jackson 1 review 2 years ago Great food and quick service! Loved the garlic knots too. mike epps 3 reviews 2 years ago Great quality pizza, fast and friendly customer service. Dylan McDowell Local Guide·138 reviews·79 photos 7 years ago Best option for a pizza lunch in D.C. This location has more indoor seating, but during prime times be prepared to walk to a nearby park. Kay Tunez 1 review 2 years ago Quey was great and very helpful since it was my first time she made my experience 10 times better. Derrick A. Morton 2 reviews 2 years ago The coolest & Pizza in the DMV everyone in there will make you laugh ! Thank you for my good 🍕 DK Walker 7 reviews 6 years ago Best pizza ever! Far from traditional tasting pizza, leaves a funky delicacy in your mouth that leaves you beyond satisfied! Renee S. Local Guide·55 reviews·4 photos 7 years ago Pretty good! The prices are reasonable (listed at the top of the menu) and pizza is delicious! I ordered the gnaric... good choice! Tray Smith 4 reviews a year ago Great place. Jainyn was great cook. She was nice and quick. Music for every ocation Local Guide·6 reviews·334 photos 5 years ago I love these pizzas Photo 1 in review by Music for every ocation Christopher Edwards 2 reviews 2 years ago I had the best experience. Customer service was A1 and the food was awesome Pauline Abah 1 review a year ago When back to this place after my Last visit and the service is always amazing Nicholas Mildebrath 1 review 2 years ago Go-to lunch spot in DuPont. Pizzas are great and filling - quick service and always good music. Tustin Neilson 6 reviews 2 years ago Dine in | Lunch | $10–20 Quick service and tasty pizza! I recommend adding the hot honey. … More helene h 1 review a year ago Delivery | Dinner Super good pizza, delicious drinks, love it <3 &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We're thrilled to hear that you enjoyed our pizza and drinks. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Jimmy Sambuo 6 reviews·7 photos 2 years ago Fast and friendly service! &pizza is my goto pizza place. Marquis Savant 1 review a year ago Delivery | Lunch Waited over 30 min for a delivery while the employees traded food with shake shack Gabriel Marín 7 reviews·1 photo a year ago Lovely place and pizza is great!! Tay was a complete gentleman. &pizza - Dupont (Owner) 2 months ago We appreciate your 5-star rating! We're glad you enjoyed the pizza and the service provided by Tay. Your response is important to us as we strive to improve our services. Thank you for taking the time to share your experience with us. Messaijah Shillingford 2 reviews a year ago The food was great! Tae gave wonderful customer service! &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We're thrilled to hear that you enjoyed the food and received wonderful customer service from Tae. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Donald Jackson 7 reviews a year ago Dine in | Lunch | $10–20 Love how the pizza is made on the spot, fresh ingredients and creative mixes Talisha Harris 4 reviews 2 years ago Terence was great! Ever want great pizza and good vibes, come to Dupont location! Corey DeAngelis Local Guide·204 reviews·623 photos 7 years ago Best custom pizza ever Photo 1 in review by Corey DeAngelis Frankie B 1 review 2 years ago Absolutely love this place. Service is quick and food is great Kaylah B Local Guide·48 reviews·18 photos a year ago Take out | Dinner | $10–20 Super fresh, super quick service even though it was very busy! Anna zakharchishin 1 review a year ago Other | $10–20 Alonzo was the absolute best. Should definitely be running the place! Baylee Childress 2 reviews 5 years ago Love this place. Always delicious. Staff is always friendly. Tyler is a bit of a Chav. Tsvetelina Petkova Local Guide·99 reviews·147 photos 4 years ago Really kice and tasty pizza. Affordable price and you choose your topics. Basically you choose your pizza from scratch. Yummy. &pizza - Dupont (Owner) 4 years ago Glad you enjoy the concept Tsvetelina! And thanks for dropping a review! Steve Murphy Local Guide·43 reviews·417 photos 5 years ago Good, quick pizza while you wait. Not as good as wood burning oven etc, but satisfies... James Papanestor Local Guide·88 reviews·574 photos 2 years ago Thin crust and the choices for the toppings are not like any other! Went three times in one week. Tarikah Omar 3 reviews 6 years ago Pizza was fantastic, service was awesome, there was an unpleasant odor when entering that definitely needs to be addressed 1 Javier Borja Local Guide·19 reviews·1 photo 5 years ago Love the food, large space with plenty of seating. It's not a warm place but in great location G Local Guide·116 reviews a year ago Food was good staff was friendly and helpful. … More Amar-Jyrel Mott 2 reviews 2 years ago I love it! Staff is nice & I've never had a bad experience! N K Local Guide·98 reviews·38 photos 6 years ago The best build to suit pizza joint I've tried. Light years ahead of blaze on quality of ingredients. Gahana Dahiya 6 reviews·1 photo 3 years ago I go to this place all the time! Food is great and the staff is always nice. &pizza - Dupont (Owner) 3 years ago Thank you so much for the review and thank you for being a returning guest! Can't wait to see you again next time! Patrice Mobitang 1 review 2 years ago Great pizza. My familly and I love this location Yuting (Nychii) Local Guide·114 reviews·1683 photos 7 years ago Really enjoy the way this chain makes pizza! This location doesn't have a lot of seating though... Sakina Allen 2 reviews 11 months ago great customer service!!!! definitely recommend. George A 1 review 2 years ago Ordered waited for 2 hours and then my order was canceled. They asked me to reorder. It was my first time ordering from them and my last time. TEAM SHERBOURNE Local Guide·405 reviews·284 photos a year ago I'm from NY and Always have to visit a &pizza while in DC! &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We are thrilled to hear that you always enjoy visiting &pizza while in DC. Your response is important to us as we strive to improve our services. We hope to continue exceeding your expectations on your future visits. Carlos Patiño Local Guide·168 reviews·431 photos 4 years ago Really, good pizza! Just pick what you want with it and enjoy. Friendly people. &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We're delighted to hear that you enjoyed our pizza and found our staff friendly. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Erica Burwell 4 reviews 6 years ago The service was good food is normal. If u r n the mood for pizza good place to go. Aris Preston 2 reviews 2 years ago Pizza is great Antoni and Bron were very helpful and lead to a great lunch. Weiyan Zhang 2 reviews 2 years ago I quite like the pizza here! Self designed pizza is always the best big boi rj 1 review a year ago Take out | Dinner Awesome establishment, good service, tasty pizza Bryan Moises Hernandez Benitez 1 review a year ago the crust is the best and the staff are great, down to earth people. Courtney Metcalfe 5 reviews 2 years ago Lavelle was awesome and gave us great service! awesome pizza Jennifer Morgan 6 reviews a year ago Take out | Dinner | $10–20 Great option for a quick / delicious late night dinner. … More James Gregory 2 reviews a year ago Good pizza great people!! Great late night fix &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We're thrilled to hear that you enjoyed our pizza and our service. We're always here to satisfy those late-night cravings. Your response is important to us as we strive to improve our services. Ms Lola 2 reviews 2 years ago Antonio was the best I love how he makes my pizza, I absolutely love this location. Adeola A 11 reviews 4 years ago The pizza is fine, they don't allow you to sit down and eat late nights on the weekend, although they are open, and the security is very rude about it. Joni Hurley 3 reviews·1 photo 5 years ago Pizza was amazing!!!! One of my best GF pizza crust (order well done) Tat hazelton 4 reviews 2 years ago Good Customer Service, Fast Paced & Loaded Pizza Up. Joseph Rhinehart 11 reviews·1 photo 2 years ago Friendly staff. Great food . Will definitely come back. AHMED RABANE 2 reviews a year ago Always great customer service. Terence is definitely a great asset for this location Kendi Johnson 1 review 2 years ago Lavelle was very professional. He put love into my pizza Justin Wang Local Guide·92 reviews 7 years ago Make your own pizza for $9? As many toppings/sauces/garnishes as you want?? I love &pizza. Tahlia Stangherlin 8 reviews·4 photos a year ago Tay was very helpful when i checked out today. very polite and friendly ! Nisha P 6 reviews·1 photo 2 years ago Great experience! Quick and convent! It’s a must try if you are in D.C. Pooja Rastogi 5 reviews·2 photos 2 years ago Love the pizza and employees!!!!!! So so nice especially lavelle Jake Backers 3 reviews a year ago This place is the best!! also the pizza??? smashing!!! Chanel Beaudoin 1 review 2 years ago Great pizza love it here. Loved the service! Allen Cardenas Local Guide·42 reviews·10 photos 5 years ago So glad there is an &pizza in Dupont. It's quick, easy, and delicious. Awesome value for your money Chanelle Combs 1 review 2 years ago Antonio the best I love this location best pizza and they close at 4am Clifton McEachin 3 reviews 2 years ago Great service!!!! The best pizza I’ve ever head!!! Lucas Orjales 2 reviews a year ago Tay was the best supervisor! Absolutely delicious pizza! Antwane Wrenn 1 review a year ago I love this location .employee are fun and patient Kristin Fillingim 1 review 2 years ago Là elle was the best!! Great service. 5 out of 5 every time!!!! &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We are thrilled to hear that you had a great experience with us. Your response is important to us as we strive to improve our services. We look forward to serving you again soon! Jackie Warner 2 reviews 2 years ago Great service and pizza! Antonio, Brianna and Jalen are the best. Veronica Sarai Melara Cornejo 1 review a year ago Good customer service! Friendly people and always willing to help. Lifeasevon 6 reviews 2 years ago The pizza is always great ! Extra crispy too David Oliveira 4 reviews 2 years ago Take out | Dinner | $10–20 Love their pizza, clean and nice location miles vondra Local Guide·10 reviews·12 photos a year ago Great pizza, even better people. JP was great! Yousif M Local Guide·26 reviews·3 photos 5 years ago Lots of crust on the pizza because of how it's made. Super fresh and feels almost healthy! Lauren Hastings 1 review 2 years ago Take out | Dinner Service was great and the vibe even better! Lavelle’s assistance was top notch Precious Johnson Local Guide·25 reviews 2 years ago Service was great at this location! Food was delicious 😋 Kannan Ramanathan Local Guide·73 reviews·27 photos 4 years ago You can just add all the ingredients you want and the dough of the pizza is thin and delicious &pizza - Dupont (Owner) 4 years ago Hey Kannan, glad you loved it! Come again soon! Al S. 1 review 2 years ago Outstanding service and made one hell of a pizza Delonte Briggs, MBA Local Guide·48 reviews·18 photos 4 years ago Staff was not welcoming and had the dude had an attitude when clarifying build your own versus a classic adding a few extra toppings...it didn't master i was willing to pay the difference.. 1 &pizza - Dupont (Owner) 4 years ago Sorry to hear that your pizza experience wasn't the best. Thank you for your feedback. I will forward this information to the appropriate people. Please reach out to us so that we can make this right. A'Jae Boyd 2 reviews 2 years ago Great customer service. Order done in a timely fashion. &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We're thrilled to hear that your order was delivered in a timely fashion. Your response is important to us as we strive to improve our services. We hope to serve you again soon! John Benson Local Guide·23 reviews·183 photos 4 years ago Customer service at this location is atrocious. The crew working the evening shift on 2/28/20 were very rude. Stay away! Dallas S. Local Guide·101 reviews·89 photos 5 years ago My first pizza in DC. Quick service and great good at a decent price. Jordhon Horelien 2 reviews 2 years ago Lavelle was an excellent help to getting the pizza of my choice. Very helpful &pizza - Dupont (Owner) 2 months ago Thank you for taking the time to leave a review. We are thrilled to hear that Lavelle was able to assist you in getting the pizza of your choice. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Courtney Wade 4 reviews 2 years ago Labella is awesome. He goes the extra mile. Thank you! Dusan Vasiljevic Local Guide·50 reviews·25 photos 4 years ago Excellent suggested choices of toppings, quick service, good enough interior. Mig Local Guide·581 reviews·590 photos 6 years ago Love this pizza: Favorite go to - Red sauce with pepporoni and sausage drizzled with pesto on top. Mercedes White 3 reviews 2 years ago Phenomenal experience with Antonio and the rest of the staff. The place was very clean! Kate Neilson 3 reviews 2 years ago Dine in | Lunch | $10–20 love & pizza! come here often and always enjoy it. … More KDASH201 14 reviews·1 photo 7 years ago Best pizza I ever had. You just have to go and try it yourself Debbie James 8 reviews 2 years ago Ran efficiently under pressure during Halloween eve and Lavelle was very helpful Bosh Gobran Local Guide·304 reviews·695 photos 7 years ago Great Pizza, fast and they have a vegan/vegetarian options:) fund staff Smash Diddy 5 reviews 6 years ago Service was good and food great who dnt love pizza lol &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We're glad to hear that you enjoyed our service and food, especially the pizza. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Heidi Wiles Local Guide·25 reviews·2 photos 7 years ago I just love the the atmosphere the people are great and the pizza is delicious. Need one in Hagerstown MD. hector paredes Local Guide·51 reviews·712 photos 2 months ago I love this Pizza … More &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We're thrilled to hear that you love our pizza. Your response is important to us as we strive to improve our services. We look forward to serving you again soon. Justin Bozeman 3 reviews 5 years ago Ordered via Uber Eats, Pizza came completely wrong from what was ordered, and added whatever they wanted to the pizza and when called , no one answers the phone and call was looped, no one ever responded to my e-mails regarding the wrong order 1 Alana Peery 6 reviews·13 photos a year ago Great pizza and better service! Kunal Vijan Local Guide·117 reviews·505 photos 4 years ago Very nice n tasty. Much better than DC Pizza James Plain Local Guide·9 reviews 5 years ago i tried the american honey pizza, and was great! The craft sodas are also really interesting! danelle hankins 8 reviews 2 years ago Antonio made me a great pizza today and answered all my questions. Fly Gurl Local Guide·193 reviews·271 photos 4 years ago The staff was great they are very customer service driven , fast , and very clean Rodolfo Diaz 1 review a year ago Great Place! Awesome customer service! Dean Naps 2 reviews a year ago Awesome pizza, great service, thank you &pizza! EBEMBI Alain 3 reviews 2 years ago Great location. Staff are really friendly and patient Robin Young 5 reviews 5 years ago Fantastic pizza and an AMAZING staff!! I could eat there everyday!!’ Javid Pourkia Local Guide·128 reviews·1295 photos 5 years ago It's not just food, is love Photo 1 in review by Javid Pourkia Petra Sosa 2 reviews·1 photo a year ago Best pizza in town , customer service is A1 ! Photo 1 in review by Petra Sosa khairy jones 3 reviews 2 years ago This was a great place to go late at night and it handled the long line well Alvaro Dalessandro Local Guide·44 reviews·3 photos 4 years ago Tasty pizza, only downside is the place didn't have Coca-Cola Money Monkey 1 review 2 years ago lavelle was extremely helpful and made sure i was set and provided good service Living the life of lele Vibing 12 reviews·2 photos a year ago Great customer service made me feel welcome &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We're thrilled to hear that our customer service made you feel welcome. Your response is important to us as we strive to improve our services. We hope to continue providing a great experience for you in the future. Abish Anklesaria Local Guide·94 reviews·53 photos 7 years ago Fresh pizza. Good toppings selection. Kid friendly as well. Great place for a fast custom pizza. Rob G Local Guide·151 reviews·301 photos 2 years ago First visit. Fast service, excellent pizza! Matt Peterson 2 reviews 2 years ago an icon, a legend, showstopping beautiful amazing never the same the best &pizza in DC Eric Midder Local Guide·146 reviews 4 years ago Could be a little quicker but very friendly staff and great pizza! Sandra Gaillardetz 4 reviews 5 years ago This Pizza was phenomenal ! Loved it and would definitely go back!!","Only provide commentary from the context included. How, if at all, does the owner of this business respond to negative reviews? &Pizza Google Reviews Josh Local Guide·316 reviews·113 photos a month ago Ordered online and my receipt had no details confirming my items. I text them like they said and they never responded. Then they have Uber do the order delivery but I didn't know that before putting the tip in and then the driver said he … More Photo 1 in review by Josh Photo 2 in review by Josh &pizza - Dupont (Owner) a month ago We regret to hear about your experience with the online ordering and delivery process. Your response is important to us as we strive to improve our services. We will address the issues you've mentioned with our team to ensure a better experience for all our customers. Thank you for bringing this to our attention. Gine “Gine The Mae Nai's Winery” MaeNaiWinery Local Guide·369 reviews·5043 photos 3 months ago Dine in | Dinner | $10–20 Such a lovely freshly made pizza with various options, really hard time to decide which one to order lol. Very fast and nice service. Pizza just got ready in 8mins. Have two long tables to enjoy, or take away. … More Photo 1 in review by Gine “Gine The Mae Nai's Winery” MaeNaiWinery Photo 2 in review by Gine “Gine The Mae Nai's Winery” MaeNaiWinery Photo 3 in review by Gine “Gine The Mae Nai's Winery” MaeNaiWinery Photo 4 in review by Gine “Gine The Mae Nai's Winery” MaeNaiWinery Photo 5 in review by Gine “Gine The Mae Nai's Winery” MaeNaiWinery Photo 6 in review by Gine “Gine The Mae Nai's Winery” MaeNaiWinery Photo 7 in review by Gine “Gine The Mae Nai's Winery” MaeNaiWinery Photo 8 in review by Gine “Gine The Mae Nai's Winery” MaeNaiWinery Photo 9 in review by Gine “Gine The Mae Nai's Winery” MaeNaiWinery &pizza - Dupont (Owner) a month ago Thank you for your 5-star rating! We're thrilled to hear that you enjoyed our freshly made pizza and fast service. Your response is important to us as we strive to improve our services. We hope to see you again soon for another delicious experience! Torianna Todd 3 reviews·2 photos a week ago NEW Take out | Dinner | $10–20 Super friendly staff and the food was really good! We got 2 pizzas- one cheese and one margarita with some extra toppings, and garlic knots. … More Photo 1 in review by Torianna Todd Photo 2 in review by Torianna Todd Addison Hosner Local Guide·100 reviews·141 photos a month ago Never had pizza from here before but ordered online for pickup during lunch. Showed up on time and the order was ready without delay. The pizza is a great serving size and depending on your appetite and what you get this could be two meals … More &pizza - Dupont (Owner) a month ago Thank you for taking the time to share your experience with us! We are thrilled to hear that you enjoyed our pizza and that your order was ready on time. Your response is important to us as we strive to improve our services. We look forward to serving you again soon! Allen Nuccio Local Guide·297 reviews·380 photos a week ago NEW Dine in | Lunch | $10–20 If you're not familiar, &pizza is like Fancy Pizza Hut in flatbread form. Their pies are pretty good and their garlic knots are delicious. This location has fantastic customer service, but also smells heavily of a bathroom for whatever reason. Anyway, pretty good all-in-all. … More Alma Local Guide·147 reviews·278 photos 7 months ago Take out | Dinner | $10–20 Pizza is good and doesn't take long from ordering to paying so it's fast and convenient. Staff is super friendly and nice … More Photo 1 in review by Alma Photo 2 in review by Alma Photo 3 in review by Alma Photo 4 in review by Alma Photo 5 in review by Alma Lizzy Amirana Local Guide·146 reviews·224 photos 4 months ago Smells like mold in the place but wonderful pizza! Their gluten free pizza with vegan cheese and meat substitute is 💣 … More Photo 1 in review by Lizzy Amirana 1 &pizza - Dupont (Owner) a month ago We regret to hear about the issue you encountered during your visit. Your response is important to us as we strive to improve our services. We're glad you enjoyed the gluten free pizza with vegan cheese and meat substitute. Thank you for sharing your experience. Emma Fan Local Guide·28 reviews·20 photos a month ago We ordered 8 pizzas (menu items) and 4 of them was made incorrectly - missing all the meat, missing veggies & pineapple, wrong sauce, missing spices. They weren’t just missing one or two ingredients, they were made into something completely … More &pizza - Dupont (Owner) a month ago We regret to hear about your experience and the incorrect pizza orders. Your response is important to us as we strive to improve our services. We will address this with our kitchen staff to ensure such mistakes are not repeated. Thank you for bringing this to our attention. Aban Koprulu 74 reviews·3 photos 3 weeks ago NEW The pizza is good but omg the sewage smell was unbearable. I tried to hold my breath and breathe through my mouth. I almost passed out. I don’t think this place is safe according USDA food and safety inspection. I will have to report it … More 1 &pizza - Dupont (Owner) 3 weeks ago We regret to hear about your experience. Your response is important to us as we strive to improve our services. We will investigate the issue immediately to ensure a safe and pleasant dining experience for all our customers. Thank you for bringing this to our attention. Jacob Fix Local Guide·22 reviews·12 photos 4 months ago Take out | Lunch | $10–20 Very fast, affordable, and huge portions. Great deal and great pizza. … More Photo 1 in review by Jacob Fix Jason A 4 reviews·2 photos 2 years ago Take out | Lunch | $10–20 Great pizza in Dupont! Walking distance from the Mayflower hotel. Fast friendly service. The Maverick is my favorite and garlic knots are a nice add on. Photo 1 in review by Jason A Photo 2 in review by Jason A Mehrnoosh Kh Local Guide·245 reviews·1644 photos 6 months ago Take out | Dinner It is a good pizza place for late night bites. … More Photo 1 in review by Mehrnoosh Kh Photo 2 in review by Mehrnoosh Kh Photo 3 in review by Mehrnoosh Kh Photo 4 in review by Mehrnoosh Kh Photo 5 in review by Mehrnoosh Kh Photo 6 in review by Mehrnoosh Kh Photo 7 in review by Mehrnoosh Kh Photo 8 in review by Mehrnoosh Kh Ryan Griffith 11 reviews 4 months ago Don't bother ordering Uber Eats here because they won't make the food and you'll have to cancel the order. And if you dine in apparently it smells like piss. … More Samuel Davie 37 reviews·102 photos a year ago Take out | Dinner | $10–20 Delicious pizza and the perfect serving for 1 person. I always get the pineapple jacked and take my Tour de Pizza cutter for a ride. Going for a pizza ride #tourdepizzacutter 🚴🏼🍕😊 Photo 2 in review by Samuel Davie 3 Alan Marrero Local Guide·215 reviews·2873 photos 5 months ago Nasty piss smell, we had to leave in an instant. No wonder the place was empty. The pizzas looked great in the pictures, if you want to eat a pizza in smelly atmosphere THIS IS IT! … More 2 Henry Kloepper Local Guide·121 reviews·77 photos 7 years ago Was quite decent. Fast, reasonable price, good taste. Though I just had Pizza Paradiso and if you have some extra time it's well worth it over &pizza, especially if you are interested in having an alcoholic drink with your pizza. If you're in a rush this works better. Photo 1 in review by Henry Kloepper Damien Shaner Local Guide·30 reviews·140 photos 3 weeks ago NEW They are so ghetto they have a security guard that locks the door and doesn't let people inside after the place fills full of ""dangerous people""...well before the actual closing time. &pizza - Dupont (Owner) 2 weeks ago We regret to hear about your experience at our restaurant. Your response is important to us as we strive to improve our services. We take the safety of our customers seriously and will address this issue with our security team. Thank you for bringing this to our attention. Diana Marquez 2 reviews 9 months ago Dine in | $10–20 My sister and I came in to grab some food after a night out it was very busy but the team was very efficient and Luis definitely made sure we had a great experience. He has exceptional customer service skills, very out going and just great at what he does and overall takes great care of guests. Will definitely be coming back soon ! Matthew Rice Local Guide·14 reviews·54 photos 4 months ago Take out | Dinner | $10–20 Pizza was decent, but as other reviews have noted, the restaurant had an unbearable stench. The owner needs to call a plumber or an exterminator (or both). … More Elizabeth Dapper 8 reviews·4 photos 3 months ago Dine in | Dinner | $10–20 Good place, good service, loud music which is always a little hard when talking with friends... but the food and the employees never disappoint! … More &pizza - Dupont (Owner) a month ago Thank you for taking the time to share your experience with us. We're glad to hear that you enjoyed the food and service, but we understand that the loud music can be a challenge. Your response is important to us as we strive to improve our services. We hope to have the opportunity to serve you again in the future. D C 8 reviews·2 photos 6 months ago Take out | Dinner I just have to add to the other reviews about the absolutely putrid horrifying smell in here, which hits you upon entering. I had ordered Uber Eats, otherwise I would have immediately left. This place most likely has an ongoing sewage issue that is not being addressed properly. No place that sells food should smell like this. … More 2 Andy Jovel 11 reviews·1 photo a year ago Take out | Lunch | $10–20 Sorry, but the pizza was cold and there was little to none chicken mostly just blue cheese crumbles. There were none jalapenos at all either. Photo 1 in review by Andy Jovel Brei Evans 4 reviews·11 photos 3 days ago NEW This locations stinks so bad. The people are nice here though. … More Cedar Baltz 7 reviews 7 months ago Take out | Dinner | $30–50 I got take out and the guy gave me 1 correct pizza I ordered and gave me a completely different order for the 2nd pizza. He showed me the first pizza with the correct toppings on it. I assumed the 2nd pizza he handed me was the right order … More Nathan Sellers Local Guide·90 reviews·323 photos 4 years ago This is really good pizza. The manager was super friendly and helpful too. My son begged to go back the whole trip and said it was the best pizza he'd ever had. Photo 1 in review by Nathan Sellers Kelli Roberts Local Guide·349 reviews·305 photos 6 years ago Second &pizza today. This location is even bigger! Food was delicious, but I would advise going light on the toppings if you choose a gluten free pizza. Too many toppings can make the pizza heavy and messy. Photo 1 in review by Kelli Roberts Photo 2 in review by Kelli Roberts 2 Jahanna Reese 13 reviews·1 photo 11 months ago This is My favorite & pizza Location, great service and they don’t rush you . 5 stars out of 5 Photo 1 in review by Jahanna Reese Josh Griswell Local Guide·26 reviews·21 photos 5 years ago Great food, good price, friendly staff! I ordered the vegan pizza and it was awesome! Their craft soda fountain has some great selections as well. Food was cooked quickly and tasted great! Photo 1 in review by Josh Griswell 1 David Zaga Local Guide·48 reviews·83 photos 6 months ago I mean the price was ok. The place smelled, clearly not very well maintained. And the pizza was ok. The guys working the counter, although dealing with a lot of customers were working hard and gave good service … More 2 Samim zamiri 1 review a month ago You gotta taste their pizza and you’ll definitely like it … More &pizza - Dupont (Owner) a month ago Thank you for your 5-star rating! We're thrilled to hear that you enjoyed our pizza. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Sabrina Lisenby 3 reviews·1 photo 2 years ago Amazing staff, great service, and was so fast. Oh by the way they have amazing pizza and garlic knots. If this isn’t enough to make you try them out, do it anyway lol 😂🤣 Photo 1 in review by Sabrina Lisenby &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We're thrilled to hear that you had an amazing experience with our staff and enjoyed our pizza and garlic knots. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Ashllyn Silva Local Guide·64 reviews·63 photos a year ago Dine in | Lunch | $10–20 Actually so obsessed with this pizza. So glad to find out they have multiple locations in my home city. Photo 1 in review by Ashllyn Silva Zhuoran Li 7 reviews·6 photos a year ago The guy is super nice. He is friendly. The pizza is so good. It is really a top place for some pizza quick bite Photo 1 in review by Zhuoran Li J Foodgeek Local Guide·715 reviews·732 photos 2 years ago So earlier today I got I texted coupon for a $5 pizza, so I walk in to dupont S location and I figure I'll just make the order in the place, and I look at the places where the ingredients are, and see slimy rod and spinach and black basil, … More Photo 1 in review by J Foodgeek 1 HoneyD 11 reviews 6 months ago Why does this place stink? Walked up expecting smell of fresh pizza but smells like dirty sewage, smells better outside. Couldn't imagine sitting down in here to eat. … More 2 Sarah Jackson Local Guide·81 reviews·2 photos 4 years ago Pizza flavor is good & could have been a 5 star. Delivery wAs about 30 mins on Fri Evening. ..but it was delivered COLD,,,,!.to order is difficult, forget calling you will only get voicemail tell you they only text or order online. They … More Photo 1 in review by Sarah Jackson 1 &pizza - Dupont (Owner) 4 years ago Hey Sarah, thanks for the review and sorry your pies didnt arrive to you in a state we're proud of. If you're up for it, feel free to reach back out and we'd be happy to make it up to you Daniel Ruiz Local Guide·49 reviews·200 photos 4 years ago Great place to eat pizza, fast service, prices are okay, each style is around $10, not so crowed and staff is friendly, very reccomended if you are hungry and looking for something quick. Photo 1 in review by Daniel Ruiz John Yeung Local Guide·130 reviews·151 photos 7 years ago How can you not like &pizza? I come here all the time. Overall it is really good but sometimes the quality is inconsistent. The pizza might be slightly burnt on the edges. The few times I want to buy soda, their machine does not have all the flavors. Photo 1 in review by John Yeung Liam Amiri Local Guide·377 reviews·2368 photos a year ago Decent pizza but don't expect some authentic NYC style pizza. … More Photo 1 in review by Liam Amiri Eddie Hoss Local Guide·268 reviews·74 photos a year ago Dine in | Dinner Oddly enough, some of the best pizza I've had in some time. Visited during the Halloween bar crawl and the three employees were overwhelmed but kept at it. Waited around 45 min for my pizza, but it was worth it. Decent prices and when … More David Dotson Local Guide·146 reviews·574 photos 2 years ago Dine in | Dinner | $10–20 Great pizza & excellent service Both Gluten Free crust & Vegan protein options available (vegan cheese, vegan sausage & chickpeas) … More Photo 1 in review by David Dotson 1 &pizza - Dupont (Owner) 2 years ago Thank you so much for the review David! We're so glad you were able to use our loyalty coupon as well! Ishmael Kamara Local Guide·117 reviews·649 photos a year ago Take out | Dinner | $20–30 &pizza is always great. Went there late on Friday for something to eat. With the crowd from the clubs be prepared to wait and they don't have any indoor seating at that time. Overall you can't go wrong with a personalized pizza from here. … More tshirt tae 7 reviews·6 photos a year ago Pizza was banging line was fast great place custom Pizza Photo 1 in review by tshirt tae Niggle W 14 reviews 6 months ago The store is quiet but the staff is very polite, clean and the pizza came out good. … More Anthony Ayo 4 reviews·1 photo a year ago Lunch | $30–50 Pizza was great! Service was just as awesome! We brought a group of 13 people and Terrence and the crew were happy and helpful. Can’t wait to come back when I’m back in town. … More williampiedra100 3 reviews·1 photo 3 weeks ago NEW Dine in | $10–20 Bryan attended us with great care. … More &pizza - Dupont (Owner) 2 weeks ago Thank you for the 5-star rating! We're thrilled to hear that Bryan took great care of you. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Vannessa Rodello Local Guide·129 reviews·103 photos 4 years ago All the toppings you want and so many options! My only criticism is the crust wasn't as crispy as I'd like. Photo 1 in review by Vannessa Rodello Photo 2 in review by Vannessa Rodello R Bakshi Local Guide·65 reviews·166 photos 6 years ago Excellent pizza and super friendly staff! Photo 1 in review by R Bakshi Photo 2 in review by R Bakshi Krystle Local Guide·107 reviews·224 photos 4 years ago It was really good. But it was sooooo hot in there and took foreverrrrrrr. Pepperoni and bacon. I'm basic lol Photo 1 in review by Krystle Leah Trunsky (raindropAuxilitrix) 1 review 11 months ago Went here with my friends—the pizza was great and the server Chris was super cool! Super friendly. Whoever made the pizza was patient with our orders too. :) Destine Jones 5 reviews 11 months ago Take out | Dinner | $10–20 I came into &Pizza today for lunch and the the staffAndre and Terrace was very helpful polite service was great clean environment fast service I was surprise to see no line so the pizza came out quick and I was able to enjoy it and get … More 1 &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We're thrilled to hear that Andre and Terrace provided helpful and polite service, and that you enjoyed a quick and delicious lunch. Your response is important to us as we strive to improve our services. We appreciate your kind words and hope to see you again soon! Roberts Brian 1 review a year ago I went through this pizza shop last night the service was amazing they were really on point, making sure the customers got everything they needed and more this will definitely be my go to pizza place yours truly Mr.Roberts.. James Drosin 2 reviews 9 months ago Dine in Luis the Manager gave me the best guest experience! Food was amazing definitely recommend. S/O to them! I will definitely be back! Heather Dorsey Local Guide·130 reviews·393 photos 4 years ago The American honey pizza is really good. And the cereal milk soda tastes exactly like cereal milk. So. Service with a snarl. Photo 1 in review by Heather Dorsey &pizza - Dupont (Owner) 4 years ago Thanks for the review Heather! :) Kate Farrell Stanford 4 reviews·2 photos 11 months ago When I walked in, no one was in there and it smelled terrible, as if the floor had been mopped with dirty toilet water. We couldn't imagine staying in there long enough to order, let alone eat. … More 2 &pizza - Dupont (Owner) 11 months ago We apologize that our service did not satisfy your expectations. We set a high standard for ourselves and are truly sorry to hear that standard was not met in your interaction with our business. Your happiness is our number one priority. We well take your feedback into consideration. Jason Miller Local Guide·401 reviews·14 photos 2 years ago Take out | Lunch | $30–50 I love &pizza and usually get awesome service however, this visit to this location was lagging. The 2 staff were seemingly working against each other and they burnt mine and my other 2 family members pizzas. I … More Michael Green Local Guide·113 reviews·665 photos a year ago Dine in | Dinner | $10–20 Flat bread pizza made your way. Staff was fun and engaging. Food was great and was more than enough. Large enough to share but on a hungry day good enough to keep it for yourself. … More Nadia M 8 reviews·4 photos a year ago Normally I’m a huge fan of &Pizza, but this location is so severely understaffed during rush hours that it has proven actually impossible to get the pizzas we ordered. The &pizza website said our order would be ready within 15-20 minutes, … More 1 Chandrell Christopher 7 reviews·3 photos 2 years ago Service was great! Really nice employees, loved syncere and lavell were amazing! Photo 1 in review by Chandrell Christopher Jlyne B Local Guide·63 reviews·14 photos 4 years ago Got a gluten free American honey and oh my goodness I wish there was one closer to where I live. Incredible tasting food and the soda was really good as well. I gave it four because a few of the toppings didn't look very fresh (wilted … More 1 &pizza - Dupont (Owner) 4 years ago Thanks for the review! :) Jamon Pulliam 2 reviews 2 years ago This location is hands down the best! I was visiting from Los Angeles and the service here was impeccable! And don’t get me started on the pizza! They took their time and put nothing but ingredients and love in that one. Would definitely recommend Dean Albrecht 3 reviews a year ago Take out | Dinner | $10–20 Excellent food with great service. Andre helped me make the right choice. Would recommend to anyone who’s in DC and wants something quick to eat. 1 Esse Darden Local Guide·287 reviews·551 photos 2 years ago Take out | Dinner | $10–20 Ordered the Manhattan, while waiting for my personalized order being made - which I received after noticing a distinctive stinginess with every topping that was applied before it was put in the oven, an excessive prolonged period of time; … More 1 &pizza - Dupont (Owner) 2 years ago Thank you for taking the time to share your feedback. We set a high standard for ourselves, and we’re so sorry to hear that this was not displayed during your visit at our location. Your feedback is important to us and we’ll make sure to make the proper adjustments for next time. I’m also going to send this feedback to the shop and district leader to address with the team there because this isn’t what we want our guests to experience at all. We hope that your next visit with us is nothing like what you experienced recently! Scott C Local Guide·33 reviews·9 photos 3 years ago Great pizza and garlic knots! Not your typical style but still quite special and worth trying...over and over again! The dough and toppings are always on point! I also appreciated their program to help frontline workers. Highly highly recommended! 1 &pizza - Dupont (Owner) 3 years ago Thanks for the review Scott! We had to try something different this time. We hope you enjoyed it though! Sean Local Guide·61 reviews·42 photos 2 years ago Take out | Dinner | $30–50 We got delivery. Late night. Pizzas were not good. Got It for a party and we all laughed at how bad it was, and how small they were in the box. (And they forgot one of our items.) all that and only a 1.5 hour wait. Haha. Only reason for the extra star (instead of just 1) was the cookies were really good! … More 1 Kiran Singh Local Guide·70 reviews·66 photos 4 years ago The pizza here is so delicious! The crust is flavorful and tasty and the tomato sauce is so deliciously tangy. I was really blown away by the quality & taste of the pizza! Their ingredients taste fresh and you can add as many toppings as … More &pizza - Dupont (Owner) 4 years ago Thank you so much!🖤🍕🖤 Michael Cupertino Local Guide·106 reviews·163 photos 4 years ago I don't know if it was an ""off day"" here, but service was so slow we had to leave. There were 3 people in front of us and we waited 20 minutes before we left. The employee was more concerned about cutting a 1/4 of an inch of crust off of … More Jessica Peters 12 reviews·6 photos 5 years ago The pizza at & pizza is great. That’s why I have been coming back for years. However beware of the customer service. Recently at the DuPont location, I enjoyed a great pizza and needed to use the restroom. When I asked an employee who was … More 2 Alok Sinha Local Guide·58 reviews a year ago Stopped by here and this is a great place for pizza. I ordered the new G and added some spicy honey and it was delicious. Would definitely recommend stopping by here if you have a chance. &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We're thrilled to hear that you enjoyed the new G pizza with added spicy honey. Your response is important to us as we strive to improve our services. We appreciate your recommendation and look forward to serving you again soon! S G Local Guide·12 reviews a year ago Amazing pizza and unique experience. Build your own pizza to a new level. Fresh toppings and an amazing taste. The place is small but the tastw is huge. Loved the food and the service. A definite must. Claire Mizutani Local Guide·54 reviews·374 photos a year ago Take out I got four pizzas to take back to my family:The Maverick, CBR, Billie, and Kalamata Harris. Two of them were on gluten-free crust. Ordering was pretty hectic because there were many young people coming to eat between going to different bars … More 2 Wanda Murphy 33 reviews 2 years ago This was the worst pizza I have ever purchased from & Pizza. The person in front of me, ordered four pizzas. They should have removed my pizza promptly. Instead, the crust is burnt, the spinach dry and the other vegetables dried out. … More &pizza - Dupont (Owner) 2 years ago Terribly sorry to hear about your experience Wanda! We have reported this information to our senior management to resolve and to take the proper measure for quality control. You can send us an additional message at 200-03 or send us an email at digitalshop@andpizza.com. Thank you again for bringing this to our attention. Robyn J Local Guide·54 reviews 5 years ago Absolutely the best pizza I have every eaten. The bread was amazingly light and doughy. I didn't have the disgustingly full feeling after eating an entire pizza. The toppings were fresh and delicious and unlimited. Love the healthy choices and sauce variety. 1 &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We're thrilled to hear that you enjoyed our pizza, especially the light and doughy crust and fresh, unlimited toppings. We're glad you appreciate our healthy choices and sauce variety. Your response is important to us as we strive to improve our services. A G 10 reviews a year ago I’m literally in this place as of 06/06/22 and it just took me a whole hour to get a pizza which is ridiculous! Low staff and no sense if urgency. Felt bad for the employee up front who seemed suer overwhelmed, pizza is good usually but won’t be back at this location. &pizza - Dupont (Owner) a year ago Hey Andy! Thanks for you review. We are sorry to hear that we did not provide the best experience! Please reach out to us at 200-03 so we can make this right. 🍕 Timur Plavan Local Guide·97 reviews·278 photos a year ago Dine in | $20–30 The most inefficient &pizza I've ever tried in my life. Ordered online, came 30 mins later and waited for another 50 minutes. Order was missing things in both pizzas. &pizza is great but I would avoid this location. … More Natalia Diaz Torres 1 review·1 photo 2 years ago If I could give 0 stars, I would. This review is based on an UberEats order. I ordered 4 pizzas and an order of … More Photo 1 in review by Natalia Diaz Torres Rishi M Local Guide·9 reviews·22 photos 2 years ago Visited late September 2021 for an online pickup order. Waited 2 hours for my order. … More 1 Michel Louis Local Guide·16 reviews·2 photos 2 years ago Take out | Dinner | $10–20 One of the best pizza I ever tried Photo 1 in review by Michel Louis Rachel Wortmann Local Guide·61 reviews·173 photos 2 years ago Ordered online and waited 45 min for my pizza. App had said it would take 10 min so was quite frustrating … More Kristen Eggleston Local Guide·50 reviews·8 photos 4 years ago The pizza is great but the service here could be a bit better. I went at a time where it wasn't busy at all. The woman who made my order was friendly and helpful and while my order was cooking, I sat at a table nearby. The woman who was at … More Jéssica Bittencourt 1 review·1 photo 2 years ago Lavelle great service, thank you! Photo 1 in review by Jéssica Bittencourt 1 Matt Ramey 3 reviews 11 months ago Dine in | Dinner | $1–10 We went in to have wholesome family dinner experience but quickly exited upon my initial smell test which returned a result consisting of bathroom juices/putrid garbage. 2 Matthew Cantisani 2 reviews a year ago Dine in | Dinner | $10–20 Excellent service!! Food was delicious and made quickly. I will definitely come back to this &pizza location! De Wheeler-Chopan 10 reviews 7 months ago Worst experience ever! Pizza wasn't ready to order. The servers states they didn't care that we waited! … More Stefan Hovy 5 reviews 6 years ago Incredible! Was in DC for a long weekend and ended up going to &pizza 3 times! Twice at this location where the staff and manager were very friendly and open for a chat. Not to mention the delicious pizza with equally delicious vegan options. Would recommend this to anyone visiting DC! 1 Joey Norris 4 reviews a year ago Take out | Dinner | $10–20 Andre was such a great help and made sure to treat us right with amazing pizza. Appreciate the amazing service and will gladly go again. S. T. Grandy 19 reviews·6 photos 4 years ago The pizza is good but I was a bit disappointed to see that the employee who made my pizza only put a racing stripe of sauce right down the middle of the dough. Literally a line down...not spread at all. Also, they may need to turn the ovens … More 1 Monte' Kent 2 reviews a year ago Andre at &pizza DuPont south was amazing.. helped me with my gift card at this location. He service and attention to detail was great. Must go location. Thanks Andre! Sameer Singhal Local Guide·41 reviews·8 photos 7 years ago Great at any time of day. This is a unique pizza experience, and I love the fact that you can customize your pizza to your liking for one flat price. Definitely a place to try, and you'll most likely want to keep coming back Cecilia Demoski 1 review 11 months ago Take out | Dinner | $10–20 This is a great place to grab some great pizza! Amazing service and good quality pizza. Miracle Parish Local Guide·75 reviews·6 photos a year ago I will be filing a police report against the fair skinned man with dreads. He put his hands on me multiple times when I was trying to exit the building. The entire line saw it and they were appalled. I was trying to get to my Uber and he … More Ali A Local Guide·691 reviews·435 photos 4 years ago Delicious, but higher prices than their quality. Crowded around noon time, my experience of course. Employees are ok, but they can be much better. … More Brie Morgan 5 reviews 2 years ago I been coming to this pizza spot for a few months and their always respectful and clean They have awesome pizza and the best customer service the manager always takes care of me and makes sure my pizza is hot and ready to go no complaints will continue to send friends and family India Marshall 28 reviews 2 years ago Employees are nice but mangers need to do a better job with organizing during rush hour. Bathrooms are never available for customers. This has been the case for over 5 years. Luis Miron 3 reviews 11 months ago Dine in | Dinner | $10–20 Amazing service by Andre! and delicious pizza. Definitely the place to eat before a night out of drinking. Breanna Duff 9 reviews·1 photo a year ago the security card told me I could not sit down even though I have a disability. There is no rule to this. He was being very rude for no reason. 1 Katie Kennedy 21 reviews 6 years ago The service was terrible here. We were there for the first time and clearly confused but rather than offering help to us, the staff ignored us. They offered no help when we had questions about some dietary restrictions either. And you can't … More 2 Evan Farrara 12 reviews·1 photo 7 years ago Incredibly loud inside to the point that the employees couldn't hear me correctly when ordering. As a result, when asked if I wanted spicy or non-spicy sauce, I replied ""non-spicy"" and got spicy anyways. That being said, it ended up being … More Mohammed Yahia Local Guide·384 reviews·1524 photos 5 years ago &pizza is a good, simple pizza place. They don't have many choices, just pizzas, but they are awesome. They have a few set pizzas you can order or a make-your-own-pizza option. They also have the option for gluten-free dough which is $3 … More 1 Jobina Beale 3 reviews a year ago Went in there today for lunch and Tay was awesome. Amazing, courteous and good customer service. I walk from Farragut West Metro to get my pizza all because of him. Gideon Tong Local Guide·155 reviews·233 photos 4 years ago Great pizza! Fast service, would go again. As someone from the west coast we also have build your own pizza places like Pieology and Blaze Pizza but this style of ""shoebox pizza"" is pretty unique and you can definitely eat a whole pizza on your own even if you don't usually eat that much. &pizza - Dupont (Owner) 4 years ago Great to hear. Thanks! Sara R. Local Guide·144 reviews·305 photos a year ago Dine in | Dinner | $10–20 Vegan-friendly, they even gave vegan pizza. I would like to see more filling vegan toppings options like some Beyond Meat or something. The service was quick and friendly. … More 1 cy mcfadgion 3 reviews 3 months ago Quan, cam and bre were amazing … More &pizza - Dupont (Owner) a month ago Thank you for your 5-star rating! We're thrilled to hear that Quan, Cam, and Bre provided amazing service. Your response is important to us as we strive to improve our services. We look forward to serving you again soon! Khaleel Johns-Watts 58 reviews 10 months ago Best late night dc spot call ahead after 3am if ur with a group and just order all the pizza Emma C Local Guide·83 reviews·85 photos 5 years ago Of all the made-to-order personalized pizza places out there, &pizza has my heart. They offer several delicious dough options including gluten free. All of the toppings are very high quality (get the meatballs!!). After topping, they put it … More 2 A “2Freckles” Oz Local Guide·15 reviews·2 photos 5 years ago I really liked this place, however my second experience here was not like my first. Took me 30 mins to get my order. The cashier was very stressed maybe it was his first day on the job because he did not know how to run the register. The … More Ada Rebecca Smith Local Guide·447 reviews·165 photos a year ago Dine in | Dinner | $10–20 The service was not great, the guy making the pizzas was very slow and wasn't able to find items that should have been easily located(the spinach was empty, he took several minutes looking for it and they were out of spinach). … More Ian Winbrock Local Guide·131 reviews·14 photos 7 years ago I love &pizza. I'm from the West Coast and we have ""cook as you wait"" pizza places, but nothing on the same level as &pizza. This place is superb. Always greeted by some friendly folks behind the counter and then I either complete one of … More Bill Hipsher Local Guide·41 reviews·987 photos 7 years ago Staff was very nice and pizza we got as ordered was great. The fountain machine was broken so your drink options were limited to can/bottle options for tea/lemonade that they had in a fridge. Ordered a Hawaiian style pizza that was supposed … More 1 Scott Dwyer 12 reviews·1 photo a year ago Great place to get a bite when you out drinking in depot circle. The pizza is awesome, and the prices are better than at the bar. … More Justin Andersen Local Guide·15 reviews a year ago Take out This was the most frustrating experience I've ever been in. Our take out order was over an hour late. And that's the least frustrating part of the night... I don't know if I have the energy to explain everything. Andrea M Local Guide·69 reviews·46 photos a year ago They gave me the wrong pizza. I texted customer service and they said they needed a picture in order to issue a refund. I told them my camera was broken and was not able to take a picture. They told me I couldn't get a full refund without a photograph but they could offer me $5 for a new pizza. Josh Higham Local Guide·148 reviews·84 photos 6 years ago Co-workers had talked this place up, but I found it only decent. I definitely enjoyed the unique soda fountain more than the pizza. Great variety of unique flavors. Pizza was fine but unremarkable. Ariel Holmes 2 reviews 4 years ago James and Deon made my night. I would have been left hungry if it was for the girl up front. But thank you 2 for the lovely service much appreciated. I will remember it & I will be back (during opening hours) thanks again! &pizza - Dupont (Owner) 4 years ago Glad to hear our team solidified your evening (and future visits) with great service. We will be sure share with both James and Deon your kind words! Thanks for stopping by, Ariel! Leanne Quinn 1 review·1 photo 2 years ago Great service and fantastic pizza! Photo 1 in review by Leanne Quinn &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We are thrilled to hear that you enjoyed our fantastic pizza and great service. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Tracey N Local Guide·87 reviews·70 photos 5 years ago Pizza would have been better if it was warmer, but their service was shorthanded..... they had one person taking out the pizza from the oven, boxing it, putting on the finishing garnishes AND ringing up the customers...... that's too … More Theresa Kemp 5 reviews a year ago Dine in | Dinner | $1–10 Andre was fantastic! He served our party fresh, hot, pizza. Thank you for the great customer service. Diana Martinez 3 reviews·2 photos 2 years ago I work nearby and I appreciate that my orders are always done right away and I can quickly just pick up. Great customer service. Very strict on covid regulations. Key 2 reviews 2 years ago Customer service was excellent upon arrival. Store was clean and needs were met in a timely fashion. Very friendly and patient staff. 5 Stars to Terence!! Greg Smith 14 reviews·2 photos 10 months ago Delivery | Lunch | $10–20 Did carry out. Pizza was good, but not great. Strange beverage options … More Bali Adawal Local Guide·203 reviews·1637 photos 4 years ago I have always liked the concept of a highly customized pizza and the overall product turns out to be quite appealing. … More 2 Aleks Nekrasov 91 reviews·67 photos 11 months ago As far as GOOD pizza goes, this place completed my order in 8 minutes. &pizza - Dupont (Owner) 11 months ago Thanks for the awesome review! Hope to see you soon. Gnelossi Hamadou Local Guide·6 reviews·7 photos a year ago Visited this place yesterday for my first time , just wanna say thank you for the entire team that work yesterday night. They were patient and friendly specially the manager Andre Cecilia Local Guide·80 reviews·2 photos 5 years ago We had a pleasant experience at a different branch of &pizza so we tried this branch. This branch was stingy on the toppings and the dining area was not wiped down after customers have eaten there. All 3 of us felt queasy after eating here... Josh Eid-Ries 10 reviews·3 photos 6 years ago Delish, super affordable and very easy to customize your order with no upcharges. The staff are a delight and the food is superb. The drink offerings are also wonderful. I'd recommend the 11 grain crust(ask for it) the mango passion fruit soda and root beer. Vegan cheese and veggie based protein options were a lovely bonus! Pradipto Banerjee Local Guide·29 reviews·96 photos 7 years ago Their pizzas are the best value for money. Unlimited toppings on a big flat bread for just $10. And they're open till 4 am, which is great when you're leaving the bars at 2 and want to get some food. NAI- NAI 3 reviews 2 years ago Dupont is awesome. The place is clean and the pizza is great! One of the workers Decostia provided excellent customer service! I definitely recommend this store! Jaqueline Veltri 2 reviews 4 years ago The pizza here is delicious but it is the second time in a row that I find a long black hair in my pizza. It’s so frustrating and disgusting! I hope management finds a way to keep the employees hair out of the food. F.A. B Local Guide·39 reviews·15 photos 4 years ago James was an amazing manager. My card wasn't working for some reason and he still made my pizza and gave it to me for free. Absolutely amazing customer service! Thank you James! &pizza - Dupont (Owner) 4 years ago Hey there! Thanks so much for the love. We always appreciate our loyal fans. Sunil Singh Local Guide·183 reviews·134 photos 5 years ago &Pizza is something like Blaze Pizza. You pick your dough, then the sauces, and then all your toppings. It's unlimited sauces, and unlimited toppings. And after the pizza is baked, you can add any other sauces, or other toppings. And … More breathemusic94 2 reviews a year ago I love coming to this &pizza, Tay is always a welcome face at this establishment, he is extremely helpful and all around fun to talk to. The food is always amazing here. Crystal 1 review·1 photo 2 years ago &pizza Great good and atmosphere, staff was friendly Photo 1 in review by Crystal Thomas Scheurich Local Guide·33 reviews·1 photo 6 years ago I really like the new fast casual trend. Others may complain about it, but it matches my lifestyle and sets a good middle ground on price. &pizza is the best example of fast casual in this region. Really awesome and ultra customizable food … More Oliver Borg 11 reviews a year ago Andre was super helpful! Fantastic late night spot, quick service, friendly staff, and good food. What more could you want. Dale L. Roberts Local Guide·52 reviews·118 photos 6 years ago This is the second &pizza I've gone to today and wow! This place is even better. There's more seating and it's not even busy. Well worth it! And the staff was friendly and attentive. 5+ stars Nibha Rastogi 7 reviews·2 photos 5 years ago ordered a craft your own... SO GOOD!!! The tribe were super courteous and I got what I wanted. Got a traditional with mushrooms, spicy Italian sausage, onions, pesto finish. Jordi Segura Local Guide·115 reviews·366 photos 7 years ago We ate in this pizza shop during our trip to Washington, and we found the pizza and drinks tasty and original. You can make your own pizza or order one of the existing recipes. I would recommend it for take out or a quick bite. Brandon Boone Local Guide·377 reviews·1050 photos 4 years ago Quick and delicious lunch, very filling and I'm a big guy. Definitely mix it up don't settle for cheese and pepperoni... Never thought I'd have honey on a pizza. &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We're thrilled to hear that you enjoyed our unique pizza options. Your response is important to us as we strive to improve our services. We hope to serve you again soon with more delicious and filling options! ROBIN THOMPSON Local Guide·94 reviews·221 photos 6 years ago I love this place! They have a great pizza selection . I love their specialty sodas. Try the cream soda. There is a wait though due to their being only one person to ring up your order and box your pizza. T Williams 9 reviews 4 years ago Best way to order a to go pizza is on their website. After a long day of sightseeing, a couple of their ""oblong"" pizzas was just right. Thin crust was great, toppings good. Prepared quickly. &pizza - Dupont (Owner) 4 years ago Thanks for the review and for stopping by, T! Ashley Craft 4 reviews 2 years ago I love The Dupont Team everyone is so nice Tay always goes above and beyond for the customers amazing customer service!! DuPont Team keep up the great work!! Jelani Phipps 8 reviews 2 years ago Food is so delicious. The manager Delonta gave me supervisor service. I would definitely go back again. You won't be disappointed!!! Nely Hernández 2 reviews·1 photo 10 months ago Love this late location . Super busy They are still very patient with customers. Lance Porciuncula 1 review 2 years ago The workers there are super friendly and nice. The service was also pretty great. Got my pizza with little wait. Ismail Gomaa Local Guide·364 reviews·1240 photos 7 years ago Some of the best pizza I've ever had. Any combination worked because their ingredients are absolutely perfect. I enjoyed everything I've tried there, even the stuff I don't usually like. Sarah Semlear Local Guide·154 reviews��·1292 photos 5 years ago The gluten free crust is pretty good! It's not a completely gf environment so they can't guarantee there is no cross contamination, but they are careful and change gloves when handling the gf crust. The options are fun and there is a good amount of toping choices for build your own. 1 &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We understand the importance of providing a safe environment for our gluten-free customers and we're glad to hear that you appreciated our efforts. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Michael williamson 9 reviews a year ago Take out | Lunch | $10–20 Pizzas are not that good and one of the workers not that friendly pizza crust had sir burnt from dirty oven … More Jennifer Telfort 4 reviews 2 years ago The service is great! Thank you so much for making my pizza just the way I like it!! I will be back again!!! Hailey Gruch 7 reviews a year ago Take out Wonderful experience... it was busy but they made me feel at ease... wonderful service... thanks to Quan, Malik, Justin and faith William Minter Local Guide·85 reviews·79 photos 7 years ago Thin crunchy crust that isn't overcooked. Awesome fresh toppings and sauce. Perfect for lunch or later night special. Not the best place to sit and eat as space is limited inside(20-25 at best) Cameron Asgharpour 1 review 2 years ago Great customer service and staff is very attentive. Pizza was awesome LadyLewis 2u Local Guide·17 reviews·15 photos 5 years ago &pizza is my fav pizza, but unfortunately, I experienced the WORST, not just customer service, but attitudes EVER! When I asked for assistance, I was only given the 202 number they have taped on the glass display. It was weird bc 2 … More Angel Aguiluz 1 review a year ago Tay is a hell of a entrepreneur! A lovely lad, Marcia also made an astonishing pizza with Nikko. 10/10 if you’re near Faragut North Rakia Pinkney 3 reviews 2 years ago The staff are very friendly and the food came out great and in a timely manner. I will be back, this is the best &pizza location! Dante Gardner 1 review 2 years ago I had an amazing experience. Antonio, and Roshan were very accommodating to my child who is particular about his pizza topping’s . 1 Scott Jason Local Guide·38 reviews·46 photos 4 years ago Thin crust pizza was very tasty and filling. I had red sauce with fresh mozzarella, tomatoes and onions. They do have a gluten free crust for $3 extra. 1 Chris Morris Local Guide·49 reviews·25 photos 4 years ago Pizza was way better than expected. Really nice staff. They were able to get people in and out quickly. I will definitely be returning. 1 &pizza - Dupont (Owner) 4 years ago Thanks for the review :) Raynell Jackson 26 reviews·26 photos 4 years ago I pizza and staff are wonderful Photo 1 in review by Raynell Jackson Photo 2 in review by Raynell Jackson Killian Devitt Local Guide·128 reviews·541 photos 8 years ago What's not to like about this place? It's just great, simple pizza. Tried the Maverick the first time I went and I haven't ordered anything else since. Perfect for lunch if you can avoid the rush. &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We're thrilled to hear that you enjoyed our Maverick pizza and that it's become your go-to choice. We appreciate your support and hope to serve you again soon. Your response is important to us as we strive to improve our services. taliyah hughes 4 reviews 2 years ago Great customer service, quick service! FOOD IS AMAZING! My favorite spot to come after a drunk night 🤪. Highly recommended Mo Love 38 reviews 3 years ago I went in there for the first time a couple of weeks ago. The restaurant had a really foul odor and I could smell it through my mask. Although, I ordered a pizza online and picked it up, I did not eat it and I will never go back to that pizzeria. 1 &pizza - Dupont (Owner) 3 years ago Thank you for taking the time to share your feedback Mo. Our management team will be looking into the odor that you are referring to for the Dupont location. I'm sorry to hear that the experience did not meet your expectations and I would like to apologize for this. Chris Oliver Local Guide·17 reviews·1 photo 8 years ago Great customisable pizza in a relaxed atmosphere. Their home made cola is to die for and so much tastier than coke or Pepsi. Only criticism is that the music was way too loud. Amanda Neilson 6 reviews 2 years ago Great experience! We had a large group and they were fast and efficient. Love the pizza! Breasia Lawson 5 reviews·1 photo 2 years ago Labella made my pizza so good and had the best costumer service ever, he was very bubbly and pleasant and Met all of my demands because I’m a very picky eater lol he’s the best Adriana Lopez 5 reviews 11 months ago Great service! Everything was on point! Andrew was very attentive and polite! Thank you 😃 Merlin Tondji 2 reviews 2 years ago This place is great . Unfortunately last night we couldn't custom the pizza however the team still amazing Briana McKellery 9 reviews·5 photos 2 years ago Beat servers best pizzas and my fav location but all are great. Definitely suggest stopping here for a late night craving after a night out! Tiffany Dendy 3 reviews a year ago Dine in | Dinner | $20–30 Wave and Twan provided excellent customer service on my visit. Gloves were changed prior to assisting us Thanks guys ! Micheal Stone 2 reviews 2 years ago Team was friendly with great service. Pizza came out great! Will continue to come back Forrice Brunson 1 review a year ago Courteous and professional staff members. My order was completed without issues. It was fresh, hot, and the toppings were 🤌🏽. Saee’Rozay 1 review a year ago Take out | Dinner | $10–20 First Time At &Pizza . Great Service By Andre ! Respectful & Kind . Will Definitely Be Back Especially At This Location Medachi 509 16 reviews 4 years ago This is the worst & pizza that I’ve ever been they don’t change their gloves. They got nasty attitude they should reconsider on hiring people there. If I’m paying $11 for pizza I should be treated with respect the customer service is terrible I can’t even tell them how I want my pizza to get done. 1 &pizza - Dupont (Owner) 4 years ago Hi Questa, thanks for the feedback. We'll be sure to address this promptly with the shop. Angel Angelov Local Guide·159 reviews·920 photos 4 years ago A bit dodgy place but pizza was perfect. They offer you to choose from anything you want to add to it and can make it as you like. Was really delicious. Not beer or any liquor though 1 Nataliya Kostiw 2 reviews a year ago Alonzo was amazing, he helped us with everything and was very polite and informative! Would definitely recommend! Simply, Tasha. Local Guide·130 reviews·244 photos 5 years ago Idk what the rating I'm assuming it must be great for I'm too drunk to realize food but let me tell you...today I walked in and walked out....the stench was crazy...it smelled like a dirty barn...or zoo...sewage...idk but I couldn't even order to go and I was just dissappointed... it is a super rainy day today.... 2 Kylie Gilbert Local Guide·19 reviews 7 years ago Could eat this every day for the rest of my life. Not a lot of seating inside though. Also check out ordering ahead, it's much faster. The sodas are good too! Josh Robichaud Local Guide·93 reviews·123 photos 8 years ago Great custom pizza at a reasonable price. Either the preset menu or build your own, can't go wrong. Plenty of seating and fast service. Andrew Isett Local Guide·185 reviews·230 photos 7 years ago Good pizza custom made the way you like. Similar to Chipotle with a burrito, &pizza allows for any toppings they have and different sauces. Always some left over too!! Ethan Granetz 3 reviews a year ago Take out | Dinner | $10–20 Andre got us food real late. He made an awesome pizza. 10/10 service J 4 Local Guide·131 reviews·64 photos 7 years ago Oh yes lawd. This pizza is so good and u dictate the toppings. Yum. Decent price for DC and a food serving size. Not glutinous but more than sufficient. Arely Castro 1 review 2 years ago Amazing service ! & the pizza was so delicious that I will come back again! Jimmy DeVault 15 reviews·1 photo 5 years ago Great food, concept and atmosphere. First time at this location and this may just be this location but service was super slow! The team here also seemed very disorganized, there was no designated cashier which caused a bottleneck at the register where everyone just stood. Maybe they were short staffed? 1 Destiny Cruz 3 reviews 2 years ago GREAT service! And even better pizza! This is my regular location Bc they never disappoint 😉 Punky Banks 1 review 4 years ago I had a great experience. Our cashier Diamond was kind, courteous, and offered great recommendations. I’ll be back soon. Overall great food and great service! &pizza - Dupont (Owner) 4 years ago Thank you so much for the great review Punky! We look forward to seeing you agin soon. Kevin S 3 reviews 2 years ago This is specifically for the website ordering experience. I typically pick up but I needed delivery and my nearby &pizza store was temporarily closed. The problem is that it is impossible to switch the store you're getting delivery from, or … More 1 &pizza - Dupont (Owner) 2 years ago Thank you for your feedback Kevin! I'm sorry to hear that this was your experience trying to order online. We'll flag this information over to our development team to fix. Najm Aldin 9 reviews 9 months ago Luis is very professional and he took care of me. Very nice guy Samantha Zarrilli Local Guide·25 reviews·2 photos 2 years ago Amazing service! So great. Lavelle went above and beyond to make us feel welcome. Promote him!! . Jeremy R. Stinson Local Guide·178 reviews·293 photos 4 years ago &Pizza is one of my favorite pizza joints in DC. Not all locations are created equal, but this particular location is always clean, the staff is friendly and helpful, and I never have to wait too long. &pizza - Dupont (Owner) 4 years ago Hey, Jeremy. Thanks so much for review! руня 11 reviews 7 years ago Great vegan options, (they have mozzarella daiya and veg meat crumbles)! Lots of fresh veggies, good unique gourmet choices of sauce too. The pesto is delicious. The price is reasonable for a vegan pizza, compared to zpizza which recently … More 1 Fabian Meneses 5 reviews a year ago Staying at a hotel close by this place has been our stop daily! From the friendly staff to the delicious food, you have to try this pizza! Mouhamadou Thioune 4 reviews a year ago I like eating at &pizza Dupont. The pizza is always on point. The place is always clean and Tay always provides good customer service. Reilly Sheehy 1 review a year ago They were so lovely - they gave me free water when my friend and I needed it most. 10/10 Ryan Norton 7 reviews 7 years ago I tried calling multiple times to have a question about their menu answered. Each time it automatically goes to a recording and it gives you the option to press ""2"" to speak to an employee. However when you choose that option the phone … More Geneva Kropper 4 reviews 4 years ago The pizza here is fine, but the staff is very rude and will let you stand at the counter without asking how they can help you. Very poor standard of hospitality and out of place in DC. nate porter 2 reviews a year ago Tay is the best. I love the customer service. He should be promoted. Nikko & Marciara are amazing and should also be promoted!! Isaiah Benjamin 3 reviews 2 years ago I always have a great experience, I work in the area the workers are always fantastic to chat with. Food is always delicious, my go to spot for lunch. Angelica Martinez Local Guide·54 reviews·115 photos 4 years ago Stopped by this place when in the area. Design your own pizza from scratch, and then customize it. The staff assemble your pizza as you watch ... you get to decide everything which goes on the pizza as you follow it down the line. We … More 1 Ariana Brown 3 reviews 2 years ago Very professional clean and made my pizza in a timely manner. Staff was perfect Levon Akopian 8 reviews a year ago Dine in | Other | $10–20 It was amazing and tasty Perfect pizzas, friendly crew … More Jamie Sneed 1 review 2 years ago Outstanding place, great service, Terrence was a huge help and help me build the perfect pizza for my first time!! Teezy Teez 2 reviews a year ago The establishment was amazing, Tay was very kind and ensured we were okay during our time at the restaurant. &pizza - Dupont (Owner) 2 months ago We're thrilled to hear that you had an amazing experience at our restaurant and that Tay took great care of you. Your response is important to us as we strive to improve our services. Thank you for the 5-star rating! We hope to welcome you back soon. kiara cooper 1 review 2 years ago I experience the best customer service with an employee name Lavelle! Definitely would recommend. The pizza was amazing !! Lisa Smith 5 reviews 2 years ago They have an excellent menu selection and you can add anything else you desire... or you can build your pizza from scratch... all at one reasonable price! Delightfully Delicious 👍 2 &pizza - Dupont (Owner) 4 years ago Thanks for the review! :) M A Local Guide·31 reviews·16 photos a year ago The vegan mozzarella and vegan sausage are amazing. To &pizza: please bring back the vegan chicken. Chris Anderson Local Guide·36 reviews·182 photos a year ago Not extremely friendly but excellent excellent pizza. The dough is the best part. 1 Sachin Bhattiprolu 2 reviews a year ago They take orders beyond 10pm but you cannot eat there because they close at 10pm. People here were incredibly rude and forcibly removed chairs WHILE 10+ people were trying to sit and eat. Incredibly rude place. Blue Moon 4 reviews 7 years ago literally the best pizza i've ever eaten. i had the vegan options. they were incredible.staff was really nice. would recommend to everyone. It’s Me Local Guide·381 reviews·169 photos 7 years ago As usual, friendly staff. First time at Dupont location, but just as good as the H St one. … More &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We regret that we no longer offer San Pellegrino and apologize for any inconvenience caused. Your response is important to us as we strive to improve our services. We appreciate your feedback and hope to see you again soon! Quennitta Winzor 1 review 2 years ago The manager is wonderful and fast. But I feel like they were catering to the white people. I almost felt invisible. Darlene Craft 4 reviews 2 years ago I love coming here the manager Tay always knows exactly what the customer service at DuPont is beyond amazing :) Sinceree Stewart 2 reviews·1 photo 2 years ago Great customer service and very patient. Photo 1 in review by Sinceree Stewart lizzle thrvxxx 2 reviews a year ago Andre was very helpful I been goin here for about and year and the customer service is great 10/10 Jas 3 reviews 2 years ago Best pizza I’ve ever had and the workers are the nicest people ever!!!! Come here for a quick bite! &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We're thrilled to hear that you enjoyed our pizza and had a great experience with our staff. Your response is important to us as we strive to improve our services. We hope to see you again soon for another quick bite! Jalen Dixon 1 review a year ago Great service and very reasonable prices! The pizza is also prepared very quickly! Candice Mulholland 4 reviews 2 years ago Terence was awesome! They are always quick and so friendly when I’m in there. 10/10 on the pizza too 😊 Tim Larkin Local Guide·72 reviews·226 photos 5 years ago Damn, this is good pizza Photo 1 in review by Tim Larkin Ron Hagage Local Guide·87 reviews·83 photos 5 years ago Subpar and overpriced pizza place. Compared to u street pizza joints, this place is trendy, hipster and serves mediocre pizza at best. … More 1 Dj Teck Entertainment 1 review 2 years ago Quick and easy. Best pizza I’ve every had. Especially after the club. Will be back Adam Christensen Local Guide·71 reviews·326 photos 8 months ago No way to reach the store and UberEats never delivered my food. … More Erika R. Local Guide·50 reviews·18 photos 5 years ago Reminds me if Blaze. Make your own pizza and craft soda, but some of those toppings should. DEFINITELY go on the pizza as it's being cooked not at the end. Beyond the Clubhouse 1 review a year ago The staff here did a great job, very attentive and engaging. Especially Antonio. A wonferful customer experience! Ryan Local Guide·12 reviews 2 years ago Take out | Dinner | $10–20 Made a mistake when placing my order online and Antonio was awesome helping me get it corrected quickly and courteously. Will Return! … More Alfredo Schonborn 3 reviews a year ago Dine in | Dinner | $10–20 This place was a fantastic establishment to eat with quality food. A recommendation to everyone Ryan Dudrow 1 review 2 years ago Great service for an amazing price for a whole pizza awesome employees 10/10 would recommend Briana Jones 1 review 2 years ago I go to this location all the time! Great customer service and the pizza is always perfect! Haylee Smith 1 review a year ago Awesome pizza & employees. Has original drinks that all taste good! Justin Adams 8 reviews 4 years ago 1st time here. The food was great and the price was right. No complaints. Wish I had found this place sooner. Trip Taker 117 reviews·58 photos 2 years ago I'd like to give it a .5 star. Says that it's open but door is locked, lights are on and you can see employees inside working. Stephen Oliver Local Guide·13 reviews·17 photos 6 years ago Greeted by smells of rancid food or trash when entering. Smell intensifies as you walk further in. Trash everywhere and dirty tables. Bathrooms out of order. … More William Nelson 2 reviews 2 years ago great location! everyone here had great service and the pizza was good! 🙌🏽 Clementina Fernandez Valle 4 reviews·7 photos 2 years ago Great service and really quick. The pizza was delicious and the place is really nice. Jade Boone 2 reviews 2 years ago Staff was very friendly and efficient with taking customers orders in a timely manner! Will definitely visit again Quita11 2 reviews a year ago Terrence was awesome!!! He answered any question I had and did it with a great sense of humor. Marcus Smith Local Guide·115 reviews·5 photos 3 years ago The staff was polite, and efficient this staff is prepared for lunch rush, I even got a bottle of water Since I do a lot of delivery work, I really appreciate these things. 1 &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating and positive feedback! We're glad to hear that you had a great experience with our staff and that the service was efficient. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Marissa Amore Local Guide·57 reviews·13 photos 5 years ago It’s pizza & it’s good. Need I say more? Great location by clubs and night life. Great place to grab a bite on the late night Michael Smalls 2 reviews 2 years ago Fantastic experience! The service was excellent and I love their pizza. &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We're thrilled to hear about your fantastic experience and love for our pizza. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Hycent Nwaneri 1 review 2 years ago Great service!! Antonio really helped me and made sure everything was taken care of for me! Definitely will be back. &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We're thrilled to hear that Antonio provided great service and made sure everything was taken care of for you. Your response is important to us as we strive to improve our services. We look forward to welcoming you back soon! Alan Harris Local Guide·151 reviews·259 photos 6 years ago It was late when I went but it was still a great pizza. I could tell the associates were ready to go but appreciated the pizza. Will come again. Isaiah “Zay” West 1 review 2 years ago We came on Christmas Eve and the service was phenomenal! Antonio and Brian were great! Thank you &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We're thrilled to hear that Antonio and Brian provided phenomenal service on Christmas Eve. Your response is important to us as we strive to improve our services. We hope to have the pleasure of serving you again soon. Ryan Stevens 10 reviews 4 years ago Truly the worst experience . The all male staff associated with the shift on December 6th, at 12:22 am was extremely rude. Customer service was just extremely poor. &pizza - Dupont (Owner) 4 years ago Hey Ryan, I'm really sorry about your experience. We'd love to hear some more details about it if you can reach out to us on our text line, 200-03. Aja Clark 11 reviews 2 years ago Service was excellent! Came to this one because the one in Georgetown was closed. Brian and Antonio were really helpful and pleasant. Beverly Barber 4 reviews·2 photos 2 years ago The staff was very helpful with everything I needed and also made sure I was safe by giving me a mask to protect myself❤️ Patricia Babb 7 reviews 2 years ago Staff was very friendly and accommodating and the pizza was exceptional. Great location :) stefanie riggins 5 reviews 7 years ago Amazingly friendly staff! Our first dining experience in DC and we plan to hit them up again!!! Fresh deliciousness! LynDale Lewis Local Guide·159 reviews·358 photos 4 years ago Good pizza... one size, so be prepared to share if you don't easy a small pizza yourself. Simple menu. &pizza - Dupont (Owner) 4 years ago Hey there! Thanks so much for the love. We always appreciate our loyal fans. Renuka Joshi 3 reviews a year ago Dine in | Dinner | $10–20 Great pizza made quickly. The team working here is super nice. tomas moser 2 reviews 2 years ago Wonderful pizza great especially after a night out. Definitely recommend. &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We're glad to hear that you enjoyed the pizza, especially after a night out. Your response is important to us as we strive to improve our services. We hope to serve you again soon. Vanessa Jimenez Local Guide·49 reviews·8 photos 7 years ago Add your favorite toppings to an amazing crust with eclectic soda flavors for a good price. Comfortable, casual atmosphere. Nista Bob-Grey 1 review 2 years ago This &pizza location is great , the staff was super friendly and I got helped really quick! Stephanie Becker Local Guide·70 reviews·76 photos 5 years ago Different pizza place. Still liked it, one pie can feed 2 people if your not real hungry. Unique combinations. 1 Richo Local Guide·18 reviews·24 photos 4 years ago Delicious pizza, Maverick with extra cheese wont dissapoint any meat lover. Open until late is very helpful. &pizza - Dupont (Owner) 4 years ago Good choice with the Maverick Ricardo! Definitely a fan favorite. Thanks for the great review too! Chris Meaclem 4 reviews·1 photo 7 years ago Only $10 for any pizza, custom made. Basically the subway of pizza - choose your base and any toppings. They charge a flat rate, not per topping. Alex B. Local Guide·190 reviews·277 photos 7 years ago Love &pizza. This place stays open late on the weekends but is pretty full of drunk club goers. Still, it hits the spot after some dancing. robert brown 1 review 2 years ago Service at this location was the best I’ve had at any in the DMV area! Definitely will be going again. Amir Ghasdi 11 reviews·15 photos 5 years ago I built my own Pizza: pesto and spicy tomato, mushroom and Tomato, whole mozzarella, Italian sausages, beef, and finishing with goat cheese and arugula and for sure garlic oil!!! Tenija Livingston 1 review 11 months ago Dine in | Lunch | $1–10 Amazing!!! The workers were welcoming and very cheerful. 10/10 Kalaa 3 reviews 2 years ago Very fast pace store love how my pizza tastes perfect every single time. Brendan M. Local Guide·95 reviews·31 photos 5 years ago The pizza is fantastic. the employees are not. I got the feeling they didn't not care about the job or product they were giving customers. Allen Local Guide·288 reviews·819 photos a year ago Very poor service here. I was the only person in line and the employees did not even acknowledge me. They were having a conversation amongst themselves. Dog Matic 1 review a year ago Fast Great service from the two brother working feb 4 at 6pm Danielle Carr 2 reviews 2 years ago The guy who made my pizza made sure it was done right like forreal lol didn’t skimp me and it looks delicious Halio J 16 reviews 5 years ago Terrible customer service. Staf will rush you and slap together a terrible job of a pizza. Management no better. No wonder employees are terrible, management is even worse. Nadeen Siddiqui 6 reviews 5 years ago Terrible service. They just threw toppings without caring about making it tasty. Don’t waste your time and money here. Chose a place that actually tries. 1 Cory Simmons 1 review 2 years ago I got food poisoning. No disrespect to the workers, but my stomach hurts so much and I’m so mad lol. Thompson Hangen Local Guide·36 reviews·9 photos 4 years ago Fast and great pizza! What's not to love about &pizza? The staff here are friendly and accommodating! Christy McCann Local Guide·48 reviews·18 photos 2 years ago Food was not made correctly and a bit late, the secjrry staff is super rude, but employees were nice. Cavin Ward-Caviness Local Guide·319 reviews·769 photos 6 years ago Fresh, quick, tons of toppings, and most importantly tasty. If you have the chance definitely go to one of the many locations and see why all the hype is deserved Esprit Cha 2 reviews a year ago Amazing pizza, amazing service, awesome experience as a whole m g 11 reviews a year ago We bought a pizza and we’re immediately screamed at and tossed out for eating it inside. Like what? The moment I hand you cash you throw me out. I can’t eat my pizza inside? &pizza - Dupont (Owner) a year ago Hi Max. Sorry to read about your experience. Can you text us at 200-03 to provide more detail. Edwin Lopez 5 reviews·2 photos a year ago &pizza is my all-time favorite for a fast casual -- and delicious -- pizza. This location is a mainstay, too! R. T. Local Guide·16 reviews 7 years ago This place was gross!!! Trash everywhere and it smelled pretty bad. There's definitely better &pizza's to go to in DC. I went in and came right back out! 1 Rebecca Schick 32 reviews a year ago Take out | Dinner | $10–20 Very tasty pizza. Staff were great JED CREEK 8 reviews 7 years ago Do not ever go here it's terrible. My friend got food poisoning, so it's not safe to go here. And the management and the staff are terrible and refuse to take responsibility. Avoid this place at all costs! Monae' Bailey 4 reviews 2 years ago Antonio was very helpful, assisted me with ordering my meal. 10/10 would recommend! Kelli Smith 3 reviews 2 years ago I always get the best service here. I live &Pizza and Terrence is great!!! Emily Nelson 1 review 4 years ago Amazing, charismatic staff and even better pizza!! Very creative and innovative pizza and drink choices :-) Josiah Tomes 4 reviews·2 photos a year ago Staff is very nice! Photo 1 in review by Josiah Tomes GLENN EVANS Local Guide·41 reviews 4 years ago DONT WAIST YOUR TIME.OR.MONEY. PLACE WOULDN'T LAST A WEEK IN JERSEY. FIRST I TRIED TO CALL AND THEY DONT TAKE CALLS U HAVE TO ORDER ONLINE OR … More 2 Gucci simon Local Guide·64 reviews·4 photos 4 years ago Food was great. The service was horrible. Only 2 ppl in the store had some manners. The REST HORRIBLE. &pizza - Dupont (Owner) 4 years ago Hi Gucci. Thanks for the feedback. We're sorry that your experience was below expectation. We'll be sure to relay this message to the Shop Lead so that improvements can be made asap. Alyse Edwards 2 reviews 2 years ago Friendly, polite and helpful staff. Pizza is good too duh! C Michele 1 review a year ago Staff is dope. Pizza is delicious. Big fan! Lauren Prather 2 reviews 2 years ago Friendly and helpful! Quick service and the food is 🔥🔥! Lavelle was amazing and super helpful! Amazing customer service! Austin Zielman Local Guide·437 reviews·1539 photos 7 years ago Great pizza served super fast! Downside is that it's directly next to/under sa club, and the constant thumping is quite disturbing. Billy Local Guide·207 reviews·404 photos 7 years ago Cool spot for a flat bread pizza. You make your own pizza which is pretty cool. The price is reasonable one pizza is good for 2ppl. Kenny Culver Local Guide·14 reviews·1 photo 4 years ago pizza was so spicy I couldn't eat it I took it back in I said hey I need a new one I don't know why it's spicy they said tough s*** bounce &pizza - Dupont (Owner) 4 years ago Hey there! I'm so sorry to hear about your bad experience. If you get a chance, please text us on our customer service line at 200-03 and we will make this right. Priya Patel 2 reviews 2 years ago Loved it! Everyone was so accommodating and understanding! Great pizza! Emir Yılkıcı 5 reviews·3 photos 7 years ago They simply blend some cheap ingredients. The food tasted not that good. I don't recommend unless everywhere else is closed. Johnny Neilson 2 reviews 2 years ago Dine in my family loves this place! very good food and friendly staff! Luis Medina (COACHMETONY) Local Guide·97 reviews·324 photos 6 years ago Great food! I'm vegetarian and I had a lot of options here. Only thing is that serving sizes are really small. Chiquita Jackson 1 review 2 years ago Great food and quick service! Loved the garlic knots too. mike epps 3 reviews 2 years ago Great quality pizza, fast and friendly customer service. Dylan McDowell Local Guide·138 reviews·79 photos 7 years ago Best option for a pizza lunch in D.C. This location has more indoor seating, but during prime times be prepared to walk to a nearby park. Kay Tunez 1 review 2 years ago Quey was great and very helpful since it was my first time she made my experience 10 times better. Derrick A. Morton 2 reviews 2 years ago The coolest & Pizza in the DMV everyone in there will make you laugh ! Thank you for my good 🍕 DK Walker 7 reviews 6 years ago Best pizza ever! Far from traditional tasting pizza, leaves a funky delicacy in your mouth that leaves you beyond satisfied! Renee S. Local Guide·55 reviews·4 photos 7 years ago Pretty good! The prices are reasonable (listed at the top of the menu) and pizza is delicious! I ordered the gnaric... good choice! Tray Smith 4 reviews a year ago Great place. Jainyn was great cook. She was nice and quick. Music for every ocation Local Guide·6 reviews·334 photos 5 years ago I love these pizzas Photo 1 in review by Music for every ocation Christopher Edwards 2 reviews 2 years ago I had the best experience. Customer service was A1 and the food was awesome Pauline Abah 1 review a year ago When back to this place after my Last visit and the service is always amazing Nicholas Mildebrath 1 review 2 years ago Go-to lunch spot in DuPont. Pizzas are great and filling - quick service and always good music. Tustin Neilson 6 reviews 2 years ago Dine in | Lunch | $10–20 Quick service and tasty pizza! I recommend adding the hot honey. … More helene h 1 review a year ago Delivery | Dinner Super good pizza, delicious drinks, love it <3 &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We're thrilled to hear that you enjoyed our pizza and drinks. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Jimmy Sambuo 6 reviews·7 photos 2 years ago Fast and friendly service! &pizza is my goto pizza place. Marquis Savant 1 review a year ago Delivery | Lunch Waited over 30 min for a delivery while the employees traded food with shake shack Gabriel Marín 7 reviews·1 photo a year ago Lovely place and pizza is great!! Tay was a complete gentleman. &pizza - Dupont (Owner) 2 months ago We appreciate your 5-star rating! We're glad you enjoyed the pizza and the service provided by Tay. Your response is important to us as we strive to improve our services. Thank you for taking the time to share your experience with us. Messaijah Shillingford 2 reviews a year ago The food was great! Tae gave wonderful customer service! &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We're thrilled to hear that you enjoyed the food and received wonderful customer service from Tae. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Donald Jackson 7 reviews a year ago Dine in | Lunch | $10–20 Love how the pizza is made on the spot, fresh ingredients and creative mixes Talisha Harris 4 reviews 2 years ago Terence was great! Ever want great pizza and good vibes, come to Dupont location! Corey DeAngelis Local Guide·204 reviews·623 photos 7 years ago Best custom pizza ever Photo 1 in review by Corey DeAngelis Frankie B 1 review 2 years ago Absolutely love this place. Service is quick and food is great Kaylah B Local Guide·48 reviews·18 photos a year ago Take out | Dinner | $10–20 Super fresh, super quick service even though it was very busy! Anna zakharchishin 1 review a year ago Other | $10–20 Alonzo was the absolute best. Should definitely be running the place! Baylee Childress 2 reviews 5 years ago Love this place. Always delicious. Staff is always friendly. Tyler is a bit of a Chav. Tsvetelina Petkova Local Guide·99 reviews·147 photos 4 years ago Really kice and tasty pizza. Affordable price and you choose your topics. Basically you choose your pizza from scratch. Yummy. &pizza - Dupont (Owner) 4 years ago Glad you enjoy the concept Tsvetelina! And thanks for dropping a review! Steve Murphy Local Guide·43 reviews·417 photos 5 years ago Good, quick pizza while you wait. Not as good as wood burning oven etc, but satisfies... James Papanestor Local Guide·88 reviews·574 photos 2 years ago Thin crust and the choices for the toppings are not like any other! Went three times in one week. Tarikah Omar 3 reviews 6 years ago Pizza was fantastic, service was awesome, there was an unpleasant odor when entering that definitely needs to be addressed 1 Javier Borja Local Guide·19 reviews·1 photo 5 years ago Love the food, large space with plenty of seating. It's not a warm place but in great location G Local Guide·116 reviews a year ago Food was good staff was friendly and helpful. … More Amar-Jyrel Mott 2 reviews 2 years ago I love it! Staff is nice & I've never had a bad experience! N K Local Guide·98 reviews·38 photos 6 years ago The best build to suit pizza joint I've tried. Light years ahead of blaze on quality of ingredients. Gahana Dahiya 6 reviews·1 photo 3 years ago I go to this place all the time! Food is great and the staff is always nice. &pizza - Dupont (Owner) 3 years ago Thank you so much for the review and thank you for being a returning guest! Can't wait to see you again next time! Patrice Mobitang 1 review 2 years ago Great pizza. My familly and I love this location Yuting (Nychii) Local Guide·114 reviews·1683 photos 7 years ago Really enjoy the way this chain makes pizza! This location doesn't have a lot of seating though... Sakina Allen 2 reviews 11 months ago great customer service!!!! definitely recommend. George A 1 review 2 years ago Ordered waited for 2 hours and then my order was canceled. They asked me to reorder. It was my first time ordering from them and my last time. TEAM SHERBOURNE Local Guide·405 reviews·284 photos a year ago I'm from NY and Always have to visit a &pizza while in DC! &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We are thrilled to hear that you always enjoy visiting &pizza while in DC. Your response is important to us as we strive to improve our services. We hope to continue exceeding your expectations on your future visits. Carlos Patiño Local Guide·168 reviews·431 photos 4 years ago Really, good pizza! Just pick what you want with it and enjoy. Friendly people. &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We're delighted to hear that you enjoyed our pizza and found our staff friendly. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Erica Burwell 4 reviews 6 years ago The service was good food is normal. If u r n the mood for pizza good place to go. Aris Preston 2 reviews 2 years ago Pizza is great Antoni and Bron were very helpful and lead to a great lunch. Weiyan Zhang 2 reviews 2 years ago I quite like the pizza here! Self designed pizza is always the best big boi rj 1 review a year ago Take out | Dinner Awesome establishment, good service, tasty pizza Bryan Moises Hernandez Benitez 1 review a year ago the crust is the best and the staff are great, down to earth people. Courtney Metcalfe 5 reviews 2 years ago Lavelle was awesome and gave us great service! awesome pizza Jennifer Morgan 6 reviews a year ago Take out | Dinner | $10–20 Great option for a quick / delicious late night dinner. … More James Gregory 2 reviews a year ago Good pizza great people!! Great late night fix &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We're thrilled to hear that you enjoyed our pizza and our service. We're always here to satisfy those late-night cravings. Your response is important to us as we strive to improve our services. Ms Lola 2 reviews 2 years ago Antonio was the best I love how he makes my pizza, I absolutely love this location. Adeola A 11 reviews 4 years ago The pizza is fine, they don't allow you to sit down and eat late nights on the weekend, although they are open, and the security is very rude about it. Joni Hurley 3 reviews·1 photo 5 years ago Pizza was amazing!!!! One of my best GF pizza crust (order well done) Tat hazelton 4 reviews 2 years ago Good Customer Service, Fast Paced & Loaded Pizza Up. Joseph Rhinehart 11 reviews·1 photo 2 years ago Friendly staff. Great food . Will definitely come back. AHMED RABANE 2 reviews a year ago Always great customer service. Terence is definitely a great asset for this location Kendi Johnson 1 review 2 years ago Lavelle was very professional. He put love into my pizza Justin Wang Local Guide·92 reviews 7 years ago Make your own pizza for $9? As many toppings/sauces/garnishes as you want?? I love &pizza. Tahlia Stangherlin 8 reviews·4 photos a year ago Tay was very helpful when i checked out today. very polite and friendly ! Nisha P 6 reviews·1 photo 2 years ago Great experience! Quick and convent! It’s a must try if you are in D.C. Pooja Rastogi 5 reviews·2 photos 2 years ago Love the pizza and employees!!!!!! So so nice especially lavelle Jake Backers 3 reviews a year ago This place is the best!! also the pizza??? smashing!!! Chanel Beaudoin 1 review 2 years ago Great pizza love it here. Loved the service! Allen Cardenas Local Guide·42 reviews·10 photos 5 years ago So glad there is an &pizza in Dupont. It's quick, easy, and delicious. Awesome value for your money Chanelle Combs 1 review 2 years ago Antonio the best I love this location best pizza and they close at 4am Clifton McEachin 3 reviews 2 years ago Great service!!!! The best pizza I’ve ever head!!! Lucas Orjales 2 reviews a year ago Tay was the best supervisor! Absolutely delicious pizza! Antwane Wrenn 1 review a year ago I love this location .employee are fun and patient Kristin Fillingim 1 review 2 years ago Là elle was the best!! Great service. 5 out of 5 every time!!!! &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We are thrilled to hear that you had a great experience with us. Your response is important to us as we strive to improve our services. We look forward to serving you again soon! Jackie Warner 2 reviews 2 years ago Great service and pizza! Antonio, Brianna and Jalen are the best. Veronica Sarai Melara Cornejo 1 review a year ago Good customer service! Friendly people and always willing to help. Lifeasevon 6 reviews 2 years ago The pizza is always great ! Extra crispy too David Oliveira 4 reviews 2 years ago Take out | Dinner | $10–20 Love their pizza, clean and nice location miles vondra Local Guide·10 reviews·12 photos a year ago Great pizza, even better people. JP was great! Yousif M Local Guide·26 reviews·3 photos 5 years ago Lots of crust on the pizza because of how it's made. Super fresh and feels almost healthy! Lauren Hastings 1 review 2 years ago Take out | Dinner Service was great and the vibe even better! Lavelle’s assistance was top notch Precious Johnson Local Guide·25 reviews 2 years ago Service was great at this location! Food was delicious 😋 Kannan Ramanathan Local Guide·73 reviews·27 photos 4 years ago You can just add all the ingredients you want and the dough of the pizza is thin and delicious &pizza - Dupont (Owner) 4 years ago Hey Kannan, glad you loved it! Come again soon! Al S. 1 review 2 years ago Outstanding service and made one hell of a pizza Delonte Briggs, MBA Local Guide·48 reviews·18 photos 4 years ago Staff was not welcoming and had the dude had an attitude when clarifying build your own versus a classic adding a few extra toppings...it didn't master i was willing to pay the difference.. 1 &pizza - Dupont (Owner) 4 years ago Sorry to hear that your pizza experience wasn't the best. Thank you for your feedback. I will forward this information to the appropriate people. Please reach out to us so that we can make this right. A'Jae Boyd 2 reviews 2 years ago Great customer service. Order done in a timely fashion. &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We're thrilled to hear that your order was delivered in a timely fashion. Your response is important to us as we strive to improve our services. We hope to serve you again soon! John Benson Local Guide·23 reviews·183 photos 4 years ago Customer service at this location is atrocious. The crew working the evening shift on 2/28/20 were very rude. Stay away! Dallas S. Local Guide·101 reviews·89 photos 5 years ago My first pizza in DC. Quick service and great good at a decent price. Jordhon Horelien 2 reviews 2 years ago Lavelle was an excellent help to getting the pizza of my choice. Very helpful &pizza - Dupont (Owner) 2 months ago Thank you for taking the time to leave a review. We are thrilled to hear that Lavelle was able to assist you in getting the pizza of your choice. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Courtney Wade 4 reviews 2 years ago Labella is awesome. He goes the extra mile. Thank you! Dusan Vasiljevic Local Guide·50 reviews·25 photos 4 years ago Excellent suggested choices of toppings, quick service, good enough interior. Mig Local Guide·581 reviews·590 photos 6 years ago Love this pizza: Favorite go to - Red sauce with pepporoni and sausage drizzled with pesto on top. Mercedes White 3 reviews 2 years ago Phenomenal experience with Antonio and the rest of the staff. The place was very clean! Kate Neilson 3 reviews 2 years ago Dine in | Lunch | $10–20 love & pizza! come here often and always enjoy it. … More KDASH201 14 reviews·1 photo 7 years ago Best pizza I ever had. You just have to go and try it yourself Debbie James 8 reviews 2 years ago Ran efficiently under pressure during Halloween eve and Lavelle was very helpful Bosh Gobran Local Guide·304 reviews·695 photos 7 years ago Great Pizza, fast and they have a vegan/vegetarian options:) fund staff Smash Diddy 5 reviews 6 years ago Service was good and food great who dnt love pizza lol &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We're glad to hear that you enjoyed our service and food, especially the pizza. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Heidi Wiles Local Guide·25 reviews·2 photos 7 years ago I just love the the atmosphere the people are great and the pizza is delicious. Need one in Hagerstown MD. hector paredes Local Guide·51 reviews·712 photos 2 months ago I love this Pizza … More &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We're thrilled to hear that you love our pizza. Your response is important to us as we strive to improve our services. We look forward to serving you again soon. Justin Bozeman 3 reviews 5 years ago Ordered via Uber Eats, Pizza came completely wrong from what was ordered, and added whatever they wanted to the pizza and when called , no one answers the phone and call was looped, no one ever responded to my e-mails regarding the wrong order 1 Alana Peery 6 reviews·13 photos a year ago Great pizza and better service! Kunal Vijan Local Guide·117 reviews·505 photos 4 years ago Very nice n tasty. Much better than DC Pizza James Plain Local Guide·9 reviews 5 years ago i tried the american honey pizza, and was great! The craft sodas are also really interesting! danelle hankins 8 reviews 2 years ago Antonio made me a great pizza today and answered all my questions. Fly Gurl Local Guide·193 reviews·271 photos 4 years ago The staff was great they are very customer service driven , fast , and very clean Rodolfo Diaz 1 review a year ago Great Place! Awesome customer service! Dean Naps 2 reviews a year ago Awesome pizza, great service, thank you &pizza! EBEMBI Alain 3 reviews 2 years ago Great location. Staff are really friendly and patient Robin Young 5 reviews 5 years ago Fantastic pizza and an AMAZING staff!! I could eat there everyday!!’ Javid Pourkia Local Guide·128 reviews·1295 photos 5 years ago It's not just food, is love Photo 1 in review by Javid Pourkia Petra Sosa 2 reviews·1 photo a year ago Best pizza in town , customer service is A1 ! Photo 1 in review by Petra Sosa khairy jones 3 reviews 2 years ago This was a great place to go late at night and it handled the long line well Alvaro Dalessandro Local Guide·44 reviews·3 photos 4 years ago Tasty pizza, only downside is the place didn't have Coca-Cola Money Monkey 1 review 2 years ago lavelle was extremely helpful and made sure i was set and provided good service Living the life of lele Vibing 12 reviews·2 photos a year ago Great customer service made me feel welcome &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We're thrilled to hear that our customer service made you feel welcome. Your response is important to us as we strive to improve our services. We hope to continue providing a great experience for you in the future. Abish Anklesaria Local Guide·94 reviews·53 photos 7 years ago Fresh pizza. Good toppings selection. Kid friendly as well. Great place for a fast custom pizza. Rob G Local Guide·151 reviews·301 photos 2 years ago First visit. Fast service, excellent pizza! Matt Peterson 2 reviews 2 years ago an icon, a legend, showstopping beautiful amazing never the same the best &pizza in DC Eric Midder Local Guide·146 reviews 4 years ago Could be a little quicker but very friendly staff and great pizza! Sandra Gaillardetz 4 reviews 5 years ago This Pizza was phenomenal ! Loved it and would definitely go back!!","Only provide commentary from the context included.
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+&Pizza Google Reviews Josh Local Guide·316 reviews·113 photos a month ago Ordered online and my receipt had no details confirming my items. I text them like they said and they never responded. Then they have Uber do the order delivery but I didn't know that before putting the tip in and then the driver said he … More Photo 1 in review by Josh Photo 2 in review by Josh &pizza - Dupont (Owner) a month ago We regret to hear about your experience with the online ordering and delivery process. Your response is important to us as we strive to improve our services. We will address the issues you've mentioned with our team to ensure a better experience for all our customers. Thank you for bringing this to our attention. Gine “Gine The Mae Nai's Winery” MaeNaiWinery Local Guide·369 reviews·5043 photos 3 months ago Dine in | Dinner | $10–20 Such a lovely freshly made pizza with various options, really hard time to decide which one to order lol. Very fast and nice service. Pizza just got ready in 8mins. Have two long tables to enjoy, or take away. … More Photo 1 in review by Gine “Gine The Mae Nai's Winery” MaeNaiWinery Photo 2 in review by Gine “Gine The Mae Nai's Winery” MaeNaiWinery Photo 3 in review by Gine “Gine The Mae Nai's Winery” MaeNaiWinery Photo 4 in review by Gine “Gine The Mae Nai's Winery” MaeNaiWinery Photo 5 in review by Gine “Gine The Mae Nai's Winery” MaeNaiWinery Photo 6 in review by Gine “Gine The Mae Nai's Winery” MaeNaiWinery Photo 7 in review by Gine “Gine The Mae Nai's Winery” MaeNaiWinery Photo 8 in review by Gine “Gine The Mae Nai's Winery” MaeNaiWinery Photo 9 in review by Gine “Gine The Mae Nai's Winery” MaeNaiWinery &pizza - Dupont (Owner) a month ago Thank you for your 5-star rating! We're thrilled to hear that you enjoyed our freshly made pizza and fast service. Your response is important to us as we strive to improve our services. We hope to see you again soon for another delicious experience! Torianna Todd 3 reviews·2 photos a week ago NEW Take out | Dinner | $10–20 Super friendly staff and the food was really good! We got 2 pizzas- one cheese and one margarita with some extra toppings, and garlic knots. … More Photo 1 in review by Torianna Todd Photo 2 in review by Torianna Todd Addison Hosner Local Guide·100 reviews·141 photos a month ago Never had pizza from here before but ordered online for pickup during lunch. Showed up on time and the order was ready without delay. The pizza is a great serving size and depending on your appetite and what you get this could be two meals … More &pizza - Dupont (Owner) a month ago Thank you for taking the time to share your experience with us! We are thrilled to hear that you enjoyed our pizza and that your order was ready on time. Your response is important to us as we strive to improve our services. We look forward to serving you again soon! Allen Nuccio Local Guide·297 reviews·380 photos a week ago NEW Dine in | Lunch | $10–20 If you're not familiar, &pizza is like Fancy Pizza Hut in flatbread form. Their pies are pretty good and their garlic knots are delicious. This location has fantastic customer service, but also smells heavily of a bathroom for whatever reason. Anyway, pretty good all-in-all. … More Alma Local Guide·147 reviews·278 photos 7 months ago Take out | Dinner | $10–20 Pizza is good and doesn't take long from ordering to paying so it's fast and convenient. Staff is super friendly and nice … More Photo 1 in review by Alma Photo 2 in review by Alma Photo 3 in review by Alma Photo 4 in review by Alma Photo 5 in review by Alma Lizzy Amirana Local Guide·146 reviews·224 photos 4 months ago Smells like mold in the place but wonderful pizza! Their gluten free pizza with vegan cheese and meat substitute is 💣 … More Photo 1 in review by Lizzy Amirana 1 &pizza - Dupont (Owner) a month ago We regret to hear about the issue you encountered during your visit. Your response is important to us as we strive to improve our services. We're glad you enjoyed the gluten free pizza with vegan cheese and meat substitute. Thank you for sharing your experience. Emma Fan Local Guide·28 reviews·20 photos a month ago We ordered 8 pizzas (menu items) and 4 of them was made incorrectly - missing all the meat, missing veggies & pineapple, wrong sauce, missing spices. They weren’t just missing one or two ingredients, they were made into something completely … More &pizza - Dupont (Owner) a month ago We regret to hear about your experience and the incorrect pizza orders. Your response is important to us as we strive to improve our services. We will address this with our kitchen staff to ensure such mistakes are not repeated. Thank you for bringing this to our attention. Aban Koprulu 74 reviews·3 photos 3 weeks ago NEW The pizza is good but omg the sewage smell was unbearable. I tried to hold my breath and breathe through my mouth. I almost passed out. I don’t think this place is safe according USDA food and safety inspection. I will have to report it … More 1 &pizza - Dupont (Owner) 3 weeks ago We regret to hear about your experience. Your response is important to us as we strive to improve our services. We will investigate the issue immediately to ensure a safe and pleasant dining experience for all our customers. Thank you for bringing this to our attention. Jacob Fix Local Guide·22 reviews·12 photos 4 months ago Take out | Lunch | $10–20 Very fast, affordable, and huge portions. Great deal and great pizza. … More Photo 1 in review by Jacob Fix Jason A 4 reviews·2 photos 2 years ago Take out | Lunch | $10–20 Great pizza in Dupont! Walking distance from the Mayflower hotel. Fast friendly service. The Maverick is my favorite and garlic knots are a nice add on. Photo 1 in review by Jason A Photo 2 in review by Jason A Mehrnoosh Kh Local Guide·245 reviews·1644 photos 6 months ago Take out | Dinner It is a good pizza place for late night bites. … More Photo 1 in review by Mehrnoosh Kh Photo 2 in review by Mehrnoosh Kh Photo 3 in review by Mehrnoosh Kh Photo 4 in review by Mehrnoosh Kh Photo 5 in review by Mehrnoosh Kh Photo 6 in review by Mehrnoosh Kh Photo 7 in review by Mehrnoosh Kh Photo 8 in review by Mehrnoosh Kh Ryan Griffith 11 reviews 4 months ago Don't bother ordering Uber Eats here because they won't make the food and you'll have to cancel the order. And if you dine in apparently it smells like piss. … More Samuel Davie 37 reviews·102 photos a year ago Take out | Dinner | $10–20 Delicious pizza and the perfect serving for 1 person. I always get the pineapple jacked and take my Tour de Pizza cutter for a ride. Going for a pizza ride #tourdepizzacutter 🚴🏼🍕😊 Photo 2 in review by Samuel Davie 3 Alan Marrero Local Guide·215 reviews·2873 photos 5 months ago Nasty piss smell, we had to leave in an instant. No wonder the place was empty. The pizzas looked great in the pictures, if you want to eat a pizza in smelly atmosphere THIS IS IT! … More 2 Henry Kloepper Local Guide·121 reviews·77 photos 7 years ago Was quite decent. Fast, reasonable price, good taste. Though I just had Pizza Paradiso and if you have some extra time it's well worth it over &pizza, especially if you are interested in having an alcoholic drink with your pizza. If you're in a rush this works better. Photo 1 in review by Henry Kloepper Damien Shaner Local Guide·30 reviews·140 photos 3 weeks ago NEW They are so ghetto they have a security guard that locks the door and doesn't let people inside after the place fills full of ""dangerous people""...well before the actual closing time. &pizza - Dupont (Owner) 2 weeks ago We regret to hear about your experience at our restaurant. Your response is important to us as we strive to improve our services. We take the safety of our customers seriously and will address this issue with our security team. Thank you for bringing this to our attention. Diana Marquez 2 reviews 9 months ago Dine in | $10–20 My sister and I came in to grab some food after a night out it was very busy but the team was very efficient and Luis definitely made sure we had a great experience. He has exceptional customer service skills, very out going and just great at what he does and overall takes great care of guests. Will definitely be coming back soon ! Matthew Rice Local Guide·14 reviews·54 photos 4 months ago Take out | Dinner | $10–20 Pizza was decent, but as other reviews have noted, the restaurant had an unbearable stench. The owner needs to call a plumber or an exterminator (or both). … More Elizabeth Dapper 8 reviews·4 photos 3 months ago Dine in | Dinner | $10–20 Good place, good service, loud music which is always a little hard when talking with friends... but the food and the employees never disappoint! … More &pizza - Dupont (Owner) a month ago Thank you for taking the time to share your experience with us. We're glad to hear that you enjoyed the food and service, but we understand that the loud music can be a challenge. Your response is important to us as we strive to improve our services. We hope to have the opportunity to serve you again in the future. D C 8 reviews·2 photos 6 months ago Take out | Dinner I just have to add to the other reviews about the absolutely putrid horrifying smell in here, which hits you upon entering. I had ordered Uber Eats, otherwise I would have immediately left. This place most likely has an ongoing sewage issue that is not being addressed properly. No place that sells food should smell like this. … More 2 Andy Jovel 11 reviews·1 photo a year ago Take out | Lunch | $10–20 Sorry, but the pizza was cold and there was little to none chicken mostly just blue cheese crumbles. There were none jalapenos at all either. Photo 1 in review by Andy Jovel Brei Evans 4 reviews·11 photos 3 days ago NEW This locations stinks so bad. The people are nice here though. … More Cedar Baltz 7 reviews 7 months ago Take out | Dinner | $30–50 I got take out and the guy gave me 1 correct pizza I ordered and gave me a completely different order for the 2nd pizza. He showed me the first pizza with the correct toppings on it. I assumed the 2nd pizza he handed me was the right order … More Nathan Sellers Local Guide·90 reviews·323 photos 4 years ago This is really good pizza. The manager was super friendly and helpful too. My son begged to go back the whole trip and said it was the best pizza he'd ever had. Photo 1 in review by Nathan Sellers Kelli Roberts Local Guide·349 reviews·305 photos 6 years ago Second &pizza today. This location is even bigger! Food was delicious, but I would advise going light on the toppings if you choose a gluten free pizza. Too many toppings can make the pizza heavy and messy. Photo 1 in review by Kelli Roberts Photo 2 in review by Kelli Roberts 2 Jahanna Reese 13 reviews·1 photo 11 months ago This is My favorite & pizza Location, great service and they don’t rush you . 5 stars out of 5 Photo 1 in review by Jahanna Reese Josh Griswell Local Guide·26 reviews·21 photos 5 years ago Great food, good price, friendly staff! I ordered the vegan pizza and it was awesome! Their craft soda fountain has some great selections as well. Food was cooked quickly and tasted great! Photo 1 in review by Josh Griswell 1 David Zaga Local Guide·48 reviews·83 photos 6 months ago I mean the price was ok. The place smelled, clearly not very well maintained. And the pizza was ok. The guys working the counter, although dealing with a lot of customers were working hard and gave good service … More 2 Samim zamiri 1 review a month ago You gotta taste their pizza and you’ll definitely like it … More &pizza - Dupont (Owner) a month ago Thank you for your 5-star rating! We're thrilled to hear that you enjoyed our pizza. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Sabrina Lisenby 3 reviews·1 photo 2 years ago Amazing staff, great service, and was so fast. Oh by the way they have amazing pizza and garlic knots. If this isn’t enough to make you try them out, do it anyway lol 😂🤣 Photo 1 in review by Sabrina Lisenby &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We're thrilled to hear that you had an amazing experience with our staff and enjoyed our pizza and garlic knots. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Ashllyn Silva Local Guide·64 reviews·63 photos a year ago Dine in | Lunch | $10–20 Actually so obsessed with this pizza. So glad to find out they have multiple locations in my home city. Photo 1 in review by Ashllyn Silva Zhuoran Li 7 reviews·6 photos a year ago The guy is super nice. He is friendly. The pizza is so good. It is really a top place for some pizza quick bite Photo 1 in review by Zhuoran Li J Foodgeek Local Guide·715 reviews·732 photos 2 years ago So earlier today I got I texted coupon for a $5 pizza, so I walk in to dupont S location and I figure I'll just make the order in the place, and I look at the places where the ingredients are, and see slimy rod and spinach and black basil, … More Photo 1 in review by J Foodgeek 1 HoneyD 11 reviews 6 months ago Why does this place stink? Walked up expecting smell of fresh pizza but smells like dirty sewage, smells better outside. Couldn't imagine sitting down in here to eat. … More 2 Sarah Jackson Local Guide·81 reviews·2 photos 4 years ago Pizza flavor is good & could have been a 5 star. Delivery wAs about 30 mins on Fri Evening. ..but it was delivered COLD,,,,!.to order is difficult, forget calling you will only get voicemail tell you they only text or order online. They … More Photo 1 in review by Sarah Jackson 1 &pizza - Dupont (Owner) 4 years ago Hey Sarah, thanks for the review and sorry your pies didnt arrive to you in a state we're proud of. If you're up for it, feel free to reach back out and we'd be happy to make it up to you Daniel Ruiz Local Guide·49 reviews·200 photos 4 years ago Great place to eat pizza, fast service, prices are okay, each style is around $10, not so crowed and staff is friendly, very reccomended if you are hungry and looking for something quick. Photo 1 in review by Daniel Ruiz John Yeung Local Guide·130 reviews·151 photos 7 years ago How can you not like &pizza? I come here all the time. Overall it is really good but sometimes the quality is inconsistent. The pizza might be slightly burnt on the edges. The few times I want to buy soda, their machine does not have all the flavors. Photo 1 in review by John Yeung Liam Amiri Local Guide·377 reviews·2368 photos a year ago Decent pizza but don't expect some authentic NYC style pizza. … More Photo 1 in review by Liam Amiri Eddie Hoss Local Guide·268 reviews·74 photos a year ago Dine in | Dinner Oddly enough, some of the best pizza I've had in some time. Visited during the Halloween bar crawl and the three employees were overwhelmed but kept at it. Waited around 45 min for my pizza, but it was worth it. Decent prices and when … More David Dotson Local Guide·146 reviews·574 photos 2 years ago Dine in | Dinner | $10–20 Great pizza & excellent service Both Gluten Free crust & Vegan protein options available (vegan cheese, vegan sausage & chickpeas) … More Photo 1 in review by David Dotson 1 &pizza - Dupont (Owner) 2 years ago Thank you so much for the review David! We're so glad you were able to use our loyalty coupon as well! Ishmael Kamara Local Guide·117 reviews·649 photos a year ago Take out | Dinner | $20–30 &pizza is always great. Went there late on Friday for something to eat. With the crowd from the clubs be prepared to wait and they don't have any indoor seating at that time. Overall you can't go wrong with a personalized pizza from here. … More tshirt tae 7 reviews·6 photos a year ago Pizza was banging line was fast great place custom Pizza Photo 1 in review by tshirt tae Niggle W 14 reviews 6 months ago The store is quiet but the staff is very polite, clean and the pizza came out good. … More Anthony Ayo 4 reviews·1 photo a year ago Lunch | $30–50 Pizza was great! Service was just as awesome! We brought a group of 13 people and Terrence and the crew were happy and helpful. Can’t wait to come back when I’m back in town. … More williampiedra100 3 reviews·1 photo 3 weeks ago NEW Dine in | $10–20 Bryan attended us with great care. … More &pizza - Dupont (Owner) 2 weeks ago Thank you for the 5-star rating! We're thrilled to hear that Bryan took great care of you. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Vannessa Rodello Local Guide·129 reviews·103 photos 4 years ago All the toppings you want and so many options! My only criticism is the crust wasn't as crispy as I'd like. Photo 1 in review by Vannessa Rodello Photo 2 in review by Vannessa Rodello R Bakshi Local Guide·65 reviews·166 photos 6 years ago Excellent pizza and super friendly staff! Photo 1 in review by R Bakshi Photo 2 in review by R Bakshi Krystle Local Guide·107 reviews·224 photos 4 years ago It was really good. But it was sooooo hot in there and took foreverrrrrrr. Pepperoni and bacon. I'm basic lol Photo 1 in review by Krystle Leah Trunsky (raindropAuxilitrix) 1 review 11 months ago Went here with my friends—the pizza was great and the server Chris was super cool! Super friendly. Whoever made the pizza was patient with our orders too. :) Destine Jones 5 reviews 11 months ago Take out | Dinner | $10–20 I came into &Pizza today for lunch and the the staffAndre and Terrace was very helpful polite service was great clean environment fast service I was surprise to see no line so the pizza came out quick and I was able to enjoy it and get … More 1 &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We're thrilled to hear that Andre and Terrace provided helpful and polite service, and that you enjoyed a quick and delicious lunch. Your response is important to us as we strive to improve our services. We appreciate your kind words and hope to see you again soon! Roberts Brian 1 review a year ago I went through this pizza shop last night the service was amazing they were really on point, making sure the customers got everything they needed and more this will definitely be my go to pizza place yours truly Mr.Roberts.. James Drosin 2 reviews 9 months ago Dine in Luis the Manager gave me the best guest experience! Food was amazing definitely recommend. S/O to them! I will definitely be back! Heather Dorsey Local Guide·130 reviews·393 photos 4 years ago The American honey pizza is really good. And the cereal milk soda tastes exactly like cereal milk. So. Service with a snarl. Photo 1 in review by Heather Dorsey &pizza - Dupont (Owner) 4 years ago Thanks for the review Heather! :) Kate Farrell Stanford 4 reviews·2 photos 11 months ago When I walked in, no one was in there and it smelled terrible, as if the floor had been mopped with dirty toilet water. We couldn't imagine staying in there long enough to order, let alone eat. … More 2 &pizza - Dupont (Owner) 11 months ago We apologize that our service did not satisfy your expectations. We set a high standard for ourselves and are truly sorry to hear that standard was not met in your interaction with our business. Your happiness is our number one priority. We well take your feedback into consideration. Jason Miller Local Guide·401 reviews·14 photos 2 years ago Take out | Lunch | $30–50 I love &pizza and usually get awesome service however, this visit to this location was lagging. The 2 staff were seemingly working against each other and they burnt mine and my other 2 family members pizzas. I … More Michael Green Local Guide·113 reviews·665 photos a year ago Dine in | Dinner | $10–20 Flat bread pizza made your way. Staff was fun and engaging. Food was great and was more than enough. Large enough to share but on a hungry day good enough to keep it for yourself. … More Nadia M 8 reviews·4 photos a year ago Normally I’m a huge fan of &Pizza, but this location is so severely understaffed during rush hours that it has proven actually impossible to get the pizzas we ordered. The &pizza website said our order would be ready within 15-20 minutes, … More 1 Chandrell Christopher 7 reviews·3 photos 2 years ago Service was great! Really nice employees, loved syncere and lavell were amazing! Photo 1 in review by Chandrell Christopher Jlyne B Local Guide·63 reviews·14 photos 4 years ago Got a gluten free American honey and oh my goodness I wish there was one closer to where I live. Incredible tasting food and the soda was really good as well. I gave it four because a few of the toppings didn't look very fresh (wilted … More 1 &pizza - Dupont (Owner) 4 years ago Thanks for the review! :) Jamon Pulliam 2 reviews 2 years ago This location is hands down the best! I was visiting from Los Angeles and the service here was impeccable! And don’t get me started on the pizza! They took their time and put nothing but ingredients and love in that one. Would definitely recommend Dean Albrecht 3 reviews a year ago Take out | Dinner | $10–20 Excellent food with great service. Andre helped me make the right choice. Would recommend to anyone who’s in DC and wants something quick to eat. 1 Esse Darden Local Guide·287 reviews·551 photos 2 years ago Take out | Dinner | $10–20 Ordered the Manhattan, while waiting for my personalized order being made - which I received after noticing a distinctive stinginess with every topping that was applied before it was put in the oven, an excessive prolonged period of time; … More 1 &pizza - Dupont (Owner) 2 years ago Thank you for taking the time to share your feedback. We set a high standard for ourselves, and we’re so sorry to hear that this was not displayed during your visit at our location. Your feedback is important to us and we’ll make sure to make the proper adjustments for next time. I’m also going to send this feedback to the shop and district leader to address with the team there because this isn’t what we want our guests to experience at all. We hope that your next visit with us is nothing like what you experienced recently! Scott C Local Guide·33 reviews·9 photos 3 years ago Great pizza and garlic knots! Not your typical style but still quite special and worth trying...over and over again! The dough and toppings are always on point! I also appreciated their program to help frontline workers. Highly highly recommended! 1 &pizza - Dupont (Owner) 3 years ago Thanks for the review Scott! We had to try something different this time. We hope you enjoyed it though! Sean Local Guide·61 reviews·42 photos 2 years ago Take out | Dinner | $30–50 We got delivery. Late night. Pizzas were not good. Got It for a party and we all laughed at how bad it was, and how small they were in the box. (And they forgot one of our items.) all that and only a 1.5 hour wait. Haha. Only reason for the extra star (instead of just 1) was the cookies were really good! … More 1 Kiran Singh Local Guide·70 reviews·66 photos 4 years ago The pizza here is so delicious! The crust is flavorful and tasty and the tomato sauce is so deliciously tangy. I was really blown away by the quality & taste of the pizza! Their ingredients taste fresh and you can add as many toppings as … More &pizza - Dupont (Owner) 4 years ago Thank you so much!🖤🍕🖤 Michael Cupertino Local Guide·106 reviews·163 photos 4 years ago I don't know if it was an ""off day"" here, but service was so slow we had to leave. There were 3 people in front of us and we waited 20 minutes before we left. The employee was more concerned about cutting a 1/4 of an inch of crust off of … More Jessica Peters 12 reviews·6 photos 5 years ago The pizza at & pizza is great. That’s why I have been coming back for years. However beware of the customer service. Recently at the DuPont location, I enjoyed a great pizza and needed to use the restroom. When I asked an employee who was … More 2 Alok Sinha Local Guide·58 reviews a year ago Stopped by here and this is a great place for pizza. I ordered the new G and added some spicy honey and it was delicious. Would definitely recommend stopping by here if you have a chance. &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We're thrilled to hear that you enjoyed the new G pizza with added spicy honey. Your response is important to us as we strive to improve our services. We appreciate your recommendation and look forward to serving you again soon! S G Local Guide·12 reviews a year ago Amazing pizza and unique experience. Build your own pizza to a new level. Fresh toppings and an amazing taste. The place is small but the tastw is huge. Loved the food and the service. A definite must. Claire Mizutani Local Guide·54 reviews·374 photos a year ago Take out I got four pizzas to take back to my family:The Maverick, CBR, Billie, and Kalamata Harris. Two of them were on gluten-free crust. Ordering was pretty hectic because there were many young people coming to eat between going to different bars … More 2 Wanda Murphy 33 reviews 2 years ago This was the worst pizza I have ever purchased from & Pizza. The person in front of me, ordered four pizzas. They should have removed my pizza promptly. Instead, the crust is burnt, the spinach dry and the other vegetables dried out. … More &pizza - Dupont (Owner) 2 years ago Terribly sorry to hear about your experience Wanda! We have reported this information to our senior management to resolve and to take the proper measure for quality control. You can send us an additional message at 200-03 or send us an email at digitalshop@andpizza.com. Thank you again for bringing this to our attention. Robyn J Local Guide·54 reviews 5 years ago Absolutely the best pizza I have every eaten. The bread was amazingly light and doughy. I didn't have the disgustingly full feeling after eating an entire pizza. The toppings were fresh and delicious and unlimited. Love the healthy choices and sauce variety. 1 &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We're thrilled to hear that you enjoyed our pizza, especially the light and doughy crust and fresh, unlimited toppings. We're glad you appreciate our healthy choices and sauce variety. Your response is important to us as we strive to improve our services. A G 10 reviews a year ago I’m literally in this place as of 06/06/22 and it just took me a whole hour to get a pizza which is ridiculous! Low staff and no sense if urgency. Felt bad for the employee up front who seemed suer overwhelmed, pizza is good usually but won’t be back at this location. &pizza - Dupont (Owner) a year ago Hey Andy! Thanks for you review. We are sorry to hear that we did not provide the best experience! Please reach out to us at 200-03 so we can make this right. 🍕 Timur Plavan Local Guide·97 reviews·278 photos a year ago Dine in | $20–30 The most inefficient &pizza I've ever tried in my life. Ordered online, came 30 mins later and waited for another 50 minutes. Order was missing things in both pizzas. &pizza is great but I would avoid this location. … More Natalia Diaz Torres 1 review·1 photo 2 years ago If I could give 0 stars, I would. This review is based on an UberEats order. I ordered 4 pizzas and an order of … More Photo 1 in review by Natalia Diaz Torres Rishi M Local Guide·9 reviews·22 photos 2 years ago Visited late September 2021 for an online pickup order. Waited 2 hours for my order. … More 1 Michel Louis Local Guide·16 reviews·2 photos 2 years ago Take out | Dinner | $10–20 One of the best pizza I ever tried Photo 1 in review by Michel Louis Rachel Wortmann Local Guide·61 reviews·173 photos 2 years ago Ordered online and waited 45 min for my pizza. App had said it would take 10 min so was quite frustrating … More Kristen Eggleston Local Guide·50 reviews·8 photos 4 years ago The pizza is great but the service here could be a bit better. I went at a time where it wasn't busy at all. The woman who made my order was friendly and helpful and while my order was cooking, I sat at a table nearby. The woman who was at … More Jéssica Bittencourt 1 review·1 photo 2 years ago Lavelle great service, thank you! Photo 1 in review by Jéssica Bittencourt 1 Matt Ramey 3 reviews 11 months ago Dine in | Dinner | $1–10 We went in to have wholesome family dinner experience but quickly exited upon my initial smell test which returned a result consisting of bathroom juices/putrid garbage. 2 Matthew Cantisani 2 reviews a year ago Dine in | Dinner | $10–20 Excellent service!! Food was delicious and made quickly. I will definitely come back to this &pizza location! De Wheeler-Chopan 10 reviews 7 months ago Worst experience ever! Pizza wasn't ready to order. The servers states they didn't care that we waited! … More Stefan Hovy 5 reviews 6 years ago Incredible! Was in DC for a long weekend and ended up going to &pizza 3 times! Twice at this location where the staff and manager were very friendly and open for a chat. Not to mention the delicious pizza with equally delicious vegan options. Would recommend this to anyone visiting DC! 1 Joey Norris 4 reviews a year ago Take out | Dinner | $10–20 Andre was such a great help and made sure to treat us right with amazing pizza. Appreciate the amazing service and will gladly go again. S. T. Grandy 19 reviews·6 photos 4 years ago The pizza is good but I was a bit disappointed to see that the employee who made my pizza only put a racing stripe of sauce right down the middle of the dough. Literally a line down...not spread at all. Also, they may need to turn the ovens … More 1 Monte' Kent 2 reviews a year ago Andre at &pizza DuPont south was amazing.. helped me with my gift card at this location. He service and attention to detail was great. Must go location. Thanks Andre! Sameer Singhal Local Guide·41 reviews·8 photos 7 years ago Great at any time of day. This is a unique pizza experience, and I love the fact that you can customize your pizza to your liking for one flat price. Definitely a place to try, and you'll most likely want to keep coming back Cecilia Demoski 1 review 11 months ago Take out | Dinner | $10–20 This is a great place to grab some great pizza! Amazing service and good quality pizza. Miracle Parish Local Guide·75 reviews·6 photos a year ago I will be filing a police report against the fair skinned man with dreads. He put his hands on me multiple times when I was trying to exit the building. The entire line saw it and they were appalled. I was trying to get to my Uber and he … More Ali A Local Guide·691 reviews·435 photos 4 years ago Delicious, but higher prices than their quality. Crowded around noon time, my experience of course. Employees are ok, but they can be much better. … More Brie Morgan 5 reviews 2 years ago I been coming to this pizza spot for a few months and their always respectful and clean They have awesome pizza and the best customer service the manager always takes care of me and makes sure my pizza is hot and ready to go no complaints will continue to send friends and family India Marshall 28 reviews 2 years ago Employees are nice but mangers need to do a better job with organizing during rush hour. Bathrooms are never available for customers. This has been the case for over 5 years. Luis Miron 3 reviews 11 months ago Dine in | Dinner | $10–20 Amazing service by Andre! and delicious pizza. Definitely the place to eat before a night out of drinking. Breanna Duff 9 reviews·1 photo a year ago the security card told me I could not sit down even though I have a disability. There is no rule to this. He was being very rude for no reason. 1 Katie Kennedy 21 reviews 6 years ago The service was terrible here. We were there for the first time and clearly confused but rather than offering help to us, the staff ignored us. They offered no help when we had questions about some dietary restrictions either. And you can't … More 2 Evan Farrara 12 reviews·1 photo 7 years ago Incredibly loud inside to the point that the employees couldn't hear me correctly when ordering. As a result, when asked if I wanted spicy or non-spicy sauce, I replied ""non-spicy"" and got spicy anyways. That being said, it ended up being … More Mohammed Yahia Local Guide·384 reviews·1524 photos 5 years ago &pizza is a good, simple pizza place. They don't have many choices, just pizzas, but they are awesome. They have a few set pizzas you can order or a make-your-own-pizza option. They also have the option for gluten-free dough which is $3 … More 1 Jobina Beale 3 reviews a year ago Went in there today for lunch and Tay was awesome. Amazing, courteous and good customer service. I walk from Farragut West Metro to get my pizza all because of him. Gideon Tong Local Guide·155 reviews·233 photos 4 years ago Great pizza! Fast service, would go again. As someone from the west coast we also have build your own pizza places like Pieology and Blaze Pizza but this style of ""shoebox pizza"" is pretty unique and you can definitely eat a whole pizza on your own even if you don't usually eat that much. &pizza - Dupont (Owner) 4 years ago Great to hear. Thanks! Sara R. Local Guide·144 reviews·305 photos a year ago Dine in | Dinner | $10–20 Vegan-friendly, they even gave vegan pizza. I would like to see more filling vegan toppings options like some Beyond Meat or something. The service was quick and friendly. … More 1 cy mcfadgion 3 reviews 3 months ago Quan, cam and bre were amazing … More &pizza - Dupont (Owner) a month ago Thank you for your 5-star rating! We're thrilled to hear that Quan, Cam, and Bre provided amazing service. Your response is important to us as we strive to improve our services. We look forward to serving you again soon! Khaleel Johns-Watts 58 reviews 10 months ago Best late night dc spot call ahead after 3am if ur with a group and just order all the pizza Emma C Local Guide·83 reviews·85 photos 5 years ago Of all the made-to-order personalized pizza places out there, &pizza has my heart. They offer several delicious dough options including gluten free. All of the toppings are very high quality (get the meatballs!!). After topping, they put it … More 2 A “2Freckles” Oz Local Guide·15 reviews·2 photos 5 years ago I really liked this place, however my second experience here was not like my first. Took me 30 mins to get my order. The cashier was very stressed maybe it was his first day on the job because he did not know how to run the register. The … More Ada Rebecca Smith Local Guide·447 reviews·165 photos a year ago Dine in | Dinner | $10–20 The service was not great, the guy making the pizzas was very slow and wasn't able to find items that should have been easily located(the spinach was empty, he took several minutes looking for it and they were out of spinach). … More Ian Winbrock Local Guide·131 reviews·14 photos 7 years ago I love &pizza. I'm from the West Coast and we have ""cook as you wait"" pizza places, but nothing on the same level as &pizza. This place is superb. Always greeted by some friendly folks behind the counter and then I either complete one of … More Bill Hipsher Local Guide·41 reviews·987 photos 7 years ago Staff was very nice and pizza we got as ordered was great. The fountain machine was broken so your drink options were limited to can/bottle options for tea/lemonade that they had in a fridge. Ordered a Hawaiian style pizza that was supposed … More 1 Scott Dwyer 12 reviews·1 photo a year ago Great place to get a bite when you out drinking in depot circle. The pizza is awesome, and the prices are better than at the bar. … More Justin Andersen Local Guide·15 reviews a year ago Take out This was the most frustrating experience I've ever been in. Our take out order was over an hour late. And that's the least frustrating part of the night... I don't know if I have the energy to explain everything. Andrea M Local Guide·69 reviews·46 photos a year ago They gave me the wrong pizza. I texted customer service and they said they needed a picture in order to issue a refund. I told them my camera was broken and was not able to take a picture. They told me I couldn't get a full refund without a photograph but they could offer me $5 for a new pizza. Josh Higham Local Guide·148 reviews·84 photos 6 years ago Co-workers had talked this place up, but I found it only decent. I definitely enjoyed the unique soda fountain more than the pizza. Great variety of unique flavors. Pizza was fine but unremarkable. Ariel Holmes 2 reviews 4 years ago James and Deon made my night. I would have been left hungry if it was for the girl up front. But thank you 2 for the lovely service much appreciated. I will remember it & I will be back (during opening hours) thanks again! &pizza - Dupont (Owner) 4 years ago Glad to hear our team solidified your evening (and future visits) with great service. We will be sure share with both James and Deon your kind words! Thanks for stopping by, Ariel! Leanne Quinn 1 review·1 photo 2 years ago Great service and fantastic pizza! Photo 1 in review by Leanne Quinn &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We are thrilled to hear that you enjoyed our fantastic pizza and great service. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Tracey N Local Guide·87 reviews·70 photos 5 years ago Pizza would have been better if it was warmer, but their service was shorthanded..... they had one person taking out the pizza from the oven, boxing it, putting on the finishing garnishes AND ringing up the customers...... that's too … More Theresa Kemp 5 reviews a year ago Dine in | Dinner | $1–10 Andre was fantastic! He served our party fresh, hot, pizza. Thank you for the great customer service. Diana Martinez 3 reviews·2 photos 2 years ago I work nearby and I appreciate that my orders are always done right away and I can quickly just pick up. Great customer service. Very strict on covid regulations. Key 2 reviews 2 years ago Customer service was excellent upon arrival. Store was clean and needs were met in a timely fashion. Very friendly and patient staff. 5 Stars to Terence!! Greg Smith 14 reviews·2 photos 10 months ago Delivery | Lunch | $10–20 Did carry out. Pizza was good, but not great. Strange beverage options … More Bali Adawal Local Guide·203 reviews·1637 photos 4 years ago I have always liked the concept of a highly customized pizza and the overall product turns out to be quite appealing. … More 2 Aleks Nekrasov 91 reviews·67 photos 11 months ago As far as GOOD pizza goes, this place completed my order in 8 minutes. &pizza - Dupont (Owner) 11 months ago Thanks for the awesome review! Hope to see you soon. Gnelossi Hamadou Local Guide·6 reviews·7 photos a year ago Visited this place yesterday for my first time , just wanna say thank you for the entire team that work yesterday night. They were patient and friendly specially the manager Andre Cecilia Local Guide·80 reviews·2 photos 5 years ago We had a pleasant experience at a different branch of &pizza so we tried this branch. This branch was stingy on the toppings and the dining area was not wiped down after customers have eaten there. All 3 of us felt queasy after eating here... Josh Eid-Ries 10 reviews·3 photos 6 years ago Delish, super affordable and very easy to customize your order with no upcharges. The staff are a delight and the food is superb. The drink offerings are also wonderful. I'd recommend the 11 grain crust(ask for it) the mango passion fruit soda and root beer. Vegan cheese and veggie based protein options were a lovely bonus! Pradipto Banerjee Local Guide·29 reviews·96 photos 7 years ago Their pizzas are the best value for money. Unlimited toppings on a big flat bread for just $10. And they're open till 4 am, which is great when you're leaving the bars at 2 and want to get some food. NAI- NAI 3 reviews 2 years ago Dupont is awesome. The place is clean and the pizza is great! One of the workers Decostia provided excellent customer service! I definitely recommend this store! Jaqueline Veltri 2 reviews 4 years ago The pizza here is delicious but it is the second time in a row that I find a long black hair in my pizza. It’s so frustrating and disgusting! I hope management finds a way to keep the employees hair out of the food. F.A. B Local Guide·39 reviews·15 photos 4 years ago James was an amazing manager. My card wasn't working for some reason and he still made my pizza and gave it to me for free. Absolutely amazing customer service! Thank you James! &pizza - Dupont (Owner) 4 years ago Hey there! Thanks so much for the love. We always appreciate our loyal fans. Sunil Singh Local Guide·183 reviews·134 photos 5 years ago &Pizza is something like Blaze Pizza. You pick your dough, then the sauces, and then all your toppings. It's unlimited sauces, and unlimited toppings. And after the pizza is baked, you can add any other sauces, or other toppings. And … More breathemusic94 2 reviews a year ago I love coming to this &pizza, Tay is always a welcome face at this establishment, he is extremely helpful and all around fun to talk to. The food is always amazing here. Crystal 1 review·1 photo 2 years ago &pizza Great good and atmosphere, staff was friendly Photo 1 in review by Crystal Thomas Scheurich Local Guide·33 reviews·1 photo 6 years ago I really like the new fast casual trend. Others may complain about it, but it matches my lifestyle and sets a good middle ground on price. &pizza is the best example of fast casual in this region. Really awesome and ultra customizable food … More Oliver Borg 11 reviews a year ago Andre was super helpful! Fantastic late night spot, quick service, friendly staff, and good food. What more could you want. Dale L. Roberts Local Guide·52 reviews·118 photos 6 years ago This is the second &pizza I've gone to today and wow! This place is even better. There's more seating and it's not even busy. Well worth it! And the staff was friendly and attentive. 5+ stars Nibha Rastogi 7 reviews·2 photos 5 years ago ordered a craft your own... SO GOOD!!! The tribe were super courteous and I got what I wanted. Got a traditional with mushrooms, spicy Italian sausage, onions, pesto finish. Jordi Segura Local Guide·115 reviews·366 photos 7 years ago We ate in this pizza shop during our trip to Washington, and we found the pizza and drinks tasty and original. You can make your own pizza or order one of the existing recipes. I would recommend it for take out or a quick bite. Brandon Boone Local Guide·377 reviews·1050 photos 4 years ago Quick and delicious lunch, very filling and I'm a big guy. Definitely mix it up don't settle for cheese and pepperoni... Never thought I'd have honey on a pizza. &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We're thrilled to hear that you enjoyed our unique pizza options. Your response is important to us as we strive to improve our services. We hope to serve you again soon with more delicious and filling options! ROBIN THOMPSON Local Guide·94 reviews·221 photos 6 years ago I love this place! They have a great pizza selection . I love their specialty sodas. Try the cream soda. There is a wait though due to their being only one person to ring up your order and box your pizza. T Williams 9 reviews 4 years ago Best way to order a to go pizza is on their website. After a long day of sightseeing, a couple of their ""oblong"" pizzas was just right. Thin crust was great, toppings good. Prepared quickly. &pizza - Dupont (Owner) 4 years ago Thanks for the review and for stopping by, T! Ashley Craft 4 reviews 2 years ago I love The Dupont Team everyone is so nice Tay always goes above and beyond for the customers amazing customer service!! DuPont Team keep up the great work!! Jelani Phipps 8 reviews 2 years ago Food is so delicious. The manager Delonta gave me supervisor service. I would definitely go back again. You won't be disappointed!!! Nely Hernández 2 reviews·1 photo 10 months ago Love this late location . Super busy They are still very patient with customers. Lance Porciuncula 1 review 2 years ago The workers there are super friendly and nice. The service was also pretty great. Got my pizza with little wait. Ismail Gomaa Local Guide·364 reviews·1240 photos 7 years ago Some of the best pizza I've ever had. Any combination worked because their ingredients are absolutely perfect. I enjoyed everything I've tried there, even the stuff I don't usually like. Sarah Semlear Local Guide·154 reviews·1292 photos 5 years ago The gluten free crust is pretty good! It's not a completely gf environment so they can't guarantee there is no cross contamination, but they are careful and change gloves when handling the gf crust. The options are fun and there is a good amount of toping choices for build your own. 1 &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We understand the importance of providing a safe environment for our gluten-free customers and we're glad to hear that you appreciated our efforts. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Michael williamson 9 reviews a year ago Take out | Lunch | $10–20 Pizzas are not that good and one of the workers not that friendly pizza crust had sir burnt from dirty oven … More Jennifer Telfort 4 reviews 2 years ago The service is great! Thank you so much for making my pizza just the way I like it!! I will be back again!!! Hailey Gruch 7 reviews a year ago Take out Wonderful experience... it was busy but they made me feel at ease... wonderful service... thanks to Quan, Malik, Justin and faith William Minter Local Guide·85 reviews·79 photos 7 years ago Thin crunchy crust that isn't overcooked. Awesome fresh toppings and sauce. Perfect for lunch or later night special. Not the best place to sit and eat as space is limited inside(20-25 at best) Cameron Asgharpour 1 review 2 years ago Great customer service and staff is very attentive. Pizza was awesome LadyLewis 2u Local Guide·17 reviews·15 photos 5 years ago &pizza is my fav pizza, but unfortunately, I experienced the WORST, not just customer service, but attitudes EVER! When I asked for assistance, I was only given the 202 number they have taped on the glass display. It was weird bc 2 … More Angel Aguiluz 1 review a year ago Tay is a hell of a entrepreneur! A lovely lad, Marcia also made an astonishing pizza with Nikko. 10/10 if you’re near Faragut North Rakia Pinkney 3 reviews 2 years ago The staff are very friendly and the food came out great and in a timely manner. I will be back, this is the best &pizza location! Dante Gardner 1 review 2 years ago I had an amazing experience. Antonio, and Roshan were very accommodating to my child who is particular about his pizza topping’s . 1 Scott Jason Local Guide·38 reviews·46 photos 4 years ago Thin crust pizza was very tasty and filling. I had red sauce with fresh mozzarella, tomatoes and onions. They do have a gluten free crust for $3 extra. 1 Chris Morris Local Guide·49 reviews·25 photos 4 years ago Pizza was way better than expected. Really nice staff. They were able to get people in and out quickly. I will definitely be returning. 1 &pizza - Dupont (Owner) 4 years ago Thanks for the review :) Raynell Jackson 26 reviews·26 photos 4 years ago I pizza and staff are wonderful Photo 1 in review by Raynell Jackson Photo 2 in review by Raynell Jackson Killian Devitt Local Guide·128 reviews·541 photos 8 years ago What's not to like about this place? It's just great, simple pizza. Tried the Maverick the first time I went and I haven't ordered anything else since. Perfect for lunch if you can avoid the rush. &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We're thrilled to hear that you enjoyed our Maverick pizza and that it's become your go-to choice. We appreciate your support and hope to serve you again soon. Your response is important to us as we strive to improve our services. taliyah hughes 4 reviews 2 years ago Great customer service, quick service! FOOD IS AMAZING! My favorite spot to come after a drunk night 🤪. Highly recommended Mo Love 38 reviews 3 years ago I went in there for the first time a couple of weeks ago. The restaurant had a really foul odor and I could smell it through my mask. Although, I ordered a pizza online and picked it up, I did not eat it and I will never go back to that pizzeria. 1 &pizza - Dupont (Owner) 3 years ago Thank you for taking the time to share your feedback Mo. Our management team will be looking into the odor that you are referring to for the Dupont location. I'm sorry to hear that the experience did not meet your expectations and I would like to apologize for this. Chris Oliver Local Guide·17 reviews·1 photo 8 years ago Great customisable pizza in a relaxed atmosphere. Their home made cola is to die for and so much tastier than coke or Pepsi. Only criticism is that the music was way too loud. Amanda Neilson 6 reviews 2 years ago Great experience! We had a large group and they were fast and efficient. Love the pizza! Breasia Lawson 5 reviews·1 photo 2 years ago Labella made my pizza so good and had the best costumer service ever, he was very bubbly and pleasant and Met all of my demands because I’m a very picky eater lol he’s the best Adriana Lopez 5 reviews 11 months ago Great service! Everything was on point! Andrew was very attentive and polite! Thank you 😃 Merlin Tondji 2 reviews 2 years ago This place is great . Unfortunately last night we couldn't custom the pizza however the team still amazing Briana McKellery 9 reviews·5 photos 2 years ago Beat servers best pizzas and my fav location but all are great. Definitely suggest stopping here for a late night craving after a night out! Tiffany Dendy 3 reviews a year ago Dine in | Dinner | $20–30 Wave and Twan provided excellent customer service on my visit. Gloves were changed prior to assisting us Thanks guys ! Micheal Stone 2 reviews 2 years ago Team was friendly with great service. Pizza came out great! Will continue to come back Forrice Brunson 1 review a year ago Courteous and professional staff members. My order was completed without issues. It was fresh, hot, and the toppings were 🤌🏽. Saee’Rozay 1 review a year ago Take out | Dinner | $10–20 First Time At &Pizza . Great Service By Andre ! Respectful & Kind . Will Definitely Be Back Especially At This Location Medachi 509 16 reviews 4 years ago This is the worst & pizza that I’ve ever been they don’t change their gloves. They got nasty attitude they should reconsider on hiring people there. If I’m paying $11 for pizza I should be treated with respect the customer service is terrible I can’t even tell them how I want my pizza to get done. 1 &pizza - Dupont (Owner) 4 years ago Hi Questa, thanks for the feedback. We'll be sure to address this promptly with the shop. Angel Angelov Local Guide·159 reviews·920 photos 4 years ago A bit dodgy place but pizza was perfect. They offer you to choose from anything you want to add to it and can make it as you like. Was really delicious. Not beer or any liquor though 1 Nataliya Kostiw 2 reviews a year ago Alonzo was amazing, he helped us with everything and was very polite and informative! Would definitely recommend! Simply, Tasha. Local Guide·130 reviews·244 photos 5 years ago Idk what the rating I'm assuming it must be great for I'm too drunk to realize food but let me tell you...today I walked in and walked out....the stench was crazy...it smelled like a dirty barn...or zoo...sewage...idk but I couldn't even order to go and I was just dissappointed... it is a super rainy day today.... 2 Kylie Gilbert Local Guide·19 reviews 7 years ago Could eat this every day for the rest of my life. Not a lot of seating inside though. Also check out ordering ahead, it's much faster. The sodas are good too! Josh Robichaud Local Guide·93 reviews·123 photos 8 years ago Great custom pizza at a reasonable price. Either the preset menu or build your own, can't go wrong. Plenty of seating and fast service. Andrew Isett Local Guide·185 reviews·230 photos 7 years ago Good pizza custom made the way you like. Similar to Chipotle with a burrito, &pizza allows for any toppings they have and different sauces. Always some left over too!! Ethan Granetz 3 reviews a year ago Take out | Dinner | $10–20 Andre got us food real late. He made an awesome pizza. 10/10 service J 4 Local Guide·131 reviews·64 photos 7 years ago Oh yes lawd. This pizza is so good and u dictate the toppings. Yum. Decent price for DC and a food serving size. Not glutinous but more than sufficient. Arely Castro 1 review 2 years ago Amazing service ! & the pizza was so delicious that I will come back again! Jimmy DeVault 15 reviews·1 photo 5 years ago Great food, concept and atmosphere. First time at this location and this may just be this location but service was super slow! The team here also seemed very disorganized, there was no designated cashier which caused a bottleneck at the register where everyone just stood. Maybe they were short staffed? 1 Destiny Cruz 3 reviews 2 years ago GREAT service! And even better pizza! This is my regular location Bc they never disappoint 😉 Punky Banks 1 review 4 years ago I had a great experience. Our cashier Diamond was kind, courteous, and offered great recommendations. I’ll be back soon. Overall great food and great service! &pizza - Dupont (Owner) 4 years ago Thank you so much for the great review Punky! We look forward to seeing you agin soon. Kevin S 3 reviews 2 years ago This is specifically for the website ordering experience. I typically pick up but I needed delivery and my nearby &pizza store was temporarily closed. The problem is that it is impossible to switch the store you're getting delivery from, or … More 1 &pizza - Dupont (Owner) 2 years ago Thank you for your feedback Kevin! I'm sorry to hear that this was your experience trying to order online. We'll flag this information over to our development team to fix. Najm Aldin 9 reviews 9 months ago Luis is very professional and he took care of me. Very nice guy Samantha Zarrilli Local Guide·25 reviews·2 photos 2 years ago Amazing service! So great. Lavelle went above and beyond to make us feel welcome. Promote him!! . Jeremy R. Stinson Local Guide·178 reviews·293 photos 4 years ago &Pizza is one of my favorite pizza joints in DC. Not all locations are created equal, but this particular location is always clean, the staff is friendly and helpful, and I never have to wait too long. &pizza - Dupont (Owner) 4 years ago Hey, Jeremy. Thanks so much for review! руня 11 reviews 7 years ago Great vegan options, (they have mozzarella daiya and veg meat crumbles)! Lots of fresh veggies, good unique gourmet choices of sauce too. The pesto is delicious. The price is reasonable for a vegan pizza, compared to zpizza which recently … More 1 Fabian Meneses 5 reviews a year ago Staying at a hotel close by this place has been our stop daily! From the friendly staff to the delicious food, you have to try this pizza! Mouhamadou Thioune 4 reviews a year ago I like eating at &pizza Dupont. The pizza is always on point. The place is always clean and Tay always provides good customer service. Reilly Sheehy 1 review a year ago They were so lovely - they gave me free water when my friend and I needed it most. 10/10 Ryan Norton 7 reviews 7 years ago I tried calling multiple times to have a question about their menu answered. Each time it automatically goes to a recording and it gives you the option to press ""2"" to speak to an employee. However when you choose that option the phone … More Geneva Kropper 4 reviews 4 years ago The pizza here is fine, but the staff is very rude and will let you stand at the counter without asking how they can help you. Very poor standard of hospitality and out of place in DC. nate porter 2 reviews a year ago Tay is the best. I love the customer service. He should be promoted. Nikko & Marciara are amazing and should also be promoted!! Isaiah Benjamin 3 reviews 2 years ago I always have a great experience, I work in the area the workers are always fantastic to chat with. Food is always delicious, my go to spot for lunch. Angelica Martinez Local Guide·54 reviews·115 photos 4 years ago Stopped by this place when in the area. Design your own pizza from scratch, and then customize it. The staff assemble your pizza as you watch ... you get to decide everything which goes on the pizza as you follow it down the line. We … More 1 Ariana Brown 3 reviews 2 years ago Very professional clean and made my pizza in a timely manner. Staff was perfect Levon Akopian 8 reviews a year ago Dine in | Other | $10–20 It was amazing and tasty Perfect pizzas, friendly crew … More Jamie Sneed 1 review 2 years ago Outstanding place, great service, Terrence was a huge help and help me build the perfect pizza for my first time!! Teezy Teez 2 reviews a year ago The establishment was amazing, Tay was very kind and ensured we were okay during our time at the restaurant. &pizza - Dupont (Owner) 2 months ago We're thrilled to hear that you had an amazing experience at our restaurant and that Tay took great care of you. Your response is important to us as we strive to improve our services. Thank you for the 5-star rating! We hope to welcome you back soon. kiara cooper 1 review 2 years ago I experience the best customer service with an employee name Lavelle! Definitely would recommend. The pizza was amazing !! Lisa Smith 5 reviews 2 years ago They have an excellent menu selection and you can add anything else you desire... or you can build your pizza from scratch... all at one reasonable price! Delightfully Delicious 👍 2 &pizza - Dupont (Owner) 4 years ago Thanks for the review! :) M A Local Guide·31 reviews·16 photos a year ago The vegan mozzarella and vegan sausage are amazing. To &pizza: please bring back the vegan chicken. Chris Anderson Local Guide·36 reviews·182 photos a year ago Not extremely friendly but excellent excellent pizza. The dough is the best part. 1 Sachin Bhattiprolu 2 reviews a year ago They take orders beyond 10pm but you cannot eat there because they close at 10pm. People here were incredibly rude and forcibly removed chairs WHILE 10+ people were trying to sit and eat. Incredibly rude place. Blue Moon 4 reviews 7 years ago literally the best pizza i've ever eaten. i had the vegan options. they were incredible.staff was really nice. would recommend to everyone. It’s Me Local Guide·381 reviews·169 photos 7 years ago As usual, friendly staff. First time at Dupont location, but just as good as the H St one. … More &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We regret that we no longer offer San Pellegrino and apologize for any inconvenience caused. Your response is important to us as we strive to improve our services. We appreciate your feedback and hope to see you again soon! Quennitta Winzor 1 review 2 years ago The manager is wonderful and fast. But I feel like they were catering to the white people. I almost felt invisible. Darlene Craft 4 reviews 2 years ago I love coming here the manager Tay always knows exactly what the customer service at DuPont is beyond amazing :) Sinceree Stewart 2 reviews·1 photo 2 years ago Great customer service and very patient. Photo 1 in review by Sinceree Stewart lizzle thrvxxx 2 reviews a year ago Andre was very helpful I been goin here for about and year and the customer service is great 10/10 Jas 3 reviews 2 years ago Best pizza I’ve ever had and the workers are the nicest people ever!!!! Come here for a quick bite! &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We're thrilled to hear that you enjoyed our pizza and had a great experience with our staff. Your response is important to us as we strive to improve our services. We hope to see you again soon for another quick bite! Jalen Dixon 1 review a year ago Great service and very reasonable prices! The pizza is also prepared very quickly! Candice Mulholland 4 reviews 2 years ago Terence was awesome! They are always quick and so friendly when I’m in there. 10/10 on the pizza too 😊 Tim Larkin Local Guide·72 reviews·226 photos 5 years ago Damn, this is good pizza Photo 1 in review by Tim Larkin Ron Hagage Local Guide·87 reviews·83 photos 5 years ago Subpar and overpriced pizza place. Compared to u street pizza joints, this place is trendy, hipster and serves mediocre pizza at best. … More 1 Dj Teck Entertainment 1 review 2 years ago Quick and easy. Best pizza I’ve every had. Especially after the club. Will be back Adam Christensen Local Guide·71 reviews·326 photos 8 months ago No way to reach the store and UberEats never delivered my food. … More Erika R. Local Guide·50 reviews·18 photos 5 years ago Reminds me if Blaze. Make your own pizza and craft soda, but some of those toppings should. DEFINITELY go on the pizza as it's being cooked not at the end. Beyond the Clubhouse 1 review a year ago The staff here did a great job, very attentive and engaging. Especially Antonio. A wonferful customer experience! Ryan Local Guide·12 reviews 2 years ago Take out | Dinner | $10–20 Made a mistake when placing my order online and Antonio was awesome helping me get it corrected quickly and courteously. Will Return! … More Alfredo Schonborn 3 reviews a year ago Dine in | Dinner | $10–20 This place was a fantastic establishment to eat with quality food. A recommendation to everyone Ryan Dudrow 1 review 2 years ago Great service for an amazing price for a whole pizza awesome employees 10/10 would recommend Briana Jones 1 review 2 years ago I go to this location all the time! Great customer service and the pizza is always perfect! Haylee Smith 1 review a year ago Awesome pizza & employees. Has original drinks that all taste good! Justin Adams 8 reviews 4 years ago 1st time here. The food was great and the price was right. No complaints. Wish I had found this place sooner. Trip Taker 117 reviews·58 photos 2 years ago I'd like to give it a .5 star. Says that it's open but door is locked, lights are on and you can see employees inside working. Stephen Oliver Local Guide·13 reviews·17 photos 6 years ago Greeted by smells of rancid food or trash when entering. Smell intensifies as you walk further in. Trash everywhere and dirty tables. Bathrooms out of order. … More William Nelson 2 reviews 2 years ago great location! everyone here had great service and the pizza was good! 🙌🏽 Clementina Fernandez Valle 4 reviews·7 photos 2 years ago Great service and really quick. The pizza was delicious and the place is really nice. Jade Boone 2 reviews 2 years ago Staff was very friendly and efficient with taking customers orders in a timely manner! Will definitely visit again Quita11 2 reviews a year ago Terrence was awesome!!! He answered any question I had and did it with a great sense of humor. Marcus Smith Local Guide·115 reviews·5 photos 3 years ago The staff was polite, and efficient this staff is prepared for lunch rush, I even got a bottle of water Since I do a lot of delivery work, I really appreciate these things. 1 &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating and positive feedback! We're glad to hear that you had a great experience with our staff and that the service was efficient. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Marissa Amore Local Guide·57 reviews·13 photos 5 years ago It’s pizza & it’s good. Need I say more? Great location by clubs and night life. Great place to grab a bite on the late night Michael Smalls 2 reviews 2 years ago Fantastic experience! The service was excellent and I love their pizza. &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We're thrilled to hear about your fantastic experience and love for our pizza. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Hycent Nwaneri 1 review 2 years ago Great service!! Antonio really helped me and made sure everything was taken care of for me! Definitely will be back. &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We're thrilled to hear that Antonio provided great service and made sure everything was taken care of for you. Your response is important to us as we strive to improve our services. We look forward to welcoming you back soon! Alan Harris Local Guide·151 reviews·259 photos 6 years ago It was late when I went but it was still a great pizza. I could tell the associates were ready to go but appreciated the pizza. Will come again. Isaiah “Zay” West 1 review 2 years ago We came on Christmas Eve and the service was phenomenal! Antonio and Brian were great! Thank you &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We're thrilled to hear that Antonio and Brian provided phenomenal service on Christmas Eve. Your response is important to us as we strive to improve our services. We hope to have the pleasure of serving you again soon. Ryan Stevens 10 reviews 4 years ago Truly the worst experience . The all male staff associated with the shift on December 6th, at 12:22 am was extremely rude. Customer service was just extremely poor. &pizza - Dupont (Owner) 4 years ago Hey Ryan, I'm really sorry about your experience. We'd love to hear some more details about it if you can reach out to us on our text line, 200-03. Aja Clark 11 reviews 2 years ago Service was excellent! Came to this one because the one in Georgetown was closed. Brian and Antonio were really helpful and pleasant. Beverly Barber 4 reviews·2 photos 2 years ago The staff was very helpful with everything I needed and also made sure I was safe by giving me a mask to protect myself❤️ Patricia Babb 7 reviews 2 years ago Staff was very friendly and accommodating and the pizza was exceptional. Great location :) stefanie riggins 5 reviews 7 years ago Amazingly friendly staff! Our first dining experience in DC and we plan to hit them up again!!! Fresh deliciousness! LynDale Lewis Local Guide·159 reviews·358 photos 4 years ago Good pizza... one size, so be prepared to share if you don't easy a small pizza yourself. Simple menu. &pizza - Dupont (Owner) 4 years ago Hey there! Thanks so much for the love. We always appreciate our loyal fans. Renuka Joshi 3 reviews a year ago Dine in | Dinner | $10–20 Great pizza made quickly. The team working here is super nice. tomas moser 2 reviews 2 years ago Wonderful pizza great especially after a night out. Definitely recommend. &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We're glad to hear that you enjoyed the pizza, especially after a night out. Your response is important to us as we strive to improve our services. We hope to serve you again soon. Vanessa Jimenez Local Guide·49 reviews·8 photos 7 years ago Add your favorite toppings to an amazing crust with eclectic soda flavors for a good price. Comfortable, casual atmosphere. Nista Bob-Grey 1 review 2 years ago This &pizza location is great , the staff was super friendly and I got helped really quick! Stephanie Becker Local Guide·70 reviews·76 photos 5 years ago Different pizza place. Still liked it, one pie can feed 2 people if your not real hungry. Unique combinations. 1 Richo Local Guide·18 reviews·24 photos 4 years ago Delicious pizza, Maverick with extra cheese wont dissapoint any meat lover. Open until late is very helpful. &pizza - Dupont (Owner) 4 years ago Good choice with the Maverick Ricardo! Definitely a fan favorite. Thanks for the great review too! Chris Meaclem 4 reviews·1 photo 7 years ago Only $10 for any pizza, custom made. Basically the subway of pizza - choose your base and any toppings. They charge a flat rate, not per topping. Alex B. Local Guide·190 reviews·277 photos 7 years ago Love &pizza. This place stays open late on the weekends but is pretty full of drunk club goers. Still, it hits the spot after some dancing. robert brown 1 review 2 years ago Service at this location was the best I’ve had at any in the DMV area! Definitely will be going again. Amir Ghasdi 11 reviews·15 photos 5 years ago I built my own Pizza: pesto and spicy tomato, mushroom and Tomato, whole mozzarella, Italian sausages, beef, and finishing with goat cheese and arugula and for sure garlic oil!!! Tenija Livingston 1 review 11 months ago Dine in | Lunch | $1–10 Amazing!!! The workers were welcoming and very cheerful. 10/10 Kalaa 3 reviews 2 years ago Very fast pace store love how my pizza tastes perfect every single time. Brendan M. Local Guide·95 reviews·31 photos 5 years ago The pizza is fantastic. the employees are not. I got the feeling they didn't not care about the job or product they were giving customers. Allen Local Guide·288 reviews·819 photos a year ago Very poor service here. I was the only person in line and the employees did not even acknowledge me. They were having a conversation amongst themselves. Dog Matic 1 review a year ago Fast Great service from the two brother working feb 4 at 6pm Danielle Carr 2 reviews 2 years ago The guy who made my pizza made sure it was done right like forreal lol didn’t skimp me and it looks delicious Halio J 16 reviews 5 years ago Terrible customer service. Staf will rush you and slap together a terrible job of a pizza. Management no better. No wonder employees are terrible, management is even worse. Nadeen Siddiqui 6 reviews 5 years ago Terrible service. They just threw toppings without caring about making it tasty. Don’t waste your time and money here. Chose a place that actually tries. 1 Cory Simmons 1 review 2 years ago I got food poisoning. No disrespect to the workers, but my stomach hurts so much and I’m so mad lol. Thompson Hangen Local Guide·36 reviews·9 photos 4 years ago Fast and great pizza! What's not to love about &pizza? The staff here are friendly and accommodating! Christy McCann Local Guide·48 reviews·18 photos 2 years ago Food was not made correctly and a bit late, the secjrry staff is super rude, but employees were nice. Cavin Ward-Caviness Local Guide·319 reviews·769 photos 6 years ago Fresh, quick, tons of toppings, and most importantly tasty. If you have the chance definitely go to one of the many locations and see why all the hype is deserved Esprit Cha 2 reviews a year ago Amazing pizza, amazing service, awesome experience as a whole m g 11 reviews a year ago We bought a pizza and we’re immediately screamed at and tossed out for eating it inside. Like what? The moment I hand you cash you throw me out. I can’t eat my pizza inside? &pizza - Dupont (Owner) a year ago Hi Max. Sorry to read about your experience. Can you text us at 200-03 to provide more detail. Edwin Lopez 5 reviews·2 photos a year ago &pizza is my all-time favorite for a fast casual -- and delicious -- pizza. This location is a mainstay, too! R. T. Local Guide·16 reviews 7 years ago This place was gross!!! Trash everywhere and it smelled pretty bad. There's definitely better &pizza's to go to in DC. I went in and came right back out! 1 Rebecca Schick 32 reviews a year ago Take out | Dinner | $10–20 Very tasty pizza. Staff were great JED CREEK 8 reviews 7 years ago Do not ever go here it's terrible. My friend got food poisoning, so it's not safe to go here. And the management and the staff are terrible and refuse to take responsibility. Avoid this place at all costs! Monae' Bailey 4 reviews 2 years ago Antonio was very helpful, assisted me with ordering my meal. 10/10 would recommend! Kelli Smith 3 reviews 2 years ago I always get the best service here. I live &Pizza and Terrence is great!!! Emily Nelson 1 review 4 years ago Amazing, charismatic staff and even better pizza!! Very creative and innovative pizza and drink choices :-) Josiah Tomes 4 reviews·2 photos a year ago Staff is very nice! Photo 1 in review by Josiah Tomes GLENN EVANS Local Guide·41 reviews 4 years ago DONT WAIST YOUR TIME.OR.MONEY. PLACE WOULDN'T LAST A WEEK IN JERSEY. FIRST I TRIED TO CALL AND THEY DONT TAKE CALLS U HAVE TO ORDER ONLINE OR … More 2 Gucci simon Local Guide·64 reviews·4 photos 4 years ago Food was great. The service was horrible. Only 2 ppl in the store had some manners. The REST HORRIBLE. &pizza - Dupont (Owner) 4 years ago Hi Gucci. Thanks for the feedback. We're sorry that your experience was below expectation. We'll be sure to relay this message to the Shop Lead so that improvements can be made asap. Alyse Edwards 2 reviews 2 years ago Friendly, polite and helpful staff. Pizza is good too duh! C Michele 1 review a year ago Staff is dope. Pizza is delicious. Big fan! Lauren Prather 2 reviews 2 years ago Friendly and helpful! Quick service and the food is 🔥🔥! Lavelle was amazing and super helpful! Amazing customer service! Austin Zielman Local Guide·437 reviews·1539 photos 7 years ago Great pizza served super fast! Downside is that it's directly next to/under sa club, and the constant thumping is quite disturbing. Billy Local Guide·207 reviews·404 photos 7 years ago Cool spot for a flat bread pizza. You make your own pizza which is pretty cool. The price is reasonable one pizza is good for 2ppl. Kenny Culver Local Guide·14 reviews·1 photo 4 years ago pizza was so spicy I couldn't eat it I took it back in I said hey I need a new one I don't know why it's spicy they said tough s*** bounce &pizza - Dupont (Owner) 4 years ago Hey there! I'm so sorry to hear about your bad experience. If you get a chance, please text us on our customer service line at 200-03 and we will make this right. Priya Patel 2 reviews 2 years ago Loved it! Everyone was so accommodating and understanding! Great pizza! Emir Yılkıcı 5 reviews·3 photos 7 years ago They simply blend some cheap ingredients. The food tasted not that good. I don't recommend unless everywhere else is closed. Johnny Neilson 2 reviews 2 years ago Dine in my family loves this place! very good food and friendly staff! Luis Medina (COACHMETONY) Local Guide·97 reviews·324 photos 6 years ago Great food! I'm vegetarian and I had a lot of options here. Only thing is that serving sizes are really small. Chiquita Jackson 1 review 2 years ago Great food and quick service! Loved the garlic knots too. mike epps 3 reviews 2 years ago Great quality pizza, fast and friendly customer service. Dylan McDowell Local Guide·138 reviews·79 photos 7 years ago Best option for a pizza lunch in D.C. This location has more indoor seating, but during prime times be prepared to walk to a nearby park. Kay Tunez 1 review 2 years ago Quey was great and very helpful since it was my first time she made my experience 10 times better. Derrick A. Morton 2 reviews 2 years ago The coolest & Pizza in the DMV everyone in there will make you laugh ! Thank you for my good 🍕 DK Walker 7 reviews 6 years ago Best pizza ever! Far from traditional tasting pizza, leaves a funky delicacy in your mouth that leaves you beyond satisfied! Renee S. Local Guide·55 reviews·4 photos 7 years ago Pretty good! The prices are reasonable (listed at the top of the menu) and pizza is delicious! I ordered the gnaric... good choice! Tray Smith 4 reviews a year ago Great place. Jainyn was great cook. She was nice and quick. Music for every ocation Local Guide·6 reviews·334 photos 5 years ago I love these pizzas Photo 1 in review by Music for every ocation Christopher Edwards 2 reviews 2 years ago I had the best experience. Customer service was A1 and the food was awesome Pauline Abah 1 review a year ago When back to this place after my Last visit and the service is always amazing Nicholas Mildebrath 1 review 2 years ago Go-to lunch spot in DuPont. Pizzas are great and filling - quick service and always good music. Tustin Neilson 6 reviews 2 years ago Dine in | Lunch | $10–20 Quick service and tasty pizza! I recommend adding the hot honey. … More helene h 1 review a year ago Delivery | Dinner Super good pizza, delicious drinks, love it <3 &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We're thrilled to hear that you enjoyed our pizza and drinks. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Jimmy Sambuo 6 reviews·7 photos 2 years ago Fast and friendly service! &pizza is my goto pizza place. Marquis Savant 1 review a year ago Delivery | Lunch Waited over 30 min for a delivery while the employees traded food with shake shack Gabriel Marín 7 reviews·1 photo a year ago Lovely place and pizza is great!! Tay was a complete gentleman. &pizza - Dupont (Owner) 2 months ago We appreciate your 5-star rating! We're glad you enjoyed the pizza and the service provided by Tay. Your response is important to us as we strive to improve our services. Thank you for taking the time to share your experience with us. Messaijah Shillingford 2 reviews a year ago The food was great! Tae gave wonderful customer service! &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We're thrilled to hear that you enjoyed the food and received wonderful customer service from Tae. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Donald Jackson 7 reviews a year ago Dine in | Lunch | $10–20 Love how the pizza is made on the spot, fresh ingredients and creative mixes Talisha Harris 4 reviews 2 years ago Terence was great! Ever want great pizza and good vibes, come to Dupont location! Corey DeAngelis Local Guide·204 reviews·623 photos 7 years ago Best custom pizza ever Photo 1 in review by Corey DeAngelis Frankie B 1 review 2 years ago Absolutely love this place. Service is quick and food is great Kaylah B Local Guide·48 reviews·18 photos a year ago Take out | Dinner | $10–20 Super fresh, super quick service even though it was very busy! Anna zakharchishin 1 review a year ago Other | $10–20 Alonzo was the absolute best. Should definitely be running the place! Baylee Childress 2 reviews 5 years ago Love this place. Always delicious. Staff is always friendly. Tyler is a bit of a Chav. Tsvetelina Petkova Local Guide·99 reviews·147 photos 4 years ago Really kice and tasty pizza. Affordable price and you choose your topics. Basically you choose your pizza from scratch. Yummy. &pizza - Dupont (Owner) 4 years ago Glad you enjoy the concept Tsvetelina! And thanks for dropping a review! Steve Murphy Local Guide·43 reviews·417 photos 5 years ago Good, quick pizza while you wait. Not as good as wood burning oven etc, but satisfies... James Papanestor Local Guide·88 reviews·574 photos 2 years ago Thin crust and the choices for the toppings are not like any other! Went three times in one week. Tarikah Omar 3 reviews 6 years ago Pizza was fantastic, service was awesome, there was an unpleasant odor when entering that definitely needs to be addressed 1 Javier Borja Local Guide·19 reviews·1 photo 5 years ago Love the food, large space with plenty of seating. It's not a warm place but in great location G Local Guide·116 reviews a year ago Food was good staff was friendly and helpful. … More Amar-Jyrel Mott 2 reviews 2 years ago I love it! Staff is nice & I've never had a bad experience! N K Local Guide·98 reviews·38 photos 6 years ago The best build to suit pizza joint I've tried. Light years ahead of blaze on quality of ingredients. Gahana Dahiya 6 reviews·1 photo 3 years ago I go to this place all the time! Food is great and the staff is always nice. &pizza - Dupont (Owner) 3 years ago Thank you so much for the review and thank you for being a returning guest! Can't wait to see you again next time! Patrice Mobitang 1 review 2 years ago Great pizza. My familly and I love this location Yuting (Nychii) Local Guide·114 reviews·1683 photos 7 years ago Really enjoy the way this chain makes pizza! This location doesn't have a lot of seating though... Sakina Allen 2 reviews 11 months ago great customer service!!!! definitely recommend. George A 1 review 2 years ago Ordered waited for 2 hours and then my order was canceled. They asked me to reorder. It was my first time ordering from them and my last time. TEAM SHERBOURNE Local Guide·405 reviews·284 photos a year ago I'm from NY and Always have to visit a &pizza while in DC! &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We are thrilled to hear that you always enjoy visiting &pizza while in DC. Your response is important to us as we strive to improve our services. We hope to continue exceeding your expectations on your future visits. Carlos Patiño Local Guide·168 reviews·431 photos 4 years ago Really, good pizza! Just pick what you want with it and enjoy. Friendly people. &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We're delighted to hear that you enjoyed our pizza and found our staff friendly. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Erica Burwell 4 reviews 6 years ago The service was good food is normal. If u r n the mood for pizza good place to go. Aris Preston 2 reviews 2 years ago Pizza is great Antoni and Bron were very helpful and lead to a great lunch. Weiyan Zhang 2 reviews 2 years ago I quite like the pizza here! Self designed pizza is always the best big boi rj 1 review a year ago Take out | Dinner Awesome establishment, good service, tasty pizza Bryan Moises Hernandez Benitez 1 review a year ago the crust is the best and the staff are great, down to earth people. Courtney Metcalfe 5 reviews 2 years ago Lavelle was awesome and gave us great service! awesome pizza Jennifer Morgan 6 reviews a year ago Take out | Dinner | $10–20 Great option for a quick / delicious late night dinner. … More James Gregory 2 reviews a year ago Good pizza great people!! Great late night fix &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We're thrilled to hear that you enjoyed our pizza and our service. We're always here to satisfy those late-night cravings. Your response is important to us as we strive to improve our services. Ms Lola 2 reviews 2 years ago Antonio was the best I love how he makes my pizza, I absolutely love this location. Adeola A 11 reviews 4 years ago The pizza is fine, they don't allow you to sit down and eat late nights on the weekend, although they are open, and the security is very rude about it. Joni Hurley 3 reviews·1 photo 5 years ago Pizza was amazing!!!! One of my best GF pizza crust (order well done) Tat hazelton 4 reviews 2 years ago Good Customer Service, Fast Paced & Loaded Pizza Up. Joseph Rhinehart 11 reviews·1 photo 2 years ago Friendly staff. Great food . Will definitely come back. AHMED RABANE 2 reviews a year ago Always great customer service. Terence is definitely a great asset for this location Kendi Johnson 1 review 2 years ago Lavelle was very professional. He put love into my pizza Justin Wang Local Guide·92 reviews 7 years ago Make your own pizza for $9? As many toppings/sauces/garnishes as you want?? I love &pizza. Tahlia Stangherlin 8 reviews·4 photos a year ago Tay was very helpful when i checked out today. very polite and friendly ! Nisha P 6 reviews·1 photo 2 years ago Great experience! Quick and convent! It’s a must try if you are in D.C. Pooja Rastogi 5 reviews·2 photos 2 years ago Love the pizza and employees!!!!!! So so nice especially lavelle Jake Backers 3 reviews a year ago This place is the best!! also the pizza??? smashing!!! Chanel Beaudoin 1 review 2 years ago Great pizza love it here. Loved the service! Allen Cardenas Local Guide·42 reviews·10 photos 5 years ago So glad there is an &pizza in Dupont. It's quick, easy, and delicious. Awesome value for your money Chanelle Combs 1 review 2 years ago Antonio the best I love this location best pizza and they close at 4am Clifton McEachin 3 reviews 2 years ago Great service!!!! The best pizza I’ve ever head!!! Lucas Orjales 2 reviews a year ago Tay was the best supervisor! Absolutely delicious pizza! Antwane Wrenn 1 review a year ago I love this location .employee are fun and patient Kristin Fillingim 1 review 2 years ago Là elle was the best!! Great service. 5 out of 5 every time!!!! &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We are thrilled to hear that you had a great experience with us. Your response is important to us as we strive to improve our services. We look forward to serving you again soon! Jackie Warner 2 reviews 2 years ago Great service and pizza! Antonio, Brianna and Jalen are the best. Veronica Sarai Melara Cornejo 1 review a year ago Good customer service! Friendly people and always willing to help. Lifeasevon 6 reviews 2 years ago The pizza is always great ! Extra crispy too David Oliveira 4 reviews 2 years ago Take out | Dinner | $10–20 Love their pizza, clean and nice location miles vondra Local Guide·10 reviews·12 photos a year ago Great pizza, even better people. JP was great! Yousif M Local Guide·26 reviews·3 photos 5 years ago Lots of crust on the pizza because of how it's made. Super fresh and feels almost healthy! Lauren Hastings 1 review 2 years ago Take out | Dinner Service was great and the vibe even better! Lavelle’s assistance was top notch Precious Johnson Local Guide·25 reviews 2 years ago Service was great at this location! Food was delicious 😋 Kannan Ramanathan Local Guide·73 reviews·27 photos 4 years ago You can just add all the ingredients you want and the dough of the pizza is thin and delicious &pizza - Dupont (Owner) 4 years ago Hey Kannan, glad you loved it! Come again soon! Al S. 1 review 2 years ago Outstanding service and made one hell of a pizza Delonte Briggs, MBA Local Guide·48 reviews·18 photos 4 years ago Staff was not welcoming and had the dude had an attitude when clarifying build your own versus a classic adding a few extra toppings...it didn't master i was willing to pay the difference.. 1 &pizza - Dupont (Owner) 4 years ago Sorry to hear that your pizza experience wasn't the best. Thank you for your feedback. I will forward this information to the appropriate people. Please reach out to us so that we can make this right. A'Jae Boyd 2 reviews 2 years ago Great customer service. Order done in a timely fashion. &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We're thrilled to hear that your order was delivered in a timely fashion. Your response is important to us as we strive to improve our services. We hope to serve you again soon! John Benson Local Guide·23 reviews·183 photos 4 years ago Customer service at this location is atrocious. The crew working the evening shift on 2/28/20 were very rude. Stay away! Dallas S. Local Guide·101 reviews·89 photos 5 years ago My first pizza in DC. Quick service and great good at a decent price. Jordhon Horelien 2 reviews 2 years ago Lavelle was an excellent help to getting the pizza of my choice. Very helpful &pizza - Dupont (Owner) 2 months ago Thank you for taking the time to leave a review. We are thrilled to hear that Lavelle was able to assist you in getting the pizza of your choice. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Courtney Wade 4 reviews 2 years ago Labella is awesome. He goes the extra mile. Thank you! Dusan Vasiljevic Local Guide·50 reviews·25 photos 4 years ago Excellent suggested choices of toppings, quick service, good enough interior. Mig Local Guide·581 reviews·590 photos 6 years ago Love this pizza: Favorite go to - Red sauce with pepporoni and sausage drizzled with pesto on top. Mercedes White 3 reviews 2 years ago Phenomenal experience with Antonio and the rest of the staff. The place was very clean! Kate Neilson 3 reviews 2 years ago Dine in | Lunch | $10–20 love & pizza! come here often and always enjoy it. … More KDASH201 14 reviews·1 photo 7 years ago Best pizza I ever had. You just have to go and try it yourself Debbie James 8 reviews 2 years ago Ran efficiently under pressure during Halloween eve and Lavelle was very helpful Bosh Gobran Local Guide·304 reviews·695 photos 7 years ago Great Pizza, fast and they have a vegan/vegetarian options:) fund staff Smash Diddy 5 reviews 6 years ago Service was good and food great who dnt love pizza lol &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We're glad to hear that you enjoyed our service and food, especially the pizza. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Heidi Wiles Local Guide·25 reviews·2 photos 7 years ago I just love the the atmosphere the people are great and the pizza is delicious. Need one in Hagerstown MD. hector paredes Local Guide·51 reviews·712 photos 2 months ago I love this Pizza … More &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We're thrilled to hear that you love our pizza. Your response is important to us as we strive to improve our services. We look forward to serving you again soon. Justin Bozeman 3 reviews 5 years ago Ordered via Uber Eats, Pizza came completely wrong from what was ordered, and added whatever they wanted to the pizza and when called , no one answers the phone and call was looped, no one ever responded to my e-mails regarding the wrong order 1 Alana Peery 6 reviews·13 photos a year ago Great pizza and better service! Kunal Vijan Local Guide·117 reviews·505 photos 4 years ago Very nice n tasty. Much better than DC Pizza James Plain Local Guide·9 reviews 5 years ago i tried the american honey pizza, and was great! The craft sodas are also really interesting! danelle hankins 8 reviews 2 years ago Antonio made me a great pizza today and answered all my questions. Fly Gurl Local Guide·193 reviews·271 photos 4 years ago The staff was great they are very customer service driven , fast , and very clean Rodolfo Diaz 1 review a year ago Great Place! Awesome customer service! Dean Naps 2 reviews a year ago Awesome pizza, great service, thank you &pizza! EBEMBI Alain 3 reviews 2 years ago Great location. Staff are really friendly and patient Robin Young 5 reviews 5 years ago Fantastic pizza and an AMAZING staff!! I could eat there everyday!!’ Javid Pourkia Local Guide·128 reviews·1295 photos 5 years ago It's not just food, is love Photo 1 in review by Javid Pourkia Petra Sosa 2 reviews·1 photo a year ago Best pizza in town , customer service is A1 ! Photo 1 in review by Petra Sosa khairy jones 3 reviews 2 years ago This was a great place to go late at night and it handled the long line well Alvaro Dalessandro Local Guide·44 reviews·3 photos 4 years ago Tasty pizza, only downside is the place didn't have Coca-Cola Money Monkey 1 review 2 years ago lavelle was extremely helpful and made sure i was set and provided good service Living the life of lele Vibing 12 reviews·2 photos a year ago Great customer service made me feel welcome &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We're thrilled to hear that our customer service made you feel welcome. Your response is important to us as we strive to improve our services. We hope to continue providing a great experience for you in the future. Abish Anklesaria Local Guide·94 reviews·53 photos 7 years ago Fresh pizza. Good toppings selection. Kid friendly as well. Great place for a fast custom pizza. Rob G Local Guide·151 reviews·301 photos 2 years ago First visit. Fast service, excellent pizza! Matt Peterson 2 reviews 2 years ago an icon, a legend, showstopping beautiful amazing never the same the best &pizza in DC Eric Midder Local Guide·146 reviews 4 years ago Could be a little quicker but very friendly staff and great pizza! Sandra Gaillardetz 4 reviews 5 years ago This Pizza was phenomenal ! Loved it and would definitely go back!!
+
+USER:
+How, if at all, does the owner of this business respond to negative reviews?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,7,14,16632,,171
+"This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge, The response should bold every name present in the response. The response should be formatted into a bullet point list. The response should be no more than twenty words long.",List every cloud gaming subscription service mentioned in this text.,"On January 18, 2022, Microsoft Corp. announced plans to acquire Activision Blizzard Inc., a video game company, for $68.7 billion.1 The Federal Trade Commission (FTC) is reviewing the acquisition,2 as provided under the Hart-Scott-Rodino Act (HSR),3 to determine whether its effect might be “substantially to lessen competition”—a violation of Section 7 of the Clayton Act. 4 Competition authorities in other countries are reviewing Microsoft’s proposed acquisition as well.5 The companies have said they expect to complete the acquisition before June 30, 2023.6 In recent decades, enforcement of antitrust laws has typically focused on how a proposed merger or acquisition might affect consumers, such as by reducing price competition in relevant product markets. Some of the FTC’s actions and statements over the last two years suggest that in its review of Microsoft’s proposed acquisition, the FTC may be considering other factors that are discussed in this report.7 This report discusses Microsoft’s proposed acquisition of Activision Blizzard, including some of the potential effects on existing product markets, labor markets, and on product markets that do not currently exist but may develop in the future. The report also provides some considerations for Congress, discussing some bills that may affect Microsoft’s proposed acquisition or Microsoft’s future behavior if the acquisition is completed. The video game industry can be separated into three components: developers or gaming studios that create and design video games; publishers who market and monetize the video games; and distributors who provide the video games to consumers.8 Video games are most commonly played on game consoles, personal computers (PCs), and mobile devices (Figure 1). Although some retailers sell physical copies of video games for consoles and PCs, the majority of video games are sold in digital format;9 games for mobile devices are sold only in digital format The extent of competition among distributors depends on the format and device used to play the game. The digital format of video games played on a console generally can only be downloaded from a digital store operated by the producer of the console. Games for PCs can be purchased from a selection of digital stores that are operated by various firms,10 including publishers and developers.11 Some of these firms also provide their games as apps on certain mobile devices;12 these are distributed through app stores, such as Google Play and Apple’s App Store. Consoles are typically sold at a loss; the manufacturers then profit from sales of games and subscription services.13 This can incentivize console producers to acquire developers and publishers and offer exclusive content.14 Technological developments have allowed some PCs and other devices, depending on their hardware capabilities, to compete with game consoles.15 For example, early in 2022, Valve Corp. released a handheld PC—Steam Deck—that resembles the Nintendo Switch console but provides features that are typically available on PCs, such as a web browser, and allows users to download third-party software, including other operating systems.16 Some firms have started offering video game subscription services that provide access to multiple games for a monthly fee, meaning users do not need to purchase each individual game.17 Some firms offer cloud gaming, which allows users to play video games using remote servers in data centers, reducing the hardware requirements needed to play the games and expanding the variety of devices that can be used.18 Cloud gaming, however, requires a high-speed internet connection and is not feasible for potential users who do not have access to sufficiently high broadband speeds.19 Subscription services reportedly provide 4% of total revenue in the North American and European video game markets.20 Some firms backed by venture capitalists and large firms that are primarily known for providing other online services have shown interest in entering the video game industry.21 For example, Netflix started offering games on mobile devices on November 2, 2021, and has acquired video game developers.22 These firms may be able to further expand the selection of distributors available for certain devices and potentially increase competition in the industry.23 Microsoft and Activision Blizzard in the Video Game Industry Microsoft distributes video games using Microsoft Store, its subscription service Game Pass,24 and its cloud gaming service Xbox Cloud Gaming (Beta);25 publishes games, including the franchises Halo and Minecraft; 26 and owns 23 gaming studios.27 In 2021, Microsoft had the second-highest share in the U.S. market for game consoles at 34.8%, according to a report from MarketLine, an industry research firm; estimates for Sony and Nintendo were 40.7% and 24.5%, respectively.28 In January 2022, Microsoft stated that it had more than 25 million Game Pass subscribers.29 In April 2022, Microsoft reported that more than 10 million people have streamed games over Xbox Cloud Gaming,30 although it is unclear how long or how many times users accessed the service. Estimates from Ampere Analysis reportedly indicate that Game Pass makes up about 60% of the video game subscription market.31 Among video game publishers in the United States, Microsoft had the highest market share at 23.9%, according to IBISWorld.32 Activision Blizzard is a video game publisher and developer primarily known for its franchise games, which include World of Warcraft, Call of Duty, Diablo, and Candy Crush. 33 The company can be separated into three segments—Activision, Blizzard, and King—that each contain their own gaming studios. Among video game publishers in the United States, Activision Blizzard had the second highest market share at 10%, according to IBISWorld.34 Activision also distributes video games for PCs through its digital store—Battle.net.35 Among video game publishers in the United States, Microsoft and Activision Blizzard are estimated to have the largest market shares.47 IBISWorld reports, however, that competition among publishers and developers is high, even though the success of new entrants, particularly among developers, is fairly low.48 Publishers and developers can face high levels of uncertainty and risk.49 Furthermore, measuring the market share of Microsoft and Activision Blizzard within the United States may not accurately reflect competition in these markets, given that these companies compete at a global level. Some industry analysts list Tencent, which is headquartered in China, as the largest video game publisher worldwide based on revenue;50 Microsoft and Activision Blizzard are listed among the top 10, along with Sony, Nintendo, EA, and Take-Two Interactive.51 Microsoft stated that after its acquisition of Activision Blizzard, it would “become the world’s third-largest gaming company by revenue, behind Tencent and Sony.” 52","List every cloud gaming subscription service mentioned in this text. This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge, The response should bold every name of a cloud gaming subscription present in the response. The response should be formatted into a bullet point list. The response should be no more than twenty words long. On January 18, 2022, Microsoft Corp. announced plans to acquire Activision Blizzard Inc., a video game company, for $68.7 billion.1 The Federal Trade Commission (FTC) is reviewing the acquisition,2 as provided under the Hart-Scott-Rodino Act (HSR),3 to determine whether its effect might be “substantially to lessen competition”—a violation of Section 7 of the Clayton Act. 4 Competition authorities in other countries are reviewing Microsoft’s proposed acquisition as well.5 The companies have said they expect to complete the acquisition before June 30, 2023.6 In recent decades, enforcement of antitrust laws has typically focused on how a proposed merger or acquisition might affect consumers, such as by reducing price competition in relevant product markets. Some of the FTC’s actions and statements over the last two years suggest that in its review of Microsoft’s proposed acquisition, the FTC may be considering other factors that are discussed in this report.7 This report discusses Microsoft’s proposed acquisition of Activision Blizzard, including some of the potential effects on existing product markets, labor markets, and on product markets that do not currently exist but may develop in the future. The report also provides some considerations for Congress, discussing some bills that may affect Microsoft’s proposed acquisition or Microsoft’s future behavior if the acquisition is completed. The video game industry can be separated into three components: developers or gaming studios that create and design video games; publishers who market and monetize the video games; and distributors who provide the video games to consumers.8 Video games are most commonly played on game consoles, personal computers (PCs), and mobile devices (Figure 1). Although some retailers sell physical copies of video games for consoles and PCs, the majority of video games are sold in digital format;9 games for mobile devices are sold only in digital format The extent of competition among distributors depends on the format and device used to play the game. The digital format of video games played on a console generally can only be downloaded from a digital store operated by the producer of the console. Games for PCs can be purchased from a selection of digital stores that are operated by various firms,10 including publishers and developers.11 Some of these firms also provide their games as apps on certain mobile devices;12 these are distributed through app stores, such as Google Play and Apple’s App Store. Consoles are typically sold at a loss; the manufacturers then profit from sales of games and subscription services.13 This can incentivize console producers to acquire developers and publishers and offer exclusive content.14 Technological developments have allowed some PCs and other devices, depending on their hardware capabilities, to compete with game consoles.15 For example, early in 2022, Valve Corp. released a handheld PC—Steam Deck—that resembles the Nintendo Switch console but provides features that are typically available on PCs, such as a web browser, and allows users to download third-party software, including other operating systems.16 Some firms have started offering video game subscription services that provide access to multiple games for a monthly fee, meaning users do not need to purchase each individual game.17 Some firms offer cloud gaming, which allows users to play video games using remote servers in data centers, reducing the hardware requirements needed to play the games and expanding the variety of devices that can be used.18 Cloud gaming, however, requires a high-speed internet connection and is not feasible for potential users who do not have access to sufficiently high broadband speeds.19 Subscription services reportedly provide 4% of total revenue in the North American and European video game markets.20 Some firms backed by venture capitalists and large firms that are primarily known for providing other online services have shown interest in entering the video game industry.21 For example, Netflix started offering games on mobile devices on November 2, 2021, and has acquired video game developers.22 These firms may be able to further expand the selection of distributors available for certain devices and potentially increase competition in the industry.23 Microsoft and Activision Blizzard in the Video Game Industry Microsoft distributes video games using Microsoft Store, its subscription service Game Pass,24 and its cloud gaming service Xbox Cloud Gaming (Beta);25 publishes games, including the franchises Halo and Minecraft; 26 and owns 23 gaming studios.27 In 2021, Microsoft had the second-highest share in the U.S. market for game consoles at 34.8%, according to a report from MarketLine, an industry research firm; estimates for Sony and Nintendo were 40.7% and 24.5%, respectively.28 In January 2022, Microsoft stated that it had more than 25 million Game Pass subscribers.29 In April 2022, Microsoft reported that more than 10 million people have streamed games over Xbox Cloud Gaming,30 although it is unclear how long or how many times users accessed the service. Estimates from Ampere Analysis reportedly indicate that Game Pass makes up about 60% of the video game subscription market.31 Among video game publishers in the United States, Microsoft had the highest market share at 23.9%, according to IBISWorld.32 Activision Blizzard is a video game publisher and developer primarily known for its franchise games, which include World of Warcraft, Call of Duty, Diablo, and Candy Crush. 33 The company can be separated into three segments—Activision, Blizzard, and King—that each contain their own gaming studios. Among video game publishers in the United States, Activision Blizzard had the second highest market share at 10%, according to IBISWorld.34 Activision also distributes video games for PCs through its digital store—Battle.net.35 Among video game publishers in the United States, Microsoft and Activision Blizzard are estimated to have the largest market shares.47 IBISWorld reports, however, that competition among publishers and developers is high, even though the success of new entrants, particularly among developers, is fairly low.48 Publishers and developers can face high levels of uncertainty and risk.49 Furthermore, measuring the market share of Microsoft and Activision Blizzard within the United States may not accurately reflect competition in these markets, given that these companies compete at a global level. Some industry analysts list Tencent, which is headquartered in China, as the largest video game publisher worldwide based on revenue;50 Microsoft and Activision Blizzard are listed among the top 10, along with Sony, Nintendo, EA, and Take-Two Interactive.51 Microsoft stated that after its acquisition of Activision Blizzard, it would “become the world’s third-largest gaming company by revenue, behind Tencent and Sony.” 52","This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge, The response should bold every name present in the response. The response should be formatted into a bullet point list. The response should be no more than twenty words long.
+
+EVIDENCE:
+On January 18, 2022, Microsoft Corp. announced plans to acquire Activision Blizzard Inc., a video game company, for $68.7 billion.1 The Federal Trade Commission (FTC) is reviewing the acquisition,2 as provided under the Hart-Scott-Rodino Act (HSR),3 to determine whether its effect might be “substantially to lessen competition”—a violation of Section 7 of the Clayton Act. 4 Competition authorities in other countries are reviewing Microsoft’s proposed acquisition as well.5 The companies have said they expect to complete the acquisition before June 30, 2023.6 In recent decades, enforcement of antitrust laws has typically focused on how a proposed merger or acquisition might affect consumers, such as by reducing price competition in relevant product markets. Some of the FTC’s actions and statements over the last two years suggest that in its review of Microsoft’s proposed acquisition, the FTC may be considering other factors that are discussed in this report.7 This report discusses Microsoft’s proposed acquisition of Activision Blizzard, including some of the potential effects on existing product markets, labor markets, and on product markets that do not currently exist but may develop in the future. The report also provides some considerations for Congress, discussing some bills that may affect Microsoft’s proposed acquisition or Microsoft’s future behavior if the acquisition is completed. The video game industry can be separated into three components: developers or gaming studios that create and design video games; publishers who market and monetize the video games; and distributors who provide the video games to consumers.8 Video games are most commonly played on game consoles, personal computers (PCs), and mobile devices (Figure 1). Although some retailers sell physical copies of video games for consoles and PCs, the majority of video games are sold in digital format;9 games for mobile devices are sold only in digital format The extent of competition among distributors depends on the format and device used to play the game. The digital format of video games played on a console generally can only be downloaded from a digital store operated by the producer of the console. Games for PCs can be purchased from a selection of digital stores that are operated by various firms,10 including publishers and developers.11 Some of these firms also provide their games as apps on certain mobile devices;12 these are distributed through app stores, such as Google Play and Apple’s App Store. Consoles are typically sold at a loss; the manufacturers then profit from sales of games and subscription services.13 This can incentivize console producers to acquire developers and publishers and offer exclusive content.14 Technological developments have allowed some PCs and other devices, depending on their hardware capabilities, to compete with game consoles.15 For example, early in 2022, Valve Corp. released a handheld PC—Steam Deck—that resembles the Nintendo Switch console but provides features that are typically available on PCs, such as a web browser, and allows users to download third-party software, including other operating systems.16 Some firms have started offering video game subscription services that provide access to multiple games for a monthly fee, meaning users do not need to purchase each individual game.17 Some firms offer cloud gaming, which allows users to play video games using remote servers in data centers, reducing the hardware requirements needed to play the games and expanding the variety of devices that can be used.18 Cloud gaming, however, requires a high-speed internet connection and is not feasible for potential users who do not have access to sufficiently high broadband speeds.19 Subscription services reportedly provide 4% of total revenue in the North American and European video game markets.20 Some firms backed by venture capitalists and large firms that are primarily known for providing other online services have shown interest in entering the video game industry.21 For example, Netflix started offering games on mobile devices on November 2, 2021, and has acquired video game developers.22 These firms may be able to further expand the selection of distributors available for certain devices and potentially increase competition in the industry.23 Microsoft and Activision Blizzard in the Video Game Industry Microsoft distributes video games using Microsoft Store, its subscription service Game Pass,24 and its cloud gaming service Xbox Cloud Gaming (Beta);25 publishes games, including the franchises Halo and Minecraft; 26 and owns 23 gaming studios.27 In 2021, Microsoft had the second-highest share in the U.S. market for game consoles at 34.8%, according to a report from MarketLine, an industry research firm; estimates for Sony and Nintendo were 40.7% and 24.5%, respectively.28 In January 2022, Microsoft stated that it had more than 25 million Game Pass subscribers.29 In April 2022, Microsoft reported that more than 10 million people have streamed games over Xbox Cloud Gaming,30 although it is unclear how long or how many times users accessed the service. Estimates from Ampere Analysis reportedly indicate that Game Pass makes up about 60% of the video game subscription market.31 Among video game publishers in the United States, Microsoft had the highest market share at 23.9%, according to IBISWorld.32 Activision Blizzard is a video game publisher and developer primarily known for its franchise games, which include World of Warcraft, Call of Duty, Diablo, and Candy Crush. 33 The company can be separated into three segments—Activision, Blizzard, and King—that each contain their own gaming studios. Among video game publishers in the United States, Activision Blizzard had the second highest market share at 10%, according to IBISWorld.34 Activision also distributes video games for PCs through its digital store—Battle.net.35 Among video game publishers in the United States, Microsoft and Activision Blizzard are estimated to have the largest market shares.47 IBISWorld reports, however, that competition among publishers and developers is high, even though the success of new entrants, particularly among developers, is fairly low.48 Publishers and developers can face high levels of uncertainty and risk.49 Furthermore, measuring the market share of Microsoft and Activision Blizzard within the United States may not accurately reflect competition in these markets, given that these companies compete at a global level. Some industry analysts list Tencent, which is headquartered in China, as the largest video game publisher worldwide based on revenue;50 Microsoft and Activision Blizzard are listed among the top 10, along with Sony, Nintendo, EA, and Take-Two Interactive.51 Microsoft stated that after its acquisition of Activision Blizzard, it would “become the world’s third-largest gaming company by revenue, behind Tencent and Sony.” 52
+
+USER:
+List every cloud gaming subscription service mentioned in this text.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,58,10,1048,,96
+"{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]","According to this reference text, explain how Vitamin K helps with bone and vascular health, and explain how vitamin K -dependent proteins play a role in vascular health. For brevity, use no more than 200 words.","Vitamin K is best known for promoting proper blood clotting and bone health.1 A meta-analysis of randomized controlled trials revealed that vitamin K supplementation also has favorable effects on glucose metabolism parameters and risk of developing type II diabetes.2 In observational studies, higher intake of vitamin K has been associated with a reduced risk of type II diabetes and improved markers of glucose control.3-5 Clinical trials have shown that vitamin K supplementation can improve metabolic health in adults with diabetes and prediabetes, significantly reducing elevated glucose and insulin levels.6-8 That may help prevent the damage caused by high blood sugar in diabetics and reduce the risk of developing type II diabetes in the first place. The Importance of Vitamin K Vitamin K is found in green leafy vegetables, fermented foods, and some animal products, particularly organ meats. It occurs in two general forms, vitamin K1 and vitamin K2.1 Vitamin K is required for the proper function and activation of different proteins known as vitamin K-dependent proteins. These proteins include several clotting factors that control blood coagulation as well as osteocalcin, a protein tied to vascular and bone health. Some of these vitamin K-dependent proteins help keep calcium in the bones, and out of blood vessels. Calcified blood vessels are one of the hallmarks of atherosclerosis and vascular dysfunction. Without adequate vitamin K, the risk of cardiovascular disease, osteoporosis, and osteopenia rises.1,9 Other vitamin K-dependent proteins have favorable t effects on metabolic function.3,10 Link to Metabolic Health Multiple types of research indicate that Vitamin K2 intake may lower risk of developing type II diabetes.11 The vitamin's role in glucose homeostasis may be due in part to the activation of osteocalcin. In addition to its role in bone mineralization, osteocalcin stimulates healthy insulin and adiponectin expression.12 Studies show that people with higher intake of vitamin K tend to have better insulin sensitivity, better control of blood glucose levels, and a decreased risk of developing type II diabetes.3,5 In an observational study embedded in a randomized controlled trial of the Mediterranean diet for prevention of cardiovascular disease, men and women without cardiovascular disease were followed for 5.5 years. Dietary information was collected annually through questionnaires. It was found that baseline intake of vitamin K1 was lower in participants who developed diabetes during the study. It was also found that the risk of developing diabetes dropped by approximately 17% for every 100 mcg of vitamin K1 consumed per day. Subjects who increased their dietary vitamin K1 intake over those 5.5 years had a 51% reduction in risk for developing diabetes, compared with those who did not increase vitamin K intake. The authors concluded that dietary vitamin K1 is associated with reduced risk of type II diabetes.13 How It Works Vitamin K appears to improve insulin function and glucose metabolism in at least two main ways: Activating vitamin K-dependent proteins is involved in regulating glucose metabolism.3 Suppressing chronic inflammation and production of pro-inflammatory compounds, which is a major contributor to diminished insulin sensitivity and metabolic disease.3 Together, these actions could help reduce elevated glycemic markers and lower risk for diabetic complications.","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== According to this reference text, explain how Vitamin K helps with bone and vascular health, and explain how vitamin K -dependent proteins play a role in vascular health. For brevity, use no more than 200 words. {passage 0} ========== Vitamin K is best known for promoting proper blood clotting and bone health.1 A meta-analysis of randomized controlled trials revealed that vitamin K supplementation also has favorable effects on glucose metabolism parameters and risk of developing type II diabetes.2 In observational studies, higher intake of vitamin K has been associated with a reduced risk of type II diabetes and improved markers of glucose control.3-5 Clinical trials have shown that vitamin K supplementation can improve metabolic health in adults with diabetes and prediabetes, significantly reducing elevated glucose and insulin levels.6-8 That may help prevent the damage caused by high blood sugar in diabetics and reduce the risk of developing type II diabetes in the first place. The Importance of Vitamin K Vitamin K is found in green leafy vegetables, fermented foods, and some animal products, particularly organ meats. It occurs in two general forms, vitamin K1 and vitamin K2.1 Vitamin K is required for the proper function and activation of different proteins known as vitamin K-dependent proteins. These proteins include several clotting factors that control blood coagulation as well as osteocalcin, a protein tied to vascular and bone health. Some of these vitamin K-dependent proteins help keep calcium in the bones, and out of blood vessels. Calcified blood vessels are one of the hallmarks of atherosclerosis and vascular dysfunction. Without adequate vitamin K, the risk of cardiovascular disease, osteoporosis, and osteopenia rises.1,9 Other vitamin K-dependent proteins have favorable t effects on metabolic function.3,10 Link to Metabolic Health Multiple types of research indicate that Vitamin K2 intake may lower risk of developing type II diabetes.11 The vitamin's role in glucose homeostasis may be due in part to the activation of osteocalcin. In addition to its role in bone mineralization, osteocalcin stimulates healthy insulin and adiponectin expression.12 Studies show that people with higher intake of vitamin K tend to have better insulin sensitivity, better control of blood glucose levels, and a decreased risk of developing type II diabetes.3,5 In an observational study embedded in a randomized controlled trial of the Mediterranean diet for prevention of cardiovascular disease, men and women without cardiovascular disease were followed for 5.5 years. Dietary information was collected annually through questionnaires. It was found that baseline intake of vitamin K1 was lower in participants who developed diabetes during the study. It was also found that the risk of developing diabetes dropped by approximately 17% for every 100 mcg of vitamin K1 consumed per day. Subjects who increased their dietary vitamin K1 intake over those 5.5 years had a 51% reduction in risk for developing diabetes, compared with those who did not increase vitamin K intake. The authors concluded that dietary vitamin K1 is associated with reduced risk of type II diabetes.13 How It Works Vitamin K appears to improve insulin function and glucose metabolism in at least two main ways: Activating vitamin K-dependent proteins is involved in regulating glucose metabolism.3 Suppressing chronic inflammation and production of pro-inflammatory compounds, which is a major contributor to diminished insulin sensitivity and metabolic disease.3 Together, these actions could help reduce elevated glycemic markers and lower risk for diabetic complications. https://www.lifeextension.com/magazine/2024/10/vitamin-k-and-blood-sugar","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]
+
+EVIDENCE:
+Vitamin K is best known for promoting proper blood clotting and bone health.1 A meta-analysis of randomized controlled trials revealed that vitamin K supplementation also has favorable effects on glucose metabolism parameters and risk of developing type II diabetes.2 In observational studies, higher intake of vitamin K has been associated with a reduced risk of type II diabetes and improved markers of glucose control.3-5 Clinical trials have shown that vitamin K supplementation can improve metabolic health in adults with diabetes and prediabetes, significantly reducing elevated glucose and insulin levels.6-8 That may help prevent the damage caused by high blood sugar in diabetics and reduce the risk of developing type II diabetes in the first place. The Importance of Vitamin K Vitamin K is found in green leafy vegetables, fermented foods, and some animal products, particularly organ meats. It occurs in two general forms, vitamin K1 and vitamin K2.1 Vitamin K is required for the proper function and activation of different proteins known as vitamin K-dependent proteins. These proteins include several clotting factors that control blood coagulation as well as osteocalcin, a protein tied to vascular and bone health. Some of these vitamin K-dependent proteins help keep calcium in the bones, and out of blood vessels. Calcified blood vessels are one of the hallmarks of atherosclerosis and vascular dysfunction. Without adequate vitamin K, the risk of cardiovascular disease, osteoporosis, and osteopenia rises.1,9 Other vitamin K-dependent proteins have favorable t effects on metabolic function.3,10 Link to Metabolic Health Multiple types of research indicate that Vitamin K2 intake may lower risk of developing type II diabetes.11 The vitamin's role in glucose homeostasis may be due in part to the activation of osteocalcin. In addition to its role in bone mineralization, osteocalcin stimulates healthy insulin and adiponectin expression.12 Studies show that people with higher intake of vitamin K tend to have better insulin sensitivity, better control of blood glucose levels, and a decreased risk of developing type II diabetes.3,5 In an observational study embedded in a randomized controlled trial of the Mediterranean diet for prevention of cardiovascular disease, men and women without cardiovascular disease were followed for 5.5 years. Dietary information was collected annually through questionnaires. It was found that baseline intake of vitamin K1 was lower in participants who developed diabetes during the study. It was also found that the risk of developing diabetes dropped by approximately 17% for every 100 mcg of vitamin K1 consumed per day. Subjects who increased their dietary vitamin K1 intake over those 5.5 years had a 51% reduction in risk for developing diabetes, compared with those who did not increase vitamin K intake. The authors concluded that dietary vitamin K1 is associated with reduced risk of type II diabetes.13 How It Works Vitamin K appears to improve insulin function and glucose metabolism in at least two main ways: Activating vitamin K-dependent proteins is involved in regulating glucose metabolism.3 Suppressing chronic inflammation and production of pro-inflammatory compounds, which is a major contributor to diminished insulin sensitivity and metabolic disease.3 Together, these actions could help reduce elevated glycemic markers and lower risk for diabetic complications.
+
+USER:
+According to this reference text, explain how Vitamin K helps with bone and vascular health, and explain how vitamin K -dependent proteins play a role in vascular health. For brevity, use no more than 200 words.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,26,36,516,,577
+Use only information found in this text to provide your answer.,How many citations are found in this text? List them.,"How Much Debt is Outstanding? Gross federal debt is composed of debt held by the public and intragovernmental debt. Debt held by the public—issued through the Bureau of the Fiscal Service—is the total amount the federal government has borrowed from the public and remains outstanding. This measure is generally considered to be the most relevant in macroeconomic terms because it is the amount of debt sold in credit markets. Intragovernmental debt is the amount owed by the federal government to other federal agencies, primarily in the Social Security, Medicare, and Civil Service Retirement and Disability trust funds, to be paid by Treasury.33 The Bureau of the Fiscal Service provides various breakdowns of debt figures. The most up-todate data on federal debt can be found on the “Debt to the Penny” section of the Bureau’s Treasury Direct website.34 The Daily Treasury Statement (DTS) and Monthly Treasury Statement (MTS) provide greater detail on the composition of federal debt, including the operating cash balance, the types of debt sold, the amount of debt subject to the debt limit, and federal tax deposits.35 The Monthly Statement of the Public Debt (MSPD) includes figures from the DTS as well as more detailed information on the types of Treasury securities outstanding.36","TEXT BLOCK: How Much Debt is Outstanding? Gross federal debt is composed of debt held by the public and intragovernmental debt. Debt held by the public—issued through the Bureau of the Fiscal Service—is the total amount the federal government has borrowed from the public and remains outstanding. This measure is generally considered to be the most relevant in macroeconomic terms because it is the amount of debt sold in credit markets. Intragovernmental debt is the amount owed by the federal government to other federal agencies, primarily in the Social Security, Medicare, and Civil Service Retirement and Disability trust funds, to be paid by Treasury.33 The Bureau of the Fiscal Service provides various breakdowns of debt figures. The most up-todate data on federal debt can be found on the “Debt to the Penny” section of the Bureau’s Treasury Direct website.34 The Daily Treasury Statement (DTS) and Monthly Treasury Statement (MTS) provide greater detail on the composition of federal debt, including the operating cash balance, the types of debt sold, the amount of debt subject to the debt limit, and federal tax deposits.35 The Monthly Statement of the Public Debt (MSPD) includes figures from the DTS as well as more detailed information on the types of Treasury securities outstanding.36 SYSTEM INSTRUCTION: Use only information found in this text to provide your answer. QUESTION: How many citations are found in this text? List them.","Use only information found in this text to provide your answer.
+
+EVIDENCE:
+How Much Debt is Outstanding? Gross federal debt is composed of debt held by the public and intragovernmental debt. Debt held by the public—issued through the Bureau of the Fiscal Service—is the total amount the federal government has borrowed from the public and remains outstanding. This measure is generally considered to be the most relevant in macroeconomic terms because it is the amount of debt sold in credit markets. Intragovernmental debt is the amount owed by the federal government to other federal agencies, primarily in the Social Security, Medicare, and Civil Service Retirement and Disability trust funds, to be paid by Treasury.33 The Bureau of the Fiscal Service provides various breakdowns of debt figures. The most up-todate data on federal debt can be found on the “Debt to the Penny” section of the Bureau’s Treasury Direct website.34 The Daily Treasury Statement (DTS) and Monthly Treasury Statement (MTS) provide greater detail on the composition of federal debt, including the operating cash balance, the types of debt sold, the amount of debt subject to the debt limit, and federal tax deposits.35 The Monthly Statement of the Public Debt (MSPD) includes figures from the DTS as well as more detailed information on the types of Treasury securities outstanding.36
+
+USER:
+How many citations are found in this text? List them.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,11,10,205,,559
+"Only refer to the document to answer the question. Only answer the question, do not add extra chatter or descriptions. Your answer should not be in bullet point format.","According to this document, can chats on a discussion board be cited for cyber bullying?","UNIVERSITY ANTI-HARASSMENT POLICY The University strictly prohibits harassment in any form, including sexual harassment, in accordance with all five pillars: love (Mathew 22:37, 39), integrity (Proverbs 11:3), discipleship (Matthew 28:19), wisdom (Proverbs 9:10) and unity (Ephesians 4:3). Harassment is serious misconduct. It subverts the mission of the University and threatens the careers, educational experience, and well-being of students, faculty and staff. In addition, harassment is contrary to the biblical principles upon which this University is founded and operates. No one has the authority to engage in this behavior, and the University does not tolerate harassment by, or directed toward, any student, employee or other persons on campus. To promote a pleasant work and educational environment free of harassment and to avoid the risk of damaging the reputation and resources of the University, all employees, students and other persons on campus are expected to refrain from any behavior that could be viewed as harassing, including immoral or unprofessional conduct. In addition, it is the duty of all employees of the University to prevent harassment by others. THREATS Proverbs 21:21 Whoever pursues righteousness and kindness will find life, righteousness and honor. 31 BULLYING/CYBER-BULLYING stopbullying.gov Bullying will not be tolerated, and students will be subject to discipline if found to have been a part of bullying in accordance with all five pillars: love (Mathew 22:37, 39), integrity (Proverbs 11:3), discipleship (Matthew 28:19), wisdom (Proverbs 9:10) and unity (Ephesians 4:3). Bullying is described as follows: Bullying is a form of aggressive behavior manifested by the use of force or coercion to affect others, particularly when the behavior is habitual and involves an imbalance of power. It can include verbal harassment, physical assault or coercion and may be directed repeatedly towards particular victims, perhaps on grounds of race, religion, gender, sexuality or ability. Bullying consists of three basic types of abuse: emotional, verbal and physical. Cyber-Bullying will not be tolerated and students will be subject to discipline if found to have been part of cyber-bullying. Cyber-bullying is described as follows: • actions that use information and communication technologies to support deliberate, repeated and hostile behavior by an individual or group that is intended to harm another or others • use of communication technologies for the intention of harming another person • use of internet service and mobile technologies such as web pages and discussion groups as well as instant messaging or text messaging with the intention of harming another person Sexual harassment is a unique form of harassment in several respects. Traditionally, a sexual harassment claim has been based on the premise that an individual with power over an employee’s employment or a student’s academic standing required sexual favors in return for job or academic rewards. Such a claim has usually involved conduct between a supervisor and subordinate or a faculty member and student. However, the legal definition of sexual harassment is much broader. For example, harassment may exist where the University tolerates an intimidating, hostile or offensive atmosphere, even if the conduct was initially welcomed or even initiated by the “victim.” Liability may also exist between co-workers at the same job level, between fellow students or between other persons of the same University status. Bullying/Cyber-Bullying Policy: fhu.edu/campuslife/studentservices HAZING In recent years, hazing has come under a lot of bad press nationally. Some states have passed legislation against the practice, including Tennessee. National fraternities are working hard to eliminate the practice. Freed-Hardeman students may seek to rationalize and say that nothing 32 FHU HAZING RESPONSE How is an incident reported? Students who feel that they have been the victim of a hazing incident can contact the Office of Student Life or the Office of Student Services directly or they may fill out a confidential hazing report form. The hazing report form may be picked up in the Office of Student Life or the Office of Student Services. Does the student who is hazed have to file a report? Anyone who witnesses hazing may report the incident in the same manner described above. What happens when a hazing incident is reported? • Once the Office of Student Life or the Office of Student Services is notified officially (see above) of a potential hazing incident, the Student Life and Student Services Offices will meet immediately to review the incident report. • The student reporting the hazing incident will be summoned to make a statement. • The students accused of hazing will be summoned to make a statement. • Other witnesses may be called for clarification. • If the hazing report proves to be valid after these meeting have occurred, all club sponsors will be notified of the allegation of hazing against their club and asked to meet with the Student Life and Student Services Office. • After club sponsors have been notified the social club officers will be called for a mandatory meeting with the Office of Student Life and the Dean of Students and sponsors to present the allegation of hazing (no student names are to be used). What is FHU’s response to hazing? In the event that hazing has occurred, students involved in the incident will forfeit their membership in their social club. They will also lose membership in the following groups if a member (UPC, Interface, Makin’ Music Director). The loss of membership will prevent them from participating in intramurals, fundraising opportunities for the club, banquets, club meetings or any other club related activities. Students will also be subject to discipline by the Office of Student Services. we do can be termed as hazing. There is a clear legal concern for any club that fails to follow the guidelines established by the University. The purpose of the guidelines is not to make the induction of new members harder for the clubs, but to protect the club and prospective members from irrational acts that may not be well thought out. Therefore, any club or individual who persists in engaging in activities that have danger of physical discomfort, pain or harm, or that subjects the student to humiliation and degradation should be aware that the club and/or the individual may become legally liable for such acts. Hazing Policy: fhu.edu/campuslife/studentservices TENNESSEE HAZING LAW Tennessee Code: 49-7-123. Hazing prohibited: stophazing.org/policy/state-laws/tennessee/ FHU HAZING RESPONSE How is an incident reported? Students who feel that they have been the victim of a hazing incident can contact the Office of Student Life or the Office of Student Services directly or they may fill out a confidential hazing report form. The hazing report form may be picked up in the Office of Student Life or the Office of Student Services. Does the student who is hazed have to file a report? Anyone who witnesses hazing may report the incident in the same manner described above. What happens when a hazing incident is reported? • Once the Office of Student Life or the Office of Student Services is notified officially (see above) of a potential hazing incident, the Student Life and Student Services Offices will meet immediately to review the incident report. • The student reporting the hazing incident will be summoned to make a statement. • The students accused of hazing will be summoned to make a statement. • Other witnesses may be called for clarification. • If the hazing report proves to be valid after these meeting have occurred, all club sponsors will be notified of the allegation of hazing against their club and asked to meet with the Student Life and Student Services Office. • After club sponsors have been notified the social club officers will be called for a mandatory meeting with the Office of Student Life and the Dean of Students and sponsors to present the allegation of hazing (no student names are to be used). What is FHU’s response to hazing? In the event that hazing has occurred, students involved in the incident will forfeit their membership in their social club. They will also lose membership in the following groups if a member (UPC, Interface, Makin’ Music Director). The loss of membership will prevent them from participating in intramurals, fundraising opportunities for the club, banquets, club meetings or any other club related activities. Students will also be subject to discipline by the Office of Student Services. we do can be termed as hazing. There is a clear legal concern for any club that fails to follow the guidelines established by the University. The purpose of the guidelines is not to make the induction of new members harder for the clubs, but to protect the club and prospective members from irrational acts that may not be well thought out. Therefore, any club or individual who persists in engaging in activities that have danger of physical discomfort, pain or harm, or that subjects the student to humiliation and degradation should be aware that the club and/or the individual may become legally liable for such acts. Hazing Policy: fhu.edu/campuslife/studentservices TENNESSEE HAZING LAW Tennessee Code: 49-7-123. Hazing prohibited: stophazing.org/policy/state-laws/tennessee/","<Article> ================== UNIVERSITY ANTI-HARASSMENT POLICY The University strictly prohibits harassment in any form, including sexual harassment, in accordance with all five pillars: love (Mathew 22:37, 39), integrity (Proverbs 11:3), discipleship (Matthew 28:19), wisdom (Proverbs 9:10) and unity (Ephesians 4:3). Harassment is serious misconduct. It subverts the mission of the University and threatens the careers, educational experience, and well-being of students, faculty and staff. In addition, harassment is contrary to the biblical principles upon which this University is founded and operates. No one has the authority to engage in this behavior, and the University does not tolerate harassment by, or directed toward, any student, employee or other persons on campus. To promote a pleasant work and educational environment free of harassment and to avoid the risk of damaging the reputation and resources of the University, all employees, students and other persons on campus are expected to refrain from any behavior that could be viewed as harassing, including immoral or unprofessional conduct. In addition, it is the duty of all employees of the University to prevent harassment by others. THREATS Proverbs 21:21 Whoever pursues righteousness and kindness will find life, righteousness and honor. 31 BULLYING/CYBER-BULLYING stopbullying.gov Bullying will not be tolerated, and students will be subject to discipline if found to have been a part of bullying in accordance with all five pillars: love (Mathew 22:37, 39), integrity (Proverbs 11:3), discipleship (Matthew 28:19), wisdom (Proverbs 9:10) and unity (Ephesians 4:3). Bullying is described as follows: Bullying is a form of aggressive behavior manifested by the use of force or coercion to affect others, particularly when the behavior is habitual and involves an imbalance of power. It can include verbal harassment, physical assault or coercion and may be directed repeatedly towards particular victims, perhaps on grounds of race, religion, gender, sexuality or ability. Bullying consists of three basic types of abuse: emotional, verbal and physical. Cyber-Bullying will not be tolerated and students will be subject to discipline if found to have been part of cyber-bullying. Cyber-bullying is described as follows: • actions that use information and communication technologies to support deliberate, repeated and hostile behavior by an individual or group that is intended to harm another or others • use of communication technologies for the intention of harming another person • use of internet service and mobile technologies such as web pages and discussion groups as well as instant messaging or text messaging with the intention of harming another person Sexual harassment is a unique form of harassment in several respects. Traditionally, a sexual harassment claim has been based on the premise that an individual with power over an employee’s employment or a student’s academic standing required sexual favors in return for job or academic rewards. Such a claim has usually involved conduct between a supervisor and subordinate or a faculty member and student. However, the legal definition of sexual harassment is much broader. For example, harassment may exist where the University tolerates an intimidating, hostile or offensive atmosphere, even if the conduct was initially welcomed or even initiated by the “victim.” Liability may also exist between co-workers at the same job level, between fellow students or between other persons of the same University status. Bullying/Cyber-Bullying Policy: fhu.edu/campuslife/studentservices HAZING In recent years, hazing has come under a lot of bad press nationally. Some states have passed legislation against the practice, including Tennessee. National fraternities are working hard to eliminate the practice. Freed-Hardeman students may seek to rationalize and say that nothing 32 FHU HAZING RESPONSE How is an incident reported? Students who feel that they have been the victim of a hazing incident can contact the Office of Student Life or the Office of Student Services directly or they may fill out a confidential hazing report form. The hazing report form may be picked up in the Office of Student Life or the Office of Student Services. Does the student who is hazed have to file a report? Anyone who witnesses hazing may report the incident in the same manner described above. What happens when a hazing incident is reported? • Once the Office of Student Life or the Office of Student Services is notified officially (see above) of a potential hazing incident, the Student Life and Student Services Offices will meet immediately to review the incident report. • The student reporting the hazing incident will be summoned to make a statement. • The students accused of hazing will be summoned to make a statement. • Other witnesses may be called for clarification. • If the hazing report proves to be valid after these meeting have occurred, all club sponsors will be notified of the allegation of hazing against their club and asked to meet with the Student Life and Student Services Office. • After club sponsors have been notified the social club officers will be called for a mandatory meeting with the Office of Student Life and the Dean of Students and sponsors to present the allegation of hazing (no student names are to be used). What is FHU’s response to hazing? In the event that hazing has occurred, students involved in the incident will forfeit their membership in their social club. They will also lose membership in the following groups if a member (UPC, Interface, Makin’ Music Director). The loss of membership will prevent them from participating in intramurals, fundraising opportunities for the club, banquets, club meetings or any other club related activities. Students will also be subject to discipline by the Office of Student Services. we do can be termed as hazing. There is a clear legal concern for any club that fails to follow the guidelines established by the University. The purpose of the guidelines is not to make the induction of new members harder for the clubs, but to protect the club and prospective members from irrational acts that may not be well thought out. Therefore, any club or individual who persists in engaging in activities that have danger of physical discomfort, pain or harm, or that subjects the student to humiliation and degradation should be aware that the club and/or the individual may become legally liable for such acts. Hazing Policy: fhu.edu/campuslife/studentservices TENNESSEE HAZING LAW Tennessee Code: 49-7-123. Hazing prohibited: stophazing.org/policy/state-laws/tennessee/ FHU HAZING RESPONSE How is an incident reported? Students who feel that they have been the victim of a hazing incident can contact the Office of Student Life or the Office of Student Services directly or they may fill out a confidential hazing report form. The hazing report form may be picked up in the Office of Student Life or the Office of Student Services. Does the student who is hazed have to file a report? Anyone who witnesses hazing may report the incident in the same manner described above. What happens when a hazing incident is reported? • Once the Office of Student Life or the Office of Student Services is notified officially (see above) of a potential hazing incident, the Student Life and Student Services Offices will meet immediately to review the incident report. • The student reporting the hazing incident will be summoned to make a statement. • The students accused of hazing will be summoned to make a statement. • Other witnesses may be called for clarification. • If the hazing report proves to be valid after these meeting have occurred, all club sponsors will be notified of the allegation of hazing against their club and asked to meet with the Student Life and Student Services Office. • After club sponsors have been notified the social club officers will be called for a mandatory meeting with the Office of Student Life and the Dean of Students and sponsors to present the allegation of hazing (no student names are to be used). What is FHU’s response to hazing? In the event that hazing has occurred, students involved in the incident will forfeit their membership in their social club. They will also lose membership in the following groups if a member (UPC, Interface, Makin’ Music Director). The loss of membership will prevent them from participating in intramurals, fundraising opportunities for the club, banquets, club meetings or any other club related activities. Students will also be subject to discipline by the Office of Student Services. we do can be termed as hazing. There is a clear legal concern for any club that fails to follow the guidelines established by the University. The purpose of the guidelines is not to make the induction of new members harder for the clubs, but to protect the club and prospective members from irrational acts that may not be well thought out. Therefore, any club or individual who persists in engaging in activities that have danger of physical discomfort, pain or harm, or that subjects the student to humiliation and degradation should be aware that the club and/or the individual may become legally liable for such acts. Hazing Policy: fhu.edu/campuslife/studentservices TENNESSEE HAZING LAW Tennessee Code: 49-7-123. Hazing prohibited: stophazing.org/policy/state-laws/tennessee/ <Instructions> ================== Only refer to the document to answer the question. Only answer the question, do not add extra chatter or descriptions. Your answer should not be in bullet point format. <Query> ================== According to this document, can chats on a discussion board be cited for cyber bullying?","Only refer to the document to answer the question. Only answer the question, do not add extra chatter or descriptions. Your answer should not be in bullet point format.
+
+EVIDENCE:
+UNIVERSITY ANTI-HARASSMENT POLICY The University strictly prohibits harassment in any form, including sexual harassment, in accordance with all five pillars: love (Mathew 22:37, 39), integrity (Proverbs 11:3), discipleship (Matthew 28:19), wisdom (Proverbs 9:10) and unity (Ephesians 4:3). Harassment is serious misconduct. It subverts the mission of the University and threatens the careers, educational experience, and well-being of students, faculty and staff. In addition, harassment is contrary to the biblical principles upon which this University is founded and operates. No one has the authority to engage in this behavior, and the University does not tolerate harassment by, or directed toward, any student, employee or other persons on campus. To promote a pleasant work and educational environment free of harassment and to avoid the risk of damaging the reputation and resources of the University, all employees, students and other persons on campus are expected to refrain from any behavior that could be viewed as harassing, including immoral or unprofessional conduct. In addition, it is the duty of all employees of the University to prevent harassment by others. THREATS Proverbs 21:21 Whoever pursues righteousness and kindness will find life, righteousness and honor. 31 BULLYING/CYBER-BULLYING stopbullying.gov Bullying will not be tolerated, and students will be subject to discipline if found to have been a part of bullying in accordance with all five pillars: love (Mathew 22:37, 39), integrity (Proverbs 11:3), discipleship (Matthew 28:19), wisdom (Proverbs 9:10) and unity (Ephesians 4:3). Bullying is described as follows: Bullying is a form of aggressive behavior manifested by the use of force or coercion to affect others, particularly when the behavior is habitual and involves an imbalance of power. It can include verbal harassment, physical assault or coercion and may be directed repeatedly towards particular victims, perhaps on grounds of race, religion, gender, sexuality or ability. Bullying consists of three basic types of abuse: emotional, verbal and physical. Cyber-Bullying will not be tolerated and students will be subject to discipline if found to have been part of cyber-bullying. Cyber-bullying is described as follows: • actions that use information and communication technologies to support deliberate, repeated and hostile behavior by an individual or group that is intended to harm another or others • use of communication technologies for the intention of harming another person • use of internet service and mobile technologies such as web pages and discussion groups as well as instant messaging or text messaging with the intention of harming another person Sexual harassment is a unique form of harassment in several respects. Traditionally, a sexual harassment claim has been based on the premise that an individual with power over an employee’s employment or a student’s academic standing required sexual favors in return for job or academic rewards. Such a claim has usually involved conduct between a supervisor and subordinate or a faculty member and student. However, the legal definition of sexual harassment is much broader. For example, harassment may exist where the University tolerates an intimidating, hostile or offensive atmosphere, even if the conduct was initially welcomed or even initiated by the “victim.” Liability may also exist between co-workers at the same job level, between fellow students or between other persons of the same University status. Bullying/Cyber-Bullying Policy: fhu.edu/campuslife/studentservices HAZING In recent years, hazing has come under a lot of bad press nationally. Some states have passed legislation against the practice, including Tennessee. National fraternities are working hard to eliminate the practice. Freed-Hardeman students may seek to rationalize and say that nothing 32 FHU HAZING RESPONSE How is an incident reported? Students who feel that they have been the victim of a hazing incident can contact the Office of Student Life or the Office of Student Services directly or they may fill out a confidential hazing report form. The hazing report form may be picked up in the Office of Student Life or the Office of Student Services. Does the student who is hazed have to file a report? Anyone who witnesses hazing may report the incident in the same manner described above. What happens when a hazing incident is reported? • Once the Office of Student Life or the Office of Student Services is notified officially (see above) of a potential hazing incident, the Student Life and Student Services Offices will meet immediately to review the incident report. • The student reporting the hazing incident will be summoned to make a statement. • The students accused of hazing will be summoned to make a statement. • Other witnesses may be called for clarification. • If the hazing report proves to be valid after these meeting have occurred, all club sponsors will be notified of the allegation of hazing against their club and asked to meet with the Student Life and Student Services Office. • After club sponsors have been notified the social club officers will be called for a mandatory meeting with the Office of Student Life and the Dean of Students and sponsors to present the allegation of hazing (no student names are to be used). What is FHU’s response to hazing? In the event that hazing has occurred, students involved in the incident will forfeit their membership in their social club. They will also lose membership in the following groups if a member (UPC, Interface, Makin’ Music Director). The loss of membership will prevent them from participating in intramurals, fundraising opportunities for the club, banquets, club meetings or any other club related activities. Students will also be subject to discipline by the Office of Student Services. we do can be termed as hazing. There is a clear legal concern for any club that fails to follow the guidelines established by the University. The purpose of the guidelines is not to make the induction of new members harder for the clubs, but to protect the club and prospective members from irrational acts that may not be well thought out. Therefore, any club or individual who persists in engaging in activities that have danger of physical discomfort, pain or harm, or that subjects the student to humiliation and degradation should be aware that the club and/or the individual may become legally liable for such acts. Hazing Policy: fhu.edu/campuslife/studentservices TENNESSEE HAZING LAW Tennessee Code: 49-7-123. Hazing prohibited: stophazing.org/policy/state-laws/tennessee/ FHU HAZING RESPONSE How is an incident reported? Students who feel that they have been the victim of a hazing incident can contact the Office of Student Life or the Office of Student Services directly or they may fill out a confidential hazing report form. The hazing report form may be picked up in the Office of Student Life or the Office of Student Services. Does the student who is hazed have to file a report? Anyone who witnesses hazing may report the incident in the same manner described above. What happens when a hazing incident is reported? • Once the Office of Student Life or the Office of Student Services is notified officially (see above) of a potential hazing incident, the Student Life and Student Services Offices will meet immediately to review the incident report. • The student reporting the hazing incident will be summoned to make a statement. • The students accused of hazing will be summoned to make a statement. • Other witnesses may be called for clarification. • If the hazing report proves to be valid after these meeting have occurred, all club sponsors will be notified of the allegation of hazing against their club and asked to meet with the Student Life and Student Services Office. • After club sponsors have been notified the social club officers will be called for a mandatory meeting with the Office of Student Life and the Dean of Students and sponsors to present the allegation of hazing (no student names are to be used). What is FHU’s response to hazing? In the event that hazing has occurred, students involved in the incident will forfeit their membership in their social club. They will also lose membership in the following groups if a member (UPC, Interface, Makin’ Music Director). The loss of membership will prevent them from participating in intramurals, fundraising opportunities for the club, banquets, club meetings or any other club related activities. Students will also be subject to discipline by the Office of Student Services. we do can be termed as hazing. There is a clear legal concern for any club that fails to follow the guidelines established by the University. The purpose of the guidelines is not to make the induction of new members harder for the clubs, but to protect the club and prospective members from irrational acts that may not be well thought out. Therefore, any club or individual who persists in engaging in activities that have danger of physical discomfort, pain or harm, or that subjects the student to humiliation and degradation should be aware that the club and/or the individual may become legally liable for such acts. Hazing Policy: fhu.edu/campuslife/studentservices TENNESSEE HAZING LAW Tennessee Code: 49-7-123. Hazing prohibited: stophazing.org/policy/state-laws/tennessee/
+
+USER:
+According to this document, can chats on a discussion board be cited for cyber bullying?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,29,15,1487,,709
+Give an answer using only the context provided.,What are the names of the Disney theme parks listed in the brochure?,"Stay in the Magic… and Play! Customize a Walt Disney World Resort vacation package to suit your style and budget. Start Planning Your Disney Vacation Play Full Video  Design your dream Disney vacation—and create magical memories to last a lifetime. Get Started What’s Exciting and New Enjoy some of the newest experiences at Walt Disney World Resort—and rediscover familiar favorites. Finding Nemo: The Big Blue… Remy’s Ratatouille Adventure Finding Nemo: The Big Blue… and Beyond! Witness a stirring spectacle of puppetry, music and more during this reimagined stage show set in Nemo’s vibrant underwater world. Remy’s Ratatouille Adventure Bring the whole family to zip, dash and scurry through Gusteau’s kitchen as you take in the sights, sounds and even smells from Remy’s world. TRON Lightcycle / Run Leave the real world behind in this high-stakes race across the Grid— the dark, computerized world from TRON. Fantasmic! Watch in awe as Mickey Mouse’s dreams come alive in a nighttime musical with stunning effects, dazzling pyrotechnics and more. 4 Enchanting Theme Parks 4 Enchanting Theme Parks There’s so much magic waiting for you in the Walt Disney World theme parks. Magic Kingdom Park Explore lands of endless enchantment, where your fantasy becomes a reality. Read More Disney’s Animal Kingdom Theme Park Encounter the magic of nature with animal adventures and entertainment. Read More Disney’s Hollywood Studios Let your adventure begin as favorite stories come to life all around you. Read More EPCOT Dare to discover a place where your imagination comes alive and curiosity waits around every corner. Read More Stay Longer and Save More on Rooms Take advantage of a special offer on rooms at select Disney Resort hotels, for stays most nights from March 25 to July 7, 2024. Learn More Stay in the Magic with Disney Resorts Collection Discover the many benefits of staying at our unique Disney Resort hotels. Enjoy More Time in the Parks Disney Resort hotel Guests get extra time to play every day. Read More Start Your Stay with a Water Park Day in 2025 Disney Resort hotel Guests arriving in 2025 can enjoy water park admission on check-in day—included with your stay! Read More Savor a World of Flavor Discover delicious dining options when you stay at a Disney Resort hotel. Read More Immerse Yourself in the Magic Disney Resort hotels offer the same legendary detail, service and storytelling that Guests love in our parks. Read More Make the Most of Your Visit Get Around with Ease It’s fun and easy to get around Walt Disney World Resort when you stay at a Disney Resort hotel. Read More Add More Magic Enjoy special offerings and benefits that take your vacation to the next level. Read More Enjoy Magical Extras with Your Package When you book a roomand-ticket package, you’ll receive Magical Extras— discounts and offerings on dining, entertainment and more. Customize Your Package More Fun for Everyone Disney Water Parks Disney water parks are unlike anything else on Earth—they’re drenched in Disney magic Read More Disney Springs Explore an amazing place featuring an eclectic mix of shops, eateries and entertainment. Read More Delectable Dining Walt Disney World Resort has dining options to delight every taste, style and budget. Read More Enchanting Extras Collection Add even more magic to your visit with a variety of unique experiences, available for a fee. Read More Design Your Disney Vacation Explore Places to Stay Choose from uniquely themed Disney Resort hotels—with options to suit your style and budget. Buy Park Tickets Purchase park tickets—and get ready to experience the theme parks and water parks!","Give an answer using only the context provided. What are the names of the Disney theme parks listed in the brochure? Stay in the Magic… and Play! Customize a Walt Disney World Resort vacation package to suit your style and budget. Start Planning Your Disney Vacation Play Full Video  Design your dream Disney vacation—and create magical memories to last a lifetime. Get Started What’s Exciting and New Enjoy some of the newest experiences at Walt Disney World Resort—and rediscover familiar favorites. Finding Nemo: The Big Blue… Remy’s Ratatouille Adventure Finding Nemo: The Big Blue… and Beyond! Witness a stirring spectacle of puppetry, music and more during this reimagined stage show set in Nemo’s vibrant underwater world. Remy’s Ratatouille Adventure Bring the whole family to zip, dash and scurry through Gusteau’s kitchen as you take in the sights, sounds and even smells from Remy’s world. TRON Lightcycle / Run Leave the real world behind in this high-stakes race across the Grid— the dark, computerized world from TRON. Fantasmic! Watch in awe as Mickey Mouse’s dreams come alive in a nighttime musical with stunning effects, dazzling pyrotechnics and more. 4 Enchanting Theme Parks 4 Enchanting Theme Parks There’s so much magic waiting for you in the Walt Disney World theme parks. Magic Kingdom Park Explore lands of endless enchantment, where your fantasy becomes a reality. Read More Disney’s Animal Kingdom Theme Park Encounter the magic of nature with animal adventures and entertainment. Read More Disney’s Hollywood Studios Let your adventure begin as favorite stories come to life all around you. Read More EPCOT Dare to discover a place where your imagination comes alive and curiosity waits around every corner. Read More Stay Longer and Save More on Rooms Take advantage of a special offer on rooms at select Disney Resort hotels, for stays most nights from March 25 to July 7, 2024. Learn More Stay in the Magic with Disney Resorts Collection Discover the many benefits of staying at our unique Disney Resort hotels. Enjoy More Time in the Parks Disney Resort hotel Guests get extra time to play every day. Read More Start Your Stay with a Water Park Day in 2025 Disney Resort hotel Guests arriving in 2025 can enjoy water park admission on check-in day—included with your stay! Read More Savor a World of Flavor Discover delicious dining options when you stay at a Disney Resort hotel. Read More Immerse Yourself in the Magic Disney Resort hotels offer the same legendary detail, service and storytelling that Guests love in our parks. Read More Make the Most of Your Visit Get Around with Ease It’s fun and easy to get around Walt Disney World Resort when you stay at a Disney Resort hotel. Read More Add More Magic Enjoy special offerings and benefits that take your vacation to the next level. Read More Enjoy Magical Extras with Your Package When you book a roomand-ticket package, you’ll receive Magical Extras— discounts and offerings on dining, entertainment and more. Customize Your Package More Fun for Everyone Disney Water Parks Disney water parks are unlike anything else on Earth—they’re drenched in Disney magic Read More Disney Springs Explore an amazing place featuring an eclectic mix of shops, eateries and entertainment. Read More Delectable Dining Walt Disney World Resort has dining options to delight every taste, style and budget. Read More Enchanting Extras Collection Add even more magic to your visit with a variety of unique experiences, available for a fee. Read More Design Your Disney Vacation Explore Places to Stay Choose from uniquely themed Disney Resort hotels—with options to suit your style and budget. Buy Park Tickets Purchase park tickets—and get ready to experience the theme parks and water parks!","Give an answer using only the context provided.
+
+EVIDENCE:
+Stay in the Magic… and Play! Customize a Walt Disney World Resort vacation package to suit your style and budget. Start Planning Your Disney Vacation Play Full Video  Design your dream Disney vacation—and create magical memories to last a lifetime. Get Started What’s Exciting and New Enjoy some of the newest experiences at Walt Disney World Resort—and rediscover familiar favorites. Finding Nemo: The Big Blue… Remy’s Ratatouille Adventure Finding Nemo: The Big Blue… and Beyond! Witness a stirring spectacle of puppetry, music and more during this reimagined stage show set in Nemo’s vibrant underwater world. Remy’s Ratatouille Adventure Bring the whole family to zip, dash and scurry through Gusteau’s kitchen as you take in the sights, sounds and even smells from Remy’s world. TRON Lightcycle / Run Leave the real world behind in this high-stakes race across the Grid— the dark, computerized world from TRON. Fantasmic! Watch in awe as Mickey Mouse’s dreams come alive in a nighttime musical with stunning effects, dazzling pyrotechnics and more. 4 Enchanting Theme Parks 4 Enchanting Theme Parks There’s so much magic waiting for you in the Walt Disney World theme parks. Magic Kingdom Park Explore lands of endless enchantment, where your fantasy becomes a reality. Read More Disney’s Animal Kingdom Theme Park Encounter the magic of nature with animal adventures and entertainment. Read More Disney’s Hollywood Studios Let your adventure begin as favorite stories come to life all around you. Read More EPCOT Dare to discover a place where your imagination comes alive and curiosity waits around every corner. Read More Stay Longer and Save More on Rooms Take advantage of a special offer on rooms at select Disney Resort hotels, for stays most nights from March 25 to July 7, 2024. Learn More Stay in the Magic with Disney Resorts Collection Discover the many benefits of staying at our unique Disney Resort hotels. Enjoy More Time in the Parks Disney Resort hotel Guests get extra time to play every day. Read More Start Your Stay with a Water Park Day in 2025 Disney Resort hotel Guests arriving in 2025 can enjoy water park admission on check-in day—included with your stay! Read More Savor a World of Flavor Discover delicious dining options when you stay at a Disney Resort hotel. Read More Immerse Yourself in the Magic Disney Resort hotels offer the same legendary detail, service and storytelling that Guests love in our parks. Read More Make the Most of Your Visit Get Around with Ease It’s fun and easy to get around Walt Disney World Resort when you stay at a Disney Resort hotel. Read More Add More Magic Enjoy special offerings and benefits that take your vacation to the next level. Read More Enjoy Magical Extras with Your Package When you book a roomand-ticket package, you’ll receive Magical Extras— discounts and offerings on dining, entertainment and more. Customize Your Package More Fun for Everyone Disney Water Parks Disney water parks are unlike anything else on Earth—they’re drenched in Disney magic Read More Disney Springs Explore an amazing place featuring an eclectic mix of shops, eateries and entertainment. Read More Delectable Dining Walt Disney World Resort has dining options to delight every taste, style and budget. Read More Enchanting Extras Collection Add even more magic to your visit with a variety of unique experiences, available for a fee. Read More Design Your Disney Vacation Explore Places to Stay Choose from uniquely themed Disney Resort hotels—with options to suit your style and budget. Buy Park Tickets Purchase park tickets—and get ready to experience the theme parks and water parks!
+
+USER:
+What are the names of the Disney theme parks listed in the brochure?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,8,13,597,,128
+Summarize the provided text. Only use information from the provided context. Do not rely on your own knowledge or outside sources of information.,Summarize the text.,"CHAPTER ONE INFECTIOUS DISEASES 1. Introduction to infectious diseases Generally infectious diseases result from bacteria, viruses, fungi, and parasites. Despite decades of dramatic progress in their treatment and prevention, infectious diseases remain a major cause of death and are responsible for worsening the living conditions of many millions of people around the world especially in the developing countries. Infections frequently challenge the clinician’s diagnostic skill and must be considered in the differential diagnosis of syndromes affecting a multitude of organ systems. Infectious diseases often do not occur in isolated cases; rather they spread through a group exposed from a point source (e.g. a water supply contaminated with cholera) or from individual to individual (e.g. via respiratory droplets spreading tuberculosis). Many factors affect the likelihood of acquiring infections which include, host, environmental microbial factors. Host and Environmental Factors For any infectious process to occur, the parasite and the host must first encounter each other. Factors such as geography (e.g. altitude and malaria), environment (e.g. mosquito breeding site and malaria), disease vectors and host behavior (e.g. sexual behavior and sexually transmitted diseases) thus influence the likelihood of infection. Many Host Factors such as age, immunization, prior illness, nutritional status, pregnancy, coexisting illnesses and emotional status all have some impact on the risk of infection after exposure to a particular pathogen. Medical care itself can increase the patient’s risk of acquiring an infection. This can occur in several ways: through contact with the pathogens during hospitalization, through injections, surgical incisions, via mucosal surfaces by end tracheal tubes and bladder catheters, through the introduction of foreign bodies, through alteration of the natural flora with antibiotics, and through treatment with suppressive drugs such as steroids. Microbial Factors Infection involves complicated interaction of parasites and host and inevitably affects both. In most cases a pathogenic process consisting of several steps is required for the development of infections. Internal Medicine 2 Since the competent host has a complex series of defense mechanisms in place to prevent infection, the successful parasite must utilize specific strategies at each of these steps. The specific strategies used by bacteria, viruses, and parasites have some similarities, but the details are unique not only for each class of organism but also for individual species within a class; Invasion; Microorganisms attached to mucosal surface use specific mechanisms to invade deeper structures. For example, meningococci and gonococci penetrate and traverse mucosal epithelial cells by transcytotic mechanism. Tropism; In order to infect a host successfully, many pathogens occupy highly specific place within the host and thus are tropic to a particular body site or cell type. For example, malaria sporozoites are rapidly cleared from the blood into the hepatocyts, where they undergo maturation and release into the circulation; trophozoites in turn can infect only the erythrocytes. Microbial virulence strategies; Microbes have developed a variety of strategies for escaping the immunity. For example, some pathogenic organisms elaborate toxins and enzymes that facilitate the invasion of the host and are often responsible for the disease state and many bacteria are encapsulated with polysaccharides that allow them to invade and deposit in the absence of specific antibodies. Immune response: Is a defense mechanism developed by the host for recognizing and responding to microorganisms. It is divided I to two major classes. Innate and Acquired Immunity. Innate immunity (Natural Immunity): Is first line of defense and serves to protect the host with out prior exposure to the infectious agent. This immune response is nonspecific and has no memory. Examples of Innate immunity include skin and mucous mebrane, phagocytoses by macrophages and nutrophils, complement system etc Acquired (Adaptive) Immunity: Is specific immune mechanism developed against a particular organism. It takes time to develop and it has long standing memory. It has two major arms: Internal Medicine 3 • Cellular immunity: comprising T- lymphocytes, NK cells • Humeral Immunity: comprises of B-Lymphocytes and antibodies produced by plasma cells. Laboratory diagnosis The lab diagnosis of infections requires the demonstration, either 1. Direct microscopic visualization of pathogens in clinical material (e.g. Plasmodium species in blood films) or the growth of microorganisms in the laboratory (e.g. culture) or 2. Indirect (e.g. antibody / serology test for HIV), of viral, bacterial, mycotic, or parasitic agents in tissues, fluids, or excreta of the host. Treatment; Optimal therapy for infectious diseases requires a broad knowledge of medicine and careful clinical judgment. Life threatening infections such as bacterial meningitis and sepsis require urgent initiation of therapy often before a specific infective organism is identified. Antimicrobial agents must be chosen empirically and must be against the range of potential infectious agents consistent with the clinical condition. In contrast, good clinical judgment sometimes dictates withholding of antimicrobials in a self limited process or until a specific diagnosis is made. Certain infections (e.g. peritonitis, necrotizing fascitis, and abscess) require surgery as a primary means of cure; in these conditions, antibiotics play only as an adjunctive role. References: 1. Kasper L., Braunwald E., Harrison’s principles of Internal medicine, 16th Edition, Intruducion to infectious diseases, pages 695-700.","Summarize the provided text. Only use information from the provided context. Do not rely on your own knowledge or outside sources of information. CHAPTER ONE INFECTIOUS DISEASES 1. Introduction to infectious diseases Generally infectious diseases result from bacteria, viruses, fungi, and parasites. Despite decades of dramatic progress in their treatment and prevention, infectious diseases remain a major cause of death and are responsible for worsening the living conditions of many millions of people around the world especially in the developing countries. Infections frequently challenge the clinician’s diagnostic skill and must be considered in the differential diagnosis of syndromes affecting a multitude of organ systems. Infectious diseases often do not occur in isolated cases; rather they spread through a group exposed from a point source (e.g. a water supply contaminated with cholera) or from individual to individual (e.g. via respiratory droplets spreading tuberculosis). Many factors affect the likelihood of acquiring infections which include, host, environmental microbial factors. Host and Environmental Factors For any infectious process to occur, the parasite and the host must first encounter each other. Factors such as geography (e.g. altitude and malaria), environment (e.g. mosquito breeding site and malaria), disease vectors and host behavior (e.g. sexual behavior and sexually transmitted diseases) thus influence the likelihood of infection. Many Host Factors such as age, immunization, prior illness, nutritional status, pregnancy, coexisting illnesses and emotional status all have some impact on the risk of infection after exposure to a particular pathogen. Medical care itself can increase the patient’s risk of acquiring an infection. This can occur in several ways: through contact with the pathogens during hospitalization, through injections, surgical incisions, via mucosal surfaces by end tracheal tubes and bladder catheters, through the introduction of foreign bodies, through alteration of the natural flora with antibiotics, and through treatment with suppressive drugs such as steroids. Microbial Factors Infection involves complicated interaction of parasites and host and inevitably affects both. In most cases a pathogenic process consisting of several steps is required for the development of infections. Internal Medicine 2 Since the competent host has a complex series of defense mechanisms in place to prevent infection, the successful parasite must utilize specific strategies at each of these steps. The specific strategies used by bacteria, viruses, and parasites have some similarities, but the details are unique not only for each class of organism but also for individual species within a class; Invasion; Microorganisms attached to mucosal surface use specific mechanisms to invade deeper structures. For example, meningococci and gonococci penetrate and traverse mucosal epithelial cells by transcytotic mechanism. Tropism; In order to infect a host successfully, many pathogens occupy highly specific place within the host and thus are tropic to a particular body site or cell type. For example, malaria sporozoites are rapidly cleared from the blood into the hepatocyts, where they undergo maturation and release into the circulation; trophozoites in turn can infect only the erythrocytes. Microbial virulence strategies; Microbes have developed a variety of strategies for escaping the immunity. For example, some pathogenic organisms elaborate toxins and enzymes that facilitate the invasion of the host and are often responsible for the disease state and many bacteria are encapsulated with polysaccharides that allow them to invade and deposit in the absence of specific antibodies. Immune response: Is a defense mechanism developed by the host for recognizing and responding to microorganisms. It is divided I to two major classes. Innate and Acquired Immunity. Innate immunity (Natural Immunity): Is first line of defense and serves to protect the host with out prior exposure to the infectious agent. This immune response is nonspecific and has no memory. Examples of Innate immunity include skin and mucous mebrane, phagocytoses by macrophages and nutrophils, complement system etc Acquired (Adaptive) Immunity: Is specific immune mechanism developed against a particular organism. It takes time to develop and it has long standing memory. It has two major arms: Internal Medicine 3 • Cellular immunity: comprising T- lymphocytes, NK cells • Humeral Immunity: comprises of B-Lymphocytes and antibodies produced by plasma cells. Laboratory diagnosis The lab diagnosis of infections requires the demonstration, either 1. Direct microscopic visualization of pathogens in clinical material (e.g. Plasmodium species in blood films) or the growth of microorganisms in the laboratory (e.g. culture) or 2. Indirect (e.g. antibody / serology test for HIV), of viral, bacterial, mycotic, or parasitic agents in tissues, fluids, or excreta of the host. Treatment; Optimal therapy for infectious diseases requires a broad knowledge of medicine and careful clinical judgment. Life threatening infections such as bacterial meningitis and sepsis require urgent initiation of therapy often before a specific infective organism is identified. Antimicrobial agents must be chosen empirically and must be against the range of potential infectious agents consistent with the clinical condition. In contrast, good clinical judgment sometimes dictates withholding of antimicrobials in a self limited process or until a specific diagnosis is made. Certain infections (e.g. peritonitis, necrotizing fascitis, and abscess) require surgery as a primary means of cure; in these conditions, antibiotics play only as an adjunctive role. References: 1. Kasper L., Braunwald E., Harrison’s principles of Internal medicine, 16th Edition, Intruducion to infectious diseases, pages 695-700. Summarize the text.","Summarize the provided text. Only use information from the provided context. Do not rely on your own knowledge or outside sources of information.
+
+EVIDENCE:
+CHAPTER ONE INFECTIOUS DISEASES 1. Introduction to infectious diseases Generally infectious diseases result from bacteria, viruses, fungi, and parasites. Despite decades of dramatic progress in their treatment and prevention, infectious diseases remain a major cause of death and are responsible for worsening the living conditions of many millions of people around the world especially in the developing countries. Infections frequently challenge the clinician’s diagnostic skill and must be considered in the differential diagnosis of syndromes affecting a multitude of organ systems. Infectious diseases often do not occur in isolated cases; rather they spread through a group exposed from a point source (e.g. a water supply contaminated with cholera) or from individual to individual (e.g. via respiratory droplets spreading tuberculosis). Many factors affect the likelihood of acquiring infections which include, host, environmental microbial factors. Host and Environmental Factors For any infectious process to occur, the parasite and the host must first encounter each other. Factors such as geography (e.g. altitude and malaria), environment (e.g. mosquito breeding site and malaria), disease vectors and host behavior (e.g. sexual behavior and sexually transmitted diseases) thus influence the likelihood of infection. Many Host Factors such as age, immunization, prior illness, nutritional status, pregnancy, coexisting illnesses and emotional status all have some impact on the risk of infection after exposure to a particular pathogen. Medical care itself can increase the patient’s risk of acquiring an infection. This can occur in several ways: through contact with the pathogens during hospitalization, through injections, surgical incisions, via mucosal surfaces by end tracheal tubes and bladder catheters, through the introduction of foreign bodies, through alteration of the natural flora with antibiotics, and through treatment with suppressive drugs such as steroids. Microbial Factors Infection involves complicated interaction of parasites and host and inevitably affects both. In most cases a pathogenic process consisting of several steps is required for the development of infections. Internal Medicine 2 Since the competent host has a complex series of defense mechanisms in place to prevent infection, the successful parasite must utilize specific strategies at each of these steps. The specific strategies used by bacteria, viruses, and parasites have some similarities, but the details are unique not only for each class of organism but also for individual species within a class; Invasion; Microorganisms attached to mucosal surface use specific mechanisms to invade deeper structures. For example, meningococci and gonococci penetrate and traverse mucosal epithelial cells by transcytotic mechanism. Tropism; In order to infect a host successfully, many pathogens occupy highly specific place within the host and thus are tropic to a particular body site or cell type. For example, malaria sporozoites are rapidly cleared from the blood into the hepatocyts, where they undergo maturation and release into the circulation; trophozoites in turn can infect only the erythrocytes. Microbial virulence strategies; Microbes have developed a variety of strategies for escaping the immunity. For example, some pathogenic organisms elaborate toxins and enzymes that facilitate the invasion of the host and are often responsible for the disease state and many bacteria are encapsulated with polysaccharides that allow them to invade and deposit in the absence of specific antibodies. Immune response: Is a defense mechanism developed by the host for recognizing and responding to microorganisms. It is divided I to two major classes. Innate and Acquired Immunity. Innate immunity (Natural Immunity): Is first line of defense and serves to protect the host with out prior exposure to the infectious agent. This immune response is nonspecific and has no memory. Examples of Innate immunity include skin and mucous mebrane, phagocytoses by macrophages and nutrophils, complement system etc Acquired (Adaptive) Immunity: Is specific immune mechanism developed against a particular organism. It takes time to develop and it has long standing memory. It has two major arms: Internal Medicine 3 • Cellular immunity: comprising T- lymphocytes, NK cells • Humeral Immunity: comprises of B-Lymphocytes and antibodies produced by plasma cells. Laboratory diagnosis The lab diagnosis of infections requires the demonstration, either 1. Direct microscopic visualization of pathogens in clinical material (e.g. Plasmodium species in blood films) or the growth of microorganisms in the laboratory (e.g. culture) or 2. Indirect (e.g. antibody / serology test for HIV), of viral, bacterial, mycotic, or parasitic agents in tissues, fluids, or excreta of the host. Treatment; Optimal therapy for infectious diseases requires a broad knowledge of medicine and careful clinical judgment. Life threatening infections such as bacterial meningitis and sepsis require urgent initiation of therapy often before a specific infective organism is identified. Antimicrobial agents must be chosen empirically and must be against the range of potential infectious agents consistent with the clinical condition. In contrast, good clinical judgment sometimes dictates withholding of antimicrobials in a self limited process or until a specific diagnosis is made. Certain infections (e.g. peritonitis, necrotizing fascitis, and abscess) require surgery as a primary means of cure; in these conditions, antibiotics play only as an adjunctive role. References: 1. Kasper L., Braunwald E., Harrison’s principles of Internal medicine, 16th Edition, Intruducion to infectious diseases, pages 695-700.
+
+USER:
+Summarize the text.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,23,3,833,,444
+"{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]",What does it mean to have gerd and how does it affect my body? Is it preventable? How do I know if I need to go to a doctor? Are there any foods or drinks I should avoid? Answer in 200 words or less.,"Gastroesophageal reflux disease is a condition in which stomach acid repeatedly flows back up into the tube connecting the mouth and stomach, called the esophagus. It's often called GERD for short. This backwash is known as acid reflux, and it can irritate the lining of the esophagus. Many people experience acid reflux now and then. However, when acid reflux happens repeatedly over time, it can cause GERD. Most people can manage the discomfort of GERD with lifestyle changes and medicines. And though it's uncommon, some may need surgery to help with symptoms. Symptoms Common symptoms of GERD include: A burning sensation in the chest, often called heartburn. Heartburn usually happens after eating and might be worse at night or while lying down. Backwash of food or sour liquid in the throat. Upper belly or chest pain. Trouble swallowing, called dysphagia. Sensation of a lump in the throat. If you have nighttime acid reflux, you also might experience: An ongoing cough. Inflammation of the vocal cords, known as laryngitis. New or worsening asthma. When to see a doctor Seek medical help right away if you have chest pain, especially if you also have shortness of breath, or jaw or arm pain. These may be symptoms of a heart attack. Make an appointment with a healthcare professional if you: Have severe or frequent GERD symptoms. Take nonprescription medicines for heartburn more than twice a week. GERD is caused by frequent acid reflux or reflux of nonacidic content from the stomach. When you swallow, a circular band of muscle around the bottom of the esophagus, called the lower esophageal sphincter, relaxes to allow food and liquid to flow into the stomach. Then the sphincter closes again. If the sphincter does not relax as is typical or it weakens, stomach acid can flow back into the esophagus. This constant backwash of acid irritates the lining of the esophagus, often causing it to become inflamed. Conditions that can increase the risk of GERD include: Obesity. Bulging of the top of the stomach up above the diaphragm, known as a hiatal hernia. Pregnancy. Connective tissue disorders, such as scleroderma. Delayed stomach emptying. Factors that can aggravate acid reflux include: Smoking. Eating large meals or eating late at night. Eating certain foods, such as fatty or fried foods. Drinking certain beverages, such as alcohol or coffee. Taking certain medicines, such as aspirin. Complications Over time, long-lasting inflammation in the esophagus can cause: Inflammation of the tissue in the esophagus, known as esophagitis. Stomach acid can break down tissue in the esophagus. This can cause inflammation, bleeding and sometimes an open sore, called an ulcer. Esophagitis can cause pain and make swallowing difficult. Narrowing of the esophagus, called an esophageal stricture. Damage to the lower esophagus from stomach acid causes scar tissue to form. The scar tissue narrows the food pathway, leading to problems with swallowing. Precancerous changes to the esophagus, known as Barrett esophagus. Damage from acid can cause changes in the tissue lining the lower esophagus. These changes are associated with an increased risk of esophageal cancer.","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== What does it mean to have gerd and how does it affect my body? Is it preventable? How do I know if I need to go to a doctor? Are there any foods or drinks I should avoid? Answer in 200 words or less. {passage 0} ========== Gastroesophageal reflux disease is a condition in which stomach acid repeatedly flows back up into the tube connecting the mouth and stomach, called the esophagus. It's often called GERD for short. This backwash is known as acid reflux, and it can irritate the lining of the esophagus. Many people experience acid reflux now and then. However, when acid reflux happens repeatedly over time, it can cause GERD. Most people can manage the discomfort of GERD with lifestyle changes and medicines. And though it's uncommon, some may need surgery to help with symptoms. Symptoms Common symptoms of GERD include: A burning sensation in the chest, often called heartburn. Heartburn usually happens after eating and might be worse at night or while lying down. Backwash of food or sour liquid in the throat. Upper belly or chest pain. Trouble swallowing, called dysphagia. Sensation of a lump in the throat. If you have nighttime acid reflux, you also might experience: An ongoing cough. Inflammation of the vocal cords, known as laryngitis. New or worsening asthma. When to see a doctor Seek medical help right away if you have chest pain, especially if you also have shortness of breath, or jaw or arm pain. These may be symptoms of a heart attack. Make an appointment with a healthcare professional if you: Have severe or frequent GERD symptoms. Take nonprescription medicines for heartburn more than twice a week. GERD is caused by frequent acid reflux or reflux of nonacidic content from the stomach. When you swallow, a circular band of muscle around the bottom of the esophagus, called the lower esophageal sphincter, relaxes to allow food and liquid to flow into the stomach. Then the sphincter closes again. If the sphincter does not relax as is typical or it weakens, stomach acid can flow back into the esophagus. This constant backwash of acid irritates the lining of the esophagus, often causing it to become inflamed. Conditions that can increase the risk of GERD include: Obesity. Bulging of the top of the stomach up above the diaphragm, known as a hiatal hernia. Pregnancy. Connective tissue disorders, such as scleroderma. Delayed stomach emptying. Factors that can aggravate acid reflux include: Smoking. Eating large meals or eating late at night. Eating certain foods, such as fatty or fried foods. Drinking certain beverages, such as alcohol or coffee. Taking certain medicines, such as aspirin. Complications Over time, long-lasting inflammation in the esophagus can cause: Inflammation of the tissue in the esophagus, known as esophagitis. Stomach acid can break down tissue in the esophagus. This can cause inflammation, bleeding and sometimes an open sore, called an ulcer. Esophagitis can cause pain and make swallowing difficult. Narrowing of the esophagus, called an esophageal stricture. Damage to the lower esophagus from stomach acid causes scar tissue to form. The scar tissue narrows the food pathway, leading to problems with swallowing. Precancerous changes to the esophagus, known as Barrett esophagus. Damage from acid can cause changes in the tissue lining the lower esophagus. These changes are associated with an increased risk of esophageal cancer. https://www.mayoclinic.org/diseases-conditions/gerd/symptoms-causes/syc-20361940","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]
+
+EVIDENCE:
+Gastroesophageal reflux disease is a condition in which stomach acid repeatedly flows back up into the tube connecting the mouth and stomach, called the esophagus. It's often called GERD for short. This backwash is known as acid reflux, and it can irritate the lining of the esophagus. Many people experience acid reflux now and then. However, when acid reflux happens repeatedly over time, it can cause GERD. Most people can manage the discomfort of GERD with lifestyle changes and medicines. And though it's uncommon, some may need surgery to help with symptoms. Symptoms Common symptoms of GERD include: A burning sensation in the chest, often called heartburn. Heartburn usually happens after eating and might be worse at night or while lying down. Backwash of food or sour liquid in the throat. Upper belly or chest pain. Trouble swallowing, called dysphagia. Sensation of a lump in the throat. If you have nighttime acid reflux, you also might experience: An ongoing cough. Inflammation of the vocal cords, known as laryngitis. New or worsening asthma. When to see a doctor Seek medical help right away if you have chest pain, especially if you also have shortness of breath, or jaw or arm pain. These may be symptoms of a heart attack. Make an appointment with a healthcare professional if you: Have severe or frequent GERD symptoms. Take nonprescription medicines for heartburn more than twice a week. GERD is caused by frequent acid reflux or reflux of nonacidic content from the stomach. When you swallow, a circular band of muscle around the bottom of the esophagus, called the lower esophageal sphincter, relaxes to allow food and liquid to flow into the stomach. Then the sphincter closes again. If the sphincter does not relax as is typical or it weakens, stomach acid can flow back into the esophagus. This constant backwash of acid irritates the lining of the esophagus, often causing it to become inflamed. Conditions that can increase the risk of GERD include: Obesity. Bulging of the top of the stomach up above the diaphragm, known as a hiatal hernia. Pregnancy. Connective tissue disorders, such as scleroderma. Delayed stomach emptying. Factors that can aggravate acid reflux include: Smoking. Eating large meals or eating late at night. Eating certain foods, such as fatty or fried foods. Drinking certain beverages, such as alcohol or coffee. Taking certain medicines, such as aspirin. Complications Over time, long-lasting inflammation in the esophagus can cause: Inflammation of the tissue in the esophagus, known as esophagitis. Stomach acid can break down tissue in the esophagus. This can cause inflammation, bleeding and sometimes an open sore, called an ulcer. Esophagitis can cause pain and make swallowing difficult. Narrowing of the esophagus, called an esophageal stricture. Damage to the lower esophagus from stomach acid causes scar tissue to form. The scar tissue narrows the food pathway, leading to problems with swallowing. Precancerous changes to the esophagus, known as Barrett esophagus. Damage from acid can cause changes in the tissue lining the lower esophagus. These changes are associated with an increased risk of esophageal cancer.
+
+USER:
+What does it mean to have gerd and how does it affect my body? Is it preventable? How do I know if I need to go to a doctor? Are there any foods or drinks I should avoid? Answer in 200 words or less.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,26,44,511,,154
+Please only respond to questions using the provided text as a reference.,What resilience factors led to the smallest declines in new business activity during the COVID-19 pandemic?,"Since its emergence in 2019, the worldwide spread of the novel coronavirus SARS-CoV-2 (COVID-19) has created a vast economic crisis as government lockdowns place considerable strain on businesses of all kinds – particularly those that rely on face- to-face contact, such as retail restaurants, and personal services. Given the importance of these businesses to local economic development and urban vitality, this paper makes use of the point-level Chicago Business License dataset to examine the impact of the COVID-19 pandemic on new business activity in the City of Chicago. The results indicate that on average, from March to September 2020, total monthly new business starts have declined by 33.4% compared to the monthly average of new starts in the City from 2016 to 2019. Food service and retail businesses have been hardest hit during this period, while chains of all types have seen larger average declines in new startup activity than independent businesses. These patterns also demonstrate interesting intra-urban spatial heterogeneity; ZIP codes with the largest resilience to pandemic-related drops in new business activity tend to have more dense, diverse, and walkable built environments, lower levels of social vulnerability, lower percentages of young residents, and higher percentages of Black and Asian (non-Hispanic) residents. These findings provide some useful evidence in support of the “15-minute city” and ethnic enclave resilience hypotheses. Interestingly, observed COVID-19 case rates also appear to have a positive relationship with new business resilience for new chain and food service establishments. This is likely due to the fact that neighborhoods with relatively high levels of new food service business activity also have relatively higher proportions of food service employees, who are more at risk for contracting COVID-19 as “essential” workers. Since the emergence of the novel SARS-CoV-2 (COVID-19) virus in late 2019, its global spread has led to a variety of negative economic consequences, from restrictions on business operations and government lockdowns to reduced consumer confidence, discretionary mobility, and stock market fluctuations (McKinsey & Company 2020). According to some estimates, real global Gross Domestic Product (GDP) dropped by 10% between 2019Q4 and 2020Q2 (McKinsey & Company 2020), while US GDP experienced its largest quarterly drop in history (9.1% in Quarter 2 of 2020), far outstripping the impact of any previous recessions (measured since data collection began in 1947) (Bauer et al. 2020, Routley 2020). Concurrently, the US unemployment rate reached its highest-ever recorded value in April 2020 at 14.7% (FRED 2020), while the S&P 500 lost 33% of its value in just one month (Capelle-Blancard, Desroziers 2020). Accordingly, US national data show that small business revenues across all industrial sectors dropped by 40% in April and had not yet recovered to pre-pandemic (January 2020) levels by August, remaining at a 20% deficit; revenue in “leisure and hospitality” small businesses, which includes the arts, entertainment, recreation, accommodation, and food service sectors, have fared even worse, bottoming out at a roughly 70% deficit and only recovering to around 40% of pre-pandemic levels (Chetty et al. 2020, Bauer et al. 2020). At the same time, as Figure 1 shows, applications for new businesses “with planned wages” dropped significantly in 2020Q1 and 2020Q2 compared to recent years, before significantly rebounding in 2020Q3 and 202Q4 (US Census Bureau 2020). While this amounts to a higher net number of applications in the first four quarters of 2020 compared to the 2016-2019 average, it is not yet clear whether this is due primarily to an administrative backlog created by the pandemic, the entrepreneurial activity of the newly unemployed, or re-adjustments in the market due to increased demand for particular kinds of goods and services (Bauer et al. 2020). Further understanding the specific effects of the pandemic on entrepreneurial activity is particularly important because new business creation is the primary engine for diversity, economic growth, and innovation in the economy as a whole (Frenken et al. 2007, Neumark et al. 2006, Wennekers, Thurik 1999), and declines in startup activity can have substantial negative long-term economic consequences (Sedl´aˇcek 2020, Guorio et al. 2016). There is also significant spatial heterogeneity in startup activity that plays an important role in cluster formation, regional economic development, and even the development trajectory of individual neighbourhoods within regions (Mack, Credit 2016, Malmberg, Maskell 2002, Florida 2002, Klepper 2009a,b, Porter 2000, Rutten, Boekema 2007). Understanding the fine-grained spatial and industrial effects of the pandemic on new businesses in more detail can help researchers and local governments to understand how to develop more economically resilient regions, which can provide insulation from future economic shocks. Data on new business applications are available on a weekly basis at the state level from the US Census Bureau’s Business Formation Statistics (2020). However, other datasets used to evaluate new business activity at finer spatial scales are not updated quickly enough to allow researchers to examine the fine-grained spatial and industrial/sectoral effects of the pandemic on new business activity. These include public datasets like the ZIP Code Business Patterns, as well as private datasets such as InfoUSA or the National Establishment Time Series (NETS). To overcome this problem, this paper utilizes a novel large dataset of business establishments (at the point level) derived from the open source Chicago Business License dataset, which is updated weekly and contains a comprehensive set of information on all new business license applications in the City of Chicago (2020) to assess two primary questions: first, to what extent has there been a decline in new business establishment1 starts during the pandemic (March to September, 2020) when compared to recent pre-pandemic trends (averages from 2016 to 2019)? Specifically, we are interested in whether there are distinct temporal trends by business sector or type (e.g., retail, food service, personal care and fitness, etc.) or between multi-establishment (or “chain”) (≥ 4 establishment) businesses and “independent” (< 4 establishment) businesses. Second, given the temporal analysis, what is the spatial expression of these trends? Are there particular areas of the city that are more resilient to declines in new business startups, and, if so, what are the characteristics of these areas? To analyse this formally, we aggregate changes in pandemic-related (i.e., March to September 2020) business activity to the ZIP code level in order to explore the relationship between pandemic-related decline and characteristics of social vulnerability, the built environment, demographics, and cumulative COVID-19 activity. The results of the analysis indicate that 1) on average, from March to September 2020 (through which complete data was available at the time of writing), total monthly new business starts have declined by 33.4% compared to the monthly average of new starts in the City from January 2016 to December 2019. 2) In general, food service and retail businesses have been hardest hit during this period (although all categories have experienced declines), while chains of all types have seen larger average declines in new startup activity (an average monthly drop of 61.9% from March to September compared to pre-pandemic averages) than independent businesses (a 29.2% drop). 3) These patterns demonstrate interesting intra-urban spatial heterogeneity; overall, a regression analysis suggests that the ZIP codes with the smallest pandemic-related declines in new business activity (i.e., those most resilient to the effects of the pandemic) tend to have more dense, diverse, and walkable built environments (defined in more detail below), lower levels of social vulnerability, lower percentages of young (age 18-39) residents, and higher percentages of Black and Asian (non-Hispanic) residents. Interestingly, observed COVID-19 case rates appear to have a positive relationship with new business resilience (after controlling for a variety of covariates), particularly for new chain and food service establishments. This could be a case of reverse causality, where areas with relatively high levels of new food service business activity also have relatively higher proportions of food service employees, who are more at risk for contracting COVID-19 as “essential” workers. New business creation provides a number of benefits to both local and macro-level economies that make it particularly important in the contemporary era of “flexible specialization” (Harvey 1989, Piore, Sabel 1984). The theoretical pathways from new business creation to economic benefits are diagrammed in Figure 2. Most directly, new (generally small) businesses create jobs that contribute to local economic growth (Birch 1987, Kirchhoff, Phillips 1988, Neumark et al. 2006). While on net these jobs may not always exceed the number of jobs lost from the older businesses they replace (Mack, Credit 2017), this process of business “churn” increases the probability of creating high-growth firms (so-called “gazelles”) that tend to produce the majority of new jobs (Henrekson, Johansson 2010, Nightingale, Coad 2014) and also provides for the “creative destruction” that fosters evolution and innovation in the economy2 by replacing jobs and businesses in older declining industries with new jobs in more innovative industries (Schumpeter 1934, 1947, 1950, Brown et al. 2006, Fogel et al. 2008). Another way that entrepreneurship fosters innovation and productivity improvement is through the creation of a more competitive economic environment that produces a selection process through which only the most viable and/or innovative businesses survive (Wennekers, Thurik 1999, Carree, Thurik 2003). Interestingly, this more competitive environment can drive a positive feedback loop through which increased competitiveness drives demand for better products, which creates incentives for additional innovation and new business creation (Teece 2007, Asheim 1996, Florida 1995, Porter 2000, Rutten, Boekema 2007, Malmberg, Maskell 2002). Fully fledged clusters, such as Silicon Valley, can develop a unique entrepreneurial culture of “competition and community” (Saxenian 1994) and attract additional educational, political, and financial investments that foster a holistic “entrepreneurial ecosystem” (Mack, Mayer 2015, Stam 2015) that captures the indigenous benefits of innovation, leading to economic success for individual businesses and associated local economic benefits, as well as providing a more supportive environment for further new business creation (Delgado et al. 2010). New businesses also contribute to innovation because they are often created as a direct result of knowledge spillovers, i.e., a new business is formed specifically to take advantage of some newly generated knowledge or idea (Acs, Audretsch 2003, Acs et al. 2009). These are often in the form of spinoffs from large existing companies, which some argue constitute the bulk of cluster forming activity (Buenstorf, Klepper 2009, Klepper, Sleeper 2005, Klepper 2009a,b). Finally, new businesses directly contribute to economic diversity. Increased diversity within related industries (i.e., “related variety”) provides another engine for innovation as the pool of new ideas and possible interactions and exchanges increases with the diversity of firms (Jacobs 1967, Boschma, Lambooy 1999, Boschma, Frenken 2006, Saviotti, Pyka 2004, Frenken et al. 2007). On the other hand, diversity through “unrelated variety” provides important portfolio benefits to local economies by distributing economic risk across a variety of different industries, making the economic system more resilient to unexpected shocks that may occur, no matter what sector they are concentrated in (Montgomery 1994, Frenken et al. 2007). In this paper, we are particularly interested in new business creation for small, independently owned businesses in customer-facing sectors such as retail and food service, for several reasons. These businesses are significant contributors to land use diversity, street life, and overall urban vitality (Jacobs 1961, Gehl 2010). At the same time, small retail shops help to contribute to a unique “sense of place” in a given locality that is the direct product of local creative efforts and sensibilities (Jacobs 1961, Relph 1976, Robertson 1999, Kunstler 1994, Walljasper 2007, Alexander 1977, Montgomery 1998). The owners of these kinds of businesses themselves are also often more connected to the specific dynamics, demands, and politics of the local community, and tend to contribute to local import substitution (increasing the local multiplier effect) by spending profits to purchase requisite subsidiary goods and services locally, rather than exporting profits to another region, as is the case with larger chain businesses (Jacobs 1967, Talen, Jeong 2019a,b).","Please only respond to questions using the provided text as a reference. What resilience factors led to the smallest declines in new business activity during the COVID-19 pandemic? Since its emergence in 2019, the worldwide spread of the novel coronavirus SARS-CoV-2 (COVID-19) has created a vast economic crisis as government lockdowns place considerable strain on businesses of all kinds – particularly those that rely on face- to-face contact, such as retail restaurants, and personal services. Given the importance of these businesses to local economic development and urban vitality, this paper makes use of the point-level Chicago Business License dataset to examine the impact of the COVID-19 pandemic on new business activity in the City of Chicago. The results indicate that on average, from March to September 2020, total monthly new business starts have declined by 33.4% compared to the monthly average of new starts in the City from 2016 to 2019. Food service and retail businesses have been hardest hit during this period, while chains of all types have seen larger average declines in new startup activity than independent businesses. These patterns also demonstrate interesting intra-urban spatial heterogeneity; ZIP codes with the largest resilience to pandemic-related drops in new business activity tend to have more dense, diverse, and walkable built environments, lower levels of social vulnerability, lower percentages of young residents, and higher percentages of Black and Asian (non-Hispanic) residents. These findings provide some useful evidence in support of the “15-minute city” and ethnic enclave resilience hypotheses. Interestingly, observed COVID-19 case rates also appear to have a positive relationship with new business resilience for new chain and food service establishments. This is likely due to the fact that neighborhoods with relatively high levels of new food service business activity also have relatively higher proportions of food service employees, who are more at risk for contracting COVID-19 as “essential” workers. Since the emergence of the novel SARS-CoV-2 (COVID-19) virus in late 2019, its global spread has led to a variety of negative economic consequences, from restrictions on business operations and government lockdowns to reduced consumer confidence, discretionary mobility, and stock market fluctuations (McKinsey & Company 2020). According to some estimates, real global Gross Domestic Product (GDP) dropped by 10% between 2019Q4 and 2020Q2 (McKinsey & Company 2020), while US GDP experienced its largest quarterly drop in history (9.1% in Quarter 2 of 2020), far outstripping the impact of any previous recessions (measured since data collection began in 1947) (Bauer et al. 2020, Routley 2020). Concurrently, the US unemployment rate reached its highest-ever recorded value in April 2020 at 14.7% (FRED 2020), while the S&P 500 lost 33% of its value in just one month (Capelle-Blancard, Desroziers 2020). Accordingly, US national data show that small business revenues across all industrial sectors dropped by 40% in April and had not yet recovered to pre-pandemic (January 2020) levels by August, remaining at a 20% deficit; revenue in “leisure and hospitality” small businesses, which includes the arts, entertainment, recreation, accommodation, and food service sectors, have fared even worse, bottoming out at a roughly 70% deficit and only recovering to around 40% of pre-pandemic levels (Chetty et al. 2020, Bauer et al. 2020). At the same time, as Figure 1 shows, applications for new businesses “with planned wages” dropped significantly in 2020Q1 and 2020Q2 compared to recent years, before significantly rebounding in 2020Q3 and 202Q4 (US Census Bureau 2020). While this amounts to a higher net number of applications in the first four quarters of 2020 compared to the 2016-2019 average, it is not yet clear whether this is due primarily to an administrative backlog created by the pandemic, the entrepreneurial activity of the newly unemployed, or re-adjustments in the market due to increased demand for particular kinds of goods and services (Bauer et al. 2020). Further understanding the specific effects of the pandemic on entrepreneurial activity is particularly important because new business creation is the primary engine for diversity, economic growth, and innovation in the economy as a whole (Frenken et al. 2007, Neumark et al. 2006, Wennekers, Thurik 1999), and declines in startup activity can have substantial negative long-term economic consequences (Sedl´aˇcek 2020, Guorio et al. 2016). There is also significant spatial heterogeneity in startup activity that plays an important role in cluster formation, regional economic development, and even the development trajectory of individual neighbourhoods within regions (Mack, Credit 2016, Malmberg, Maskell 2002, Florida 2002, Klepper 2009a,b, Porter 2000, Rutten, Boekema 2007). Understanding the fine-grained spatial and industrial effects of the pandemic on new businesses in more detail can help researchers and local governments to understand how to develop more economically resilient regions, which can provide insulation from future economic shocks. Data on new business applications are available on a weekly basis at the state level from the US Census Bureau’s Business Formation Statistics (2020). However, other datasets used to evaluate new business activity at finer spatial scales are not updated quickly enough to allow researchers to examine the fine-grained spatial and industrial/sectoral effects of the pandemic on new business activity. These include public datasets like the ZIP Code Business Patterns, as well as private datasets such as InfoUSA or the National Establishment Time Series (NETS). To overcome this problem, this paper utilizes a novel large dataset of business establishments (at the point level) derived from the open source Chicago Business License dataset, which is updated weekly and contains a comprehensive set of information on all new business license applications in the City of Chicago (2020) to assess two primary questions: first, to what extent has there been a decline in new business establishment1 starts during the pandemic (March to September, 2020) when compared to recent pre-pandemic trends (averages from 2016 to 2019)? Specifically, we are interested in whether there are distinct temporal trends by business sector or type (e.g., retail, food service, personal care and fitness, etc.) or between multi-establishment (or “chain”) (≥ 4 establishment) businesses and “independent” (< 4 establishment) businesses. Second, given the temporal analysis, what is the spatial expression of these trends? Are there particular areas of the city that are more resilient to declines in new business startups, and, if so, what are the characteristics of these areas? To analyse this formally, we aggregate changes in pandemic-related (i.e., March to September 2020) business activity to the ZIP code level in order to explore the relationship between pandemic-related decline and characteristics of social vulnerability, the built environment, demographics, and cumulative COVID-19 activity. The results of the analysis indicate that 1) on average, from March to September 2020 (through which complete data was available at the time of writing), total monthly new business starts have declined by 33.4% compared to the monthly average of new starts in the City from January 2016 to December 2019. 2) In general, food service and retail businesses have been hardest hit during this period (although all categories have experienced declines), while chains of all types have seen larger average declines in new startup activity (an average monthly drop of 61.9% from March to September compared to pre-pandemic averages) than independent businesses (a 29.2% drop). 3) These patterns demonstrate interesting intra-urban spatial heterogeneity; overall, a regression analysis suggests that the ZIP codes with the smallest pandemic-related declines in new business activity (i.e., those most resilient to the effects of the pandemic) tend to have more dense, diverse, and walkable built environments (defined in more detail below), lower levels of social vulnerability, lower percentages of young (age 18-39) residents, and higher percentages of Black and Asian (non-Hispanic) residents. Interestingly, observed COVID-19 case rates appear to have a positive relationship with new business resilience (after controlling for a variety of covariates), particularly for new chain and food service establishments. This could be a case of reverse causality, where areas with relatively high levels of new food service business activity also have relatively higher proportions of food service employees, who are more at risk for contracting COVID-19 as “essential” workers. New business creation provides a number of benefits to both local and macro-level economies that make it particularly important in the contemporary era of “flexible specialization” (Harvey 1989, Piore, Sabel 1984). The theoretical pathways from new business creation to economic benefits are diagrammed in Figure 2. Most directly, new (generally small) businesses create jobs that contribute to local economic growth (Birch 1987, Kirchhoff, Phillips 1988, Neumark et al. 2006). While on net these jobs may not always exceed the number of jobs lost from the older businesses they replace (Mack, Credit 2017), this process of business “churn” increases the probability of creating high-growth firms (so-called “gazelles”) that tend to produce the majority of new jobs (Henrekson, Johansson 2010, Nightingale, Coad 2014) and also provides for the “creative destruction” that fosters evolution and innovation in the economy2 by replacing jobs and businesses in older declining industries with new jobs in more innovative industries (Schumpeter 1934, 1947, 1950, Brown et al. 2006, Fogel et al. 2008). Another way that entrepreneurship fosters innovation and productivity improvement is through the creation of a more competitive economic environment that produces a selection process through which only the most viable and/or innovative businesses survive (Wennekers, Thurik 1999, Carree, Thurik 2003). Interestingly, this more competitive environment can drive a positive feedback loop through which increased competitiveness drives demand for better products, which creates incentives for additional innovation and new business creation (Teece 2007, Asheim 1996, Florida 1995, Porter 2000, Rutten, Boekema 2007, Malmberg, Maskell 2002). Fully fledged clusters, such as Silicon Valley, can develop a unique entrepreneurial culture of “competition and community” (Saxenian 1994) and attract additional educational, political, and financial investments that foster a holistic “entrepreneurial ecosystem” (Mack, Mayer 2015, Stam 2015) that captures the indigenous benefits of innovation, leading to economic success for individual businesses and associated local economic benefits, as well as providing a more supportive environment for further new business creation (Delgado et al. 2010). New businesses also contribute to innovation because they are often created as a direct result of knowledge spillovers, i.e., a new business is formed specifically to take advantage of some newly generated knowledge or idea (Acs, Audretsch 2003, Acs et al. 2009). These are often in the form of spinoffs from large existing companies, which some argue constitute the bulk of cluster forming activity (Buenstorf, Klepper 2009, Klepper, Sleeper 2005, Klepper 2009a,b). Finally, new businesses directly contribute to economic diversity. Increased diversity within related industries (i.e., “related variety”) provides another engine for innovation as the pool of new ideas and possible interactions and exchanges increases with the diversity of firms (Jacobs 1967, Boschma, Lambooy 1999, Boschma, Frenken 2006, Saviotti, Pyka 2004, Frenken et al. 2007). On the other hand, diversity through “unrelated variety” provides important portfolio benefits to local economies by distributing economic risk across a variety of different industries, making the economic system more resilient to unexpected shocks that may occur, no matter what sector they are concentrated in (Montgomery 1994, Frenken et al. 2007). In this paper, we are particularly interested in new business creation for small, independently owned businesses in customer-facing sectors such as retail and food service, for several reasons. These businesses are significant contributors to land use diversity, street life, and overall urban vitality (Jacobs 1961, Gehl 2010). At the same time, small retail shops help to contribute to a unique “sense of place” in a given locality that is the direct product of local creative efforts and sensibilities (Jacobs 1961, Relph 1976, Robertson 1999, Kunstler 1994, Walljasper 2007, Alexander 1977, Montgomery 1998). The owners of these kinds of businesses themselves are also often more connected to the specific dynamics, demands, and politics of the local community, and tend to contribute to local import substitution (increasing the local multiplier effect) by spending profits to purchase requisite subsidiary goods and services locally, rather than exporting profits to another region, as is the case with larger chain businesses (Jacobs 1967, Talen, Jeong 2019a,b).","Please only respond to questions using the provided text as a reference.
+
+EVIDENCE:
+Since its emergence in 2019, the worldwide spread of the novel coronavirus SARS-CoV-2 (COVID-19) has created a vast economic crisis as government lockdowns place considerable strain on businesses of all kinds – particularly those that rely on face- to-face contact, such as retail restaurants, and personal services. Given the importance of these businesses to local economic development and urban vitality, this paper makes use of the point-level Chicago Business License dataset to examine the impact of the COVID-19 pandemic on new business activity in the City of Chicago. The results indicate that on average, from March to September 2020, total monthly new business starts have declined by 33.4% compared to the monthly average of new starts in the City from 2016 to 2019. Food service and retail businesses have been hardest hit during this period, while chains of all types have seen larger average declines in new startup activity than independent businesses. These patterns also demonstrate interesting intra-urban spatial heterogeneity; ZIP codes with the largest resilience to pandemic-related drops in new business activity tend to have more dense, diverse, and walkable built environments, lower levels of social vulnerability, lower percentages of young residents, and higher percentages of Black and Asian (non-Hispanic) residents. These findings provide some useful evidence in support of the “15-minute city” and ethnic enclave resilience hypotheses. Interestingly, observed COVID-19 case rates also appear to have a positive relationship with new business resilience for new chain and food service establishments. This is likely due to the fact that neighborhoods with relatively high levels of new food service business activity also have relatively higher proportions of food service employees, who are more at risk for contracting COVID-19 as “essential” workers. Since the emergence of the novel SARS-CoV-2 (COVID-19) virus in late 2019, its global spread has led to a variety of negative economic consequences, from restrictions on business operations and government lockdowns to reduced consumer confidence, discretionary mobility, and stock market fluctuations (McKinsey & Company 2020). According to some estimates, real global Gross Domestic Product (GDP) dropped by 10% between 2019Q4 and 2020Q2 (McKinsey & Company 2020), while US GDP experienced its largest quarterly drop in history (9.1% in Quarter 2 of 2020), far outstripping the impact of any previous recessions (measured since data collection began in 1947) (Bauer et al. 2020, Routley 2020). Concurrently, the US unemployment rate reached its highest-ever recorded value in April 2020 at 14.7% (FRED 2020), while the S&P 500 lost 33% of its value in just one month (Capelle-Blancard, Desroziers 2020). Accordingly, US national data show that small business revenues across all industrial sectors dropped by 40% in April and had not yet recovered to pre-pandemic (January 2020) levels by August, remaining at a 20% deficit; revenue in “leisure and hospitality” small businesses, which includes the arts, entertainment, recreation, accommodation, and food service sectors, have fared even worse, bottoming out at a roughly 70% deficit and only recovering to around 40% of pre-pandemic levels (Chetty et al. 2020, Bauer et al. 2020). At the same time, as Figure 1 shows, applications for new businesses “with planned wages” dropped significantly in 2020Q1 and 2020Q2 compared to recent years, before significantly rebounding in 2020Q3 and 202Q4 (US Census Bureau 2020). While this amounts to a higher net number of applications in the first four quarters of 2020 compared to the 2016-2019 average, it is not yet clear whether this is due primarily to an administrative backlog created by the pandemic, the entrepreneurial activity of the newly unemployed, or re-adjustments in the market due to increased demand for particular kinds of goods and services (Bauer et al. 2020). Further understanding the specific effects of the pandemic on entrepreneurial activity is particularly important because new business creation is the primary engine for diversity, economic growth, and innovation in the economy as a whole (Frenken et al. 2007, Neumark et al. 2006, Wennekers, Thurik 1999), and declines in startup activity can have substantial negative long-term economic consequences (Sedl´aˇcek 2020, Guorio et al. 2016). There is also significant spatial heterogeneity in startup activity that plays an important role in cluster formation, regional economic development, and even the development trajectory of individual neighbourhoods within regions (Mack, Credit 2016, Malmberg, Maskell 2002, Florida 2002, Klepper 2009a,b, Porter 2000, Rutten, Boekema 2007). Understanding the fine-grained spatial and industrial effects of the pandemic on new businesses in more detail can help researchers and local governments to understand how to develop more economically resilient regions, which can provide insulation from future economic shocks. Data on new business applications are available on a weekly basis at the state level from the US Census Bureau’s Business Formation Statistics (2020). However, other datasets used to evaluate new business activity at finer spatial scales are not updated quickly enough to allow researchers to examine the fine-grained spatial and industrial/sectoral effects of the pandemic on new business activity. These include public datasets like the ZIP Code Business Patterns, as well as private datasets such as InfoUSA or the National Establishment Time Series (NETS). To overcome this problem, this paper utilizes a novel large dataset of business establishments (at the point level) derived from the open source Chicago Business License dataset, which is updated weekly and contains a comprehensive set of information on all new business license applications in the City of Chicago (2020) to assess two primary questions: first, to what extent has there been a decline in new business establishment1 starts during the pandemic (March to September, 2020) when compared to recent pre-pandemic trends (averages from 2016 to 2019)? Specifically, we are interested in whether there are distinct temporal trends by business sector or type (e.g., retail, food service, personal care and fitness, etc.) or between multi-establishment (or “chain”) (≥ 4 establishment) businesses and “independent” (< 4 establishment) businesses. Second, given the temporal analysis, what is the spatial expression of these trends? Are there particular areas of the city that are more resilient to declines in new business startups, and, if so, what are the characteristics of these areas? To analyse this formally, we aggregate changes in pandemic-related (i.e., March to September 2020) business activity to the ZIP code level in order to explore the relationship between pandemic-related decline and characteristics of social vulnerability, the built environment, demographics, and cumulative COVID-19 activity. The results of the analysis indicate that 1) on average, from March to September 2020 (through which complete data was available at the time of writing), total monthly new business starts have declined by 33.4% compared to the monthly average of new starts in the City from January 2016 to December 2019. 2) In general, food service and retail businesses have been hardest hit during this period (although all categories have experienced declines), while chains of all types have seen larger average declines in new startup activity (an average monthly drop of 61.9% from March to September compared to pre-pandemic averages) than independent businesses (a 29.2% drop). 3) These patterns demonstrate interesting intra-urban spatial heterogeneity; overall, a regression analysis suggests that the ZIP codes with the smallest pandemic-related declines in new business activity (i.e., those most resilient to the effects of the pandemic) tend to have more dense, diverse, and walkable built environments (defined in more detail below), lower levels of social vulnerability, lower percentages of young (age 18-39) residents, and higher percentages of Black and Asian (non-Hispanic) residents. Interestingly, observed COVID-19 case rates appear to have a positive relationship with new business resilience (after controlling for a variety of covariates), particularly for new chain and food service establishments. This could be a case of reverse causality, where areas with relatively high levels of new food service business activity also have relatively higher proportions of food service employees, who are more at risk for contracting COVID-19 as “essential” workers. New business creation provides a number of benefits to both local and macro-level economies that make it particularly important in the contemporary era of “flexible specialization” (Harvey 1989, Piore, Sabel 1984). The theoretical pathways from new business creation to economic benefits are diagrammed in Figure 2. Most directly, new (generally small) businesses create jobs that contribute to local economic growth (Birch 1987, Kirchhoff, Phillips 1988, Neumark et al. 2006). While on net these jobs may not always exceed the number of jobs lost from the older businesses they replace (Mack, Credit 2017), this process of business “churn” increases the probability of creating high-growth firms (so-called “gazelles”) that tend to produce the majority of new jobs (Henrekson, Johansson 2010, Nightingale, Coad 2014) and also provides for the “creative destruction” that fosters evolution and innovation in the economy2 by replacing jobs and businesses in older declining industries with new jobs in more innovative industries (Schumpeter 1934, 1947, 1950, Brown et al. 2006, Fogel et al. 2008). Another way that entrepreneurship fosters innovation and productivity improvement is through the creation of a more competitive economic environment that produces a selection process through which only the most viable and/or innovative businesses survive (Wennekers, Thurik 1999, Carree, Thurik 2003). Interestingly, this more competitive environment can drive a positive feedback loop through which increased competitiveness drives demand for better products, which creates incentives for additional innovation and new business creation (Teece 2007, Asheim 1996, Florida 1995, Porter 2000, Rutten, Boekema 2007, Malmberg, Maskell 2002). Fully fledged clusters, such as Silicon Valley, can develop a unique entrepreneurial culture of “competition and community” (Saxenian 1994) and attract additional educational, political, and financial investments that foster a holistic “entrepreneurial ecosystem” (Mack, Mayer 2015, Stam 2015) that captures the indigenous benefits of innovation, leading to economic success for individual businesses and associated local economic benefits, as well as providing a more supportive environment for further new business creation (Delgado et al. 2010). New businesses also contribute to innovation because they are often created as a direct result of knowledge spillovers, i.e., a new business is formed specifically to take advantage of some newly generated knowledge or idea (Acs, Audretsch 2003, Acs et al. 2009). These are often in the form of spinoffs from large existing companies, which some argue constitute the bulk of cluster forming activity (Buenstorf, Klepper 2009, Klepper, Sleeper 2005, Klepper 2009a,b). Finally, new businesses directly contribute to economic diversity. Increased diversity within related industries (i.e., “related variety”) provides another engine for innovation as the pool of new ideas and possible interactions and exchanges increases with the diversity of firms (Jacobs 1967, Boschma, Lambooy 1999, Boschma, Frenken 2006, Saviotti, Pyka 2004, Frenken et al. 2007). On the other hand, diversity through “unrelated variety” provides important portfolio benefits to local economies by distributing economic risk across a variety of different industries, making the economic system more resilient to unexpected shocks that may occur, no matter what sector they are concentrated in (Montgomery 1994, Frenken et al. 2007). In this paper, we are particularly interested in new business creation for small, independently owned businesses in customer-facing sectors such as retail and food service, for several reasons. These businesses are significant contributors to land use diversity, street life, and overall urban vitality (Jacobs 1961, Gehl 2010). At the same time, small retail shops help to contribute to a unique “sense of place” in a given locality that is the direct product of local creative efforts and sensibilities (Jacobs 1961, Relph 1976, Robertson 1999, Kunstler 1994, Walljasper 2007, Alexander 1977, Montgomery 1998). The owners of these kinds of businesses themselves are also often more connected to the specific dynamics, demands, and politics of the local community, and tend to contribute to local import substitution (increasing the local multiplier effect) by spending profits to purchase requisite subsidiary goods and services locally, rather than exporting profits to another region, as is the case with larger chain businesses (Jacobs 1967, Talen, Jeong 2019a,b).
+
+USER:
+What resilience factors led to the smallest declines in new business activity during the COVID-19 pandemic?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,12,16,1951,,115
+Answer the question using only the information given in the context block. Give your answer as a bulleted list.,What are the pros and cons of using a CPAP machine?,"If you have sleep apnea, not enough air can flow into your lungs through your mouth and nose during sleep, even though breathing efforts continue. When this happens, the amount of oxygen in your blood decreases. Your brain responds by awakening you enough to tighten the upper airway muscles and open your windpipe. Normal breaths then start again, often with a loud snort or choking sound. Although people who have sleep apnea typically snore loudly and frequently, not everyone who snores has sleep apnea. Because people who have sleep apnea frequently go from deeper sleep to lighter sleep during the night, they rarely spend enough time in deep, restorative stages of sleep. They are therefore often excessively sleepy during the day. Such sleepiness is thought to lead to mood and behavior problems, including depression, and it more than triples the risk of being in a traffic or work-related accident. The many brief drops in blood-oxygen levels that occur during the night can result in morning headaches and trouble concentrating, thinking clearly, learning, and remembering. Additionally, the intermittent oxygen drops and reduced sleep quality together trigger the release of stress hormones. These hormones raise your blood pressure and heart rate and boost the risk of heart attack, stroke, irregular heartbeats, and congestive heart failure. In addition, untreated sleep apnea can lead to changes in energy metabolism (the way your body changes food and oxygen into energy) that increase the risk for developing obesity and diabetes. Anyone can have sleep apnea. It is estimated that at least 12–18 million American adults have sleep apnea, making it as common as asthma. More than one-half of the people who have sleep apnea are overweight. Sleep apnea is more common in men. More than 1 in 25 middle-aged men and 1 in 50 middle-aged women have sleep apnea along with extreme daytime sleepiness. About 3 percent of children and 10 percent or more of people over age 65 have sleep apnea. This condition occurs more frequently in African Americans, Asians, Native Americans, and Hispanics than in Caucasians. More than one-half of all people who have sleep apnea are not diagnosed. People who have sleep apnea generally are not aware that their breathing stops in the night. They just notice that they don’t feel well rested when they wake up and are sleepy throughout the day. Their bed partners are likely to notice, however, that they snore loudly and frequently and that they often stop breathing briefly while sleeping. Doctors suspect sleep apnea if these symptoms are present, but the diagnosis must be confirmed with overnight sleep monitoring. This monitoring will reveal pauses in breathing, frequent sleep arousals (changes from sleep to wakefulness), and intermittent drops in levels of oxygen in the blood. Like adults who have sleep apnea, children who have this disorder usually snore loudly, snort or gasp, and have brief pauses in breath ing while sleeping. Small children often have enlarged tonsils and adenoids that increase their risk for sleep apnea. But doctors may not suspect sleep apnea in children because, instead of showing the typical signs of sleepiness during the day, these children often become agitated and may be considered hyperactive. The effects of sleep apnea in children may include poor school performance and difficult, aggressive behavior. A number of factors can make a person susceptible to sleep apnea. These factors include: Throat muscles and tongue that relax more than normal while asleep Enlarged tonsils and adenoids Being overweight—the excess fat tissue around your neck makes it harder to keep the throat area open Head and neck shape that creates a somewhat smaller airway size in the mouth and throat area Congestion, due to allergies, that also can narrow the airway Family history of sleep apnea If your doctor suspects that you have sleep apnea, you may be referred to a sleep specialist. Some of the ways to help diagnose sleep apnea include: A medical history that includes asking you and your family questions about how you sleep and how you function during the day. Checking your mouth, nose, and throat for extra or large tissues—for example, checking the tonsils, uvula (the tissue that hangs from the middle of the back of the mouth), and soft palate (the roof of your mouth in the back of your throat). An overnight recording of what happens with your breathing during sleep (polysomnogram, or PSG). A multiple sleep latency test (MSLT), usually done in a sleep center, to see how quickly you fall asleep at times when you would normally be awake. (Falling asleep in only a few minutes usually means that you are very sleepy during the day. Being very sleepy during the day can be a sign of sleep apnea. Once all the tests are completed, the sleep specialist will review the results and work with you and your family to develop a treatment plan. Changes in daily activities or habits may help reduce your symptoms: Sleep on your side instead of on your back. Sleeping on your side will help reduce the amount of upper airway collapse during sleep. Avoid alcohol, smoking, sleeping pills, herbal supplements, and any other medications that make you sleepy. They make it harder for your airways to stay open while you sleep, and sedatives can make the breathing pauses longer and more severe. Tobacco smoke irritates the airways and can help trigger the intermittent collapse of the upper airway. Lose weight if you are overweight. Even a little weight loss can sometimes improve symptoms. These changes may be all that are needed to treat mild sleep apnea. However, if you have moderate or severe sleep apnea, you will need additional, more direct treatment approaches. Continuous positive airway pressure (CPAP) is the most effective treatment for sleep apnea in adults. A CPAP machine uses mild air pressure to keep your airways open while you sleep. The machine delivers air to your airways through a specially designed nasal mask. The mask does not breathe for you; the flow of air creates increased pressure to keep the airways in your nose and mouth more open while you sleep. The air pressure is adjusted so that it is just enough to stop your airways from briefly becoming too small during sleep. The pressure is constant and continuous. Sleep apnea will return if CPAP is stopped or if it is used incorrectly. People who have severe sleep apnea symptoms generally feel much better once they begin treatment with CPAP. CPAP treatment can cause side effects in some people. Possible side effects include dry or stuffy nose, irritation of the skin on the face, bloating of the stom ach, sore eyes, or headaches. If you have trouble with CPAP side effects, work with your sleep specialist and support staff. Together, you can do things to reduce or eliminate these problems. Currently, no medications cure sleep apnea. However, some prescription medications may help relieve the excessive sleepiness that sometimes persists even with CPAP treatment of sleep apnea. Another treatment approach that may help some people is the use of a mouthpiece (oral or dental appliance). If you have mild sleep apnea or do not have sleep apnea but snore very loudly, your doctor or dentist also may recommend this. A custom-fitted plastic mouth piece will be made by a dentist or an orthodontist (a specialist in correcting teeth or jaw problems). The mouthpiece will adjust your lower jaw and tongue to help keep the airway in your throat more open while you are sleeping. Air can then flow more easily into your lungs because there is less resistance to breathing. Following up with the dentist or orthodontist is important to correct any side effects and to be sure that your mouthpiece continues to fit properly. It is also important to have a followup sleep study to see whether your sleep apnea has improved. Some people who have sleep apnea may benefit from surgery; this depends on the findings of the evaluation by the sleep specialist. Removing tonsils and adenoids that are blocking the airway is done frequently, especially in children. Uvulopalatopharyngoplasty (UPPP) is a surgery for adults that removes the tonsils, uvula, and part of the soft palate. Tracheostomy is a surgery used rarely and only in severe sleep apnea when no other treatments have been successful. A small hole is made in the windpipe, and a tube is inserted. Air will flow through the tube and into the lungs, bypass ing the obstruction in the upper airway.","Answer the question using only the information given in the context block. Give your answer as a bulleted list. What are the pros and cons of using a CPAP machine? If you have sleep apnea, not enough air can flow into your lungs through your mouth and nose during sleep, even though breathing efforts continue. When this happens, the amount of oxygen in your blood decreases. Your brain responds by awakening you enough to tighten the upper airway muscles and open your windpipe. Normal breaths then start again, often with a loud snort or choking sound. Although people who have sleep apnea typically snore loudly and frequently, not everyone who snores has sleep apnea. Because people who have sleep apnea frequently go from deeper sleep to lighter sleep during the night, they rarely spend enough time in deep, restorative stages of sleep. They are therefore often excessively sleepy during the day. Such sleepiness is thought to lead to mood and behavior problems, including depression, and it more than triples the risk of being in a traffic or work-related accident. The many brief drops in blood-oxygen levels that occur during the night can result in morning headaches and trouble concentrating, thinking clearly, learning, and remembering. Additionally, the intermittent oxygen drops and reduced sleep quality together trigger the release of stress hormones. These hormones raise your blood pressure and heart rate and boost the risk of heart attack, stroke, irregular heartbeats, and congestive heart failure. In addition, untreated sleep apnea can lead to changes in energy metabolism (the way your body changes food and oxygen into energy) that increase the risk for developing obesity and diabetes. Anyone can have sleep apnea. It is estimated that at least 12–18 million American adults have sleep apnea, making it as common as asthma. More than one-half of the people who have sleep apnea are overweight. Sleep apnea is more common in men. More than 1 in 25 middle-aged men and 1 in 50 middle-aged women have sleep apnea along with extreme daytime sleepiness. About 3 percent of children and 10 percent or more of people over age 65 have sleep apnea. This condition occurs more frequently in African Americans, Asians, Native Americans, and Hispanics than in Caucasians. More than one-half of all people who have sleep apnea are not diagnosed. People who have sleep apnea generally are not aware that their breathing stops in the night. They just notice that they don’t feel well rested when they wake up and are sleepy throughout the day. Their bed partners are likely to notice, however, that they snore loudly and frequently and that they often stop breathing briefly while sleeping. Doctors suspect sleep apnea if these symptoms are present, but the diagnosis must be confirmed with overnight sleep monitoring. This monitoring will reveal pauses in breathing, frequent sleep arousals (changes from sleep to wakefulness), and intermittent drops in levels of oxygen in the blood. Like adults who have sleep apnea, children who have this disorder usually snore loudly, snort or gasp, and have brief pauses in breath ing while sleeping. Small children often have enlarged tonsils and adenoids that increase their risk for sleep apnea. But doctors may not suspect sleep apnea in children because, instead of showing the typical signs of sleepiness during the day, these children often become agitated and may be considered hyperactive. The effects of sleep apnea in children may include poor school performance and difficult, aggressive behavior. A number of factors can make a person susceptible to sleep apnea. These factors include: Throat muscles and tongue that relax more than normal while asleep Enlarged tonsils and adenoids Being overweight—the excess fat tissue around your neck makes it harder to keep the throat area open Head and neck shape that creates a somewhat smaller airway size in the mouth and throat area Congestion, due to allergies, that also can narrow the airway Family history of sleep apnea If your doctor suspects that you have sleep apnea, you may be referred to a sleep specialist. Some of the ways to help diagnose sleep apnea include: A medical history that includes asking you and your family questions about how you sleep and how you function during the day. Checking your mouth, nose, and throat for extra or large tissues—for example, checking the tonsils, uvula (the tissue that hangs from the middle of the back of the mouth), and soft palate (the roof of your mouth in the back of your throat). An overnight recording of what happens with your breathing during sleep (polysomnogram, or PSG). A multiple sleep latency test (MSLT), usually done in a sleep center, to see how quickly you fall asleep at times when you would normally be awake. (Falling asleep in only a few minutes usually means that you are very sleepy during the day. Being very sleepy during the day can be a sign of sleep apnea. Once all the tests are completed, the sleep specialist will review the results and work with you and your family to develop a treatment plan. Changes in daily activities or habits may help reduce your symptoms: Sleep on your side instead of on your back. Sleeping on your side will help reduce the amount of upper airway collapse during sleep. Avoid alcohol, smoking, sleeping pills, herbal supplements, and any other medications that make you sleepy. They make it harder for your airways to stay open while you sleep, and sedatives can make the breathing pauses longer and more severe. Tobacco smoke irritates the airways and can help trigger the intermittent collapse of the upper airway. Lose weight if you are overweight. Even a little weight loss can sometimes improve symptoms. These changes may be all that are needed to treat mild sleep apnea. However, if you have moderate or severe sleep apnea, you will need additional, more direct treatment approaches. Continuous positive airway pressure (CPAP) is the most effective treatment for sleep apnea in adults. A CPAP machine uses mild air pressure to keep your airways open while you sleep. The machine delivers air to your airways through a specially designed nasal mask. The mask does not breathe for you; the flow of air creates increased pressure to keep the airways in your nose and mouth more open while you sleep. The air pressure is adjusted so that it is just enough to stop your airways from briefly becoming too small during sleep. The pressure is constant and continuous. Sleep apnea will return if CPAP is stopped or if it is used incorrectly. People who have severe sleep apnea symptoms generally feel much better once they begin treatment with CPAP. CPAP treatment can cause side effects in some people. Possible side effects include dry or stuffy nose, irritation of the skin on the face, bloating of the stom ach, sore eyes, or headaches. If you have trouble with CPAP side effects, work with your sleep specialist and support staff. Together, you can do things to reduce or eliminate these problems. Currently, no medications cure sleep apnea. However, some prescription medications may help relieve the excessive sleepiness that sometimes persists even with CPAP treatment of sleep apnea. Another treatment approach that may help some people is the use of a mouthpiece (oral or dental appliance). If you have mild sleep apnea or do not have sleep apnea but snore very loudly, your doctor or dentist also may recommend this. A custom-fitted plastic mouth piece will be made by a dentist or an orthodontist (a specialist in correcting teeth or jaw problems). The mouthpiece will adjust your lower jaw and tongue to help keep the airway in your throat more open while you are sleeping. Air can then flow more easily into your lungs because there is less resistance to breathing. Following up with the dentist or orthodontist is important to correct any side effects and to be sure that your mouthpiece continues to fit properly. It is also important to have a followup sleep study to see whether your sleep apnea has improved. Some people who have sleep apnea may benefit from surgery; this depends on the findings of the evaluation by the sleep specialist. Removing tonsils and adenoids that are blocking the airway is done frequently, especially in children. Uvulopalatopharyngoplasty (UPPP) is a surgery for adults that removes the tonsils, uvula, and part of the soft palate. Tracheostomy is a surgery used rarely and only in severe sleep apnea when no other treatments have been successful. A small hole is made in the windpipe, and a tube is inserted. Air will flow through the tube and into the lungs, bypass ing the obstruction in the upper airway.","Answer the question using only the information given in the context block. Give your answer as a bulleted list.
+
+EVIDENCE:
+If you have sleep apnea, not enough air can flow into your lungs through your mouth and nose during sleep, even though breathing efforts continue. When this happens, the amount of oxygen in your blood decreases. Your brain responds by awakening you enough to tighten the upper airway muscles and open your windpipe. Normal breaths then start again, often with a loud snort or choking sound. Although people who have sleep apnea typically snore loudly and frequently, not everyone who snores has sleep apnea. Because people who have sleep apnea frequently go from deeper sleep to lighter sleep during the night, they rarely spend enough time in deep, restorative stages of sleep. They are therefore often excessively sleepy during the day. Such sleepiness is thought to lead to mood and behavior problems, including depression, and it more than triples the risk of being in a traffic or work-related accident. The many brief drops in blood-oxygen levels that occur during the night can result in morning headaches and trouble concentrating, thinking clearly, learning, and remembering. Additionally, the intermittent oxygen drops and reduced sleep quality together trigger the release of stress hormones. These hormones raise your blood pressure and heart rate and boost the risk of heart attack, stroke, irregular heartbeats, and congestive heart failure. In addition, untreated sleep apnea can lead to changes in energy metabolism (the way your body changes food and oxygen into energy) that increase the risk for developing obesity and diabetes. Anyone can have sleep apnea. It is estimated that at least 12–18 million American adults have sleep apnea, making it as common as asthma. More than one-half of the people who have sleep apnea are overweight. Sleep apnea is more common in men. More than 1 in 25 middle-aged men and 1 in 50 middle-aged women have sleep apnea along with extreme daytime sleepiness. About 3 percent of children and 10 percent or more of people over age 65 have sleep apnea. This condition occurs more frequently in African Americans, Asians, Native Americans, and Hispanics than in Caucasians. More than one-half of all people who have sleep apnea are not diagnosed. People who have sleep apnea generally are not aware that their breathing stops in the night. They just notice that they don’t feel well rested when they wake up and are sleepy throughout the day. Their bed partners are likely to notice, however, that they snore loudly and frequently and that they often stop breathing briefly while sleeping. Doctors suspect sleep apnea if these symptoms are present, but the diagnosis must be confirmed with overnight sleep monitoring. This monitoring will reveal pauses in breathing, frequent sleep arousals (changes from sleep to wakefulness), and intermittent drops in levels of oxygen in the blood. Like adults who have sleep apnea, children who have this disorder usually snore loudly, snort or gasp, and have brief pauses in breath ing while sleeping. Small children often have enlarged tonsils and adenoids that increase their risk for sleep apnea. But doctors may not suspect sleep apnea in children because, instead of showing the typical signs of sleepiness during the day, these children often become agitated and may be considered hyperactive. The effects of sleep apnea in children may include poor school performance and difficult, aggressive behavior. A number of factors can make a person susceptible to sleep apnea. These factors include: Throat muscles and tongue that relax more than normal while asleep Enlarged tonsils and adenoids Being overweight—the excess fat tissue around your neck makes it harder to keep the throat area open Head and neck shape that creates a somewhat smaller airway size in the mouth and throat area Congestion, due to allergies, that also can narrow the airway Family history of sleep apnea If your doctor suspects that you have sleep apnea, you may be referred to a sleep specialist. Some of the ways to help diagnose sleep apnea include: A medical history that includes asking you and your family questions about how you sleep and how you function during the day. Checking your mouth, nose, and throat for extra or large tissues—for example, checking the tonsils, uvula (the tissue that hangs from the middle of the back of the mouth), and soft palate (the roof of your mouth in the back of your throat). An overnight recording of what happens with your breathing during sleep (polysomnogram, or PSG). A multiple sleep latency test (MSLT), usually done in a sleep center, to see how quickly you fall asleep at times when you would normally be awake. (Falling asleep in only a few minutes usually means that you are very sleepy during the day. Being very sleepy during the day can be a sign of sleep apnea. Once all the tests are completed, the sleep specialist will review the results and work with you and your family to develop a treatment plan. Changes in daily activities or habits may help reduce your symptoms: Sleep on your side instead of on your back. Sleeping on your side will help reduce the amount of upper airway collapse during sleep. Avoid alcohol, smoking, sleeping pills, herbal supplements, and any other medications that make you sleepy. They make it harder for your airways to stay open while you sleep, and sedatives can make the breathing pauses longer and more severe. Tobacco smoke irritates the airways and can help trigger the intermittent collapse of the upper airway. Lose weight if you are overweight. Even a little weight loss can sometimes improve symptoms. These changes may be all that are needed to treat mild sleep apnea. However, if you have moderate or severe sleep apnea, you will need additional, more direct treatment approaches. Continuous positive airway pressure (CPAP) is the most effective treatment for sleep apnea in adults. A CPAP machine uses mild air pressure to keep your airways open while you sleep. The machine delivers air to your airways through a specially designed nasal mask. The mask does not breathe for you; the flow of air creates increased pressure to keep the airways in your nose and mouth more open while you sleep. The air pressure is adjusted so that it is just enough to stop your airways from briefly becoming too small during sleep. The pressure is constant and continuous. Sleep apnea will return if CPAP is stopped or if it is used incorrectly. People who have severe sleep apnea symptoms generally feel much better once they begin treatment with CPAP. CPAP treatment can cause side effects in some people. Possible side effects include dry or stuffy nose, irritation of the skin on the face, bloating of the stom ach, sore eyes, or headaches. If you have trouble with CPAP side effects, work with your sleep specialist and support staff. Together, you can do things to reduce or eliminate these problems. Currently, no medications cure sleep apnea. However, some prescription medications may help relieve the excessive sleepiness that sometimes persists even with CPAP treatment of sleep apnea. Another treatment approach that may help some people is the use of a mouthpiece (oral or dental appliance). If you have mild sleep apnea or do not have sleep apnea but snore very loudly, your doctor or dentist also may recommend this. A custom-fitted plastic mouth piece will be made by a dentist or an orthodontist (a specialist in correcting teeth or jaw problems). The mouthpiece will adjust your lower jaw and tongue to help keep the airway in your throat more open while you are sleeping. Air can then flow more easily into your lungs because there is less resistance to breathing. Following up with the dentist or orthodontist is important to correct any side effects and to be sure that your mouthpiece continues to fit properly. It is also important to have a followup sleep study to see whether your sleep apnea has improved. Some people who have sleep apnea may benefit from surgery; this depends on the findings of the evaluation by the sleep specialist. Removing tonsils and adenoids that are blocking the airway is done frequently, especially in children. Uvulopalatopharyngoplasty (UPPP) is a surgery for adults that removes the tonsils, uvula, and part of the soft palate. Tracheostomy is a surgery used rarely and only in severe sleep apnea when no other treatments have been successful. A small hole is made in the windpipe, and a tube is inserted. Air will flow through the tube and into the lungs, bypass ing the obstruction in the upper airway.
+
+USER:
+What are the pros and cons of using a CPAP machine?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,19,11,1414,,98
+"{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]","What does author and professor Vauhini Vara have to say about the role of artificial intelligence and literature? Is it a positive perspective? If so, what is her argument?","If artificial intelligence (AI) continues to evolve and becomes capable of producing first-rate literature, will the technology eventually replace human writers? Author, journalist and professor Vauhini Vara addressed the topic during a recent lecture at The Ohio State University’s Columbus campus. Vara spoke on Dec. 7 at Pomerene Hall as part of Ohio State’s “ART-ificial: An Intelligence Co-Lab” project, which is funded by the university’s Artificial Intelligence in the Arts, Humanities and Engineering: Interdisciplinary Collaborations program. The project included a speaker series throughout the spring and autumn semesters that was organized by Elissa Washuta, an associate professor in the Department of English, and Austen Osworth, a lecturer in the School of Creative Writing at the University of British Columbia. “I think we need to talk at length about what these tools are for and what they’re not for and what they can do and what they can’t do and what writing is for,” Washuta said. “A lot of these things are not immediately apparent to students who are learning about writing for the first time in college. They’re having their first encounters with writing studies in college in composition classes.” In her presentation titled “If Computers Can Write, Why Should We?” Vara discussed her relationship with AI as a writing tool. She has written for The New York Times Magazine and Wired, among other publications. She also teaches at Colorado State University as a 2023-24 visiting assistant professor of creative writing. “In the years ahead, scientists are definitely going to work to make AI better and better and better at producing language in the form of literature,” Vara said. “I have no doubt that writers will, like I did, find it interesting and even moving to experiment with AI in their own work.” Vara is the author of “This is Salvaged,” which was named one of the best books of 2023 by Publisher’s Weekly, and “The Immortal King Rao” (2022), which was a finalist for the Pulitzer Prize and was shortlisted for the National Book Critics Circle’s John Leonard Prize and the Dayton Literary Peace Prize. “The Immortal King Rao,” Vara’s debut novel, imagines a future in which those in power deploy AI to remake all aspects of society — criminal justice, education, communication. AI also figured prominently in Vara’s essay “Ghosts,” about her grief over her older sister’s death. She used GPT-3, an AI technology that evolved into ChatGPT, as a writing tool while composing the essay. “Ghosts” went viral upon its publication in The Believer Magazine in 2021. The essay was adapted for an episode of National Public Radio’s “This American Life” and anthologized in “Best American Essays 2022.” “It was more well-received by far than anything else I’d written at that point. And I thought I should feel proud of that to an extent, and I sort of did,” Vara said. “But I was also ambivalent because even though GPT-3 didn’t share the byline with me, I felt like on an artistic level, I could only take partial credit for the piece.” In addition to casting doubt on writers’ originality, AI may replicate the blind spots of the humans who program the technology, Vara said. “The companies behind AI models were training these models by feeding them existing texts … everything from internet message boards to Wikipedia to published books written by human authors,” she said. “The trainings have been used without the consent of the people who’ve written [the published texts]. It was also becoming clear that the models’ outputs … reflected biases, including racial and gender stereotypes.” Though her experiment with AI resulted in a well-received essay, Vara said she has since returned to writing without technological assistance. However, she continues to explore the potential consequences of AI. “I think it’s important to keep in mind that the publishing industry has an incentive to pursue AI-based writing in some form, being that it will almost certainly be cheaper than hiring human writers or paying human writers to produce literature,” she said. “I do hope that as much as that’s all true, we stay aware as readers, as a society, of what it would mean to cede ground to computers entirely in a form that has traditionally been meant for humans to convey what it’s like to be human living in the world to other humans.” Discussions are underway to continue the “ART-ificial: An Intelligence Co-Lab” project next year, Washuta said. “We’re hoping to see if we can continue our work together,” she said. “I think everybody who’s been involved in the planning and who’s presented has been really energized by the conversations that we’ve had.”","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== What does author and professor Vauhini Vara have to say about the role of artificial intelligence and literature? Is it a positive perspective? If so, what is her argument? {passage 0} ========== If artificial intelligence (AI) continues to evolve and becomes capable of producing first-rate literature, will the technology eventually replace human writers? Author, journalist and professor Vauhini Vara addressed the topic during a recent lecture at The Ohio State University’s Columbus campus. Vara spoke on Dec. 7 at Pomerene Hall as part of Ohio State’s “ART-ificial: An Intelligence Co-Lab” project, which is funded by the university’s Artificial Intelligence in the Arts, Humanities and Engineering: Interdisciplinary Collaborations program. The project included a speaker series throughout the spring and autumn semesters that was organized by Elissa Washuta, an associate professor in the Department of English, and Austen Osworth, a lecturer in the School of Creative Writing at the University of British Columbia. “I think we need to talk at length about what these tools are for and what they’re not for and what they can do and what they can’t do and what writing is for,” Washuta said. “A lot of these things are not immediately apparent to students who are learning about writing for the first time in college. They’re having their first encounters with writing studies in college in composition classes.” In her presentation titled “If Computers Can Write, Why Should We?” Vara discussed her relationship with AI as a writing tool. She has written for The New York Times Magazine and Wired, among other publications. She also teaches at Colorado State University as a 2023-24 visiting assistant professor of creative writing. “In the years ahead, scientists are definitely going to work to make AI better and better and better at producing language in the form of literature,” Vara said. “I have no doubt that writers will, like I did, find it interesting and even moving to experiment with AI in their own work.” Vara is the author of “This is Salvaged,” which was named one of the best books of 2023 by Publisher’s Weekly, and “The Immortal King Rao” (2022), which was a finalist for the Pulitzer Prize and was shortlisted for the National Book Critics Circle’s John Leonard Prize and the Dayton Literary Peace Prize. “The Immortal King Rao,” Vara’s debut novel, imagines a future in which those in power deploy AI to remake all aspects of society — criminal justice, education, communication. AI also figured prominently in Vara’s essay “Ghosts,” about her grief over her older sister’s death. She used GPT-3, an AI technology that evolved into ChatGPT, as a writing tool while composing the essay. “Ghosts” went viral upon its publication in The Believer Magazine in 2021. The essay was adapted for an episode of National Public Radio’s “This American Life” and anthologized in “Best American Essays 2022.” “It was more well-received by far than anything else I’d written at that point. And I thought I should feel proud of that to an extent, and I sort of did,” Vara said. “But I was also ambivalent because even though GPT-3 didn’t share the byline with me, I felt like on an artistic level, I could only take partial credit for the piece.” In addition to casting doubt on writers’ originality, AI may replicate the blind spots of the humans who program the technology, Vara said. “The companies behind AI models were training these models by feeding them existing texts … everything from internet message boards to Wikipedia to published books written by human authors,” she said. “The trainings have been used without the consent of the people who’ve written [the published texts]. It was also becoming clear that the models’ outputs … reflected biases, including racial and gender stereotypes.” Though her experiment with AI resulted in a well-received essay, Vara said she has since returned to writing without technological assistance. However, she continues to explore the potential consequences of AI. “I think it’s important to keep in mind that the publishing industry has an incentive to pursue AI-based writing in some form, being that it will almost certainly be cheaper than hiring human writers or paying human writers to produce literature,” she said. “I do hope that as much as that’s all true, we stay aware as readers, as a society, of what it would mean to cede ground to computers entirely in a form that has traditionally been meant for humans to convey what it’s like to be human living in the world to other humans.” Discussions are underway to continue the “ART-ificial: An Intelligence Co-Lab” project next year, Washuta said. “We’re hoping to see if we can continue our work together,” she said. “I think everybody who’s been involved in the planning and who’s presented has been really energized by the conversations that we’ve had.” https://english.osu.edu/alumni-newsletter/winter-2024/role-ai-literature","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]
+
+EVIDENCE:
+If artificial intelligence (AI) continues to evolve and becomes capable of producing first-rate literature, will the technology eventually replace human writers? Author, journalist and professor Vauhini Vara addressed the topic during a recent lecture at The Ohio State University’s Columbus campus. Vara spoke on Dec. 7 at Pomerene Hall as part of Ohio State’s “ART-ificial: An Intelligence Co-Lab” project, which is funded by the university’s Artificial Intelligence in the Arts, Humanities and Engineering: Interdisciplinary Collaborations program. The project included a speaker series throughout the spring and autumn semesters that was organized by Elissa Washuta, an associate professor in the Department of English, and Austen Osworth, a lecturer in the School of Creative Writing at the University of British Columbia. “I think we need to talk at length about what these tools are for and what they’re not for and what they can do and what they can’t do and what writing is for,” Washuta said. “A lot of these things are not immediately apparent to students who are learning about writing for the first time in college. They’re having their first encounters with writing studies in college in composition classes.” In her presentation titled “If Computers Can Write, Why Should We?” Vara discussed her relationship with AI as a writing tool. She has written for The New York Times Magazine and Wired, among other publications. She also teaches at Colorado State University as a 2023-24 visiting assistant professor of creative writing. “In the years ahead, scientists are definitely going to work to make AI better and better and better at producing language in the form of literature,” Vara said. “I have no doubt that writers will, like I did, find it interesting and even moving to experiment with AI in their own work.” Vara is the author of “This is Salvaged,” which was named one of the best books of 2023 by Publisher’s Weekly, and “The Immortal King Rao” (2022), which was a finalist for the Pulitzer Prize and was shortlisted for the National Book Critics Circle’s John Leonard Prize and the Dayton Literary Peace Prize. “The Immortal King Rao,” Vara’s debut novel, imagines a future in which those in power deploy AI to remake all aspects of society — criminal justice, education, communication. AI also figured prominently in Vara’s essay “Ghosts,” about her grief over her older sister’s death. She used GPT-3, an AI technology that evolved into ChatGPT, as a writing tool while composing the essay. “Ghosts” went viral upon its publication in The Believer Magazine in 2021. The essay was adapted for an episode of National Public Radio’s “This American Life” and anthologized in “Best American Essays 2022.” “It was more well-received by far than anything else I’d written at that point. And I thought I should feel proud of that to an extent, and I sort of did,” Vara said. “But I was also ambivalent because even though GPT-3 didn’t share the byline with me, I felt like on an artistic level, I could only take partial credit for the piece.” In addition to casting doubt on writers’ originality, AI may replicate the blind spots of the humans who program the technology, Vara said. “The companies behind AI models were training these models by feeding them existing texts … everything from internet message boards to Wikipedia to published books written by human authors,” she said. “The trainings have been used without the consent of the people who’ve written [the published texts]. It was also becoming clear that the models’ outputs … reflected biases, including racial and gender stereotypes.” Though her experiment with AI resulted in a well-received essay, Vara said she has since returned to writing without technological assistance. However, she continues to explore the potential consequences of AI. “I think it’s important to keep in mind that the publishing industry has an incentive to pursue AI-based writing in some form, being that it will almost certainly be cheaper than hiring human writers or paying human writers to produce literature,” she said. “I do hope that as much as that’s all true, we stay aware as readers, as a society, of what it would mean to cede ground to computers entirely in a form that has traditionally been meant for humans to convey what it’s like to be human living in the world to other humans.” Discussions are underway to continue the “ART-ificial: An Intelligence Co-Lab” project next year, Washuta said. “We’re hoping to see if we can continue our work together,” she said. “I think everybody who’s been involved in the planning and who’s presented has been really energized by the conversations that we’ve had.”
+
+USER:
+What does author and professor Vauhini Vara have to say about the role of artificial intelligence and literature? Is it a positive perspective? If so, what is her argument?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,26,29,770,,556
+Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document],I would like to know about the idea of holistic healthcare within business. How does holistic healthcare affect businesses and employees? What are the health benefits?,"Holistic healthcare recognises the connection and balance between physical, mental, and spiritual wellbeing. Rather than concentrating on episodic care, it looks at the interaction between different conditions and wellbeing factors to treat a whole person. It aims to prevent, as well as treat, health issues. Ten years ago, NHS England, along with other national partners, signed up to a series of commitments to support integrated care. The purpose included: improve outcomes in population health and healthcare tackle inequalities in outcomes, experience and access enhance productivity and value for money Today this same challenge and opportunity is set for employers. Eighty seven percent of employees expect their employer to support them in balancing work and personal commitments. Yet nearly one in five employers aren't doing anything to improve employee health and wellbeing. There are significant benefits to proactively addressing workforce wellbeing. And the most valuable approach is a holistic one. Let’s explore why. For senior HR leaders, taking a holistic approach to wellbeing comes with a variety of advantages. According to the CIPD’s Health and wellbeing at work 2022 report: 48 percent of HR leaders agree their organisation’s employee health and wellbeing strategy has created a healthier and more inclusive culture. 46 percent agree that it has created better employee morale and engagement. 33 percent agree that it has created more effective working relationships. 27 percent agree that it has improved productivity. Over the next decade, there will be 3.7 million more workers aged between 50 and the state pension age. At the same time, Generations Z and Alpha are establishing their place in the workforce. A holistic approach to health is an excellent way to support an inclusive workplace. There's no ‘one-size-fits-all’ when it comes to health. What it means to ‘live well’ looks different for different people. So, you need to find a way to cater to every individual's unique needs. Currently, only half of all organisations take a strategic approach to employee wellbeing. Over a third remain reactive to employee needs. For you to stand out, you need to actively listen to every employee and find ways to serve their needs. And having done so, you then need to find wellbeing solutions that cater to those requirements. The bottom line? Develop a wellness strategy that has the flexibility to meet myriad needs and you will start to see tangible benefits. The connection between mind and body is indisputable. Many studies show that physical wellness is directly influenced by mental wellness, and vice versa. In fact, having a serious mental illness can reduce your life expectancy by 10 to 20 years due to the impact it has across your body. This includes increased risk of heart disease, as well as a possible increase in your risk of cancer. In the workplace, mental health concerns are the top cause of long-term employee absences at work. What's more, psychological conditions like severe anxiety and depression impact creativity and productivity. 79 percent of UK adults feel stressed at least once per month. And approximately two in three employees believe work is a significant source of stress. As an HR leader, it’s imperative you understand and advocate for mind-body wellness at work. Find creative ways to promote holistic health strategies and offer teams the relevant support to ensure they bring their best selves to work. 33 percent of workers report that workplace stress decreases productivity. It’s therefore critical that you find ways to address it. What’s more, happier employees are approximately 12 percent more productive. Holistic health is important because it acts as a core enabler of employee happiness and productivity. There is an indisputable connection between good health and wellbeing and a reduction in stress. And unsurprisingly, reducing stress boosts happiness, which in turn increases productivity. In addition to employee happiness is employee health. In the UK, musculoskeletal (MSK) conditions affect 1 in 4 of the adult population. A large proportion of these conditions affect young working people who experience daily symptoms including pain, stiffness, and limited movement. Taking a holistic approach to health helps employees better manage not only the symptoms that arise from conditions like MSK, but also the root causes. These often include repetitive daily motion, inactivity, and overwork. Plus, it helps them manage the emotional burden that comes with chronic pain. Presenteeism can cost your company £4,000 in lost business per employee, each year. Despite this, only 30 percent of HR leaders report their organisation has taken steps to tackle it. You can reduce instances of presenteeism and leavism with a holistic wellbeing strategy. This ensures employees take the time they need to recover and return to work stronger than ever. It also allows them to then maintain their wellbeing while at work. This reduces the risk of relapse and increases focus and productivity. Stressed employees are more than three times as likely to seek employment elsewhere compared to their less-stressed co-workers. To reduce the risk of turnover, ensure managers offer regular check-ins with employees. This helps you monitor employee wellbeing and mitigate any impending departures. Your commitment to the health of your workforce goes a long way in creating trust and respect. In turn, this generates engagement and builds loyalty. A holistic healthcare strategy balances physical, emotional, and mental wellbeing. In turn, this encourages employees to take care of their entire selves. And in return, your employees will bring their entire selves into the workplace. Our wellbeing platform offers employees the opportunity to receive personalised wellbeing advice within a single, streamlined solution. It equips employees with everything they need to take care of their whole health. This includes regular check-ins and engaging self-guided programmes. It also includes personalised chatbots, and access to specialist follow-up care when needed.","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. I would like to know about the idea of holistic healthcare within business. How does holistic healthcare affect businesses and employees? What are the health benefits? Holistic healthcare recognises the connection and balance between physical, mental, and spiritual wellbeing. Rather than concentrating on episodic care, it looks at the interaction between different conditions and wellbeing factors to treat a whole person. It aims to prevent, as well as treat, health issues. Ten years ago, NHS England, along with other national partners, signed up to a series of commitments to support integrated care. The purpose included: improve outcomes in population health and healthcare tackle inequalities in outcomes, experience and access enhance productivity and value for money Today this same challenge and opportunity is set for employers. Eighty seven percent of employees expect their employer to support them in balancing work and personal commitments. Yet nearly one in five employers aren't doing anything to improve employee health and wellbeing. There are significant benefits to proactively addressing workforce wellbeing. And the most valuable approach is a holistic one. Let’s explore why. For senior HR leaders, taking a holistic approach to wellbeing comes with a variety of advantages. According to the CIPD’s Health and wellbeing at work 2022 report: 48 percent of HR leaders agree their organisation’s employee health and wellbeing strategy has created a healthier and more inclusive culture. 46 percent agree that it has created better employee morale and engagement. 33 percent agree that it has created more effective working relationships. 27 percent agree that it has improved productivity. Over the next decade, there will be 3.7 million more workers aged between 50 and the state pension age. At the same time, Generations Z and Alpha are establishing their place in the workforce. A holistic approach to health is an excellent way to support an inclusive workplace. There's no ‘one-size-fits-all’ when it comes to health. What it means to ‘live well’ looks different for different people. So, you need to find a way to cater to every individual's unique needs. Currently, only half of all organisations take a strategic approach to employee wellbeing. Over a third remain reactive to employee needs. For you to stand out, you need to actively listen to every employee and find ways to serve their needs. And having done so, you then need to find wellbeing solutions that cater to those requirements. The bottom line? Develop a wellness strategy that has the flexibility to meet myriad needs and you will start to see tangible benefits. The connection between mind and body is indisputable. Many studies show that physical wellness is directly influenced by mental wellness, and vice versa. In fact, having a serious mental illness can reduce your life expectancy by 10 to 20 years due to the impact it has across your body. This includes increased risk of heart disease, as well as a possible increase in your risk of cancer. In the workplace, mental health concerns are the top cause of long-term employee absences at work. What's more, psychological conditions like severe anxiety and depression impact creativity and productivity. 79 percent of UK adults feel stressed at least once per month. And approximately two in three employees believe work is a significant source of stress. As an HR leader, it’s imperative you understand and advocate for mind-body wellness at work. Find creative ways to promote holistic health strategies and offer teams the relevant support to ensure they bring their best selves to work. 33 percent of workers report that workplace stress decreases productivity. It’s therefore critical that you find ways to address it. What’s more, happier employees are approximately 12 percent more productive. Holistic health is important because it acts as a core enabler of employee happiness and productivity. There is an indisputable connection between good health and wellbeing and a reduction in stress. And unsurprisingly, reducing stress boosts happiness, which in turn increases productivity. In addition to employee happiness is employee health. In the UK, musculoskeletal (MSK) conditions affect 1 in 4 of the adult population. A large proportion of these conditions affect young working people who experience daily symptoms including pain, stiffness, and limited movement. Taking a holistic approach to health helps employees better manage not only the symptoms that arise from conditions like MSK, but also the root causes. These often include repetitive daily motion, inactivity, and overwork. Plus, it helps them manage the emotional burden that comes with chronic pain. Presenteeism can cost your company £4,000 in lost business per employee, each year. Despite this, only 30 percent of HR leaders report their organisation has taken steps to tackle it. You can reduce instances of presenteeism and leavism with a holistic wellbeing strategy. This ensures employees take the time they need to recover and return to work stronger than ever. It also allows them to then maintain their wellbeing while at work. This reduces the risk of relapse and increases focus and productivity. Stressed employees are more than three times as likely to seek employment elsewhere compared to their less-stressed co-workers. To reduce the risk of turnover, ensure managers offer regular check-ins with employees. This helps you monitor employee wellbeing and mitigate any impending departures. Your commitment to the health of your workforce goes a long way in creating trust and respect. In turn, this generates engagement and builds loyalty. A holistic healthcare strategy balances physical, emotional, and mental wellbeing. In turn, this encourages employees to take care of their entire selves. And in return, your employees will bring their entire selves into the workplace. Our wellbeing platform offers employees the opportunity to receive personalised wellbeing advice within a single, streamlined solution. It equips employees with everything they need to take care of their whole health. This includes regular check-ins and engaging self-guided programmes. It also includes personalised chatbots, and access to specialist follow-up care when needed. https://www.healthhero.com/blog/what-is-holistic-healthcare-and-why-is-it-important","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]
+
+EVIDENCE:
+Holistic healthcare recognises the connection and balance between physical, mental, and spiritual wellbeing. Rather than concentrating on episodic care, it looks at the interaction between different conditions and wellbeing factors to treat a whole person. It aims to prevent, as well as treat, health issues. Ten years ago, NHS England, along with other national partners, signed up to a series of commitments to support integrated care. The purpose included: improve outcomes in population health and healthcare tackle inequalities in outcomes, experience and access enhance productivity and value for money Today this same challenge and opportunity is set for employers. Eighty seven percent of employees expect their employer to support them in balancing work and personal commitments. Yet nearly one in five employers aren't doing anything to improve employee health and wellbeing. There are significant benefits to proactively addressing workforce wellbeing. And the most valuable approach is a holistic one. Let’s explore why. For senior HR leaders, taking a holistic approach to wellbeing comes with a variety of advantages. According to the CIPD’s Health and wellbeing at work 2022 report: 48 percent of HR leaders agree their organisation’s employee health and wellbeing strategy has created a healthier and more inclusive culture. 46 percent agree that it has created better employee morale and engagement. 33 percent agree that it has created more effective working relationships. 27 percent agree that it has improved productivity. Over the next decade, there will be 3.7 million more workers aged between 50 and the state pension age. At the same time, Generations Z and Alpha are establishing their place in the workforce. A holistic approach to health is an excellent way to support an inclusive workplace. There's no ‘one-size-fits-all’ when it comes to health. What it means to ‘live well’ looks different for different people. So, you need to find a way to cater to every individual's unique needs. Currently, only half of all organisations take a strategic approach to employee wellbeing. Over a third remain reactive to employee needs. For you to stand out, you need to actively listen to every employee and find ways to serve their needs. And having done so, you then need to find wellbeing solutions that cater to those requirements. The bottom line? Develop a wellness strategy that has the flexibility to meet myriad needs and you will start to see tangible benefits. The connection between mind and body is indisputable. Many studies show that physical wellness is directly influenced by mental wellness, and vice versa. In fact, having a serious mental illness can reduce your life expectancy by 10 to 20 years due to the impact it has across your body. This includes increased risk of heart disease, as well as a possible increase in your risk of cancer. In the workplace, mental health concerns are the top cause of long-term employee absences at work. What's more, psychological conditions like severe anxiety and depression impact creativity and productivity. 79 percent of UK adults feel stressed at least once per month. And approximately two in three employees believe work is a significant source of stress. As an HR leader, it’s imperative you understand and advocate for mind-body wellness at work. Find creative ways to promote holistic health strategies and offer teams the relevant support to ensure they bring their best selves to work. 33 percent of workers report that workplace stress decreases productivity. It’s therefore critical that you find ways to address it. What’s more, happier employees are approximately 12 percent more productive. Holistic health is important because it acts as a core enabler of employee happiness and productivity. There is an indisputable connection between good health and wellbeing and a reduction in stress. And unsurprisingly, reducing stress boosts happiness, which in turn increases productivity. In addition to employee happiness is employee health. In the UK, musculoskeletal (MSK) conditions affect 1 in 4 of the adult population. A large proportion of these conditions affect young working people who experience daily symptoms including pain, stiffness, and limited movement. Taking a holistic approach to health helps employees better manage not only the symptoms that arise from conditions like MSK, but also the root causes. These often include repetitive daily motion, inactivity, and overwork. Plus, it helps them manage the emotional burden that comes with chronic pain. Presenteeism can cost your company £4,000 in lost business per employee, each year. Despite this, only 30 percent of HR leaders report their organisation has taken steps to tackle it. You can reduce instances of presenteeism and leavism with a holistic wellbeing strategy. This ensures employees take the time they need to recover and return to work stronger than ever. It also allows them to then maintain their wellbeing while at work. This reduces the risk of relapse and increases focus and productivity. Stressed employees are more than three times as likely to seek employment elsewhere compared to their less-stressed co-workers. To reduce the risk of turnover, ensure managers offer regular check-ins with employees. This helps you monitor employee wellbeing and mitigate any impending departures. Your commitment to the health of your workforce goes a long way in creating trust and respect. In turn, this generates engagement and builds loyalty. A holistic healthcare strategy balances physical, emotional, and mental wellbeing. In turn, this encourages employees to take care of their entire selves. And in return, your employees will bring their entire selves into the workplace. Our wellbeing platform offers employees the opportunity to receive personalised wellbeing advice within a single, streamlined solution. It equips employees with everything they need to take care of their whole health. This includes regular check-ins and engaging self-guided programmes. It also includes personalised chatbots, and access to specialist follow-up care when needed.
+
+USER:
+I would like to know about the idea of holistic healthcare within business. How does holistic healthcare affect businesses and employees? What are the health benefits?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,24,26,950,,225
+Only use the provided context when answering this task and format your response in bullet points with and follow each with an explanation,What industries will be created or accelerated by robotic ecosystems?,"IMPACT ON WORKFORCE While automation will cause significant changes in the composition of employment, it will not cause mass unemployment. Quite the contrary, displaced workers will fill new higher-value-add jobs, and the labor force is likely to increase. The positive impact associated with the retraining of soldiers after World War II8 is quite instructive. The economy assimilated returning soldiers surprisingly well, boosting productivity significantly. Though, as automation accelerates job turnover, the cost of friction in the labor market, which currently stands at more than $630B per annum is expected to grow. These frictions present tremendous opportunity for companies that help firms reduce time-to-hire, provide workers with new skill-sets, and train new employees more efficiently. In the United States today, 5.4 million jobs are unfilled because of skillset mismatches, as shown below. ARK’s research indicates that recruiting and training account for over 2/3 the cost of friction in the labor market. The opportunity for recruiting and retraining has never been better. Some companies already are responding. In 2013, corporate spending on training increased by 15%, to $70 billion and then increased another 10% in 2014.9 Companies such as Cornerstone on Demand (CSOD), Manpower (MAN), Robert Half (RHI), DeVry (DV), Adecco (AHEXY), and LinkedIn (LNKD), which acquired Lynda.com, offer career skill-building programs, and should benefit significantly as automation permeates more industries. The productivity associated with automation will have a profound impact on economic growth. According to ARK’s research, real GDP per worker in the US will double from $113,000 in 2013 to $236,000 in 2035, or at an annual rate of 3.4%. Without automation, productivity would increase at roughly half that rate, or 1.8%, limiting real GDP per worker to $167,000, as shown below. As automation proliferates, the growth of real GDP per worker will accelerate from 2.2% during the next ten years, to roughly 5% between 2025 and 2035. By 2035, real GDP will be 42% higher with automation than without it, as shown below. It will reach roughly $40 trillion, or nearly $12 trillion above the $28 trillion that would otherwise be the case. Clearly, the extra $12 trillion in extra GDP will bring with it many more new jobs. Robotics ecosystems will create new industries and accelerate their growth. Companies already pioneering this movement include Google (GOOG) and Tesla (TSLA) in the autonomous vehicle market, as well as AeroVironment (AVAV), Amazon (AMZN) and Elbit Systems (ESLT) in the drone space. Service robots are in their infancy, but could undergo explosive growth. Early examples include vacuum and lawnmower robots manufactured by iRobot (IRBT), medical robots by Intuitive Surgical (ISRG), and industrial robots by KUKA (KUKAY). Even more embryonic are ReWalk’s10 (RWLK) robot exoskeletons enabling paraplegics to walk.11 Other companies benefitting from these trends manufacture sensors, microcontrollers, cameras, batteries, computerized numerical controls, and materials required for production. Cognex (CGNX), Ambarella (AMBA), Panasonic (PCRFY), Fanuc (FANUY), and Rockwell Automation (ROK) will be prime beneficiaries. Automation will permeate every sector of the economy, with accommodation and food services, agriculture, and retail trade garnering the biggest boosts to productivity. By 2035, GDP per worker will increase by 58% in the accommodation and food services sector, 55% in agriculture, and 53% in retail trade, as depicted below. Spending on automation is poised to soar orders of magnitude above current investment levels. Cumulatively, it will increase by roughly $3.8 trillion through 2035. As artificial intelligence solves increasingly complex problems, the return on investment from “smarter” robots, drones, and automation will drive adoption. Between 2015 and 2035, annual investment in automation could increase at a 16.5% annual growth rate from $11 billion to $242 billion, as illustrated below. During the next decade it should compound at a 33% annual rate. Given the declining cost curves in technology, unit growth rates could be even higher. Several sectors will spend disproportionately on automation to boost productivity. In 2035, manufacturing will account for the largest percentage, 13% of the total, or $31 billion. Spearheaded by companies like Amazon (AMZN), the retail sector will spend roughly $26 billion, or 11% of the total investment. In 2014, Amazon boosted the number of Kiva robots in its global distribution centers from 1,000 to 15,000, a fifteen fold increase in one year, and then doubled its Kiva install base to 30,000 in 2015. Game on! Closely related to retail, the accommodation and food services category is set to spend $24 billion as shown in figure 9.","What industries will be created or accelerated by robotic ecosystems? Only use the provided context when answering this task and format your response in bullet points with and follow each with an explanation. IMPACT ON WORKFORCE While automation will cause significant changes in the composition of employment, it will not cause mass unemployment. Quite the contrary, displaced workers will fill new higher-value-add jobs, and the labor force is likely to increase. The positive impact associated with the retraining of soldiers after World War II8 is quite instructive. The economy assimilated returning soldiers surprisingly well, boosting productivity significantly. Though, as automation accelerates job turnover, the cost of friction in the labor market, which currently stands at more than $630B per annum is expected to grow. These frictions present tremendous opportunity for companies that help firms reduce time-to-hire, provide workers with new skill-sets, and train new employees more efficiently. In the United States today, 5.4 million jobs are unfilled because of skillset mismatches, as shown below. ARK’s research indicates that recruiting and training account for over 2/3 the cost of friction in the labor market. The opportunity for recruiting and retraining has never been better. Some companies already are responding. In 2013, corporate spending on training increased by 15%, to $70 billion and then increased another 10% in 2014.9 Companies such as Cornerstone on Demand (CSOD), Manpower (MAN), Robert Half (RHI), DeVry (DV), Adecco (AHEXY), and LinkedIn (LNKD), which acquired Lynda.com, offer career skill-building programs, and should benefit significantly as automation permeates more industries. The productivity associated with automation will have a profound impact on economic growth. According to ARK’s research, real GDP per worker in the US will double from $113,000 in 2013 to $236,000 in 2035, or at an annual rate of 3.4%. Without automation, productivity would increase at roughly half that rate, or 1.8%, limiting real GDP per worker to $167,000, as shown below. As automation proliferates, the growth of real GDP per worker will accelerate from 2.2% during the next ten years, to roughly 5% between 2025 and 2035. By 2035, real GDP will be 42% higher with automation than without it, as shown below. It will reach roughly $40 trillion, or nearly $12 trillion above the $28 trillion that would otherwise be the case. Clearly, the extra $12 trillion in extra GDP will bring with it many more new jobs. Robotics ecosystems will create new industries and accelerate their growth. Companies already pioneering this movement include Google (GOOG) and Tesla (TSLA) in the autonomous vehicle market, as well as AeroVironment (AVAV), Amazon (AMZN) and Elbit Systems (ESLT) in the drone space. Service robots are in their infancy, but could undergo explosive growth. Early examples include vacuum and lawnmower robots manufactured by iRobot (IRBT), medical robots by Intuitive Surgical (ISRG), and industrial robots by KUKA (KUKAY). Even more embryonic are ReWalk’s10 (RWLK) robot exoskeletons enabling paraplegics to walk.11 Other companies benefitting from these trends manufacture sensors, microcontrollers, cameras, batteries, computerized numerical controls, and materials required for production. Cognex (CGNX), Ambarella (AMBA), Panasonic (PCRFY), Fanuc (FANUY), and Rockwell Automation (ROK) will be prime beneficiaries. Automation will permeate every sector of the economy, with accommodation and food services, agriculture, and retail trade garnering the biggest boosts to productivity. By 2035, GDP per worker will increase by 58% in the accommodation and food services sector, 55% in agriculture, and 53% in retail trade, as depicted below. Spending on automation is poised to soar orders of magnitude above current investment levels. Cumulatively, it will increase by roughly $3.8 trillion through 2035. As artificial intelligence solves increasingly complex problems, the return on investment from “smarter” robots, drones, and automation will drive adoption. Between 2015 and 2035, annual investment in automation could increase at a 16.5% annual growth rate from $11 billion to $242 billion, as illustrated below. During the next decade it should compound at a 33% annual rate. Given the declining cost curves in technology, unit growth rates could be even higher. Several sectors will spend disproportionately on automation to boost productivity. In 2035, manufacturing will account for the largest percentage, 13% of the total, or $31 billion. Spearheaded by companies like Amazon (AMZN), the retail sector will spend roughly $26 billion, or 11% of the total investment. In 2014, Amazon boosted the number of Kiva robots in its global distribution centers from 1,000 to 15,000, a fifteen fold increase in one year, and then doubled its Kiva install base to 30,000 in 2015. Game on! Closely related to retail, the accommodation and food services category is set to spend $24 billion as shown in figure 9.","Only use the provided context when answering this task and format your response in bullet points with and follow each with an explanation
+
+EVIDENCE:
+IMPACT ON WORKFORCE While automation will cause significant changes in the composition of employment, it will not cause mass unemployment. Quite the contrary, displaced workers will fill new higher-value-add jobs, and the labor force is likely to increase. The positive impact associated with the retraining of soldiers after World War II8 is quite instructive. The economy assimilated returning soldiers surprisingly well, boosting productivity significantly. Though, as automation accelerates job turnover, the cost of friction in the labor market, which currently stands at more than $630B per annum is expected to grow. These frictions present tremendous opportunity for companies that help firms reduce time-to-hire, provide workers with new skill-sets, and train new employees more efficiently. In the United States today, 5.4 million jobs are unfilled because of skillset mismatches, as shown below. ARK’s research indicates that recruiting and training account for over 2/3 the cost of friction in the labor market. The opportunity for recruiting and retraining has never been better. Some companies already are responding. In 2013, corporate spending on training increased by 15%, to $70 billion and then increased another 10% in 2014.9 Companies such as Cornerstone on Demand (CSOD), Manpower (MAN), Robert Half (RHI), DeVry (DV), Adecco (AHEXY), and LinkedIn (LNKD), which acquired Lynda.com, offer career skill-building programs, and should benefit significantly as automation permeates more industries. The productivity associated with automation will have a profound impact on economic growth. According to ARK’s research, real GDP per worker in the US will double from $113,000 in 2013 to $236,000 in 2035, or at an annual rate of 3.4%. Without automation, productivity would increase at roughly half that rate, or 1.8%, limiting real GDP per worker to $167,000, as shown below. As automation proliferates, the growth of real GDP per worker will accelerate from 2.2% during the next ten years, to roughly 5% between 2025 and 2035. By 2035, real GDP will be 42% higher with automation than without it, as shown below. It will reach roughly $40 trillion, or nearly $12 trillion above the $28 trillion that would otherwise be the case. Clearly, the extra $12 trillion in extra GDP will bring with it many more new jobs. Robotics ecosystems will create new industries and accelerate their growth. Companies already pioneering this movement include Google (GOOG) and Tesla (TSLA) in the autonomous vehicle market, as well as AeroVironment (AVAV), Amazon (AMZN) and Elbit Systems (ESLT) in the drone space. Service robots are in their infancy, but could undergo explosive growth. Early examples include vacuum and lawnmower robots manufactured by iRobot (IRBT), medical robots by Intuitive Surgical (ISRG), and industrial robots by KUKA (KUKAY). Even more embryonic are ReWalk’s10 (RWLK) robot exoskeletons enabling paraplegics to walk.11 Other companies benefitting from these trends manufacture sensors, microcontrollers, cameras, batteries, computerized numerical controls, and materials required for production. Cognex (CGNX), Ambarella (AMBA), Panasonic (PCRFY), Fanuc (FANUY), and Rockwell Automation (ROK) will be prime beneficiaries. Automation will permeate every sector of the economy, with accommodation and food services, agriculture, and retail trade garnering the biggest boosts to productivity. By 2035, GDP per worker will increase by 58% in the accommodation and food services sector, 55% in agriculture, and 53% in retail trade, as depicted below. Spending on automation is poised to soar orders of magnitude above current investment levels. Cumulatively, it will increase by roughly $3.8 trillion through 2035. As artificial intelligence solves increasingly complex problems, the return on investment from “smarter” robots, drones, and automation will drive adoption. Between 2015 and 2035, annual investment in automation could increase at a 16.5% annual growth rate from $11 billion to $242 billion, as illustrated below. During the next decade it should compound at a 33% annual rate. Given the declining cost curves in technology, unit growth rates could be even higher. Several sectors will spend disproportionately on automation to boost productivity. In 2035, manufacturing will account for the largest percentage, 13% of the total, or $31 billion. Spearheaded by companies like Amazon (AMZN), the retail sector will spend roughly $26 billion, or 11% of the total investment. In 2014, Amazon boosted the number of Kiva robots in its global distribution centers from 1,000 to 15,000, a fifteen fold increase in one year, and then doubled its Kiva install base to 30,000 in 2015. Game on! Closely related to retail, the accommodation and food services category is set to spend $24 billion as shown in figure 9.
+
+USER:
+What industries will be created or accelerated by robotic ecosystems?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,23,10,732,,127
+This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. Give your answer in bullet points and follow each one with an explanation.,Please summarize this text for a layperson.,"Selective serotonin reuptake inhibitors (SSRIs) are the most frequently prescribed antidepressants. SSRIs are called selective because they affect serotonin rather than other chemicals in the brain. These drugs block the reuptake (removal) of serotonin, which keeps the level of serotonin balanced and helps regulate mood. SSRIs Affect Serotonin Levels in the Brain There are currently seven SSRI drugs on the market in the United States (TABLE 1). These medications are generally safer than older antidepressants, with fewer side effects and drug interactions. In general, SSRIs have received approval from the FDA as safe and effective in the treatment of major depressive disorder. Many are also approved for anxiety disorders such as panic disorder, generalized anxiety disorder, and social anxiety disorder. Certain drugs in this category are also approved for use in obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), premenstrual dysphoric disorder (PMDD), and bulimia. SSRIs are slightly different in how quickly they work and how long they stay in the body. Their side effects also differ somewhat. Common side effects include nervousness, problems sleeping, headache, dry mouth, nausea, changes in sexual desire, and erectile dysfunction. Nausea can be reduced by taking the medicine with food. Nervousness and insomnia can be reduced by taking the drug just before bedtime. Most adverse effects of SSRIs gradually disappear after a few weeks of therapy. SSRIs show an effect after 4 to 6 weeks of daily use. If one drug in this category does not work in a particular person, another drug may work. SSRIs can interact with other medications that also cause increased serotonin levels in the brain. These include other antidepressants, prescription opioids, migraine medications, cocaine, and St. John’s wort (a medicinal herb used to treat depression). If one or more of these drugs are used with an SSRI, a high level of serotonin in the brain can result in serotonin syndrome. Symptoms such as extreme anxiety, tremors, fast heartbeat, sweating, and confusion require emergency care. Although SSRIs are not addictive, stopping them abruptly can cause symptoms that mimic withdrawal. A doctor should provide guidelines for slowly tapering off an SSRI to avoid symptoms of nausea, dizziness, and fatigue. Warnings and Precautions Generally, SSRIs are safe and carry few risks. All antidepressants, including SSRIs, can cause an increase in suicidal thoughts or actions, especially in young adults beginning therapy or changing dosages. SSRIs can increase the risk of gastrointestinal bleeding when taken with nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, or with drugs with a side effect of bleeding, such as warfarin. Taking a drug that lowers stomach acid may be helpful. Women who are considering pregnancy, who are pregnant, or who are breastfeeding should discuss the potential effects of SSRIs on the fetus or infant and consider a break in therapy to avoid exposure. Several SSRIs are being studied for diseases other than those specified in their FDA labeling. Some of the uses that have shown promise include prevention of migraine, pain of diabetic neuropathy, fibromyalgia, vasovagal syncope (fainting), and premature ejaculation.","This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. Give your answer in bullet points and follow each one with an explanation. Please summarize this text for a layperson. Selective serotonin reuptake inhibitors (SSRIs) are the most frequently prescribed antidepressants. SSRIs are called selective because they affect serotonin rather than other chemicals in the brain. These drugs block the reuptake (removal) of serotonin, which keeps the level of serotonin balanced and helps regulate mood. SSRIs Affect Serotonin Levels in the Brain There are currently seven SSRI drugs on the market in the United States (TABLE 1). These medications are generally safer than older antidepressants, with fewer side effects and drug interactions. In general, SSRIs have received approval from the FDA as safe and effective in the treatment of major depressive disorder. Many are also approved for anxiety disorders such as panic disorder, generalized anxiety disorder, and social anxiety disorder. Certain drugs in this category are also approved for use in obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), premenstrual dysphoric disorder (PMDD), and bulimia. SSRIs are slightly different in how quickly they work and how long they stay in the body. Their side effects also differ somewhat. Common side effects include nervousness, problems sleeping, headache, dry mouth, nausea, changes in sexual desire, and erectile dysfunction. Nausea can be reduced by taking the medicine with food. Nervousness and insomnia can be reduced by taking the drug just before bedtime. Most adverse effects of SSRIs gradually disappear after a few weeks of therapy. SSRIs show an effect after 4 to 6 weeks of daily use. If one drug in this category does not work in a particular person, another drug may work. SSRIs can interact with other medications that also cause increased serotonin levels in the brain. These include other antidepressants, prescription opioids, migraine medications, cocaine, and St. John’s wort (a medicinal herb used to treat depression). If one or more of these drugs are used with an SSRI, a high level of serotonin in the brain can result in serotonin syndrome. Symptoms such as extreme anxiety, tremors, fast heartbeat, sweating, and confusion require emergency care. Although SSRIs are not addictive, stopping them abruptly can cause symptoms that mimic withdrawal. A doctor should provide guidelines for slowly tapering off an SSRI to avoid symptoms of nausea, dizziness, and fatigue. Warnings and Precautions Generally, SSRIs are safe and carry few risks. All antidepressants, including SSRIs, can cause an increase in suicidal thoughts or actions, especially in young adults beginning therapy or changing dosages. SSRIs can increase the risk of gastrointestinal bleeding when taken with nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, or with drugs with a side effect of bleeding, such as warfarin. Taking a drug that lowers stomach acid may be helpful. Women who are considering pregnancy, who are pregnant, or who are breastfeeding should discuss the potential effects of SSRIs on the fetus or infant and consider a break in therapy to avoid exposure. Several SSRIs are being studied for diseases other than those specified in their FDA labeling. Some of the uses that have shown promise include prevention of migraine, pain of diabetic neuropathy, fibromyalgia, vasovagal syncope (fainting), and premature ejaculation.","This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. Give your answer in bullet points and follow each one with an explanation.
+
+EVIDENCE:
+Selective serotonin reuptake inhibitors (SSRIs) are the most frequently prescribed antidepressants. SSRIs are called selective because they affect serotonin rather than other chemicals in the brain. These drugs block the reuptake (removal) of serotonin, which keeps the level of serotonin balanced and helps regulate mood. SSRIs Affect Serotonin Levels in the Brain There are currently seven SSRI drugs on the market in the United States (TABLE 1). These medications are generally safer than older antidepressants, with fewer side effects and drug interactions. In general, SSRIs have received approval from the FDA as safe and effective in the treatment of major depressive disorder. Many are also approved for anxiety disorders such as panic disorder, generalized anxiety disorder, and social anxiety disorder. Certain drugs in this category are also approved for use in obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), premenstrual dysphoric disorder (PMDD), and bulimia. SSRIs are slightly different in how quickly they work and how long they stay in the body. Their side effects also differ somewhat. Common side effects include nervousness, problems sleeping, headache, dry mouth, nausea, changes in sexual desire, and erectile dysfunction. Nausea can be reduced by taking the medicine with food. Nervousness and insomnia can be reduced by taking the drug just before bedtime. Most adverse effects of SSRIs gradually disappear after a few weeks of therapy. SSRIs show an effect after 4 to 6 weeks of daily use. If one drug in this category does not work in a particular person, another drug may work. SSRIs can interact with other medications that also cause increased serotonin levels in the brain. These include other antidepressants, prescription opioids, migraine medications, cocaine, and St. John’s wort (a medicinal herb used to treat depression). If one or more of these drugs are used with an SSRI, a high level of serotonin in the brain can result in serotonin syndrome. Symptoms such as extreme anxiety, tremors, fast heartbeat, sweating, and confusion require emergency care. Although SSRIs are not addictive, stopping them abruptly can cause symptoms that mimic withdrawal. A doctor should provide guidelines for slowly tapering off an SSRI to avoid symptoms of nausea, dizziness, and fatigue. Warnings and Precautions Generally, SSRIs are safe and carry few risks. All antidepressants, including SSRIs, can cause an increase in suicidal thoughts or actions, especially in young adults beginning therapy or changing dosages. SSRIs can increase the risk of gastrointestinal bleeding when taken with nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, or with drugs with a side effect of bleeding, such as warfarin. Taking a drug that lowers stomach acid may be helpful. Women who are considering pregnancy, who are pregnant, or who are breastfeeding should discuss the potential effects of SSRIs on the fetus or infant and consider a break in therapy to avoid exposure. Several SSRIs are being studied for diseases other than those specified in their FDA labeling. Some of the uses that have shown promise include prevention of migraine, pain of diabetic neuropathy, fibromyalgia, vasovagal syncope (fainting), and premature ejaculation.
+
+USER:
+Please summarize this text for a layperson.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,41,7,503,,169
+You can only respond to the prompt using the information in the context block and no other sources. Give your answer in bullet points and follow each one with an explanation.,"In simple terms, what are key components of US strategic goals related to subsea cables?","Transatlantic Tech Bridge: Digital Infrastructure and Subsea Cables, a US Perspective 1. US strategic interests in digital infrastructure and its industrial policy The United States’ overarching strategic goal is an open, secure, interoperable and global internet, one where US digital leaders can compete (and win). This requires trusted digital infrastructure. US investment in digital infrastructure reveals both domestic and international priorities. The 2021 Bipartisan Infrastructure Bill provides 65 billion US dollars for high-speed internet deployment.6 Its focus is on providing connectivity for low-income households through the Affordable Connectivity Program and reaching underserved rural, agricultural and tribal areas.7 The “Internet for All” initiative manages grants for infrastructure and training.8 In the international development space, digital infrastructure is one of three pillars of USAID’s digital strategy and its digital ecosystem framework.9 US firms retain a leading position in the ownership of subsea cables, and along with Japanese and French firms continue to supply the equipment for most projects. Cables were traditionally owned by a consortium of telecom firms, but this model has seen its share diminish with the influx of cables owned by content providers (the hyperscalers). Unlike other digital technologies, the supply chain for the raw materials that make up the cables is not dependent on China.10 Global cooperation takes place through formats like the UN’s International Telecommunications Union and multistakeholder arrangements like the International Cable Protection Committee. The United Nations Convention on the Law of the Sea (UNCLOS) provides an important legal framework for ocean policy and undersea cables, including cable protection zones and a dispute resolution framework. The US, however, has failed to ratify UNCLOS for decades and even in the case of US ratification, credible enforcement would be difficult.11 Geopolitics and rising concerns about China have upended the world of subsea cables. Digital infrastructure, and undersea cables in particular, fit into a wider strategy for the US and are a key element of “outcompeting” China. This is leading to what has been dubbed a “subsea cold war”.12 Concerns are multifaceted and overlapping, including the physical security of infrastructure, espionage, economic competitiveness and support for domestic firms, fears of technology leakage and geopolitical competition. In promoting the view that “the digital backbones of the modern economy must be open, trusted, interoperable, reliable, and secure”,13 US strategy is highly focused on countering China’s “digital silk road”. Digital infrastructure is critical, but also a potential vector for insecurity and subject to disruptions, both accidental and deliberate. But attribution and assessing conflicting motivations among potential adversaries can be difficult. There is still significant uncertainty around cyberthreats and subsea cables, with limited publicly available information or attribution. The majority of cable faults – around a hundred per year – are attributable to accidental errors, such as damage from fishing vessels, or geologic incidents.14 But the risk and fear of state-directed cyber attacks or physical sabotage is rising. Many examples remain hypothetical; and concrete details or attribution are classified or unknown. One of the few known events, a 2022 cyber-attack in Hawaii that the Department of Homeland Security claimed to have foiled, was merely attributed to an “international hacking group”.15 Chinese ships have been accused of damaging cables in the Taiwan straits as part of a pressure campaign on the island.16 The US is particularly concerned about potential for espionage from adversaries like China and Russia. Tapping into and filtering the enormous quantities of information on subsea cables is extremely difficult, especially at great depths, and only a few countries likely have such capabilities. Landing stations where cables come ashore, however, have been identified as potential vulnerabilities, where lax security could allow for monitoring or tapping of the cables. The US can illustrate its concerns about growing control of infrastructure by adversaries by pointing to cases like the Federated States of Micronesia, where China pressured the government to grant it control of cables and telecom infrastructure via a Memorandum of Understanding.17 The point here is that Chinese infrastructure investments through the digital silk road will lead to de-facto control and facilitate espionage. Cost-reduction measures by cable owners have also led to increased deployment of remote network management systems, which introduce new vulnerabilities to hacking or sabotage since they are connected to the internet.18 The US has responded to these concerns with legislation like the Secure and Trusted Communications Networks Act of 2019, which charged the Federal Communications Commission with carrying out the complex rip-and-replace process for Huawei-made infrastructure domestically.19 The US has also expressed concerns about Europe’s reliance on 5G infrastructure from Huawei.20 The National Security Strategy released in October 2022 warns that autocratic governments “leverage access to their markets and control of global digital infrastructure for coercive purposes” and cites China as a source of “untrusted digital infrastructure”.21 The US has also acted to ensure continued market dominance by US and allied firms. Between 2015 and 2019, Chinese investments through the digital silk road led to control by Huawei Marine (which became HMN Tech in 2019) of about 15 per cent of the global market.22 Sanctions were placed on HMN Tech in 2021, citing its “intention to acquire American technology to help modernize China’s People’s Liberation Army”.23 This issue also predates the current Biden Administration. In addition to sanctions placed on Huawei, President Trump’s “Executive Order on Establishing the Committee for the Assessment of Foreign Participation in the United States Telecommunications Services Sector” provided structure to an interagency team known as “Team Telecom” charged with reviewing foreign investment in telecom and broadcast firms.24 Run by the Department of Justice’s National Security Division, it makes licensing recommendations to the Federal Communications Commission with the goal of ensuring that no cable directly connects the US and the Chinese mainland or Hong Kong.25 The US Congress has also been somewhat vocal on the issue. For example, the Undersea Cable Control Act passed the House in March 2023.26 Recent years have therefore seen significant shifts in undersea cable investment, with many new cables rerouted to avoid China and the South China Sea.27 While warnings of an undersea splinternet may be exaggerated, the sector is nevertheless seeing important shifts in investment, particularly for transpacific cables. From 2016 to 2020, 75 per cent of cables included at least one Chinese owner. Projections for 2021–2025 plummet to 0 per cent (see Figure 2). Significant reductions are apparent in other Asia connections as well. The US government has also intervened in cases of Chinese involvement in infrastructure projects and exerted pressure which has led to cancellation of cable initiatives or contracts if awarded to Chinese firms. For example, a 2018 proposed consortium led by Amazon, Meta and China Mobile met with opposition from Washington. US security concerns remained even following China Mobile’s departure, and the project was shelved despite much of the cable having already been laid.28 The 600 million US dollar SeaWeMe-6 cable connecting Singapore to France was awarded to the US’s SubCom over HMN Tech following diplomatic pressure and incentives like training grants to local telecom firms from the US Trade and Development Agency.29 At the same time, this pressure, along with sanctions, has influenced cable-building endeavours that do not include US investors or connect geographically to the US.30 Such events illustrate the strategic competitive and economic interests at stake, as technology becomes a key site of geopolitical competition. In order to counter China, the United States is working to build a network of partnerships on digital infrastructure. The US CABLES programme provides capacity building and technical assistance to members of the Quad alliance in the Indo-Pacific.31 The Partnership for Global Infrastructure and Investment (PGII) through the G7 aims to offer an alternative to China’s Belt and Road Investments,32 and included cables as part of a recent PGII announcement on the sidelines of the G20.33 The US also launched the Trilateral Partnership for Infrastructure Investment with Australia and Japan in 2018.34 The NATO undersea infrastructure coordination cell, launched in 2023, coordinates between military, civilian and industry interests in subsea infrastructure to increase security.35 The State Department’s 2020 Clean Network Initiative, whose scope extends beyond subsea cables, created a set of shared principles and practices for countries and companies with the goal of blocking Chinese market dominance.36","System instruction: You can only respond to the prompt using the information in the context block and no other sources. Give your answer in bullet points and follow each one with an explanation. Question: In simple terms, what are key components of US strategic goals related to subsea cables? Context block: Transatlantic Tech Bridge: Digital Infrastructure and Subsea Cables, a US Perspective 1. US strategic interests in digital infrastructure and its industrial policy The United States’ overarching strategic goal is an open, secure, interoperable and global internet, one where US digital leaders can compete (and win). This requires trusted digital infrastructure. US investment in digital infrastructure reveals both domestic and international priorities. The 2021 Bipartisan Infrastructure Bill provides 65 billion US dollars for high-speed internet deployment.6 Its focus is on providing connectivity for low-income households through the Affordable Connectivity Program and reaching underserved rural, agricultural and tribal areas.7 The “Internet for All” initiative manages grants for infrastructure and training.8 In the international development space, digital infrastructure is one of three pillars of USAID’s digital strategy and its digital ecosystem framework.9 US firms retain a leading position in the ownership of subsea cables, and along with Japanese and French firms continue to supply the equipment for most projects. Cables were traditionally owned by a consortium of telecom firms, but this model has seen its share diminish with the influx of cables owned by content providers (the hyperscalers). Unlike other digital technologies, the supply chain for the raw materials that make up the cables is not dependent on China.10 Global cooperation takes place through formats like the UN’s International Telecommunications Union and multistakeholder arrangements like the International Cable Protection Committee. The United Nations Convention on the Law of the Sea (UNCLOS) provides an important legal framework for ocean policy and undersea cables, including cable protection zones and a dispute resolution framework. The US, however, has failed to ratify UNCLOS for decades and even in the case of US ratification, credible enforcement would be difficult.11 Geopolitics and rising concerns about China have upended the world of subsea cables. Digital infrastructure, and undersea cables in particular, fit into a wider strategy for the US and are a key element of “outcompeting” China. This is leading to what has been dubbed a “subsea cold war”.12 Concerns are multifaceted and overlapping, including the physical security of infrastructure, espionage, economic competitiveness and support for domestic firms, fears of technology leakage and geopolitical competition. In promoting the view that “the digital backbones of the modern economy must be open, trusted, interoperable, reliable, and secure”,13 US strategy is highly focused on countering China’s “digital silk road”. Digital infrastructure is critical, but also a potential vector for insecurity and subject to disruptions, both accidental and deliberate. But attribution and assessing conflicting motivations among potential adversaries can be difficult. There is still significant uncertainty around cyberthreats and subsea cables, with limited publicly available information or attribution. The majority of cable faults – around a hundred per year – are attributable to accidental errors, such as damage from fishing vessels, or geologic incidents.14 But the risk and fear of state-directed cyber attacks or physical sabotage is rising. Many examples remain hypothetical; and concrete details or attribution are classified or unknown. One of the few known events, a 2022 cyber-attack in Hawaii that the Department of Homeland Security claimed to have foiled, was merely attributed to an “international hacking group”.15 Chinese ships have been accused of damaging cables in the Taiwan straits as part of a pressure campaign on the island.16 The US is particularly concerned about potential for espionage from adversaries like China and Russia. Tapping into and filtering the enormous quantities of information on subsea cables is extremely difficult, especially at great depths, and only a few countries likely have such capabilities. Landing stations where cables come ashore, however, have been identified as potential vulnerabilities, where lax security could allow for monitoring or tapping of the cables. The US can illustrate its concerns about growing control of infrastructure by adversaries by pointing to cases like the Federated States of Micronesia, where China pressured the government to grant it control of cables and telecom infrastructure via a Memorandum of Understanding.17 The point here is that Chinese infrastructure investments through the digital silk road will lead to de-facto control and facilitate espionage. Cost-reduction measures by cable owners have also led to increased deployment of remote network management systems, which introduce new vulnerabilities to hacking or sabotage since they are connected to the internet.18 The US has responded to these concerns with legislation like the Secure and Trusted Communications Networks Act of 2019, which charged the Federal Communications Commission with carrying out the complex rip-and-replace process for Huawei-made infrastructure domestically.19 The US has also expressed concerns about Europe’s reliance on 5G infrastructure from Huawei.20 The National Security Strategy released in October 2022 warns that autocratic governments “leverage access to their markets and control of global digital infrastructure for coercive purposes” and cites China as a source of “untrusted digital infrastructure”.21 The US has also acted to ensure continued market dominance by US and allied firms. Between 2015 and 2019, Chinese investments through the digital silk road led to control by Huawei Marine (which became HMN Tech in 2019) of about 15 per cent of the global market.22 Sanctions were placed on HMN Tech in 2021, citing its “intention to acquire American technology to help modernize China’s People’s Liberation Army”.23 This issue also predates the current Biden Administration. In addition to sanctions placed on Huawei, President Trump’s “Executive Order on Establishing the Committee for the Assessment of Foreign Participation in the United States Telecommunications Services Sector” provided structure to an interagency team known as “Team Telecom” charged with reviewing foreign investment in telecom and broadcast firms.24 Run by the Department of Justice’s National Security Division, it makes licensing recommendations to the Federal Communications Commission with the goal of ensuring that no cable directly connects the US and the Chinese mainland or Hong Kong.25 The US Congress has also been somewhat vocal on the issue. For example, the Undersea Cable Control Act passed the House in March 2023.26 Recent years have therefore seen significant shifts in undersea cable investment, with many new cables rerouted to avoid China and the South China Sea.27 While warnings of an undersea splinternet may be exaggerated, the sector is nevertheless seeing important shifts in investment, particularly for transpacific cables. From 2016 to 2020, 75 per cent of cables included at least one Chinese owner. Projections for 2021–2025 plummet to 0 per cent (see Figure 2). Significant reductions are apparent in other Asia connections as well. The US government has also intervened in cases of Chinese involvement in infrastructure projects and exerted pressure which has led to cancellation of cable initiatives or contracts if awarded to Chinese firms. For example, a 2018 proposed consortium led by Amazon, Meta and China Mobile met with opposition from Washington. US security concerns remained even following China Mobile’s departure, and the project was shelved despite much of the cable having already been laid.28 The 600 million US dollar SeaWeMe-6 cable connecting Singapore to France was awarded to the US’s SubCom over HMN Tech following diplomatic pressure and incentives like training grants to local telecom firms from the US Trade and Development Agency.29 At the same time, this pressure, along with sanctions, has influenced cable-building endeavours that do not include US investors or connect geographically to the US.30 Such events illustrate the strategic competitive and economic interests at stake, as technology becomes a key site of geopolitical competition. In order to counter China, the United States is working to build a network of partnerships on digital infrastructure. The US CABLES programme provides capacity building and technical assistance to members of the Quad alliance in the Indo-Pacific.31 The Partnership for Global Infrastructure and Investment (PGII) through the G7 aims to offer an alternative to China’s Belt and Road Investments,32 and included cables as part of a recent PGII announcement on the sidelines of the G20.33 The US also launched the Trilateral Partnership for Infrastructure Investment with Australia and Japan in 2018.34 The NATO undersea infrastructure coordination cell, launched in 2023, coordinates between military, civilian and industry interests in subsea infrastructure to increase security.35 The State Department’s 2020 Clean Network Initiative, whose scope extends beyond subsea cables, created a set of shared principles and practices for countries and companies with the goal of blocking Chinese market dominance.36","You can only respond to the prompt using the information in the context block and no other sources. Give your answer in bullet points and follow each one with an explanation.
+
+EVIDENCE:
+Transatlantic Tech Bridge: Digital Infrastructure and Subsea Cables, a US Perspective 1. US strategic interests in digital infrastructure and its industrial policy The United States’ overarching strategic goal is an open, secure, interoperable and global internet, one where US digital leaders can compete (and win). This requires trusted digital infrastructure. US investment in digital infrastructure reveals both domestic and international priorities. The 2021 Bipartisan Infrastructure Bill provides 65 billion US dollars for high-speed internet deployment.6 Its focus is on providing connectivity for low-income households through the Affordable Connectivity Program and reaching underserved rural, agricultural and tribal areas.7 The “Internet for All” initiative manages grants for infrastructure and training.8 In the international development space, digital infrastructure is one of three pillars of USAID’s digital strategy and its digital ecosystem framework.9 US firms retain a leading position in the ownership of subsea cables, and along with Japanese and French firms continue to supply the equipment for most projects. Cables were traditionally owned by a consortium of telecom firms, but this model has seen its share diminish with the influx of cables owned by content providers (the hyperscalers). Unlike other digital technologies, the supply chain for the raw materials that make up the cables is not dependent on China.10 Global cooperation takes place through formats like the UN’s International Telecommunications Union and multistakeholder arrangements like the International Cable Protection Committee. The United Nations Convention on the Law of the Sea (UNCLOS) provides an important legal framework for ocean policy and undersea cables, including cable protection zones and a dispute resolution framework. The US, however, has failed to ratify UNCLOS for decades and even in the case of US ratification, credible enforcement would be difficult.11 Geopolitics and rising concerns about China have upended the world of subsea cables. Digital infrastructure, and undersea cables in particular, fit into a wider strategy for the US and are a key element of “outcompeting” China. This is leading to what has been dubbed a “subsea cold war”.12 Concerns are multifaceted and overlapping, including the physical security of infrastructure, espionage, economic competitiveness and support for domestic firms, fears of technology leakage and geopolitical competition. In promoting the view that “the digital backbones of the modern economy must be open, trusted, interoperable, reliable, and secure”,13 US strategy is highly focused on countering China’s “digital silk road”. Digital infrastructure is critical, but also a potential vector for insecurity and subject to disruptions, both accidental and deliberate. But attribution and assessing conflicting motivations among potential adversaries can be difficult. There is still significant uncertainty around cyberthreats and subsea cables, with limited publicly available information or attribution. The majority of cable faults – around a hundred per year – are attributable to accidental errors, such as damage from fishing vessels, or geologic incidents.14 But the risk and fear of state-directed cyber attacks or physical sabotage is rising. Many examples remain hypothetical; and concrete details or attribution are classified or unknown. One of the few known events, a 2022 cyber-attack in Hawaii that the Department of Homeland Security claimed to have foiled, was merely attributed to an “international hacking group”.15 Chinese ships have been accused of damaging cables in the Taiwan straits as part of a pressure campaign on the island.16 The US is particularly concerned about potential for espionage from adversaries like China and Russia. Tapping into and filtering the enormous quantities of information on subsea cables is extremely difficult, especially at great depths, and only a few countries likely have such capabilities. Landing stations where cables come ashore, however, have been identified as potential vulnerabilities, where lax security could allow for monitoring or tapping of the cables. The US can illustrate its concerns about growing control of infrastructure by adversaries by pointing to cases like the Federated States of Micronesia, where China pressured the government to grant it control of cables and telecom infrastructure via a Memorandum of Understanding.17 The point here is that Chinese infrastructure investments through the digital silk road will lead to de-facto control and facilitate espionage. Cost-reduction measures by cable owners have also led to increased deployment of remote network management systems, which introduce new vulnerabilities to hacking or sabotage since they are connected to the internet.18 The US has responded to these concerns with legislation like the Secure and Trusted Communications Networks Act of 2019, which charged the Federal Communications Commission with carrying out the complex rip-and-replace process for Huawei-made infrastructure domestically.19 The US has also expressed concerns about Europe’s reliance on 5G infrastructure from Huawei.20 The National Security Strategy released in October 2022 warns that autocratic governments “leverage access to their markets and control of global digital infrastructure for coercive purposes” and cites China as a source of “untrusted digital infrastructure”.21 The US has also acted to ensure continued market dominance by US and allied firms. Between 2015 and 2019, Chinese investments through the digital silk road led to control by Huawei Marine (which became HMN Tech in 2019) of about 15 per cent of the global market.22 Sanctions were placed on HMN Tech in 2021, citing its “intention to acquire American technology to help modernize China’s People’s Liberation Army”.23 This issue also predates the current Biden Administration. In addition to sanctions placed on Huawei, President Trump’s “Executive Order on Establishing the Committee for the Assessment of Foreign Participation in the United States Telecommunications Services Sector” provided structure to an interagency team known as “Team Telecom” charged with reviewing foreign investment in telecom and broadcast firms.24 Run by the Department of Justice’s National Security Division, it makes licensing recommendations to the Federal Communications Commission with the goal of ensuring that no cable directly connects the US and the Chinese mainland or Hong Kong.25 The US Congress has also been somewhat vocal on the issue. For example, the Undersea Cable Control Act passed the House in March 2023.26 Recent years have therefore seen significant shifts in undersea cable investment, with many new cables rerouted to avoid China and the South China Sea.27 While warnings of an undersea splinternet may be exaggerated, the sector is nevertheless seeing important shifts in investment, particularly for transpacific cables. From 2016 to 2020, 75 per cent of cables included at least one Chinese owner. Projections for 2021–2025 plummet to 0 per cent (see Figure 2). Significant reductions are apparent in other Asia connections as well. The US government has also intervened in cases of Chinese involvement in infrastructure projects and exerted pressure which has led to cancellation of cable initiatives or contracts if awarded to Chinese firms. For example, a 2018 proposed consortium led by Amazon, Meta and China Mobile met with opposition from Washington. US security concerns remained even following China Mobile’s departure, and the project was shelved despite much of the cable having already been laid.28 The 600 million US dollar SeaWeMe-6 cable connecting Singapore to France was awarded to the US’s SubCom over HMN Tech following diplomatic pressure and incentives like training grants to local telecom firms from the US Trade and Development Agency.29 At the same time, this pressure, along with sanctions, has influenced cable-building endeavours that do not include US investors or connect geographically to the US.30 Such events illustrate the strategic competitive and economic interests at stake, as technology becomes a key site of geopolitical competition. In order to counter China, the United States is working to build a network of partnerships on digital infrastructure. The US CABLES programme provides capacity building and technical assistance to members of the Quad alliance in the Indo-Pacific.31 The Partnership for Global Infrastructure and Investment (PGII) through the G7 aims to offer an alternative to China’s Belt and Road Investments,32 and included cables as part of a recent PGII announcement on the sidelines of the G20.33 The US also launched the Trilateral Partnership for Infrastructure Investment with Australia and Japan in 2018.34 The NATO undersea infrastructure coordination cell, launched in 2023, coordinates between military, civilian and industry interests in subsea infrastructure to increase security.35 The State Department’s 2020 Clean Network Initiative, whose scope extends beyond subsea cables, created a set of shared principles and practices for countries and companies with the goal of blocking Chinese market dominance.36
+
+USER:
+In simple terms, what are key components of US strategic goals related to subsea cables?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,31,15,1357,,9
+"<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> [user request] <TEXT> [context document]","List the travel bags referenced in the text in order, from the one that holds the most items to the one that holds the least. Describe what it is about these bags that makes them preferable to other travel bags, and include the colors when referencing them, if given.","What is the Best Purse to Travel With | Shop the Post Top: SoCo Vintage (old, similar) // Jeans: Loft (old, similar) // Purse: Coach (old, similar) // Sunglasses: Coach (old,similar) // Purse: kate spade new york (in black) What is the Best Purse to Travel With | How to Pick If there is one accessory I love, it is a good purse. I love how they are practical, but can make an entire outfit look put together. I have a lot of purses...too many probably! But I get a lot out of each one of them. There are so many different kinds of purses and so many different ways to use them. I will be talking a lot about other purses in later posts, but today I want to talk about the best purses to take when you are traveling. I personally think that a good cross-body bag is the best kind of bag to have when traveling. They are so versatile and they allow you to have your hands free while still storing your necessities in style. What is the Best Purse to Travel With | My Favorites In Turkey, I was touting a Coach Mini Willis cross body. I have this bag in three different colors and it's a great bag for traveling! While it is on the smaller side, it is big enough to hold a small wallet, phone, chapstick and sunglasses. It is perfect for when you are touring a city but don't want to take a lot with you. It's also really nice because you can easily move it to hang in front of you so you can ward off pickpockets! For my birthday last year, my mom gave me the Michael Kors Large Jet Set Traveler in gray. That is a pretty awesome bag. It fits perfectly into my Michael Kors computer bag so I can throw it in there right before I get on a plane and I can pull it back out when I get off. I love that the color goes with just about anything and it fits a LOT of stuff! The last trip I took it on, I got a wallet, glasses, sunglasses, phone, planner, notebook and some pens in there. I have been really happy with how well it has worn too. The leather isn't my favorite but it has a coating on it that keeps stains and water off. Here you can glimpse my newest cross-body obsession from kate spade new york. I took this on my recent trip to Jordan and I loved it! It is much bigger than the Coach bag, and has more room in it than the Michael Kors. It also has a zipper pocket that folds down across the top. The leather on this bag is so soft and I love how pink it is. I found this beauty for a steal at a kate spade outlet sale. The entire store was 50% off with an additional 20% bags. It was a great buy! I will keep an eye out for their next outlet sale and make sure I update you all on it!","<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> List the travel bags referenced in the text in order, from the one that holds the most items to the one that holds the least. Describe what it is about these bags that makes them preferable to other travel bags, and include the colors when referencing them, if given. <TEXT> What is the Best Purse to Travel With | Shop the Post Top: SoCo Vintage (old, similar) // Jeans: Loft (old, similar) // Purse: Coach (old, similar) // Sunglasses: Coach (old,similar) // Purse: kate spade new york (in black) What is the Best Purse to Travel With | How to Pick If there is one accessory I love, it is a good purse. I love how they are practical, but can make an entire outfit look put together. I have a lot of purses...too many probably! But I get a lot out of each one of them. There are so many different kinds of purses and so many different ways to use them. I will be talking a lot about other purses in later posts, but today I want to talk about the best purses to take when you are traveling. I personally think that a good cross-body bag is the best kind of bag to have when traveling. They are so versatile and they allow you to have your hands free while still storing your necessities in style. What is the Best Purse to Travel With | My Favorites In Turkey, I was touting a Coach Mini Willis cross body. I have this bag in three different colors and it's a great bag for traveling! While it is on the smaller side, it is big enough to hold a small wallet, phone, chapstick and sunglasses. It is perfect for when you are touring a city but don't want to take a lot with you. It's also really nice because you can easily move it to hang in front of you so you can ward off pickpockets! For my birthday last year, my mom gave me the Michael Kors Large Jet Set Traveler in gray. That is a pretty awesome bag. It fits perfectly into my Michael Kors computer bag so I can throw it in there right before I get on a plane and I can pull it back out when I get off. I love that the color goes with just about anything and it fits a LOT of stuff! The last trip I took it on, I got a wallet, glasses, sunglasses, phone, planner, notebook and some pens in there. I have been really happy with how well it has worn too. The leather isn't my favorite but it has a coating on it that keeps stains and water off. Here you can glimpse my newest cross-body obsession from kate spade new york. I took this on my recent trip to Jordan and I loved it! It is much bigger than the Coach bag, and has more room in it than the Michael Kors. It also has a zipper pocket that folds down across the top. The leather on this bag is so soft and I love how pink it is. I found this beauty for a steal at a kate spade outlet sale. The entire store was 50% off with an additional 20% bags. It was a great buy! I will keep an eye out for their next outlet sale and make sure I update you all on it! https://breezingthrough.com/blog/what-is-the-best-purse-to-travel-with","<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> [user request] <TEXT> [context document]
+
+EVIDENCE:
+What is the Best Purse to Travel With | Shop the Post Top: SoCo Vintage (old, similar) // Jeans: Loft (old, similar) // Purse: Coach (old, similar) // Sunglasses: Coach (old,similar) // Purse: kate spade new york (in black) What is the Best Purse to Travel With | How to Pick If there is one accessory I love, it is a good purse. I love how they are practical, but can make an entire outfit look put together. I have a lot of purses...too many probably! But I get a lot out of each one of them. There are so many different kinds of purses and so many different ways to use them. I will be talking a lot about other purses in later posts, but today I want to talk about the best purses to take when you are traveling. I personally think that a good cross-body bag is the best kind of bag to have when traveling. They are so versatile and they allow you to have your hands free while still storing your necessities in style. What is the Best Purse to Travel With | My Favorites In Turkey, I was touting a Coach Mini Willis cross body. I have this bag in three different colors and it's a great bag for traveling! While it is on the smaller side, it is big enough to hold a small wallet, phone, chapstick and sunglasses. It is perfect for when you are touring a city but don't want to take a lot with you. It's also really nice because you can easily move it to hang in front of you so you can ward off pickpockets! For my birthday last year, my mom gave me the Michael Kors Large Jet Set Traveler in gray. That is a pretty awesome bag. It fits perfectly into my Michael Kors computer bag so I can throw it in there right before I get on a plane and I can pull it back out when I get off. I love that the color goes with just about anything and it fits a LOT of stuff! The last trip I took it on, I got a wallet, glasses, sunglasses, phone, planner, notebook and some pens in there. I have been really happy with how well it has worn too. The leather isn't my favorite but it has a coating on it that keeps stains and water off. Here you can glimpse my newest cross-body obsession from kate spade new york. I took this on my recent trip to Jordan and I loved it! It is much bigger than the Coach bag, and has more room in it than the Michael Kors. It also has a zipper pocket that folds down across the top. The leather on this bag is so soft and I love how pink it is. I found this beauty for a steal at a kate spade outlet sale. The entire store was 50% off with an additional 20% bags. It was a great buy! I will keep an eye out for their next outlet sale and make sure I update you all on it!
+
+USER:
+List the travel bags referenced in the text in order, from the one that holds the most items to the one that holds the least. Describe what it is about these bags that makes them preferable to other travel bags, and include the colors when referencing them, if given.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,20,49,523,,100
+"This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. Give your answer in bullet points with the proper noun and key word bolded, followed by a short explanation with no, unasked for information.","What states, mentioned in the text, have enacted some type of prohibition or restriction on price rises during proclaimed emergencies and specifically mention the key word,""fuel"", by name.","State Price-Gouging Laws Many states have enacted some type of prohibition or limitation on price increases during declared emergencies. Generally, these state laws take one of two basic forms. Some states prohibit the sale of goods and services at what are deemed to be “unconscionable” or “excessive” prices in the area and during the period of a designated emergency. Other states have established a maximum permissible increase in the prices for retail goods during a designated emergency period. Many statutes of both kinds include an exemption if price increases are the result of increased costs incurred for procuring the goods or services in question. Gasoline Price Increases: Federal and State Authority to Limit “Price Gouging” Congressional Research Service 2 Examples of State Statutes Prohibitions on “Excessive” or “Unconscionable” Pricing One common way that states address price gouging is to ban prices that are considered to be (for example) “excessive” or “unconscionable,” as defined in the statute or left to the discretion of the courts. These statutes generally bar such increases during designated emergency periods. The process for emergency designation is also usually defined in the statute. Frequently, the state’s governor is granted authority to designate an emergency during which the price limitations are in place. For example, the New York statute provides that: During any abnormal disruption of the market for consumer goods and services vital and necessary for the health, safety and welfare of consumers, no party within the chain of distribution of such consumer goods or services or both shall sell or offer to sell any such goods or services or both for an amount which represents an unconscionably excessive price.5 The statute defines abnormal disruption of the market as a real or threatened change to the market “resulting from stress of weather, convulsion of nature, failure or shortage of electric power or other source of energy, strike, civil disorder, war, military action, national or local emergency … which results in the declaration of a state of emergency by the governor.”6 The statute provides only for criminal liability and leaves the ultimate decision as to whether a price is “unconscionably excessive” to prosecutors (for charging purposes) and to the courts, with no separate cause of action created for private parties. As guidance in such cases, the statute notes that if there is a “gross disparity” between the price during the disruption and the price prior to the disruption, or if the price “grossly exceeds” the price at which the same or similar goods are available in the area, such disparity will be considered prima facie evidence that a price is unconscionable.7 Similarly, Florida’s statute bars “unconscionable pricing” during declared states of emergency.8 If the amount being charged represents a “gross disparity” from the average price at which the product or service was sold in the usual course of business (or available in the “trade area”) during the 30 days immediately prior to a declaration of a state of emergency, it is considered prima facie evidence of “unconscionable pricing,” which constitutes an “unlawful act or practice.” 9 However, pricing is not considered unconscionable if the increase is attributable to additional costs incurred by the seller or is the result of national or international market trends.10 As with the New York statute, the Florida statute offers guidance, but the question of whether certain prices during an emergency are deemed “unconscionable” is ultimately left to the courts. Many state price-gouging laws are triggered only by a declaration of emergency in response to localized conditions. Thus, they will generally not apply after a declared emergency ends or in areas not directly affected by a particular emergency or natural disaster. However, at least two Gasoline Price Increases: Federal and State Authority to Limit “Price Gouging” Congressional Research Service 3 states have laws prohibiting excessive pricing that impose liability even without a declaration of any type of emergency. Maine law prohibits “unjust or unreasonable” profits in the sale, exchange, or handling of necessities, defined to include fuel.11 Michigan’s consumer protection act simply prohibits “charging the consumer a price that is grossly in excess of the price at which similar property or services are sold.” 12 Prohibitions of Price Increases Beyond a Certain Percentage In contrast to a general ban on “excessive” or “unconscionable” pricing, some state statutes leave less to the courts’ discretion and instead place limits on price increases of certain goods during emergencies. For example, California’s anti-price-gouging statute states that for a period of 30 days following the proclamation of a state of emergency by the President of the United States or the governor of California or the declaration of a local emergency by the relevant executive officer, it is unlawful to sell or offer certain goods and services (including emergency and medical supplies, building and transportation materials, fuel, etc.) at a price more than 10% higher than the price of the good prior to the proclamation of emergency.13 As a defense, a seller can show that the price increase was directly attributable to additional costs imposed on it by the supplier of the goods or additional costs for the labor and material used to provide the services.14 The prohibition lasts for 30 days from the date of issuance of the emergency proclamation.15 West Virginia has also adopted an anti-price-gouging measure based on caps to percentage increases in price during times of emergency. The West Virginia statute provides that upon a declaration of a state of emergency by the President of the United States, the governor, or the state legislature, it is unlawful to sell or offer to sell certain critical goods and services “for a price greater than ten percent above the price charged by that person for those goods and services on the tenth day immediately preceding the declaration of emergency.” 16 West Virginia also provides an exception for price increases attributable to increased costs on the seller imposed by the supplier or to added costs of providing the goods or services during the emergency.17 Some states use language barring “unconscionable” or “excessive” pricing in a manner similar to the state statutes described in the previous section but define these terms with hard caps instead of leaving their exact definition to the discretion of the courts. For example, the Alabama statute makes it unlawful for anyone to “impose unconscionable prices for the sale or rental of any commodity or rental facility during the period of a declared state of emergency.” 18 However, it provides that prima facie evidence of unconscionable pricing exists “if any person, during a state of emergency declared pursuant to the powers granted to the Governor, charges a price that exceeds, by an amount equal to or in excess of 25%, the average price at which the same or similar commodity or rental facility was obtainable in the affected area during the last 30 days Gasoline Price Increases: Federal and State Authority to Limit “Price Gouging” Congressional Research Service 4 immediately prior to the declared state of emergency.” 19 As with most other state price-gouging statutes, the statute does not apply if the price increase is attributable to reasonable costs incurred by the seller in connection with the rental or sale of the commodity.20 A few other states have imposed caps on price increases during emergencies even tighter than the one imposed by the aforementioned statutes. Some state statutes ban any price increase during periods of emergency. For example, in Georgia, it is considered an “unlawful, unfair and deceptive trade practice” for anyone doing business in an areas where a state of emergency has been declared to sell or offer for sale at retail any goods or services identified by the Governor in the declaration of the state of emergency necessary to preserve, protect, or sustain the life, health, or safety of persons or their property at a price higher than the price at which such goods were sold or offered for sale immediately prior to the declaration of a state of emergency.21 As with other state gouging statutes, the Georgia statute provides an exception for price increases that reflect “an increase in cost of the goods or services to the person selling the goods or services or an increase in the cost of transporting the goods or services into the area.”","This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. Give your answer in bullet points with the proper noun and key word bolded, followed by a short explanation with no, unasked for information. What states, mentioned in the text, have enacted some type of prohibition or restriction on price rises during proclaimed emergencies and specifically mention the key word,""fuel"", by name. State Price-Gouging Laws Many states have enacted some type of prohibition or limitation on price increases during declared emergencies. Generally, these state laws take one of two basic forms. Some states prohibit the sale of goods and services at what are deemed to be “unconscionable” or “excessive” prices in the area and during the period of a designated emergency. Other states have established a maximum permissible increase in the prices for retail goods during a designated emergency period. Many statutes of both kinds include an exemption if price increases are the result of increased costs incurred for procuring the goods or services in question. Gasoline Price Increases: Federal and State Authority to Limit “Price Gouging” Congressional Research Service 2 Examples of State Statutes Prohibitions on “Excessive” or “Unconscionable” Pricing One common way that states address price gouging is to ban prices that are considered to be (for example) “excessive” or “unconscionable,” as defined in the statute or left to the discretion of the courts. These statutes generally bar such increases during designated emergency periods. The process for emergency designation is also usually defined in the statute. Frequently, the state’s governor is granted authority to designate an emergency during which the price limitations are in place. For example, the New York statute provides that: During any abnormal disruption of the market for consumer goods and services vital and necessary for the health, safety and welfare of consumers, no party within the chain of distribution of such consumer goods or services or both shall sell or offer to sell any such goods or services or both for an amount which represents an unconscionably excessive price.5 The statute defines abnormal disruption of the market as a real or threatened change to the market “resulting from stress of weather, convulsion of nature, failure or shortage of electric power or other source of energy, strike, civil disorder, war, military action, national or local emergency … which results in the declaration of a state of emergency by the governor.”6 The statute provides only for criminal liability and leaves the ultimate decision as to whether a price is “unconscionably excessive” to prosecutors (for charging purposes) and to the courts, with no separate cause of action created for private parties. As guidance in such cases, the statute notes that if there is a “gross disparity” between the price during the disruption and the price prior to the disruption, or if the price “grossly exceeds” the price at which the same or similar goods are available in the area, such disparity will be considered prima facie evidence that a price is unconscionable.7 Similarly, Florida’s statute bars “unconscionable pricing” during declared states of emergency.8 If the amount being charged represents a “gross disparity” from the average price at which the product or service was sold in the usual course of business (or available in the “trade area”) during the 30 days immediately prior to a declaration of a state of emergency, it is considered prima facie evidence of “unconscionable pricing,” which constitutes an “unlawful act or practice.” 9 However, pricing is not considered unconscionable if the increase is attributable to additional costs incurred by the seller or is the result of national or international market trends.10 As with the New York statute, the Florida statute offers guidance, but the question of whether certain prices during an emergency are deemed “unconscionable” is ultimately left to the courts. Many state price-gouging laws are triggered only by a declaration of emergency in response to localized conditions. Thus, they will generally not apply after a declared emergency ends or in areas not directly affected by a particular emergency or natural disaster. However, at least two Gasoline Price Increases: Federal and State Authority to Limit “Price Gouging” Congressional Research Service 3 states have laws prohibiting excessive pricing that impose liability even without a declaration of any type of emergency. Maine law prohibits “unjust or unreasonable” profits in the sale, exchange, or handling of necessities, defined to include fuel.11 Michigan’s consumer protection act simply prohibits “charging the consumer a price that is grossly in excess of the price at which similar property or services are sold.” 12 Prohibitions of Price Increases Beyond a Certain Percentage In contrast to a general ban on “excessive” or “unconscionable” pricing, some state statutes leave less to the courts’ discretion and instead place limits on price increases of certain goods during emergencies. For example, California’s anti-price-gouging statute states that for a period of 30 days following the proclamation of a state of emergency by the President of the United States or the governor of California or the declaration of a local emergency by the relevant executive officer, it is unlawful to sell or offer certain goods and services (including emergency and medical supplies, building and transportation materials, fuel, etc.) at a price more than 10% higher than the price of the good prior to the proclamation of emergency.13 As a defense, a seller can show that the price increase was directly attributable to additional costs imposed on it by the supplier of the goods or additional costs for the labor and material used to provide the services.14 The prohibition lasts for 30 days from the date of issuance of the emergency proclamation.15 West Virginia has also adopted an anti-price-gouging measure based on caps to percentage increases in price during times of emergency. The West Virginia statute provides that upon a declaration of a state of emergency by the President of the United States, the governor, or the state legislature, it is unlawful to sell or offer to sell certain critical goods and services “for a price greater than ten percent above the price charged by that person for those goods and services on the tenth day immediately preceding the declaration of emergency.” 16 West Virginia also provides an exception for price increases attributable to increased costs on the seller imposed by the supplier or to added costs of providing the goods or services during the emergency.17 Some states use language barring “unconscionable” or “excessive” pricing in a manner similar to the state statutes described in the previous section but define these terms with hard caps instead of leaving their exact definition to the discretion of the courts. For example, the Alabama statute makes it unlawful for anyone to “impose unconscionable prices for the sale or rental of any commodity or rental facility during the period of a declared state of emergency.” 18 However, it provides that prima facie evidence of unconscionable pricing exists “if any person, during a state of emergency declared pursuant to the powers granted to the Governor, charges a price that exceeds, by an amount equal to or in excess of 25%, the average price at which the same or similar commodity or rental facility was obtainable in the affected area during the last 30 days Gasoline Price Increases: Federal and State Authority to Limit “Price Gouging” Congressional Research Service 4 immediately prior to the declared state of emergency.” 19 As with most other state price-gouging statutes, the statute does not apply if the price increase is attributable to reasonable costs incurred by the seller in connection with the rental or sale of the commodity.20 A few other states have imposed caps on price increases during emergencies even tighter than the one imposed by the aforementioned statutes. Some state statutes ban any price increase during periods of emergency. For example, in Georgia, it is considered an “unlawful, unfair and deceptive trade practice” for anyone doing business in an areas where a state of emergency has been declared to sell or offer for sale at retail any goods or services identified by the Governor in the declaration of the state of emergency necessary to preserve, protect, or sustain the life, health, or safety of persons or their property at a price higher than the price at which such goods were sold or offered for sale immediately prior to the declaration of a state of emergency.21 As with other state gouging statutes, the Georgia statute provides an exception for price increases that reflect “an increase in cost of the goods or services to the person selling the goods or services or an increase in the cost of transporting the goods or services into the area.”","This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. Give your answer in bullet points with the proper noun and key word bolded, followed by a short explanation with no, unasked for information.
+
+EVIDENCE:
+State Price-Gouging Laws Many states have enacted some type of prohibition or limitation on price increases during declared emergencies. Generally, these state laws take one of two basic forms. Some states prohibit the sale of goods and services at what are deemed to be “unconscionable” or “excessive” prices in the area and during the period of a designated emergency. Other states have established a maximum permissible increase in the prices for retail goods during a designated emergency period. Many statutes of both kinds include an exemption if price increases are the result of increased costs incurred for procuring the goods or services in question. Gasoline Price Increases: Federal and State Authority to Limit “Price Gouging” Congressional Research Service 2 Examples of State Statutes Prohibitions on “Excessive” or “Unconscionable” Pricing One common way that states address price gouging is to ban prices that are considered to be (for example) “excessive” or “unconscionable,” as defined in the statute or left to the discretion of the courts. These statutes generally bar such increases during designated emergency periods. The process for emergency designation is also usually defined in the statute. Frequently, the state’s governor is granted authority to designate an emergency during which the price limitations are in place. For example, the New York statute provides that: During any abnormal disruption of the market for consumer goods and services vital and necessary for the health, safety and welfare of consumers, no party within the chain of distribution of such consumer goods or services or both shall sell or offer to sell any such goods or services or both for an amount which represents an unconscionably excessive price.5 The statute defines abnormal disruption of the market as a real or threatened change to the market “resulting from stress of weather, convulsion of nature, failure or shortage of electric power or other source of energy, strike, civil disorder, war, military action, national or local emergency … which results in the declaration of a state of emergency by the governor.”6 The statute provides only for criminal liability and leaves the ultimate decision as to whether a price is “unconscionably excessive” to prosecutors (for charging purposes) and to the courts, with no separate cause of action created for private parties. As guidance in such cases, the statute notes that if there is a “gross disparity” between the price during the disruption and the price prior to the disruption, or if the price “grossly exceeds” the price at which the same or similar goods are available in the area, such disparity will be considered prima facie evidence that a price is unconscionable.7 Similarly, Florida’s statute bars “unconscionable pricing” during declared states of emergency.8 If the amount being charged represents a “gross disparity” from the average price at which the product or service was sold in the usual course of business (or available in the “trade area”) during the 30 days immediately prior to a declaration of a state of emergency, it is considered prima facie evidence of “unconscionable pricing,” which constitutes an “unlawful act or practice.” 9 However, pricing is not considered unconscionable if the increase is attributable to additional costs incurred by the seller or is the result of national or international market trends.10 As with the New York statute, the Florida statute offers guidance, but the question of whether certain prices during an emergency are deemed “unconscionable” is ultimately left to the courts. Many state price-gouging laws are triggered only by a declaration of emergency in response to localized conditions. Thus, they will generally not apply after a declared emergency ends or in areas not directly affected by a particular emergency or natural disaster. However, at least two Gasoline Price Increases: Federal and State Authority to Limit “Price Gouging” Congressional Research Service 3 states have laws prohibiting excessive pricing that impose liability even without a declaration of any type of emergency. Maine law prohibits “unjust or unreasonable” profits in the sale, exchange, or handling of necessities, defined to include fuel.11 Michigan’s consumer protection act simply prohibits “charging the consumer a price that is grossly in excess of the price at which similar property or services are sold.” 12 Prohibitions of Price Increases Beyond a Certain Percentage In contrast to a general ban on “excessive” or “unconscionable” pricing, some state statutes leave less to the courts’ discretion and instead place limits on price increases of certain goods during emergencies. For example, California’s anti-price-gouging statute states that for a period of 30 days following the proclamation of a state of emergency by the President of the United States or the governor of California or the declaration of a local emergency by the relevant executive officer, it is unlawful to sell or offer certain goods and services (including emergency and medical supplies, building and transportation materials, fuel, etc.) at a price more than 10% higher than the price of the good prior to the proclamation of emergency.13 As a defense, a seller can show that the price increase was directly attributable to additional costs imposed on it by the supplier of the goods or additional costs for the labor and material used to provide the services.14 The prohibition lasts for 30 days from the date of issuance of the emergency proclamation.15 West Virginia has also adopted an anti-price-gouging measure based on caps to percentage increases in price during times of emergency. The West Virginia statute provides that upon a declaration of a state of emergency by the President of the United States, the governor, or the state legislature, it is unlawful to sell or offer to sell certain critical goods and services “for a price greater than ten percent above the price charged by that person for those goods and services on the tenth day immediately preceding the declaration of emergency.” 16 West Virginia also provides an exception for price increases attributable to increased costs on the seller imposed by the supplier or to added costs of providing the goods or services during the emergency.17 Some states use language barring “unconscionable” or “excessive” pricing in a manner similar to the state statutes described in the previous section but define these terms with hard caps instead of leaving their exact definition to the discretion of the courts. For example, the Alabama statute makes it unlawful for anyone to “impose unconscionable prices for the sale or rental of any commodity or rental facility during the period of a declared state of emergency.” 18 However, it provides that prima facie evidence of unconscionable pricing exists “if any person, during a state of emergency declared pursuant to the powers granted to the Governor, charges a price that exceeds, by an amount equal to or in excess of 25%, the average price at which the same or similar commodity or rental facility was obtainable in the affected area during the last 30 days Gasoline Price Increases: Federal and State Authority to Limit “Price Gouging” Congressional Research Service 4 immediately prior to the declared state of emergency.” 19 As with most other state price-gouging statutes, the statute does not apply if the price increase is attributable to reasonable costs incurred by the seller in connection with the rental or sale of the commodity.20 A few other states have imposed caps on price increases during emergencies even tighter than the one imposed by the aforementioned statutes. Some state statutes ban any price increase during periods of emergency. For example, in Georgia, it is considered an “unlawful, unfair and deceptive trade practice” for anyone doing business in an areas where a state of emergency has been declared to sell or offer for sale at retail any goods or services identified by the Governor in the declaration of the state of emergency necessary to preserve, protect, or sustain the life, health, or safety of persons or their property at a price higher than the price at which such goods were sold or offered for sale immediately prior to the declaration of a state of emergency.21 As with other state gouging statutes, the Georgia statute provides an exception for price increases that reflect “an increase in cost of the goods or services to the person selling the goods or services or an increase in the cost of transporting the goods or services into the area.”
+
+USER:
+What states, mentioned in the text, have enacted some type of prohibition or restriction on price rises during proclaimed emergencies and specifically mention the key word,""fuel"", by name.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,52,28,1375,,795
+- Refer only to the context document in your answer. Do not employ any outside knowledge. - Summarise this into one paragraph - Use less than 200 words.,"According to the above document only, How does puppy socialization classes correlate with adult dog behavior?","**The Importance of Puppy Socialization** The current literature and common consensus among dog behavior experts is that lack of appropriate socialization during the sensitive period, along with lack of appropriate ongoing socialization during the dog’s life, plays a large role in whether or not the dog develops behavioral problems. Lack of appropriate early socialization to a range of people and other animals, as well as different environments, can result in adult dogs that exhibit problematic behaviors, such as undesirable aggression and fearfulness. Lack of exposure to animals that will be forming part of the puppy’s social group as an adult, which may include other dogs, different animal species, and people and children, can result in an individual that is unable to form strong social bonds with these groups. In one study, social and environmental exposure administered to puppies was found to be positively correlated with measures of sociability, and negatively correlated with measures of fear and aggression. Socialization with other animal species was negatively associated with inappropriate predatory behavior, and dogs that attended puppy preschool were found to be less fearful, less aggressive, and more social. Another study, however, highlights the importance of appropriate types of socialization: adult dogs with a fear of noises, such as thunder and fireworks, were more likely to have experienced thunder when they were younger than 4 months of age. This evidence indicates that early experiences play an important part in shaping behavior. If done in an appropriate manner, these experiences will help to reduce the likelihood of problematic behavior occurring in future. However, if this process is not well controlled, it could result in an increased likelihood of undesirable adult behavior. A 1999 study examined the effects of socialization on the ability to play search games with humans, an important element of search and rescue dog training. Dogs that had not been exposed to humans before they were 1 year of age could never learn how to play a searching game, while pet dogs with human exposure were able to learn how to play. However, one of the human-deprived dogs had lived with humans until it was 4 months old before being removed from the human environment, and it performed better than the other human-deprived dogs in this study. While the performance of a single dog should not lead to generalizations, this study demonstrates the positive long-term effects of early socialization to humans, possibly even if a dog is later removed from human environments for an extended period of time. A study conducted by Appleby et al investigated whether there was a relationship between the display of aggressive and avoidance behavior and dogs’ experiences during the first 6 months of their life. Their results indicated significant differences in aggression toward unfamiliar people and avoidance behavior between dogs who were raised in kennels, a barn, or a shed, compared with a domestic setting (ie, in the breeder’s home). This result points to the importance of environment in the socialization process. Breeders who raise a litter of puppies in a kennel, barn, or shed should be able to provide adequate socialization to the puppies; however, they may have to make a special effort to ensure that these experiences occur. The relationship between socialization practice and the prevalence of undesirable behaviors in adult dogs is important not just because these behaviors are annoying to owners. Undesirable behaviors may also signal the presence of other underlying issues that may impact negatively on the welfare of the dog. They may result from an underlying physical health problem, for example, or confusion about what behaviors are expected by the owner, and/or poor mental health in the dog. This can become a vicious cycle; a poorly socialized dog does not understand what its owner expects and may receive conflicting or confusing messages from the owner, which causes it to become stressed, resulting in more undesirable behavior. If the owner does not then make his/her expectations for the dog known in a very clear way or lower these expectations in accordance with the dog’s ability to meet them, then this stress continues, causing even further undesirable behavior. It is important that owners and veterinarians take behavioral problems seriously; regardless of whether or not they escalate to the point where the owner considers relinquishing the dog to a shelter, the dog’s welfare may be compromised if it is displaying problematic behaviors. There are breed differences in the development of stimulus response, according to Scott and Fuller’s seminal work in the 1960s. For example, a larger percentage of Fox terriers and Beagles had developed a startle response at 3 weeks of age than Cocker spaniels and Shetland Sheepdogs. However, by 4 weeks, all dogs of all breeds studied had developed the startle response. Furthermore, Coppinger and Coppinger state that different socialization experiences will have varying effects on certain dog breeds. They exposed a Labrador retriever puppy to livestock, in order to determine whether it would be possible to turn her into a livestock guarding dog. Unlike a dog that is bred specifically for that purpose, the Labrador never showed intense protective behaviors toward the livestock. Therefore, it is likely that breeding specifically for certain traits does influence ideal socialization practices and amounts. Perhaps there are sex differences in socialization practice needs, based on adult behavioral outcomes. Male dogs are more likely to be rated by authorities as expressing dominant and aggressive behaviors, and female dogs are more likely to be perceived as more obedient, easier to housetrain, and more demanding of affection. However, to our knowledge, sex differences in socialization have not been examined, even though Scott and Fuller did explain that, at any given moment in a dog’s development, males are likely to be physically larger than females, and size does affect behavior. They also state, however, that growth curve differences between the sexes do not necessarily correlate with differences in the rate of learning, so it is possible that there is no discernible sex difference in socialization needs. The results of available studies provide strong evidence of a link between inadequate socialization during puppy-hood and undesirable adult dog behaviors. What they do not explain, however, is how much socialization is optimal. Having no socialization has very clear negative impacts, so there must be a minimum amount required, but how much this actually consists of is not known. Also unknown is whether there is a maximum amount of socialization required, beyond which any extra socialization is unnecessary or even detrimental. These studies also do not explain why there is a link between puppy socialization and adult behavior. One possible reason is that the socialization periods during puppyhood are like biological windows that open and close at certain times, and an animal that does not have necessary experiences during those windows misses the opportunity forever. More likely is that there are periods where a puppy is developmentally more sensitive/receptive to certain experiences, and that learning plays a critical role in this process. Animals can only learn about things to which they are introduced, and they may do so more readily during a sensitive period. Therefore, a lack of exposure to a particular object or type of animal at the correct developmental time necessarily means that dogs do not have the chance to learn, or take longer to learn, whether that object or animal is harmless or dangerous. In addition, since mild stress seems to be an integral part of the socialization and exposure process, a lack of mild desensitization-related stress early in life may have negative neurological effects on the dog and make it incapable of handling any amount of stress later in life. Most likely, a combination of learning via desensitization and stress inoculation acts to prevent the behavioral problems noted in adult dogs without adequate socialization experiences. Despite the general agreement that puppy socialization practices are crucial in the development of normal social relationships and psychological health in adult dogs, the evidence is less clear on the benefit of puppy classes specifically. Many studies about the effects of puppy classes on adult dog behavior have been epidemiological in nature, meaning that they correlate the behavior of adult dogs with various demographic, owner, and environmental factors. This method is useful in establishing which factors have a stronger predictive value on the outcome, but there is some debate as to whether they can truly determine causal relationships. This can limit their utility in evaluating whether a single factor, such as attendance at a puppy class, has a clear effect on adult dog behavior. Nonetheless, because controlled experimental studies on specific populations of puppies are rare, epidemiological studies are probably the best available alternative in understanding whether there is any relationship between puppy classes and adult dog behavior. Another study showed that attendance at puppy classes reduced the risk of aggression toward unfamiliar people. As with the study by Duxbury et al, there were many other factors predicting less aggressive behavior, including being a desexed female, having a female owner, attending ring-craft classes, and positive reinforcement training methods. A further study showed a similar result: attendance at puppy socialization classes was associated with improved positive social behaviors, and fewer behavioral problems, as adults. Other factors that predicted these outcomes were being a male dog, a higher level of environmental and social interactions overall, and remaining in the litter longer. Taken together, the results of these studies suggest that socialization classes are one piece of the puzzle in developing adult dog behavior. Since these studies sometimes show contradictory results (eg, male dogs showed fewer behavioral problems in one study and desexed females showed less aggression in another), it is possible that the samples, or unaccounted for variables, have affected the results of these epidemiological studies. Another reason why puppy socialization classes do not always appear to singularly affect adult dog behavior could relate to the ways in which some classes are run. In most countries, there are no accreditation procedures in place and puppy classes may be run by people who lack the skills or experience necessary for this purpose. Perhaps many puppies simply find the experience too stressful to receive a noticeable benefit. Although mild stress is a component of socialization, it is important not to stress puppies too much, or else the benefits will not be conferred.","{QUERY} According to the above document only, How does puppy socialization classes correlate with adult dog behavior? {TASK DESCRIPTION} - Refer only to the context document in your answer. Do not employ any outside knowledge. - Summarise this into one paragraph - Use less than 200 words. {TEXT PASSAGE} **The Importance of Puppy Socialization** The current literature and common consensus among dog behavior experts is that lack of appropriate socialization during the sensitive period, along with lack of appropriate ongoing socialization during the dog’s life, plays a large role in whether or not the dog develops behavioral problems. Lack of appropriate early socialization to a range of people and other animals, as well as different environments, can result in adult dogs that exhibit problematic behaviors, such as undesirable aggression and fearfulness. Lack of exposure to animals that will be forming part of the puppy’s social group as an adult, which may include other dogs, different animal species, and people and children, can result in an individual that is unable to form strong social bonds with these groups. In one study, social and environmental exposure administered to puppies was found to be positively correlated with measures of sociability, and negatively correlated with measures of fear and aggression. Socialization with other animal species was negatively associated with inappropriate predatory behavior, and dogs that attended puppy preschool were found to be less fearful, less aggressive, and more social. Another study, however, highlights the importance of appropriate types of socialization: adult dogs with a fear of noises, such as thunder and fireworks, were more likely to have experienced thunder when they were younger than 4 months of age. This evidence indicates that early experiences play an important part in shaping behavior. If done in an appropriate manner, these experiences will help to reduce the likelihood of problematic behavior occurring in future. However, if this process is not well controlled, it could result in an increased likelihood of undesirable adult behavior. A 1999 study examined the effects of socialization on the ability to play search games with humans, an important element of search and rescue dog training. Dogs that had not been exposed to humans before they were 1 year of age could never learn how to play a searching game, while pet dogs with human exposure were able to learn how to play. However, one of the human-deprived dogs had lived with humans until it was 4 months old before being removed from the human environment, and it performed better than the other human-deprived dogs in this study. While the performance of a single dog should not lead to generalizations, this study demonstrates the positive long-term effects of early socialization to humans, possibly even if a dog is later removed from human environments for an extended period of time. A study conducted by Appleby et al investigated whether there was a relationship between the display of aggressive and avoidance behavior and dogs’ experiences during the first 6 months of their life. Their results indicated significant differences in aggression toward unfamiliar people and avoidance behavior between dogs who were raised in kennels, a barn, or a shed, compared with a domestic setting (ie, in the breeder’s home). This result points to the importance of environment in the socialization process. Breeders who raise a litter of puppies in a kennel, barn, or shed should be able to provide adequate socialization to the puppies; however, they may have to make a special effort to ensure that these experiences occur. The relationship between socialization practice and the prevalence of undesirable behaviors in adult dogs is important not just because these behaviors are annoying to owners. Undesirable behaviors may also signal the presence of other underlying issues that may impact negatively on the welfare of the dog. They may result from an underlying physical health problem, for example, or confusion about what behaviors are expected by the owner, and/or poor mental health in the dog. This can become a vicious cycle; a poorly socialized dog does not understand what its owner expects and may receive conflicting or confusing messages from the owner, which causes it to become stressed, resulting in more undesirable behavior. If the owner does not then make his/her expectations for the dog known in a very clear way or lower these expectations in accordance with the dog’s ability to meet them, then this stress continues, causing even further undesirable behavior. It is important that owners and veterinarians take behavioral problems seriously; regardless of whether or not they escalate to the point where the owner considers relinquishing the dog to a shelter, the dog’s welfare may be compromised if it is displaying problematic behaviors. There are breed differences in the development of stimulus response, according to Scott and Fuller’s seminal work in the 1960s. For example, a larger percentage of Fox terriers and Beagles had developed a startle response at 3 weeks of age than Cocker spaniels and Shetland Sheepdogs. However, by 4 weeks, all dogs of all breeds studied had developed the startle response. Furthermore, Coppinger and Coppinger state that different socialization experiences will have varying effects on certain dog breeds. They exposed a Labrador retriever puppy to livestock, in order to determine whether it would be possible to turn her into a livestock guarding dog. Unlike a dog that is bred specifically for that purpose, the Labrador never showed intense protective behaviors toward the livestock. Therefore, it is likely that breeding specifically for certain traits does influence ideal socialization practices and amounts. Perhaps there are sex differences in socialization practice needs, based on adult behavioral outcomes. Male dogs are more likely to be rated by authorities as expressing dominant and aggressive behaviors, and female dogs are more likely to be perceived as more obedient, easier to housetrain, and more demanding of affection. However, to our knowledge, sex differences in socialization have not been examined, even though Scott and Fuller did explain that, at any given moment in a dog’s development, males are likely to be physically larger than females, and size does affect behavior. They also state, however, that growth curve differences between the sexes do not necessarily correlate with differences in the rate of learning, so it is possible that there is no discernible sex difference in socialization needs. The results of available studies provide strong evidence of a link between inadequate socialization during puppy-hood and undesirable adult dog behaviors. What they do not explain, however, is how much socialization is optimal. Having no socialization has very clear negative impacts, so there must be a minimum amount required, but how much this actually consists of is not known. Also unknown is whether there is a maximum amount of socialization required, beyond which any extra socialization is unnecessary or even detrimental. These studies also do not explain why there is a link between puppy socialization and adult behavior. One possible reason is that the socialization periods during puppyhood are like biological windows that open and close at certain times, and an animal that does not have necessary experiences during those windows misses the opportunity forever. More likely is that there are periods where a puppy is developmentally more sensitive/receptive to certain experiences, and that learning plays a critical role in this process. Animals can only learn about things to which they are introduced, and they may do so more readily during a sensitive period. Therefore, a lack of exposure to a particular object or type of animal at the correct developmental time necessarily means that dogs do not have the chance to learn, or take longer to learn, whether that object or animal is harmless or dangerous. In addition, since mild stress seems to be an integral part of the socialization and exposure process, a lack of mild desensitization-related stress early in life may have negative neurological effects on the dog and make it incapable of handling any amount of stress later in life. Most likely, a combination of learning via desensitization and stress inoculation acts to prevent the behavioral problems noted in adult dogs without adequate socialization experiences. Despite the general agreement that puppy socialization practices are crucial in the development of normal social relationships and psychological health in adult dogs, the evidence is less clear on the benefit of puppy classes specifically. Many studies about the effects of puppy classes on adult dog behavior have been epidemiological in nature, meaning that they correlate the behavior of adult dogs with various demographic, owner, and environmental factors. This method is useful in establishing which factors have a stronger predictive value on the outcome, but there is some debate as to whether they can truly determine causal relationships. This can limit their utility in evaluating whether a single factor, such as attendance at a puppy class, has a clear effect on adult dog behavior. Nonetheless, because controlled experimental studies on specific populations of puppies are rare, epidemiological studies are probably the best available alternative in understanding whether there is any relationship between puppy classes and adult dog behavior. Another study showed that attendance at puppy classes reduced the risk of aggression toward unfamiliar people. As with the study by Duxbury et al, there were many other factors predicting less aggressive behavior, including being a desexed female, having a female owner, attending ring-craft classes, and positive reinforcement training methods. A further study showed a similar result: attendance at puppy socialization classes was associated with improved positive social behaviors, and fewer behavioral problems, as adults. Other factors that predicted these outcomes were being a male dog, a higher level of environmental and social interactions overall, and remaining in the litter longer. Taken together, the results of these studies suggest that socialization classes are one piece of the puzzle in developing adult dog behavior. Since these studies sometimes show contradictory results (eg, male dogs showed fewer behavioral problems in one study and desexed females showed less aggression in another), it is possible that the samples, or unaccounted for variables, have affected the results of these epidemiological studies. Another reason why puppy socialization classes do not always appear to singularly affect adult dog behavior could relate to the ways in which some classes are run. In most countries, there are no accreditation procedures in place and puppy classes may be run by people who lack the skills or experience necessary for this purpose. Perhaps many puppies simply find the experience too stressful to receive a noticeable benefit. Although mild stress is a component of socialization, it is important not to stress puppies too much, or else the benefits will not be conferred.","- Refer only to the context document in your answer. Do not employ any outside knowledge. - Summarise this into one paragraph - Use less than 200 words.
+
+EVIDENCE:
+**The Importance of Puppy Socialization** The current literature and common consensus among dog behavior experts is that lack of appropriate socialization during the sensitive period, along with lack of appropriate ongoing socialization during the dog’s life, plays a large role in whether or not the dog develops behavioral problems. Lack of appropriate early socialization to a range of people and other animals, as well as different environments, can result in adult dogs that exhibit problematic behaviors, such as undesirable aggression and fearfulness. Lack of exposure to animals that will be forming part of the puppy’s social group as an adult, which may include other dogs, different animal species, and people and children, can result in an individual that is unable to form strong social bonds with these groups. In one study, social and environmental exposure administered to puppies was found to be positively correlated with measures of sociability, and negatively correlated with measures of fear and aggression. Socialization with other animal species was negatively associated with inappropriate predatory behavior, and dogs that attended puppy preschool were found to be less fearful, less aggressive, and more social. Another study, however, highlights the importance of appropriate types of socialization: adult dogs with a fear of noises, such as thunder and fireworks, were more likely to have experienced thunder when they were younger than 4 months of age. This evidence indicates that early experiences play an important part in shaping behavior. If done in an appropriate manner, these experiences will help to reduce the likelihood of problematic behavior occurring in future. However, if this process is not well controlled, it could result in an increased likelihood of undesirable adult behavior. A 1999 study examined the effects of socialization on the ability to play search games with humans, an important element of search and rescue dog training. Dogs that had not been exposed to humans before they were 1 year of age could never learn how to play a searching game, while pet dogs with human exposure were able to learn how to play. However, one of the human-deprived dogs had lived with humans until it was 4 months old before being removed from the human environment, and it performed better than the other human-deprived dogs in this study. While the performance of a single dog should not lead to generalizations, this study demonstrates the positive long-term effects of early socialization to humans, possibly even if a dog is later removed from human environments for an extended period of time. A study conducted by Appleby et al investigated whether there was a relationship between the display of aggressive and avoidance behavior and dogs’ experiences during the first 6 months of their life. Their results indicated significant differences in aggression toward unfamiliar people and avoidance behavior between dogs who were raised in kennels, a barn, or a shed, compared with a domestic setting (ie, in the breeder’s home). This result points to the importance of environment in the socialization process. Breeders who raise a litter of puppies in a kennel, barn, or shed should be able to provide adequate socialization to the puppies; however, they may have to make a special effort to ensure that these experiences occur. The relationship between socialization practice and the prevalence of undesirable behaviors in adult dogs is important not just because these behaviors are annoying to owners. Undesirable behaviors may also signal the presence of other underlying issues that may impact negatively on the welfare of the dog. They may result from an underlying physical health problem, for example, or confusion about what behaviors are expected by the owner, and/or poor mental health in the dog. This can become a vicious cycle; a poorly socialized dog does not understand what its owner expects and may receive conflicting or confusing messages from the owner, which causes it to become stressed, resulting in more undesirable behavior. If the owner does not then make his/her expectations for the dog known in a very clear way or lower these expectations in accordance with the dog’s ability to meet them, then this stress continues, causing even further undesirable behavior. It is important that owners and veterinarians take behavioral problems seriously; regardless of whether or not they escalate to the point where the owner considers relinquishing the dog to a shelter, the dog’s welfare may be compromised if it is displaying problematic behaviors. There are breed differences in the development of stimulus response, according to Scott and Fuller’s seminal work in the 1960s. For example, a larger percentage of Fox terriers and Beagles had developed a startle response at 3 weeks of age than Cocker spaniels and Shetland Sheepdogs. However, by 4 weeks, all dogs of all breeds studied had developed the startle response. Furthermore, Coppinger and Coppinger state that different socialization experiences will have varying effects on certain dog breeds. They exposed a Labrador retriever puppy to livestock, in order to determine whether it would be possible to turn her into a livestock guarding dog. Unlike a dog that is bred specifically for that purpose, the Labrador never showed intense protective behaviors toward the livestock. Therefore, it is likely that breeding specifically for certain traits does influence ideal socialization practices and amounts. Perhaps there are sex differences in socialization practice needs, based on adult behavioral outcomes. Male dogs are more likely to be rated by authorities as expressing dominant and aggressive behaviors, and female dogs are more likely to be perceived as more obedient, easier to housetrain, and more demanding of affection. However, to our knowledge, sex differences in socialization have not been examined, even though Scott and Fuller did explain that, at any given moment in a dog’s development, males are likely to be physically larger than females, and size does affect behavior. They also state, however, that growth curve differences between the sexes do not necessarily correlate with differences in the rate of learning, so it is possible that there is no discernible sex difference in socialization needs. The results of available studies provide strong evidence of a link between inadequate socialization during puppy-hood and undesirable adult dog behaviors. What they do not explain, however, is how much socialization is optimal. Having no socialization has very clear negative impacts, so there must be a minimum amount required, but how much this actually consists of is not known. Also unknown is whether there is a maximum amount of socialization required, beyond which any extra socialization is unnecessary or even detrimental. These studies also do not explain why there is a link between puppy socialization and adult behavior. One possible reason is that the socialization periods during puppyhood are like biological windows that open and close at certain times, and an animal that does not have necessary experiences during those windows misses the opportunity forever. More likely is that there are periods where a puppy is developmentally more sensitive/receptive to certain experiences, and that learning plays a critical role in this process. Animals can only learn about things to which they are introduced, and they may do so more readily during a sensitive period. Therefore, a lack of exposure to a particular object or type of animal at the correct developmental time necessarily means that dogs do not have the chance to learn, or take longer to learn, whether that object or animal is harmless or dangerous. In addition, since mild stress seems to be an integral part of the socialization and exposure process, a lack of mild desensitization-related stress early in life may have negative neurological effects on the dog and make it incapable of handling any amount of stress later in life. Most likely, a combination of learning via desensitization and stress inoculation acts to prevent the behavioral problems noted in adult dogs without adequate socialization experiences. Despite the general agreement that puppy socialization practices are crucial in the development of normal social relationships and psychological health in adult dogs, the evidence is less clear on the benefit of puppy classes specifically. Many studies about the effects of puppy classes on adult dog behavior have been epidemiological in nature, meaning that they correlate the behavior of adult dogs with various demographic, owner, and environmental factors. This method is useful in establishing which factors have a stronger predictive value on the outcome, but there is some debate as to whether they can truly determine causal relationships. This can limit their utility in evaluating whether a single factor, such as attendance at a puppy class, has a clear effect on adult dog behavior. Nonetheless, because controlled experimental studies on specific populations of puppies are rare, epidemiological studies are probably the best available alternative in understanding whether there is any relationship between puppy classes and adult dog behavior. Another study showed that attendance at puppy classes reduced the risk of aggression toward unfamiliar people. As with the study by Duxbury et al, there were many other factors predicting less aggressive behavior, including being a desexed female, having a female owner, attending ring-craft classes, and positive reinforcement training methods. A further study showed a similar result: attendance at puppy socialization classes was associated with improved positive social behaviors, and fewer behavioral problems, as adults. Other factors that predicted these outcomes were being a male dog, a higher level of environmental and social interactions overall, and remaining in the litter longer. Taken together, the results of these studies suggest that socialization classes are one piece of the puzzle in developing adult dog behavior. Since these studies sometimes show contradictory results (eg, male dogs showed fewer behavioral problems in one study and desexed females showed less aggression in another), it is possible that the samples, or unaccounted for variables, have affected the results of these epidemiological studies. Another reason why puppy socialization classes do not always appear to singularly affect adult dog behavior could relate to the ways in which some classes are run. In most countries, there are no accreditation procedures in place and puppy classes may be run by people who lack the skills or experience necessary for this purpose. Perhaps many puppies simply find the experience too stressful to receive a noticeable benefit. Although mild stress is a component of socialization, it is important not to stress puppies too much, or else the benefits will not be conferred.
+
+USER:
+According to the above document only, How does puppy socialization classes correlate with adult dog behavior?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,28,16,1713,,402
+"""================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""","I'm working on a thesis related to AI in cybersecurity and came across Google's new AI Cyber Defense Initiative. I'm trying to understand how this initiative shifts the ""Defender's Dilemma"" in practical terms. Can AI really anticipate threats, and if so, wouldn't this create a new challenge of false positives or over-reliance on automated systems? Also, could the open-sourcing of Magika actually expose vulnerabilities, given it's now public? How does this balance with Google's push for collaboration and security transparency?","Google LLC today announced a new AI Cyber Defense Initiative and proposed a new policy and technology agenda aimed at harnessing the power of artificial intelligence to bolster cybersecurity defenses globally. The new initiative is designed to counteract evolving threats by leveraging AI’s capabilities to enhance threat detection, automate vulnerability management and improve incident response efficiency. Google argues that the main challenge in cybersecurity is that attackers need only one successful, novel threat to break through the best defenses. On the flip side, defenders need to deploy the best defenses at all times across increasingly complex digital terrain with no margin for error. Google calls this the “Defender’s Dilemma,” and there has never been a reliable way to tip that balance. This is where AI enters the picture. Google believes AI at scale can tackle the Defender’s Dilemma. AI can do so by allowing security professionals and defenders to scale up their work in threat detection and related cybersecurity defense requirements. The AI Cyber Defense initiative aims to employ AI not only to respond to threats but to anticipate and neutralize them before they can cause harm. The idea behind the initiative is that the traditional reactive cybersecurity model is no longer sufficient in a world where cyberthreats are becoming increasingly sophisticated and pervasive. The new initiative includes deploying AI-driven algorithms designed to identify and analyze patterns indicative of cyber threats. Using data generated across its global network, Google will train AI systems to learn from the full range of threats and teach them to adapt to new tactics employed by cybercriminals. As part of the initiative, Google is also using AI to drive significant advances in vulnerability management. The idea is that by identifying vulnerabilities within software and systems, AI can significantly reduce the window of opportunity for attackers to exploit these weaknesses. Thrown into the mix is AI’s ability to suggest and implement fixes to vulnerabilities, streaming the patching process and, in doing so, further reducing the risk of a breach. The initiative further outlines the use of AI in incident response and automates the analysis of indices to identify the source, method and extent of an attack. Google is calling for a collaborative approach to recognizing the global nature of cyberthreats and calls for partnerships between industries and governments to share intelligence, best practices and advancements in AI-driven security measures. As part of the program, Google is expanding its Google.org Cybersecurity Seminars Program to cover all of Europe. Finally, Google announced today that it’s open-sourcing Magika, a new, AI-powered tool to aid defenders through file type identification, essential for detecting malware. Magika is already used to help protect products, including Gmail, Drive and Safe Browsing and is used by Google’s VirusTotal team to foster a safer digital environment. Google says Magika outperforms conventional file identification methods, providing an overall 30% accuracy boost and up to 95% higher precision on traditionally hard-to-identify but potentially problematic content such as VBA, JavaScript and Powershell. “The AI revolution is already underway,” Google concludes in a blog post on the announcements. “While people rightly applaud the promise of new medicines and scientific breakthroughs, we’re also excited about AI’s potential to solve generational security challenges while bringing us close to the safe, secure and trusted digital world we deserve.”","""================ <TEXT PASSAGE> ======= Google LLC today announced a new AI Cyber Defense Initiative and proposed a new policy and technology agenda aimed at harnessing the power of artificial intelligence to bolster cybersecurity defenses globally. The new initiative is designed to counteract evolving threats by leveraging AI’s capabilities to enhance threat detection, automate vulnerability management and improve incident response efficiency. Google argues that the main challenge in cybersecurity is that attackers need only one successful, novel threat to break through the best defenses. On the flip side, defenders need to deploy the best defenses at all times across increasingly complex digital terrain with no margin for error. Google calls this the “Defender’s Dilemma,” and there has never been a reliable way to tip that balance. This is where AI enters the picture. Google believes AI at scale can tackle the Defender’s Dilemma. AI can do so by allowing security professionals and defenders to scale up their work in threat detection and related cybersecurity defense requirements. The AI Cyber Defense initiative aims to employ AI not only to respond to threats but to anticipate and neutralize them before they can cause harm. The idea behind the initiative is that the traditional reactive cybersecurity model is no longer sufficient in a world where cyberthreats are becoming increasingly sophisticated and pervasive. The new initiative includes deploying AI-driven algorithms designed to identify and analyze patterns indicative of cyber threats. Using data generated across its global network, Google will train AI systems to learn from the full range of threats and teach them to adapt to new tactics employed by cybercriminals. As part of the initiative, Google is also using AI to drive significant advances in vulnerability management. The idea is that by identifying vulnerabilities within software and systems, AI can significantly reduce the window of opportunity for attackers to exploit these weaknesses. Thrown into the mix is AI’s ability to suggest and implement fixes to vulnerabilities, streaming the patching process and, in doing so, further reducing the risk of a breach. The initiative further outlines the use of AI in incident response and automates the analysis of indices to identify the source, method and extent of an attack. Google is calling for a collaborative approach to recognizing the global nature of cyberthreats and calls for partnerships between industries and governments to share intelligence, best practices and advancements in AI-driven security measures. As part of the program, Google is expanding its Google.org Cybersecurity Seminars Program to cover all of Europe. Finally, Google announced today that it’s open-sourcing Magika, a new, AI-powered tool to aid defenders through file type identification, essential for detecting malware. Magika is already used to help protect products, including Gmail, Drive and Safe Browsing and is used by Google’s VirusTotal team to foster a safer digital environment. Google says Magika outperforms conventional file identification methods, providing an overall 30% accuracy boost and up to 95% higher precision on traditionally hard-to-identify but potentially problematic content such as VBA, JavaScript and Powershell. “The AI revolution is already underway,” Google concludes in a blog post on the announcements. “While people rightly applaud the promise of new medicines and scientific breakthroughs, we’re also excited about AI’s potential to solve generational security challenges while bringing us close to the safe, secure and trusted digital world we deserve.” https://siliconangle.com/2024/02/15/google-announces-ai-cyber-defense-initiative-enhance-global-cybersecurity/ ================ <QUESTION> ======= I'm working on a thesis related to AI in cybersecurity and came across Google's new AI Cyber Defense Initiative. I'm trying to understand how this initiative shifts the ""Defender's Dilemma"" in practical terms. Can AI really anticipate threats, and if so, wouldn't this create a new challenge of false positives or over-reliance on automated systems? Also, could the open-sourcing of Magika actually expose vulnerabilities, given it's now public? How does this balance with Google's push for collaboration and security transparency? ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""","""================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""
+
+EVIDENCE:
+Google LLC today announced a new AI Cyber Defense Initiative and proposed a new policy and technology agenda aimed at harnessing the power of artificial intelligence to bolster cybersecurity defenses globally. The new initiative is designed to counteract evolving threats by leveraging AI’s capabilities to enhance threat detection, automate vulnerability management and improve incident response efficiency. Google argues that the main challenge in cybersecurity is that attackers need only one successful, novel threat to break through the best defenses. On the flip side, defenders need to deploy the best defenses at all times across increasingly complex digital terrain with no margin for error. Google calls this the “Defender’s Dilemma,” and there has never been a reliable way to tip that balance. This is where AI enters the picture. Google believes AI at scale can tackle the Defender’s Dilemma. AI can do so by allowing security professionals and defenders to scale up their work in threat detection and related cybersecurity defense requirements. The AI Cyber Defense initiative aims to employ AI not only to respond to threats but to anticipate and neutralize them before they can cause harm. The idea behind the initiative is that the traditional reactive cybersecurity model is no longer sufficient in a world where cyberthreats are becoming increasingly sophisticated and pervasive. The new initiative includes deploying AI-driven algorithms designed to identify and analyze patterns indicative of cyber threats. Using data generated across its global network, Google will train AI systems to learn from the full range of threats and teach them to adapt to new tactics employed by cybercriminals. As part of the initiative, Google is also using AI to drive significant advances in vulnerability management. The idea is that by identifying vulnerabilities within software and systems, AI can significantly reduce the window of opportunity for attackers to exploit these weaknesses. Thrown into the mix is AI’s ability to suggest and implement fixes to vulnerabilities, streaming the patching process and, in doing so, further reducing the risk of a breach. The initiative further outlines the use of AI in incident response and automates the analysis of indices to identify the source, method and extent of an attack. Google is calling for a collaborative approach to recognizing the global nature of cyberthreats and calls for partnerships between industries and governments to share intelligence, best practices and advancements in AI-driven security measures. As part of the program, Google is expanding its Google.org Cybersecurity Seminars Program to cover all of Europe. Finally, Google announced today that it’s open-sourcing Magika, a new, AI-powered tool to aid defenders through file type identification, essential for detecting malware. Magika is already used to help protect products, including Gmail, Drive and Safe Browsing and is used by Google’s VirusTotal team to foster a safer digital environment. Google says Magika outperforms conventional file identification methods, providing an overall 30% accuracy boost and up to 95% higher precision on traditionally hard-to-identify but potentially problematic content such as VBA, JavaScript and Powershell. “The AI revolution is already underway,” Google concludes in a blog post on the announcements. “While people rightly applaud the promise of new medicines and scientific breakthroughs, we’re also excited about AI’s potential to solve generational security challenges while bringing us close to the safe, secure and trusted digital world we deserve.”
+
+USER:
+I'm working on a thesis related to AI in cybersecurity and came across Google's new AI Cyber Defense Initiative. I'm trying to understand how this initiative shifts the ""Defender's Dilemma"" in practical terms. Can AI really anticipate threats, and if so, wouldn't this create a new challenge of false positives or over-reliance on automated systems? Also, could the open-sourcing of Magika actually expose vulnerabilities, given it's now public? How does this balance with Google's push for collaboration and security transparency?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,49,80,546,,538
+[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.,What are the differences between antibacterial soap and regular soap? Which soap would you recommend as being better for preventing ilness? Answer in a minimum of 200 words.,"We’re exposed to millions of germs and bacteria every day. Many of us use antibacterial products to reduce our risk of getting sick or passing germs and bacteria onto others – but are they really more effective at killing the “bad guys” than regular soap? Eric Haugen, MD, UnityPoint Health helps us understand the pros and cons. Antibacterial Soap Antibacterial soap (also called antimicrobial or antiseptic) is any cleaning product with active antimicrobial ingredients added and not found in regular soaps. “An antimicrobial is something that works to kills microorganisms or stops their growth. For example, antibiotics and antibacterial soaps are used to fight bacteria,” Dr. Haugen says. Antibacterial soaps used to contain the chemical triclosan, but the U.S. Food and Drug Administration (FDA) banned it from household and health care products, because research suggests it may impact hormone levels and bacterial resistance. “While bacteria sound like a bad thing, it can actually be good for you. Your body needs bacteria to maintain a healthy, balanced environment on your skin,"" Dr. Haugen says. If you’re not sure if your soap is antibacterial, look for the word “antibacterial” on the label. The FDA says a Drug Fact Label is another sign a hand soap or body wash has antibacterial ingredients in it. Pros of Antibacterial Soap Antibacterial soap still kills bad bacteria, but it shouldn’t be overused. It's easy to find in most stores. Cons of Antibacterial Soap Overuse of antibacterial products can reduce the healthy bacteria on your skin. Added chemicals to antibacterial soaps can remove natural oils, making skin drier. Using antibacterial soap or hand sanitizer can make people think they do not have to wash their hands as thoroughly or frequently. Tips for Using Hand Sanitizer When soap and running water are unavailable, using hand sanitizers with at least 60 percent alcohol levels can be an effective alternative. “While hand sanitizer is nice in a pinch, it doesn’t eliminate all germs and should not be used when hands are visibly greasy or dirty,” Dr. Haugen says. The Centers for Disease Control and Prevention (CDC) recommends the following tips for children and adults using hand sanitizer: Apply enough hand sanitizer to cover all surfaces of the hands. Rub sanitizer on hands covering the tops, between fingers and fingertips. Keep rubbing until hands are dry or for about 20 seconds. Regular or Plain Soap Regular soap is designed to decrease water’s surface tension and lift dirt and oils off surfaces, so it can be easily rinsed away. Though regular soap does not contain added antibacterial chemicals, it's effective in getting rid of bacteria and other virus-causing germs. Pros of Regular Soap Antibacterial soaps are no more effective than regular soap and water for killing disease-causing germs. Regular soap tends to be less expensive than antibacterial soap and hand sanitizers. Regular soap won’t kill healthy bacteria on the skin’s surface. Cons of Regular Soap People may not wash hands thoroughly enough for regular soap to kill bad bacteria. You must look at the labels closely to find a regular soap. 5 Steps for Effective Handwashing “It’s more important for you to focus on your handwashing technique than what type of soap you use. Washing hands with soap (either antibacterial or regular) and water is one of the best ways to remove germs, avoid getting sick and prevent the spread of germs to others,” Dr. Haugen says. The CDC recommends these five tips for effective handwashing: Wet. Place your hands under running (cold or warm) water and add soap. Lather. Rub your hands together, making a soapy lather. Scrub. Wash the front and back of hands, between your fingers and under nails for at least 20 seconds or two rounds of the song “Happy Birthday.” Rinse. Place your hands well under running (cold or warm) water until the soap is gone. Dry. hands thoroughly with a clean towel or air dry them. Have little ones around? Read 6 ways to make handwashing fun for kids next.","[question] What are the differences between antibacterial soap and regular soap? Which soap would you recommend as being better for preventing ilness? Answer in a minimum of 200 words. ===================== [text] We’re exposed to millions of germs and bacteria every day. Many of us use antibacterial products to reduce our risk of getting sick or passing germs and bacteria onto others – but are they really more effective at killing the “bad guys” than regular soap? Eric Haugen, MD, UnityPoint Health helps us understand the pros and cons. Antibacterial Soap Antibacterial soap (also called antimicrobial or antiseptic) is any cleaning product with active antimicrobial ingredients added and not found in regular soaps. “An antimicrobial is something that works to kills microorganisms or stops their growth. For example, antibiotics and antibacterial soaps are used to fight bacteria,” Dr. Haugen says. Antibacterial soaps used to contain the chemical triclosan, but the U.S. Food and Drug Administration (FDA) banned it from household and health care products, because research suggests it may impact hormone levels and bacterial resistance. “While bacteria sound like a bad thing, it can actually be good for you. Your body needs bacteria to maintain a healthy, balanced environment on your skin,"" Dr. Haugen says. If you’re not sure if your soap is antibacterial, look for the word “antibacterial” on the label. The FDA says a Drug Fact Label is another sign a hand soap or body wash has antibacterial ingredients in it. Pros of Antibacterial Soap Antibacterial soap still kills bad bacteria, but it shouldn’t be overused. It's easy to find in most stores. Cons of Antibacterial Soap Overuse of antibacterial products can reduce the healthy bacteria on your skin. Added chemicals to antibacterial soaps can remove natural oils, making skin drier. Using antibacterial soap or hand sanitizer can make people think they do not have to wash their hands as thoroughly or frequently. Tips for Using Hand Sanitizer When soap and running water are unavailable, using hand sanitizers with at least 60 percent alcohol levels can be an effective alternative. “While hand sanitizer is nice in a pinch, it doesn’t eliminate all germs and should not be used when hands are visibly greasy or dirty,” Dr. Haugen says. The Centers for Disease Control and Prevention (CDC) recommends the following tips for children and adults using hand sanitizer: Apply enough hand sanitizer to cover all surfaces of the hands. Rub sanitizer on hands covering the tops, between fingers and fingertips. Keep rubbing until hands are dry or for about 20 seconds. Regular or Plain Soap Regular soap is designed to decrease water’s surface tension and lift dirt and oils off surfaces, so it can be easily rinsed away. Though regular soap does not contain added antibacterial chemicals, it's effective in getting rid of bacteria and other virus-causing germs. Pros of Regular Soap Antibacterial soaps are no more effective than regular soap and water for killing disease-causing germs. Regular soap tends to be less expensive than antibacterial soap and hand sanitizers. Regular soap won’t kill healthy bacteria on the skin’s surface. Cons of Regular Soap People may not wash hands thoroughly enough for regular soap to kill bad bacteria. You must look at the labels closely to find a regular soap. 5 Steps for Effective Handwashing “It’s more important for you to focus on your handwashing technique than what type of soap you use. Washing hands with soap (either antibacterial or regular) and water is one of the best ways to remove germs, avoid getting sick and prevent the spread of germs to others,” Dr. Haugen says. The CDC recommends these five tips for effective handwashing: Wet. Place your hands under running (cold or warm) water and add soap. Lather. Rub your hands together, making a soapy lather. Scrub. Wash the front and back of hands, between your fingers and under nails for at least 20 seconds or two rounds of the song “Happy Birthday.” Rinse. Place your hands well under running (cold or warm) water until the soap is gone. Dry. hands thoroughly with a clean towel or air dry them. Have little ones around? Read 6 ways to make handwashing fun for kids next. https://www.unitypoint.org/news-and-articles/antibacterial-soap-vs-regular-soap-which-one-is-better ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.","[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
+
+EVIDENCE:
+We’re exposed to millions of germs and bacteria every day. Many of us use antibacterial products to reduce our risk of getting sick or passing germs and bacteria onto others – but are they really more effective at killing the “bad guys” than regular soap? Eric Haugen, MD, UnityPoint Health helps us understand the pros and cons. Antibacterial Soap Antibacterial soap (also called antimicrobial or antiseptic) is any cleaning product with active antimicrobial ingredients added and not found in regular soaps. “An antimicrobial is something that works to kills microorganisms or stops their growth. For example, antibiotics and antibacterial soaps are used to fight bacteria,” Dr. Haugen says. Antibacterial soaps used to contain the chemical triclosan, but the U.S. Food and Drug Administration (FDA) banned it from household and health care products, because research suggests it may impact hormone levels and bacterial resistance. “While bacteria sound like a bad thing, it can actually be good for you. Your body needs bacteria to maintain a healthy, balanced environment on your skin,"" Dr. Haugen says. If you’re not sure if your soap is antibacterial, look for the word “antibacterial” on the label. The FDA says a Drug Fact Label is another sign a hand soap or body wash has antibacterial ingredients in it. Pros of Antibacterial Soap Antibacterial soap still kills bad bacteria, but it shouldn’t be overused. It's easy to find in most stores. Cons of Antibacterial Soap Overuse of antibacterial products can reduce the healthy bacteria on your skin. Added chemicals to antibacterial soaps can remove natural oils, making skin drier. Using antibacterial soap or hand sanitizer can make people think they do not have to wash their hands as thoroughly or frequently. Tips for Using Hand Sanitizer When soap and running water are unavailable, using hand sanitizers with at least 60 percent alcohol levels can be an effective alternative. “While hand sanitizer is nice in a pinch, it doesn’t eliminate all germs and should not be used when hands are visibly greasy or dirty,” Dr. Haugen says. The Centers for Disease Control and Prevention (CDC) recommends the following tips for children and adults using hand sanitizer: Apply enough hand sanitizer to cover all surfaces of the hands. Rub sanitizer on hands covering the tops, between fingers and fingertips. Keep rubbing until hands are dry or for about 20 seconds. Regular or Plain Soap Regular soap is designed to decrease water’s surface tension and lift dirt and oils off surfaces, so it can be easily rinsed away. Though regular soap does not contain added antibacterial chemicals, it's effective in getting rid of bacteria and other virus-causing germs. Pros of Regular Soap Antibacterial soaps are no more effective than regular soap and water for killing disease-causing germs. Regular soap tends to be less expensive than antibacterial soap and hand sanitizers. Regular soap won’t kill healthy bacteria on the skin’s surface. Cons of Regular Soap People may not wash hands thoroughly enough for regular soap to kill bad bacteria. You must look at the labels closely to find a regular soap. 5 Steps for Effective Handwashing “It’s more important for you to focus on your handwashing technique than what type of soap you use. Washing hands with soap (either antibacterial or regular) and water is one of the best ways to remove germs, avoid getting sick and prevent the spread of germs to others,” Dr. Haugen says. The CDC recommends these five tips for effective handwashing: Wet. Place your hands under running (cold or warm) water and add soap. Lather. Rub your hands together, making a soapy lather. Scrub. Wash the front and back of hands, between your fingers and under nails for at least 20 seconds or two rounds of the song “Happy Birthday.” Rinse. Place your hands well under running (cold or warm) water until the soap is gone. Dry. hands thoroughly with a clean towel or air dry them. Have little ones around? Read 6 ways to make handwashing fun for kids next.
+
+USER:
+What are the differences between antibacterial soap and regular soap? Which soap would you recommend as being better for preventing ilness? Answer in a minimum of 200 words.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,28,28,664,,850
+Only respond with the most direct answer possible. Do not discuss anything else. Use only information from the provided document.,What are the pros and cons?,"Michael M. 1.0 out of 5 stars Don't spend your hard on money on this garbage, you will regret it when it breaks within the year. Reviewed in the United States on February 8, 2024 If you want a TV that last and is user friendly DO NOT BUY Hisense. The of the HDMI ports failed for no reason. The TV sat securely with a PC and a PS5 connected and both ports broke. Hisense deemed it non-warranty because of a microscopic pinhole in the screen, which they also refused to cover. The user interface if non-nonsensical, clunky, and awkward. At night I like to turn on the auto-volume leveling (which isn't even very good, it's still fluctuates wildly in volume compared to Visio) you will have to navigate through a maze of sub-menu'. During the day I would reverse the process, it's not a user friendly TV, the menu's don't make sense, most of the settings don't have any detail description just a cryptic one-word setting. Bunny S. 1.0 out of 5 stars Worst customer service ever!! Purchased an 85 inch from Best Buy. Worked fine for a month or two then the sound started going out I would have to literally turn the TV off and back on to get the sound they’ve been out twice and they were a no-show on one appointment finally here it is December and I’ve gotten them to, tell me the TV cannot be repaired. Still waiting for my money to be returned/refunded. The only person that was nice was one of the repairman. You call the repair line and it was always a major ordeal. You cannot speak to a supervisor, the worst experience I’ve ever had , I will never purchase another one of their products ever again. JP 1.0 out of 5 stars Do not buy a TV from Hisense!! I've had my TV for 2 years. I keep all documents when I buy large appliances because I know that if I don't and they break I'd be SOL. Called Hisense the day my TV just stopped turning on and although I sent them pictures of all my documents they said they needed a manager to review my case. Two days later they texted me saying that my warranty was for the wrong TV and sent me a link to a web page for a warranty they said was the right one. I texted back asking for someone to call and explain. No one did. I called several days later and was hung up on, left on hold, and eventually told they would not honor my warranty. Do not buy this TV. There was no reason for my TV to stop working. Now I have a 70 inch wall weight. Tracy L. 2.0 out of 5 stars Good for a few The TV works fine for a year or do then it won't work like it should. The apps won't work right or not at all. The apps that are permanently on the TV you can't uninstall so you can reset the app. It won't update at all. Over all it's a throw away TV good just to get by for a better one. Tammy B. 1.0 out of 5 stars Sucks There is not one thing that I liked about that TV I thought the price was good but they could give me another one for free and I wouldn't take it. The worst TV to try and figure out how to navigate I've ever had and you couldn't get Alexa or The voice Assistant to work on it ever. Tania A. 5.0 out of 5 stars works excellent just to need linking. i love it Ernie 5.0 out of 5 stars working great make sure you set up everything with the same google account or alexa account if you dint you wont see it on ur device Jared B. 5.0 out of 5 stars Easy to setup and works great I setup my Hisense U75H Google TV to work with Alexa. Turned on and off TV, changed volume, muted, unmuted. They all worked on the first command. I'm surprised so many people are having so many issues. Cole 5.0 out of 5 stars It does work after setup. sign out of hisense account then sign back in. it will prompt you to ebavke the tv and it works great. Eileen G. 5.0 out of 5 stars Works, first attempt This works for the Hisense 55U7G. Not sure about all of the negative reviews without model numbers. l assume that many are working with models before Alexa enabling. I'm sure that it would do more with a Fire TV. I'm working with Android TV in my model. John S. 3.0 out of 5 stars Log out and then enable skill again the review below works. have to enable askoll, create hisense accout, then log out of Hisense, go back to alexa enable akill, and the linking then works when gou log back in. Stupid it cant just work the first time. Ricardo 3.0 out of 5 stars Works Great The app works 100% with Alexa, I’m able to tell Alexa pretty much a lot of commands from turning the tv on and off, control volume, etc. Amazon Customer 3.0 out of 5 stars More commands added but still lacking When I first got this skill, it had zero functionality, but over time commands to turn the TV on and off as well as adjust volume and change both the channel and the various inputs have come into play. Still missing commands to open up specific apps, which would definitely make this app a must-have for anyone with a Hisense. Matt 3.0 out of 5 stars Missing a major feature it's a pain to setup, but it works. So before you lose your mind, Go into network settings and change the ""Wake-on-Lan/Wifi"" to ON. (Depends on how it's connected to the internet) and you'll be able to turn it on and off. Unfortunately it doesn't start any apps. it's just on and off, change input, and control volume. Juanito D. 3.0 out of 5 stars It work.. barely halfway It a little hard to set up, but in the same time is easy, just be ready in the time to setup with you smarthphone and email ready to follow step by step. I saw many reviews saying the only thing do is turn off the TV, no turn on, that's not a problem of the skill is just the tv setting. At least in my Hisense Android TV at factory settings comes with the Wake on Wireless Network off, just turned on in Network setting and can turn on the TV with Alexa commands. The only thing I can't do is change the input with commands, in the skill setting tell I can do it but Alexa tell me: Can find any devices who can do that. But the commands if tell the skill we can do work; can Turn on/off, modify Vol. and activate apps.","Only respond with the most direct answer possible. Do not discuss anything else. Use only information from the provided document. What are the pros and cons? Michael M. 1.0 out of 5 stars Don't spend your hard on money on this garbage, you will regret it when it breaks within the year. Reviewed in the United States on February 8, 2024 If you want a TV that last and is user friendly DO NOT BUY Hisense. The of the HDMI ports failed for no reason. The TV sat securely with a PC and a PS5 connected and both ports broke. Hisense deemed it non-warranty because of a microscopic pinhole in the screen, which they also refused to cover. The user interface if non-nonsensical, clunky, and awkward. At night I like to turn on the auto-volume leveling (which isn't even very good, it's still fluctuates wildly in volume compared to Visio) you will have to navigate through a maze of sub-menu'. During the day I would reverse the process, it's not a user friendly TV, the menu's don't make sense, most of the settings don't have any detail description just a cryptic one-word setting. Bunny S. 1.0 out of 5 stars Worst customer service ever!! Purchased an 85 inch from Best Buy. Worked fine for a month or two then the sound started going out I would have to literally turn the TV off and back on to get the sound they’ve been out twice and they were a no-show on one appointment finally here it is December and I’ve gotten them to, tell me the TV cannot be repaired. Still waiting for my money to be returned/refunded. The only person that was nice was one of the repairman. You call the repair line and it was always a major ordeal. You cannot speak to a supervisor, the worst experience I’ve ever had , I will never purchase another one of their products ever again. JP 1.0 out of 5 stars Do not buy a TV from Hisense!! I've had my TV for 2 years. I keep all documents when I buy large appliances because I know that if I don't and they break I'd be SOL. Called Hisense the day my TV just stopped turning on and although I sent them pictures of all my documents they said they needed a manager to review my case. Two days later they texted me saying that my warranty was for the wrong TV and sent me a link to a web page for a warranty they said was the right one. I texted back asking for someone to call and explain. No one did. I called several days later and was hung up on, left on hold, and eventually told they would not honor my warranty. Do not buy this TV. There was no reason for my TV to stop working. Now I have a 70 inch wall weight. Tracy L. 2.0 out of 5 stars Good for a few The TV works fine for a year or do then it won't work like it should. The apps won't work right or not at all. The apps that are permanently on the TV you can't uninstall so you can reset the app. It won't update at all. Over all it's a throw away TV good just to get by for a better one. Tammy B. 1.0 out of 5 stars Sucks There is not one thing that I liked about that TV I thought the price was good but they could give me another one for free and I wouldn't take it. The worst TV to try and figure out how to navigate I've ever had and you couldn't get Alexa or The voice Assistant to work on it ever. Tania A. 5.0 out of 5 stars works excellent just to need linking. i love it Ernie 5.0 out of 5 stars working great make sure you set up everything with the same google account or alexa account if you dint you wont see it on ur device Jared B. 5.0 out of 5 stars Easy to setup and works great I setup my Hisense U75H Google TV to work with Alexa. Turned on and off TV, changed volume, muted, unmuted. They all worked on the first command. I'm surprised so many people are having so many issues. Cole 5.0 out of 5 stars It does work after setup. sign out of hisense account then sign back in. it will prompt you to ebavke the tv and it works great. Eileen G. 5.0 out of 5 stars Works, first attempt This works for the Hisense 55U7G. Not sure about all of the negative reviews without model numbers. l assume that many are working with models before Alexa enabling. I'm sure that it would do more with a Fire TV. I'm working with Android TV in my model. John S. 3.0 out of 5 stars Log out and then enable skill again the review below works. have to enable askoll, create hisense accout, then log out of Hisense, go back to alexa enable akill, and the linking then works when gou log back in. Stupid it cant just work the first time. Ricardo 3.0 out of 5 stars Works Great The app works 100% with Alexa, I’m able to tell Alexa pretty much a lot of commands from turning the tv on and off, control volume, etc. Amazon Customer 3.0 out of 5 stars More commands added but still lacking When I first got this skill, it had zero functionality, but over time commands to turn the TV on and off as well as adjust volume and change both the channel and the various inputs have come into play. Still missing commands to open up specific apps, which would definitely make this app a must-have for anyone with a Hisense. Matt 3.0 out of 5 stars Missing a major feature it's a pain to setup, but it works. So before you lose your mind, Go into network settings and change the ""Wake-on-Lan/Wifi"" to ON. (Depends on how it's connected to the internet) and you'll be able to turn it on and off. Unfortunately it doesn't start any apps. it's just on and off, change input, and control volume. Juanito D. 3.0 out of 5 stars It work.. barely halfway It a little hard to set up, but in the same time is easy, just be ready in the time to setup with you smarthphone and email ready to follow step by step. I saw many reviews saying the only thing do is turn off the TV, no turn on, that's not a problem of the skill is just the tv setting. At least in my Hisense Android TV at factory settings comes with the Wake on Wireless Network off, just turned on in Network setting and can turn on the TV with Alexa commands. The only thing I can't do is change the input with commands, in the skill setting tell I can do it but Alexa tell me: Can find any devices who can do that. But the commands if tell the skill we can do work; can Turn on/off, modify Vol. and activate apps.","Only respond with the most direct answer possible. Do not discuss anything else. Use only information from the provided document.
+
+EVIDENCE:
+Michael M. 1.0 out of 5 stars Don't spend your hard on money on this garbage, you will regret it when it breaks within the year. Reviewed in the United States on February 8, 2024 If you want a TV that last and is user friendly DO NOT BUY Hisense. The of the HDMI ports failed for no reason. The TV sat securely with a PC and a PS5 connected and both ports broke. Hisense deemed it non-warranty because of a microscopic pinhole in the screen, which they also refused to cover. The user interface if non-nonsensical, clunky, and awkward. At night I like to turn on the auto-volume leveling (which isn't even very good, it's still fluctuates wildly in volume compared to Visio) you will have to navigate through a maze of sub-menu'. During the day I would reverse the process, it's not a user friendly TV, the menu's don't make sense, most of the settings don't have any detail description just a cryptic one-word setting. Bunny S. 1.0 out of 5 stars Worst customer service ever!! Purchased an 85 inch from Best Buy. Worked fine for a month or two then the sound started going out I would have to literally turn the TV off and back on to get the sound they’ve been out twice and they were a no-show on one appointment finally here it is December and I’ve gotten them to, tell me the TV cannot be repaired. Still waiting for my money to be returned/refunded. The only person that was nice was one of the repairman. You call the repair line and it was always a major ordeal. You cannot speak to a supervisor, the worst experience I’ve ever had , I will never purchase another one of their products ever again. JP 1.0 out of 5 stars Do not buy a TV from Hisense!! I've had my TV for 2 years. I keep all documents when I buy large appliances because I know that if I don't and they break I'd be SOL. Called Hisense the day my TV just stopped turning on and although I sent them pictures of all my documents they said they needed a manager to review my case. Two days later they texted me saying that my warranty was for the wrong TV and sent me a link to a web page for a warranty they said was the right one. I texted back asking for someone to call and explain. No one did. I called several days later and was hung up on, left on hold, and eventually told they would not honor my warranty. Do not buy this TV. There was no reason for my TV to stop working. Now I have a 70 inch wall weight. Tracy L. 2.0 out of 5 stars Good for a few The TV works fine for a year or do then it won't work like it should. The apps won't work right or not at all. The apps that are permanently on the TV you can't uninstall so you can reset the app. It won't update at all. Over all it's a throw away TV good just to get by for a better one. Tammy B. 1.0 out of 5 stars Sucks There is not one thing that I liked about that TV I thought the price was good but they could give me another one for free and I wouldn't take it. The worst TV to try and figure out how to navigate I've ever had and you couldn't get Alexa or The voice Assistant to work on it ever. Tania A. 5.0 out of 5 stars works excellent just to need linking. i love it Ernie 5.0 out of 5 stars working great make sure you set up everything with the same google account or alexa account if you dint you wont see it on ur device Jared B. 5.0 out of 5 stars Easy to setup and works great I setup my Hisense U75H Google TV to work with Alexa. Turned on and off TV, changed volume, muted, unmuted. They all worked on the first command. I'm surprised so many people are having so many issues. Cole 5.0 out of 5 stars It does work after setup. sign out of hisense account then sign back in. it will prompt you to ebavke the tv and it works great. Eileen G. 5.0 out of 5 stars Works, first attempt This works for the Hisense 55U7G. Not sure about all of the negative reviews without model numbers. l assume that many are working with models before Alexa enabling. I'm sure that it would do more with a Fire TV. I'm working with Android TV in my model. John S. 3.0 out of 5 stars Log out and then enable skill again the review below works. have to enable askoll, create hisense accout, then log out of Hisense, go back to alexa enable akill, and the linking then works when gou log back in. Stupid it cant just work the first time. Ricardo 3.0 out of 5 stars Works Great The app works 100% with Alexa, I’m able to tell Alexa pretty much a lot of commands from turning the tv on and off, control volume, etc. Amazon Customer 3.0 out of 5 stars More commands added but still lacking When I first got this skill, it had zero functionality, but over time commands to turn the TV on and off as well as adjust volume and change both the channel and the various inputs have come into play. Still missing commands to open up specific apps, which would definitely make this app a must-have for anyone with a Hisense. Matt 3.0 out of 5 stars Missing a major feature it's a pain to setup, but it works. So before you lose your mind, Go into network settings and change the ""Wake-on-Lan/Wifi"" to ON. (Depends on how it's connected to the internet) and you'll be able to turn it on and off. Unfortunately it doesn't start any apps. it's just on and off, change input, and control volume. Juanito D. 3.0 out of 5 stars It work.. barely halfway It a little hard to set up, but in the same time is easy, just be ready in the time to setup with you smarthphone and email ready to follow step by step. I saw many reviews saying the only thing do is turn off the TV, no turn on, that's not a problem of the skill is just the tv setting. At least in my Hisense Android TV at factory settings comes with the Wake on Wireless Network off, just turned on in Network setting and can turn on the TV with Alexa commands. The only thing I can't do is change the input with commands, in the skill setting tell I can do it but Alexa tell me: Can find any devices who can do that. But the commands if tell the skill we can do work; can Turn on/off, modify Vol. and activate apps.
+
+USER:
+What are the pros and cons?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,20,6,1177,,670
+"You are required to answer by only using information in the above text. Don't insert any intro or outro, just the answer to the prompt. Use bullet points and be extremely concise. Don't use hypotheticals in your answers, state only what you can prove to be true based on the text.",Explain how the proposed framework in the above text relates to python code snippets.,"Adverse Drug Reactions (ADRs) are a leading cause of hospital admissions and healthcare costs. Traditional methods of ADR reporting often rely on post-marketing surveillance, and manual reporting of ADRs to the local or national pharmacovigilance agencies for causality assessment and final reporting to the WHO. High-income countries have their own national (i.e., USFDA) and regional (i.e., European Medicines Agency / EMA) pharmacovigilance agencies. However, this process is slow and inefficient. This article proposes a novel framework for integrating ADR detection into clinical workflows using Electronic Medical Record (EMR) systems, crowdsourced reporting from patients and healthcare professionals, and graph theory for generating automated ADR signals and reports to the local or national pharmacovigilance agencies. The system leverages automated data collection from EMRs (drug prescriptions, clinical notes) by EMR data scraping, integrating ADR dictionaries and drug databases to automate the generation of ranked ADR signals. By applying graph theory, the system filters and upranks connections between drugs and ADRs, considering the temporal relationship between drug administration and ADR occurrence. This automated approach offers a significant improvement in ADR reporting, enabling faster detection and more accurate predictions. Methodologies, framework visualizations and python code snippets are included to aid implementation.","Adverse Drug Reactions (ADRs) are a leading cause of hospital admissions and healthcare costs. Traditional methods of ADR reporting often rely on post-marketing surveillance, and manual reporting of ADRs to the local or national pharmacovigilance agencies for causality assessment and final reporting to the WHO. High-income countries have their own national (i.e., USFDA) and regional (i.e., European Medicines Agency / EMA) pharmacovigilance agencies. However, this process is slow and inefficient. This article proposes a novel framework for integrating ADR detection into clinical workflows using Electronic Medical Record (EMR) systems, crowdsourced reporting from patients and healthcare professionals, and graph theory for generating automated ADR signals and reports to the local or national pharmacovigilance agencies. The system leverages automated data collection from EMRs (drug prescriptions, clinical notes) by EMR data scraping, integrating ADR dictionaries and drug databases to automate the generation of ranked ADR signals. By applying graph theory, the system filters and upranks connections between drugs and ADRs, considering the temporal relationship between drug administration and ADR occurrence. This automated approach offers a significant improvement in ADR reporting, enabling faster detection and more accurate predictions. Methodologies, framework visualizations and python code snippets are included to aid implementation. Explain how the proposed framework in the above text relates to python code snippets. You are required to answer by only using information in the above text. Don't insert any intro or outro, just the answer to the prompt. Use bullet points and be extremely concise. Don't use hypotheticals in your answers, state only what you can prove to be true based on the text.","You are required to answer by only using information in the above text. Don't insert any intro or outro, just the answer to the prompt. Use bullet points and be extremely concise. Don't use hypotheticals in your answers, state only what you can prove to be true based on the text.
+
+EVIDENCE:
+Adverse Drug Reactions (ADRs) are a leading cause of hospital admissions and healthcare costs. Traditional methods of ADR reporting often rely on post-marketing surveillance, and manual reporting of ADRs to the local or national pharmacovigilance agencies for causality assessment and final reporting to the WHO. High-income countries have their own national (i.e., USFDA) and regional (i.e., European Medicines Agency / EMA) pharmacovigilance agencies. However, this process is slow and inefficient. This article proposes a novel framework for integrating ADR detection into clinical workflows using Electronic Medical Record (EMR) systems, crowdsourced reporting from patients and healthcare professionals, and graph theory for generating automated ADR signals and reports to the local or national pharmacovigilance agencies. The system leverages automated data collection from EMRs (drug prescriptions, clinical notes) by EMR data scraping, integrating ADR dictionaries and drug databases to automate the generation of ranked ADR signals. By applying graph theory, the system filters and upranks connections between drugs and ADRs, considering the temporal relationship between drug administration and ADR occurrence. This automated approach offers a significant improvement in ADR reporting, enabling faster detection and more accurate predictions. Methodologies, framework visualizations and python code snippets are included to aid implementation.
+
+USER:
+Explain how the proposed framework in the above text relates to python code snippets.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,51,14,196,,467
+Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document],"I'm so confused by this text. How many mice were used in this study? What controls were used to limit bias? Who was the main author and what are their qualifications? Can you give me a list of all authors associated with the University of Copenhagen? list them in an alphabetical, bulleted format.","New research describes for the first time how a spreading wave of disruption and the flow of fluid in the brain triggers headaches, detailing the connection between the neurological symptoms associated with aura and the migraine that follows. The study also identifies new proteins that could be responsible for headaches and may serve as foundation for new migraine drugs. “In this study, we describe the interaction between the central and peripheral nervous system brought about by increased concentrations of proteins released in the brain during an episode of spreading depolarization, a phenomenon responsible for the aura associated with migraines,” said Maiken Nedergaard, MD, DMSc, co-director of the University of Rochester Center for Translational Neuromedicine and lead author of the new study, which appears in the journal Science. “These findings provide us with a host of new targets to suppress sensory nerve activation to prevent and treat migraines and strengthen existing therapies.” ""These findings provide us with a host of new targets to suppress sensory nerve activation to prevent and treat migraines and strengthen existing therapies.” Maiken Nedergaard, MD, DMSc It is estimated that one out of 10 people experience migraines and in about a quarter of these cases the headache is preceded by an aura, a sensory disturbance that can includes light flashes, blind spots, double vision, and tingling sensations or limb numbness. These symptoms typically appear five to 60 minutes prior to the headache. The cause of the aura is a phenomenon called cortical spreading depression, a temporary depolarization of neurons and other cells caused by diffusion of glutamate and potassium that radiates like a wave across the brain, reducing oxygen levels and impairing blood flow. Most frequently, the depolarization event is located in the visual processing center of the brain cortex, hence the visual symptoms that first herald a coming headache. While migraines auras arise in the brain, the organ itself cannot sense pain. These signals must instead be transmitted from the central nervous system—the brain and spinal cord—to the peripheral nervous system, the communication network that transmits information between brain with the rest of the body and includes sensory nerves responsible for sending information such as touch and pain. The process of communication between the brain and peripheral sensory nerves in migraines has largely remained a mystery. Fluid Dynamics Models Shed Light on Migraine Pain Origins Nedergaard and her colleagues at the University of Rochester and the University of Copenhagen are pioneers in understanding the flow of fluids in the brain. In 2012, her lab was the first to describe the glymphatic system, which uses cerebrospinal fluid (CSF) to wash away toxic proteins in the brain. In partnership with experts in fluid dynamics, the team has built detailed models of how the CSF moves in the brain and its role in transporting proteins, neurotransmitters, and other chemicals. The most widely accepted theory is that nerve endings resting on the outer surface of the membranes that enclose the brain are responsible for the headaches that follow an aura. The new study, which was conducted in mice, describes a different route and identifies proteins, many of which are potential new drug targets, that may be responsible for activating the nerves and causing pain. As the depolarization wave spreads, neurons release a host of inflammatory and other proteins into CSF. In a series of experiments in mice, the researchers showed how CSF transports these proteins to the trigeminal ganglion, a large bundle of nerves that rests at the base of the skull and supplies sensory information to the head and face. It was assumed that the trigeminal ganglion, like the rest of the peripheral nervous system, rested outside the blood-brain-barrier, which tightly controls what molecules enter and leave the brain. However, the researchers identified a previously unknown gap in the barrier that allowed CSF to flow directly into the trigeminal ganglion, exposing sensory nerves to the cocktail of proteins released by the brain. Migraine-Associated Proteins Double During Brain Wave Activity model_image Analyzing the molecules, the researchers identified twelve proteins called ligands that bind with receptors on sensory nerves found in the trigeminal ganglion, potentially causing these cells to activate. The concentrations of several of these proteins found in CSF more than doubled following a cortical spreading depression. One of the proteins, calcitonin gene-related peptide (CGRP), is already the target of a new class of drugs to treat and prevent migraines called CGRP inhibitors. Other identified proteins are known to play a role in other pain conditions, such as neuropathic pain, and are likely important in migraine headaches as well. “We have identified a new signaling pathway and several molecules that activate sensory nerves in the peripheral nervous system. Among the identified molecules are those already associated with migraines, but we didn't know exactly how and where the migraine inducing action occurred,” said Martin Kaag Rasmussen, PhD, a postdoctoral fellow at the University of Copenhagen and first author of the study. “Defining the role of these newly identified ligand-receptor pairs may enable the discovery of new pharmacological targets, which could benefit the large portion of patients not responding to available therapies.” The researchers also observed that the transport of proteins released in one side of the brain reaches mostly the nerves in the trigeminal ganglion on the same side, potentially explaining why pain occurs on one side of the head during most migraines. Additional co-authors Kjeld Mollgard, Peter Bork, Pia Weikop, Tina Esmail, Lylia Drici, Nicolai Albrechtsen, Matthias Mann, Yuki Mori, and Jonathan Carlsen with the University of Copenhagen, Nguyen Huynh and Steve Goldman with URMC, and Nima Ghitani and Alexander Chesler with the National Institute of Neurological Disorders and Stroke (NINDS). The research was supported with funding from the Novo Nordisk Foundation, NINDS, the US Army Research Office, the Lundbeck Foundation, and the Dr. Miriam and Sheldon G. Adelson Medical Research Foundation.","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. I'm so confused by this text. How many mice were used in this study? What controls were used to limit bias? Who was the main author and what are their qualifications? Can you give me a list of all authors associated with the University of Copenhagen? list them in an alphabetical, bulleted format. New research describes for the first time how a spreading wave of disruption and the flow of fluid in the brain triggers headaches, detailing the connection between the neurological symptoms associated with aura and the migraine that follows. The study also identifies new proteins that could be responsible for headaches and may serve as foundation for new migraine drugs. “In this study, we describe the interaction between the central and peripheral nervous system brought about by increased concentrations of proteins released in the brain during an episode of spreading depolarization, a phenomenon responsible for the aura associated with migraines,” said Maiken Nedergaard, MD, DMSc, co-director of the University of Rochester Center for Translational Neuromedicine and lead author of the new study, which appears in the journal Science. “These findings provide us with a host of new targets to suppress sensory nerve activation to prevent and treat migraines and strengthen existing therapies.” ""These findings provide us with a host of new targets to suppress sensory nerve activation to prevent and treat migraines and strengthen existing therapies.” Maiken Nedergaard, MD, DMSc It is estimated that one out of 10 people experience migraines and in about a quarter of these cases the headache is preceded by an aura, a sensory disturbance that can includes light flashes, blind spots, double vision, and tingling sensations or limb numbness. These symptoms typically appear five to 60 minutes prior to the headache. The cause of the aura is a phenomenon called cortical spreading depression, a temporary depolarization of neurons and other cells caused by diffusion of glutamate and potassium that radiates like a wave across the brain, reducing oxygen levels and impairing blood flow. Most frequently, the depolarization event is located in the visual processing center of the brain cortex, hence the visual symptoms that first herald a coming headache. While migraines auras arise in the brain, the organ itself cannot sense pain. These signals must instead be transmitted from the central nervous system—the brain and spinal cord—to the peripheral nervous system, the communication network that transmits information between brain with the rest of the body and includes sensory nerves responsible for sending information such as touch and pain. The process of communication between the brain and peripheral sensory nerves in migraines has largely remained a mystery. Fluid Dynamics Models Shed Light on Migraine Pain Origins Nedergaard and her colleagues at the University of Rochester and the University of Copenhagen are pioneers in understanding the flow of fluids in the brain. In 2012, her lab was the first to describe the glymphatic system, which uses cerebrospinal fluid (CSF) to wash away toxic proteins in the brain. In partnership with experts in fluid dynamics, the team has built detailed models of how the CSF moves in the brain and its role in transporting proteins, neurotransmitters, and other chemicals. The most widely accepted theory is that nerve endings resting on the outer surface of the membranes that enclose the brain are responsible for the headaches that follow an aura. The new study, which was conducted in mice, describes a different route and identifies proteins, many of which are potential new drug targets, that may be responsible for activating the nerves and causing pain. As the depolarization wave spreads, neurons release a host of inflammatory and other proteins into CSF. In a series of experiments in mice, the researchers showed how CSF transports these proteins to the trigeminal ganglion, a large bundle of nerves that rests at the base of the skull and supplies sensory information to the head and face. It was assumed that the trigeminal ganglion, like the rest of the peripheral nervous system, rested outside the blood-brain-barrier, which tightly controls what molecules enter and leave the brain. However, the researchers identified a previously unknown gap in the barrier that allowed CSF to flow directly into the trigeminal ganglion, exposing sensory nerves to the cocktail of proteins released by the brain. Migraine-Associated Proteins Double During Brain Wave Activity model_image Analyzing the molecules, the researchers identified twelve proteins called ligands that bind with receptors on sensory nerves found in the trigeminal ganglion, potentially causing these cells to activate. The concentrations of several of these proteins found in CSF more than doubled following a cortical spreading depression. One of the proteins, calcitonin gene-related peptide (CGRP), is already the target of a new class of drugs to treat and prevent migraines called CGRP inhibitors. Other identified proteins are known to play a role in other pain conditions, such as neuropathic pain, and are likely important in migraine headaches as well. “We have identified a new signaling pathway and several molecules that activate sensory nerves in the peripheral nervous system. Among the identified molecules are those already associated with migraines, but we didn't know exactly how and where the migraine inducing action occurred,” said Martin Kaag Rasmussen, PhD, a postdoctoral fellow at the University of Copenhagen and first author of the study. “Defining the role of these newly identified ligand-receptor pairs may enable the discovery of new pharmacological targets, which could benefit the large portion of patients not responding to available therapies.” The researchers also observed that the transport of proteins released in one side of the brain reaches mostly the nerves in the trigeminal ganglion on the same side, potentially explaining why pain occurs on one side of the head during most migraines. Additional co-authors Kjeld Mollgard, Peter Bork, Pia Weikop, Tina Esmail, Lylia Drici, Nicolai Albrechtsen, Matthias Mann, Yuki Mori, and Jonathan Carlsen with the University of Copenhagen, Nguyen Huynh and Steve Goldman with URMC, and Nima Ghitani and Alexander Chesler with the National Institute of Neurological Disorders and Stroke (NINDS). The research was supported with funding from the Novo Nordisk Foundation, NINDS, the US Army Research Office, the Lundbeck Foundation, and the Dr. Miriam and Sheldon G. Adelson Medical Research Foundation. https://www.urmc.rochester.edu/news/story/study-reveals-brain-fluid-dynamics-as-key-to-migraine-mysteries-new-therapies","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]
+
+EVIDENCE:
+New research describes for the first time how a spreading wave of disruption and the flow of fluid in the brain triggers headaches, detailing the connection between the neurological symptoms associated with aura and the migraine that follows. The study also identifies new proteins that could be responsible for headaches and may serve as foundation for new migraine drugs. “In this study, we describe the interaction between the central and peripheral nervous system brought about by increased concentrations of proteins released in the brain during an episode of spreading depolarization, a phenomenon responsible for the aura associated with migraines,” said Maiken Nedergaard, MD, DMSc, co-director of the University of Rochester Center for Translational Neuromedicine and lead author of the new study, which appears in the journal Science. “These findings provide us with a host of new targets to suppress sensory nerve activation to prevent and treat migraines and strengthen existing therapies.” ""These findings provide us with a host of new targets to suppress sensory nerve activation to prevent and treat migraines and strengthen existing therapies.” Maiken Nedergaard, MD, DMSc It is estimated that one out of 10 people experience migraines and in about a quarter of these cases the headache is preceded by an aura, a sensory disturbance that can includes light flashes, blind spots, double vision, and tingling sensations or limb numbness. These symptoms typically appear five to 60 minutes prior to the headache. The cause of the aura is a phenomenon called cortical spreading depression, a temporary depolarization of neurons and other cells caused by diffusion of glutamate and potassium that radiates like a wave across the brain, reducing oxygen levels and impairing blood flow. Most frequently, the depolarization event is located in the visual processing center of the brain cortex, hence the visual symptoms that first herald a coming headache. While migraines auras arise in the brain, the organ itself cannot sense pain. These signals must instead be transmitted from the central nervous system—the brain and spinal cord—to the peripheral nervous system, the communication network that transmits information between brain with the rest of the body and includes sensory nerves responsible for sending information such as touch and pain. The process of communication between the brain and peripheral sensory nerves in migraines has largely remained a mystery. Fluid Dynamics Models Shed Light on Migraine Pain Origins Nedergaard and her colleagues at the University of Rochester and the University of Copenhagen are pioneers in understanding the flow of fluids in the brain. In 2012, her lab was the first to describe the glymphatic system, which uses cerebrospinal fluid (CSF) to wash away toxic proteins in the brain. In partnership with experts in fluid dynamics, the team has built detailed models of how the CSF moves in the brain and its role in transporting proteins, neurotransmitters, and other chemicals. The most widely accepted theory is that nerve endings resting on the outer surface of the membranes that enclose the brain are responsible for the headaches that follow an aura. The new study, which was conducted in mice, describes a different route and identifies proteins, many of which are potential new drug targets, that may be responsible for activating the nerves and causing pain. As the depolarization wave spreads, neurons release a host of inflammatory and other proteins into CSF. In a series of experiments in mice, the researchers showed how CSF transports these proteins to the trigeminal ganglion, a large bundle of nerves that rests at the base of the skull and supplies sensory information to the head and face. It was assumed that the trigeminal ganglion, like the rest of the peripheral nervous system, rested outside the blood-brain-barrier, which tightly controls what molecules enter and leave the brain. However, the researchers identified a previously unknown gap in the barrier that allowed CSF to flow directly into the trigeminal ganglion, exposing sensory nerves to the cocktail of proteins released by the brain. Migraine-Associated Proteins Double During Brain Wave Activity model_image Analyzing the molecules, the researchers identified twelve proteins called ligands that bind with receptors on sensory nerves found in the trigeminal ganglion, potentially causing these cells to activate. The concentrations of several of these proteins found in CSF more than doubled following a cortical spreading depression. One of the proteins, calcitonin gene-related peptide (CGRP), is already the target of a new class of drugs to treat and prevent migraines called CGRP inhibitors. Other identified proteins are known to play a role in other pain conditions, such as neuropathic pain, and are likely important in migraine headaches as well. “We have identified a new signaling pathway and several molecules that activate sensory nerves in the peripheral nervous system. Among the identified molecules are those already associated with migraines, but we didn't know exactly how and where the migraine inducing action occurred,” said Martin Kaag Rasmussen, PhD, a postdoctoral fellow at the University of Copenhagen and first author of the study. “Defining the role of these newly identified ligand-receptor pairs may enable the discovery of new pharmacological targets, which could benefit the large portion of patients not responding to available therapies.” The researchers also observed that the transport of proteins released in one side of the brain reaches mostly the nerves in the trigeminal ganglion on the same side, potentially explaining why pain occurs on one side of the head during most migraines. Additional co-authors Kjeld Mollgard, Peter Bork, Pia Weikop, Tina Esmail, Lylia Drici, Nicolai Albrechtsen, Matthias Mann, Yuki Mori, and Jonathan Carlsen with the University of Copenhagen, Nguyen Huynh and Steve Goldman with URMC, and Nima Ghitani and Alexander Chesler with the National Institute of Neurological Disorders and Stroke (NINDS). The research was supported with funding from the Novo Nordisk Foundation, NINDS, the US Army Research Office, the Lundbeck Foundation, and the Dr. Miriam and Sheldon G. Adelson Medical Research Foundation.
+
+USER:
+I'm so confused by this text. How many mice were used in this study? What controls were used to limit bias? Who was the main author and what are their qualifications? Can you give me a list of all authors associated with the University of Copenhagen? list them in an alphabetical, bulleted format.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,24,53,972,,239
+Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document],"My husband is applying for an FHA mortgage loan. We don't have any creditor accounts together. He has a good job, but doesn't have a credit score. He pays the rent that includes our water bill. I pay the electric bill and our cell phones in my name. He pays day care every month in cash and has an agreement to pay my brother-in-law for a buy-here-pay-here car note every month with a money order. Neither of us have bank accounts. Is there anything we can use as credit for him since none of this shows on his credit report?","Credit Requirements (A) General Credit Requirements FHA’s general credit policy requires Lenders to analyze the Borrower’s credit history, liabilities, and debts to determine creditworthiness. The Lender must obtain a merged credit report from an independent consumer reporting agency. The Lender must obtain a credit report for each Borrower who will be obligated on the loan Note. The Lender may obtain a joint report for individuals with joint accounts. Before making a determination on the creditworthiness of an applicant, a Lender must conduct an interview to resolve any material discrepancies between the information on the loan application and information on the credit report to determine accurate and complete information. The Lender is not required to obtain a credit report for non-credit qualifying Streamline Refinance transactions. (B) Types of Credit History (1) Traditional Credit Lenders must pull a credit report that draws and merges information from three national credit bureaus. Lenders are prohibited from developing non-traditional credit history to use in place of a traditional credit report. If the credit report generates a credit score, the Lender must utilize traditional credit history. (a) Requirements for the Credit Report Credit reports must obtain all information from three credit repositories pertaining to credit, residence history, and public records information; be in an easy to read and understandable format; and not require code translations. The credit report may not contain whiteouts, erasures, or alterations. The Lender must retain copies of all credit reports. The credit report must include: the name of the Lender ordering the report; the name, address, and telephone number of the consumer reporting agency; the name and SSN of each Borrower; and the primary repository from which any particular information was pulled, for each account listed. A truncated SSN is acceptable for FHA loan insurance purposes provided that the loan application captures the full nine-digit SSN. The credit report must also include: all inquiries made within the last 90 Days; all credit and legal information not considered obsolete under the FCRA, including information for the last seven years regarding: bankruptcies; Judgments; lawsuits; foreclosures; and tax liens; and for each Borrower debt listed: the date the account was opened; high credit amount; required monthly payment amount; unpaid balance; and payment history. (b) Updated Credit Report or Supplement to the Credit Report The Lender must obtain an updated credit report or supplement if the underwriter identifies material inconsistencies between any information in the case binder and the original credit report. (2) Non-traditional Credit For Borrowers without a credit score, the Lender must independently develop the Borrower’s credit history using the requirements outlined below. (a) Independent Verification of Non-traditional Credit Providers The Lender may independently verify the Borrower’s credit references by documenting the existence of the credit provider and that the provider extended credit to the Borrower. To verify the existence of each credit provider, the Lender must review public records from the state, county, or city or other documents providing a similar level of objective information. To verify credit information, the Lender must: use a published address or telephone number for the credit provider and not rely solely on information provided by the applicant; and obtain the most recent 12 months of canceled checks, or equivalent proof of payment, demonstrating the timing of payment to the credit provider. To verify the Borrower’s rental payment history, the Lender must obtain a rental reference from the appropriate rental management company or landlord, demonstrating the timing of payment for the most recent 12 months in lieu of 12 months of canceled checks or equivalent proof of payment. (b) Sufficiency of Non-traditional Credit References To be sufficient to establish the Borrower’s credit, the non-traditional credit history must include three credit references, including at least one of the following: rental housing payments (subject to independent verification if the Borrower is a renter); telephone service; or utility company reference (if not included in the rental housing payment), including: gas; electricity; water; television service; or Internet service. If the Lender cannot obtain all three credit references from the list above, the Lender may use the following sources of unreported recurring debt: insurance premiums not payroll deducted (e.g., medical, auto, life, renter’s insurance); payment to child care providers made to businesses that provide such services; school tuition; retail store credit cards (e.g., from department, furniture, or appliance stores, or specialty stores); rent-to-own (e.g., furniture, appliances); payment of that part of medical bills not covered by insurance; a documented 12-month history of savings evidenced by regular deposits resulting in an increased balance to the account that: were made at least quarterly; were not payroll deducted; and caused no Insufficient Funds (NSF) checks; an automobile lease; a personal loan from an individual with repayment terms in writing and supported by canceled checks to document the payments; or a documented 12-month history of payment by the Borrower on an account for which the Borrower is an authorized user.","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. My husband is applying for an FHA mortgage loan. We don't have any creditor accounts together. He has a good job, but doesn't have a credit score. He pays the rent that includes our water bill. I pay the electric bill and our cell phones in my name. He pays day care every month in cash and has an agreement to pay my brother-in-law for a buy-here-pay-here car note every month with a money order. Neither of us have bank accounts. Is there anything we can use as credit for him since none of this shows on his credit report? Credit Requirements (A) General Credit Requirements FHA’s general credit policy requires Lenders to analyze the Borrower’s credit history, liabilities, and debts to determine creditworthiness. The Lender must obtain a merged credit report from an independent consumer reporting agency. The Lender must obtain a credit report for each Borrower who will be obligated on the loan Note. The Lender may obtain a joint report for individuals with joint accounts. Before making a determination on the creditworthiness of an applicant, a Lender must conduct an interview to resolve any material discrepancies between the information on the loan application and information on the credit report to determine accurate and complete information. The Lender is not required to obtain a credit report for non-credit qualifying Streamline Refinance transactions. (B) Types of Credit History (1) Traditional Credit Lenders must pull a credit report that draws and merges information from three national credit bureaus. Lenders are prohibited from developing non-traditional credit history to use in place of a traditional credit report. If the credit report generates a credit score, the Lender must utilize traditional credit history. (a) Requirements for the Credit Report Credit reports must obtain all information from three credit repositories pertaining to credit, residence history, and public records information; be in an easy to read and understandable format; and not require code translations. The credit report may not contain whiteouts, erasures, or alterations. The Lender must retain copies of all credit reports. The credit report must include: the name of the Lender ordering the report; the name, address, and telephone number of the consumer reporting agency; the name and SSN of each Borrower; and the primary repository from which any particular information was pulled, for each account listed. A truncated SSN is acceptable for FHA loan insurance purposes provided that the loan application captures the full nine-digit SSN. The credit report must also include: all inquiries made within the last 90 Days; all credit and legal information not considered obsolete under the FCRA, including information for the last seven years regarding: bankruptcies; Judgments; lawsuits; foreclosures; and tax liens; and for each Borrower debt listed: the date the account was opened; high credit amount; required monthly payment amount; unpaid balance; and payment history. (b) Updated Credit Report or Supplement to the Credit Report The Lender must obtain an updated credit report or supplement if the underwriter identifies material inconsistencies between any information in the case binder and the original credit report. (2) Non-traditional Credit For Borrowers without a credit score, the Lender must independently develop the Borrower’s credit history using the requirements outlined below. (a) Independent Verification of Non-traditional Credit Providers The Lender may independently verify the Borrower’s credit references by documenting the existence of the credit provider and that the provider extended credit to the Borrower. To verify the existence of each credit provider, the Lender must review public records from the state, county, or city or other documents providing a similar level of objective information. To verify credit information, the Lender must: use a published address or telephone number for the credit provider and not rely solely on information provided by the applicant; and obtain the most recent 12 months of canceled checks, or equivalent proof of payment, demonstrating the timing of payment to the credit provider. To verify the Borrower’s rental payment history, the Lender must obtain a rental reference from the appropriate rental management company or landlord, demonstrating the timing of payment for the most recent 12 months in lieu of 12 months of canceled checks or equivalent proof of payment. (b) Sufficiency of Non-traditional Credit References To be sufficient to establish the Borrower’s credit, the non-traditional credit history must include three credit references, including at least one of the following: rental housing payments (subject to independent verification if the Borrower is a renter); telephone service; or utility company reference (if not included in the rental housing payment), including: gas; electricity; water; television service; or Internet service. If the Lender cannot obtain all three credit references from the list above, the Lender may use the following sources of unreported recurring debt: insurance premiums not payroll deducted (e.g., medical, auto, life, renter’s insurance); payment to child care providers made to businesses that provide such services; school tuition; retail store credit cards (e.g., from department, furniture, or appliance stores, or specialty stores); rent-to-own (e.g., furniture, appliances); payment of that part of medical bills not covered by insurance; a documented 12-month history of savings evidenced by regular deposits resulting in an increased balance to the account that: were made at least quarterly; were not payroll deducted; and caused no Insufficient Funds (NSF) checks; an automobile lease; a personal loan from an individual with repayment terms in writing and supported by canceled checks to document the payments; or a documented 12-month history of payment by the Borrower on an account for which the Borrower is an authorized user. https://www.hud.gov/sites/dfiles/OCHCO/documents/40001-hsgh-update15-052024.pdf","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]
+
+EVIDENCE:
+Credit Requirements (A) General Credit Requirements FHA’s general credit policy requires Lenders to analyze the Borrower’s credit history, liabilities, and debts to determine creditworthiness. The Lender must obtain a merged credit report from an independent consumer reporting agency. The Lender must obtain a credit report for each Borrower who will be obligated on the loan Note. The Lender may obtain a joint report for individuals with joint accounts. Before making a determination on the creditworthiness of an applicant, a Lender must conduct an interview to resolve any material discrepancies between the information on the loan application and information on the credit report to determine accurate and complete information. The Lender is not required to obtain a credit report for non-credit qualifying Streamline Refinance transactions. (B) Types of Credit History (1) Traditional Credit Lenders must pull a credit report that draws and merges information from three national credit bureaus. Lenders are prohibited from developing non-traditional credit history to use in place of a traditional credit report. If the credit report generates a credit score, the Lender must utilize traditional credit history. (a) Requirements for the Credit Report Credit reports must obtain all information from three credit repositories pertaining to credit, residence history, and public records information; be in an easy to read and understandable format; and not require code translations. The credit report may not contain whiteouts, erasures, or alterations. The Lender must retain copies of all credit reports. The credit report must include: the name of the Lender ordering the report; the name, address, and telephone number of the consumer reporting agency; the name and SSN of each Borrower; and the primary repository from which any particular information was pulled, for each account listed. A truncated SSN is acceptable for FHA loan insurance purposes provided that the loan application captures the full nine-digit SSN. The credit report must also include: all inquiries made within the last 90 Days; all credit and legal information not considered obsolete under the FCRA, including information for the last seven years regarding: bankruptcies; Judgments; lawsuits; foreclosures; and tax liens; and for each Borrower debt listed: the date the account was opened; high credit amount; required monthly payment amount; unpaid balance; and payment history. (b) Updated Credit Report or Supplement to the Credit Report The Lender must obtain an updated credit report or supplement if the underwriter identifies material inconsistencies between any information in the case binder and the original credit report. (2) Non-traditional Credit For Borrowers without a credit score, the Lender must independently develop the Borrower’s credit history using the requirements outlined below. (a) Independent Verification of Non-traditional Credit Providers The Lender may independently verify the Borrower’s credit references by documenting the existence of the credit provider and that the provider extended credit to the Borrower. To verify the existence of each credit provider, the Lender must review public records from the state, county, or city or other documents providing a similar level of objective information. To verify credit information, the Lender must: use a published address or telephone number for the credit provider and not rely solely on information provided by the applicant; and obtain the most recent 12 months of canceled checks, or equivalent proof of payment, demonstrating the timing of payment to the credit provider. To verify the Borrower’s rental payment history, the Lender must obtain a rental reference from the appropriate rental management company or landlord, demonstrating the timing of payment for the most recent 12 months in lieu of 12 months of canceled checks or equivalent proof of payment. (b) Sufficiency of Non-traditional Credit References To be sufficient to establish the Borrower’s credit, the non-traditional credit history must include three credit references, including at least one of the following: rental housing payments (subject to independent verification if the Borrower is a renter); telephone service; or utility company reference (if not included in the rental housing payment), including: gas; electricity; water; television service; or Internet service. If the Lender cannot obtain all three credit references from the list above, the Lender may use the following sources of unreported recurring debt: insurance premiums not payroll deducted (e.g., medical, auto, life, renter’s insurance); payment to child care providers made to businesses that provide such services; school tuition; retail store credit cards (e.g., from department, furniture, or appliance stores, or specialty stores); rent-to-own (e.g., furniture, appliances); payment of that part of medical bills not covered by insurance; a documented 12-month history of savings evidenced by regular deposits resulting in an increased balance to the account that: were made at least quarterly; were not payroll deducted; and caused no Insufficient Funds (NSF) checks; an automobile lease; a personal loan from an individual with repayment terms in writing and supported by canceled checks to document the payments; or a documented 12-month history of payment by the Borrower on an account for which the Borrower is an authorized user.
+
+USER:
+My husband is applying for an FHA mortgage loan. We don't have any creditor accounts together. He has a good job, but doesn't have a credit score. He pays the rent that includes our water bill. I pay the electric bill and our cell phones in my name. He pays day care every month in cash and has an agreement to pay my brother-in-law for a buy-here-pay-here car note every month with a money order. Neither of us have bank accounts. Is there anything we can use as credit for him since none of this shows on his credit report?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,24,100,813,,727
+"{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]","My family loves to eat cereal but there's a lot of unhealthy cereal at supermarkets. When I go shopping for cereal, what do I look for to get healthy cereal?","Cereal is a quick, easy and delicious breakfast option. It can be healthy, too — if you’re filling your cereal bowl from the right box. Many of the eye-catching boxes in the cereal aisle are more sugar bombs than balanced breakfasts, says registered dietitian Beth Czerwony, RD. (Spoiler alert: Funny-shaped marshmallows DO NOT offer much nutritional value.) So, how can you choose a breakfast cereal worthy of spooning for the most important meal of the day? Czerwony has a few suggestions. All the information you need to separate the healthy cereal options from those that are sweet treats in disguise is readily available. All it takes is some nutrition label reading while you’re shopping. “Want to know what cereal is healthy?” asks Czerwony. “The answer is on the side of the box.” Here’s what you want to find: Whole grains supply a healthy foundation for cereals. It doesn’t matter whether it’s whole wheat, whole-grain flour, whole-grain oats or whole-grain brown rice either. “When it comes to nutritional value, whole grains provide quite a payoff,” says Czerwony. Compared to white flour and other refined grains, whole grains are higher in fiber, protein and nutrients, like iron, magnesium, selenium and B vitamins. The reason? Those processed grains lose much of their nutritional value during the milling process. A diet rich in whole grains also can lower your risk of heart disease and help prevent diabetes. (Talk about getting a lot done at breakfast!) Another bonus of whole grain? Fiber, which is fabulous for digestion and your gut health “Fiber slows down digestion so that sugars from what you ate trickle into your bloodstream,” explains Czerwony. “You don’t have those highs and lows, which keeps your body in better balance.” Fiber helps you stay full, too — which means a hearty bowl of fiber-rich cereal for breakfast can help hold you over until lunch and keep your stomach from rumbling during a mid-morning meeting. Pro tip: Aim for at least 3 grams of fiber per serving with cereal. Protein can also help you feel full. While sweet cereals may have only 1 or 2 grams of protein, healthier options can have closer to 10 grams. (Oatmeal can run even higher in the protein count, too, if you count it as a cereal.) Let’s start with this basic fact: Most Americans eat way more than the recommended daily limit on sugar. (In case you’re wondering, the general rule of thumb for daily sugar intake is no more than 36 grams for men and 25 grams for women). To start your day on the right foot, look for lower-sugar cereals with less than 9 grams of sugar per serving. “Keep it in the single digits,” recommends Czerwony. Another good guideline: Don’t pick cereals with sugar listed in the top five ingredients. And beware of “sugar imposters” such as glucose, maltodextrin, high fructose corn syrup and evaporated cane juice. Salt in cereal? You bet — and sweeter cereals are more likely to have elevated sodium levels. “Sweet and salt go together,” says Czerwony. “Manufacturers will add that sodium in to make something sweet taste even sweeter.” Look to choose a cereal with less than 140 milligrams of sodium per serving. Aim for an even lower number if you have high blood pressure (hypertension) or kidney issues. Cereal can be pretty sneaky. Healthy-sounding options like granola, for instance, can pack a surprising amount of fat, sugar and unwanted carbohydrates into those crunchy breakfast nuggets. “A cereal may contain whole grains and be high in fiber and still not be the best choice depending on what else is tossed in there,” cautions Czerwony. “It’s easy to make something unhealthy.” That means it’s up to you to be savvy when looking at the nutrition label and ingredients list. (Want to learn more about reading a nutrition label? Then check out these tips from a registered dietitian.) Your best bet for cereals is to keep your selection plain. “That’s code for skipping flavored and frosted varieties,” says Czerwony. So, you’re going to make a healthy choice and select a basic cereal without magical marshmallows or miniature cookies. The good news? It’s pretty easy to add some excitement to that plain bowl. “A lot of cereals are a neutral when it comes to taste,” notes Czerwony. “That gives you a lot of room to drop in some healthy flavor.” She suggests adding: Fresh fruit. “Topping your cereal with blueberries or some other fresh fruit adds a lot of zing while also being good for you, says Czerwony. (Try to avoid sprinkling in dried fruits, though, as they can be high in sugar.) Nuts. Dropping a few almonds or walnuts on top of your cereal brings crunchy goodness, and nuts are full of health benefits. But watch quantities, as a big pile of nuts can be high in calories. Spices. A dash of cinnamon or another favorite spice can punch up a bowl of cereal. “Spices are great alternatives because they add flavor without adding extra sugar or fats,” says Czerwony. Natural sweeteners. Still craving some sweetness? If so, a drizzle of pure maple syrup or honey may satisfy your sweet tooth. “They’re better for you than refined sugars,” she says. “Moderation is still key, though.”","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== My family loves to eat cereal but there's a lot of unhealthy cereal at supermarkets. When I go shopping for cereal, what do I look for to get healthy cereal? {passage 0} ========== Cereal is a quick, easy and delicious breakfast option. It can be healthy, too — if you’re filling your cereal bowl from the right box. Many of the eye-catching boxes in the cereal aisle are more sugar bombs than balanced breakfasts, says registered dietitian Beth Czerwony, RD. (Spoiler alert: Funny-shaped marshmallows DO NOT offer much nutritional value.) So, how can you choose a breakfast cereal worthy of spooning for the most important meal of the day? Czerwony has a few suggestions. All the information you need to separate the healthy cereal options from those that are sweet treats in disguise is readily available. All it takes is some nutrition label reading while you’re shopping. “Want to know what cereal is healthy?” asks Czerwony. “The answer is on the side of the box.” Here’s what you want to find: Whole grains supply a healthy foundation for cereals. It doesn’t matter whether it’s whole wheat, whole-grain flour, whole-grain oats or whole-grain brown rice either. “When it comes to nutritional value, whole grains provide quite a payoff,” says Czerwony. Compared to white flour and other refined grains, whole grains are higher in fiber, protein and nutrients, like iron, magnesium, selenium and B vitamins. The reason? Those processed grains lose much of their nutritional value during the milling process. A diet rich in whole grains also can lower your risk of heart disease and help prevent diabetes. (Talk about getting a lot done at breakfast!) Another bonus of whole grain? Fiber, which is fabulous for digestion and your gut health “Fiber slows down digestion so that sugars from what you ate trickle into your bloodstream,” explains Czerwony. “You don’t have those highs and lows, which keeps your body in better balance.” Fiber helps you stay full, too — which means a hearty bowl of fiber-rich cereal for breakfast can help hold you over until lunch and keep your stomach from rumbling during a mid-morning meeting. Pro tip: Aim for at least 3 grams of fiber per serving with cereal. Protein can also help you feel full. While sweet cereals may have only 1 or 2 grams of protein, healthier options can have closer to 10 grams. (Oatmeal can run even higher in the protein count, too, if you count it as a cereal.) Let’s start with this basic fact: Most Americans eat way more than the recommended daily limit on sugar. (In case you’re wondering, the general rule of thumb for daily sugar intake is no more than 36 grams for men and 25 grams for women). To start your day on the right foot, look for lower-sugar cereals with less than 9 grams of sugar per serving. “Keep it in the single digits,” recommends Czerwony. Another good guideline: Don’t pick cereals with sugar listed in the top five ingredients. And beware of “sugar imposters” such as glucose, maltodextrin, high fructose corn syrup and evaporated cane juice. Salt in cereal? You bet — and sweeter cereals are more likely to have elevated sodium levels. “Sweet and salt go together,” says Czerwony. “Manufacturers will add that sodium in to make something sweet taste even sweeter.” Look to choose a cereal with less than 140 milligrams of sodium per serving. Aim for an even lower number if you have high blood pressure (hypertension) or kidney issues. Cereal can be pretty sneaky. Healthy-sounding options like granola, for instance, can pack a surprising amount of fat, sugar and unwanted carbohydrates into those crunchy breakfast nuggets. “A cereal may contain whole grains and be high in fiber and still not be the best choice depending on what else is tossed in there,” cautions Czerwony. “It’s easy to make something unhealthy.” That means it’s up to you to be savvy when looking at the nutrition label and ingredients list. (Want to learn more about reading a nutrition label? Then check out these tips from a registered dietitian.) Your best bet for cereals is to keep your selection plain. “That’s code for skipping flavored and frosted varieties,” says Czerwony. So, you’re going to make a healthy choice and select a basic cereal without magical marshmallows or miniature cookies. The good news? It’s pretty easy to add some excitement to that plain bowl. “A lot of cereals are a neutral when it comes to taste,” notes Czerwony. “That gives you a lot of room to drop in some healthy flavor.” She suggests adding: Fresh fruit. “Topping your cereal with blueberries or some other fresh fruit adds a lot of zing while also being good for you, says Czerwony. (Try to avoid sprinkling in dried fruits, though, as they can be high in sugar.) Nuts. Dropping a few almonds or walnuts on top of your cereal brings crunchy goodness, and nuts are full of health benefits. But watch quantities, as a big pile of nuts can be high in calories. Spices. A dash of cinnamon or another favorite spice can punch up a bowl of cereal. “Spices are great alternatives because they add flavor without adding extra sugar or fats,” says Czerwony. Natural sweeteners. Still craving some sweetness? If so, a drizzle of pure maple syrup or honey may satisfy your sweet tooth. “They’re better for you than refined sugars,” she says. “Moderation is still key, though.” https://health.clevelandclinic.org/how-to-pick-a-healthy-cereal","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]
+
+EVIDENCE:
+Cereal is a quick, easy and delicious breakfast option. It can be healthy, too — if you’re filling your cereal bowl from the right box. Many of the eye-catching boxes in the cereal aisle are more sugar bombs than balanced breakfasts, says registered dietitian Beth Czerwony, RD. (Spoiler alert: Funny-shaped marshmallows DO NOT offer much nutritional value.) So, how can you choose a breakfast cereal worthy of spooning for the most important meal of the day? Czerwony has a few suggestions. All the information you need to separate the healthy cereal options from those that are sweet treats in disguise is readily available. All it takes is some nutrition label reading while you’re shopping. “Want to know what cereal is healthy?” asks Czerwony. “The answer is on the side of the box.” Here’s what you want to find: Whole grains supply a healthy foundation for cereals. It doesn’t matter whether it’s whole wheat, whole-grain flour, whole-grain oats or whole-grain brown rice either. “When it comes to nutritional value, whole grains provide quite a payoff,” says Czerwony. Compared to white flour and other refined grains, whole grains are higher in fiber, protein and nutrients, like iron, magnesium, selenium and B vitamins. The reason? Those processed grains lose much of their nutritional value during the milling process. A diet rich in whole grains also can lower your risk of heart disease and help prevent diabetes. (Talk about getting a lot done at breakfast!) Another bonus of whole grain? Fiber, which is fabulous for digestion and your gut health “Fiber slows down digestion so that sugars from what you ate trickle into your bloodstream,” explains Czerwony. “You don’t have those highs and lows, which keeps your body in better balance.” Fiber helps you stay full, too — which means a hearty bowl of fiber-rich cereal for breakfast can help hold you over until lunch and keep your stomach from rumbling during a mid-morning meeting. Pro tip: Aim for at least 3 grams of fiber per serving with cereal. Protein can also help you feel full. While sweet cereals may have only 1 or 2 grams of protein, healthier options can have closer to 10 grams. (Oatmeal can run even higher in the protein count, too, if you count it as a cereal.) Let’s start with this basic fact: Most Americans eat way more than the recommended daily limit on sugar. (In case you’re wondering, the general rule of thumb for daily sugar intake is no more than 36 grams for men and 25 grams for women). To start your day on the right foot, look for lower-sugar cereals with less than 9 grams of sugar per serving. “Keep it in the single digits,” recommends Czerwony. Another good guideline: Don’t pick cereals with sugar listed in the top five ingredients. And beware of “sugar imposters” such as glucose, maltodextrin, high fructose corn syrup and evaporated cane juice. Salt in cereal? You bet — and sweeter cereals are more likely to have elevated sodium levels. “Sweet and salt go together,” says Czerwony. “Manufacturers will add that sodium in to make something sweet taste even sweeter.” Look to choose a cereal with less than 140 milligrams of sodium per serving. Aim for an even lower number if you have high blood pressure (hypertension) or kidney issues. Cereal can be pretty sneaky. Healthy-sounding options like granola, for instance, can pack a surprising amount of fat, sugar and unwanted carbohydrates into those crunchy breakfast nuggets. “A cereal may contain whole grains and be high in fiber and still not be the best choice depending on what else is tossed in there,” cautions Czerwony. “It’s easy to make something unhealthy.” That means it’s up to you to be savvy when looking at the nutrition label and ingredients list. (Want to learn more about reading a nutrition label? Then check out these tips from a registered dietitian.) Your best bet for cereals is to keep your selection plain. “That’s code for skipping flavored and frosted varieties,” says Czerwony. So, you’re going to make a healthy choice and select a basic cereal without magical marshmallows or miniature cookies. The good news? It’s pretty easy to add some excitement to that plain bowl. “A lot of cereals are a neutral when it comes to taste,” notes Czerwony. “That gives you a lot of room to drop in some healthy flavor.” She suggests adding: Fresh fruit. “Topping your cereal with blueberries or some other fresh fruit adds a lot of zing while also being good for you, says Czerwony. (Try to avoid sprinkling in dried fruits, though, as they can be high in sugar.) Nuts. Dropping a few almonds or walnuts on top of your cereal brings crunchy goodness, and nuts are full of health benefits. But watch quantities, as a big pile of nuts can be high in calories. Spices. A dash of cinnamon or another favorite spice can punch up a bowl of cereal. “Spices are great alternatives because they add flavor without adding extra sugar or fats,” says Czerwony. Natural sweeteners. Still craving some sweetness? If so, a drizzle of pure maple syrup or honey may satisfy your sweet tooth. “They’re better for you than refined sugars,” she says. “Moderation is still key, though.”
+
+USER:
+My family loves to eat cereal but there's a lot of unhealthy cereal at supermarkets. When I go shopping for cereal, what do I look for to get healthy cereal?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,26,30,874,,558
+[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.,discuss wether the fine tuning of LLMs on medical datasets has consistently improved risk prediction performance for Alzheimer’s disease using ĖHRs. Discuss the specific methods proposed for handling some of the different setbacks is prediction accuracy.,"1Introduction Alzheimer’s disease (AD) and Alzheimer’s disease related dementias (ADRD) are neurodegenerative disorders primarily affecting memory and cognitive functions. They gradually erode overall function abilities, eventually leading to death [39]. The development of AD/ADRD treatment has been slow due to the complex disease pathology and clinical manifestations. The decline of memory and cognitive functions is associated with pathological progression and structural changes of the brain [28], which can be identified from neuroimage or biomarkers from cerebro-spinal fluid. However, those procedures are expensive and invasive, which are unlikely to be ordered for asymptomatic patients. For real world patients, typically only the electronic health records (EHRs) collected from their routined care are available[6, 18]. These data include information like demographics, lab tests, diagnoses, medications, and procedures, and they provide a potential opportunity for risk prediction of AD/ADRD [34]. Risk prediction from EHRs is commonly formulated as a supervised learning problem [56] and one can model with existing supervised learning (SLs) tools, such as logistic regression (LR) [68], XGBoost (XGB) [44], and multi-layer perceptron (MLP) [54]. However, SL approaches face significant challenges in predicting risk from EHRs, due to the complexity of medical problems and the noisy nature of the data [75]. Moreover, EHRs do not contain all critical information that is needed for risk prediction for particular conditions. For example, diagnosis of MCI requires a comprehensive evaluation of cognitive functions, such as memory, executive function, and language. In early stages, when symptoms are subtle and not extensively documented in the EHRs, risk | Type | Vital sign | Lab. Test | ICD | RxNorm | CPT | |------|------------|-----------|-----|--------|-----| | Domain | ℝ | ℝ | [0,1] (Positive, Negative) | [0,1] (Positive, Negative) | [0,1] (Positive, Negative) | | Example | Blood Pressure, Age | Hemoglobin Level | J18.9 for Pneumonia | 4099 for Estrogen | A4206 for DME and supplies | | Short Explanation | Physiological measurement to assess a patient's status | Analyzing biochemical markers using blood and urine | Alphanumeric system classifying diseases | Standardized nomenclature system for clinical drugs | Medical procedure identification for billing | Table 1: Brief explanation of the five categories; Vital sign, Laboratory test, ICD code, RxNorm code, and CPT code, in the EHR dataset, describing each patient. prediction using traditional machine-learning approaches can be difficult. Though some information in EHRs may be weakly related to the risk, SL models may or may not be able to pick them up. Recent advancements in pre-trained large language models (LLMs) [61, 62, 1, 8, 58] have demonstrated their capability to provide robust reasoning power, particularly with rich contextual information and domain knowledge. Intuitively, LLM can leverage its reasoning capability and flexible in-context learning (ICL) strategies to better derive valuable insights from EHRs. However, there are still several technical challenges to achieve this goal. The first one is how to perform effective reasoning with an EHR database. While fine-tuning external knowledge into the LLMs has been a major approach in many domains, it is not trivial to fine-tune knowledge from EHR to LLMs. EHR includes clinical information for individual patients and evolves over time, whereas LLMs are typically learned and tuned using static information. The second challenge is the representation of medical records for reasoning. LLMs are probability models trained to understand and reason with natural language, and it is not clear how structured EHRs, such as vital, diagnosis codes, and prescriptions, are best represented in LLMs for effective reasoning. The third challenge is rooted in the inherent data quality issues in EHR data, which could be noisy as they were originally designed for billing purposes. The presence of such events is likely to compromise and greatly mislead the reasoning of LLMs. Contributions. Here, we summarize the contributions as follows: - We identified the strengths and weaknesses of SLs and LLMs in risk predictions from EHR. From the SLs’ perspective, they provide accurate predictions for confident samples, which are typically aligned well with training data distribution. However, when the samples are not common or the features are sparse, SLs are usually not confident about the predictions and generate poorer predictions than LLMs, showing the value of reasoning from LLMs in EHR analysis. • Based on our findings, we propose a collaborative approach that combines SLs and LLMs through a confidence- driven selection process for enhanced ADRD risk prediction. This method dynamically selects between SL and LLM predictions based on confidence levels, effectively leveraging the strengths of SLs for high-confidence cases and LLMs for low-confidence instances. Furthermore, we incorporate a meticulously designed ICL demonstration denoising strategy to save the ICL performance of LLMs, which in turn boosts the overall efficiency of the pipeline. • We validate our approach using a real-world dataset from the OHSU health system, highlighting the effectiveness of our method and its superiority over traditional SLs and LLMs in predicting ADRD. Additionally, we conduct experiments with different sizes of LLMs and models fine-tuned on various medical datasets. Our findings suggest that neither a larger model size nor fine-tuning on medical data consistently improves risk prediction performance. Further investigation is required to check these dynamics in practice. LLMs for Clinical Domain LLMs possess strong capability in performing various tasks, including those in the medical field [23]. In particular, many studies have attempted to develop new LLMs specifically for medical tasks. For example, Med-PaLM [55] represents a medical domain-specific variant of the PaLM model. Similarly, based on Alpaca [57], MedAlpaca [21] was proposed, and fine-tuend LLaMA [61, 62] for medical domain, PMC-LLaMA [67] was suggested. Chat-bot oriented model [70] and Huatuo-GPT [71] were trained using the dataset obtained from the real-world doctors and ChatGPT [1]. Yang et al. [69] trained and release the GatorTron model. Different from proposing a new medical-specific models, several works have aimed to directly use the pre-trained LLMs in a zero-shot manner. For example in [42, 38] used GPT models for the medical field. Nori et al. [43] proposed a way of leveraging pre-trained LLMs for the medical field by leveraging some techniques including in-context learning, and chain-of-thought.","[question] discuss wether the fine tuning of LLMs on medical datasets has consistently improved risk prediction performance for Alzheimer’s disease using ĖHRs. Discuss the specific methods proposed for handling some of the different setbacks is prediction accuracy. ===================== [text] 1Introduction Alzheimer’s disease (AD) and Alzheimer’s disease related dementias (ADRD) are neurodegenerative disorders primarily affecting memory and cognitive functions. They gradually erode overall function abilities, eventually leading to death [39]. The development of AD/ADRD treatment has been slow due to the complex disease pathology and clinical manifestations. The decline of memory and cognitive functions is associated with pathological progression and structural changes of the brain [28], which can be identified from neuroimage or biomarkers from cerebro-spinal fluid. However, those procedures are expensive and invasive, which are unlikely to be ordered for asymptomatic patients. For real world patients, typically only the electronic health records (EHRs) collected from their routined care are available[6, 18]. These data include information like demographics, lab tests, diagnoses, medications, and procedures, and they provide a potential opportunity for risk prediction of AD/ADRD [34]. Risk prediction from EHRs is commonly formulated as a supervised learning problem [56] and one can model with existing supervised learning (SLs) tools, such as logistic regression (LR) [68], XGBoost (XGB) [44], and multi-layer perceptron (MLP) [54]. However, SL approaches face significant challenges in predicting risk from EHRs, due to the complexity of medical problems and the noisy nature of the data [75]. Moreover, EHRs do not contain all critical information that is needed for risk prediction for particular conditions. For example, diagnosis of MCI requires a comprehensive evaluation of cognitive functions, such as memory, executive function, and language. In early stages, when symptoms are subtle and not extensively documented in the EHRs, risk | Type | Vital sign | Lab. Test | ICD | RxNorm | CPT | |------|------------|-----------|-----|--------|-----| | Domain | ℝ | ℝ | [0,1] (Positive, Negative) | [0,1] (Positive, Negative) | [0,1] (Positive, Negative) | | Example | Blood Pressure, Age | Hemoglobin Level | J18.9 for Pneumonia | 4099 for Estrogen | A4206 for DME and supplies | | Short Explanation | Physiological measurement to assess a patient's status | Analyzing biochemical markers using blood and urine | Alphanumeric system classifying diseases | Standardized nomenclature system for clinical drugs | Medical procedure identification for billing | Table 1: Brief explanation of the five categories; Vital sign, Laboratory test, ICD code, RxNorm code, and CPT code, in the EHR dataset, describing each patient. prediction using traditional machine-learning approaches can be difficult. Though some information in EHRs may be weakly related to the risk, SL models may or may not be able to pick them up. Recent advancements in pre-trained large language models (LLMs) [61, 62, 1, 8, 58] have demonstrated their capability to provide robust reasoning power, particularly with rich contextual information and domain knowledge. Intuitively, LLM can leverage its reasoning capability and flexible in-context learning (ICL) strategies to better derive valuable insights from EHRs. However, there are still several technical challenges to achieve this goal. The first one is how to perform effective reasoning with an EHR database. While fine-tuning external knowledge into the LLMs has been a major approach in many domains, it is not trivial to fine-tune knowledge from EHR to LLMs. EHR includes clinical information for individual patients and evolves over time, whereas LLMs are typically learned and tuned using static information. The second challenge is the representation of medical records for reasoning. LLMs are probability models trained to understand and reason with natural language, and it is not clear how structured EHRs, such as vital, diagnosis codes, and prescriptions, are best represented in LLMs for effective reasoning. The third challenge is rooted in the inherent data quality issues in EHR data, which could be noisy as they were originally designed for billing purposes. The presence of such events is likely to compromise and greatly mislead the reasoning of LLMs. Contributions. Here, we summarize the contributions as follows: - We identified the strengths and weaknesses of SLs and LLMs in risk predictions from EHR. From the SLs’ perspective, they provide accurate predictions for confident samples, which are typically aligned well with training data distribution. However, when the samples are not common or the features are sparse, SLs are usually not confident about the predictions and generate poorer predictions than LLMs, showing the value of reasoning from LLMs in EHR analysis. • Based on our findings, we propose a collaborative approach that combines SLs and LLMs through a confidence- driven selection process for enhanced ADRD risk prediction. This method dynamically selects between SL and LLM predictions based on confidence levels, effectively leveraging the strengths of SLs for high-confidence cases and LLMs for low-confidence instances. Furthermore, we incorporate a meticulously designed ICL demonstration denoising strategy to save the ICL performance of LLMs, which in turn boosts the overall efficiency of the pipeline. • We validate our approach using a real-world dataset from the OHSU health system, highlighting the effectiveness of our method and its superiority over traditional SLs and LLMs in predicting ADRD. Additionally, we conduct experiments with different sizes of LLMs and models fine-tuned on various medical datasets. Our findings suggest that neither a larger model size nor fine-tuning on medical data consistently improves risk prediction performance. Further investigation is required to check these dynamics in practice. LLMs for Clinical Domain LLMs possess strong capability in performing various tasks, including those in the medical field [23]. In particular, many studies have attempted to develop new LLMs specifically for medical tasks. For example, Med-PaLM [55] represents a medical domain-specific variant of the PaLM model. Similarly, based on Alpaca [57], MedAlpaca [21] was proposed, and fine-tuend LLaMA [61, 62] for medical domain, PMC-LLaMA [67] was suggested. Chat-bot oriented model [70] and Huatuo-GPT [71] were trained using the dataset obtained from the real-world doctors and ChatGPT [1]. Yang et al. [69] trained and release the GatorTron model. Different from proposing a new medical-specific models, several works have aimed to directly use the pre-trained LLMs in a zero-shot manner. For example in [42, 38] used GPT models for the medical field. Nori et al. [43] proposed a way of leveraging pre-trained LLMs for the medical field by leveraging some techniques including in-context learning, and chain-of-thought. https://arxiv.org/pdf/2405.16413 ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.","[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
+
+EVIDENCE:
+1Introduction Alzheimer’s disease (AD) and Alzheimer’s disease related dementias (ADRD) are neurodegenerative disorders primarily affecting memory and cognitive functions. They gradually erode overall function abilities, eventually leading to death [39]. The development of AD/ADRD treatment has been slow due to the complex disease pathology and clinical manifestations. The decline of memory and cognitive functions is associated with pathological progression and structural changes of the brain [28], which can be identified from neuroimage or biomarkers from cerebro-spinal fluid. However, those procedures are expensive and invasive, which are unlikely to be ordered for asymptomatic patients. For real world patients, typically only the electronic health records (EHRs) collected from their routined care are available[6, 18]. These data include information like demographics, lab tests, diagnoses, medications, and procedures, and they provide a potential opportunity for risk prediction of AD/ADRD [34]. Risk prediction from EHRs is commonly formulated as a supervised learning problem [56] and one can model with existing supervised learning (SLs) tools, such as logistic regression (LR) [68], XGBoost (XGB) [44], and multi-layer perceptron (MLP) [54]. However, SL approaches face significant challenges in predicting risk from EHRs, due to the complexity of medical problems and the noisy nature of the data [75]. Moreover, EHRs do not contain all critical information that is needed for risk prediction for particular conditions. For example, diagnosis of MCI requires a comprehensive evaluation of cognitive functions, such as memory, executive function, and language. In early stages, when symptoms are subtle and not extensively documented in the EHRs, risk | Type | Vital sign | Lab. Test | ICD | RxNorm | CPT | |------|------------|-----------|-----|--------|-----| | Domain | ℝ | ℝ | [0,1] (Positive, Negative) | [0,1] (Positive, Negative) | [0,1] (Positive, Negative) | | Example | Blood Pressure, Age | Hemoglobin Level | J18.9 for Pneumonia | 4099 for Estrogen | A4206 for DME and supplies | | Short Explanation | Physiological measurement to assess a patient's status | Analyzing biochemical markers using blood and urine | Alphanumeric system classifying diseases | Standardized nomenclature system for clinical drugs | Medical procedure identification for billing | Table 1: Brief explanation of the five categories; Vital sign, Laboratory test, ICD code, RxNorm code, and CPT code, in the EHR dataset, describing each patient. prediction using traditional machine-learning approaches can be difficult. Though some information in EHRs may be weakly related to the risk, SL models may or may not be able to pick them up. Recent advancements in pre-trained large language models (LLMs) [61, 62, 1, 8, 58] have demonstrated their capability to provide robust reasoning power, particularly with rich contextual information and domain knowledge. Intuitively, LLM can leverage its reasoning capability and flexible in-context learning (ICL) strategies to better derive valuable insights from EHRs. However, there are still several technical challenges to achieve this goal. The first one is how to perform effective reasoning with an EHR database. While fine-tuning external knowledge into the LLMs has been a major approach in many domains, it is not trivial to fine-tune knowledge from EHR to LLMs. EHR includes clinical information for individual patients and evolves over time, whereas LLMs are typically learned and tuned using static information. The second challenge is the representation of medical records for reasoning. LLMs are probability models trained to understand and reason with natural language, and it is not clear how structured EHRs, such as vital, diagnosis codes, and prescriptions, are best represented in LLMs for effective reasoning. The third challenge is rooted in the inherent data quality issues in EHR data, which could be noisy as they were originally designed for billing purposes. The presence of such events is likely to compromise and greatly mislead the reasoning of LLMs. Contributions. Here, we summarize the contributions as follows: - We identified the strengths and weaknesses of SLs and LLMs in risk predictions from EHR. From the SLs’ perspective, they provide accurate predictions for confident samples, which are typically aligned well with training data distribution. However, when the samples are not common or the features are sparse, SLs are usually not confident about the predictions and generate poorer predictions than LLMs, showing the value of reasoning from LLMs in EHR analysis. • Based on our findings, we propose a collaborative approach that combines SLs and LLMs through a confidence- driven selection process for enhanced ADRD risk prediction. This method dynamically selects between SL and LLM predictions based on confidence levels, effectively leveraging the strengths of SLs for high-confidence cases and LLMs for low-confidence instances. Furthermore, we incorporate a meticulously designed ICL demonstration denoising strategy to save the ICL performance of LLMs, which in turn boosts the overall efficiency of the pipeline. • We validate our approach using a real-world dataset from the OHSU health system, highlighting the effectiveness of our method and its superiority over traditional SLs and LLMs in predicting ADRD. Additionally, we conduct experiments with different sizes of LLMs and models fine-tuned on various medical datasets. Our findings suggest that neither a larger model size nor fine-tuning on medical data consistently improves risk prediction performance. Further investigation is required to check these dynamics in practice. LLMs for Clinical Domain LLMs possess strong capability in performing various tasks, including those in the medical field [23]. In particular, many studies have attempted to develop new LLMs specifically for medical tasks. For example, Med-PaLM [55] represents a medical domain-specific variant of the PaLM model. Similarly, based on Alpaca [57], MedAlpaca [21] was proposed, and fine-tuend LLaMA [61, 62] for medical domain, PMC-LLaMA [67] was suggested. Chat-bot oriented model [70] and Huatuo-GPT [71] were trained using the dataset obtained from the real-world doctors and ChatGPT [1]. Yang et al. [69] trained and release the GatorTron model. Different from proposing a new medical-specific models, several works have aimed to directly use the pre-trained LLMs in a zero-shot manner. For example in [42, 38] used GPT models for the medical field. Nori et al. [43] proposed a way of leveraging pre-trained LLMs for the medical field by leveraging some techniques including in-context learning, and chain-of-thought.
+
+USER:
+discuss wether the fine tuning of LLMs on medical datasets has consistently improved risk prediction performance for Alzheimer’s disease using ĖHRs. Discuss the specific methods proposed for handling some of the different setbacks is prediction accuracy.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,28,36,1004,,238
+Use only the information provided in the prompt to answer questions. Do not use any prior knowledge or external sources. List the response without numbers or bullet points. Restate the question as an introductory sentence. No other text in the response.,What are the conditions that have a differential diagnosis of angina pectoris?,"Diffuse Esophageal Spasm ■ Essentials of Diagnosis • Dysphagia, noncardiac chest pain, hypersalivation, reflux of recently ingested food • May be precipitated by ingestion of hot or cold foods • Endoscopic, radiographic, and manometric demonstration of nonpropulsive hyperperistalsis; lower esophageal sphincter relaxes normally • “Nutcracker esophagus” variant with prolonged, high-pressure (> 175 mm Hg) propulsive contractions ■ Differential Diagnosis • Angina pectoris • Esophageal or mediastinal tumors • Aperistalsis • Achalasia • Psychiatric disease ■ Treatment • Trial of acid suppression. • Calcium channel blockers such as nifedipine or diltiazem in combination with nitrates often effective. For patient failing to respond, possible role for sildenafil, botulinum toxin. • Trazodone or tricyclic antidepressants for substernal pain ■ Pearl This condition may be indistinguishable from myocardial ischemia; exclude that possibility before investigating the esophagus. Reference Grübel C, Borovicka J, Schwizer W, Fox M, Hebbard G. Diffuse esophageal spasm. Am J Gastroenterol 2008;103:450. [PMID: 18005367] Chapter 3 Gastrointestinal Diseases 77 3 Disaccharidase (Lactase) Deficiency ■ Essentials of Diagnosis • Common in Asians and blacks, in whom lactase enzyme deficiency is nearly ubiquitous and begins in childhood; can also be acquired temporarily after gastroenteritis of other causes • Symptoms vary from abdominal bloating, distention, cramps, and flatulence to explosive diarrhea in response to disaccharide ingestion • Stool pH < 5.5; reducing substances present in stool • Abnormal lactose hydrogen breath test, resolution of symptoms on lactose-free diet, or flat glucose response to disaccharide loading suggests the diagnosis ■ Differential Diagnosis • Chronic mucosal malabsorptive disorders • Irritable bowel syndrome • Celiac sprue • Small intestinal bacterial overgrowth • Inflammatory bowel disease • Pancreatic insufficiency • Giardiasis • Excess artificial sweetener use ■ Treatment • Restriction of dietary lactose; usually happens by experience in affected minorities from early life • Lactase enzyme supplementation • Maintenance of adequate nutritional and calcium intake ■ Pearl Consider this in undiagnosed diarrhea; the patient may not be aware of ingesting lactose-containing foods. Foreign Bodies in the Esophagus ■ Essentials of Diagnosis • Most common in children, edentulous older patients, and the severely mentally impaired • Occurs at physiologic areas of narrowing (upper esophageal sphincter, the level of the aortic arch, or the diaphragmatic hiatus) • Other predisposing factors favoring impaction include Zenker’s diverticulum, webs, achalasia, peptic strictures, or malignancy • Recent ingestion of food or foreign material (coins most commonly in children, meat bolus most common in adults), but the history may be missing • Vague discomfort in chest or neck, dysphagia, inability to handle secretions, odynophagia, hypersalivation, and stridor or dyspnea in children • Radiographic or endoscopic evidence of esophageal obstruction by foreign body ■ Differential Diagnosis • Esophageal stricture • Eosinophilic esophagitis • Esophageal or mediastinal tumor • Angina pectoris ■ Treatment • Endoscopic removal with airway protection as needed and the use of an overtube if sharp objects are present • Emergent endoscopy should be used for sharp objects, disk batteries (secondary to risk of perforation due to their caustic nature), or evidence of the inability to handle secretions; objects retained in the esophagus should be removed within 24 hours of ingestion • Endoscopy is successful in > 90% of cases; avoid barium studies before endoscopy, as they impair visualization ■ Pearl Treatment is ordinarily straightforward; diagnosis may not be, especially in the very young and very old. Reference Eisen GM, Baron TH, Dominitz JA, et al; American Society for Gastrointestinal Endoscopy. Guideline for the management of ingested foreign bodies. Gastrointest Endosc 2002;55:802. [PMID: 12024131] Gastritis ■ Essentials of Diagnosis • May be acute (erosive) or indolent (atrophic); multiple varied causes • Symptoms often vague and include nausea, vomiting, anorexia, nondescript upper abdominal distress • Mild epigastric tenderness to palpation; in some, physical signs absent • Iron deficiency anemia not unusual • Endoscopy with gastric biopsy for definitive diagnosis • Multiple associations include stress and diminished mucosal blood flow (burns, sepsis, critical illness), drugs (NSAIDs, salicylates), atrophic states (aging, pernicious anemia), previous surgery (gastrectomy, Billroth II), H. pylori infection, acute or chronic alcoholism ■ Differential Diagnosis • Peptic ulcer • Hiatal hernia • Malignancy of stomach or pancreas • Cholecystitis • Ischemic cardiac disease ■ Treatment • Avoidance of alcohol, caffeine, salicylates, tobacco, and NSAIDs • Investigate for presence of H. pylori; eradicate if present • Proton pump inhibitors in patients receiving oral feedings, H2 inhibitors, or sucralfate • Prevention in high-risk patients (eg, intensive care setting) using these same agents ■ Pearl Ninety-five percent of gastroenterologists and a high proportion of other health care workers carry H. pylori. Reference El-Zimaity H. Gastritis and gastric atrophy. Curr Opin Gastroenterol 2008;24:682. [PMID: 19122515] 84 Current Essentials of Medicine 3 Gastroesophageal Reflux Disease (GERD) ■ Essentials of Diagnosis • Substernal burning (pyrosis) or pressure, aggravated by recumbency and relieved with sitting; can cause dysphagia, odynophagia, atypical chest pain; proton pump inhibitor may be diagnostic and therapeutic; further testing when diagnosis unclear, symptoms refractory • Reflux, hiatal hernia may be found at barium study • Incompetent lower esophageal sphincter (LES); endoscopy with biopsy may be necessary to exclude other diagnoses • Esophageal pH helpful during symptoms • Diminished LES tone also seen in obesity, pregnancy, hiatal hernia, nasogastric tube ■ Differential Diagnosis • Peptic ulcer disease • Angina pectoris • Achalasia, esophageal spasm, pill esophagitis ■ Treatment • Weight loss, avoidance of late-night meals, elevation of head of bed • Avoid chocolate, caffeine, tobacco, alcohol • High-dose H2 blockers or proton pump inhibitors • Surgical fundoplication for patients intolerant or allergic to medical therapy or refractory cases with predominantly regurgitation or nonacid reflux; use caution in patients whose primary complaint is heartburn and who are found to have nonerosive GER, as these patients likely have a component of visceral hypersensitivity that may be exacerbated by surgery. ■ Pearl Eradication of H. pylori may actually worsen GERD; the gastric acid secretion increases upon eradication of the bacterium. Reference Fass R. Proton pump inhibitor failure: what are the therapeutic options? Am J Gastroenterol 2009;104(suppl):S33. [PMID: 19262545] Chapter 3 Gastrointestinal Diseases 85 3 Intestinal Tuberculosis ■ Essentials of Diagnosis • Chronic abdominal pain, anorexia, bloating; weight loss, fever, diarrhea, new-onset ascites in many • Mild right lower quadrant tenderness, as ileocecal area is the most commonly involved intestinal site; fistula-in-ano sometimes seen • Barium study may reveal mucosal ulcerations or scarring and fibrosis with narrowing of the small or large intestine • In peritonitis, ascitic fluid has high protein and mononuclear pleocytosis; peritoneal biopsy with granulomas is more sensitive than ascites AFB culture; high adenosine deaminase levels in ascitic fluid may suggest the diagnosis; TB peritonitis more common in those with immune compromise • Complications include intestinal obstruction, hemorrhage, fistula formation, and bacterial overgrowth with malabsorption ■ Differential Diagnosis • Carcinoma of the colon or small bowel • Inflammatory bowel disease: Crohn’s disease • Ameboma or Yersinia infection • Intestinal lymphoma or amyloidosis • Ovarian or peritoneal carcinomatosis • Mycobacterium avium-intracellulare infection ■ Treatment • Standard therapy for tuberculosis; as infection heals, the affected bowel may develop stricture ■ Pearl Seen uncommonly in the developed world, but experienced clinicians have long noted that exploratory laparotomy for suspected small bowel obstruction relieves symptoms without antituberculous therapy. Reference Donoghue HD, Holton J. Intestinal tuberculosis. Curr Opin Infect Dis 2009;22:490. [PMID: 19623062] Carpal Tunnel Syndrome ■ Essentials of Diagnosis • The most common entrapment neuropathy, caused by compression of the median nerve (which innervates the flexor muscles of the wrist and fingers) • Middle-aged women and those with a history of repetitive use of the hands commonly affected • Pain classically worse at night (sleep with hands curled into the body) and exacerbated by hand movement • Initial symptoms of pain or paresthesias in thumb, index, middle, and lateral part of ring finger; progression to thenar eminence wasting • Pain radiation to forearm, shoulder, neck, chest, or other fingers of the hand not uncommon • Positive Tinel’s sign • Usually idiopathic; in bilateral onset consider secondary causes including rheumatoid arthritis, amyloidosis, sarcoidosis, hypothyroidism, diabetes, pregnancy, acromegaly, gout • Diagnosis is primarily clinical; detection of deficits by electrodiagnostic testing (assessing nerve conduction velocity) very helpful to guide referral for surgical release ■ Differential Diagnosis • C6 or C7 cervical radiculopathy • Thoracic outlet syndrome leading to brachial plexus neuropathy • Mononeuritis multiplex • Syringomyelia • Multiple sclerosis • Angina pectoris, especially when left-sided ■ Treatment • Conservative measures initially, including hand rest, nocturnal splinting of wrists, anti-inflammatory medications • Steroid injection into the carpal tunnel occasionally • Surgical decompression in a few who have nerve conduction abnormalities; best done before development of thenar atrophy ■ Pearl Carpal tunnel affects the radial three and one-half fingers, myocardial ischemia the ulnar one and one-half; remember this in evaluating arm pain—and hope it’s the right arm. Reference Dahlin LB, Salö M, Thomsen N, Stütz N. Carpal tunnel syndrome and treatment of recurrent symptoms. Scand J Plast Reconstr Surg Hand Surg 2010;44:4. [PMID: 20136467]","Use only the information provided in the prompt to answer questions. Do not use any prior knowledge or external sources. List the response without numbers or bullet points. Restate the question as an introductory sentence. No other text in the response. What are the conditions that have a differential diagnosis of angina pectoris? Diffuse Esophageal Spasm ■ Essentials of Diagnosis • Dysphagia, noncardiac chest pain, hypersalivation, reflux of recently ingested food • May be precipitated by ingestion of hot or cold foods • Endoscopic, radiographic, and manometric demonstration of nonpropulsive hyperperistalsis; lower esophageal sphincter relaxes normally • “Nutcracker esophagus” variant with prolonged, high-pressure (> 175 mm Hg) propulsive contractions ■ Differential Diagnosis • Angina pectoris • Esophageal or mediastinal tumors • Aperistalsis • Achalasia • Psychiatric disease ■ Treatment • Trial of acid suppression. • Calcium channel blockers such as nifedipine or diltiazem in combination with nitrates often effective. For patient failing to respond, possible role for sildenafil, botulinum toxin. • Trazodone or tricyclic antidepressants for substernal pain ■ Pearl This condition may be indistinguishable from myocardial ischemia; exclude that possibility before investigating the esophagus. Reference Grübel C, Borovicka J, Schwizer W, Fox M, Hebbard G. Diffuse esophageal spasm. Am J Gastroenterol 2008;103:450. [PMID: 18005367] Chapter 3 Gastrointestinal Diseases 77 3 Disaccharidase (Lactase) Deficiency ■ Essentials of Diagnosis • Common in Asians and blacks, in whom lactase enzyme deficiency is nearly ubiquitous and begins in childhood; can also be acquired temporarily after gastroenteritis of other causes • Symptoms vary from abdominal bloating, distention, cramps, and flatulence to explosive diarrhea in response to disaccharide ingestion • Stool pH < 5.5; reducing substances present in stool • Abnormal lactose hydrogen breath test, resolution of symptoms on lactose-free diet, or flat glucose response to disaccharide loading suggests the diagnosis ■ Differential Diagnosis • Chronic mucosal malabsorptive disorders • Irritable bowel syndrome • Celiac sprue • Small intestinal bacterial overgrowth • Inflammatory bowel disease • Pancreatic insufficiency • Giardiasis • Excess artificial sweetener use ■ Treatment • Restriction of dietary lactose; usually happens by experience in affected minorities from early life • Lactase enzyme supplementation • Maintenance of adequate nutritional and calcium intake ■ Pearl Consider this in undiagnosed diarrhea; the patient may not be aware of ingesting lactose-containing foods. Foreign Bodies in the Esophagus ■ Essentials of Diagnosis • Most common in children, edentulous older patients, and the severely mentally impaired • Occurs at physiologic areas of narrowing (upper esophageal sphincter, the level of the aortic arch, or the diaphragmatic hiatus) • Other predisposing factors favoring impaction include Zenker’s diverticulum, webs, achalasia, peptic strictures, or malignancy • Recent ingestion of food or foreign material (coins most commonly in children, meat bolus most common in adults), but the history may be missing • Vague discomfort in chest or neck, dysphagia, inability to handle secretions, odynophagia, hypersalivation, and stridor or dyspnea in children • Radiographic or endoscopic evidence of esophageal obstruction by foreign body ■ Differential Diagnosis • Esophageal stricture • Eosinophilic esophagitis • Esophageal or mediastinal tumor • Angina pectoris ■ Treatment • Endoscopic removal with airway protection as needed and the use of an overtube if sharp objects are present • Emergent endoscopy should be used for sharp objects, disk batteries (secondary to risk of perforation due to their caustic nature), or evidence of the inability to handle secretions; objects retained in the esophagus should be removed within 24 hours of ingestion • Endoscopy is successful in > 90% of cases; avoid barium studies before endoscopy, as they impair visualization ■ Pearl Treatment is ordinarily straightforward; diagnosis may not be, especially in the very young and very old. Reference Eisen GM, Baron TH, Dominitz JA, et al; American Society for Gastrointestinal Endoscopy. Guideline for the management of ingested foreign bodies. Gastrointest Endosc 2002;55:802. [PMID: 12024131] Gastritis ■ Essentials of Diagnosis • May be acute (erosive) or indolent (atrophic); multiple varied causes • Symptoms often vague and include nausea, vomiting, anorexia, nondescript upper abdominal distress • Mild epigastric tenderness to palpation; in some, physical signs absent • Iron deficiency anemia not unusual • Endoscopy with gastric biopsy for definitive diagnosis • Multiple associations include stress and diminished mucosal blood flow (burns, sepsis, critical illness), drugs (NSAIDs, salicylates), atrophic states (aging, pernicious anemia), previous surgery (gastrectomy, Billroth II), H. pylori infection, acute or chronic alcoholism ■ Differential Diagnosis • Peptic ulcer • Hiatal hernia • Malignancy of stomach or pancreas • Cholecystitis • Ischemic cardiac disease ■ Treatment • Avoidance of alcohol, caffeine, salicylates, tobacco, and NSAIDs • Investigate for presence of H. pylori; eradicate if present • Proton pump inhibitors in patients receiving oral feedings, H2 inhibitors, or sucralfate • Prevention in high-risk patients (eg, intensive care setting) using these same agents ■ Pearl Ninety-five percent of gastroenterologists and a high proportion of other health care workers carry H. pylori. Reference El-Zimaity H. Gastritis and gastric atrophy. Curr Opin Gastroenterol 2008;24:682. [PMID: 19122515] 84 Current Essentials of Medicine 3 Gastroesophageal Reflux Disease (GERD) ■ Essentials of Diagnosis • Substernal burning (pyrosis) or pressure, aggravated by recumbency and relieved with sitting; can cause dysphagia, odynophagia, atypical chest pain; proton pump inhibitor may be diagnostic and therapeutic; further testing when diagnosis unclear, symptoms refractory • Reflux, hiatal hernia may be found at barium study • Incompetent lower esophageal sphincter (LES); endoscopy with biopsy may be necessary to exclude other diagnoses • Esophageal pH helpful during symptoms • Diminished LES tone also seen in obesity, pregnancy, hiatal hernia, nasogastric tube ■ Differential Diagnosis • Peptic ulcer disease • Angina pectoris • Achalasia, esophageal spasm, pill esophagitis ■ Treatment • Weight loss, avoidance of late-night meals, elevation of head of bed • Avoid chocolate, caffeine, tobacco, alcohol • High-dose H2 blockers or proton pump inhibitors • Surgical fundoplication for patients intolerant or allergic to medical therapy or refractory cases with predominantly regurgitation or nonacid reflux; use caution in patients whose primary complaint is heartburn and who are found to have nonerosive GER, as these patients likely have a component of visceral hypersensitivity that may be exacerbated by surgery. ■ Pearl Eradication of H. pylori may actually worsen GERD; the gastric acid secretion increases upon eradication of the bacterium. Reference Fass R. Proton pump inhibitor failure: what are the therapeutic options? Am J Gastroenterol 2009;104(suppl):S33. [PMID: 19262545] Chapter 3 Gastrointestinal Diseases 85 3 Intestinal Tuberculosis ■ Essentials of Diagnosis • Chronic abdominal pain, anorexia, bloating; weight loss, fever, diarrhea, new-onset ascites in many • Mild right lower quadrant tenderness, as ileocecal area is the most commonly involved intestinal site; fistula-in-ano sometimes seen • Barium study may reveal mucosal ulcerations or scarring and fibrosis with narrowing of the small or large intestine • In peritonitis, ascitic fluid has high protein and mononuclear pleocytosis; peritoneal biopsy with granulomas is more sensitive than ascites AFB culture; high adenosine deaminase levels in ascitic fluid may suggest the diagnosis; TB peritonitis more common in those with immune compromise • Complications include intestinal obstruction, hemorrhage, fistula formation, and bacterial overgrowth with malabsorption ■ Differential Diagnosis • Carcinoma of the colon or small bowel • Inflammatory bowel disease: Crohn’s disease • Ameboma or Yersinia infection • Intestinal lymphoma or amyloidosis • Ovarian or peritoneal carcinomatosis • Mycobacterium avium-intracellulare infection ■ Treatment • Standard therapy for tuberculosis; as infection heals, the affected bowel may develop stricture Carpal Tunnel Syndrome ■ Essentials of Diagnosis • The most common entrapment neuropathy, caused by compression of the median nerve (which innervates the flexor muscles of the wrist and fingers) • Middle-aged women and those with a history of repetitive use of the hands commonly affected • Pain classically worse at night (sleep with hands curled into the body) and exacerbated by hand movement • Initial symptoms of pain or paresthesias in thumb, index, middle, and lateral part of ring finger; progression to thenar eminence wasting • Pain radiation to forearm, shoulder, neck, chest, or other fingers of the hand not uncommon • Positive Tinel’s sign • Usually idiopathic; in bilateral onset consider secondary causes including rheumatoid arthritis, amyloidosis, sarcoidosis, hypothyroidism, diabetes, pregnancy, acromegaly, gout • Diagnosis is primarily clinical; detection of deficits by electrodiagnostic testing (assessing nerve conduction velocity) very helpful to guide referral for surgical release ■ Differential Diagnosis • C6 or C7 cervical radiculopathy • Thoracic outlet syndrome leading to brachial plexus neuropathy • Mononeuritis multiplex • Syringomyelia • Multiple sclerosis • Angina pectoris, especially when left-sided ■ Treatment • Conservative measures initially, including hand rest, nocturnal splinting of wrists, anti-inflammatory medications • Steroid injection into the carpal tunnel occasionally • Surgical decompression in a few who have nerve conduction abnormalities; best done before development of thenar atrophy ■ Pearl Carpal tunnel affects the radial three and one-half fingers, myocardial ischemia the ulnar one and one-half; remember this in evaluating arm pain—and hope it’s the right arm. Reference Dahlin LB, Salö M, Thomsen N, Stütz N. Carpal tunnel syndrome and treatment of recurrent symptoms. Scand J Plast Reconstr Surg Hand Surg 2010;44:4. [PMID: 20136467]","Use only the information provided in the prompt to answer questions. Do not use any prior knowledge or external sources. List the response without numbers or bullet points. Restate the question as an introductory sentence. No other text in the response.
+
+EVIDENCE:
+Diffuse Esophageal Spasm ■ Essentials of Diagnosis • Dysphagia, noncardiac chest pain, hypersalivation, reflux of recently ingested food • May be precipitated by ingestion of hot or cold foods • Endoscopic, radiographic, and manometric demonstration of nonpropulsive hyperperistalsis; lower esophageal sphincter relaxes normally • “Nutcracker esophagus” variant with prolonged, high-pressure (> 175 mm Hg) propulsive contractions ■ Differential Diagnosis • Angina pectoris • Esophageal or mediastinal tumors • Aperistalsis • Achalasia • Psychiatric disease ■ Treatment • Trial of acid suppression. • Calcium channel blockers such as nifedipine or diltiazem in combination with nitrates often effective. For patient failing to respond, possible role for sildenafil, botulinum toxin. • Trazodone or tricyclic antidepressants for substernal pain ■ Pearl This condition may be indistinguishable from myocardial ischemia; exclude that possibility before investigating the esophagus. Reference Grübel C, Borovicka J, Schwizer W, Fox M, Hebbard G. Diffuse esophageal spasm. Am J Gastroenterol 2008;103:450. [PMID: 18005367] Chapter 3 Gastrointestinal Diseases 77 3 Disaccharidase (Lactase) Deficiency ■ Essentials of Diagnosis • Common in Asians and blacks, in whom lactase enzyme deficiency is nearly ubiquitous and begins in childhood; can also be acquired temporarily after gastroenteritis of other causes • Symptoms vary from abdominal bloating, distention, cramps, and flatulence to explosive diarrhea in response to disaccharide ingestion • Stool pH < 5.5; reducing substances present in stool • Abnormal lactose hydrogen breath test, resolution of symptoms on lactose-free diet, or flat glucose response to disaccharide loading suggests the diagnosis ■ Differential Diagnosis • Chronic mucosal malabsorptive disorders • Irritable bowel syndrome • Celiac sprue • Small intestinal bacterial overgrowth • Inflammatory bowel disease • Pancreatic insufficiency • Giardiasis • Excess artificial sweetener use ■ Treatment • Restriction of dietary lactose; usually happens by experience in affected minorities from early life • Lactase enzyme supplementation • Maintenance of adequate nutritional and calcium intake ■ Pearl Consider this in undiagnosed diarrhea; the patient may not be aware of ingesting lactose-containing foods. Foreign Bodies in the Esophagus ■ Essentials of Diagnosis • Most common in children, edentulous older patients, and the severely mentally impaired • Occurs at physiologic areas of narrowing (upper esophageal sphincter, the level of the aortic arch, or the diaphragmatic hiatus) • Other predisposing factors favoring impaction include Zenker’s diverticulum, webs, achalasia, peptic strictures, or malignancy • Recent ingestion of food or foreign material (coins most commonly in children, meat bolus most common in adults), but the history may be missing • Vague discomfort in chest or neck, dysphagia, inability to handle secretions, odynophagia, hypersalivation, and stridor or dyspnea in children • Radiographic or endoscopic evidence of esophageal obstruction by foreign body ■ Differential Diagnosis • Esophageal stricture • Eosinophilic esophagitis • Esophageal or mediastinal tumor • Angina pectoris ■ Treatment • Endoscopic removal with airway protection as needed and the use of an overtube if sharp objects are present • Emergent endoscopy should be used for sharp objects, disk batteries (secondary to risk of perforation due to their caustic nature), or evidence of the inability to handle secretions; objects retained in the esophagus should be removed within 24 hours of ingestion • Endoscopy is successful in > 90% of cases; avoid barium studies before endoscopy, as they impair visualization ■ Pearl Treatment is ordinarily straightforward; diagnosis may not be, especially in the very young and very old. Reference Eisen GM, Baron TH, Dominitz JA, et al; American Society for Gastrointestinal Endoscopy. Guideline for the management of ingested foreign bodies. Gastrointest Endosc 2002;55:802. [PMID: 12024131] Gastritis ■ Essentials of Diagnosis • May be acute (erosive) or indolent (atrophic); multiple varied causes • Symptoms often vague and include nausea, vomiting, anorexia, nondescript upper abdominal distress • Mild epigastric tenderness to palpation; in some, physical signs absent • Iron deficiency anemia not unusual • Endoscopy with gastric biopsy for definitive diagnosis • Multiple associations include stress and diminished mucosal blood flow (burns, sepsis, critical illness), drugs (NSAIDs, salicylates), atrophic states (aging, pernicious anemia), previous surgery (gastrectomy, Billroth II), H. pylori infection, acute or chronic alcoholism ■ Differential Diagnosis • Peptic ulcer • Hiatal hernia • Malignancy of stomach or pancreas • Cholecystitis • Ischemic cardiac disease ■ Treatment • Avoidance of alcohol, caffeine, salicylates, tobacco, and NSAIDs • Investigate for presence of H. pylori; eradicate if present • Proton pump inhibitors in patients receiving oral feedings, H2 inhibitors, or sucralfate • Prevention in high-risk patients (eg, intensive care setting) using these same agents ■ Pearl Ninety-five percent of gastroenterologists and a high proportion of other health care workers carry H. pylori. Reference El-Zimaity H. Gastritis and gastric atrophy. Curr Opin Gastroenterol 2008;24:682. [PMID: 19122515] 84 Current Essentials of Medicine 3 Gastroesophageal Reflux Disease (GERD) ■ Essentials of Diagnosis • Substernal burning (pyrosis) or pressure, aggravated by recumbency and relieved with sitting; can cause dysphagia, odynophagia, atypical chest pain; proton pump inhibitor may be diagnostic and therapeutic; further testing when diagnosis unclear, symptoms refractory • Reflux, hiatal hernia may be found at barium study • Incompetent lower esophageal sphincter (LES); endoscopy with biopsy may be necessary to exclude other diagnoses • Esophageal pH helpful during symptoms • Diminished LES tone also seen in obesity, pregnancy, hiatal hernia, nasogastric tube ■ Differential Diagnosis • Peptic ulcer disease • Angina pectoris • Achalasia, esophageal spasm, pill esophagitis ■ Treatment • Weight loss, avoidance of late-night meals, elevation of head of bed • Avoid chocolate, caffeine, tobacco, alcohol • High-dose H2 blockers or proton pump inhibitors • Surgical fundoplication for patients intolerant or allergic to medical therapy or refractory cases with predominantly regurgitation or nonacid reflux; use caution in patients whose primary complaint is heartburn and who are found to have nonerosive GER, as these patients likely have a component of visceral hypersensitivity that may be exacerbated by surgery. ■ Pearl Eradication of H. pylori may actually worsen GERD; the gastric acid secretion increases upon eradication of the bacterium. Reference Fass R. Proton pump inhibitor failure: what are the therapeutic options? Am J Gastroenterol 2009;104(suppl):S33. [PMID: 19262545] Chapter 3 Gastrointestinal Diseases 85 3 Intestinal Tuberculosis ■ Essentials of Diagnosis • Chronic abdominal pain, anorexia, bloating; weight loss, fever, diarrhea, new-onset ascites in many • Mild right lower quadrant tenderness, as ileocecal area is the most commonly involved intestinal site; fistula-in-ano sometimes seen • Barium study may reveal mucosal ulcerations or scarring and fibrosis with narrowing of the small or large intestine • In peritonitis, ascitic fluid has high protein and mononuclear pleocytosis; peritoneal biopsy with granulomas is more sensitive than ascites AFB culture; high adenosine deaminase levels in ascitic fluid may suggest the diagnosis; TB peritonitis more common in those with immune compromise • Complications include intestinal obstruction, hemorrhage, fistula formation, and bacterial overgrowth with malabsorption ■ Differential Diagnosis • Carcinoma of the colon or small bowel • Inflammatory bowel disease: Crohn’s disease • Ameboma or Yersinia infection • Intestinal lymphoma or amyloidosis • Ovarian or peritoneal carcinomatosis • Mycobacterium avium-intracellulare infection ■ Treatment • Standard therapy for tuberculosis; as infection heals, the affected bowel may develop stricture ■ Pearl Seen uncommonly in the developed world, but experienced clinicians have long noted that exploratory laparotomy for suspected small bowel obstruction relieves symptoms without antituberculous therapy. Reference Donoghue HD, Holton J. Intestinal tuberculosis. Curr Opin Infect Dis 2009;22:490. [PMID: 19623062] Carpal Tunnel Syndrome ■ Essentials of Diagnosis • The most common entrapment neuropathy, caused by compression of the median nerve (which innervates the flexor muscles of the wrist and fingers) • Middle-aged women and those with a history of repetitive use of the hands commonly affected • Pain classically worse at night (sleep with hands curled into the body) and exacerbated by hand movement • Initial symptoms of pain or paresthesias in thumb, index, middle, and lateral part of ring finger; progression to thenar eminence wasting • Pain radiation to forearm, shoulder, neck, chest, or other fingers of the hand not uncommon • Positive Tinel’s sign • Usually idiopathic; in bilateral onset consider secondary causes including rheumatoid arthritis, amyloidosis, sarcoidosis, hypothyroidism, diabetes, pregnancy, acromegaly, gout • Diagnosis is primarily clinical; detection of deficits by electrodiagnostic testing (assessing nerve conduction velocity) very helpful to guide referral for surgical release ■ Differential Diagnosis • C6 or C7 cervical radiculopathy • Thoracic outlet syndrome leading to brachial plexus neuropathy • Mononeuritis multiplex • Syringomyelia • Multiple sclerosis • Angina pectoris, especially when left-sided ■ Treatment • Conservative measures initially, including hand rest, nocturnal splinting of wrists, anti-inflammatory medications • Steroid injection into the carpal tunnel occasionally • Surgical decompression in a few who have nerve conduction abnormalities; best done before development of thenar atrophy ■ Pearl Carpal tunnel affects the radial three and one-half fingers, myocardial ischemia the ulnar one and one-half; remember this in evaluating arm pain—and hope it’s the right arm. Reference Dahlin LB, Salö M, Thomsen N, Stütz N. Carpal tunnel syndrome and treatment of recurrent symptoms. Scand J Plast Reconstr Surg Hand Surg 2010;44:4. [PMID: 20136467]
+
+USER:
+What are the conditions that have a differential diagnosis of angina pectoris?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,41,12,1484,,623
+Use only the provided text for your answers.,What are some current challenges with our DHCP system as it stands?,"Authentication for DHCP Messages Status of this Memo This document specifies an Internet standards track protocol for the Internet community, and requests discussion and suggestions for improvements. Please refer to the current edition of the ""Internet Official Protocol Standards"" (STD 1) for the standardization state and status of this protocol. Distribution of this memo is unlimited. Copyright Notice Copyright (C) The Internet Society (2001). All Rights Reserved. Abstract This document defines a new Dynamic Host Configuration Protocol (DHCP) option through which authorization tickets can be easily generated and newly attached hosts with proper authorization can be automatically configured from an authenticated DHCP server. DHCP provides a framework for passing configuration information to hosts on a TCP/IP network. In some situations, network administrators may wish to constrain the allocation of addresses to authorized hosts. Additionally, some network administrators may wish to provide for authentication of the source and contents of DHCP messages. 1. Introduction DHCP [1] transports protocol stack configuration parameters from centrally administered servers to TCP/IP hosts. Among those parameters are an IP address. DHCP servers can be configured to dynamically allocate addresses from a pool of addresses, eliminating a manual step in configuration of TCP/IP hosts. Some network administrators may wish to provide authentication of the source and contents of DHCP messages. For example, clients may be subject to denial of service attacks through the use of bogus DHCP servers, or may simply be misconfigured due to unintentionally instantiated DHCP servers. Network administrators may wish to constrain the allocation of addresses to authorized hosts to avoid denial of service attacks in ""hostile"" environments where the network Droms & Arbaugh Standards Track [Page 1] RFC 3118 Authentication for DHCP Messages June 2001 medium is not physically secured, such as wireless networks or college residence halls. This document defines a technique that can provide both entity authentication and message authentication. The current protocol combines the original Schiller-Huitema-Droms authentication mechanism defined in a previous work in progress with the ""delayed authentication"" proposal developed by Bill Arbaugh. 1.1 DHCP threat model The threat to DHCP is inherently an insider threat (assuming a properly configured network where BOOTP ports are blocked on the enterprise’s perimeter gateways.) Regardless of the gateway configuration, however, the potential attacks by insiders and outsiders are the same. The attack specific to a DHCP client is the possibility of the establishment of a ""rogue"" server with the intent of providing incorrect configuration information to the client. The motivation for doing so may be to establish a ""man in the middle"" attack or it may be for a ""denial of service"" attack. There is another threat to DHCP clients from mistakenly or accidentally configured DHCP servers that answer DHCP client requests with unintentionally incorrect configuration parameters. The threat specific to a DHCP server is an invalid client masquerading as a valid client. The motivation for this may be for ""theft of service"", or to circumvent auditing for any number of nefarious purposes. The threat common to both the client and the server is the resource ""denial of service"" (DoS) attack. These attacks typically involve the exhaustion of valid addresses, or the exhaustion of CPU or network bandwidth, and are present anytime there is a shared resource. In current practice, redundancy mitigates DoS attacks the best. 1.2 Design goals These are the goals that were used in the development of the authentication protocol, listed in order of importance: 1. Address the threats presented in Section 1.1. 2. Avoid changing the current protocol. Droms & Arbaugh Standards Track [Page 2] RFC 3118 Authentication for DHCP Messages June 2001 3. Limit state required by the server. 4. Limit complexity (complexity breeds design and implementation errors). 1.3 Requirements Terminology The key words ""MUST"", ""MUST NOT"", ""REQUIRED"", ""SHALL"", ""SHALL NOT"", ""SHOULD"", ""SHOULD NOT"", ""RECOMMENDED"", ""MAY"" and ""OPTIONAL"" in this document are to be interpreted as described in RFC 2119 [5]. 1.4 DHCP Terminology This document uses the following terms: o ""DHCP client"" A DHCP client or ""client"" is an Internet host using DHCP to obtain configuration parameters such as a network address. o ""DHCP server"" A DHCP server or ""server"" is an Internet host that returns configuration parameters to DHCP clients. The code for the authentication option is 90, and the length field contains the length of the protocol, RDM, algorithm, Replay Detection fields and authentication information fields in octets.The protocol field defines the particular technique for authentication used in the option. New protocols are defined as described in Section 6. The algorithm field defines the specific algorithm within the technique identified by the protocol field. The Replay Detection field is per the RDM, and the authentication information field is per the protocol in use. The Replay Detection Method (RDM) field determines the type of replay detection used in the Replay Detection field. If the RDM field contains 0x00, the replay detection field MUST be set to the value of a monotonically increasing counter. Using a counter value such as the current time of day (e.g., an NTP-format timestamp [4]) can reduce the danger of replay attacks. This method MUST be supported by all protocols. 3. Interaction with Relay Agents Because a DHCP relay agent may alter the values of the ’giaddr’ and ’hops’ fields in the DHCP message, the contents of those two fields MUST be set to zero for the computation of any hash function over the message header. Additionally, a relay agent may append the DHCP relay agent information option 82 [7] as the last option in a message to servers. If a server finds option 82 included in a received message, the server MUST compute any hash function as if the option were NOT included in the message without changing the order of options. Whenever the server sends back option 82 to a relay agent, the server MUST not include the option in the computation of any hash function over the message. will be defined as separate protocols. 5. Delayed authentication If the protocol field is 1, the message is using the ""delayed authentication"" mechanism. In delayed authentication, the client requests authentication in its DHCPDISCOVER message and the server replies with a DHCPOFFER message that includes authentication information. This authentication information contains a nonce value generated by the source as a message authentication code (MAC) to provide message authentication and entity authentication. This document defines the use of a particular technique based on the HMAC protocol [3] using the MD5 hash [2]. 5.1 Management Issues The ""delayed authentication"" protocol does not attempt to address situations where a client may roam from one administrative domain to another, i.e., interdomain roaming. This protocol is focused on solving the intradomain problem where the out-of-band exchange of a shared secret is feasible. Replay Detection - as defined by the RDM field K - a secret value shared between the source and destination of the message; each secret has a unique identifier (secret ID) secret ID - the unique identifier for the secret value used to generate the MAC for this message HMAC-MD5 - the MAC generating function [3, 2]. The sender computes the MAC using the HMAC generation algorithm [3] and the MD5 hash function [2]. The entire DHCP message (except as noted below), including the DHCP message header and the options field, is used as input to the HMAC-MD5 computation function. The ’secret ID’ field MUST be set to the identifier of the secret used to generate the MAC. DISCUSSION: Algorithm 1 specifies the use of HMAC-MD5. Use of a different technique, such as HMAC-SHA, will be specified as a separate protocol. Delayed authentication requires a shared secret key for each client on each DHCP server with which that client may wish to use the DHCP protocol. Each secret key has a unique identifier that can be used by a receiver to determine which secret was used to generate the MAC in the DHCP message. Therefore, delayed authentication may not scale well in an architecture in which a DHCP client connects to multiple administrative domains. 5.3 Message validation To validate an incoming message, the receiver first checks that the value in the replay detection field is acceptable according to the replay detection method specified by the RDM field. Next, the receiver computes the MAC as described in [3]. The receiver MUST set the ’MAC’ field of the authentication option to all 0s for computation of the MAC, and because a DHCP relay agent may alter the values of the ’giaddr’ and ’hops’ fields in the DHCP message, the contents of those two fields MUST also be set to zero for the computation of the MAC. If the MAC computed by the receiver does not match the MAC contained in the authentication option, the receiver MUST discard the DHCP message. Section 3 provides additional information on handling messages that include option 82 (Relay Agents). 5.4 Key utilization Each DHCP client has a key, K. The client uses its key to encode any messages it sends to the server and to authenticate and verify any messages it receives from the server. The client’s key SHOULD be initially distributed to the client through some out-of-band mechanism, and SHOULD be stored locally on the client for use in all authenticated DHCP messages. Once the client has been given its key, it SHOULD use that key for all transactions even if the client’s configuration changes; e.g., if the client is assigned a new network address. Each DHCP server MUST know, or be able to obtain in a secure manner, the keys for all authorized clients. If all clients use the same key, clients can perform both entity and message authentication for all messages received from servers. However, the sharing of keys is strongly discouraged as it allows for unauthorized clients to masquerade as authorized clients by obtaining a copy of the shared key. To authenticate the identity of individual clients, each client MUST be configured with a unique key. Appendix A describes a technique for key management. 5.5 Client considerations This section describes the behavior of a DHCP client using delayed authentication. 5.5.1 INIT state When in INIT state, the client uses delayed authentication as follows: 1. The client MUST include the authentication request option in its DHCPDISCOVER message along with a client identifier option [6] to identify itself uniquely to the server. 2. The client MUST perform the validation test described in section 5.3 on any DHCPOFFER messages that include authentication information. If one or more DHCPOFFER messages pass the validation test, the client chooses one of the offered configurations. Client behavior if no DHCPOFFER messages include authentication information or pass the validation test is controlled by local policy in the client. According to client policy, the client MAY choose to respond to a DHCPOFFER message that has not been authenticated. The decision to set local policy to accept unauthenticated messages should be made with care. Accepting an unauthenticated DHCPOFFER message can make the client vulnerable to spoofing and other attacks. If local users are not explicitly informed that the client has accepted an unauthenticated DHCPOFFER message, the users may incorrectly assume that the client has received an authenticated address and is not subject to DHCP attacks through unauthenticated messages. A client MUST be configurable to decline unauthenticated messages, and SHOULD be configured by default to decline unauthenticated messages. A client MAY choose to differentiate between DHCPOFFER messages with no authentication information and DHCPOFFER messages that do not pass the validation test; for example, a client might accept the former and discard the latter. If a client does accept an unauthenticated message, the client SHOULD inform any local users and SHOULD log the event. 3. The client replies with a DHCPREQUEST message that MUST include authentication information encoded with the same secret used by the server in the selected DHCPOFFER message. 4. If the client authenticated the DHCPOFFER it accepted, the client MUST validate the DHCPACK message from the server. The client MUST discard the DHCPACK if the message fails to pass validation and MAY log the validation failure. If the DHCPACK fails to pass validation, the client MUST revert to INIT state and returns to step 1. The client MAY choose to remember which server replied with a DHCPACK message that failed to pass validation and discard subsequent messages from that server. If the client accepted a DHCPOFFER message that did not include authentication information or did not pass the validation test, the client MAY accept an unauthenticated DHCPACK message from the server. 5.5.2 INIT-REBOOT state When in INIT-REBOOT state, the client MUST use the secret it used in its DHCPREQUEST message to obtain its current configuration to generate authentication information for the DHCPREQUEST message. The client MAY choose to accept unauthenticated DHCPACK/DHCPNAK messages if no authenticated messages were received. The client MUST treat the receipt (or lack thereof) of any DHCPACK/DHCPNAK messages as specified in section 3.2 of [1]. 5.5.3 RENEWING state When in RENEWING state, the client uses the secret it used in its initial DHCPREQUEST message to obtain its current configuration to generate authentication information for the DHCPREQUEST message. If client receives no DHCPACK messages or none of the DHCPACK messages pass validation, the client behaves as if it had not received a DHCPACK message in section 4.4.5 of the DHCP specification [1]. 5.5.4 REBINDING state When in REBINDING state, the client uses the secret it used in its initial DHCPREQUEST message to obtain its current configuration to generate authentication information for the DHCPREQUEST message. If client receives no DHCPACK messages or none of the DHCPACK messages pass validation, the client behaves as if it had not received a DHCPACK message in section 4.4.5 of the DHCP specification [1]. 5.5.5 DHCPINFORM message Since the client already has some configuration information, the client may also have established a shared secret value, K, with a server. Therefore, the client SHOULD use the authentication request as in a DHCPDISCOVER message when a shared secret value exists. The client MUST treat any received DHCPACK messages as it does DHCPOFFER messages, see section 5.5.1. 5.5.6 DHCPRELEASE message Since the client is already in the BOUND state, the client will have a security association already established with the server. Therefore, the client MUST include authentication information with the DHCPRELEASE message. 5.6 Server considerations This section describes the behavior of a server in response to client messages using delayed authentication. 5.6.1 General considerations Each server maintains a list of secrets and identifiers for those secrets that it shares with clients and potential clients. This information must be maintained in such a way that the server can: * Identify an appropriate secret and the identifier for that secret for use with a client that the server may not have previously communicated with * Retrieve the secret and identifier used by a client to which the server has provided previous configuration information Each server MUST save the counter from the previous authenticated message. A server MUST discard any incoming message which fails the replay detection check as defined by the RDM avoid replay attacks. DISCUSSION: The authenticated DHCPREQUEST message from a client in INIT-REBOOT state can only be validated by servers that used the same secret in their DHCPOFFER messages. Other servers will discard the DHCPREQUEST messages. Thus, only servers that used the secret selected by the client will be able to determine that their offered configuration information was not selected and the offered network address can be returned to the server’s pool of available addresses. The servers that cannot validate the DHCPREQUEST message will eventually return their offered network addresses to their pool of available addresses as described in section 3.1 of the DHCP specification [1]. 5.6.2 After receiving a DHCPDISCOVER message The server selects a secret for the client and includes authentication information in the DHCPOFFER message as specified in section 5, above. The server MUST record the identifier of the secret selected for the client and use that same secret for validating subsequent messages with the client. 5.6.3 After receiving a DHCPREQUEST message The server uses the secret identified in the message and validates the message as specified in section 5.3. If the message fails to pass validation or the server does not know the secret identified by the ’secret ID’ field, the server MUST discard the message and MAY choose to log the validation failure. If the message passes the validation procedure, the server responds as described in the DHCP specification. The server MUST include authentication information generated as specified in section 5.2. 5.6.4 After receiving a DHCPINFORM message The server MAY choose to accept unauthenticated DHCPINFORM messages, or only accept authenticated DHCPINFORM messages based on a site policy. When a client includes the authentication request in a DHCPINFORM message, the server MUST respond with an authenticated DHCPACK message. If the server does not have a shared secret value established with the sender of the DHCPINFORM message, then the server MAY respond with an unauthenticated DHCPACK message, or a DHCPNAK if the server does not accept unauthenticated clients based on the site policy, or the server MAY choose not to respond to the DHCPINFORM message. 6. IANA Considerations Section 2 defines a new DHCP option called the Authentication Option, whose option code is 90. This document specifies three new name spaces associated with the Authentication Option, which are to be created and maintained by IANA: Protocol, Algorithm and RDM. Initial values assigned from the Protocol name space are 0 (for the configuration token Protocol in section 4) and 1 (for the delayed authentication Protocol in section 5). Additional values from the Protocol name space will be assigned through IETF Consensus, as defined in RFC 2434 [8]. The Algorithm name space is specific to individual Protocols. That is, each Protocol has its own Algorithm name space. The guidelines for assigning Algorithm name space values for a particular protocol should be specified along with the definition of a new Protocol. For the configuration token Protocol, the Algorithm field MUST be 0. For the delayed authentication Protocol, the Algorithm value 1 is assigned to the HMAC-MD5 generating function as defined in section 5. Additional values from the Algorithm name space for Algorithm 1 will be assigned through IETF Consensus, as defined in RFC 2434. The initial value of 0 from the RDM name space is assigned to the use of a monotonically increasing value as defined in section 2. Additional values from the RDM name space will be assigned through IETF Consensus, as defined in RFC 2434. 7. References [1] Droms, R., ""Dynamic Host Configuration Protocol"", RFC 2131, March 1997. [2] Rivest, R., ""The MD5 Message-Digest Algorithm"", RFC 1321, April 1992.[3] Krawczyk H., Bellare, M. and R. Canetti, ""HMAC: Keyed-Hashing for Message Authentication"", RFC 2104, February 1997. [4] Mills, D., ""Network Time Protocol (Version 3)"", RFC 1305, March 1992. [5] Bradner, S., ""Key words for use in RFCs to Indicate Requirement Levels"", RFC 2219, March 1997. [6] Alexander, S. and R. Droms, ""DHCP Options and BOOTP Vendor Extensions"", RFC 2132, March 1997. [7] Patrick, M., ""DHCP Relay Agent Information Option"", RFC 3046, January 2001. [8] Narten, T. and H. Alvestrand, ""Guidelines for Writing and IANA Considerations Section in RFCs"", BCP 26, RFC 2434, October 1998. 8. Acknowledgments Jeff Schiller and Christian Huitema developed the original version of this authentication protocol in a terminal room BOF at the Dallas IETF meeting, December 1995. One of the editors (Droms) transcribed the notes from that discussion, which form the basis for this document. The editors appreciate Jeff’s and Christian’s patience in reviewing this document and its earlier drafts. The ""delayed authentication"" mechanism used in section 5 is due to Bill Arbaugh. The threat model and requirements in sections 1.1 and 1.2 come from Bill’s negotiation protocol proposal. The attendees of an interim meeting of the DHC WG held in June, 1998, including Peter Ford, Kim Kinnear, Glenn Waters, Rob Stevens, Bill Arbaugh, Baiju Patel, Carl Smith, Thomas Narten, Stewart Kwan, Munil Shah, Olafur Gudmundsson, Robert Watson, Ralph Droms, Mike Dooley, Greg Rabil and Arun Kapur, developed the threat model and reviewed several alternative proposals. The replay detection method field is due to Vipul Gupta. Other input from Bill Sommerfield is gratefully acknowledged. Thanks also to John Wilkins, Ran Atkinson, Shawn Mamros and Thomas Narten for reviewing earlier drafts of this document. 9. Security Considerations This document describes authentication and verification mechanisms for DHCP. 9.1 Protocol vulnerabilities The configuration token authentication mechanism is vulnerable to interception and provides only the most rudimentary protection against inadvertently instantiated DHCP servers. The delayed authentication mechanism described in this document is vulnerable to a denial of service attack through flooding with DHCPDISCOVER messages, which are not authenticated by this protocol. Such an attack may overwhelm the computer on which the DHCP server is running and may exhaust the addresses available for assignment by the DHCP server. Delayed authentication may also be vulnerable to a denial of service attack through flooding with authenticated messages, which may overwhelm the computer on which the DHCP server is running as the authentication keys for the incoming messages are computed. 9.2 Protocol limitations Delayed authentication does not support interdomain authentication. A real digital signature mechanism such as RSA, while currently computationally infeasible, would provide better security. Appendix A - Key Management Technique To avoid centralized management of a list of random keys, suppose K for each client is generated from the pair (client identifier [6], subnet address, e.g., 192.168.1.0), which must be unique to that client. That is, K = MAC(MK, unique-id), where MK is a secret master key and MAC is a keyed one-way function such as HMAC-MD5. Without knowledge of the master key MK, an unauthorized client cannot generate its own key K. The server can quickly validate an incoming message from a new client by regenerating K from the client-id. For known clients, the server can choose to recover the client’s K dynamically from the client-id in the DHCP message, or can choose to precompute and cache all of the Ks a priori. By deriving all keys from a single master key, the DHCP server does not need access to clear text passwords, and can compute and verify the keyed MACs without requiring help from a centralized authentication server. To avoid compromise of this key management system, the master key, MK, MUST NOT be stored by any clients. The client SHOULD only be given its key, K. If MK is compromised, a new MK SHOULD be chosen and all clients given new individual keys. Full Copyright Statement Copyright (C) The Internet Society (2001). All Rights Reserved. This document and translations of it may be copied and furnished to others, and derivative works that comment on or otherwise explain it or assist in its implementation may be prepared, copied, published and distributed, in whole or in part, without restriction of any kind, provided that the above copyright notice and this paragraph are included on all such copies and derivative works. However, this document itself may not be modified in any way, such as by removing the copyright notice or references to the Internet Society or other Internet organizations, except as needed for the purpose of developing Internet standards in which case the procedures for copyrights defined in the Internet Standards process must be followed, or as required to translate it into languages other than English. The limited permissions granted above are perpetual and will not be revoked by the Internet Society or its successors or assigns. This document and the information contained herein is provided on an ""AS IS"" basis and THE INTERNET SOCIETY AND THE INTERNET ENGINEERING TASK FORCE DISCLAIMS ALL WARRANTIES, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO ANY WARRANTY THAT THE USE OF THE INFORMATION HEREIN WILL NOT INFRINGE ANY RIGHTS OR ANY IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. Acknowledgement Funding for the RFC Editor function is currently provided by the Internet Society.","Use only the provided text for your answers. What are some current challenges with our DHCP system as it stands? Authentication for DHCP Messages Status of this Memo This document specifies an Internet standards track protocol for the Internet community, and requests discussion and suggestions for improvements. Please refer to the current edition of the ""Internet Official Protocol Standards"" (STD 1) for the standardization state and status of this protocol. Distribution of this memo is unlimited. Copyright Notice Copyright (C) The Internet Society (2001). All Rights Reserved. Abstract This document defines a new Dynamic Host Configuration Protocol (DHCP) option through which authorization tickets can be easily generated and newly attached hosts with proper authorization can be automatically configured from an authenticated DHCP server. DHCP provides a framework for passing configuration information to hosts on a TCP/IP network. In some situations, network administrators may wish to constrain the allocation of addresses to authorized hosts. Additionally, some network administrators may wish to provide for authentication of the source and contents of DHCP messages. 1. Introduction DHCP [1] transports protocol stack configuration parameters from centrally administered servers to TCP/IP hosts. Among those parameters are an IP address. DHCP servers can be configured to dynamically allocate addresses from a pool of addresses, eliminating a manual step in configuration of TCP/IP hosts. Some network administrators may wish to provide authentication of the source and contents of DHCP messages. For example, clients may be subject to denial of service attacks through the use of bogus DHCP servers, or may simply be misconfigured due to unintentionally instantiated DHCP servers. Network administrators may wish to constrain the allocation of addresses to authorized hosts to avoid denial of service attacks in ""hostile"" environments where the network Droms & Arbaugh Standards Track [Page 1] RFC 3118 Authentication for DHCP Messages June 2001 medium is not physically secured, such as wireless networks or college residence halls. This document defines a technique that can provide both entity authentication and message authentication. The current protocol combines the original Schiller-Huitema-Droms authentication mechanism defined in a previous work in progress with the ""delayed authentication"" proposal developed by Bill Arbaugh. 1.1 DHCP threat model The threat to DHCP is inherently an insider threat (assuming a properly configured network where BOOTP ports are blocked on the enterprise’s perimeter gateways.) Regardless of the gateway configuration, however, the potential attacks by insiders and outsiders are the same. The attack specific to a DHCP client is the possibility of the establishment of a ""rogue"" server with the intent of providing incorrect configuration information to the client. The motivation for doing so may be to establish a ""man in the middle"" attack or it may be for a ""denial of service"" attack. There is another threat to DHCP clients from mistakenly or accidentally configured DHCP servers that answer DHCP client requests with unintentionally incorrect configuration parameters. The threat specific to a DHCP server is an invalid client masquerading as a valid client. The motivation for this may be for ""theft of service"", or to circumvent auditing for any number of nefarious purposes. The threat common to both the client and the server is the resource ""denial of service"" (DoS) attack. These attacks typically involve the exhaustion of valid addresses, or the exhaustion of CPU or network bandwidth, and are present anytime there is a shared resource. In current practice, redundancy mitigates DoS attacks the best. 1.2 Design goals These are the goals that were used in the development of the authentication protocol, listed in order of importance: 1. Address the threats presented in Section 1.1. 2. Avoid changing the current protocol. Droms & Arbaugh Standards Track [Page 2] RFC 3118 Authentication for DHCP Messages June 2001 3. Limit state required by the server. 4. Limit complexity (complexity breeds design and implementation errors). 1.3 Requirements Terminology The key words ""MUST"", ""MUST NOT"", ""REQUIRED"", ""SHALL"", ""SHALL NOT"", ""SHOULD"", ""SHOULD NOT"", ""RECOMMENDED"", ""MAY"" and ""OPTIONAL"" in this document are to be interpreted as described in RFC 2119 [5]. 1.4 DHCP Terminology This document uses the following terms: o ""DHCP client"" A DHCP client or ""client"" is an Internet host using DHCP to obtain configuration parameters such as a network address. o ""DHCP server"" A DHCP server or ""server"" is an Internet host that returns configuration parameters to DHCP clients. The code for the authentication option is 90, and the length field contains the length of the protocol, RDM, algorithm, Replay Detection fields and authentication information fields in octets.The protocol field defines the particular technique for authentication used in the option. New protocols are defined as described in Section 6. The algorithm field defines the specific algorithm within the technique identified by the protocol field. The Replay Detection field is per the RDM, and the authentication information field is per the protocol in use. The Replay Detection Method (RDM) field determines the type of replay detection used in the Replay Detection field. If the RDM field contains 0x00, the replay detection field MUST be set to the value of a monotonically increasing counter. Using a counter value such as the current time of day (e.g., an NTP-format timestamp [4]) can reduce the danger of replay attacks. This method MUST be supported by all protocols. 3. Interaction with Relay Agents Because a DHCP relay agent may alter the values of the ’giaddr’ and ’hops’ fields in the DHCP message, the contents of those two fields MUST be set to zero for the computation of any hash function over the message header. Additionally, a relay agent may append the DHCP relay agent information option 82 [7] as the last option in a message to servers. If a server finds option 82 included in a received message, the server MUST compute any hash function as if the option were NOT included in the message without changing the order of options. Whenever the server sends back option 82 to a relay agent, the server MUST not include the option in the computation of any hash function over the message. will be defined as separate protocols. 5. Delayed authentication If the protocol field is 1, the message is using the ""delayed authentication"" mechanism. In delayed authentication, the client requests authentication in its DHCPDISCOVER message and the server replies with a DHCPOFFER message that includes authentication information. This authentication information contains a nonce value generated by the source as a message authentication code (MAC) to provide message authentication and entity authentication. This document defines the use of a particular technique based on the HMAC protocol [3] using the MD5 hash [2]. 5.1 Management Issues The ""delayed authentication"" protocol does not attempt to address situations where a client may roam from one administrative domain to another, i.e., interdomain roaming. This protocol is focused on solving the intradomain problem where the out-of-band exchange of a shared secret is feasible. Replay Detection - as defined by the RDM field K - a secret value shared between the source and destination of the message; each secret has a unique identifier (secret ID) secret ID - the unique identifier for the secret value used to generate the MAC for this message HMAC-MD5 - the MAC generating function [3, 2]. The sender computes the MAC using the HMAC generation algorithm [3] and the MD5 hash function [2]. The entire DHCP message (except as noted below), including the DHCP message header and the options field, is used as input to the HMAC-MD5 computation function. The ’secret ID’ field MUST be set to the identifier of the secret used to generate the MAC. DISCUSSION: Algorithm 1 specifies the use of HMAC-MD5. Use of a different technique, such as HMAC-SHA, will be specified as a separate protocol. Delayed authentication requires a shared secret key for each client on each DHCP server with which that client may wish to use the DHCP protocol. Each secret key has a unique identifier that can be used by a receiver to determine which secret was used to generate the MAC in the DHCP message. Therefore, delayed authentication may not scale well in an architecture in which a DHCP client connects to multiple administrative domains. 5.3 Message validation To validate an incoming message, the receiver first checks that the value in the replay detection field is acceptable according to the replay detection method specified by the RDM field. Next, the receiver computes the MAC as described in [3]. The receiver MUST set the ’MAC’ field of the authentication option to all 0s for computation of the MAC, and because a DHCP relay agent may alter the values of the ’giaddr’ and ’hops’ fields in the DHCP message, the contents of those two fields MUST also be set to zero for the computation of the MAC. If the MAC computed by the receiver does not match the MAC contained in the authentication option, the receiver MUST discard the DHCP message. Section 3 provides additional information on handling messages that include option 82 (Relay Agents). 5.4 Key utilization Each DHCP client has a key, K. The client uses its key to encode any messages it sends to the server and to authenticate and verify any messages it receives from the server. The client’s key SHOULD be initially distributed to the client through some out-of-band mechanism, and SHOULD be stored locally on the client for use in all authenticated DHCP messages. Once the client has been given its key, it SHOULD use that key for all transactions even if the client’s configuration changes; e.g., if the client is assigned a new network address. Each DHCP server MUST know, or be able to obtain in a secure manner, the keys for all authorized clients. If all clients use the same key, clients can perform both entity and message authentication for all messages received from servers. However, the sharing of keys is strongly discouraged as it allows for unauthorized clients to masquerade as authorized clients by obtaining a copy of the shared key. To authenticate the identity of individual clients, each client MUST be configured with a unique key. Appendix A describes a technique for key management. 5.5 Client considerations This section describes the behavior of a DHCP client using delayed authentication. 5.5.1 INIT state When in INIT state, the client uses delayed authentication as follows: 1. The client MUST include the authentication request option in its DHCPDISCOVER message along with a client identifier option [6] to identify itself uniquely to the server. 2. The client MUST perform the validation test described in section 5.3 on any DHCPOFFER messages that include authentication information. If one or more DHCPOFFER messages pass the validation test, the client chooses one of the offered configurations. Client behavior if no DHCPOFFER messages include authentication information or pass the validation test is controlled by local policy in the client. According to client policy, the client MAY choose to respond to a DHCPOFFER message that has not been authenticated. The decision to set local policy to accept unauthenticated messages should be made with care. Accepting an unauthenticated DHCPOFFER message can make the client vulnerable to spoofing and other attacks. If local users are not explicitly informed that the client has accepted an unauthenticated DHCPOFFER message, the users may incorrectly assume that the client has received an authenticated address and is not subject to DHCP attacks through unauthenticated messages. A client MUST be configurable to decline unauthenticated messages, and SHOULD be configured by default to decline unauthenticated messages. A client MAY choose to differentiate between DHCPOFFER messages with no authentication information and DHCPOFFER messages that do not pass the validation test; for example, a client might accept the former and discard the latter. If a client does accept an unauthenticated message, the client SHOULD inform any local users and SHOULD log the event. 3. The client replies with a DHCPREQUEST message that MUST include authentication information encoded with the same secret used by the server in the selected DHCPOFFER message. 4. If the client authenticated the DHCPOFFER it accepted, the client MUST validate the DHCPACK message from the server. The client MUST discard the DHCPACK if the message fails to pass validation and MAY log the validation failure. If the DHCPACK fails to pass validation, the client MUST revert to INIT state and returns to step 1. The client MAY choose to remember which server replied with a DHCPACK message that failed to pass validation and discard subsequent messages from that server. If the client accepted a DHCPOFFER message that did not include authentication information or did not pass the validation test, the client MAY accept an unauthenticated DHCPACK message from the server. 5.5.2 INIT-REBOOT state When in INIT-REBOOT state, the client MUST use the secret it used in its DHCPREQUEST message to obtain its current configuration to generate authentication information for the DHCPREQUEST message. The client MAY choose to accept unauthenticated DHCPACK/DHCPNAK messages if no authenticated messages were received. The client MUST treat the receipt (or lack thereof) of any DHCPACK/DHCPNAK messages as specified in section 3.2 of [1]. 5.5.3 RENEWING state When in RENEWING state, the client uses the secret it used in its initial DHCPREQUEST message to obtain its current configuration to generate authentication information for the DHCPREQUEST message. If client receives no DHCPACK messages or none of the DHCPACK messages pass validation, the client behaves as if it had not received a DHCPACK message in section 4.4.5 of the DHCP specification [1]. 5.5.4 REBINDING state When in REBINDING state, the client uses the secret it used in its initial DHCPREQUEST message to obtain its current configuration to generate authentication information for the DHCPREQUEST message. If client receives no DHCPACK messages or none of the DHCPACK messages pass validation, the client behaves as if it had not received a DHCPACK message in section 4.4.5 of the DHCP specification [1]. 5.5.5 DHCPINFORM message Since the client already has some configuration information, the client may also have established a shared secret value, K, with a server. Therefore, the client SHOULD use the authentication request as in a DHCPDISCOVER message when a shared secret value exists. The client MUST treat any received DHCPACK messages as it does DHCPOFFER messages, see section 5.5.1. 5.5.6 DHCPRELEASE message Since the client is already in the BOUND state, the client will have a security association already established with the server. Therefore, the client MUST include authentication information with the DHCPRELEASE message. 5.6 Server considerations This section describes the behavior of a server in response to client messages using delayed authentication. 5.6.1 General considerations Each server maintains a list of secrets and identifiers for those secrets that it shares with clients and potential clients. This information must be maintained in such a way that the server can: * Identify an appropriate secret and the identifier for that secret for use with a client that the server may not have previously communicated with * Retrieve the secret and identifier used by a client to which the server has provided previous configuration information Each server MUST save the counter from the previous authenticated message. A server MUST discard any incoming message which fails the replay detection check as defined by the RDM avoid replay attacks. DISCUSSION: The authenticated DHCPREQUEST message from a client in INIT-REBOOT state can only be validated by servers that used the same secret in their DHCPOFFER messages. Other servers will discard the DHCPREQUEST messages. Thus, only servers that used the secret selected by the client will be able to determine that their offered configuration information was not selected and the offered network address can be returned to the server’s pool of available addresses. The servers that cannot validate the DHCPREQUEST message will eventually return their offered network addresses to their pool of available addresses as described in section 3.1 of the DHCP specification [1]. 5.6.2 After receiving a DHCPDISCOVER message The server selects a secret for the client and includes authentication information in the DHCPOFFER message as specified in section 5, above. The server MUST record the identifier of the secret selected for the client and use that same secret for validating subsequent messages with the client. 5.6.3 After receiving a DHCPREQUEST message The server uses the secret identified in the message and validates the message as specified in section 5.3. If the message fails to pass validation or the server does not know the secret identified by the ’secret ID’ field, the server MUST discard the message and MAY choose to log the validation failure. If the message passes the validation procedure, the server responds as described in the DHCP specification. The server MUST include authentication information generated as specified in section 5.2. 5.6.4 After receiving a DHCPINFORM message The server MAY choose to accept unauthenticated DHCPINFORM messages, or only accept authenticated DHCPINFORM messages based on a site policy. When a client includes the authentication request in a DHCPINFORM message, the server MUST respond with an authenticated DHCPACK message. If the server does not have a shared secret value established with the sender of the DHCPINFORM message, then the server MAY respond with an unauthenticated DHCPACK message, or a DHCPNAK if the server does not accept unauthenticated clients based on the site policy, or the server MAY choose not to respond to the DHCPINFORM message. 6. IANA Considerations Section 2 defines a new DHCP option called the Authentication Option, whose option code is 90. This document specifies three new name spaces associated with the Authentication Option, which are to be created and maintained by IANA: Protocol, Algorithm and RDM. Initial values assigned from the Protocol name space are 0 (for the configuration token Protocol in section 4) and 1 (for the delayed authentication Protocol in section 5). Additional values from the Protocol name space will be assigned through IETF Consensus, as defined in RFC 2434 [8]. The Algorithm name space is specific to individual Protocols. That is, each Protocol has its own Algorithm name space. The guidelines for assigning Algorithm name space values for a particular protocol should be specified along with the definition of a new Protocol. For the configuration token Protocol, the Algorithm field MUST be 0. For the delayed authentication Protocol, the Algorithm value 1 is assigned to the HMAC-MD5 generating function as defined in section 5. Additional values from the Algorithm name space for Algorithm 1 will be assigned through IETF Consensus, as defined in RFC 2434. The initial value of 0 from the RDM name space is assigned to the use of a monotonically increasing value as defined in section 2. Additional values from the RDM name space will be assigned through IETF Consensus, as defined in RFC 2434. 7. References [1] Droms, R., ""Dynamic Host Configuration Protocol"", RFC 2131, March 1997. [2] Rivest, R., ""The MD5 Message-Digest Algorithm"", RFC 1321, April 1992.[3] Krawczyk H., Bellare, M. and R. Canetti, ""HMAC: Keyed-Hashing for Message Authentication"", RFC 2104, February 1997. [4] Mills, D., ""Network Time Protocol (Version 3)"", RFC 1305, March 1992. [5] Bradner, S., ""Key words for use in RFCs to Indicate Requirement Levels"", RFC 2219, March 1997. [6] Alexander, S. and R. Droms, ""DHCP Options and BOOTP Vendor Extensions"", RFC 2132, March 1997. [7] Patrick, M., ""DHCP Relay Agent Information Option"", RFC 3046, January 2001. [8] Narten, T. and H. Alvestrand, ""Guidelines for Writing and IANA Considerations Section in RFCs"", BCP 26, RFC 2434, October 1998. 8. Acknowledgments Jeff Schiller and Christian Huitema developed the original version of this authentication protocol in a terminal room BOF at the Dallas IETF meeting, December 1995. One of the editors (Droms) transcribed the notes from that discussion, which form the basis for this document. The editors appreciate Jeff’s and Christian’s patience in reviewing this document and its earlier drafts. The ""delayed authentication"" mechanism used in section 5 is due to Bill Arbaugh. The threat model and requirements in sections 1.1 and 1.2 come from Bill’s negotiation protocol proposal. The attendees of an interim meeting of the DHC WG held in June, 1998, including Peter Ford, Kim Kinnear, Glenn Waters, Rob Stevens, Bill Arbaugh, Baiju Patel, Carl Smith, Thomas Narten, Stewart Kwan, Munil Shah, Olafur Gudmundsson, Robert Watson, Ralph Droms, Mike Dooley, Greg Rabil and Arun Kapur, developed the threat model and reviewed several alternative proposals. The replay detection method field is due to Vipul Gupta. Other input from Bill Sommerfield is gratefully acknowledged. Thanks also to John Wilkins, Ran Atkinson, Shawn Mamros and Thomas Narten for reviewing earlier drafts of this document. 9. Security Considerations This document describes authentication and verification mechanisms for DHCP. 9.1 Protocol vulnerabilities The configuration token authentication mechanism is vulnerable to interception and provides only the most rudimentary protection against inadvertently instantiated DHCP servers. The delayed authentication mechanism described in this document is vulnerable to a denial of service attack through flooding with DHCPDISCOVER messages, which are not authenticated by this protocol. Such an attack may overwhelm the computer on which the DHCP server is running and may exhaust the addresses available for assignment by the DHCP server. Delayed authentication may also be vulnerable to a denial of service attack through flooding with authenticated messages, which may overwhelm the computer on which the DHCP server is running as the authentication keys for the incoming messages are computed. 9.2 Protocol limitations Delayed authentication does not support interdomain authentication. A real digital signature mechanism such as RSA, while currently computationally infeasible, would provide better security. Appendix A - Key Management Technique To avoid centralized management of a list of random keys, suppose K for each client is generated from the pair (client identifier [6], subnet address, e.g., 192.168.1.0), which must be unique to that client. That is, K = MAC(MK, unique-id), where MK is a secret master key and MAC is a keyed one-way function such as HMAC-MD5. Without knowledge of the master key MK, an unauthorized client cannot generate its own key K. The server can quickly validate an incoming message from a new client by regenerating K from the client-id. For known clients, the server can choose to recover the client’s K dynamically from the client-id in the DHCP message, or can choose to precompute and cache all of the Ks a priori. By deriving all keys from a single master key, the DHCP server does not need access to clear text passwords, and can compute and verify the keyed MACs without requiring help from a centralized authentication server. To avoid compromise of this key management system, the master key, MK, MUST NOT be stored by any clients. The client SHOULD only be given its key, K. If MK is compromised, a new MK SHOULD be chosen and all clients given new individual keys. Full Copyright Statement Copyright (C) The Internet Society (2001). All Rights Reserved. This document and translations of it may be copied and furnished to others, and derivative works that comment on or otherwise explain it or assist in its implementation may be prepared, copied, published and distributed, in whole or in part, without restriction of any kind, provided that the above copyright notice and this paragraph are included on all such copies and derivative works. However, this document itself may not be modified in any way, such as by removing the copyright notice or references to the Internet Society or other Internet organizations, except as needed for the purpose of developing Internet standards in which case the procedures for copyrights defined in the Internet Standards process must be followed, or as required to translate it into languages other than English. The limited permissions granted above are perpetual and will not be revoked by the Internet Society or its successors or assigns. This document and the information contained herein is provided on an ""AS IS"" basis and THE INTERNET SOCIETY AND THE INTERNET ENGINEERING TASK FORCE DISCLAIMS ALL WARRANTIES, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO ANY WARRANTY THAT THE USE OF THE INFORMATION HEREIN WILL NOT INFRINGE ANY RIGHTS OR ANY IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. Acknowledgement Funding for the RFC Editor function is currently provided by the Internet Society.","Use only the provided text for your answers.
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+EVIDENCE:
+Authentication for DHCP Messages Status of this Memo This document specifies an Internet standards track protocol for the Internet community, and requests discussion and suggestions for improvements. Please refer to the current edition of the ""Internet Official Protocol Standards"" (STD 1) for the standardization state and status of this protocol. Distribution of this memo is unlimited. Copyright Notice Copyright (C) The Internet Society (2001). All Rights Reserved. Abstract This document defines a new Dynamic Host Configuration Protocol (DHCP) option through which authorization tickets can be easily generated and newly attached hosts with proper authorization can be automatically configured from an authenticated DHCP server. DHCP provides a framework for passing configuration information to hosts on a TCP/IP network. In some situations, network administrators may wish to constrain the allocation of addresses to authorized hosts. Additionally, some network administrators may wish to provide for authentication of the source and contents of DHCP messages. 1. Introduction DHCP [1] transports protocol stack configuration parameters from centrally administered servers to TCP/IP hosts. Among those parameters are an IP address. DHCP servers can be configured to dynamically allocate addresses from a pool of addresses, eliminating a manual step in configuration of TCP/IP hosts. Some network administrators may wish to provide authentication of the source and contents of DHCP messages. For example, clients may be subject to denial of service attacks through the use of bogus DHCP servers, or may simply be misconfigured due to unintentionally instantiated DHCP servers. Network administrators may wish to constrain the allocation of addresses to authorized hosts to avoid denial of service attacks in ""hostile"" environments where the network Droms & Arbaugh Standards Track [Page 1] RFC 3118 Authentication for DHCP Messages June 2001 medium is not physically secured, such as wireless networks or college residence halls. This document defines a technique that can provide both entity authentication and message authentication. The current protocol combines the original Schiller-Huitema-Droms authentication mechanism defined in a previous work in progress with the ""delayed authentication"" proposal developed by Bill Arbaugh. 1.1 DHCP threat model The threat to DHCP is inherently an insider threat (assuming a properly configured network where BOOTP ports are blocked on the enterprise’s perimeter gateways.) Regardless of the gateway configuration, however, the potential attacks by insiders and outsiders are the same. The attack specific to a DHCP client is the possibility of the establishment of a ""rogue"" server with the intent of providing incorrect configuration information to the client. The motivation for doing so may be to establish a ""man in the middle"" attack or it may be for a ""denial of service"" attack. There is another threat to DHCP clients from mistakenly or accidentally configured DHCP servers that answer DHCP client requests with unintentionally incorrect configuration parameters. The threat specific to a DHCP server is an invalid client masquerading as a valid client. The motivation for this may be for ""theft of service"", or to circumvent auditing for any number of nefarious purposes. The threat common to both the client and the server is the resource ""denial of service"" (DoS) attack. These attacks typically involve the exhaustion of valid addresses, or the exhaustion of CPU or network bandwidth, and are present anytime there is a shared resource. In current practice, redundancy mitigates DoS attacks the best. 1.2 Design goals These are the goals that were used in the development of the authentication protocol, listed in order of importance: 1. Address the threats presented in Section 1.1. 2. Avoid changing the current protocol. Droms & Arbaugh Standards Track [Page 2] RFC 3118 Authentication for DHCP Messages June 2001 3. Limit state required by the server. 4. Limit complexity (complexity breeds design and implementation errors). 1.3 Requirements Terminology The key words ""MUST"", ""MUST NOT"", ""REQUIRED"", ""SHALL"", ""SHALL NOT"", ""SHOULD"", ""SHOULD NOT"", ""RECOMMENDED"", ""MAY"" and ""OPTIONAL"" in this document are to be interpreted as described in RFC 2119 [5]. 1.4 DHCP Terminology This document uses the following terms: o ""DHCP client"" A DHCP client or ""client"" is an Internet host using DHCP to obtain configuration parameters such as a network address. o ""DHCP server"" A DHCP server or ""server"" is an Internet host that returns configuration parameters to DHCP clients. The code for the authentication option is 90, and the length field contains the length of the protocol, RDM, algorithm, Replay Detection fields and authentication information fields in octets.The protocol field defines the particular technique for authentication used in the option. New protocols are defined as described in Section 6. The algorithm field defines the specific algorithm within the technique identified by the protocol field. The Replay Detection field is per the RDM, and the authentication information field is per the protocol in use. The Replay Detection Method (RDM) field determines the type of replay detection used in the Replay Detection field. If the RDM field contains 0x00, the replay detection field MUST be set to the value of a monotonically increasing counter. Using a counter value such as the current time of day (e.g., an NTP-format timestamp [4]) can reduce the danger of replay attacks. This method MUST be supported by all protocols. 3. Interaction with Relay Agents Because a DHCP relay agent may alter the values of the ’giaddr’ and ’hops’ fields in the DHCP message, the contents of those two fields MUST be set to zero for the computation of any hash function over the message header. Additionally, a relay agent may append the DHCP relay agent information option 82 [7] as the last option in a message to servers. If a server finds option 82 included in a received message, the server MUST compute any hash function as if the option were NOT included in the message without changing the order of options. Whenever the server sends back option 82 to a relay agent, the server MUST not include the option in the computation of any hash function over the message. will be defined as separate protocols. 5. Delayed authentication If the protocol field is 1, the message is using the ""delayed authentication"" mechanism. In delayed authentication, the client requests authentication in its DHCPDISCOVER message and the server replies with a DHCPOFFER message that includes authentication information. This authentication information contains a nonce value generated by the source as a message authentication code (MAC) to provide message authentication and entity authentication. This document defines the use of a particular technique based on the HMAC protocol [3] using the MD5 hash [2]. 5.1 Management Issues The ""delayed authentication"" protocol does not attempt to address situations where a client may roam from one administrative domain to another, i.e., interdomain roaming. This protocol is focused on solving the intradomain problem where the out-of-band exchange of a shared secret is feasible. Replay Detection - as defined by the RDM field K - a secret value shared between the source and destination of the message; each secret has a unique identifier (secret ID) secret ID - the unique identifier for the secret value used to generate the MAC for this message HMAC-MD5 - the MAC generating function [3, 2]. The sender computes the MAC using the HMAC generation algorithm [3] and the MD5 hash function [2]. The entire DHCP message (except as noted below), including the DHCP message header and the options field, is used as input to the HMAC-MD5 computation function. The ’secret ID’ field MUST be set to the identifier of the secret used to generate the MAC. DISCUSSION: Algorithm 1 specifies the use of HMAC-MD5. Use of a different technique, such as HMAC-SHA, will be specified as a separate protocol. Delayed authentication requires a shared secret key for each client on each DHCP server with which that client may wish to use the DHCP protocol. Each secret key has a unique identifier that can be used by a receiver to determine which secret was used to generate the MAC in the DHCP message. Therefore, delayed authentication may not scale well in an architecture in which a DHCP client connects to multiple administrative domains. 5.3 Message validation To validate an incoming message, the receiver first checks that the value in the replay detection field is acceptable according to the replay detection method specified by the RDM field. Next, the receiver computes the MAC as described in [3]. The receiver MUST set the ’MAC’ field of the authentication option to all 0s for computation of the MAC, and because a DHCP relay agent may alter the values of the ’giaddr’ and ’hops’ fields in the DHCP message, the contents of those two fields MUST also be set to zero for the computation of the MAC. If the MAC computed by the receiver does not match the MAC contained in the authentication option, the receiver MUST discard the DHCP message. Section 3 provides additional information on handling messages that include option 82 (Relay Agents). 5.4 Key utilization Each DHCP client has a key, K. The client uses its key to encode any messages it sends to the server and to authenticate and verify any messages it receives from the server. The client’s key SHOULD be initially distributed to the client through some out-of-band mechanism, and SHOULD be stored locally on the client for use in all authenticated DHCP messages. Once the client has been given its key, it SHOULD use that key for all transactions even if the client’s configuration changes; e.g., if the client is assigned a new network address. Each DHCP server MUST know, or be able to obtain in a secure manner, the keys for all authorized clients. If all clients use the same key, clients can perform both entity and message authentication for all messages received from servers. However, the sharing of keys is strongly discouraged as it allows for unauthorized clients to masquerade as authorized clients by obtaining a copy of the shared key. To authenticate the identity of individual clients, each client MUST be configured with a unique key. Appendix A describes a technique for key management. 5.5 Client considerations This section describes the behavior of a DHCP client using delayed authentication. 5.5.1 INIT state When in INIT state, the client uses delayed authentication as follows: 1. The client MUST include the authentication request option in its DHCPDISCOVER message along with a client identifier option [6] to identify itself uniquely to the server. 2. The client MUST perform the validation test described in section 5.3 on any DHCPOFFER messages that include authentication information. If one or more DHCPOFFER messages pass the validation test, the client chooses one of the offered configurations. Client behavior if no DHCPOFFER messages include authentication information or pass the validation test is controlled by local policy in the client. According to client policy, the client MAY choose to respond to a DHCPOFFER message that has not been authenticated. The decision to set local policy to accept unauthenticated messages should be made with care. Accepting an unauthenticated DHCPOFFER message can make the client vulnerable to spoofing and other attacks. If local users are not explicitly informed that the client has accepted an unauthenticated DHCPOFFER message, the users may incorrectly assume that the client has received an authenticated address and is not subject to DHCP attacks through unauthenticated messages. A client MUST be configurable to decline unauthenticated messages, and SHOULD be configured by default to decline unauthenticated messages. A client MAY choose to differentiate between DHCPOFFER messages with no authentication information and DHCPOFFER messages that do not pass the validation test; for example, a client might accept the former and discard the latter. If a client does accept an unauthenticated message, the client SHOULD inform any local users and SHOULD log the event. 3. The client replies with a DHCPREQUEST message that MUST include authentication information encoded with the same secret used by the server in the selected DHCPOFFER message. 4. If the client authenticated the DHCPOFFER it accepted, the client MUST validate the DHCPACK message from the server. The client MUST discard the DHCPACK if the message fails to pass validation and MAY log the validation failure. If the DHCPACK fails to pass validation, the client MUST revert to INIT state and returns to step 1. The client MAY choose to remember which server replied with a DHCPACK message that failed to pass validation and discard subsequent messages from that server. If the client accepted a DHCPOFFER message that did not include authentication information or did not pass the validation test, the client MAY accept an unauthenticated DHCPACK message from the server. 5.5.2 INIT-REBOOT state When in INIT-REBOOT state, the client MUST use the secret it used in its DHCPREQUEST message to obtain its current configuration to generate authentication information for the DHCPREQUEST message. The client MAY choose to accept unauthenticated DHCPACK/DHCPNAK messages if no authenticated messages were received. The client MUST treat the receipt (or lack thereof) of any DHCPACK/DHCPNAK messages as specified in section 3.2 of [1]. 5.5.3 RENEWING state When in RENEWING state, the client uses the secret it used in its initial DHCPREQUEST message to obtain its current configuration to generate authentication information for the DHCPREQUEST message. If client receives no DHCPACK messages or none of the DHCPACK messages pass validation, the client behaves as if it had not received a DHCPACK message in section 4.4.5 of the DHCP specification [1]. 5.5.4 REBINDING state When in REBINDING state, the client uses the secret it used in its initial DHCPREQUEST message to obtain its current configuration to generate authentication information for the DHCPREQUEST message. If client receives no DHCPACK messages or none of the DHCPACK messages pass validation, the client behaves as if it had not received a DHCPACK message in section 4.4.5 of the DHCP specification [1]. 5.5.5 DHCPINFORM message Since the client already has some configuration information, the client may also have established a shared secret value, K, with a server. Therefore, the client SHOULD use the authentication request as in a DHCPDISCOVER message when a shared secret value exists. The client MUST treat any received DHCPACK messages as it does DHCPOFFER messages, see section 5.5.1. 5.5.6 DHCPRELEASE message Since the client is already in the BOUND state, the client will have a security association already established with the server. Therefore, the client MUST include authentication information with the DHCPRELEASE message. 5.6 Server considerations This section describes the behavior of a server in response to client messages using delayed authentication. 5.6.1 General considerations Each server maintains a list of secrets and identifiers for those secrets that it shares with clients and potential clients. This information must be maintained in such a way that the server can: * Identify an appropriate secret and the identifier for that secret for use with a client that the server may not have previously communicated with * Retrieve the secret and identifier used by a client to which the server has provided previous configuration information Each server MUST save the counter from the previous authenticated message. A server MUST discard any incoming message which fails the replay detection check as defined by the RDM avoid replay attacks. DISCUSSION: The authenticated DHCPREQUEST message from a client in INIT-REBOOT state can only be validated by servers that used the same secret in their DHCPOFFER messages. Other servers will discard the DHCPREQUEST messages. Thus, only servers that used the secret selected by the client will be able to determine that their offered configuration information was not selected and the offered network address can be returned to the server’s pool of available addresses. The servers that cannot validate the DHCPREQUEST message will eventually return their offered network addresses to their pool of available addresses as described in section 3.1 of the DHCP specification [1]. 5.6.2 After receiving a DHCPDISCOVER message The server selects a secret for the client and includes authentication information in the DHCPOFFER message as specified in section 5, above. The server MUST record the identifier of the secret selected for the client and use that same secret for validating subsequent messages with the client. 5.6.3 After receiving a DHCPREQUEST message The server uses the secret identified in the message and validates the message as specified in section 5.3. If the message fails to pass validation or the server does not know the secret identified by the ’secret ID’ field, the server MUST discard the message and MAY choose to log the validation failure. If the message passes the validation procedure, the server responds as described in the DHCP specification. The server MUST include authentication information generated as specified in section 5.2. 5.6.4 After receiving a DHCPINFORM message The server MAY choose to accept unauthenticated DHCPINFORM messages, or only accept authenticated DHCPINFORM messages based on a site policy. When a client includes the authentication request in a DHCPINFORM message, the server MUST respond with an authenticated DHCPACK message. If the server does not have a shared secret value established with the sender of the DHCPINFORM message, then the server MAY respond with an unauthenticated DHCPACK message, or a DHCPNAK if the server does not accept unauthenticated clients based on the site policy, or the server MAY choose not to respond to the DHCPINFORM message. 6. IANA Considerations Section 2 defines a new DHCP option called the Authentication Option, whose option code is 90. This document specifies three new name spaces associated with the Authentication Option, which are to be created and maintained by IANA: Protocol, Algorithm and RDM. Initial values assigned from the Protocol name space are 0 (for the configuration token Protocol in section 4) and 1 (for the delayed authentication Protocol in section 5). Additional values from the Protocol name space will be assigned through IETF Consensus, as defined in RFC 2434 [8]. The Algorithm name space is specific to individual Protocols. That is, each Protocol has its own Algorithm name space. The guidelines for assigning Algorithm name space values for a particular protocol should be specified along with the definition of a new Protocol. For the configuration token Protocol, the Algorithm field MUST be 0. For the delayed authentication Protocol, the Algorithm value 1 is assigned to the HMAC-MD5 generating function as defined in section 5. Additional values from the Algorithm name space for Algorithm 1 will be assigned through IETF Consensus, as defined in RFC 2434. The initial value of 0 from the RDM name space is assigned to the use of a monotonically increasing value as defined in section 2. Additional values from the RDM name space will be assigned through IETF Consensus, as defined in RFC 2434. 7. References [1] Droms, R., ""Dynamic Host Configuration Protocol"", RFC 2131, March 1997. [2] Rivest, R., ""The MD5 Message-Digest Algorithm"", RFC 1321, April 1992.[3] Krawczyk H., Bellare, M. and R. Canetti, ""HMAC: Keyed-Hashing for Message Authentication"", RFC 2104, February 1997. [4] Mills, D., ""Network Time Protocol (Version 3)"", RFC 1305, March 1992. [5] Bradner, S., ""Key words for use in RFCs to Indicate Requirement Levels"", RFC 2219, March 1997. [6] Alexander, S. and R. Droms, ""DHCP Options and BOOTP Vendor Extensions"", RFC 2132, March 1997. [7] Patrick, M., ""DHCP Relay Agent Information Option"", RFC 3046, January 2001. [8] Narten, T. and H. Alvestrand, ""Guidelines for Writing and IANA Considerations Section in RFCs"", BCP 26, RFC 2434, October 1998. 8. Acknowledgments Jeff Schiller and Christian Huitema developed the original version of this authentication protocol in a terminal room BOF at the Dallas IETF meeting, December 1995. One of the editors (Droms) transcribed the notes from that discussion, which form the basis for this document. The editors appreciate Jeff’s and Christian’s patience in reviewing this document and its earlier drafts. The ""delayed authentication"" mechanism used in section 5 is due to Bill Arbaugh. The threat model and requirements in sections 1.1 and 1.2 come from Bill’s negotiation protocol proposal. The attendees of an interim meeting of the DHC WG held in June, 1998, including Peter Ford, Kim Kinnear, Glenn Waters, Rob Stevens, Bill Arbaugh, Baiju Patel, Carl Smith, Thomas Narten, Stewart Kwan, Munil Shah, Olafur Gudmundsson, Robert Watson, Ralph Droms, Mike Dooley, Greg Rabil and Arun Kapur, developed the threat model and reviewed several alternative proposals. The replay detection method field is due to Vipul Gupta. Other input from Bill Sommerfield is gratefully acknowledged. Thanks also to John Wilkins, Ran Atkinson, Shawn Mamros and Thomas Narten for reviewing earlier drafts of this document. 9. Security Considerations This document describes authentication and verification mechanisms for DHCP. 9.1 Protocol vulnerabilities The configuration token authentication mechanism is vulnerable to interception and provides only the most rudimentary protection against inadvertently instantiated DHCP servers. The delayed authentication mechanism described in this document is vulnerable to a denial of service attack through flooding with DHCPDISCOVER messages, which are not authenticated by this protocol. Such an attack may overwhelm the computer on which the DHCP server is running and may exhaust the addresses available for assignment by the DHCP server. Delayed authentication may also be vulnerable to a denial of service attack through flooding with authenticated messages, which may overwhelm the computer on which the DHCP server is running as the authentication keys for the incoming messages are computed. 9.2 Protocol limitations Delayed authentication does not support interdomain authentication. A real digital signature mechanism such as RSA, while currently computationally infeasible, would provide better security. Appendix A - Key Management Technique To avoid centralized management of a list of random keys, suppose K for each client is generated from the pair (client identifier [6], subnet address, e.g., 192.168.1.0), which must be unique to that client. That is, K = MAC(MK, unique-id), where MK is a secret master key and MAC is a keyed one-way function such as HMAC-MD5. Without knowledge of the master key MK, an unauthorized client cannot generate its own key K. The server can quickly validate an incoming message from a new client by regenerating K from the client-id. For known clients, the server can choose to recover the client’s K dynamically from the client-id in the DHCP message, or can choose to precompute and cache all of the Ks a priori. By deriving all keys from a single master key, the DHCP server does not need access to clear text passwords, and can compute and verify the keyed MACs without requiring help from a centralized authentication server. To avoid compromise of this key management system, the master key, MK, MUST NOT be stored by any clients. The client SHOULD only be given its key, K. If MK is compromised, a new MK SHOULD be chosen and all clients given new individual keys. Full Copyright Statement Copyright (C) The Internet Society (2001). All Rights Reserved. This document and translations of it may be copied and furnished to others, and derivative works that comment on or otherwise explain it or assist in its implementation may be prepared, copied, published and distributed, in whole or in part, without restriction of any kind, provided that the above copyright notice and this paragraph are included on all such copies and derivative works. However, this document itself may not be modified in any way, such as by removing the copyright notice or references to the Internet Society or other Internet organizations, except as needed for the purpose of developing Internet standards in which case the procedures for copyrights defined in the Internet Standards process must be followed, or as required to translate it into languages other than English. The limited permissions granted above are perpetual and will not be revoked by the Internet Society or its successors or assigns. This document and the information contained herein is provided on an ""AS IS"" basis and THE INTERNET SOCIETY AND THE INTERNET ENGINEERING TASK FORCE DISCLAIMS ALL WARRANTIES, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO ANY WARRANTY THAT THE USE OF THE INFORMATION HEREIN WILL NOT INFRINGE ANY RIGHTS OR ANY IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. Acknowledgement Funding for the RFC Editor function is currently provided by the Internet Society.
+
+USER:
+What are some current challenges with our DHCP system as it stands?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,8,12,3977,,107
+"You can only answer a prompt using the information contained in the prompt context, you cannot rely on your own knowledge or outside knowledge to answer, only what is shown in the literal text of the prompt.",Please summarise what the Animal Welfare Act is and what/who is affected by this act.,"In 1966, Congress passed legislation that later became known as the Animal Welfare Act (P.L. 89-544) with goals of preventing the theft and sale of pets to research laboratories and regulating the humane care and handling of dogs, cats, and other laboratory animals. The Animal Welfare Act as amended (AWA, 7 U.S.C. §§2131-2156) is the central federal statute governing the humane care and handling of mammals and certain other animals. Since its enactment, Congress has amended the law to expand the types of animals it covers and activities it regulates and to clarify various provisions. These amendments have strengthened enforcement, expanded coverage to more animals and activities, and curtailed cruel practices (e.g., animal fighting), among other things. The AWA covers any live or dead warm-blooded animal, as defined, determined by the U.S. Department of Agriculture (USDA) to be used for research, exhibition, or as a pet. In addition, the AWA addresses animal fighting and the importation of certain dogs into the United States. The AWA’s statutory definition of animal excludes birds, rats, and mice bred for research; horses not used for research; and other farm animals used in the production of food and fiber. The act applies to animal dealers (e.g., pet breeders, medical research suppliers), exhibitors (e.g., zoos, circuses), research facilities (e.g., private and federal laboratories that use animals in research), and transporters (e.g., airlines, railroads, truckers). Covered entities must meet certain standards described in law and regulation and keep certain records. The AWA establishes penalties for noncompliance. USDA’s Animal and Plant Health Inspection Service (APHIS) administers the AWA. In carrying out this responsibility, APHIS promulgates and updates AWA regulations; licenses and registers entities subject to the AWA; inspects the premises of licensed and registered entities; investigates potential violations; and enforces AWA provisions. Animal welfare issues generate significant attention from stakeholder groups. For example, animal welfare advocates have called on Congress to define specific standards for animal care within AWA legislation, increase AWA enforcement, and expand AWA coverage to even more covered animals, entities, and activities. Other stakeholders, including entities regulated under the AWA, have called on Congress to streamline USDA’s AWA oversight and enforcement. Additional issues debated in recent years include the role and care of research animals and federal oversight of pet breeding operations, circuses, and animal shelters.","You can only answer a prompt using the information contained in the prompt context, you cannot rely on your own knowledge or outside knowledge to answer, only what is shown in the literal text of the prompt. In 1966, Congress passed legislation that later became known as the Animal Welfare Act (P.L. 89-544) with goals of preventing the theft and sale of pets to research laboratories and regulating the humane care and handling of dogs, cats, and other laboratory animals. The Animal Welfare Act as amended (AWA, 7 U.S.C. §§2131-2156) is the central federal statute governing the humane care and handling of mammals and certain other animals. Since its enactment, Congress has amended the law to expand the types of animals it covers and activities it regulates and to clarify various provisions. These amendments have strengthened enforcement, expanded coverage to more animals and activities, and curtailed cruel practices (e.g., animal fighting), among other things. The AWA covers any live or dead warm-blooded animal, as defined, determined by the U.S. Department of Agriculture (USDA) to be used for research, exhibition, or as a pet. In addition, the AWA addresses animal fighting and the importation of certain dogs into the United States. The AWA’s statutory definition of animal excludes birds, rats, and mice bred for research; horses not used for research; and other farm animals used in the production of food and fiber. The act applies to animal dealers (e.g., pet breeders, medical research suppliers), exhibitors (e.g., zoos, circuses), research facilities (e.g., private and federal laboratories that use animals in research), and transporters (e.g., airlines, railroads, truckers). Covered entities must meet certain standards described in law and regulation and keep certain records. The AWA establishes penalties for noncompliance. USDA’s Animal and Plant Health Inspection Service (APHIS) administers the AWA. In carrying out this responsibility, APHIS promulgates and updates AWA regulations; licenses and registers entities subject to the AWA; inspects the premises of licensed and registered entities; investigates potential violations; and enforces AWA provisions. Animal welfare issues generate significant attention from stakeholder groups. For example, animal welfare advocates have called on Congress to define specific standards for animal care within AWA legislation, increase AWA enforcement, and expand AWA coverage to even more covered animals, entities, and activities. Other stakeholders, including entities regulated under the AWA, have called on Congress to streamline USDA’s AWA oversight and enforcement. Additional issues debated in recent years include the role and care of research animals and federal oversight of pet breeding operations, circuses, and animal shelters. Please summarise what the Animal Welfare Act is and what/who is affected by this act.","You can only answer a prompt using the information contained in the prompt context, you cannot rely on your own knowledge or outside knowledge to answer, only what is shown in the literal text of the prompt.
+
+EVIDENCE:
+In 1966, Congress passed legislation that later became known as the Animal Welfare Act (P.L. 89-544) with goals of preventing the theft and sale of pets to research laboratories and regulating the humane care and handling of dogs, cats, and other laboratory animals. The Animal Welfare Act as amended (AWA, 7 U.S.C. §§2131-2156) is the central federal statute governing the humane care and handling of mammals and certain other animals. Since its enactment, Congress has amended the law to expand the types of animals it covers and activities it regulates and to clarify various provisions. These amendments have strengthened enforcement, expanded coverage to more animals and activities, and curtailed cruel practices (e.g., animal fighting), among other things. The AWA covers any live or dead warm-blooded animal, as defined, determined by the U.S. Department of Agriculture (USDA) to be used for research, exhibition, or as a pet. In addition, the AWA addresses animal fighting and the importation of certain dogs into the United States. The AWA’s statutory definition of animal excludes birds, rats, and mice bred for research; horses not used for research; and other farm animals used in the production of food and fiber. The act applies to animal dealers (e.g., pet breeders, medical research suppliers), exhibitors (e.g., zoos, circuses), research facilities (e.g., private and federal laboratories that use animals in research), and transporters (e.g., airlines, railroads, truckers). Covered entities must meet certain standards described in law and regulation and keep certain records. The AWA establishes penalties for noncompliance. USDA’s Animal and Plant Health Inspection Service (APHIS) administers the AWA. In carrying out this responsibility, APHIS promulgates and updates AWA regulations; licenses and registers entities subject to the AWA; inspects the premises of licensed and registered entities; investigates potential violations; and enforces AWA provisions. Animal welfare issues generate significant attention from stakeholder groups. For example, animal welfare advocates have called on Congress to define specific standards for animal care within AWA legislation, increase AWA enforcement, and expand AWA coverage to even more covered animals, entities, and activities. Other stakeholders, including entities regulated under the AWA, have called on Congress to streamline USDA’s AWA oversight and enforcement. Additional issues debated in recent years include the role and care of research animals and federal oversight of pet breeding operations, circuses, and animal shelters.
+
+USER:
+Please summarise what the Animal Welfare Act is and what/who is affected by this act.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,37,15,381,,562
+"Only use the information provided in the context block to answer the question. When appropriate, provide the answer in a bulleted list. Keep each bullet point to one to two sentences.",What types of things can influence a person's decisions about how to save for retirement?,"As discussed earlier in this report, household decisionmaking related to retirement has become more important over time. The shift from DB to DC retirement plans requires families to assume more responsibility for managing their retirement and making decisions about retirement account contributions and investments, as well as making decisions about how to draw down these funds in retirement. For this reason, understanding household decisionmaking in retirement planning is important, particularly when considering retirement savings policy issues and the impact of different policy options on retirement security. The life-cycle model is a prevalent economic hypothesis that assumes households usually want to keep consumption levels stable over time.57 For example, severely reducing consumption one month may be more painful for people than the pleasure of a much higher household consumption level in another month. Therefore, people save and invest during their careers in order to afford a stable income across their lives, including in retirement. This model suggests that wealth should increase as people age, which generally fits household financial data in the United States.58 In this theory, households adjust their savings rate during their working years rationally, based on interest rates, investment returns, life expectancy, Social Security or pension benefits, and other relevant factors. Evidence exists that some households adjust their retirement planning based on these types of factors.59 However, in the United States, income and consumption move together more closely than the life-cycle model would predict, suggesting some households may not save enough for their retirement needs or other lower-income periods. Mainstream economic theory asserts that competitive free markets generally lead to efficient distributions of goods and services to maximize value for society.61 If certain conditions hold, policy interventions cannot improve on the financial decisions that consumers make based on their unique situations and preferences. For this reason, some policymakers are hesitant to disrupt free markets, based on the theory that prices determined by market forces lead to efficient outcomes without intervention. However, in these theoretical frameworks, a free market may become inefficient due to departures from standard economic assumptions, which includes assuming that consumers and firms act rationally with perfect information. When these assumptions do not hold, it may cause a reduction in economic efficiency and consumer welfare. In these cases, government policy can potentially bring the market to a more efficient outcome, maximizing social welfare. Yet, policymakers often find it challenging to determine whether a policy intervention will help or harm a particular market to reach its efficient outcome. The following section discusses behavioral biases, which are a specific departure from the rational decisionmaking condition associated with theoretical economic efficiency. This departure is particularly important for understanding people’s decisionmaking in saving for retirement and investment markets. When people act with predictable biases, markets may become less efficient, and government policy—such as consumer disclosures or other plan design requirements—may be appropriate. However, these policies may also lead to unintended outcomes, which should be taken into account. Behavioral research suggests that people tend to have biases in rather predictable patterns.62 This research suggests that the human brain has evolved to quickly make judgments in bounded, rational ways, using heuristics—or mental shortcuts—to make decisions. These heuristics generally help people make appropriate decisions quickly and easily, but they can sometimes result in choices that make the decisionmaker worse off financially. For example, the number, order, and structure of options, as well as the process around the choice, can change decisions for many people. A few of these biases tend to be particularly important for understanding retirement planning decisionmaking: Choice Architecture. Research suggests that how financial decisions are framed can affect consumer decisionmaking. Framing can affect decisions in many ways. • Anchoring. People can be influenced, or anchored, by an initial number, even if it is unrelated to their next choice.64 In one illustration of this concept, researchers had subjects spin a wheel of fortune with numbers between 0 and 100, then asked them the percentage of African countries in the United Nations. The random number generated in the first stage subconsciously affected subjects’ guesses in the second stage, even though they were not related. Therefore, without the anchor, people’s estimates likely would have been different. In the retirement savings context, the automatic contribution rate in 401(k)s and the percent of salary at which employers provide maximum matches may be anchors that influence how much a person decides to put toward retirement savings. • Defaults. People can also be influenced by defaults established in how a decision is framed. 66 For example, employees are more likely to be enrolled in a 401(k) plan if an employer defaults them into it than if they actively need to make a choice to participate. • Choice Overload. When making decisions, people often find it difficult to navigate complexity, such as many choices to choose from or items to consider. In the retirement savings context, this means that more investment fund options in retirement savings plans can sometimes lead to procrastination or failure to make a decision. Choice overload can also lead to poor decisionmaking, as some research suggests that fewer choices in retirement savings plans might lead to better retirement investment decisions • Asset Allocation and Diversification. People tend to naively make diversification choices when making allocation decisions. For example, in the retirement context, when making decisions about how much to invest in a collection of funds, some people choose to spread their investments evenly across available funds (whether financially appropriate for their situation or not). Biases Toward the Future. Research suggests that common cognitive biases towards the future can also affect consumer decisionmaking. Present Bias. When people tend to put more value on having something now, rather than in the future—even when there is a large benefit for waiting—this behavior is called present bias. For example, in the retirement context, people tend to have a preference for lump sums over annuities, independent of risk considerations. Research suggests that people with more present bias tend to save less for retirement when controlling for other factors. Self-Control. Even when people decide they should do something, such as saving for the future or choosing a retirement plan, self-control and procrastination may prevent them from following their intentions. These human biases might lead consumers to make financial decisions that are not optimal, such as undersaving. Although consumers might not be aware of these biases when making financial decisions, firms may take advantage of them to attract consumers. For example, choice architecture biases might influence how marketing materials are developed, emphasizing certain terms—such as high past investment return rate—to make a financial product seem more desirable to consumers. In addition, product features may be developed to take advantage of people’s present bias or selfcontrol mistakes. Less knowledgeable retirement savers’ decisionmaking might be more sensitive to choice architecture biases. Biases can also be used to encourage people to save more for retirement and make better retirement decisions. For example, some research suggests that choice architecture environments can make retirement more salient (e.g., annual consumer disclosures that project future retirement income may lead to more retirement savings). Moreover, how saving and investment options are framed may help some people make better retirement decisions. For example, some research suggests that preference checklists, which list factors—such as perceived health, life expectancy, and risk of outliving one’s resources—that people should consider when making a retirement decision, may improve retirement decisionmaking. Although these techniques can be used to encourage socially beneficial goals, such as planning and saving more for retirement, changing the choice environment can also sometimes have perverse impacts. For example, defaulting people at a fixed savings rate can increase participation in retirement plans on average but may discourage some people from making an active decision when they start a new job to increase the contribution rate from the default to a higher level. For these people, the lower contribution rate may lead to less retirement savings over time. Likewise, defaulting people into life-cycle retirement investment plans may lead to more appropriate long-term investment decisions on average, but the investment default also may encourage fewer people to make active decisions or put them in a plan that may conflict with other savings vehicles. Moreover, although defaulting people into 401(k)s can increase the number of people who save for retirement, it may also lead to increased consumer debt without large impacts on household net worth over time.","As discussed earlier in this report, household decisionmaking related to retirement has become more important over time. The shift from DB to DC retirement plans requires families to assume more responsibility for managing their retirement and making decisions about retirement account contributions and investments, as well as making decisions about how to draw down these funds in retirement. For this reason, understanding household decisionmaking in retirement planning is important, particularly when considering retirement savings policy issues and the impact of different policy options on retirement security. The life-cycle model is a prevalent economic hypothesis that assumes households usually want to keep consumption levels stable over time.57 For example, severely reducing consumption one month may be more painful for people than the pleasure of a much higher household consumption level in another month. Therefore, people save and invest during their careers in order to afford a stable income across their lives, including in retirement. This model suggests that wealth should increase as people age, which generally fits household financial data in the United States.58 In this theory, households adjust their savings rate during their working years rationally, based on interest rates, investment returns, life expectancy, Social Security or pension benefits, and other relevant factors. Evidence exists that some households adjust their retirement planning based on these types of factors.59 However, in the United States, income and consumption move together more closely than the life-cycle model would predict, suggesting some households may not save enough for their retirement needs or other lower-income periods. Mainstream economic theory asserts that competitive free markets generally lead to efficient distributions of goods and services to maximize value for society.61 If certain conditions hold, policy interventions cannot improve on the financial decisions that consumers make based on their unique situations and preferences. For this reason, some policymakers are hesitant to disrupt free markets, based on the theory that prices determined by market forces lead to efficient outcomes without intervention. However, in these theoretical frameworks, a free market may become inefficient due to departures from standard economic assumptions, which includes assuming that consumers and firms act rationally with perfect information. When these assumptions do not hold, it may cause a reduction in economic efficiency and consumer welfare. In these cases, government policy can potentially bring the market to a more efficient outcome, maximizing social welfare. Yet, policymakers often find it challenging to determine whether a policy intervention will help or harm a particular market to reach its efficient outcome. The following section discusses behavioral biases, which are a specific departure from the rational decisionmaking condition associated with theoretical economic efficiency. This departure is particularly important for understanding people’s decisionmaking in saving for retirement and investment markets. When people act with predictable biases, markets may become less efficient, and government policy—such as consumer disclosures or other plan design requirements—may be appropriate. However, these policies may also lead to unintended outcomes, which should be taken into account. Behavioral research suggests that people tend to have biases in rather predictable patterns.62 This research suggests that the human brain has evolved to quickly make judgments in bounded, rational ways, using heuristics—or mental shortcuts—to make decisions. These heuristics generally help people make appropriate decisions quickly and easily, but they can sometimes result in choices that make the decisionmaker worse off financially. For example, the number, order, and structure of options, as well as the process around the choice, can change decisions for many people. A few of these biases tend to be particularly important for understanding retirement planning decisionmaking: Choice Architecture. Research suggests that how financial decisions are framed can affect consumer decisionmaking. Framing can affect decisions in many ways. • Anchoring. People can be influenced, or anchored, by an initial number, even if it is unrelated to their next choice.64 In one illustration of this concept, researchers had subjects spin a wheel of fortune with numbers between 0 and 100, then asked them the percentage of African countries in the United Nations. The random number generated in the first stage subconsciously affected subjects’ guesses in the second stage, even though they were not related. Therefore, without the anchor, people’s estimates likely would have been different. In the retirement savings context, the automatic contribution rate in 401(k)s and the percent of salary at which employers provide maximum matches may be anchors that influence how much a person decides to put toward retirement savings. • Defaults. People can also be influenced by defaults established in how a decision is framed. 66 For example, employees are more likely to be enrolled in a 401(k) plan if an employer defaults them into it than if they actively need to make a choice to participate. • Choice Overload. When making decisions, people often find it difficult to navigate complexity, such as many choices to choose from or items to consider. In the retirement savings context, this means that more investment fund options in retirement savings plans can sometimes lead to procrastination or failure to make a decision. Choice overload can also lead to poor decisionmaking, as some research suggests that fewer choices in retirement savings plans might lead to better retirement investment decisions • Asset Allocation and Diversification. People tend to naively make diversification choices when making allocation decisions. For example, in the retirement context, when making decisions about how much to invest in a collection of funds, some people choose to spread their investments evenly across available funds (whether financially appropriate for their situation or not). Biases Toward the Future. Research suggests that common cognitive biases towards the future can also affect consumer decisionmaking. Present Bias. When people tend to put more value on having something now, rather than in the future—even when there is a large benefit for waiting—this behavior is called present bias. For example, in the retirement context, people tend to have a preference for lump sums over annuities, independent of risk considerations. Research suggests that people with more present bias tend to save less for retirement when controlling for other factors. Self-Control. Even when people decide they should do something, such as saving for the future or choosing a retirement plan, self-control and procrastination may prevent them from following their intentions. These human biases might lead consumers to make financial decisions that are not optimal, such as undersaving. Although consumers might not be aware of these biases when making financial decisions, firms may take advantage of them to attract consumers. For example, choice architecture biases might influence how marketing materials are developed, emphasizing certain terms—such as high past investment return rate—to make a financial product seem more desirable to consumers. In addition, product features may be developed to take advantage of people’s present bias or selfcontrol mistakes. Less knowledgeable retirement savers’ decisionmaking might be more sensitive to choice architecture biases. Biases can also be used to encourage people to save more for retirement and make better retirement decisions. For example, some research suggests that choice architecture environments can make retirement more salient (e.g., annual consumer disclosures that project future retirement income may lead to more retirement savings). Moreover, how saving and investment options are framed may help some people make better retirement decisions. For example, some research suggests that preference checklists, which list factors—such as perceived health, life expectancy, and risk of outliving one’s resources—that people should consider when making a retirement decision, may improve retirement decisionmaking. Although these techniques can be used to encourage socially beneficial goals, such as planning and saving more for retirement, changing the choice environment can also sometimes have perverse impacts. For example, defaulting people at a fixed savings rate can increase participation in retirement plans on average but may discourage some people from making an active decision when they start a new job to increase the contribution rate from the default to a higher level. For these people, the lower contribution rate may lead to less retirement savings over time. Likewise, defaulting people into life-cycle retirement investment plans may lead to more appropriate long-term investment decisions on average, but the investment default also may encourage fewer people to make active decisions or put them in a plan that may conflict with other savings vehicles. Moreover, although defaulting people into 401(k)s can increase the number of people who save for retirement, it may also lead to increased consumer debt without large impacts on household net worth over time. Only use the information provided in the context block to answer the question. When appropriate, provide the answer in a bulleted list. Keep each bullet point to one to two sentences. What types of things can influence a person's decisions about how to save for retirement?","Only use the information provided in the context block to answer the question. When appropriate, provide the answer in a bulleted list. Keep each bullet point to one to two sentences.
+
+EVIDENCE:
+As discussed earlier in this report, household decisionmaking related to retirement has become more important over time. The shift from DB to DC retirement plans requires families to assume more responsibility for managing their retirement and making decisions about retirement account contributions and investments, as well as making decisions about how to draw down these funds in retirement. For this reason, understanding household decisionmaking in retirement planning is important, particularly when considering retirement savings policy issues and the impact of different policy options on retirement security. The life-cycle model is a prevalent economic hypothesis that assumes households usually want to keep consumption levels stable over time.57 For example, severely reducing consumption one month may be more painful for people than the pleasure of a much higher household consumption level in another month. Therefore, people save and invest during their careers in order to afford a stable income across their lives, including in retirement. This model suggests that wealth should increase as people age, which generally fits household financial data in the United States.58 In this theory, households adjust their savings rate during their working years rationally, based on interest rates, investment returns, life expectancy, Social Security or pension benefits, and other relevant factors. Evidence exists that some households adjust their retirement planning based on these types of factors.59 However, in the United States, income and consumption move together more closely than the life-cycle model would predict, suggesting some households may not save enough for their retirement needs or other lower-income periods. Mainstream economic theory asserts that competitive free markets generally lead to efficient distributions of goods and services to maximize value for society.61 If certain conditions hold, policy interventions cannot improve on the financial decisions that consumers make based on their unique situations and preferences. For this reason, some policymakers are hesitant to disrupt free markets, based on the theory that prices determined by market forces lead to efficient outcomes without intervention. However, in these theoretical frameworks, a free market may become inefficient due to departures from standard economic assumptions, which includes assuming that consumers and firms act rationally with perfect information. When these assumptions do not hold, it may cause a reduction in economic efficiency and consumer welfare. In these cases, government policy can potentially bring the market to a more efficient outcome, maximizing social welfare. Yet, policymakers often find it challenging to determine whether a policy intervention will help or harm a particular market to reach its efficient outcome. The following section discusses behavioral biases, which are a specific departure from the rational decisionmaking condition associated with theoretical economic efficiency. This departure is particularly important for understanding people’s decisionmaking in saving for retirement and investment markets. When people act with predictable biases, markets may become less efficient, and government policy—such as consumer disclosures or other plan design requirements—may be appropriate. However, these policies may also lead to unintended outcomes, which should be taken into account. Behavioral research suggests that people tend to have biases in rather predictable patterns.62 This research suggests that the human brain has evolved to quickly make judgments in bounded, rational ways, using heuristics—or mental shortcuts—to make decisions. These heuristics generally help people make appropriate decisions quickly and easily, but they can sometimes result in choices that make the decisionmaker worse off financially. For example, the number, order, and structure of options, as well as the process around the choice, can change decisions for many people. A few of these biases tend to be particularly important for understanding retirement planning decisionmaking: Choice Architecture. Research suggests that how financial decisions are framed can affect consumer decisionmaking. Framing can affect decisions in many ways. • Anchoring. People can be influenced, or anchored, by an initial number, even if it is unrelated to their next choice.64 In one illustration of this concept, researchers had subjects spin a wheel of fortune with numbers between 0 and 100, then asked them the percentage of African countries in the United Nations. The random number generated in the first stage subconsciously affected subjects’ guesses in the second stage, even though they were not related. Therefore, without the anchor, people’s estimates likely would have been different. In the retirement savings context, the automatic contribution rate in 401(k)s and the percent of salary at which employers provide maximum matches may be anchors that influence how much a person decides to put toward retirement savings. • Defaults. People can also be influenced by defaults established in how a decision is framed. 66 For example, employees are more likely to be enrolled in a 401(k) plan if an employer defaults them into it than if they actively need to make a choice to participate. • Choice Overload. When making decisions, people often find it difficult to navigate complexity, such as many choices to choose from or items to consider. In the retirement savings context, this means that more investment fund options in retirement savings plans can sometimes lead to procrastination or failure to make a decision. Choice overload can also lead to poor decisionmaking, as some research suggests that fewer choices in retirement savings plans might lead to better retirement investment decisions • Asset Allocation and Diversification. People tend to naively make diversification choices when making allocation decisions. For example, in the retirement context, when making decisions about how much to invest in a collection of funds, some people choose to spread their investments evenly across available funds (whether financially appropriate for their situation or not). Biases Toward the Future. Research suggests that common cognitive biases towards the future can also affect consumer decisionmaking. Present Bias. When people tend to put more value on having something now, rather than in the future—even when there is a large benefit for waiting—this behavior is called present bias. For example, in the retirement context, people tend to have a preference for lump sums over annuities, independent of risk considerations. Research suggests that people with more present bias tend to save less for retirement when controlling for other factors. Self-Control. Even when people decide they should do something, such as saving for the future or choosing a retirement plan, self-control and procrastination may prevent them from following their intentions. These human biases might lead consumers to make financial decisions that are not optimal, such as undersaving. Although consumers might not be aware of these biases when making financial decisions, firms may take advantage of them to attract consumers. For example, choice architecture biases might influence how marketing materials are developed, emphasizing certain terms—such as high past investment return rate—to make a financial product seem more desirable to consumers. In addition, product features may be developed to take advantage of people’s present bias or selfcontrol mistakes. Less knowledgeable retirement savers’ decisionmaking might be more sensitive to choice architecture biases. Biases can also be used to encourage people to save more for retirement and make better retirement decisions. For example, some research suggests that choice architecture environments can make retirement more salient (e.g., annual consumer disclosures that project future retirement income may lead to more retirement savings). Moreover, how saving and investment options are framed may help some people make better retirement decisions. For example, some research suggests that preference checklists, which list factors—such as perceived health, life expectancy, and risk of outliving one’s resources—that people should consider when making a retirement decision, may improve retirement decisionmaking. Although these techniques can be used to encourage socially beneficial goals, such as planning and saving more for retirement, changing the choice environment can also sometimes have perverse impacts. For example, defaulting people at a fixed savings rate can increase participation in retirement plans on average but may discourage some people from making an active decision when they start a new job to increase the contribution rate from the default to a higher level. For these people, the lower contribution rate may lead to less retirement savings over time. Likewise, defaulting people into life-cycle retirement investment plans may lead to more appropriate long-term investment decisions on average, but the investment default also may encourage fewer people to make active decisions or put them in a plan that may conflict with other savings vehicles. Moreover, although defaulting people into 401(k)s can increase the number of people who save for retirement, it may also lead to increased consumer debt without large impacts on household net worth over time.
+
+USER:
+What types of things can influence a person's decisions about how to save for retirement?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,31,15,1391,,288
+"<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> [user request] <TEXT> [context document]","Which one of these should I buy? Money is no object, but fuel efficiency and range are critical to me. Give me enough detail to make a really informed decision.","Here's Every New Electric Vehicle Model for Sale in the U.S. Electric vehicles make up a small percentage of the total automotive market today, but their appeal continues to grow as the automakers expand their range, performance, and style—and as recharging becomes quicker and easier. Shoppers looking for zero-emissions driving now have an expansive list of vehicles to choose from, with a wide variety of body styles and several different price points. Audi e-tron GT 2024 audi rs etron gtAudi Audi's take on the Porsche Taycan bears the name e-tron GT. Sharing its key mechanical bits with Porsche's electric sedan, the e-tron GT wears distinct bodywork and interior decor. Two flavors of Audi's low-slung EV are available: standard e-tron GT and rowdy RS e-tron GT. Both come exclusively with all-wheel drive, courtesy of an electric motor at each axle, and a 93.4-kWh battery pack. The two electric motors in the entry-level e-tron GT work together to produce a combined peak of 522 horsepower, while the RS e-tron GT ups the ante to 637 ponies. Regardless of trim, both variants of Audi's low-slung electric sedan net 249 miles of EPA-estimated range for 2024. Base price: $107,995 EPA fuel economy, combined/city/highway: 85/85/85 MPGe EPA combined range: 249 miles LEARN MORE ABOUT THE E-TRON GT Audi Q4 e-tron 2022 audi q4 50 etron quattro prestigeAudi Bearing the name Q4 e-tron, this Audi compact electric SUV shares components with the Volkswagen ID.4. Befitting its reputation, the four-ringed brand's battery-electric SUV is notably swankier than its more mainstream VW cousin. Rear-drive comes standard, however, all-wheel-drive is optionally available. A 77.0-kWh lithium-ion battery pack affords up to 265 miles of EPA-rated driving range. Those looking for a bit of extra style can opt for the Q4 e-tron Sportback is the fastback equivalent to the brand's squareback Q4 e-tron. Unlike its squarer stablemate, though, the Sportback comes exclusively with all-wheel drive. There's no cheaper and more efficient rear-driver option here. Though the dual-motor setup is more powerful than the single-motor of the entry-level Q4 e-tron squareback, it's also a good deal less efficient. As such, the Sportback's 95 MPGe combined rating is down 8 MPGe to the most efficient Q4 e-tron squareback. Base price: $50,995 EPA fuel economy, combined/city/highway: 103/112/94 MPGe EPA combined range: 265 miles LEARN MORE ABOUT THE Q4 E-TRON Advertisement - Continue Reading Below Audi Q8 e-tron 2024 audi q8 and sq8 etronaudi Last year's Audi e-tron SUV becomes the Q8 e-tron for 2024. A sizable 95.0-kWh lithium-ion battery pack and two electric motors (one at each axle) generate a peak of 402 horsepower and 490 pound-feet of torque. Unfortunately, the Audi's 226 miles of range isn't that impressive. That said, in our testing, the Q8 e-tron hit 60 mph in 5.2 seconds, so it's at least rather quick. An even more powerful 496-hp SQ8 e-tron is also available, however, it manages a mere 73 MPGe combined and offers less range than the standard Q8 e-tron. Audi also offers the Q8 (and SQ8) e-tron in fastback Sportback guise. Though going the Sportback route adds a few grand to the price tag, it also nets an EPA-rated range of up to 296 miles thanks to its additional efficiency. Base price: $75,595 EPA fuel economy, combined/city/highway: 81/80/83 MPGe EPA combined range: 285 miles LEARN MORE ABOUT THE Q8 E-TRON BMW i4 2022 bmw i4 electric sedan in silverBMW The BMW i4 is an electric four-door fastback available in four distinct flavors: the sensible eDrive35, the mid-level eDrive40, the dual-motor xDrive40, and the racy M50. The eDrive i4 variants pack a single rear-axle-mounted electric motor. An 80.7-kWh battery pack supplies enough electricity to take the mid-level eDrive40 more than 300 miles on a full charge, according to the EPA. Opting for the pricier all-wheel-drive i4 M50 allows this Bimmer to race to 60 mph in 3.3 seconds. Alas, the additional power of the M50 drops the i4's driving range down to an EPA-estimated 271 miles. Base price: $53,195 EPA fuel economy, combined/city/highway: 120/122/119 MPGe EPA combined range: 276 miles LEARN MORE ABOUT THE I4 Advertisement - Continue Reading Below BMW i5 2024 bmw i5BMW The i5 is the electric variant of BMW's popular 5-series sedan, and it offers a similar driving experience to its conventionally powered sibling. Two models of i5 are available: the range-optimized eDrive40 and the performance-minded M60 xDrive (a mid-level xDrive40 arrives for 2025). The cabin draws heavily from that of the larger i7, which is a good thing. If you like your electric sedans with a little extra oomph, get the M60 xDrive for its 510-horsepower dual-motor powertrain. Base price: $67,795 EPA fuel economy, combined/city/highway: 105/104/105 MPGe EPA combined range: 295 miles LEARN MORE ABOUT THE I5 BMW i7 2023 bmw i7 xdrive60BMW Flagship luxury and electric motoring converge for BMW with the introduction of the i7. Despite its size, the i7 is fairly efficient in eDrive50 guise, boasting an EPA combined rating of 90 MPGe and up to 321 miles per charge. To get to those maximums though, you’ll have to restrain yourself from ordering the optional 20- or 21-inch wheels, as either one of those reduces range and efficiency slightly. No matter which wheels you choose, you’ll find the i7 is both quick and quiet with an interior that is both plush and ultramodern. Base price: $106,695 EPA fuel economy, combined/city/highway: 90/87/95 MPGe EPA combined range: 321 miles LEARN MORE ABOUT THE I7 Advertisement - Continue Reading Below BMW iX 2022 bmw ix xdrive50 in redJessica Lynn Walker|Car and Driver The BMW iX's design may polarize, but its elegantly appointed interior is sure to impress. As is its all-wheel-drive battery-electric powertrain, which includes two electric motors (one at each axle) that produce a total of 516 horsepower in xDrive50 guise. Those in need of even more power can snag the 610 horsepower iX M60. No matter the trim, the iX packs serious dynamic performance. And yet, it's also surprisingly efficient. Its 83 MPGe combined figure helps this big SUV earn an EPA-rated range of 307 miles. Base price: $88,095 EPA fuel economy, combined/city/highway: 83/83/82 MPGe EPA combined range: 307 miles LEARN MORE ABOUT THE IX Cadillac Lyriq 2023 cadillac lyriqCadillac Cadillac’s first entry into the luxury electric SUV category is the slick-looking Lyriq. It shares its battery tech with other high-profile GM EVs, including the GMC Hummer EV pickup truck, but it wears a more upscale wardrobe. The rear-wheel-drive model offers the most range—up to 314 miles per charge. The all-wheel-drive model adds an additional electric motor to produce a combined 500 horsepower. Unlike Caddy’s sports sedans, the Lyriq’s driving demeanor takes on a more comfortable, cruising-focused feel and the quiet cabin is spacious for both people and cargo. Base price: $58,590 EPA fuel economy, combined/city/highway: 88/95/82 MPGe EPA combined range: 314 miles LEARN MORE ABOUT THE LYRIQ Chevrolet Blazer EV 2024 chevrolet blazer ev rsChevrolet Apart from being a midsize two-row Chevy SUV wearing aggressive styling, the Blazer EV shares little in common with its gas-powered relative. The Blazer EV comes in three trim levels: LT, RS, and SS. Many drivetrain combinations are available, ranging from a mild single-motor front-wheel-drive setup for the base LT to a wild 557-horsepower dual-motor all-wheel-drive fitment for the SS. Base price: $53,195 EPA fuel economy, combined/city/highway: 96/103/88 MPGe EPA combined range: 279 miles","<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> Which one of these should I buy? Money is no object, but fuel efficiency and range are critical to me. Give me enough detail to make a really informed decision. <TEXT> Here's Every New Electric Vehicle Model for Sale in the U.S. Electric vehicles make up a small percentage of the total automotive market today, but their appeal continues to grow as the automakers expand their range, performance, and style—and as recharging becomes quicker and easier. Shoppers looking for zero-emissions driving now have an expansive list of vehicles to choose from, with a wide variety of body styles and several different price points. Audi e-tron GT 2024 audi rs etron gtAudi Audi's take on the Porsche Taycan bears the name e-tron GT. Sharing its key mechanical bits with Porsche's electric sedan, the e-tron GT wears distinct bodywork and interior decor. Two flavors of Audi's low-slung EV are available: standard e-tron GT and rowdy RS e-tron GT. Both come exclusively with all-wheel drive, courtesy of an electric motor at each axle, and a 93.4-kWh battery pack. The two electric motors in the entry-level e-tron GT work together to produce a combined peak of 522 horsepower, while the RS e-tron GT ups the ante to 637 ponies. Regardless of trim, both variants of Audi's low-slung electric sedan net 249 miles of EPA-estimated range for 2024. Base price: $107,995 EPA fuel economy, combined/city/highway: 85/85/85 MPGe EPA combined range: 249 miles LEARN MORE ABOUT THE E-TRON GT Audi Q4 e-tron 2022 audi q4 50 etron quattro prestigeAudi Bearing the name Q4 e-tron, this Audi compact electric SUV shares components with the Volkswagen ID.4. Befitting its reputation, the four-ringed brand's battery-electric SUV is notably swankier than its more mainstream VW cousin. Rear-drive comes standard, however, all-wheel-drive is optionally available. A 77.0-kWh lithium-ion battery pack affords up to 265 miles of EPA-rated driving range. Those looking for a bit of extra style can opt for the Q4 e-tron Sportback is the fastback equivalent to the brand's squareback Q4 e-tron. Unlike its squarer stablemate, though, the Sportback comes exclusively with all-wheel drive. There's no cheaper and more efficient rear-driver option here. Though the dual-motor setup is more powerful than the single-motor of the entry-level Q4 e-tron squareback, it's also a good deal less efficient. As such, the Sportback's 95 MPGe combined rating is down 8 MPGe to the most efficient Q4 e-tron squareback. Base price: $50,995 EPA fuel economy, combined/city/highway: 103/112/94 MPGe EPA combined range: 265 miles LEARN MORE ABOUT THE Q4 E-TRON Advertisement - Continue Reading Below Audi Q8 e-tron 2024 audi q8 and sq8 etronaudi Last year's Audi e-tron SUV becomes the Q8 e-tron for 2024. A sizable 95.0-kWh lithium-ion battery pack and two electric motors (one at each axle) generate a peak of 402 horsepower and 490 pound-feet of torque. Unfortunately, the Audi's 226 miles of range isn't that impressive. That said, in our testing, the Q8 e-tron hit 60 mph in 5.2 seconds, so it's at least rather quick. An even more powerful 496-hp SQ8 e-tron is also available, however, it manages a mere 73 MPGe combined and offers less range than the standard Q8 e-tron. Audi also offers the Q8 (and SQ8) e-tron in fastback Sportback guise. Though going the Sportback route adds a few grand to the price tag, it also nets an EPA-rated range of up to 296 miles thanks to its additional efficiency. Base price: $75,595 EPA fuel economy, combined/city/highway: 81/80/83 MPGe EPA combined range: 285 miles LEARN MORE ABOUT THE Q8 E-TRON BMW i4 2022 bmw i4 electric sedan in silverBMW The BMW i4 is an electric four-door fastback available in four distinct flavors: the sensible eDrive35, the mid-level eDrive40, the dual-motor xDrive40, and the racy M50. The eDrive i4 variants pack a single rear-axle-mounted electric motor. An 80.7-kWh battery pack supplies enough electricity to take the mid-level eDrive40 more than 300 miles on a full charge, according to the EPA. Opting for the pricier all-wheel-drive i4 M50 allows this Bimmer to race to 60 mph in 3.3 seconds. Alas, the additional power of the M50 drops the i4's driving range down to an EPA-estimated 271 miles. Base price: $53,195 EPA fuel economy, combined/city/highway: 120/122/119 MPGe EPA combined range: 276 miles LEARN MORE ABOUT THE I4 Advertisement - Continue Reading Below BMW i5 2024 bmw i5BMW The i5 is the electric variant of BMW's popular 5-series sedan, and it offers a similar driving experience to its conventionally powered sibling. Two models of i5 are available: the range-optimized eDrive40 and the performance-minded M60 xDrive (a mid-level xDrive40 arrives for 2025). The cabin draws heavily from that of the larger i7, which is a good thing. If you like your electric sedans with a little extra oomph, get the M60 xDrive for its 510-horsepower dual-motor powertrain. Base price: $67,795 EPA fuel economy, combined/city/highway: 105/104/105 MPGe EPA combined range: 295 miles LEARN MORE ABOUT THE I5 BMW i7 2023 bmw i7 xdrive60BMW Flagship luxury and electric motoring converge for BMW with the introduction of the i7. Despite its size, the i7 is fairly efficient in eDrive50 guise, boasting an EPA combined rating of 90 MPGe and up to 321 miles per charge. To get to those maximums though, you’ll have to restrain yourself from ordering the optional 20- or 21-inch wheels, as either one of those reduces range and efficiency slightly. No matter which wheels you choose, you’ll find the i7 is both quick and quiet with an interior that is both plush and ultramodern. Base price: $106,695 EPA fuel economy, combined/city/highway: 90/87/95 MPGe EPA combined range: 321 miles LEARN MORE ABOUT THE I7 Advertisement - Continue Reading Below BMW iX 2022 bmw ix xdrive50 in redJessica Lynn Walker|Car and Driver The BMW iX's design may polarize, but its elegantly appointed interior is sure to impress. As is its all-wheel-drive battery-electric powertrain, which includes two electric motors (one at each axle) that produce a total of 516 horsepower in xDrive50 guise. Those in need of even more power can snag the 610 horsepower iX M60. No matter the trim, the iX packs serious dynamic performance. And yet, it's also surprisingly efficient. Its 83 MPGe combined figure helps this big SUV earn an EPA-rated range of 307 miles. Base price: $88,095 EPA fuel economy, combined/city/highway: 83/83/82 MPGe EPA combined range: 307 miles LEARN MORE ABOUT THE IX Cadillac Lyriq 2023 cadillac lyriqCadillac Cadillac’s first entry into the luxury electric SUV category is the slick-looking Lyriq. It shares its battery tech with other high-profile GM EVs, including the GMC Hummer EV pickup truck, but it wears a more upscale wardrobe. The rear-wheel-drive model offers the most range—up to 314 miles per charge. The all-wheel-drive model adds an additional electric motor to produce a combined 500 horsepower. Unlike Caddy’s sports sedans, the Lyriq’s driving demeanor takes on a more comfortable, cruising-focused feel and the quiet cabin is spacious for both people and cargo. Base price: $58,590 EPA fuel economy, combined/city/highway: 88/95/82 MPGe EPA combined range: 314 miles LEARN MORE ABOUT THE LYRIQ Chevrolet Blazer EV 2024 chevrolet blazer ev rsChevrolet Apart from being a midsize two-row Chevy SUV wearing aggressive styling, the Blazer EV shares little in common with its gas-powered relative. The Blazer EV comes in three trim levels: LT, RS, and SS. Many drivetrain combinations are available, ranging from a mild single-motor front-wheel-drive setup for the base LT to a wild 557-horsepower dual-motor all-wheel-drive fitment for the SS. Base price: $53,195 EPA fuel economy, combined/city/highway: 96/103/88 MPGe EPA combined range: 279 miles https://www.caranddriver.com/features/g32463239/new-ev-models-us/?utm_source=google&utm_medium=cpc&utm_campaign=dda_ga_cd_ext_prog_org_us_g32463239&utm_source=google&utm_medium=cpc&utm_campaign=dda_ga_cd_md_bm_prog_org_us_20600399402&gad_source=1&gclid=CjwKCAjw_4S3BhAAEiwA_64Yhm8SAofgx5e15GZ4218GmxzQi1fBbihK5U_xLAG0ndpWd_rScc9HYRoCPJ0QAvD_BwE","<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> [user request] <TEXT> [context document]
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+Here's Every New Electric Vehicle Model for Sale in the U.S. Electric vehicles make up a small percentage of the total automotive market today, but their appeal continues to grow as the automakers expand their range, performance, and style—and as recharging becomes quicker and easier. Shoppers looking for zero-emissions driving now have an expansive list of vehicles to choose from, with a wide variety of body styles and several different price points. Audi e-tron GT 2024 audi rs etron gtAudi Audi's take on the Porsche Taycan bears the name e-tron GT. Sharing its key mechanical bits with Porsche's electric sedan, the e-tron GT wears distinct bodywork and interior decor. Two flavors of Audi's low-slung EV are available: standard e-tron GT and rowdy RS e-tron GT. Both come exclusively with all-wheel drive, courtesy of an electric motor at each axle, and a 93.4-kWh battery pack. The two electric motors in the entry-level e-tron GT work together to produce a combined peak of 522 horsepower, while the RS e-tron GT ups the ante to 637 ponies. Regardless of trim, both variants of Audi's low-slung electric sedan net 249 miles of EPA-estimated range for 2024. Base price: $107,995 EPA fuel economy, combined/city/highway: 85/85/85 MPGe EPA combined range: 249 miles LEARN MORE ABOUT THE E-TRON GT Audi Q4 e-tron 2022 audi q4 50 etron quattro prestigeAudi Bearing the name Q4 e-tron, this Audi compact electric SUV shares components with the Volkswagen ID.4. Befitting its reputation, the four-ringed brand's battery-electric SUV is notably swankier than its more mainstream VW cousin. Rear-drive comes standard, however, all-wheel-drive is optionally available. A 77.0-kWh lithium-ion battery pack affords up to 265 miles of EPA-rated driving range. Those looking for a bit of extra style can opt for the Q4 e-tron Sportback is the fastback equivalent to the brand's squareback Q4 e-tron. Unlike its squarer stablemate, though, the Sportback comes exclusively with all-wheel drive. There's no cheaper and more efficient rear-driver option here. Though the dual-motor setup is more powerful than the single-motor of the entry-level Q4 e-tron squareback, it's also a good deal less efficient. As such, the Sportback's 95 MPGe combined rating is down 8 MPGe to the most efficient Q4 e-tron squareback. Base price: $50,995 EPA fuel economy, combined/city/highway: 103/112/94 MPGe EPA combined range: 265 miles LEARN MORE ABOUT THE Q4 E-TRON Advertisement - Continue Reading Below Audi Q8 e-tron 2024 audi q8 and sq8 etronaudi Last year's Audi e-tron SUV becomes the Q8 e-tron for 2024. A sizable 95.0-kWh lithium-ion battery pack and two electric motors (one at each axle) generate a peak of 402 horsepower and 490 pound-feet of torque. Unfortunately, the Audi's 226 miles of range isn't that impressive. That said, in our testing, the Q8 e-tron hit 60 mph in 5.2 seconds, so it's at least rather quick. An even more powerful 496-hp SQ8 e-tron is also available, however, it manages a mere 73 MPGe combined and offers less range than the standard Q8 e-tron. Audi also offers the Q8 (and SQ8) e-tron in fastback Sportback guise. Though going the Sportback route adds a few grand to the price tag, it also nets an EPA-rated range of up to 296 miles thanks to its additional efficiency. Base price: $75,595 EPA fuel economy, combined/city/highway: 81/80/83 MPGe EPA combined range: 285 miles LEARN MORE ABOUT THE Q8 E-TRON BMW i4 2022 bmw i4 electric sedan in silverBMW The BMW i4 is an electric four-door fastback available in four distinct flavors: the sensible eDrive35, the mid-level eDrive40, the dual-motor xDrive40, and the racy M50. The eDrive i4 variants pack a single rear-axle-mounted electric motor. An 80.7-kWh battery pack supplies enough electricity to take the mid-level eDrive40 more than 300 miles on a full charge, according to the EPA. Opting for the pricier all-wheel-drive i4 M50 allows this Bimmer to race to 60 mph in 3.3 seconds. Alas, the additional power of the M50 drops the i4's driving range down to an EPA-estimated 271 miles. Base price: $53,195 EPA fuel economy, combined/city/highway: 120/122/119 MPGe EPA combined range: 276 miles LEARN MORE ABOUT THE I4 Advertisement - Continue Reading Below BMW i5 2024 bmw i5BMW The i5 is the electric variant of BMW's popular 5-series sedan, and it offers a similar driving experience to its conventionally powered sibling. Two models of i5 are available: the range-optimized eDrive40 and the performance-minded M60 xDrive (a mid-level xDrive40 arrives for 2025). The cabin draws heavily from that of the larger i7, which is a good thing. If you like your electric sedans with a little extra oomph, get the M60 xDrive for its 510-horsepower dual-motor powertrain. Base price: $67,795 EPA fuel economy, combined/city/highway: 105/104/105 MPGe EPA combined range: 295 miles LEARN MORE ABOUT THE I5 BMW i7 2023 bmw i7 xdrive60BMW Flagship luxury and electric motoring converge for BMW with the introduction of the i7. Despite its size, the i7 is fairly efficient in eDrive50 guise, boasting an EPA combined rating of 90 MPGe and up to 321 miles per charge. To get to those maximums though, you’ll have to restrain yourself from ordering the optional 20- or 21-inch wheels, as either one of those reduces range and efficiency slightly. No matter which wheels you choose, you’ll find the i7 is both quick and quiet with an interior that is both plush and ultramodern. Base price: $106,695 EPA fuel economy, combined/city/highway: 90/87/95 MPGe EPA combined range: 321 miles LEARN MORE ABOUT THE I7 Advertisement - Continue Reading Below BMW iX 2022 bmw ix xdrive50 in redJessica Lynn Walker|Car and Driver The BMW iX's design may polarize, but its elegantly appointed interior is sure to impress. As is its all-wheel-drive battery-electric powertrain, which includes two electric motors (one at each axle) that produce a total of 516 horsepower in xDrive50 guise. Those in need of even more power can snag the 610 horsepower iX M60. No matter the trim, the iX packs serious dynamic performance. And yet, it's also surprisingly efficient. Its 83 MPGe combined figure helps this big SUV earn an EPA-rated range of 307 miles. Base price: $88,095 EPA fuel economy, combined/city/highway: 83/83/82 MPGe EPA combined range: 307 miles LEARN MORE ABOUT THE IX Cadillac Lyriq 2023 cadillac lyriqCadillac Cadillac’s first entry into the luxury electric SUV category is the slick-looking Lyriq. It shares its battery tech with other high-profile GM EVs, including the GMC Hummer EV pickup truck, but it wears a more upscale wardrobe. The rear-wheel-drive model offers the most range—up to 314 miles per charge. The all-wheel-drive model adds an additional electric motor to produce a combined 500 horsepower. Unlike Caddy’s sports sedans, the Lyriq’s driving demeanor takes on a more comfortable, cruising-focused feel and the quiet cabin is spacious for both people and cargo. Base price: $58,590 EPA fuel economy, combined/city/highway: 88/95/82 MPGe EPA combined range: 314 miles LEARN MORE ABOUT THE LYRIQ Chevrolet Blazer EV 2024 chevrolet blazer ev rsChevrolet Apart from being a midsize two-row Chevy SUV wearing aggressive styling, the Blazer EV shares little in common with its gas-powered relative. The Blazer EV comes in three trim levels: LT, RS, and SS. Many drivetrain combinations are available, ranging from a mild single-motor front-wheel-drive setup for the base LT to a wild 557-horsepower dual-motor all-wheel-drive fitment for the SS. Base price: $53,195 EPA fuel economy, combined/city/highway: 96/103/88 MPGe EPA combined range: 279 miles
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+Which one of these should I buy? Money is no object, but fuel efficiency and range are critical to me. Give me enough detail to make a really informed decision.
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+"{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]","Could you provide three of the fastest growing chain restaurants in the United States, and tell me what has allowed them to be successful? They should have recent sales growth of at least 20%.","When people think of restaurant chains, they think of the most popular ones; McDonald's, KFC, Pizza Hut, and so on. However, the fastest-growing restaurant chains in the U.S. are names that might not be common to most eaters. On top of that, the rise of the health-conscious consumer has made an impact on what is most popular these days. The time of people not caring about what they eat is over. The following list of restaurants is ranked by sales growth. You might be surprised by what company proudly owns that coveted top spot. You might also find some investing opportunities along the way. All numbers below as of May 21, 2019. 1. Mod Pizza Sales Growth: 44.7% Total Unit Growth: 33% Estimated Sales Per Unit (ESPU) Growth: 1.2% You can guess the specialty served at this restaurant, which is the fastest-growing chain in the U.S. for the second consecutive year. Mod Pizza falls into the fast-casual food category, with the owners focused on a socially conscious platform. Mod pays above the minimum wage, donates significantly to charity, and hires people from all walks of life, including those who have spent time in rehab or prison. Mod Pizza grew 44.7% in the previous year with sales of $390.7 million. Mod Pizza opened in 2008, has over 400 locations, and is targeting total locations of 1,000 by 2024. 2. First Watch Sales Growth: 33% Total Unit Growth: 23% Estimated Sales Per Unit (ESPU) Growth: 8.8% First Watch focuses on breakfast food and caters to families. It's the fastest growing food chain in the family dining sector. The restaurant serves food that is health conscious, in tune with what customers are looking for in their dietary intake. In 2018, it was also voted one of the best places to work by the Business Intelligence Group. The company saw sales growth of 33% from the previous year and currently has over 350 locations and is targeting a total number of locations to be around 600. 3. Shake Shack Sales Growth: 27.3% Total Unit Growth: 36% Estimated Sales Per Unit (ESPU) Growth: -7.8% Shake Shack needs no introduction. It is one of the most popular burger chains in the world, with locations in many countries, and it all started from a stand in New York City. The company is a pioneer in how it attracts employees, such as testing a four-day workweek. Shake Shack saw sales growth of 27.3% from the previous year. The company is a powerhouse with over 250 locations worldwide, including 10 Shake Shacks in airports around the world. 4. Lazy Dog Sales Growth: 27.1% Total Unit Growth: 20% Estimated Sales Per Unit (ESPU) Growth: 6.3% Lazy Dog is about the atmosphere. They've created a restaurant that takes people to the Rockies with their cabin-like decor. The food focuses on popular American staples, such as burgers and ribs, and they've also tapped into the popular craft beer trend, offering plenty of craft beers to wash down all that food with. The company saw sales growth of 27.1% and operates a little over 30 restaurants in a handful of states with plans to open further across the country. 5. The Habit Burger Grill Sales Growth: 22.9% Total Unit Growth: 18% Estimated Sales Per Unit (ESPU) Growth: 2.9% The Habit Burger Grill is a fast-casual restaurant whose specialty is charbroiled burgers. They saw sales growth of 22.9% and have approximately 250 locations. In March 2020, Habit Burger Grill was bought by Yum! Brands, the same company that owns Taco Bell and KFC. 6. Raising Cane's Chicken Fingers Sales Growth: 22.5% Total Unit Growth: 13.6% Estimated Sales Per Unit (ESPU) Growth: 6.5% First opened in 1996 in Baton Rouge, La., Raising Cane's Chicken Fingers offers— you guessed it—chicken fingers (never frozen) and its own dipping sauce that employees have to swear to never reveal its components. It's the fastest growing chain focused on chicken, with sales growth of 22.5% with almost 500 locations. 7. True Food Kitchen Sales Growth: 22.2% Total Unit Growth: 19% Estimated Sales Per Unit (ESPU) Growth: -1.7% True Food Kitchen is a health-focused brand that has grown rapidly and continues to do so. Its introduced delivery, added a loyalty program, and received an infusion of capital from Oprah Winfrey. The company saw sales grow by 22.2% and has 33 locations nationwide. 8. Tropical Smoothie Cafe Sales Growth: 20.3% Total Unit Growth: 14.5% Estimated Sales Per Unit (ESPU) Growth: 4.3% As the name would note, this restaurant chain specializes in smoothies. However, as part of its growth strategy, the company has focused on food offerings that have helped spur growth. 60% of sales come from smoothies and the rest from food. The company saw sales growth of 20.3% and has 836 locations. 9. Jersey Mike's Subs Sales Growth: 17.8% Total Unit Growth: 11.2% Estimated Sales Per Unit (ESPU) Growth: 5.1% Jersey Mike’s Subs focuses on sandwiches, has grown rapidly, and has now started to work with Uber Eats and to offer drive-thru options. The company saw sales growth of 17.8% and has an astonishing 1,600 locations nationwide. 10. Blaze Fast-Fire'd Pizza Sales Growth: 17.1% Total Unit Growth: 24.9% Estimated Sales Per Unit (ESPU) Growth: -10% Blaze Fast-Fire'd Pizza focuses on pizzas and is known for its 11-inch pizza pie and has been testing a 14-inch pizza pie as well. The company is a leader in the fast-casual sector, with sales growth of 17.1% and 300 locations. The Bottom Line You might find some investment opportunities on this list, but it is also important to recognize what types of restaurant chains are growing the quickest and where food trends are moving, before making any decisions.","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== Could you provide three of the fastest growing chain restaurants in the United States, and tell me what has allowed them to be successful? They should have recent sales growth of at least 20%. {passage 0} ========== When people think of restaurant chains, they think of the most popular ones; McDonald's, KFC, Pizza Hut, and so on. However, the fastest-growing restaurant chains in the U.S. are names that might not be common to most eaters. On top of that, the rise of the health-conscious consumer has made an impact on what is most popular these days. The time of people not caring about what they eat is over. The following list of restaurants is ranked by sales growth. You might be surprised by what company proudly owns that coveted top spot. You might also find some investing opportunities along the way. All numbers below as of May 21, 2019. 1. Mod Pizza Sales Growth: 44.7% Total Unit Growth: 33% Estimated Sales Per Unit (ESPU) Growth: 1.2% You can guess the specialty served at this restaurant, which is the fastest-growing chain in the U.S. for the second consecutive year. Mod Pizza falls into the fast-casual food category, with the owners focused on a socially conscious platform. Mod pays above the minimum wage, donates significantly to charity, and hires people from all walks of life, including those who have spent time in rehab or prison. Mod Pizza grew 44.7% in the previous year with sales of $390.7 million. Mod Pizza opened in 2008, has over 400 locations, and is targeting total locations of 1,000 by 2024. 2. First Watch Sales Growth: 33% Total Unit Growth: 23% Estimated Sales Per Unit (ESPU) Growth: 8.8% First Watch focuses on breakfast food and caters to families. It's the fastest growing food chain in the family dining sector. The restaurant serves food that is health conscious, in tune with what customers are looking for in their dietary intake. In 2018, it was also voted one of the best places to work by the Business Intelligence Group. The company saw sales growth of 33% from the previous year and currently has over 350 locations and is targeting a total number of locations to be around 600. 3. Shake Shack Sales Growth: 27.3% Total Unit Growth: 36% Estimated Sales Per Unit (ESPU) Growth: -7.8% Shake Shack needs no introduction. It is one of the most popular burger chains in the world, with locations in many countries, and it all started from a stand in New York City. The company is a pioneer in how it attracts employees, such as testing a four-day workweek. Shake Shack saw sales growth of 27.3% from the previous year. The company is a powerhouse with over 250 locations worldwide, including 10 Shake Shacks in airports around the world. 4. Lazy Dog Sales Growth: 27.1% Total Unit Growth: 20% Estimated Sales Per Unit (ESPU) Growth: 6.3% Lazy Dog is about the atmosphere. They've created a restaurant that takes people to the Rockies with their cabin-like decor. The food focuses on popular American staples, such as burgers and ribs, and they've also tapped into the popular craft beer trend, offering plenty of craft beers to wash down all that food with. The company saw sales growth of 27.1% and operates a little over 30 restaurants in a handful of states with plans to open further across the country. 5. The Habit Burger Grill Sales Growth: 22.9% Total Unit Growth: 18% Estimated Sales Per Unit (ESPU) Growth: 2.9% The Habit Burger Grill is a fast-casual restaurant whose specialty is charbroiled burgers. They saw sales growth of 22.9% and have approximately 250 locations. In March 2020, Habit Burger Grill was bought by Yum! Brands, the same company that owns Taco Bell and KFC. 6. Raising Cane's Chicken Fingers Sales Growth: 22.5% Total Unit Growth: 13.6% Estimated Sales Per Unit (ESPU) Growth: 6.5% First opened in 1996 in Baton Rouge, La., Raising Cane's Chicken Fingers offers— you guessed it—chicken fingers (never frozen) and its own dipping sauce that employees have to swear to never reveal its components. It's the fastest growing chain focused on chicken, with sales growth of 22.5% with almost 500 locations. 7. True Food Kitchen Sales Growth: 22.2% Total Unit Growth: 19% Estimated Sales Per Unit (ESPU) Growth: -1.7% True Food Kitchen is a health-focused brand that has grown rapidly and continues to do so. Its introduced delivery, added a loyalty program, and received an infusion of capital from Oprah Winfrey. The company saw sales grow by 22.2% and has 33 locations nationwide. 8. Tropical Smoothie Cafe Sales Growth: 20.3% Total Unit Growth: 14.5% Estimated Sales Per Unit (ESPU) Growth: 4.3% As the name would note, this restaurant chain specializes in smoothies. However, as part of its growth strategy, the company has focused on food offerings that have helped spur growth. 60% of sales come from smoothies and the rest from food. The company saw sales growth of 20.3% and has 836 locations. 9. Jersey Mike's Subs Sales Growth: 17.8% Total Unit Growth: 11.2% Estimated Sales Per Unit (ESPU) Growth: 5.1% Jersey Mike’s Subs focuses on sandwiches, has grown rapidly, and has now started to work with Uber Eats and to offer drive-thru options. The company saw sales growth of 17.8% and has an astonishing 1,600 locations nationwide. 10. Blaze Fast-Fire'd Pizza Sales Growth: 17.1% Total Unit Growth: 24.9% Estimated Sales Per Unit (ESPU) Growth: -10% Blaze Fast-Fire'd Pizza focuses on pizzas and is known for its 11-inch pizza pie and has been testing a 14-inch pizza pie as well. The company is a leader in the fast-casual sector, with sales growth of 17.1% and 300 locations. The Bottom Line You might find some investment opportunities on this list, but it is also important to recognize what types of restaurant chains are growing the quickest and where food trends are moving, before making any decisions. https://www.investopedia.com/articles/markets/062615/americas-10-fastestgrowing-restaurant-chains.asp","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]
+
+EVIDENCE:
+When people think of restaurant chains, they think of the most popular ones; McDonald's, KFC, Pizza Hut, and so on. However, the fastest-growing restaurant chains in the U.S. are names that might not be common to most eaters. On top of that, the rise of the health-conscious consumer has made an impact on what is most popular these days. The time of people not caring about what they eat is over. The following list of restaurants is ranked by sales growth. You might be surprised by what company proudly owns that coveted top spot. You might also find some investing opportunities along the way. All numbers below as of May 21, 2019. 1. Mod Pizza Sales Growth: 44.7% Total Unit Growth: 33% Estimated Sales Per Unit (ESPU) Growth: 1.2% You can guess the specialty served at this restaurant, which is the fastest-growing chain in the U.S. for the second consecutive year. Mod Pizza falls into the fast-casual food category, with the owners focused on a socially conscious platform. Mod pays above the minimum wage, donates significantly to charity, and hires people from all walks of life, including those who have spent time in rehab or prison. Mod Pizza grew 44.7% in the previous year with sales of $390.7 million. Mod Pizza opened in 2008, has over 400 locations, and is targeting total locations of 1,000 by 2024. 2. First Watch Sales Growth: 33% Total Unit Growth: 23% Estimated Sales Per Unit (ESPU) Growth: 8.8% First Watch focuses on breakfast food and caters to families. It's the fastest growing food chain in the family dining sector. The restaurant serves food that is health conscious, in tune with what customers are looking for in their dietary intake. In 2018, it was also voted one of the best places to work by the Business Intelligence Group. The company saw sales growth of 33% from the previous year and currently has over 350 locations and is targeting a total number of locations to be around 600. 3. Shake Shack Sales Growth: 27.3% Total Unit Growth: 36% Estimated Sales Per Unit (ESPU) Growth: -7.8% Shake Shack needs no introduction. It is one of the most popular burger chains in the world, with locations in many countries, and it all started from a stand in New York City. The company is a pioneer in how it attracts employees, such as testing a four-day workweek. Shake Shack saw sales growth of 27.3% from the previous year. The company is a powerhouse with over 250 locations worldwide, including 10 Shake Shacks in airports around the world. 4. Lazy Dog Sales Growth: 27.1% Total Unit Growth: 20% Estimated Sales Per Unit (ESPU) Growth: 6.3% Lazy Dog is about the atmosphere. They've created a restaurant that takes people to the Rockies with their cabin-like decor. The food focuses on popular American staples, such as burgers and ribs, and they've also tapped into the popular craft beer trend, offering plenty of craft beers to wash down all that food with. The company saw sales growth of 27.1% and operates a little over 30 restaurants in a handful of states with plans to open further across the country. 5. The Habit Burger Grill Sales Growth: 22.9% Total Unit Growth: 18% Estimated Sales Per Unit (ESPU) Growth: 2.9% The Habit Burger Grill is a fast-casual restaurant whose specialty is charbroiled burgers. They saw sales growth of 22.9% and have approximately 250 locations. In March 2020, Habit Burger Grill was bought by Yum! Brands, the same company that owns Taco Bell and KFC. 6. Raising Cane's Chicken Fingers Sales Growth: 22.5% Total Unit Growth: 13.6% Estimated Sales Per Unit (ESPU) Growth: 6.5% First opened in 1996 in Baton Rouge, La., Raising Cane's Chicken Fingers offers— you guessed it—chicken fingers (never frozen) and its own dipping sauce that employees have to swear to never reveal its components. It's the fastest growing chain focused on chicken, with sales growth of 22.5% with almost 500 locations. 7. True Food Kitchen Sales Growth: 22.2% Total Unit Growth: 19% Estimated Sales Per Unit (ESPU) Growth: -1.7% True Food Kitchen is a health-focused brand that has grown rapidly and continues to do so. Its introduced delivery, added a loyalty program, and received an infusion of capital from Oprah Winfrey. The company saw sales grow by 22.2% and has 33 locations nationwide. 8. Tropical Smoothie Cafe Sales Growth: 20.3% Total Unit Growth: 14.5% Estimated Sales Per Unit (ESPU) Growth: 4.3% As the name would note, this restaurant chain specializes in smoothies. However, as part of its growth strategy, the company has focused on food offerings that have helped spur growth. 60% of sales come from smoothies and the rest from food. The company saw sales growth of 20.3% and has 836 locations. 9. Jersey Mike's Subs Sales Growth: 17.8% Total Unit Growth: 11.2% Estimated Sales Per Unit (ESPU) Growth: 5.1% Jersey Mike’s Subs focuses on sandwiches, has grown rapidly, and has now started to work with Uber Eats and to offer drive-thru options. The company saw sales growth of 17.8% and has an astonishing 1,600 locations nationwide. 10. Blaze Fast-Fire'd Pizza Sales Growth: 17.1% Total Unit Growth: 24.9% Estimated Sales Per Unit (ESPU) Growth: -10% Blaze Fast-Fire'd Pizza focuses on pizzas and is known for its 11-inch pizza pie and has been testing a 14-inch pizza pie as well. The company is a leader in the fast-casual sector, with sales growth of 17.1% and 300 locations. The Bottom Line You might find some investment opportunities on this list, but it is also important to recognize what types of restaurant chains are growing the quickest and where food trends are moving, before making any decisions.
+
+USER:
+Could you provide three of the fastest growing chain restaurants in the United States, and tell me what has allowed them to be successful? They should have recent sales growth of at least 20%.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,26,34,943,,656
+"{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]","Explain the clinical symptoms of rhabdovirus in under 600 words and so a 5th grader can understand. At the end of the explanation, provide a description of the virus in bold print.","Clinical Manifestations Rabies virus causes acute infection of the central nervous system. Five general stages are recognized in humans: incubation, prodrome, acute neurologic period, coma, and death. The incubation period is exceptionally variable, ranging from fewer than 10 days to longer than 2 years, but is usually 1–3 months. Structure Rabies virus is a rod- or bullet-shaped, single-stranded, negative-sense, unsegmented, enveloped RNA virus. The virus genome encodes five proteins. Classification and Antigenic Types Placement within the family is based on the distinctive morphology of the virus particle. Cross- reactive nucleoprotein antigens or comparative genomic sequences determine inclusion in the genus Lyssavirus, which includes rabies virus and at least five other pathogenic rabies-like viruses. Multiplication The viral RNA uncoats in the cytoplasm of infected cells. The genome is transcribed by a virion-associated RNA-dependent RNA polymerase. Viral RNA is then translated into individual viral proteins. Replication occurs with synthesis of positive-stranded RNA templates for the production of progeny negative-stranded RNA. Pathogenesis After inoculation, rabies virus may enter the peripheral nervous system directly and migrates to the brain or may replicate in muscle tissue, remaining sequestered at or near the entry site during incubation, prior to central nervous system invasion and replication. It then spreads centrifugally to numerous other organs. The case:fatality ratio approaches unity, but exact pathogenic mechanisms are not fully understood. Host Defenses Susceptibility to lethal infection is related to the animal species, viral variant, inoculum concentration, location and severity of exposure, and host immune status. Both virus-neutralizing antibodies and cell-mediated immunity are important in host defense. Epidemiology Rabies occurs in nearly all countries. Disease in humans is almost always due to a bite by an infected mammal. Nonbite exposures (e.g., mucosal contact) rarely cause rabies in humans. Diagnosis Early diagnosis is difficult. Rabies should be suspected in human cases of unexplained viral encephalitis with a history of animal bite. Unvaccinated persons are often negative for virus-neutralizing antibodies until late in the course of disease. Virus isolation from saliva, positive immunofluorescent skin biopsies or virus neutralizing antibody (from cerebrospinal fluid, or serum of a non-vaccinated patient), establish a diagnosis. Control Vaccination of susceptible animal species, particularly dogs and cats, will control this zoonotic disease. Introduction The family Rhabdoviridae consists of more than 100 single-stranded, negative-sense, nonsegmented viruses that infect a wide variety of hosts, including vertebrates, invertebrates, and plants. Common to all members of the family is a distinctive rod- or bullet-shaped morphology. Human pathogens of medical importance are found in the genera Lyssavirus and Vesiculovirus.Only rabies virus, medically the most significant member of the genus Lyssavirus, is reviewed in this chapter. Clinical Manifestations Five general stages of rabies are recognized in humans: incubation, prodrome, acute neurologic period, coma, and death (or, very rarely, recovery) (Fig. 61-1). No specific antirabies agents are useful once clinical signs or symptoms develop. The incubation period in rabies, usually 30 to 90 days but ranging from as few as 5 days to longer than 2 years after initial exposure, is more variable than in any other acute infection. Incubation periods may be somewhat shorter in children and in individuals bitten close to the central nervous system (e.g., the head). Clinical symptoms are first noted during the prodromal period, which usually lasts from 2 to 10 days. These symptoms are often nonspecific (general malaise, fever, and fatigue) or suggest involvement of the respiratory system (sore throat, cough, and dyspnea), gastrointestinal system (anorexia, dysphagia, nausea, vomiting, abdominal pain, and diarrhea), or central nervous systems (headache, vertigo, anxiety, apprehension, irritability, and nervousness). More remarkable abnormalities (agitation, photophobia, priapism, increased libido, insomnia, nightmares, and depression) may also occur, suggesting encephalitis, psychiatric disturbances, or brain conditions. Pain or paresthesia at the site of virus inoculation, combined with a history of recent animal bite, should suggest a consideration of rabies. The acute neurologic period begins with objective signs of central nervous system dysfunction. The disease may be classified as furious rabies if hyperactivity (i.e., hydrophobia) predominates and as dumb rabies if paralysis dominates the clinical picture. Fever, paresthesia, nuchal rigidity, muscle fasciculations, focal and generalized convulsions, hyperventilation, and hypersalivation may occur in both forms of the disease. At the end of the acute neurologic phase, periods of rapid, irregular breathing may begin; paralysis and coma soon follow. Respiratory arrest may occur thereafter, unless the patient is receiving ventilatory assistance, which may prolong survival for days, weeks, or longer, with death due to other complications. Although life support measures can prolong the clinical course of rabies, rarely will they affect the outcome of disease. The possibility of recovery, however, must be recognized, and when resources permit, every effort should be made to support the patient. At least seven cases of human “recovery” have been documented. Structure The rabies virus is a negative-sense, non-segmented, single-stranded RNA virus measuring approximately 60 nm × 180 nm. It is composed of an internal protein core or nucleocapsid, containing the nucleic acid, and an outer envelope, a lipid-containing bilayer covered with transmembrane glycoprotein spikes. The virus genome encodes five proteins associated with either the ribonucleoprotein (RNP) complex or the viral envelope (Fig. 61-3). The L (transcriptase), N (nucleoprotein), and NS (transcriptase-associated) proteins comprise the RNP complex, together with the viral RNA. These aggregate in the cytoplasm of virus-infected neurons and compose Negri bodies, the characteristic histopathologic finding of rabies virus infection. The M (matrix) and G (glycoprotein) proteins are associated with the lipid envelope. The G protein forms the protrusions that cover the outer surface of the virion envelope and is the only rabies virus protein known to induce virus-neutralizing antibody. Classification and Antigenic Types The genus Lyssavirus includes rabies virus and the antigenically- and genetically-related rabies- like viruses: Lagos bat, Mokola, and Duvenhage viruses, and two suggested subtypes of European bat lyssaviruses. Cross-protection studies suggest that animals immunized with traditional rabies vaccines may not be fully protected if challenged with other lyssaviruses. Rabies viruses may be categorized as either fixed (adapted by passage in animals or cell culture) or street (wild type). The use of monoclonal antibodies and genetic sequencing to differentiate street rabies viruses has been helpful in identifying viral variants originating in major host reservoirs throughout the world and suggesting the likely sources of human exposure when a history of definitive animal bite was otherwise missing from a patient's case history. Multiplication The replication of rabies virus is believed to be similar to that of other negative-stranded RNA viruses. The virus attaches to the host cell membranes via the G protein, penetrates the cytoplasm by fusion or pinocytosis, and is uncoated to RNP. The core initiates primary transcription of the five complementary monocistronic messenger RNAs by using the virion-associated RNA-dependent RNA polymerase. Each RNA is then translated into an individual viral protein. After viral proteins have been synthesized, replication of the genomic RNA continues with the synthesis of full length, positive-stranded RNA, which acts as a template for the production of progeny negative-stranded RNA.","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== Explain the clinical symptoms of rhabdovirus in under 600 words and so a 5th grader can understand. At the end of the explanation, provide a description of the virus in bold print. {passage 0} ========== Clinical Manifestations Rabies virus causes acute infection of the central nervous system. Five general stages are recognized in humans: incubation, prodrome, acute neurologic period, coma, and death. The incubation period is exceptionally variable, ranging from fewer than 10 days to longer than 2 years, but is usually 1–3 months. Structure Rabies virus is a rod- or bullet-shaped, single-stranded, negative-sense, unsegmented, enveloped RNA virus. The virus genome encodes five proteins. Classification and Antigenic Types Placement within the family is based on the distinctive morphology of the virus particle. Cross- reactive nucleoprotein antigens or comparative genomic sequences determine inclusion in the genus Lyssavirus, which includes rabies virus and at least five other pathogenic rabies-like viruses. Multiplication The viral RNA uncoats in the cytoplasm of infected cells. The genome is transcribed by a virion-associated RNA-dependent RNA polymerase. Viral RNA is then translated into individual viral proteins. Replication occurs with synthesis of positive-stranded RNA templates for the production of progeny negative-stranded RNA. Pathogenesis After inoculation, rabies virus may enter the peripheral nervous system directly and migrates to the brain or may replicate in muscle tissue, remaining sequestered at or near the entry site during incubation, prior to central nervous system invasion and replication. It then spreads centrifugally to numerous other organs. The case:fatality ratio approaches unity, but exact pathogenic mechanisms are not fully understood. Host Defenses Susceptibility to lethal infection is related to the animal species, viral variant, inoculum concentration, location and severity of exposure, and host immune status. Both virus-neutralizing antibodies and cell-mediated immunity are important in host defense. Epidemiology Rabies occurs in nearly all countries. Disease in humans is almost always due to a bite by an infected mammal. Nonbite exposures (e.g., mucosal contact) rarely cause rabies in humans. Diagnosis Early diagnosis is difficult. Rabies should be suspected in human cases of unexplained viral encephalitis with a history of animal bite. Unvaccinated persons are often negative for virus-neutralizing antibodies until late in the course of disease. Virus isolation from saliva, positive immunofluorescent skin biopsies or virus neutralizing antibody (from cerebrospinal fluid, or serum of a non-vaccinated patient), establish a diagnosis. Control Vaccination of susceptible animal species, particularly dogs and cats, will control this zoonotic disease. Introduction The family Rhabdoviridae consists of more than 100 single-stranded, negative-sense, nonsegmented viruses that infect a wide variety of hosts, including vertebrates, invertebrates, and plants. Common to all members of the family is a distinctive rod- or bullet-shaped morphology. Human pathogens of medical importance are found in the genera Lyssavirus and Vesiculovirus.Only rabies virus, medically the most significant member of the genus Lyssavirus, is reviewed in this chapter. Clinical Manifestations Five general stages of rabies are recognized in humans: incubation, prodrome, acute neurologic period, coma, and death (or, very rarely, recovery) (Fig. 61-1). No specific antirabies agents are useful once clinical signs or symptoms develop. The incubation period in rabies, usually 30 to 90 days but ranging from as few as 5 days to longer than 2 years after initial exposure, is more variable than in any other acute infection. Incubation periods may be somewhat shorter in children and in individuals bitten close to the central nervous system (e.g., the head). Clinical symptoms are first noted during the prodromal period, which usually lasts from 2 to 10 days. These symptoms are often nonspecific (general malaise, fever, and fatigue) or suggest involvement of the respiratory system (sore throat, cough, and dyspnea), gastrointestinal system (anorexia, dysphagia, nausea, vomiting, abdominal pain, and diarrhea), or central nervous systems (headache, vertigo, anxiety, apprehension, irritability, and nervousness). More remarkable abnormalities (agitation, photophobia, priapism, increased libido, insomnia, nightmares, and depression) may also occur, suggesting encephalitis, psychiatric disturbances, or brain conditions. Pain or paresthesia at the site of virus inoculation, combined with a history of recent animal bite, should suggest a consideration of rabies. The acute neurologic period begins with objective signs of central nervous system dysfunction. The disease may be classified as furious rabies if hyperactivity (i.e., hydrophobia) predominates and as dumb rabies if paralysis dominates the clinical picture. Fever, paresthesia, nuchal rigidity, muscle fasciculations, focal and generalized convulsions, hyperventilation, and hypersalivation may occur in both forms of the disease. At the end of the acute neurologic phase, periods of rapid, irregular breathing may begin; paralysis and coma soon follow. Respiratory arrest may occur thereafter, unless the patient is receiving ventilatory assistance, which may prolong survival for days, weeks, or longer, with death due to other complications. Although life support measures can prolong the clinical course of rabies, rarely will they affect the outcome of disease. The possibility of recovery, however, must be recognized, and when resources permit, every effort should be made to support the patient. At least seven cases of human “recovery” have been documented. Structure The rabies virus is a negative-sense, non-segmented, single-stranded RNA virus measuring approximately 60 nm × 180 nm. It is composed of an internal protein core or nucleocapsid, containing the nucleic acid, and an outer envelope, a lipid-containing bilayer covered with transmembrane glycoprotein spikes. The virus genome encodes five proteins associated with either the ribonucleoprotein (RNP) complex or the viral envelope (Fig. 61-3). The L (transcriptase), N (nucleoprotein), and NS (transcriptase-associated) proteins comprise the RNP complex, together with the viral RNA. These aggregate in the cytoplasm of virus-infected neurons and compose Negri bodies, the characteristic histopathologic finding of rabies virus infection. The M (matrix) and G (glycoprotein) proteins are associated with the lipid envelope. The G protein forms the protrusions that cover the outer surface of the virion envelope and is the only rabies virus protein known to induce virus-neutralizing antibody. Classification and Antigenic Types The genus Lyssavirus includes rabies virus and the antigenically- and genetically-related rabies- like viruses: Lagos bat, Mokola, and Duvenhage viruses, and two suggested subtypes of European bat lyssaviruses. Cross-protection studies suggest that animals immunized with traditional rabies vaccines may not be fully protected if challenged with other lyssaviruses. Rabies viruses may be categorized as either fixed (adapted by passage in animals or cell culture) or street (wild type). The use of monoclonal antibodies and genetic sequencing to differentiate street rabies viruses has been helpful in identifying viral variants originating in major host reservoirs throughout the world and suggesting the likely sources of human exposure when a history of definitive animal bite was otherwise missing from a patient's case history. Multiplication The replication of rabies virus is believed to be similar to that of other negative-stranded RNA viruses. The virus attaches to the host cell membranes via the G protein, penetrates the cytoplasm by fusion or pinocytosis, and is uncoated to RNP. The core initiates primary transcription of the five complementary monocistronic messenger RNAs by using the virion-associated RNA-dependent RNA polymerase. Each RNA is then translated into an individual viral protein. After viral proteins have been synthesized, replication of the genomic RNA continues with the synthesis of full length, positive-stranded RNA, which acts as a template for the production of progeny negative-stranded RNA. https://www.ncbi.nlm.nih.gov/books/NBK8618/","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]
+
+EVIDENCE:
+Clinical Manifestations Rabies virus causes acute infection of the central nervous system. Five general stages are recognized in humans: incubation, prodrome, acute neurologic period, coma, and death. The incubation period is exceptionally variable, ranging from fewer than 10 days to longer than 2 years, but is usually 1–3 months. Structure Rabies virus is a rod- or bullet-shaped, single-stranded, negative-sense, unsegmented, enveloped RNA virus. The virus genome encodes five proteins. Classification and Antigenic Types Placement within the family is based on the distinctive morphology of the virus particle. Cross- reactive nucleoprotein antigens or comparative genomic sequences determine inclusion in the genus Lyssavirus, which includes rabies virus and at least five other pathogenic rabies-like viruses. Multiplication The viral RNA uncoats in the cytoplasm of infected cells. The genome is transcribed by a virion-associated RNA-dependent RNA polymerase. Viral RNA is then translated into individual viral proteins. Replication occurs with synthesis of positive-stranded RNA templates for the production of progeny negative-stranded RNA. Pathogenesis After inoculation, rabies virus may enter the peripheral nervous system directly and migrates to the brain or may replicate in muscle tissue, remaining sequestered at or near the entry site during incubation, prior to central nervous system invasion and replication. It then spreads centrifugally to numerous other organs. The case:fatality ratio approaches unity, but exact pathogenic mechanisms are not fully understood. Host Defenses Susceptibility to lethal infection is related to the animal species, viral variant, inoculum concentration, location and severity of exposure, and host immune status. Both virus-neutralizing antibodies and cell-mediated immunity are important in host defense. Epidemiology Rabies occurs in nearly all countries. Disease in humans is almost always due to a bite by an infected mammal. Nonbite exposures (e.g., mucosal contact) rarely cause rabies in humans. Diagnosis Early diagnosis is difficult. Rabies should be suspected in human cases of unexplained viral encephalitis with a history of animal bite. Unvaccinated persons are often negative for virus-neutralizing antibodies until late in the course of disease. Virus isolation from saliva, positive immunofluorescent skin biopsies or virus neutralizing antibody (from cerebrospinal fluid, or serum of a non-vaccinated patient), establish a diagnosis. Control Vaccination of susceptible animal species, particularly dogs and cats, will control this zoonotic disease. Introduction The family Rhabdoviridae consists of more than 100 single-stranded, negative-sense, nonsegmented viruses that infect a wide variety of hosts, including vertebrates, invertebrates, and plants. Common to all members of the family is a distinctive rod- or bullet-shaped morphology. Human pathogens of medical importance are found in the genera Lyssavirus and Vesiculovirus.Only rabies virus, medically the most significant member of the genus Lyssavirus, is reviewed in this chapter. Clinical Manifestations Five general stages of rabies are recognized in humans: incubation, prodrome, acute neurologic period, coma, and death (or, very rarely, recovery) (Fig. 61-1). No specific antirabies agents are useful once clinical signs or symptoms develop. The incubation period in rabies, usually 30 to 90 days but ranging from as few as 5 days to longer than 2 years after initial exposure, is more variable than in any other acute infection. Incubation periods may be somewhat shorter in children and in individuals bitten close to the central nervous system (e.g., the head). Clinical symptoms are first noted during the prodromal period, which usually lasts from 2 to 10 days. These symptoms are often nonspecific (general malaise, fever, and fatigue) or suggest involvement of the respiratory system (sore throat, cough, and dyspnea), gastrointestinal system (anorexia, dysphagia, nausea, vomiting, abdominal pain, and diarrhea), or central nervous systems (headache, vertigo, anxiety, apprehension, irritability, and nervousness). More remarkable abnormalities (agitation, photophobia, priapism, increased libido, insomnia, nightmares, and depression) may also occur, suggesting encephalitis, psychiatric disturbances, or brain conditions. Pain or paresthesia at the site of virus inoculation, combined with a history of recent animal bite, should suggest a consideration of rabies. The acute neurologic period begins with objective signs of central nervous system dysfunction. The disease may be classified as furious rabies if hyperactivity (i.e., hydrophobia) predominates and as dumb rabies if paralysis dominates the clinical picture. Fever, paresthesia, nuchal rigidity, muscle fasciculations, focal and generalized convulsions, hyperventilation, and hypersalivation may occur in both forms of the disease. At the end of the acute neurologic phase, periods of rapid, irregular breathing may begin; paralysis and coma soon follow. Respiratory arrest may occur thereafter, unless the patient is receiving ventilatory assistance, which may prolong survival for days, weeks, or longer, with death due to other complications. Although life support measures can prolong the clinical course of rabies, rarely will they affect the outcome of disease. The possibility of recovery, however, must be recognized, and when resources permit, every effort should be made to support the patient. At least seven cases of human “recovery” have been documented. Structure The rabies virus is a negative-sense, non-segmented, single-stranded RNA virus measuring approximately 60 nm × 180 nm. It is composed of an internal protein core or nucleocapsid, containing the nucleic acid, and an outer envelope, a lipid-containing bilayer covered with transmembrane glycoprotein spikes. The virus genome encodes five proteins associated with either the ribonucleoprotein (RNP) complex or the viral envelope (Fig. 61-3). The L (transcriptase), N (nucleoprotein), and NS (transcriptase-associated) proteins comprise the RNP complex, together with the viral RNA. These aggregate in the cytoplasm of virus-infected neurons and compose Negri bodies, the characteristic histopathologic finding of rabies virus infection. The M (matrix) and G (glycoprotein) proteins are associated with the lipid envelope. The G protein forms the protrusions that cover the outer surface of the virion envelope and is the only rabies virus protein known to induce virus-neutralizing antibody. Classification and Antigenic Types The genus Lyssavirus includes rabies virus and the antigenically- and genetically-related rabies- like viruses: Lagos bat, Mokola, and Duvenhage viruses, and two suggested subtypes of European bat lyssaviruses. Cross-protection studies suggest that animals immunized with traditional rabies vaccines may not be fully protected if challenged with other lyssaviruses. Rabies viruses may be categorized as either fixed (adapted by passage in animals or cell culture) or street (wild type). The use of monoclonal antibodies and genetic sequencing to differentiate street rabies viruses has been helpful in identifying viral variants originating in major host reservoirs throughout the world and suggesting the likely sources of human exposure when a history of definitive animal bite was otherwise missing from a patient's case history. Multiplication The replication of rabies virus is believed to be similar to that of other negative-stranded RNA viruses. The virus attaches to the host cell membranes via the G protein, penetrates the cytoplasm by fusion or pinocytosis, and is uncoated to RNP. The core initiates primary transcription of the five complementary monocistronic messenger RNAs by using the virion-associated RNA-dependent RNA polymerase. Each RNA is then translated into an individual viral protein. After viral proteins have been synthesized, replication of the genomic RNA continues with the synthesis of full length, positive-stranded RNA, which acts as a template for the production of progeny negative-stranded RNA.
+
+USER:
+Explain the clinical symptoms of rhabdovirus in under 600 words and so a 5th grader can understand. At the end of the explanation, provide a description of the virus in bold print.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,26,32,1150,,30
+[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.,"Explain simply in 250 words or less the goal of this study, how it was conducted, the results, and whether or not niPGT-A might be a viable method for genetic testing of human embryos.","Fertil Steril. 2024 Jul;122(1):42-51. doi: 10.1016/j.fertnstert.2024.02.030. Epub 2024 Feb 19. A pilot study to investigate the clinically predictive values of copy number variations detected by next-generation sequencing of cell-free deoxyribonucleic acid in spent culture media Gary Nakhuda 1, Sally Rodriguez 2, Sophia Tormasi 2, Catherine Welch 2 Affiliations Expand PMID: 38382698 DOI: 10.1016/j.fertnstert.2024.02.030 Free article Abstract Objective: To investigate the positive predictive value and false positive risk of copy number variations (CNV's) detected in cell free deoxyribonucleic acid (DNA) from spent culture media for nonviable or aneuploid embryos. Design: Diagnostic/prognostic accuracy study. Patient(s): Patients aged 35 and younger with an indication for IVF-ICSI and elective single frozen embryo transfer at a single, private IVF center. Intervention: Embryo selection was performed according to the conventional grading, blinded to noninvasive preimplantation genetic testing for aneuploidy (niPGT-A) results. After clinical outcomes were established, spent culture media samples were analyzed. Main outcome measures: Prognostic accuracy of CNVs according to niPGT-A results to predict nonviability or clinical aneuploidy. Results: One hundred twenty patients completed the study. Interpretations of next-generation sequencing (NGS) profiles were as follows: 7.5% (n = 9) failed quality control; 62.5% (n = 75) no CNVs detected; and 30% (n = 36) abnormal copy number detected. Stratification of abnormal NGS profiles was as follows: 15% (n = 18) whole chromosome and 15% (n = 18) uncertain reproductive potential. An intermediate CNV was evident in 27.8% (n = 5) of the whole chromosome abnormalities. The negative predictive value for samples with no detected abnormality was 57.3% (43/75). Whole chromosome abnormality was associated with a positive predictive value of 94.4% (17/18), lower sustained implantation rate (5.6%, 1/18), and higher relative risk (RR) for nonviability compared with no detected abnormalities (RR 2.21, 95% CI: 1.66-2.94). No other CNVs were associated with significant differences in the sustained implantation or RRs for nonviability. Unequal sex chromosome proportions suggested that maternal contamination was not uncommon. A secondary descriptive analysis of 705 supernumerary embryos revealed proportions of NGS profile interpretations similar to the transferred cohort. Significant median absolute pairwise differences between certain subcategories of CNV abnormalities were apparent. Conclusion: Whole chromosome abnormalities were associated with a high positive predictive value and significant RR for nonviability. Embryos associated with other CNVs had sustained implantation rates similar to those with no abnormalities detected. Further studies are required to validate the clinical applicability of niPGT-A. Clinical trial registration number: clinicaltrials.gov (NCT04732013). Keywords: Noninvasive PGT-A; PGT-A; cfDNA; niPGT-A; nonselection. Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved. PubMed Disclaimer Conflict of interest statement Declaration of Interests G.N. is a shareholder in The Fertility Partners (TFP), the parent company of Olive Fertility Centre. S.R. has minority ownership interests in Sequence46. S.T. has minority ownership interests in Sequence46; C.W. has minority ownership interests in Sequence46. Thermo Fisher Scientific is a vendor to Sequence46 but does not have any other affiliations with the authors. Thermo Fisher provided consumables for the NGS methods required for the study but no direct financial support.","[question] Explain simply in 250 words or less the goal of this study, how it was conducted, the results, and whether or not niPGT-A might be a viable method for genetic testing of human embryos. ===================== [text] Fertil Steril. 2024 Jul;122(1):42-51. doi: 10.1016/j.fertnstert.2024.02.030. Epub 2024 Feb 19. A pilot study to investigate the clinically predictive values of copy number variations detected by next-generation sequencing of cell-free deoxyribonucleic acid in spent culture media Gary Nakhuda 1, Sally Rodriguez 2, Sophia Tormasi 2, Catherine Welch 2 Affiliations Expand PMID: 38382698 DOI: 10.1016/j.fertnstert.2024.02.030 Free article Abstract Objective: To investigate the positive predictive value and false positive risk of copy number variations (CNV's) detected in cell free deoxyribonucleic acid (DNA) from spent culture media for nonviable or aneuploid embryos. Design: Diagnostic/prognostic accuracy study. Patient(s): Patients aged 35 and younger with an indication for IVF-ICSI and elective single frozen embryo transfer at a single, private IVF center. Intervention: Embryo selection was performed according to the conventional grading, blinded to noninvasive preimplantation genetic testing for aneuploidy (niPGT-A) results. After clinical outcomes were established, spent culture media samples were analyzed. Main outcome measures: Prognostic accuracy of CNVs according to niPGT-A results to predict nonviability or clinical aneuploidy. Results: One hundred twenty patients completed the study. Interpretations of next-generation sequencing (NGS) profiles were as follows: 7.5% (n = 9) failed quality control; 62.5% (n = 75) no CNVs detected; and 30% (n = 36) abnormal copy number detected. Stratification of abnormal NGS profiles was as follows: 15% (n = 18) whole chromosome and 15% (n = 18) uncertain reproductive potential. An intermediate CNV was evident in 27.8% (n = 5) of the whole chromosome abnormalities. The negative predictive value for samples with no detected abnormality was 57.3% (43/75). Whole chromosome abnormality was associated with a positive predictive value of 94.4% (17/18), lower sustained implantation rate (5.6%, 1/18), and higher relative risk (RR) for nonviability compared with no detected abnormalities (RR 2.21, 95% CI: 1.66-2.94). No other CNVs were associated with significant differences in the sustained implantation or RRs for nonviability. Unequal sex chromosome proportions suggested that maternal contamination was not uncommon. A secondary descriptive analysis of 705 supernumerary embryos revealed proportions of NGS profile interpretations similar to the transferred cohort. Significant median absolute pairwise differences between certain subcategories of CNV abnormalities were apparent. Conclusion: Whole chromosome abnormalities were associated with a high positive predictive value and significant RR for nonviability. Embryos associated with other CNVs had sustained implantation rates similar to those with no abnormalities detected. Further studies are required to validate the clinical applicability of niPGT-A. Clinical trial registration number: clinicaltrials.gov (NCT04732013). Keywords: Noninvasive PGT-A; PGT-A; cfDNA; niPGT-A; nonselection. Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved. PubMed Disclaimer Conflict of interest statement Declaration of Interests G.N. is a shareholder in The Fertility Partners (TFP), the parent company of Olive Fertility Centre. S.R. has minority ownership interests in Sequence46. S.T. has minority ownership interests in Sequence46; C.W. has minority ownership interests in Sequence46. Thermo Fisher Scientific is a vendor to Sequence46 but does not have any other affiliations with the authors. Thermo Fisher provided consumables for the NGS methods required for the study but no direct financial support. https://pubmed.ncbi.nlm.nih.gov/38382698/ ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.","[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
+
+EVIDENCE:
+Fertil Steril. 2024 Jul;122(1):42-51. doi: 10.1016/j.fertnstert.2024.02.030. Epub 2024 Feb 19. A pilot study to investigate the clinically predictive values of copy number variations detected by next-generation sequencing of cell-free deoxyribonucleic acid in spent culture media Gary Nakhuda 1, Sally Rodriguez 2, Sophia Tormasi 2, Catherine Welch 2 Affiliations Expand PMID: 38382698 DOI: 10.1016/j.fertnstert.2024.02.030 Free article Abstract Objective: To investigate the positive predictive value and false positive risk of copy number variations (CNV's) detected in cell free deoxyribonucleic acid (DNA) from spent culture media for nonviable or aneuploid embryos. Design: Diagnostic/prognostic accuracy study. Patient(s): Patients aged 35 and younger with an indication for IVF-ICSI and elective single frozen embryo transfer at a single, private IVF center. Intervention: Embryo selection was performed according to the conventional grading, blinded to noninvasive preimplantation genetic testing for aneuploidy (niPGT-A) results. After clinical outcomes were established, spent culture media samples were analyzed. Main outcome measures: Prognostic accuracy of CNVs according to niPGT-A results to predict nonviability or clinical aneuploidy. Results: One hundred twenty patients completed the study. Interpretations of next-generation sequencing (NGS) profiles were as follows: 7.5% (n = 9) failed quality control; 62.5% (n = 75) no CNVs detected; and 30% (n = 36) abnormal copy number detected. Stratification of abnormal NGS profiles was as follows: 15% (n = 18) whole chromosome and 15% (n = 18) uncertain reproductive potential. An intermediate CNV was evident in 27.8% (n = 5) of the whole chromosome abnormalities. The negative predictive value for samples with no detected abnormality was 57.3% (43/75). Whole chromosome abnormality was associated with a positive predictive value of 94.4% (17/18), lower sustained implantation rate (5.6%, 1/18), and higher relative risk (RR) for nonviability compared with no detected abnormalities (RR 2.21, 95% CI: 1.66-2.94). No other CNVs were associated with significant differences in the sustained implantation or RRs for nonviability. Unequal sex chromosome proportions suggested that maternal contamination was not uncommon. A secondary descriptive analysis of 705 supernumerary embryos revealed proportions of NGS profile interpretations similar to the transferred cohort. Significant median absolute pairwise differences between certain subcategories of CNV abnormalities were apparent. Conclusion: Whole chromosome abnormalities were associated with a high positive predictive value and significant RR for nonviability. Embryos associated with other CNVs had sustained implantation rates similar to those with no abnormalities detected. Further studies are required to validate the clinical applicability of niPGT-A. Clinical trial registration number: clinicaltrials.gov (NCT04732013). Keywords: Noninvasive PGT-A; PGT-A; cfDNA; niPGT-A; nonselection. Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved. PubMed Disclaimer Conflict of interest statement Declaration of Interests G.N. is a shareholder in The Fertility Partners (TFP), the parent company of Olive Fertility Centre. S.R. has minority ownership interests in Sequence46. S.T. has minority ownership interests in Sequence46; C.W. has minority ownership interests in Sequence46. Thermo Fisher Scientific is a vendor to Sequence46 but does not have any other affiliations with the authors. Thermo Fisher provided consumables for the NGS methods required for the study but no direct financial support.
+
+USER:
+Explain simply in 250 words or less the goal of this study, how it was conducted, the results, and whether or not niPGT-A might be a viable method for genetic testing of human embryos.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,28,34,498,,550
+"This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. Respond in 100 words or less and you may not use less than five bullet points in your answer. If you cannot answer using the context alone, say ""I cannot determine the answer to that due to lack of context""",Why do the types of mergers Congress is stating that Blizzard being acquired through Microsoft presents problems to consumers?,"Acquisition of Activision Blizzard Microsoft’s proposed acquisition may be considered both a vertical merger, in which one firm is the supplier and the other is a customer in the supply chain, and a horizontal merger, in which the merging firms are direct competitors, offering similar products or services that are considered substitutes. One concern with vertical mergers is that they may lead to foreclosure, a situation in which a supplier that competes with the merged firm loses access to a potential customer or a buyer that competes with the merged firm is denied access to a supplier. A concern with horizontal mergers is that they may significantly increase the market share of the merged firm, increasing concentration in the market and reducing competition, thereby enabling the remaining firms to raise prices. Microsoft’s proposed acquisition may also raise other concerns that typically have not been raised in merger challenges in recent decades, such as dominance in markets that may develop in the future and labor market monopsony.36 A key question about Microsoft’s proposed acquisition may be the extent to which Microsoft might restrict the availability of Activision Blizzard’s video games to its consoles and its streaming and cloud gaming services. Such a restriction would mean that other companies’ consoles or streaming or cloud gaming services would not be able to offer Activision Blizzard’s games to consumers. Microsoft has stated that if the merger is approved, it would continue to make Call of Duty and other popular Activision games available on other gaming consoles in addition to its Xbox.37 The statement specifies that Activision’s popular content would be “available on competing platforms like Sony’s PlayStation.” It is unclear, however, if this commitment pertains only to Sony’s consoles or also applies to PlayStation Plus,38 Sony’s version of Game Pass. Additionally, it is unclear whether Activision Blizzard’s games would be available on other streaming or cloud gaming services. Microsoft could also limit the availability of other games that are or will be under development. In 2020, after acquiring ZeniMax Media, parent company of the video game developer Bethesda Softworks,39 Microsoft stated that it would honor the exclusivity commitments Bethesda made with Sony for certain games for one year,40 but that future Bethesda games would be made available for “other consoles on a case by case basis.” 41 The game Starfield, officially introduced by Bethesda in 2018,42 is scheduled to be released in November 2022 exclusively on Microsoft’s Xbox Series X and S consoles and Windows PCs; it will not be available on other consoles.43 One potential concern may be how Microsoft’s acquisition might affect competition among digital stores selling video games for PCs, a market in which both Microsoft and Activision Blizzard compete. Following the acquisition, Microsoft could operate both Microsoft Store and Battle.net. This may not have a significant effect on competition, however, because Valve Corp.’s Steam is considered to be the dominant market player among PC digital stores. In a 2021 lawsuit alleging anticompetitive practices by Valve, video game developer Wolfire Games estimated that Valve controlled at least 75% of PC desktop game distribution.44 With respect to subscription or cloud gaming services, Microsoft may be able to increase its market share with the acquisition by offering more content than other providers. In addition to developing its own games, Microsoft has entered partnerships with various developers and publishers. For example, some Game Pass subscribers can access games on Electronic Arts (EA) Play for no additional cost,45 and Fortnite is available for free on Xbox Cloud Gaming without a Game Pass membership, although users must have a Microsoft account.46 If Microsoft allows other subscription or cloud gaming services to distribute Activision Blizzard’s video games, it may charge these providers a fee to do so, meaning potential competitors could face an additional cost that Microsoft would not. Consumers would arguably benefit from having a greater selection of video games offered through Microsoft’s subscription and cloud gaming services. However, if other subscription and cloud gaming service providers are unable to increase their market shares, Microsoft may be able to dominate the market, potentially allowing Microsoft to increase prices in the future. The salience of this concern may reflect opinions on whether antitrust enforcement should consider potential effects on the industry that may affect competition in the future or focus exclusively on consumer welfare. Among video game publishers in the United States, Microsoft and Activision Blizzard are estimated to have the largest market shares.47 IBISWorld reports, however, that competition among publishers and developers is high, even though the success of new entrants, particularly among developers, is fairly low.48 Publishers and developers can face high levels of uncertainty and risk.49 Furthermore, measuring the market share of Microsoft and Activision Blizzard within the United States may not accurately reflect competition in these markets, given that these companies compete at a global level. Some industry analysts list Tencent, which is headquartered in China, as the largest video game publisher worldwide based on revenue;50 Microsoft and Activision Blizzard are listed among the top 10, along with Sony, Nintendo, EA, and Take-Two Interactive.51 Microsoft stated that after its acquisition of Activision Blizzard, it would “become the world’s third-largest gaming company by revenue, behind Tencent and Sony.” 52 Microsoft’s acquisition could reduce the number of potential employers in the video game industry. At an FTC forum, an Activision Blizzard employee raised concern that consolidation in the industry could enable firms to hire employees at lower wages than in a competitive market.58 During its acquisition of ZeniMax, Microsoft reportedly stated that it did not plan on making changes to ZeniMax and that ZeniMax would operate independently following the acquisition.59 One industry analyst viewed the acquisition as a means to support gaming studios under ZeniMax, which had been struggling financially; according to the analyst, without the acquisition, ZeniMax would have likely faced layoffs and released fewer games.60 If Microsoft were to utilize a similar approach with Activision Blizzard, allowing it to essentially operate as a separate entity within Microsoft, the acquisition might not significantly affect the labor market for developers. Furthermore, some employees may have skills that would be easily transferrable to firms outside of the video game industry, which could limit Microsoft’s ability to control wages. Nevertheless, Microsoft’s acquisition would reduce the number of large, established firms in the video game industry, which could provide it with greater negotiating power. Another concern may be that Microsoft’s proposed acquisition could affect ongoing efforts to reach a collective bargaining agreement for Activision Blizzard employees. This concern was raised by an Activision Blizzard employee at an FTC forum and by some Senators in a March 2022 letter to the FTC,61 which cited Microsoft’s dismissal of temporary quality assurance workers two years after they formed a union in 2014.62 However, on June 13, 2022, Microsoft and the Communications Workers of America—the union that has been assisting Activision Blizzard employees—announced that they had entered a labor neutrality agreement enabling workers “to freely and fairly make a choice about union representation,” which would apply beginning 60 days after Microsoft’s acquisition is completed.63 Furthermore, it is unclear whether working conditions would improve if Activision Blizzard were to remain an independent company rather than being acquired by Microsoft. Some antitrust enforcers are reportedly considering some of the concerns discussed in the previous section, including the potential effect of Microsoft’s proposed acquisition on competing gaming subscription services and the market for game developers.64 In response to the March 2022 letter from some Senators asking the FTC to consider whether the transaction might exacerbate anticompetitive conduct in the labor market,65 FTC Chair Lina Khan stated that she shares those Senators’ concerns about monopsony power in labor markets.","Why do the types of mergers Congress is stating that Blizzard being acquired through Microsoft presents problems to consumers? This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. Respond in 100 words or less and you may not use less than five bullet points in your answer. If you cannot answer using the context alone, say ""I cannot determine the answer to that due to lack of context"" Acquisition of Activision Blizzard Microsoft’s proposed acquisition may be considered both a vertical merger, in which one firm is the supplier and the other is a customer in the supply chain, and a horizontal merger, in which the merging firms are direct competitors, offering similar products or services that are considered substitutes. One concern with vertical mergers is that they may lead to foreclosure, a situation in which a supplier that competes with the merged firm loses access to a potential customer or a buyer that competes with the merged firm is denied access to a supplier. A concern with horizontal mergers is that they may significantly increase the market share of the merged firm, increasing concentration in the market and reducing competition, thereby enabling the remaining firms to raise prices. Microsoft’s proposed acquisition may also raise other concerns that typically have not been raised in merger challenges in recent decades, such as dominance in markets that may develop in the future and labor market monopsony.36 A key question about Microsoft’s proposed acquisition may be the extent to which Microsoft might restrict the availability of Activision Blizzard’s video games to its consoles and its streaming and cloud gaming services. Such a restriction would mean that other companies’ consoles or streaming or cloud gaming services would not be able to offer Activision Blizzard’s games to consumers. Microsoft has stated that if the merger is approved, it would continue to make Call of Duty and other popular Activision games available on other gaming consoles in addition to its Xbox.37 The statement specifies that Activision’s popular content would be “available on competing platforms like Sony’s PlayStation.” It is unclear, however, if this commitment pertains only to Sony’s consoles or also applies to PlayStation Plus,38 Sony’s version of Game Pass. Additionally, it is unclear whether Activision Blizzard’s games would be available on other streaming or cloud gaming services. Microsoft could also limit the availability of other games that are or will be under development. In 2020, after acquiring ZeniMax Media, parent company of the video game developer Bethesda Softworks,39 Microsoft stated that it would honor the exclusivity commitments Bethesda made with Sony for certain games for one year,40 but that future Bethesda games would be made available for “other consoles on a case by case basis.” 41 The game Starfield, officially introduced by Bethesda in 2018,42 is scheduled to be released in November 2022 exclusively on Microsoft’s Xbox Series X and S consoles and Windows PCs; it will not be available on other consoles.43 One potential concern may be how Microsoft’s acquisition might affect competition among digital stores selling video games for PCs, a market in which both Microsoft and Activision Blizzard compete. Following the acquisition, Microsoft could operate both Microsoft Store and Battle.net. This may not have a significant effect on competition, however, because Valve Corp.’s Steam is considered to be the dominant market player among PC digital stores. In a 2021 lawsuit alleging anticompetitive practices by Valve, video game developer Wolfire Games estimated that Valve controlled at least 75% of PC desktop game distribution.44 With respect to subscription or cloud gaming services, Microsoft may be able to increase its market share with the acquisition by offering more content than other providers. In addition to developing its own games, Microsoft has entered partnerships with various developers and publishers. For example, some Game Pass subscribers can access games on Electronic Arts (EA) Play for no additional cost,45 and Fortnite is available for free on Xbox Cloud Gaming without a Game Pass membership, although users must have a Microsoft account.46 If Microsoft allows other subscription or cloud gaming services to distribute Activision Blizzard’s video games, it may charge these providers a fee to do so, meaning potential competitors could face an additional cost that Microsoft would not. Consumers would arguably benefit from having a greater selection of video games offered through Microsoft’s subscription and cloud gaming services. However, if other subscription and cloud gaming service providers are unable to increase their market shares, Microsoft may be able to dominate the market, potentially allowing Microsoft to increase prices in the future. The salience of this concern may reflect opinions on whether antitrust enforcement should consider potential effects on the industry that may affect competition in the future or focus exclusively on consumer welfare. Among video game publishers in the United States, Microsoft and Activision Blizzard are estimated to have the largest market shares.47 IBISWorld reports, however, that competition among publishers and developers is high, even though the success of new entrants, particularly among developers, is fairly low.48 Publishers and developers can face high levels of uncertainty and risk.49 Furthermore, measuring the market share of Microsoft and Activision Blizzard within the United States may not accurately reflect competition in these markets, given that these companies compete at a global level. Some industry analysts list Tencent, which is headquartered in China, as the largest video game publisher worldwide based on revenue;50 Microsoft and Activision Blizzard are listed among the top 10, along with Sony, Nintendo, EA, and Take-Two Interactive.51 Microsoft stated that after its acquisition of Activision Blizzard, it would “become the world’s third-largest gaming company by revenue, behind Tencent and Sony.” 52 Microsoft’s acquisition could reduce the number of potential employers in the video game industry. At an FTC forum, an Activision Blizzard employee raised concern that consolidation in the industry could enable firms to hire employees at lower wages than in a competitive market.58 During its acquisition of ZeniMax, Microsoft reportedly stated that it did not plan on making changes to ZeniMax and that ZeniMax would operate independently following the acquisition.59 One industry analyst viewed the acquisition as a means to support gaming studios under ZeniMax, which had been struggling financially; according to the analyst, without the acquisition, ZeniMax would have likely faced layoffs and released fewer games.60 If Microsoft were to utilize a similar approach with Activision Blizzard, allowing it to essentially operate as a separate entity within Microsoft, the acquisition might not significantly affect the labor market for developers. Furthermore, some employees may have skills that would be easily transferrable to firms outside of the video game industry, which could limit Microsoft’s ability to control wages. Nevertheless, Microsoft’s acquisition would reduce the number of large, established firms in the video game industry, which could provide it with greater negotiating power. Another concern may be that Microsoft’s proposed acquisition could affect ongoing efforts to reach a collective bargaining agreement for Activision Blizzard employees. This concern was raised by an Activision Blizzard employee at an FTC forum and by some Senators in a March 2022 letter to the FTC,61 which cited Microsoft’s dismissal of temporary quality assurance workers two years after they formed a union in 2014.62 However, on June 13, 2022, Microsoft and the Communications Workers of America—the union that has been assisting Activision Blizzard employees—announced that they had entered a labor neutrality agreement enabling workers “to freely and fairly make a choice about union representation,” which would apply beginning 60 days after Microsoft’s acquisition is completed.63 Furthermore, it is unclear whether working conditions would improve if Activision Blizzard were to remain an independent company rather than being acquired by Microsoft. Some antitrust enforcers are reportedly considering some of the concerns discussed in the previous section, including the potential effect of Microsoft’s proposed acquisition on competing gaming subscription services and the market for game developers.64 In response to the March 2022 letter from some Senators asking the FTC to consider whether the transaction might exacerbate anticompetitive conduct in the labor market,65 FTC Chair Lina Khan stated that she shares those Senators’ concerns about monopsony power in labor markets.","This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. Respond in 100 words or less and you may not use less than five bullet points in your answer. If you cannot answer using the context alone, say ""I cannot determine the answer to that due to lack of context""
+
+EVIDENCE:
+Acquisition of Activision Blizzard Microsoft’s proposed acquisition may be considered both a vertical merger, in which one firm is the supplier and the other is a customer in the supply chain, and a horizontal merger, in which the merging firms are direct competitors, offering similar products or services that are considered substitutes. One concern with vertical mergers is that they may lead to foreclosure, a situation in which a supplier that competes with the merged firm loses access to a potential customer or a buyer that competes with the merged firm is denied access to a supplier. A concern with horizontal mergers is that they may significantly increase the market share of the merged firm, increasing concentration in the market and reducing competition, thereby enabling the remaining firms to raise prices. Microsoft’s proposed acquisition may also raise other concerns that typically have not been raised in merger challenges in recent decades, such as dominance in markets that may develop in the future and labor market monopsony.36 A key question about Microsoft’s proposed acquisition may be the extent to which Microsoft might restrict the availability of Activision Blizzard’s video games to its consoles and its streaming and cloud gaming services. Such a restriction would mean that other companies’ consoles or streaming or cloud gaming services would not be able to offer Activision Blizzard’s games to consumers. Microsoft has stated that if the merger is approved, it would continue to make Call of Duty and other popular Activision games available on other gaming consoles in addition to its Xbox.37 The statement specifies that Activision’s popular content would be “available on competing platforms like Sony’s PlayStation.” It is unclear, however, if this commitment pertains only to Sony’s consoles or also applies to PlayStation Plus,38 Sony’s version of Game Pass. Additionally, it is unclear whether Activision Blizzard’s games would be available on other streaming or cloud gaming services. Microsoft could also limit the availability of other games that are or will be under development. In 2020, after acquiring ZeniMax Media, parent company of the video game developer Bethesda Softworks,39 Microsoft stated that it would honor the exclusivity commitments Bethesda made with Sony for certain games for one year,40 but that future Bethesda games would be made available for “other consoles on a case by case basis.” 41 The game Starfield, officially introduced by Bethesda in 2018,42 is scheduled to be released in November 2022 exclusively on Microsoft’s Xbox Series X and S consoles and Windows PCs; it will not be available on other consoles.43 One potential concern may be how Microsoft’s acquisition might affect competition among digital stores selling video games for PCs, a market in which both Microsoft and Activision Blizzard compete. Following the acquisition, Microsoft could operate both Microsoft Store and Battle.net. This may not have a significant effect on competition, however, because Valve Corp.’s Steam is considered to be the dominant market player among PC digital stores. In a 2021 lawsuit alleging anticompetitive practices by Valve, video game developer Wolfire Games estimated that Valve controlled at least 75% of PC desktop game distribution.44 With respect to subscription or cloud gaming services, Microsoft may be able to increase its market share with the acquisition by offering more content than other providers. In addition to developing its own games, Microsoft has entered partnerships with various developers and publishers. For example, some Game Pass subscribers can access games on Electronic Arts (EA) Play for no additional cost,45 and Fortnite is available for free on Xbox Cloud Gaming without a Game Pass membership, although users must have a Microsoft account.46 If Microsoft allows other subscription or cloud gaming services to distribute Activision Blizzard’s video games, it may charge these providers a fee to do so, meaning potential competitors could face an additional cost that Microsoft would not. Consumers would arguably benefit from having a greater selection of video games offered through Microsoft’s subscription and cloud gaming services. However, if other subscription and cloud gaming service providers are unable to increase their market shares, Microsoft may be able to dominate the market, potentially allowing Microsoft to increase prices in the future. The salience of this concern may reflect opinions on whether antitrust enforcement should consider potential effects on the industry that may affect competition in the future or focus exclusively on consumer welfare. Among video game publishers in the United States, Microsoft and Activision Blizzard are estimated to have the largest market shares.47 IBISWorld reports, however, that competition among publishers and developers is high, even though the success of new entrants, particularly among developers, is fairly low.48 Publishers and developers can face high levels of uncertainty and risk.49 Furthermore, measuring the market share of Microsoft and Activision Blizzard within the United States may not accurately reflect competition in these markets, given that these companies compete at a global level. Some industry analysts list Tencent, which is headquartered in China, as the largest video game publisher worldwide based on revenue;50 Microsoft and Activision Blizzard are listed among the top 10, along with Sony, Nintendo, EA, and Take-Two Interactive.51 Microsoft stated that after its acquisition of Activision Blizzard, it would “become the world’s third-largest gaming company by revenue, behind Tencent and Sony.” 52 Microsoft’s acquisition could reduce the number of potential employers in the video game industry. At an FTC forum, an Activision Blizzard employee raised concern that consolidation in the industry could enable firms to hire employees at lower wages than in a competitive market.58 During its acquisition of ZeniMax, Microsoft reportedly stated that it did not plan on making changes to ZeniMax and that ZeniMax would operate independently following the acquisition.59 One industry analyst viewed the acquisition as a means to support gaming studios under ZeniMax, which had been struggling financially; according to the analyst, without the acquisition, ZeniMax would have likely faced layoffs and released fewer games.60 If Microsoft were to utilize a similar approach with Activision Blizzard, allowing it to essentially operate as a separate entity within Microsoft, the acquisition might not significantly affect the labor market for developers. Furthermore, some employees may have skills that would be easily transferrable to firms outside of the video game industry, which could limit Microsoft’s ability to control wages. Nevertheless, Microsoft’s acquisition would reduce the number of large, established firms in the video game industry, which could provide it with greater negotiating power. Another concern may be that Microsoft’s proposed acquisition could affect ongoing efforts to reach a collective bargaining agreement for Activision Blizzard employees. This concern was raised by an Activision Blizzard employee at an FTC forum and by some Senators in a March 2022 letter to the FTC,61 which cited Microsoft’s dismissal of temporary quality assurance workers two years after they formed a union in 2014.62 However, on June 13, 2022, Microsoft and the Communications Workers of America—the union that has been assisting Activision Blizzard employees—announced that they had entered a labor neutrality agreement enabling workers “to freely and fairly make a choice about union representation,” which would apply beginning 60 days after Microsoft’s acquisition is completed.63 Furthermore, it is unclear whether working conditions would improve if Activision Blizzard were to remain an independent company rather than being acquired by Microsoft. Some antitrust enforcers are reportedly considering some of the concerns discussed in the previous section, including the potential effect of Microsoft’s proposed acquisition on competing gaming subscription services and the market for game developers.64 In response to the March 2022 letter from some Senators asking the FTC to consider whether the transaction might exacerbate anticompetitive conduct in the labor market,65 FTC Chair Lina Khan stated that she shares those Senators’ concerns about monopsony power in labor markets.
+
+USER:
+Why do the types of mergers Congress is stating that Blizzard being acquired through Microsoft presents problems to consumers?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,68,19,1273,,151
+Give me your answer as a full sentence. Answer the question only using the context provided in the document.,Can anyone file an Amicus Brief?,"**LEGAL BRIEF** A legal brief is a document that makes an argument as to why the person filing the brief should win the case or otherwise see his motion granted. This document contains the issues in dispute, the facts of the matter, and arguments in support of the party’s position. A legal brief that is submitted with a motion can also be referred to as a “memorandum of law.” This usually happens at the trial court level. To explore this concept, consider the following legal brief definition. Definition of Legal Brief Noun A short and concise statement A document that presents a legal argument to a court explaining why that party should prevail over the other. Origin 1250-1300 Middle English bref What is a Legal Brief A legal brief is a document that is submitted to a court by a party to a lawsuit. In the document, that party lists the reasons why he should prevail over the other party or parties to the lawsuit. Legal briefs are often submitted together with a motion at the trial court level. These legal briefs are referred to as “legal memorandums,” or “memorandums of law.” A legal brief is different from a law school brief. In law school, students are typically asked to prepare a “brief” that gives an overview of a case, such as the issue at hand and an analysis of the facts. An example of a legal brief that can be considered a memorandum of law is one that accompanies a motion for summary judgment. A motion for summary judgment explains to the court why it is impossible for the opposing party to win the case, and requests that it be dismissed. Upon the court’s granting of summary judgment, the case is then effectively over. Legal briefs are also filed with the appellate court when an appeal has been entered. While trial courts hold trials to establish the facts of a case, appellate courts are more interested in whether or not the trial court made a mistake in issuing the decision that it did. Therefore, almost all appeals are heard via the briefs that are filed by the parties. Arguments are then heard from the parties’ attorneys, which are made based on the points presented in the legal briefs. Cases that are of a higher caliber and that are granted a writ of certiorari by the Supreme Court, can be argued on one of two examples of legal briefs: a merit brief, or an amicus brief. Merits briefs are filed by the parties to the case and, like at the lower court level, argue each side’s reasons they should win. Amicus briefs, however, are filed by people who are not parties to the case, but who have information to support one point of view or the other. These briefs focus on policy-related issues, and/or finer points of law. They can also explain why the case should be decided in favor of one party over the other when the law does not clearly apply to the issues at hand. Amicus briefs are typically filed by experts who specialize in the topics that are being discussed. For example, legal briefs are often filed by the American Civil Liberties Union (ACLU) on civil rights cases because they are experts on the subject, even if they are not directly involved with the parties to the case. Anyone can file an amicus brief to a case, so long as the court allows it. How to Write a Legal Before writing a legal brief, the person writing the brief should first consult the rules of the court to which the brief will be submitted. Different courts have different rules insofar as how to write a legal brief, such as the format of the brief, the number of pages that are permitted, and the presentation of citations. Court rules are normally published and, if the court has a website, the rules are usually posted there as well for easy reference. The State Bar of Wisconsin compiled a list of helpful tips on how to write a legal brief from judges who have extensive experience reading them. What follows are a few of their suggestions on how to write a legal brief that is better than average: Parties Should Persuade, Not Argue – A brief is effective when the judge reading it wonders why the parties to the action are arguing over such an obvious issue. Briefs Should Be Concise – Most cases can be boiled down to a single issue, so less is more when crafting a strong argument. Points Should Be Accurate – The parties should not argue points they are unable to prove. Relief Should Be Requested – The parties should not hesitate to be specific in the relief they’re requesting. Those drafting legal briefs often get caught up in raising all the facts of a case within that brief. This often results in the key points of a case getting buried in the other details being presented, and an otherwise good argument is lost. The last thing a brief should do is anger or bore the judge reading it. Therefore, only the best arguments should be presented, not every argument. It is also good to use the names of the parties, rather than “plaintiff” or “appellant.” This keeps the reader engaged in the narrative that is being told, and makes the argument that is being presented more persuasive to the person reading it. The more a judge can be drawn into reading a brief, the better chance that party has of prevailing at trial. Another common mistake is a failure to back up good arguments with good citations. Often, the person drafting a brief will cite case law and assume the judge is familiar with the facts of that case. It is therefore assumed that the judge will understand why that case is being cited with little or no explanation as to why. This is not necessarily true. Case citations should be accompanied by a brief explanation that clarifies the relevance of the holding whenever possible. If the case is not read thoroughly by the party citing it, it can actually work against him by acting as ammunition for the other side. In other words, he may be using an argument against his case, rather than for it. Formatting and Language of Legal Briefs There are specific rules regarding the formatting and language of a legal brief, depending on the court. As far as the U.S. Supreme Court is concerned, legal briefs must be written in 12-point type, in Century Schoolbook font. This is referred to as the “Supreme Court font.” Each legal brief submitted to the Supreme Court must be accompanied by a signed certificate that confirms that the brief’s formatting and language is in compliance with the imposed word limitations. The author’s signature must be notarized if he is not a member of the Bar of the Supreme Court or counsel of record. The word count, which is given by the word processing system that is used to draft the brief, must be listed on the certificate. The word count refers only to the text of the document and its footnotes. It does not include the additional sections of the brief, which can include the table of contents, the table of cited authorities, and/or any appendix that may be affixed to it. Nor are block quotations detailing constitutional provisions, treaties, statutes, ordinances, and regulations involved in the case included in the word count. Briefs submitted to the U.S. Supreme Court must be bound in booklet format, on paper cut to exactly 6 1/2″ x 9 1/4″, and the color, weight, and brightness of the paper is specified, as are the margins, size of footnotes, and the gutter. In addition to rules regarding formatting and language, the Supreme Court also has binding requirements for its briefs. Briefs should be saddle-stitched, which is the neat, center-spine stapling that is usually used for pamphlets, or perfect-bound, which is like the binding that joins together the pages of a book. Bindings made from plastic, metal, or string are not allowed, nor are spiral bindings. Even the color of the cover of the brief bears significance with the Supreme Court. For instance, an orange cover tells the Court that the brief is in opposition to a writ of certiorari. A light blue cover identifies a merits brief of Petitioner or Appellant, and a light green cover is attached to briefs of amicus curiae in support of Petitioner or Appellant. These are only a few of the colors that are used for Supreme Court brief covers. All of these requirements can be found on the Supreme Court’s website. Legalese It used to be that simple legal writing was frowned upon by the courts. To compensate, attorneys began writing in “legalese,” which is legal writing that is convoluted and confusing to most people. Terms like “heretofore,” “aforementioned,” and “thereafter” are considered legalese. Simpler legal writing uses fewer words, is clearer to the reader, and is significantly shorter in the number of total pages. When attorneys remove the legalese from their briefs, they are able to convey the same message that might otherwise have been lost in their use of more complicated legal terms. Legal Brief Sample The rules of the court to which a brief will be submitted take precedence over any legal brief sample that may be referenced in drafting the brief. While Appellate briefs are rarely published, those looking for sample legal briefs can reference the Supreme Court’s . This series contains full texts of some of the briefs that have been submitted for argument before the Supreme Court. Related Legal Terms and Issues Notary – A person authorized to perform certain legal tasks, such as the certification of contracts, deeds, or other documents that are referenced in court. Writ of Certiorari – An order issued by a higher court demanding a lower court forward all records of a specific case for review","[Task] ================== Give me your answer as a full sentence. Answer the question only using the context provided in the document. ================ [Question] ================== Can anyone file an Amicus Brief? ================ [Text] ================== **LEGAL BRIEF** A legal brief is a document that makes an argument as to why the person filing the brief should win the case or otherwise see his motion granted. This document contains the issues in dispute, the facts of the matter, and arguments in support of the party’s position. A legal brief that is submitted with a motion can also be referred to as a “memorandum of law.” This usually happens at the trial court level. To explore this concept, consider the following legal brief definition. Definition of Legal Brief Noun A short and concise statement A document that presents a legal argument to a court explaining why that party should prevail over the other. Origin 1250-1300 Middle English bref What is a Legal Brief A legal brief is a document that is submitted to a court by a party to a lawsuit. In the document, that party lists the reasons why he should prevail over the other party or parties to the lawsuit. Legal briefs are often submitted together with a motion at the trial court level. These legal briefs are referred to as “legal memorandums,” or “memorandums of law.” A legal brief is different from a law school brief. In law school, students are typically asked to prepare a “brief” that gives an overview of a case, such as the issue at hand and an analysis of the facts. An example of a legal brief that can be considered a memorandum of law is one that accompanies a motion for summary judgment. A motion for summary judgment explains to the court why it is impossible for the opposing party to win the case, and requests that it be dismissed. Upon the court’s granting of summary judgment, the case is then effectively over. Legal briefs are also filed with the appellate court when an appeal has been entered. While trial courts hold trials to establish the facts of a case, appellate courts are more interested in whether or not the trial court made a mistake in issuing the decision that it did. Therefore, almost all appeals are heard via the briefs that are filed by the parties. Arguments are then heard from the parties’ attorneys, which are made based on the points presented in the legal briefs. Cases that are of a higher caliber and that are granted a writ of certiorari by the Supreme Court, can be argued on one of two examples of legal briefs: a merit brief, or an amicus brief. Merits briefs are filed by the parties to the case and, like at the lower court level, argue each side’s reasons they should win. Amicus briefs, however, are filed by people who are not parties to the case, but who have information to support one point of view or the other. These briefs focus on policy-related issues, and/or finer points of law. They can also explain why the case should be decided in favor of one party over the other when the law does not clearly apply to the issues at hand. Amicus briefs are typically filed by experts who specialize in the topics that are being discussed. For example, legal briefs are often filed by the American Civil Liberties Union (ACLU) on civil rights cases because they are experts on the subject, even if they are not directly involved with the parties to the case. Anyone can file an amicus brief to a case, so long as the court allows it. How to Write a Legal Before writing a legal brief, the person writing the brief should first consult the rules of the court to which the brief will be submitted. Different courts have different rules insofar as how to write a legal brief, such as the format of the brief, the number of pages that are permitted, and the presentation of citations. Court rules are normally published and, if the court has a website, the rules are usually posted there as well for easy reference. The State Bar of Wisconsin compiled a list of helpful tips on how to write a legal brief from judges who have extensive experience reading them. What follows are a few of their suggestions on how to write a legal brief that is better than average: Parties Should Persuade, Not Argue – A brief is effective when the judge reading it wonders why the parties to the action are arguing over such an obvious issue. Briefs Should Be Concise – Most cases can be boiled down to a single issue, so less is more when crafting a strong argument. Points Should Be Accurate – The parties should not argue points they are unable to prove. Relief Should Be Requested – The parties should not hesitate to be specific in the relief they’re requesting. Those drafting legal briefs often get caught up in raising all the facts of a case within that brief. This often results in the key points of a case getting buried in the other details being presented, and an otherwise good argument is lost. The last thing a brief should do is anger or bore the judge reading it. Therefore, only the best arguments should be presented, not every argument. It is also good to use the names of the parties, rather than “plaintiff” or “appellant.” This keeps the reader engaged in the narrative that is being told, and makes the argument that is being presented more persuasive to the person reading it. The more a judge can be drawn into reading a brief, the better chance that party has of prevailing at trial. Another common mistake is a failure to back up good arguments with good citations. Often, the person drafting a brief will cite case law and assume the judge is familiar with the facts of that case. It is therefore assumed that the judge will understand why that case is being cited with little or no explanation as to why. This is not necessarily true. Case citations should be accompanied by a brief explanation that clarifies the relevance of the holding whenever possible. If the case is not read thoroughly by the party citing it, it can actually work against him by acting as ammunition for the other side. In other words, he may be using an argument against his case, rather than for it. Formatting and Language of Legal Briefs There are specific rules regarding the formatting and language of a legal brief, depending on the court. As far as the U.S. Supreme Court is concerned, legal briefs must be written in 12-point type, in Century Schoolbook font. This is referred to as the “Supreme Court font.” Each legal brief submitted to the Supreme Court must be accompanied by a signed certificate that confirms that the brief’s formatting and language is in compliance with the imposed word limitations. The author’s signature must be notarized if he is not a member of the Bar of the Supreme Court or counsel of record. The word count, which is given by the word processing system that is used to draft the brief, must be listed on the certificate. The word count refers only to the text of the document and its footnotes. It does not include the additional sections of the brief, which can include the table of contents, the table of cited authorities, and/or any appendix that may be affixed to it. Nor are block quotations detailing constitutional provisions, treaties, statutes, ordinances, and regulations involved in the case included in the word count. Briefs submitted to the U.S. Supreme Court must be bound in booklet format, on paper cut to exactly 6 1/2″ x 9 1/4″, and the color, weight, and brightness of the paper is specified, as are the margins, size of footnotes, and the gutter. In addition to rules regarding formatting and language, the Supreme Court also has binding requirements for its briefs. Briefs should be saddle-stitched, which is the neat, center-spine stapling that is usually used for pamphlets, or perfect-bound, which is like the binding that joins together the pages of a book. Bindings made from plastic, metal, or string are not allowed, nor are spiral bindings. Even the color of the cover of the brief bears significance with the Supreme Court. For instance, an orange cover tells the Court that the brief is in opposition to a writ of certiorari. A light blue cover identifies a merits brief of Petitioner or Appellant, and a light green cover is attached to briefs of amicus curiae in support of Petitioner or Appellant. These are only a few of the colors that are used for Supreme Court brief covers. All of these requirements can be found on the Supreme Court’s website. Legalese It used to be that simple legal writing was frowned upon by the courts. To compensate, attorneys began writing in “legalese,” which is legal writing that is convoluted and confusing to most people. Terms like “heretofore,” “aforementioned,” and “thereafter” are considered legalese. Simpler legal writing uses fewer words, is clearer to the reader, and is significantly shorter in the number of total pages. When attorneys remove the legalese from their briefs, they are able to convey the same message that might otherwise have been lost in their use of more complicated legal terms. Legal Brief Sample The rules of the court to which a brief will be submitted take precedence over any legal brief sample that may be referenced in drafting the brief. While Appellate briefs are rarely published, those looking for sample legal briefs can reference the Supreme Court’s . This series contains full texts of some of the briefs that have been submitted for argument before the Supreme Court. Related Legal Terms and Issues Notary – A person authorized to perform certain legal tasks, such as the certification of contracts, deeds, or other documents that are referenced in court. Writ of Certiorari – An order issued by a higher court demanding a lower court forward all records of a specific case for review","Give me your answer as a full sentence. Answer the question only using the context provided in the document.
+
+EVIDENCE:
+**LEGAL BRIEF** A legal brief is a document that makes an argument as to why the person filing the brief should win the case or otherwise see his motion granted. This document contains the issues in dispute, the facts of the matter, and arguments in support of the party’s position. A legal brief that is submitted with a motion can also be referred to as a “memorandum of law.” This usually happens at the trial court level. To explore this concept, consider the following legal brief definition. Definition of Legal Brief Noun A short and concise statement A document that presents a legal argument to a court explaining why that party should prevail over the other. Origin 1250-1300 Middle English bref What is a Legal Brief A legal brief is a document that is submitted to a court by a party to a lawsuit. In the document, that party lists the reasons why he should prevail over the other party or parties to the lawsuit. Legal briefs are often submitted together with a motion at the trial court level. These legal briefs are referred to as “legal memorandums,” or “memorandums of law.” A legal brief is different from a law school brief. In law school, students are typically asked to prepare a “brief” that gives an overview of a case, such as the issue at hand and an analysis of the facts. An example of a legal brief that can be considered a memorandum of law is one that accompanies a motion for summary judgment. A motion for summary judgment explains to the court why it is impossible for the opposing party to win the case, and requests that it be dismissed. Upon the court’s granting of summary judgment, the case is then effectively over. Legal briefs are also filed with the appellate court when an appeal has been entered. While trial courts hold trials to establish the facts of a case, appellate courts are more interested in whether or not the trial court made a mistake in issuing the decision that it did. Therefore, almost all appeals are heard via the briefs that are filed by the parties. Arguments are then heard from the parties’ attorneys, which are made based on the points presented in the legal briefs. Cases that are of a higher caliber and that are granted a writ of certiorari by the Supreme Court, can be argued on one of two examples of legal briefs: a merit brief, or an amicus brief. Merits briefs are filed by the parties to the case and, like at the lower court level, argue each side’s reasons they should win. Amicus briefs, however, are filed by people who are not parties to the case, but who have information to support one point of view or the other. These briefs focus on policy-related issues, and/or finer points of law. They can also explain why the case should be decided in favor of one party over the other when the law does not clearly apply to the issues at hand. Amicus briefs are typically filed by experts who specialize in the topics that are being discussed. For example, legal briefs are often filed by the American Civil Liberties Union (ACLU) on civil rights cases because they are experts on the subject, even if they are not directly involved with the parties to the case. Anyone can file an amicus brief to a case, so long as the court allows it. How to Write a Legal Before writing a legal brief, the person writing the brief should first consult the rules of the court to which the brief will be submitted. Different courts have different rules insofar as how to write a legal brief, such as the format of the brief, the number of pages that are permitted, and the presentation of citations. Court rules are normally published and, if the court has a website, the rules are usually posted there as well for easy reference. The State Bar of Wisconsin compiled a list of helpful tips on how to write a legal brief from judges who have extensive experience reading them. What follows are a few of their suggestions on how to write a legal brief that is better than average: Parties Should Persuade, Not Argue – A brief is effective when the judge reading it wonders why the parties to the action are arguing over such an obvious issue. Briefs Should Be Concise – Most cases can be boiled down to a single issue, so less is more when crafting a strong argument. Points Should Be Accurate – The parties should not argue points they are unable to prove. Relief Should Be Requested – The parties should not hesitate to be specific in the relief they’re requesting. Those drafting legal briefs often get caught up in raising all the facts of a case within that brief. This often results in the key points of a case getting buried in the other details being presented, and an otherwise good argument is lost. The last thing a brief should do is anger or bore the judge reading it. Therefore, only the best arguments should be presented, not every argument. It is also good to use the names of the parties, rather than “plaintiff” or “appellant.” This keeps the reader engaged in the narrative that is being told, and makes the argument that is being presented more persuasive to the person reading it. The more a judge can be drawn into reading a brief, the better chance that party has of prevailing at trial. Another common mistake is a failure to back up good arguments with good citations. Often, the person drafting a brief will cite case law and assume the judge is familiar with the facts of that case. It is therefore assumed that the judge will understand why that case is being cited with little or no explanation as to why. This is not necessarily true. Case citations should be accompanied by a brief explanation that clarifies the relevance of the holding whenever possible. If the case is not read thoroughly by the party citing it, it can actually work against him by acting as ammunition for the other side. In other words, he may be using an argument against his case, rather than for it. Formatting and Language of Legal Briefs There are specific rules regarding the formatting and language of a legal brief, depending on the court. As far as the U.S. Supreme Court is concerned, legal briefs must be written in 12-point type, in Century Schoolbook font. This is referred to as the “Supreme Court font.” Each legal brief submitted to the Supreme Court must be accompanied by a signed certificate that confirms that the brief’s formatting and language is in compliance with the imposed word limitations. The author’s signature must be notarized if he is not a member of the Bar of the Supreme Court or counsel of record. The word count, which is given by the word processing system that is used to draft the brief, must be listed on the certificate. The word count refers only to the text of the document and its footnotes. It does not include the additional sections of the brief, which can include the table of contents, the table of cited authorities, and/or any appendix that may be affixed to it. Nor are block quotations detailing constitutional provisions, treaties, statutes, ordinances, and regulations involved in the case included in the word count. Briefs submitted to the U.S. Supreme Court must be bound in booklet format, on paper cut to exactly 6 1/2″ x 9 1/4″, and the color, weight, and brightness of the paper is specified, as are the margins, size of footnotes, and the gutter. In addition to rules regarding formatting and language, the Supreme Court also has binding requirements for its briefs. Briefs should be saddle-stitched, which is the neat, center-spine stapling that is usually used for pamphlets, or perfect-bound, which is like the binding that joins together the pages of a book. Bindings made from plastic, metal, or string are not allowed, nor are spiral bindings. Even the color of the cover of the brief bears significance with the Supreme Court. For instance, an orange cover tells the Court that the brief is in opposition to a writ of certiorari. A light blue cover identifies a merits brief of Petitioner or Appellant, and a light green cover is attached to briefs of amicus curiae in support of Petitioner or Appellant. These are only a few of the colors that are used for Supreme Court brief covers. All of these requirements can be found on the Supreme Court’s website. Legalese It used to be that simple legal writing was frowned upon by the courts. To compensate, attorneys began writing in “legalese,” which is legal writing that is convoluted and confusing to most people. Terms like “heretofore,” “aforementioned,” and “thereafter” are considered legalese. Simpler legal writing uses fewer words, is clearer to the reader, and is significantly shorter in the number of total pages. When attorneys remove the legalese from their briefs, they are able to convey the same message that might otherwise have been lost in their use of more complicated legal terms. Legal Brief Sample The rules of the court to which a brief will be submitted take precedence over any legal brief sample that may be referenced in drafting the brief. While Appellate briefs are rarely published, those looking for sample legal briefs can reference the Supreme Court’s . This series contains full texts of some of the briefs that have been submitted for argument before the Supreme Court. Related Legal Terms and Issues Notary – A person authorized to perform certain legal tasks, such as the certification of contracts, deeds, or other documents that are referenced in court. Writ of Certiorari – An order issued by a higher court demanding a lower court forward all records of a specific case for review
+
+USER:
+Can anyone file an Amicus Brief?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,19,6,1666,,813
+"""================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",What projects has NASA invested in the space economy? Where can the regular person invest in the space economy? Summarize in 500 words or less.,"Outer space has come a long way since the 1960s. Matthew Weinzierl explains the current state of the space economy, highlighting the various opportunities for businesses hidden among the stars. A new space race—one fueled more by commercial conquest than intergalactic domination—is charting solutions to pressing problems in national security, climate change, and communication. With costs poised to drop and innovation on the rise, the economics of cosmic exploration and commerce are rapidly changing. Harvard Business School Senior Associate Dean Matthew Weinzierl’s new research explores the business opportunities hidden among the stars, particularly in data from and through space, but also in tourism, manufacturing, and even space-based resources. “From national security to climate change observation and trying to fix some of the biggest problems on Earth, the space economy is now interwoven in our everyday lives,” says Weinzierl, who is also the Joseph and Jacqueline Elbling Professor of Business Administration. Baskin: What are the highest-growth areas in the space economy? Weinzierl: What’s really interesting about what’s happening in space is the fundamental transformation of how it’s being organized. For a long time, when most people thought about what we do in space as humans, they thought of it as primarily a government-led activity. They thought of the James Webb telescope, the International Space Station, or the space shuttle. “If you look at the area of space getting the most attention―manufacturing of launch vehicles and satellites―its growth is in fact quite strong.” What’s changed over the past couple decades is that the government-led model, which served us extremely well back in the 1960s, has been revolutionized by bringing in market forces in a way that they never were before. Competition that we take for granted in most sectors of the economy is now driving efficiencies and innovations in the space sector, making it much more of a typical industry, or at least a typical industry with a tremendous amount of technological growth in it. What we found in our recent paper (which I coauthored with Tina Highfill of the U.S. Bureau of Economic Analysis) is that growth in the space sector overall has been quite modest over the past decade or so, but if you look at the area of space getting the most attention―manufacturing of launch vehicles and satellites―its growth is in fact quite strong. That’s especially true when you adjust for the quality improvements and price declines in that area; something our research is the first to quantify. In other words, we can see the dynamism of the space sector in the data. Baskin: What was the inflection point for this growth? Weinzierl: The key point is the early 2000s. The second of two shuttle losses, in 2003, meant that the last space shuttle flight was in 2011. This was a serious crisis for the American space community, given that, 40 years earlier, we put people on the moon. There was this sense that: “Wait a minute, I thought we were going to have space hotels and moon bases.” Instead, the United States was going to have to buy trips for our astronauts to the Space Station from Russia. This caused real soul-searching in the sector. It’s also when NASA started investing in the commercial space sector in a more concerted way. It created a program called Commercial Orbital Transportation Services (COTS). It spent $500 million to start seeding rocket launch companies to provide a new way to get back to the Space Station, which included companies like Blue Origin, SpaceX, and Sierra. A couple of decades later, SpaceX, in particular, has absolutely revolutionized the costs of launching rockets and thus doing anything in space. Baskin: How might the space economy affect the future of investing? Weinzierl: Space investing is a tricky sector. There was a big boom, a few years ago, in these private space enterprises trying to go public through special purpose acquisition companies (SPACs). In a SPAC, somebody would start a company with the sole idea of acquiring a private company and taking it public—and people who had signed up to invest in the original company could decide whether or not to stick with it. “Space is one of these industries where typical venture capital models struggle with the deep levels of uncertainty and the longer time frames that it requires.” The trouble is that, partly because SPACs are a bit opaque, they lend themselves to the risk of hype behind their projections. Most space SPACs crashed in value as soon as they went public, so many investors got a real sense that space is a dangerous place to invest. But, when you talk to people who are sophisticated space investors, they say, “Sure, that was a bit of a crazy cycle.” But it’s also a bit of an understandable cycle. Space is one of these industries where typical venture capital models struggle with the deep levels of uncertainty and the longer time frames that it requires. But, if you’re a sophisticated space investor with a solid theory for how to understand the pitches you’re hearing, there are still great ideas and companies out there. The sector has been quite resilient, in many ways. Baskin: How will the space economy affect the future of work? Weinzierl: In the next five to 10 years, the vast majority of economic activity directly tied to space, which would affect your typical worker, is going to be based on satellites, namely using data from them about the Earth and data through them as satellite internet expands its reach. If we look out a bit further, you get more speculative but exciting ideas like space manufacturing, tourism, and potentially resource extraction from places like the moon and asteroids. In many ways, those ideas seem very sci-fi. But technology is well-developed for several of them, and it’s more about finding the right business cases. The sector is looking feverishly for them, and, as costs keep coming down, I’m relatively optimistic that more of what seems like sci-fi will become reality over the next couple of decades. If you think about data as being the backbone of the modern economy, and the transmission of information increasingly defining what so many industries are, space is very much at the center of that over the next five to 10 years. I think the clearest way to see that is through the SpaceX Starlink constellation, which is already a constellation of several thousand satellites. Many thousands more are planned to provide high-speed Internet through satellites around the world. Amazon is planning a similar constellation of satellites, as is China. Of course, the initial application of that is just providing Internet coverage to places where it’s hard to run fiber-optic cables. But, if you think about the Internet of Things, and the connectivity that everyone is planning to have between every device in every place on Earth, which will enable all sorts of functionality—especially in terms of mobile processing or mobile devices—the existence of this Internet transformation really could redefine sectors quite broadly in a way we can’t foresee. That’s the real magic of markets, after all.","""================ <TEXT PASSAGE> ======= Outer space has come a long way since the 1960s. Matthew Weinzierl explains the current state of the space economy, highlighting the various opportunities for businesses hidden among the stars. A new space race—one fueled more by commercial conquest than intergalactic domination—is charting solutions to pressing problems in national security, climate change, and communication. With costs poised to drop and innovation on the rise, the economics of cosmic exploration and commerce are rapidly changing. Harvard Business School Senior Associate Dean Matthew Weinzierl’s new research explores the business opportunities hidden among the stars, particularly in data from and through space, but also in tourism, manufacturing, and even space-based resources. “From national security to climate change observation and trying to fix some of the biggest problems on Earth, the space economy is now interwoven in our everyday lives,” says Weinzierl, who is also the Joseph and Jacqueline Elbling Professor of Business Administration. Baskin: What are the highest-growth areas in the space economy? Weinzierl: What’s really interesting about what’s happening in space is the fundamental transformation of how it’s being organized. For a long time, when most people thought about what we do in space as humans, they thought of it as primarily a government-led activity. They thought of the James Webb telescope, the International Space Station, or the space shuttle. “If you look at the area of space getting the most attention―manufacturing of launch vehicles and satellites―its growth is in fact quite strong.” What’s changed over the past couple decades is that the government-led model, which served us extremely well back in the 1960s, has been revolutionized by bringing in market forces in a way that they never were before. Competition that we take for granted in most sectors of the economy is now driving efficiencies and innovations in the space sector, making it much more of a typical industry, or at least a typical industry with a tremendous amount of technological growth in it. What we found in our recent paper (which I coauthored with Tina Highfill of the U.S. Bureau of Economic Analysis) is that growth in the space sector overall has been quite modest over the past decade or so, but if you look at the area of space getting the most attention―manufacturing of launch vehicles and satellites―its growth is in fact quite strong. That’s especially true when you adjust for the quality improvements and price declines in that area; something our research is the first to quantify. In other words, we can see the dynamism of the space sector in the data. Baskin: What was the inflection point for this growth? Weinzierl: The key point is the early 2000s. The second of two shuttle losses, in 2003, meant that the last space shuttle flight was in 2011. This was a serious crisis for the American space community, given that, 40 years earlier, we put people on the moon. There was this sense that: “Wait a minute, I thought we were going to have space hotels and moon bases.” Instead, the United States was going to have to buy trips for our astronauts to the Space Station from Russia. This caused real soul-searching in the sector. It’s also when NASA started investing in the commercial space sector in a more concerted way. It created a program called Commercial Orbital Transportation Services (COTS). It spent $500 million to start seeding rocket launch companies to provide a new way to get back to the Space Station, which included companies like Blue Origin, SpaceX, and Sierra. A couple of decades later, SpaceX, in particular, has absolutely revolutionized the costs of launching rockets and thus doing anything in space. Baskin: How might the space economy affect the future of investing? Weinzierl: Space investing is a tricky sector. There was a big boom, a few years ago, in these private space enterprises trying to go public through special purpose acquisition companies (SPACs). In a SPAC, somebody would start a company with the sole idea of acquiring a private company and taking it public—and people who had signed up to invest in the original company could decide whether or not to stick with it. “Space is one of these industries where typical venture capital models struggle with the deep levels of uncertainty and the longer time frames that it requires.” The trouble is that, partly because SPACs are a bit opaque, they lend themselves to the risk of hype behind their projections. Most space SPACs crashed in value as soon as they went public, so many investors got a real sense that space is a dangerous place to invest. But, when you talk to people who are sophisticated space investors, they say, “Sure, that was a bit of a crazy cycle.” But it’s also a bit of an understandable cycle. Space is one of these industries where typical venture capital models struggle with the deep levels of uncertainty and the longer time frames that it requires. But, if you’re a sophisticated space investor with a solid theory for how to understand the pitches you’re hearing, there are still great ideas and companies out there. The sector has been quite resilient, in many ways. Baskin: How will the space economy affect the future of work? Weinzierl: In the next five to 10 years, the vast majority of economic activity directly tied to space, which would affect your typical worker, is going to be based on satellites, namely using data from them about the Earth and data through them as satellite internet expands its reach. If we look out a bit further, you get more speculative but exciting ideas like space manufacturing, tourism, and potentially resource extraction from places like the moon and asteroids. In many ways, those ideas seem very sci-fi. But technology is well-developed for several of them, and it’s more about finding the right business cases. The sector is looking feverishly for them, and, as costs keep coming down, I’m relatively optimistic that more of what seems like sci-fi will become reality over the next couple of decades. If you think about data as being the backbone of the modern economy, and the transmission of information increasingly defining what so many industries are, space is very much at the center of that over the next five to 10 years. I think the clearest way to see that is through the SpaceX Starlink constellation, which is already a constellation of several thousand satellites. Many thousands more are planned to provide high-speed Internet through satellites around the world. Amazon is planning a similar constellation of satellites, as is China. Of course, the initial application of that is just providing Internet coverage to places where it’s hard to run fiber-optic cables. But, if you think about the Internet of Things, and the connectivity that everyone is planning to have between every device in every place on Earth, which will enable all sorts of functionality—especially in terms of mobile processing or mobile devices—the existence of this Internet transformation really could redefine sectors quite broadly in a way we can’t foresee. That’s the real magic of markets, after all. https://hbswk.hbs.edu/item/space-economy-qa ================ <QUESTION> ======= What projects has NASA invested in the space economy? Where can the regular person invest in the space economy? Summarize in 500 words or less. ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""","""================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""
+
+EVIDENCE:
+Outer space has come a long way since the 1960s. Matthew Weinzierl explains the current state of the space economy, highlighting the various opportunities for businesses hidden among the stars. A new space race—one fueled more by commercial conquest than intergalactic domination—is charting solutions to pressing problems in national security, climate change, and communication. With costs poised to drop and innovation on the rise, the economics of cosmic exploration and commerce are rapidly changing. Harvard Business School Senior Associate Dean Matthew Weinzierl’s new research explores the business opportunities hidden among the stars, particularly in data from and through space, but also in tourism, manufacturing, and even space-based resources. “From national security to climate change observation and trying to fix some of the biggest problems on Earth, the space economy is now interwoven in our everyday lives,” says Weinzierl, who is also the Joseph and Jacqueline Elbling Professor of Business Administration. Baskin: What are the highest-growth areas in the space economy? Weinzierl: What’s really interesting about what’s happening in space is the fundamental transformation of how it’s being organized. For a long time, when most people thought about what we do in space as humans, they thought of it as primarily a government-led activity. They thought of the James Webb telescope, the International Space Station, or the space shuttle. “If you look at the area of space getting the most attention―manufacturing of launch vehicles and satellites―its growth is in fact quite strong.” What’s changed over the past couple decades is that the government-led model, which served us extremely well back in the 1960s, has been revolutionized by bringing in market forces in a way that they never were before. Competition that we take for granted in most sectors of the economy is now driving efficiencies and innovations in the space sector, making it much more of a typical industry, or at least a typical industry with a tremendous amount of technological growth in it. What we found in our recent paper (which I coauthored with Tina Highfill of the U.S. Bureau of Economic Analysis) is that growth in the space sector overall has been quite modest over the past decade or so, but if you look at the area of space getting the most attention―manufacturing of launch vehicles and satellites―its growth is in fact quite strong. That’s especially true when you adjust for the quality improvements and price declines in that area; something our research is the first to quantify. In other words, we can see the dynamism of the space sector in the data. Baskin: What was the inflection point for this growth? Weinzierl: The key point is the early 2000s. The second of two shuttle losses, in 2003, meant that the last space shuttle flight was in 2011. This was a serious crisis for the American space community, given that, 40 years earlier, we put people on the moon. There was this sense that: “Wait a minute, I thought we were going to have space hotels and moon bases.” Instead, the United States was going to have to buy trips for our astronauts to the Space Station from Russia. This caused real soul-searching in the sector. It’s also when NASA started investing in the commercial space sector in a more concerted way. It created a program called Commercial Orbital Transportation Services (COTS). It spent $500 million to start seeding rocket launch companies to provide a new way to get back to the Space Station, which included companies like Blue Origin, SpaceX, and Sierra. A couple of decades later, SpaceX, in particular, has absolutely revolutionized the costs of launching rockets and thus doing anything in space. Baskin: How might the space economy affect the future of investing? Weinzierl: Space investing is a tricky sector. There was a big boom, a few years ago, in these private space enterprises trying to go public through special purpose acquisition companies (SPACs). In a SPAC, somebody would start a company with the sole idea of acquiring a private company and taking it public—and people who had signed up to invest in the original company could decide whether or not to stick with it. “Space is one of these industries where typical venture capital models struggle with the deep levels of uncertainty and the longer time frames that it requires.” The trouble is that, partly because SPACs are a bit opaque, they lend themselves to the risk of hype behind their projections. Most space SPACs crashed in value as soon as they went public, so many investors got a real sense that space is a dangerous place to invest. But, when you talk to people who are sophisticated space investors, they say, “Sure, that was a bit of a crazy cycle.” But it’s also a bit of an understandable cycle. Space is one of these industries where typical venture capital models struggle with the deep levels of uncertainty and the longer time frames that it requires. But, if you’re a sophisticated space investor with a solid theory for how to understand the pitches you’re hearing, there are still great ideas and companies out there. The sector has been quite resilient, in many ways. Baskin: How will the space economy affect the future of work? Weinzierl: In the next five to 10 years, the vast majority of economic activity directly tied to space, which would affect your typical worker, is going to be based on satellites, namely using data from them about the Earth and data through them as satellite internet expands its reach. If we look out a bit further, you get more speculative but exciting ideas like space manufacturing, tourism, and potentially resource extraction from places like the moon and asteroids. In many ways, those ideas seem very sci-fi. But technology is well-developed for several of them, and it’s more about finding the right business cases. The sector is looking feverishly for them, and, as costs keep coming down, I’m relatively optimistic that more of what seems like sci-fi will become reality over the next couple of decades. If you think about data as being the backbone of the modern economy, and the transmission of information increasingly defining what so many industries are, space is very much at the center of that over the next five to 10 years. I think the clearest way to see that is through the SpaceX Starlink constellation, which is already a constellation of several thousand satellites. Many thousands more are planned to provide high-speed Internet through satellites around the world. Amazon is planning a similar constellation of satellites, as is China. Of course, the initial application of that is just providing Internet coverage to places where it’s hard to run fiber-optic cables. But, if you think about the Internet of Things, and the connectivity that everyone is planning to have between every device in every place on Earth, which will enable all sorts of functionality—especially in terms of mobile processing or mobile devices—the existence of this Internet transformation really could redefine sectors quite broadly in a way we can’t foresee. That’s the real magic of markets, after all.
+
+USER:
+What projects has NASA invested in the space economy? Where can the regular person invest in the space economy? Summarize in 500 words or less.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,49,25,1180,,119
+"Respond using only the available context. Do not use dictionaries, internal knowledge, or any other resource. If the query is not answerable using the available context, respond with ""Sorry, I dunno :("".",I don't really understand this. What is AICOA and how is it different from monopoly and Sherman and stuff?,"Yelp’s Self-preferencing Claims AMERICANACTIONFORUM.ORG Yelp brought its lawsuit against Google largely alleging a violation of Section 2 of the Sherman Act, which prohibits the illegal monopolization of a market. To succeed on a Section 2 illegal monopolization claim, a plaintiff must show two elements: 1) that the defendant had monopoly power in a relevant market, and 2) that the firm illegally acquired or maintained that monopoly power using anticompetitive means. While Yelp alleges a few different theories in the case, this paper focuses on the claim that Google is using monopoly power in the general search market to self-preference local search offerings at the expense of rivals such as Yelp. Element 1: Monopoly Power First, Yelp must show that Google has monopoly power in a relevant market. For the type of conduct at issue in this case, Yelp would likely need to show that Google both has monopoly power in the general search market and uses that monopoly power to attempt to monopolize the more specific local search market. The timing of this lawsuit is not a coincidence. In July, the DOJ won its case arguing that Google had illegally monopolized the general search market through the use of default search engine agreements with browsers and smartphone manufacturers. While that specific conduct isn’t at issue here, Yelp will almost certainly point to the finding that Google does, in fact, have monopoly power in general search. This provides Yelp with a strong foundation for its case, and if a court accepts Yelp’s argument, Yelp would simply need to show either that Google has monopoly power in the local search market or that Google has sufficient market power to pose a dangerous probability of monopolizing that market. Yelp’s case isn’t clear cut, however. First, the decision in the DOJ case is not binding here because Yelp is suing in a different jurisdiction, though a district court opinion from another jurisdiction may be a persuasive authority. Even if the judge in the Yelp case defers to the D.C. decision, the D.C. decision largely dismissed arguments about generative AI being a viable alternative to the traditional search engine because, at the time of discovery, the technology didn’t exist commercially. Within the past two years, tools that offer similar search functionality such as ChatGPT have grown significantly, providing an alternative to Google’s general search product and restricting Google’s ability to act as a monopolist. Second, Google will undoubtedly argue that local search is not distinct from general search. Element 2: Anticompetitive Conduct In addition to monopoly power, Yelp will need to show that Google could acquire that monopoly power in the local search market through “willful acquisition…as distinguished from growth or development as a consequence of a superior product, business acumen, or historic accident.” At the core of the complaint, Yelp alleges that “Google has degraded quality, demoted rivals, and grown its monopoly power by (1) inserting Google’s own vertical search results at the top of its horizontal search results page to divert user attention away from organic search results and (2) excluding rivals and their vertical content from that prime placement in the vertical search sections that populate the top of the [search engine results page].” This argument relies on what is known as “self-preferencing,” a legal theory that has become popular in European competition law in recent years, but is largely dismissed by U.S. courts. Courts in the United States have found that even firms with monopoly power generally have no duty to deal with their rivals, as firms AMERICANACTIONFORUM.ORG should be able to choose how they offer their products and services to better compete on the merits. Some tying arrangements can violate the law, but tying arguments generally require a firm to tie the purchase of a product in a market in which the firm has monopoly power to the purchase of a product in another market in which the firm does not have monopoly power. Yet as antitrust scholar Herbert Hovenkamp has explained, these types of tying agreements do not usually reach mere preferential ordering of goods that falls short of prohibitions on dealing. The reason courts generally don’t recognize self-preferencing as a viable theory of harm under the law is because firms use these displays to compete on the merits. If a customer searches for “best local lunch spots near me,” for example, Yelp would still be the top general search result on the website, though Google Places appears at the top of the result with a direct list of restaurants, their reviews, and their locations. Google, by incorporating its own vertical products, provides the user with immediate suggestions to the question, a tool to see how individuals rate the restaurants, and a map to see how far away they are. And if users want a more detailed local search option, they can simply click on the Yelp link right below the vertical offerings. Courts tend to prefer to give firms freedom to design their products as they see fit, largely due to concerns that mandating specific designs could negatively affect competition and consumers. AICOA in an Alternate Universe The American Innovation and Choice Online Act specifically targets the kind of conduct at issue here. First, the bill would designate large technology platforms like Google as covered platforms. Second, the bill would make it illegal to “preference the products, services, or lines of business of the covered platform operator over those of another business user on the covered platform in a manner that would materially harm competition,” along with a variety of other restrictions on harming smaller competitors. Under AICOA, a case against Google would more likely succeed, though it would still present challenges. First, and most important, Yelp couldn’t bring the case directly under the law, as AICOA would require the Department of Justice, the Federal Trade Commission, or a state attorney general to bring a claim. Yelp could still bring private litigation, and perhaps having this law on the books may persuade courts to recognize a self- preferencing claim, but it would not be able to bring an AICOA claim. Second, under AICOA, a plaintiff could largely ignore any discussion of monopoly power. Monopoly power is difficult to demonstrate, and it is extremely costly to adjudicate at trial for all parties involved. It is, however, a critical part to the competition analysis: If a firm lacks the power to profitably raise prices or exclude rivals, it is unlikely that the firm’s behavior would harm competition regardless of how it acts, as alternatives exist and business would go elsewhere. Instead, under AICOA, Google would essentially already be found to have that power, forgoing any analysis of market structure and restrictions on behavior, and would hold instead that the firm is large enough for the courts to be concerned. AMERICANACTIONFORUM.ORG Third, AICOA specifically prohibits self-preferencing, a theory largely not recognized by courts in the United States as described above. Though the legislation includes language about materially harming competition, courts would have flexibility in interpreting that provision. It could simply be a rule of reason analysis in which the court weighs the procompetitive justifications against the anticompetitive harms, but it could also mean that there is some harm to the competitive process, regardless of whether there are procompetitive justifications or even on the net a benefit to competition. Similarly, the legislation would allow defendants to argue an affirmative defense that the conduct was “reasonably tailored and reasonably necessary…to maintain or substantially enhance the core functionality of the covered platform,” but affirmative defenses mean that the defendant has already been found in violation of the law and have the burden of proving by a preponderance of the evidence that the defense applies. In other words, it would be up to the defendant to prove that that the conduct was reasonably tailored and reasonably necessary. This is similar to the burden-shifting analysis under the current anticompetitive conduct element of Section 2 claims – but by requiring the defendant prove that the conduct would “substantially” enhance the core functionality of a product, a firm like Google would have a more difficult time arguing the procompetitive case for conduct that led to vertical integration.","[Respond using only the available context. Do not use dictionaries, internal knowledge, or any other resource. If the query is not answerable using the available context, respond with ""Sorry, I dunno :("".] Context: [Yelp’s Self-preferencing Claims AMERICANACTIONFORUM.ORG Yelp brought its lawsuit against Google largely alleging a violation of Section 2 of the Sherman Act, which prohibits the illegal monopolization of a market. To succeed on a Section 2 illegal monopolization claim, a plaintiff must show two elements: 1) that the defendant had monopoly power in a relevant market, and 2) that the firm illegally acquired or maintained that monopoly power using anticompetitive means. While Yelp alleges a few different theories in the case, this paper focuses on the claim that Google is using monopoly power in the general search market to self-preference local search offerings at the expense of rivals such as Yelp. Element 1: Monopoly Power First, Yelp must show that Google has monopoly power in a relevant market. For the type of conduct at issue in this case, Yelp would likely need to show that Google both has monopoly power in the general search market and uses that monopoly power to attempt to monopolize the more specific local search market. The timing of this lawsuit is not a coincidence. In July, the DOJ won its case arguing that Google had illegally monopolized the general search market through the use of default search engine agreements with browsers and smartphone manufacturers. While that specific conduct isn’t at issue here, Yelp will almost certainly point to the finding that Google does, in fact, have monopoly power in general search. This provides Yelp with a strong foundation for its case, and if a court accepts Yelp’s argument, Yelp would simply need to show either that Google has monopoly power in the local search market or that Google has sufficient market power to pose a dangerous probability of monopolizing that market. Yelp’s case isn’t clear cut, however. First, the decision in the DOJ case is not binding here because Yelp is suing in a different jurisdiction, though a district court opinion from another jurisdiction may be a persuasive authority. Even if the judge in the Yelp case defers to the D.C. decision, the D.C. decision largely dismissed arguments about generative AI being a viable alternative to the traditional search engine because, at the time of discovery, the technology didn’t exist commercially. Within the past two years, tools that offer similar search functionality such as ChatGPT have grown significantly, providing an alternative to Google’s general search product and restricting Google’s ability to act as a monopolist. Second, Google will undoubtedly argue that local search is not distinct from general search. Element 2: Anticompetitive Conduct In addition to monopoly power, Yelp will need to show that Google could acquire that monopoly power in the local search market through “willful acquisition…as distinguished from growth or development as a consequence of a superior product, business acumen, or historic accident.” At the core of the complaint, Yelp alleges that “Google has degraded quality, demoted rivals, and grown its monopoly power by (1) inserting Google’s own vertical search results at the top of its horizontal search results page to divert user attention away from organic search results and (2) excluding rivals and their vertical content from that prime placement in the vertical search sections that populate the top of the [search engine results page].” This argument relies on what is known as “self-preferencing,” a legal theory that has become popular in European competition law in recent years, but is largely dismissed by U.S. courts. Courts in the United States have found that even firms with monopoly power generally have no duty to deal with their rivals, as firms AMERICANACTIONFORUM.ORG should be able to choose how they offer their products and services to better compete on the merits. Some tying arrangements can violate the law, but tying arguments generally require a firm to tie the purchase of a product in a market in which the firm has monopoly power to the purchase of a product in another market in which the firm does not have monopoly power. Yet as antitrust scholar Herbert Hovenkamp has explained, these types of tying agreements do not usually reach mere preferential ordering of goods that falls short of prohibitions on dealing. The reason courts generally don’t recognize self-preferencing as a viable theory of harm under the law is because firms use these displays to compete on the merits. If a customer searches for “best local lunch spots near me,” for example, Yelp would still be the top general search result on the website, though Google Places appears at the top of the result with a direct list of restaurants, their reviews, and their locations. Google, by incorporating its own vertical products, provides the user with immediate suggestions to the question, a tool to see how individuals rate the restaurants, and a map to see how far away they are. And if users want a more detailed local search option, they can simply click on the Yelp link right below the vertical offerings. Courts tend to prefer to give firms freedom to design their products as they see fit, largely due to concerns that mandating specific designs could negatively affect competition and consumers. AICOA in an Alternate Universe The American Innovation and Choice Online Act specifically targets the kind of conduct at issue here. First, the bill would designate large technology platforms like Google as covered platforms. Second, the bill would make it illegal to “preference the products, services, or lines of business of the covered platform operator over those of another business user on the covered platform in a manner that would materially harm competition,” along with a variety of other restrictions on harming smaller competitors. Under AICOA, a case against Google would more likely succeed, though it would still present challenges. First, and most important, Yelp couldn’t bring the case directly under the law, as AICOA would require the Department of Justice, the Federal Trade Commission, or a state attorney general to bring a claim. Yelp could still bring private litigation, and perhaps having this law on the books may persuade courts to recognize a self- preferencing claim, but it would not be able to bring an AICOA claim. Second, under AICOA, a plaintiff could largely ignore any discussion of monopoly power. Monopoly power is difficult to demonstrate, and it is extremely costly to adjudicate at trial for all parties involved. It is, however, a critical part to the competition analysis: If a firm lacks the power to profitably raise prices or exclude rivals, it is unlikely that the firm’s behavior would harm competition regardless of how it acts, as alternatives exist and business would go elsewhere. Instead, under AICOA, Google would essentially already be found to have that power, forgoing any analysis of market structure and restrictions on behavior, and would hold instead that the firm is large enough for the courts to be concerned. AMERICANACTIONFORUM.ORG Third, AICOA specifically prohibits self-preferencing, a theory largely not recognized by courts in the United States as described above. Though the legislation includes language about materially harming competition, courts would have flexibility in interpreting that provision. It could simply be a rule of reason analysis in which the court weighs the procompetitive justifications against the anticompetitive harms, but it could also mean that there is some harm to the competitive process, regardless of whether there are procompetitive justifications or even on the net a benefit to competition. Similarly, the legislation would allow defendants to argue an affirmative defense that the conduct was “reasonably tailored and reasonably necessary…to maintain or substantially enhance the core functionality of the covered platform,” but affirmative defenses mean that the defendant has already been found in violation of the law and have the burden of proving by a preponderance of the evidence that the defense applies. In other words, it would be up to the defendant to prove that that the conduct was reasonably tailored and reasonably necessary. This is similar to the burden-shifting analysis under the current anticompetitive conduct element of Section 2 claims – but by requiring the defendant prove that the conduct would “substantially” enhance the core functionality of a product, a firm like Google would have a more difficult time arguing the procompetitive case for conduct that led to vertical integration.] User query: [I don't really understand this. What is AICOA and how is it different from monopoly and Sherman and stuff?]","Respond using only the available context. Do not use dictionaries, internal knowledge, or any other resource. If the query is not answerable using the available context, respond with ""Sorry, I dunno :("".
+
+EVIDENCE:
+Yelp’s Self-preferencing Claims AMERICANACTIONFORUM.ORG Yelp brought its lawsuit against Google largely alleging a violation of Section 2 of the Sherman Act, which prohibits the illegal monopolization of a market. To succeed on a Section 2 illegal monopolization claim, a plaintiff must show two elements: 1) that the defendant had monopoly power in a relevant market, and 2) that the firm illegally acquired or maintained that monopoly power using anticompetitive means. While Yelp alleges a few different theories in the case, this paper focuses on the claim that Google is using monopoly power in the general search market to self-preference local search offerings at the expense of rivals such as Yelp. Element 1: Monopoly Power First, Yelp must show that Google has monopoly power in a relevant market. For the type of conduct at issue in this case, Yelp would likely need to show that Google both has monopoly power in the general search market and uses that monopoly power to attempt to monopolize the more specific local search market. The timing of this lawsuit is not a coincidence. In July, the DOJ won its case arguing that Google had illegally monopolized the general search market through the use of default search engine agreements with browsers and smartphone manufacturers. While that specific conduct isn’t at issue here, Yelp will almost certainly point to the finding that Google does, in fact, have monopoly power in general search. This provides Yelp with a strong foundation for its case, and if a court accepts Yelp’s argument, Yelp would simply need to show either that Google has monopoly power in the local search market or that Google has sufficient market power to pose a dangerous probability of monopolizing that market. Yelp’s case isn’t clear cut, however. First, the decision in the DOJ case is not binding here because Yelp is suing in a different jurisdiction, though a district court opinion from another jurisdiction may be a persuasive authority. Even if the judge in the Yelp case defers to the D.C. decision, the D.C. decision largely dismissed arguments about generative AI being a viable alternative to the traditional search engine because, at the time of discovery, the technology didn’t exist commercially. Within the past two years, tools that offer similar search functionality such as ChatGPT have grown significantly, providing an alternative to Google’s general search product and restricting Google’s ability to act as a monopolist. Second, Google will undoubtedly argue that local search is not distinct from general search. Element 2: Anticompetitive Conduct In addition to monopoly power, Yelp will need to show that Google could acquire that monopoly power in the local search market through “willful acquisition…as distinguished from growth or development as a consequence of a superior product, business acumen, or historic accident.” At the core of the complaint, Yelp alleges that “Google has degraded quality, demoted rivals, and grown its monopoly power by (1) inserting Google’s own vertical search results at the top of its horizontal search results page to divert user attention away from organic search results and (2) excluding rivals and their vertical content from that prime placement in the vertical search sections that populate the top of the [search engine results page].” This argument relies on what is known as “self-preferencing,” a legal theory that has become popular in European competition law in recent years, but is largely dismissed by U.S. courts. Courts in the United States have found that even firms with monopoly power generally have no duty to deal with their rivals, as firms AMERICANACTIONFORUM.ORG should be able to choose how they offer their products and services to better compete on the merits. Some tying arrangements can violate the law, but tying arguments generally require a firm to tie the purchase of a product in a market in which the firm has monopoly power to the purchase of a product in another market in which the firm does not have monopoly power. Yet as antitrust scholar Herbert Hovenkamp has explained, these types of tying agreements do not usually reach mere preferential ordering of goods that falls short of prohibitions on dealing. The reason courts generally don’t recognize self-preferencing as a viable theory of harm under the law is because firms use these displays to compete on the merits. If a customer searches for “best local lunch spots near me,” for example, Yelp would still be the top general search result on the website, though Google Places appears at the top of the result with a direct list of restaurants, their reviews, and their locations. Google, by incorporating its own vertical products, provides the user with immediate suggestions to the question, a tool to see how individuals rate the restaurants, and a map to see how far away they are. And if users want a more detailed local search option, they can simply click on the Yelp link right below the vertical offerings. Courts tend to prefer to give firms freedom to design their products as they see fit, largely due to concerns that mandating specific designs could negatively affect competition and consumers. AICOA in an Alternate Universe The American Innovation and Choice Online Act specifically targets the kind of conduct at issue here. First, the bill would designate large technology platforms like Google as covered platforms. Second, the bill would make it illegal to “preference the products, services, or lines of business of the covered platform operator over those of another business user on the covered platform in a manner that would materially harm competition,” along with a variety of other restrictions on harming smaller competitors. Under AICOA, a case against Google would more likely succeed, though it would still present challenges. First, and most important, Yelp couldn’t bring the case directly under the law, as AICOA would require the Department of Justice, the Federal Trade Commission, or a state attorney general to bring a claim. Yelp could still bring private litigation, and perhaps having this law on the books may persuade courts to recognize a self- preferencing claim, but it would not be able to bring an AICOA claim. Second, under AICOA, a plaintiff could largely ignore any discussion of monopoly power. Monopoly power is difficult to demonstrate, and it is extremely costly to adjudicate at trial for all parties involved. It is, however, a critical part to the competition analysis: If a firm lacks the power to profitably raise prices or exclude rivals, it is unlikely that the firm’s behavior would harm competition regardless of how it acts, as alternatives exist and business would go elsewhere. Instead, under AICOA, Google would essentially already be found to have that power, forgoing any analysis of market structure and restrictions on behavior, and would hold instead that the firm is large enough for the courts to be concerned. AMERICANACTIONFORUM.ORG Third, AICOA specifically prohibits self-preferencing, a theory largely not recognized by courts in the United States as described above. Though the legislation includes language about materially harming competition, courts would have flexibility in interpreting that provision. It could simply be a rule of reason analysis in which the court weighs the procompetitive justifications against the anticompetitive harms, but it could also mean that there is some harm to the competitive process, regardless of whether there are procompetitive justifications or even on the net a benefit to competition. Similarly, the legislation would allow defendants to argue an affirmative defense that the conduct was “reasonably tailored and reasonably necessary…to maintain or substantially enhance the core functionality of the covered platform,” but affirmative defenses mean that the defendant has already been found in violation of the law and have the burden of proving by a preponderance of the evidence that the defense applies. In other words, it would be up to the defendant to prove that that the conduct was reasonably tailored and reasonably necessary. This is similar to the burden-shifting analysis under the current anticompetitive conduct element of Section 2 claims – but by requiring the defendant prove that the conduct would “substantially” enhance the core functionality of a product, a firm like Google would have a more difficult time arguing the procompetitive case for conduct that led to vertical integration.
+
+USER:
+I don't really understand this. What is AICOA and how is it different from monopoly and Sherman and stuff?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,32,19,1359,,304
+Base your entire response on the document I gave you. I need to know the absolute basic information about what is being said here.,Summarize the Annual Report.,"section should be read in conjunction with the Consolidated Financial Statements and accompanying notes thereto included in Item 8 of this Annual Report on Form 10-K. Overview Timberland Bancorp, Inc., a Washington corporation, is the holding company for Timberland Bank. The Bank opened for business in 1915 and serves consumers and businesses across Grays Harbor, Thurston, Pierce, King, Kitsap and Lewis counties, Washington with a full range of lending and deposit services through its 23 branches (including its main office in Hoquiam). At September 30, 2022, the Company had total assets of $1.86 billion, net loans receivable of $1.13 billion, total deposits of $1.63 billion and total shareholders’ equity of $218.57 million. The Company’s business activities generally are limited to passive investment activities and oversight of its investment in the Bank. Accordingly, the information set forth in this report relates primarily to the Bank’s operations. The Bank is a community-oriented bank which has traditionally offered a variety of savings products to its retail and business customers while concentrating its lending activities on real estate secured loans. Lending activities have been focused primarily on the origination of loans secured by real estate, including residential construction loans, one- to four-family residential loans, multi-family loans and commercial real estate loans. The Bank originates adjustable-rate residential mortgage loans, some of which do not qualify for sale in the secondary market. The Bank also originates commercial business loans and other consumer loans. The profitability of the Company’s operations depends primarily on its net interest income after provision for (recapture of) loan losses. Net interest income is the difference between interest income, which is the income that the Company earns on interest-earning assets, which are primarily loans and investments, and interest expense, which is the amount that the Company pays on its interest-bearing liabilities, which are primarily deposits and borrowings (as needed). Net interest income is affected by changes in the volume and mix of interest-earning assets, the interest earned on those assets, the volume and mix of interest-bearing liabilities and the interest paid on those interest-bearing liabilities. Management attempts to maintain a net interest margin placing it within the top quartile of its Washington State peers. Changes in market interest rates, the slope of the yield curve, and interest we earn on interest earning assets or pay on interest bearing liabilities, as well as the volume and types of interest earning assets, interest bearing and non-interest bearing liabilities and shareholders’ equity, usually have the largest impact on changes in our net interest spread, net interest margin and net interest income during a reporting period. Since March 2022, in response to inflation, the FOMC of the Federal Reserve has increased the target range for the federal funds rate by 300 basis points, including 150 basis points during the third calendar calendar quarter of 2022, to a range of 3.00% to 3.25% as of September 30, 2022. In November 2022, the FOMC increased the target range for the federal funds rate another 75 basis points to a range of 3.75% to 4.00%. We believe our balance sheet is structured to enhance our average yield on interest-earning assets as the lagging benefit of variable rate interest-earnings assets beginning to reprice occurs as well as a higher net interest margin if the FOMC continues to raise the targeted federal funds rate in an effort to curb inflation, which appears likely based on recent Federal Reserve communications and interest rate forecasts. The provision for (recapture of) loan losses is dependent on changes in the loan portfolio and management’s assessment of the collectability of the loan portfolio as well as prevailing economic and market conditions. The allowance for loan losses reflects the amount that the Company believes is adequate to cover probable credit losses inherent in its loan portfolio. The Company recorded a provision for loan losses of $270,000 for the year ended September 30, 2022, primarily due to increased loan portfolio growth. The Company did not record a provision for loan losses for the year ended September 30, 2021, primarily reflecting the improving economy and the resulting decline in forecasted probable loan losses from COVID-19 during that fiscal year. Net income is also affected by non-interest income and non-interest expense. For the year ended September 30, 2022, non-interest income consisted primarily of service charges on deposit accounts, gain on sales of loans, ATM and debit card interchange transaction fees, an increase in the cash surrender value of BOLI, escrow fees and other operating income. Noninterest income is also increased by net recoveries on investment securities and reduced by net OTTI losses on investment securities, if any. Non-interest income is also decreased by valuation allowances on loan servicing rights and increased by recoveries of valuation allowances on loan servicing rights, if any. Non-interest expense consisted primarily of salaries and employee benefits, premises and equipment, advertising, ATM and debit card interchange transaction fees, postage and courier expenses, amortization of CDI, state and local taxes, professional fees, FDIC insurance premiums, loan administration and foreclosure expenses, data processing and telecommunications expenses, deposit operation expenses and other non-interest expenses. Non-interest expense in certain periods are reduced by gains on the sale of premises and equipment and by gains on the sale of OREO. Non-interest income and non-interest expense are affected by the growth of the Company's operations and growth in the number and balances of loan and deposit accounts. 51 Results of operations may be affected significantly by general and local economic and competitive conditions, changes in market interest rates, governmental policies and actions of regulatory authorities. Operating Strategy The Company is a bank holding company which operates primarily through its subsidiary, the Bank. The Company's primary objective is to operate the Bank as a well capitalized, profitable, independent, community-oriented financial institution, serving customers in its primary market area of Grays Harbor, Pierce, Thurston, Kitsap, King and Lewis counties. The Company's strategy is to provide products and superior service to small businesses and individuals located in its primary market area. The Company's goal is to deliver returns to shareholders by focusing on the origination of higher-yielding assets (in particular, commercial real estate, construction, and commercial business loans), increasing core deposit balances, managing problem assets, efficiently managing expenses, and seeking expansion opportunities. The Company seeks to achieve these results by focusing on the following objectives: Expand our presence within our existing market areas by capturing opportunities resulting from changes in the competitive environment. We currently conduct our business primarily in western Washington. We have a community bank strategy that emphasizes responsive and personalized service to our customers. As a result of the consolidation of banks in our market areas, we believe that there is an opportunity for a community and customer focused bank to expand its customer base. By offering timely decision making, delivering appropriate banking products and services, and providing customer access to our senior managers, we believe that community banks, such as Timberland Bank, can distinguish themselves from larger banks operating in our market areas. We believe that we have a significant opportunity to attract additional borrowers and depositors and expand our market presence and market share within our extensive branch footprint. Portfolio diversification. In recent years, we have limited the origination of speculative construction loans and land development loans in favor of loans that possess credit profiles representing less risk to the Bank. We continue originating owner/builder and custom construction loans, multi-family loans, commercial business loans and commercial real estate loans which offer higher risk adjusted returns, shorter maturities and more sensitivity to interest rate fluctuations than fixed-rate oneto four-family loans. We anticipate capturing more of each customer's banking relationship by cross selling our loan and deposit products and offering additional services to our customers. Increase core deposits and other retail deposit products. We focus on establishing a total banking relationship with our customers with the intent of internally funding our loan portfolio. We anticipate that the continued focus on customer relationships will increase our level of core deposits. In addition to our retail branches, we maintain technology based products such as business cash management and a business remote deposit product that enable us to compete effectively with banks of all sizes. Managing exposure to fluctuating interest rates. For many years, the majority of the loans the Bank has retained in its portfolio have generally possessed periodic interest rate adjustment features or have been relatively short-term in nature. Loans originated for portfolio retention have generally included ARM loans, short-term construction loans, and, to a lesser extent, commercial business loans with interest rates tied to a market index such as the Prime Rate. Longer term fixed-rate mortgage loans have generally been originated for sale into the secondary market, although from time to time, the Bank may retain a portion of its fixed-rate mortgage loan originations and extend the initial fixed-rate period of its hybrid ARM commercial real estate loans for asset/liability purposes. Continue generating revenues through mortgage banking operations. The majority of the fixed-rate residential mortgage loans we originate have historically been sold into the secondary market with servicing retained. This strategy produces gains on the sale of such loans and reduces the interest rate and credit risk associated with fixed-rate residential lending. We continue to originate custom construction and owner/builder construction loans for sale into the secondary market upon the completion of construction. Maintaining strong asset quality. We believe that strong asset quality is a key to our long-term financial success. The percentage of non-performing loans to loans receivable, net was 0.18% and 0.29% at September 30, 2022 and 2021, respectively. The Company's percentage of non-performing assets to total assets at September 30, 2022 was 0.12% compared to 0.18% at September 30, 2021. Non-performing assets have decreased to $2.17 million at September 30, 2022 from $3.17 million at September 30, 2021. We continue to seek to reduce the level of non-performing assets through collections, writedowns, modifications and sales of OREO. We also take proactive steps to resolve our non-performing loans, including negotiating payment plans, forbearances, loan modifications and loan extensions and accepting short payoffs on delinquent loans when such actions have been deemed appropriate. Although the Company plans to continue to place emphasis on certain 52","Base your entire response on the document I gave you. I need to know the absolute basic information about what is being said here. Summarize the Annual Report. section should be read in conjunction with the Consolidated Financial Statements and accompanying notes thereto included in Item 8 of this Annual Report on Form 10-K. Overview Timberland Bancorp, Inc., a Washington corporation, is the holding company for Timberland Bank. The Bank opened for business in 1915 and serves consumers and businesses across Grays Harbor, Thurston, Pierce, King, Kitsap and Lewis counties, Washington with a full range of lending and deposit services through its 23 branches (including its main office in Hoquiam). At September 30, 2022, the Company had total assets of $1.86 billion, net loans receivable of $1.13 billion, total deposits of $1.63 billion and total shareholders’ equity of $218.57 million. The Company’s business activities generally are limited to passive investment activities and oversight of its investment in the Bank. Accordingly, the information set forth in this report relates primarily to the Bank’s operations. The Bank is a community-oriented bank which has traditionally offered a variety of savings products to its retail and business customers while concentrating its lending activities on real estate secured loans. Lending activities have been focused primarily on the origination of loans secured by real estate, including residential construction loans, one- to four-family residential loans, multi-family loans and commercial real estate loans. The Bank originates adjustable-rate residential mortgage loans, some of which do not qualify for sale in the secondary market. The Bank also originates commercial business loans and other consumer loans. The profitability of the Company’s operations depends primarily on its net interest income after provision for (recapture of) loan losses. Net interest income is the difference between interest income, which is the income that the Company earns on interest-earning assets, which are primarily loans and investments, and interest expense, which is the amount that the Company pays on its interest-bearing liabilities, which are primarily deposits and borrowings (as needed). Net interest income is affected by changes in the volume and mix of interest-earning assets, the interest earned on those assets, the volume and mix of interest-bearing liabilities and the interest paid on those interest-bearing liabilities. Management attempts to maintain a net interest margin placing it within the top quartile of its Washington State peers. Changes in market interest rates, the slope of the yield curve, and interest we earn on interest earning assets or pay on interest bearing liabilities, as well as the volume and types of interest earning assets, interest bearing and non-interest bearing liabilities and shareholders’ equity, usually have the largest impact on changes in our net interest spread, net interest margin and net interest income during a reporting period. Since March 2022, in response to inflation, the FOMC of the Federal Reserve has increased the target range for the federal funds rate by 300 basis points, including 150 basis points during the third calendar calendar quarter of 2022, to a range of 3.00% to 3.25% as of September 30, 2022. In November 2022, the FOMC increased the target range for the federal funds rate another 75 basis points to a range of 3.75% to 4.00%. We believe our balance sheet is structured to enhance our average yield on interest-earning assets as the lagging benefit of variable rate interest-earnings assets beginning to reprice occurs as well as a higher net interest margin if the FOMC continues to raise the targeted federal funds rate in an effort to curb inflation, which appears likely based on recent Federal Reserve communications and interest rate forecasts. The provision for (recapture of) loan losses is dependent on changes in the loan portfolio and management’s assessment of the collectability of the loan portfolio as well as prevailing economic and market conditions. The allowance for loan losses reflects the amount that the Company believes is adequate to cover probable credit losses inherent in its loan portfolio. The Company recorded a provision for loan losses of $270,000 for the year ended September 30, 2022, primarily due to increased loan portfolio growth. The Company did not record a provision for loan losses for the year ended September 30, 2021, primarily reflecting the improving economy and the resulting decline in forecasted probable loan losses from COVID-19 during that fiscal year. Net income is also affected by non-interest income and non-interest expense. For the year ended September 30, 2022, non-interest income consisted primarily of service charges on deposit accounts, gain on sales of loans, ATM and debit card interchange transaction fees, an increase in the cash surrender value of BOLI, escrow fees and other operating income. Noninterest income is also increased by net recoveries on investment securities and reduced by net OTTI losses on investment securities, if any. Non-interest income is also decreased by valuation allowances on loan servicing rights and increased by recoveries of valuation allowances on loan servicing rights, if any. Non-interest expense consisted primarily of salaries and employee benefits, premises and equipment, advertising, ATM and debit card interchange transaction fees, postage and courier expenses, amortization of CDI, state and local taxes, professional fees, FDIC insurance premiums, loan administration and foreclosure expenses, data processing and telecommunications expenses, deposit operation expenses and other non-interest expenses. Non-interest expense in certain periods are reduced by gains on the sale of premises and equipment and by gains on the sale of OREO. Non-interest income and non-interest expense are affected by the growth of the Company's operations and growth in the number and balances of loan and deposit accounts. 51 Results of operations may be affected significantly by general and local economic and competitive conditions, changes in market interest rates, governmental policies and actions of regulatory authorities. Operating Strategy The Company is a bank holding company which operates primarily through its subsidiary, the Bank. The Company's primary objective is to operate the Bank as a well capitalized, profitable, independent, community-oriented financial institution, serving customers in its primary market area of Grays Harbor, Pierce, Thurston, Kitsap, King and Lewis counties. The Company's strategy is to provide products and superior service to small businesses and individuals located in its primary market area. The Company's goal is to deliver returns to shareholders by focusing on the origination of higher-yielding assets (in particular, commercial real estate, construction, and commercial business loans), increasing core deposit balances, managing problem assets, efficiently managing expenses, and seeking expansion opportunities. The Company seeks to achieve these results by focusing on the following objectives: Expand our presence within our existing market areas by capturing opportunities resulting from changes in the competitive environment. We currently conduct our business primarily in western Washington. We have a community bank strategy that emphasizes responsive and personalized service to our customers. As a result of the consolidation of banks in our market areas, we believe that there is an opportunity for a community and customer focused bank to expand its customer base. By offering timely decision making, delivering appropriate banking products and services, and providing customer access to our senior managers, we believe that community banks, such as Timberland Bank, can distinguish themselves from larger banks operating in our market areas. We believe that we have a significant opportunity to attract additional borrowers and depositors and expand our market presence and market share within our extensive branch footprint. Portfolio diversification. In recent years, we have limited the origination of speculative construction loans and land development loans in favor of loans that possess credit profiles representing less risk to the Bank. We continue originating owner/builder and custom construction loans, multi-family loans, commercial business loans and commercial real estate loans which offer higher risk adjusted returns, shorter maturities and more sensitivity to interest rate fluctuations than fixed-rate oneto four-family loans. We anticipate capturing more of each customer's banking relationship by cross selling our loan and deposit products and offering additional services to our customers. Increase core deposits and other retail deposit products. We focus on establishing a total banking relationship with our customers with the intent of internally funding our loan portfolio. We anticipate that the continued focus on customer relationships will increase our level of core deposits. In addition to our retail branches, we maintain technology based products such as business cash management and a business remote deposit product that enable us to compete effectively with banks of all sizes. Managing exposure to fluctuating interest rates. For many years, the majority of the loans the Bank has retained in its portfolio have generally possessed periodic interest rate adjustment features or have been relatively short-term in nature. Loans originated for portfolio retention have generally included ARM loans, short-term construction loans, and, to a lesser extent, commercial business loans with interest rates tied to a market index such as the Prime Rate. Longer term fixed-rate mortgage loans have generally been originated for sale into the secondary market, although from time to time, the Bank may retain a portion of its fixed-rate mortgage loan originations and extend the initial fixed-rate period of its hybrid ARM commercial real estate loans for asset/liability purposes. Continue generating revenues through mortgage banking operations. The majority of the fixed-rate residential mortgage loans we originate have historically been sold into the secondary market with servicing retained. This strategy produces gains on the sale of such loans and reduces the interest rate and credit risk associated with fixed-rate residential lending. We continue to originate custom construction and owner/builder construction loans for sale into the secondary market upon the completion of construction. Maintaining strong asset quality. We believe that strong asset quality is a key to our long-term financial success. The percentage of non-performing loans to loans receivable, net was 0.18% and 0.29% at September 30, 2022 and 2021, respectively. The Company's percentage of non-performing assets to total assets at September 30, 2022 was 0.12% compared to 0.18% at September 30, 2021. Non-performing assets have decreased to $2.17 million at September 30, 2022 from $3.17 million at September 30, 2021. We continue to seek to reduce the level of non-performing assets through collections, writedowns, modifications and sales of OREO. We also take proactive steps to resolve our non-performing loans, including negotiating payment plans, forbearances, loan modifications and loan extensions and accepting short payoffs on delinquent loans when such actions have been deemed appropriate. Although the Company plans to continue to place emphasis on certain 52","Base your entire response on the document I gave you. I need to know the absolute basic information about what is being said here.
+
+EVIDENCE:
+section should be read in conjunction with the Consolidated Financial Statements and accompanying notes thereto included in Item 8 of this Annual Report on Form 10-K. Overview Timberland Bancorp, Inc., a Washington corporation, is the holding company for Timberland Bank. The Bank opened for business in 1915 and serves consumers and businesses across Grays Harbor, Thurston, Pierce, King, Kitsap and Lewis counties, Washington with a full range of lending and deposit services through its 23 branches (including its main office in Hoquiam). At September 30, 2022, the Company had total assets of $1.86 billion, net loans receivable of $1.13 billion, total deposits of $1.63 billion and total shareholders’ equity of $218.57 million. The Company’s business activities generally are limited to passive investment activities and oversight of its investment in the Bank. Accordingly, the information set forth in this report relates primarily to the Bank’s operations. The Bank is a community-oriented bank which has traditionally offered a variety of savings products to its retail and business customers while concentrating its lending activities on real estate secured loans. Lending activities have been focused primarily on the origination of loans secured by real estate, including residential construction loans, one- to four-family residential loans, multi-family loans and commercial real estate loans. The Bank originates adjustable-rate residential mortgage loans, some of which do not qualify for sale in the secondary market. The Bank also originates commercial business loans and other consumer loans. The profitability of the Company’s operations depends primarily on its net interest income after provision for (recapture of) loan losses. Net interest income is the difference between interest income, which is the income that the Company earns on interest-earning assets, which are primarily loans and investments, and interest expense, which is the amount that the Company pays on its interest-bearing liabilities, which are primarily deposits and borrowings (as needed). Net interest income is affected by changes in the volume and mix of interest-earning assets, the interest earned on those assets, the volume and mix of interest-bearing liabilities and the interest paid on those interest-bearing liabilities. Management attempts to maintain a net interest margin placing it within the top quartile of its Washington State peers. Changes in market interest rates, the slope of the yield curve, and interest we earn on interest earning assets or pay on interest bearing liabilities, as well as the volume and types of interest earning assets, interest bearing and non-interest bearing liabilities and shareholders’ equity, usually have the largest impact on changes in our net interest spread, net interest margin and net interest income during a reporting period. Since March 2022, in response to inflation, the FOMC of the Federal Reserve has increased the target range for the federal funds rate by 300 basis points, including 150 basis points during the third calendar calendar quarter of 2022, to a range of 3.00% to 3.25% as of September 30, 2022. In November 2022, the FOMC increased the target range for the federal funds rate another 75 basis points to a range of 3.75% to 4.00%. We believe our balance sheet is structured to enhance our average yield on interest-earning assets as the lagging benefit of variable rate interest-earnings assets beginning to reprice occurs as well as a higher net interest margin if the FOMC continues to raise the targeted federal funds rate in an effort to curb inflation, which appears likely based on recent Federal Reserve communications and interest rate forecasts. The provision for (recapture of) loan losses is dependent on changes in the loan portfolio and management’s assessment of the collectability of the loan portfolio as well as prevailing economic and market conditions. The allowance for loan losses reflects the amount that the Company believes is adequate to cover probable credit losses inherent in its loan portfolio. The Company recorded a provision for loan losses of $270,000 for the year ended September 30, 2022, primarily due to increased loan portfolio growth. The Company did not record a provision for loan losses for the year ended September 30, 2021, primarily reflecting the improving economy and the resulting decline in forecasted probable loan losses from COVID-19 during that fiscal year. Net income is also affected by non-interest income and non-interest expense. For the year ended September 30, 2022, non-interest income consisted primarily of service charges on deposit accounts, gain on sales of loans, ATM and debit card interchange transaction fees, an increase in the cash surrender value of BOLI, escrow fees and other operating income. Noninterest income is also increased by net recoveries on investment securities and reduced by net OTTI losses on investment securities, if any. Non-interest income is also decreased by valuation allowances on loan servicing rights and increased by recoveries of valuation allowances on loan servicing rights, if any. Non-interest expense consisted primarily of salaries and employee benefits, premises and equipment, advertising, ATM and debit card interchange transaction fees, postage and courier expenses, amortization of CDI, state and local taxes, professional fees, FDIC insurance premiums, loan administration and foreclosure expenses, data processing and telecommunications expenses, deposit operation expenses and other non-interest expenses. Non-interest expense in certain periods are reduced by gains on the sale of premises and equipment and by gains on the sale of OREO. Non-interest income and non-interest expense are affected by the growth of the Company's operations and growth in the number and balances of loan and deposit accounts. 51 Results of operations may be affected significantly by general and local economic and competitive conditions, changes in market interest rates, governmental policies and actions of regulatory authorities. Operating Strategy The Company is a bank holding company which operates primarily through its subsidiary, the Bank. The Company's primary objective is to operate the Bank as a well capitalized, profitable, independent, community-oriented financial institution, serving customers in its primary market area of Grays Harbor, Pierce, Thurston, Kitsap, King and Lewis counties. The Company's strategy is to provide products and superior service to small businesses and individuals located in its primary market area. The Company's goal is to deliver returns to shareholders by focusing on the origination of higher-yielding assets (in particular, commercial real estate, construction, and commercial business loans), increasing core deposit balances, managing problem assets, efficiently managing expenses, and seeking expansion opportunities. The Company seeks to achieve these results by focusing on the following objectives: Expand our presence within our existing market areas by capturing opportunities resulting from changes in the competitive environment. We currently conduct our business primarily in western Washington. We have a community bank strategy that emphasizes responsive and personalized service to our customers. As a result of the consolidation of banks in our market areas, we believe that there is an opportunity for a community and customer focused bank to expand its customer base. By offering timely decision making, delivering appropriate banking products and services, and providing customer access to our senior managers, we believe that community banks, such as Timberland Bank, can distinguish themselves from larger banks operating in our market areas. We believe that we have a significant opportunity to attract additional borrowers and depositors and expand our market presence and market share within our extensive branch footprint. Portfolio diversification. In recent years, we have limited the origination of speculative construction loans and land development loans in favor of loans that possess credit profiles representing less risk to the Bank. We continue originating owner/builder and custom construction loans, multi-family loans, commercial business loans and commercial real estate loans which offer higher risk adjusted returns, shorter maturities and more sensitivity to interest rate fluctuations than fixed-rate oneto four-family loans. We anticipate capturing more of each customer's banking relationship by cross selling our loan and deposit products and offering additional services to our customers. Increase core deposits and other retail deposit products. We focus on establishing a total banking relationship with our customers with the intent of internally funding our loan portfolio. We anticipate that the continued focus on customer relationships will increase our level of core deposits. In addition to our retail branches, we maintain technology based products such as business cash management and a business remote deposit product that enable us to compete effectively with banks of all sizes. Managing exposure to fluctuating interest rates. For many years, the majority of the loans the Bank has retained in its portfolio have generally possessed periodic interest rate adjustment features or have been relatively short-term in nature. Loans originated for portfolio retention have generally included ARM loans, short-term construction loans, and, to a lesser extent, commercial business loans with interest rates tied to a market index such as the Prime Rate. Longer term fixed-rate mortgage loans have generally been originated for sale into the secondary market, although from time to time, the Bank may retain a portion of its fixed-rate mortgage loan originations and extend the initial fixed-rate period of its hybrid ARM commercial real estate loans for asset/liability purposes. Continue generating revenues through mortgage banking operations. The majority of the fixed-rate residential mortgage loans we originate have historically been sold into the secondary market with servicing retained. This strategy produces gains on the sale of such loans and reduces the interest rate and credit risk associated with fixed-rate residential lending. We continue to originate custom construction and owner/builder construction loans for sale into the secondary market upon the completion of construction. Maintaining strong asset quality. We believe that strong asset quality is a key to our long-term financial success. The percentage of non-performing loans to loans receivable, net was 0.18% and 0.29% at September 30, 2022 and 2021, respectively. The Company's percentage of non-performing assets to total assets at September 30, 2022 was 0.12% compared to 0.18% at September 30, 2021. Non-performing assets have decreased to $2.17 million at September 30, 2022 from $3.17 million at September 30, 2021. We continue to seek to reduce the level of non-performing assets through collections, writedowns, modifications and sales of OREO. We also take proactive steps to resolve our non-performing loans, including negotiating payment plans, forbearances, loan modifications and loan extensions and accepting short payoffs on delinquent loans when such actions have been deemed appropriate. Although the Company plans to continue to place emphasis on certain 52
+
+USER:
+Summarize the Annual Report.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,24,4,1693,,441
+"Answer questions based only on information provided in the context block. Do not use external resources or any prior knowledge. Give your answer in bullet points, with a brief explanation following each one.",What do I need to be on the lookout for if I'm worried about pre-eclampsia?,"1 Preeclampsia - Topic of the Month J U LY 6 , 2022 What is preeclampsia? Preeclampsia is a life-threatening disorder that most often occurs during pregnancy, although ten percent of cases occur in the postpartum period. The disorder is defined by two major symptoms found after 20 weeks of pregnancy, the most significant is a rapid rise in blood pressure (hypertension) combined with the presence of protein in the urine (proteinuria). For some women, proteinuria does not occur; for these women, preeclampsia is diagnosed as hypertension with thrombocytopenia (low platelet count), impaired liver function, renal insufficiency (poor kidney function), pulmonary edema (excess fluid in the lungs), and/or cerebral or visual disturbances (brain and vision problems). Preeclampsia is just one of the hypertensive disorders that may occur during pregnancy, others include chronic hypertension, gestational hypertension, HELLP syndrome, and eclampsia. Hypertensive disorders during pregnancy result in one of the leading causes of maternal and perinatal mortality worldwide.4 Historically, women and infants of color and American Indian women and their infants are disproportionately affected.3 Shocking statistics3: ▪ Hypertensive disorders affect 4-10% of pregnancies in the US. ▪ Severe hypertension contributes to 9% of maternal deaths in the US. ▪ One-third of severe childbirth complications result from preeclampsia/eclampsia. What are the maternal risks? PREECLAMPSIA - TO PIC O F THE MONTH 2 Preeclampsia puts great stress on the heart and can impair liver and kidney function. There is also a risk of suffering a stroke, seizures, hemorrhaging, multiple organ failure, placenta abruption (placenta separates from wall of uterus), and even maternal and/or infant death. What are the risks to the infant? Preeclampsia may restrict the flow of blood to the placenta, decreasing the oxygen and nutrients the fetus needs to thrive. Lack of these essential components can contribute to low infant birth weight, preterm delivery, and a chance of experiencing a stillbirth. Prematurity is the second leading cause of infant death in Minnesota.3 Infants that are born premature have a higher risk of long-term health and development difficulties. The prevention of preterm birth is critical to supporting infant health, promoting health equity, and controlling healthcare costs.3 WIC Pregnancy Related Risk Codes – refer to Implications for WIC Services 304 History of Preeclampsia 345 Hypertension and Prehypertension What are the warning signs? Preeclampsia typically occurs during the third trimester of pregnancy (after 28 weeks). For the postpartum parent, preeclampsia can occur within 48 hours of delivery or up to six weeks later. Parents who recognize any of these symptoms below should immediately contact their healthcare provider. Common warning signs of preeclampsia: ▪ Persistent headache that gets worse overtime ▪ Any changes in vision such as seeing spots or blurred vision ▪ Sudden and severe swelling in hands or face ▪ Sudden weight gain ▪ Nausea and vomiting in second half of pregnancy ▪ Pain in right upper abdomen or shoulder ▪ Shortness of breath or heavy chest Is preeclampsia preventable? It is not widely understood what causes preeclampsia. For this reason, doctors recommend parents maintain regular prenatal and postnatal visits with their healthcare providers and be vigilant of the signs and symptoms of the condition. Preventative care is the best defense against any pregnancy related hypertensive disorders. Preventative tips: PREECLAMPSIA - TO PIC O F THE MONTH 3 ▪ Attend regular healthcare visits and all prenatal visits ▪ Follow a healthy dietary pattern with regular daily meals and snacks ▪ Aim for an adequate calcium intake. While it is not yet conclusive, when dietary calcium is inadequate, research suggests that adequate calcium intake may help prevent preeclampsia. ▪ Maintain a healthy pre-pregnancy weight and gain appropriately during pregnancy ▪ Stay active with 150 minutes of moderate activity each week ▪ Reduce intake of tobacco products or consider smoking cessation A history of preeclampsia increases the risk of future hypertension, cardiovascular disease, and stroke. The above healthy lifestyle habits can help reduce the risk. Postpartum nutrition education contacts can provide an opportune time to follow up on this. For more information about Hypertensive Disorders of pregnancy: Blood Pressure During Pregnancy- December 14, 2021, Bay State Health Training Opportunity Section 5.3: Nutrition Risk Assessment policy explains the importance for WIC staff to obtain and synthesize information about a participant medical/health/nutrition status to most appropriately individualize WIC services. This includes asking questions that allow for education based on the participant’s concerns and offering referrals when necessary. Using the Pregnant Woman complete question format during the assessment may help you to most accurately determine if there are concerns the participant or their healthcare provider have regarding their medical, health, and/or nutrition. Exercise: 1. Read through the Pregnant Woman complete question format alone or as a group. 2. Discuss with a co-worker or as a group what questions would help identify some of the risk factors for preeclampsia. (HINT: Read through the risk factors above.) 3. What education can you offer to support the health of the at-risk participant? (HINT: Read through the preventative tips above.) Resources 1. Preeclampsia Foundation 2. HEAR HER Campaign -Centerfor Disease Control and Prevention (CDC) 3. Hypertension in Pregnancy -Minnesota Perinatal Quality Collaborative (MNPQC) 4. Hypertension and Preeclampsia in Pregnancy -The American College of Obstetricians and Gynecologists (ACOG) Topic ideas? Share yourfuture topic suggestion with carole.Kelnhofer@state.mn.us. PREECLAMPSIA - TO PIC O F THE MONTH 4 Reference – Complete Listing of Hyperlinks 304 History of Preeclampsia (https://www.health.state.mn.us/docs/people/wic/localagency/nutrition/riskcodes/bioclinmed /304mn.pdf) 345 Hypertension and Prehypertension (https://www.health.state.mn.us/docs/people/wic/localagency/nutrition/riskcodes/bioclinmed /345mn.pdf) Blood Pressure During Pregnancy (https://www.youtube.com/watch?v=Ff061nIXPx0&t=537s) Preeclampsia Foundation (https://www.preeclampsia.org/) HEAR HER Campaign (https://www.cdc.gov/hearher/index.html) Hypertension in Pregnancy (https://minnesotaperinatal.org/hypertension-in-pregnancy/) Hypertension and Preeclampsia in Pregnancy (https://www.acog.org/topics/hypertension-andpreeclampsia-in-pregnancy) Minnesota Department of Health - WIC Program, 85 E 7th Place, PO BOX 64882, ST PAUL MN 55164-0882; 1-800-657-3942, health.wic@state.mn.us, www.health.state.mn.us; to obtain this information in a different format, call: 1-800-657-3942.","System instruction: [Answer questions based only on information provided in the context block. Do not use external resources or any prior knowledge. Give your answer in bullet points, with a brief explanation following each one.] Question: [What do I need to be on the lookout for if I'm worried about pre-eclampsia?] Context block: [1 Preeclampsia - Topic of the Month J U LY 6 , 2022 What is preeclampsia? Preeclampsia is a life-threatening disorder that most often occurs during pregnancy, although ten percent of cases occur in the postpartum period. The disorder is defined by two major symptoms found after 20 weeks of pregnancy, the most significant is a rapid rise in blood pressure (hypertension) combined with the presence of protein in the urine (proteinuria). For some women, proteinuria does not occur; for these women, preeclampsia is diagnosed as hypertension with thrombocytopenia (low platelet count), impaired liver function, renal insufficiency (poor kidney function), pulmonary edema (excess fluid in the lungs), and/or cerebral or visual disturbances (brain and vision problems). Preeclampsia is just one of the hypertensive disorders that may occur during pregnancy, others include chronic hypertension, gestational hypertension, HELLP syndrome, and eclampsia. Hypertensive disorders during pregnancy result in one of the leading causes of maternal and perinatal mortality worldwide.4 Historically, women and infants of color and American Indian women and their infants are disproportionately affected.3 Shocking statistics3: ▪ Hypertensive disorders affect 4-10% of pregnancies in the US. ▪ Severe hypertension contributes to 9% of maternal deaths in the US. ▪ One-third of severe childbirth complications result from preeclampsia/eclampsia. What are the maternal risks? PREECLAMPSIA - TO PIC O F THE MONTH 2 Preeclampsia puts great stress on the heart and can impair liver and kidney function. There is also a risk of suffering a stroke, seizures, hemorrhaging, multiple organ failure, placenta abruption (placenta separates from wall of uterus), and even maternal and/or infant death. What are the risks to the infant? Preeclampsia may restrict the flow of blood to the placenta, decreasing the oxygen and nutrients the fetus needs to thrive. Lack of these essential components can contribute to low infant birth weight, preterm delivery, and a chance of experiencing a stillbirth. Prematurity is the second leading cause of infant death in Minnesota.3 Infants that are born premature have a higher risk of long-term health and development difficulties. The prevention of preterm birth is critical to supporting infant health, promoting health equity, and controlling healthcare costs.3 WIC Pregnancy Related Risk Codes – refer to Implications for WIC Services 304 History of Preeclampsia 345 Hypertension and Prehypertension What are the warning signs? Preeclampsia typically occurs during the third trimester of pregnancy (after 28 weeks). For the postpartum parent, preeclampsia can occur within 48 hours of delivery or up to six weeks later. Parents who recognize any of these symptoms below should immediately contact their healthcare provider. Common warning signs of preeclampsia: ▪ Persistent headache that gets worse overtime ▪ Any changes in vision such as seeing spots or blurred vision ▪ Sudden and severe swelling in hands or face ▪ Sudden weight gain ▪ Nausea and vomiting in second half of pregnancy ▪ Pain in right upper abdomen or shoulder ▪ Shortness of breath or heavy chest Is preeclampsia preventable? It is not widely understood what causes preeclampsia. For this reason, doctors recommend parents maintain regular prenatal and postnatal visits with their healthcare providers and be vigilant of the signs and symptoms of the condition. Preventative care is the best defense against any pregnancy related hypertensive disorders. Preventative tips: PREECLAMPSIA - TO PIC O F THE MONTH 3 ▪ Attend regular healthcare visits and all prenatal visits ▪ Follow a healthy dietary pattern with regular daily meals and snacks ▪ Aim for an adequate calcium intake. While it is not yet conclusive, when dietary calcium is inadequate, research suggests that adequate calcium intake may help prevent preeclampsia. ▪ Maintain a healthy pre-pregnancy weight and gain appropriately during pregnancy ▪ Stay active with 150 minutes of moderate activity each week ▪ Reduce intake of tobacco products or consider smoking cessation A history of preeclampsia increases the risk of future hypertension, cardiovascular disease, and stroke. The above healthy lifestyle habits can help reduce the risk. Postpartum nutrition education contacts can provide an opportune time to follow up on this. For more information about Hypertensive Disorders of pregnancy: Blood Pressure During Pregnancy- December 14, 2021, Bay State Health Training Opportunity Section 5.3: Nutrition Risk Assessment policy explains the importance for WIC staff to obtain and synthesize information about a participant medical/health/nutrition status to most appropriately individualize WIC services. This includes asking questions that allow for education based on the participant’s concerns and offering referrals when necessary. Using the Pregnant Woman complete question format during the assessment may help you to most accurately determine if there are concerns the participant or their healthcare provider have regarding their medical, health, and/or nutrition. Exercise: 1. Read through the Pregnant Woman complete question format alone or as a group. 2. Discuss with a co-worker or as a group what questions would help identify some of the risk factors for preeclampsia. (HINT: Read through the risk factors above.) 3. What education can you offer to support the health of the at-risk participant? (HINT: Read through the preventative tips above.) Resources 1. Preeclampsia Foundation 2. HEAR HER Campaign -Centerfor Disease Control and Prevention (CDC) 3. Hypertension in Pregnancy -Minnesota Perinatal Quality Collaborative (MNPQC) 4. Hypertension and Preeclampsia in Pregnancy -The American College of Obstetricians and Gynecologists (ACOG) Topic ideas? Share yourfuture topic suggestion with carole.Kelnhofer@state.mn.us. PREECLAMPSIA - TO PIC O F THE MONTH 4 Reference – Complete Listing of Hyperlinks 304 History of Preeclampsia (https://www.health.state.mn.us/docs/people/wic/localagency/nutrition/riskcodes/bioclinmed /304mn.pdf) 345 Hypertension and Prehypertension (https://www.health.state.mn.us/docs/people/wic/localagency/nutrition/riskcodes/bioclinmed /345mn.pdf) Blood Pressure During Pregnancy (https://www.youtube.com/watch?v=Ff061nIXPx0&t=537s) Preeclampsia Foundation (https://www.preeclampsia.org/) HEAR HER Campaign (https://www.cdc.gov/hearher/index.html) Hypertension in Pregnancy (https://minnesotaperinatal.org/hypertension-in-pregnancy/) Hypertension and Preeclampsia in Pregnancy (https://www.acog.org/topics/hypertension-andpreeclampsia-in-pregnancy) Minnesota Department of Health - WIC Program, 85 E 7th Place, PO BOX 64882, ST PAUL MN 55164-0882; 1-800-657-3942, health.wic@state.mn.us, www.health.state.mn.us; to obtain this information in a different format, call: 1-800-657-3942.]","Answer questions based only on information provided in the context block. Do not use external resources or any prior knowledge. Give your answer in bullet points, with a brief explanation following each one.
+
+EVIDENCE:
+1 Preeclampsia - Topic of the Month J U LY 6 , 2022 What is preeclampsia? Preeclampsia is a life-threatening disorder that most often occurs during pregnancy, although ten percent of cases occur in the postpartum period. The disorder is defined by two major symptoms found after 20 weeks of pregnancy, the most significant is a rapid rise in blood pressure (hypertension) combined with the presence of protein in the urine (proteinuria). For some women, proteinuria does not occur; for these women, preeclampsia is diagnosed as hypertension with thrombocytopenia (low platelet count), impaired liver function, renal insufficiency (poor kidney function), pulmonary edema (excess fluid in the lungs), and/or cerebral or visual disturbances (brain and vision problems). Preeclampsia is just one of the hypertensive disorders that may occur during pregnancy, others include chronic hypertension, gestational hypertension, HELLP syndrome, and eclampsia. Hypertensive disorders during pregnancy result in one of the leading causes of maternal and perinatal mortality worldwide.4 Historically, women and infants of color and American Indian women and their infants are disproportionately affected.3 Shocking statistics3: ▪ Hypertensive disorders affect 4-10% of pregnancies in the US. ▪ Severe hypertension contributes to 9% of maternal deaths in the US. ▪ One-third of severe childbirth complications result from preeclampsia/eclampsia. What are the maternal risks? PREECLAMPSIA - TO PIC O F THE MONTH 2 Preeclampsia puts great stress on the heart and can impair liver and kidney function. There is also a risk of suffering a stroke, seizures, hemorrhaging, multiple organ failure, placenta abruption (placenta separates from wall of uterus), and even maternal and/or infant death. What are the risks to the infant? Preeclampsia may restrict the flow of blood to the placenta, decreasing the oxygen and nutrients the fetus needs to thrive. Lack of these essential components can contribute to low infant birth weight, preterm delivery, and a chance of experiencing a stillbirth. Prematurity is the second leading cause of infant death in Minnesota.3 Infants that are born premature have a higher risk of long-term health and development difficulties. The prevention of preterm birth is critical to supporting infant health, promoting health equity, and controlling healthcare costs.3 WIC Pregnancy Related Risk Codes – refer to Implications for WIC Services 304 History of Preeclampsia 345 Hypertension and Prehypertension What are the warning signs? Preeclampsia typically occurs during the third trimester of pregnancy (after 28 weeks). For the postpartum parent, preeclampsia can occur within 48 hours of delivery or up to six weeks later. Parents who recognize any of these symptoms below should immediately contact their healthcare provider. Common warning signs of preeclampsia: ▪ Persistent headache that gets worse overtime ▪ Any changes in vision such as seeing spots or blurred vision ▪ Sudden and severe swelling in hands or face ▪ Sudden weight gain ▪ Nausea and vomiting in second half of pregnancy ▪ Pain in right upper abdomen or shoulder ▪ Shortness of breath or heavy chest Is preeclampsia preventable? It is not widely understood what causes preeclampsia. For this reason, doctors recommend parents maintain regular prenatal and postnatal visits with their healthcare providers and be vigilant of the signs and symptoms of the condition. Preventative care is the best defense against any pregnancy related hypertensive disorders. Preventative tips: PREECLAMPSIA - TO PIC O F THE MONTH 3 ▪ Attend regular healthcare visits and all prenatal visits ▪ Follow a healthy dietary pattern with regular daily meals and snacks ▪ Aim for an adequate calcium intake. While it is not yet conclusive, when dietary calcium is inadequate, research suggests that adequate calcium intake may help prevent preeclampsia. ▪ Maintain a healthy pre-pregnancy weight and gain appropriately during pregnancy ▪ Stay active with 150 minutes of moderate activity each week ▪ Reduce intake of tobacco products or consider smoking cessation A history of preeclampsia increases the risk of future hypertension, cardiovascular disease, and stroke. The above healthy lifestyle habits can help reduce the risk. Postpartum nutrition education contacts can provide an opportune time to follow up on this. For more information about Hypertensive Disorders of pregnancy: Blood Pressure During Pregnancy- December 14, 2021, Bay State Health Training Opportunity Section 5.3: Nutrition Risk Assessment policy explains the importance for WIC staff to obtain and synthesize information about a participant medical/health/nutrition status to most appropriately individualize WIC services. This includes asking questions that allow for education based on the participant’s concerns and offering referrals when necessary. Using the Pregnant Woman complete question format during the assessment may help you to most accurately determine if there are concerns the participant or their healthcare provider have regarding their medical, health, and/or nutrition. Exercise: 1. Read through the Pregnant Woman complete question format alone or as a group. 2. Discuss with a co-worker or as a group what questions would help identify some of the risk factors for preeclampsia. (HINT: Read through the risk factors above.) 3. What education can you offer to support the health of the at-risk participant? (HINT: Read through the preventative tips above.) Resources 1. Preeclampsia Foundation 2. HEAR HER Campaign -Centerfor Disease Control and Prevention (CDC) 3. Hypertension in Pregnancy -Minnesota Perinatal Quality Collaborative (MNPQC) 4. Hypertension and Preeclampsia in Pregnancy -The American College of Obstetricians and Gynecologists (ACOG) Topic ideas? Share yourfuture topic suggestion with carole.Kelnhofer@state.mn.us. PREECLAMPSIA - TO PIC O F THE MONTH 4 Reference – Complete Listing of Hyperlinks 304 History of Preeclampsia (https://www.health.state.mn.us/docs/people/wic/localagency/nutrition/riskcodes/bioclinmed /304mn.pdf) 345 Hypertension and Prehypertension (https://www.health.state.mn.us/docs/people/wic/localagency/nutrition/riskcodes/bioclinmed /345mn.pdf) Blood Pressure During Pregnancy (https://www.youtube.com/watch?v=Ff061nIXPx0&t=537s) Preeclampsia Foundation (https://www.preeclampsia.org/) HEAR HER Campaign (https://www.cdc.gov/hearher/index.html) Hypertension in Pregnancy (https://minnesotaperinatal.org/hypertension-in-pregnancy/) Hypertension and Preeclampsia in Pregnancy (https://www.acog.org/topics/hypertension-andpreeclampsia-in-pregnancy) Minnesota Department of Health - WIC Program, 85 E 7th Place, PO BOX 64882, ST PAUL MN 55164-0882; 1-800-657-3942, health.wic@state.mn.us, www.health.state.mn.us; to obtain this information in a different format, call: 1-800-657-3942.
+
+USER:
+What do I need to be on the lookout for if I'm worried about pre-eclampsia?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",True,33,15,952,,761
+[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.,What are the most common pathways to allow me to obtain permanent residency in Spain without any significant time or financial commitments required from me?,"Overview of Spain Permanent Residence Permit There are substantial benefits of living in Spain and having Permanent Residency status. Advantages of getting a Permanent Residency card in Spain include having many of the same rights as Spanish citizens. With Permanent Residency you are entitled to work, study and access healthcare. It does not give you the right to vote in national elections or hold a Spanish passport – these rights are only available to those who hold full Spanish citizenship. However, obtaining Permanent Residency is a major step towards eventually obtaining citizenship of Spain. Qualifying for Permanent Residency in Spain There are conditions that must be met before applying for Permanent Residency in Spain. You should ensure you meet all the criteria before applying otherwise you could risk refusal – which can be costly and impact on future immigration applications. If you are unclear if you do qualify for Permanent Residency then you may want to consider contacting an immigration specialist to seek advice. The following are able to acquire the right of permanent residence once five years of continuous living legally in Spain has been reached: Citizens of a EU state and family members who not EU state nationals Workers or those self-employed who have reached pension age – as long as they have worked in Spain for the previous 12 months. Self-employed workers who opt for early retirement – although they must have been working in Spain for the previous year before applying. Workers or self-employed who worked in Spain but have had to stop working due to permanent incapacity to work. Workers or self-employed workers who have worked and lived in Spain for three years and have then worked in another EU country but have continued to have a place of residence in Spain which they have returned to at least once a week. Non-EU national family members of a Spanish citizen or EU citizen who have been living in Spain for five years as long as the family relationship still exists – or if the relationship has ended due to dealth, annulment or divorce. Documents Required When Applying For Residency in Spain In order to be eligible for the benefits associated with gaining a Permanent Residency in Spain, the candidate must provide documentation attesting to their legal residency during the previous five years. When you have completed the necessary duration of time in Spain, you can apply for a Permanent Residency visa. You must go to the appropriate police station in Spain with the application form and required paperwork, as well as the funds to pay the processing fee. You must submit your application for Permanent Residence at least three months prior to your present visa or permission expiration. You will be asked to provide the following documents: A completed application form. Provide evidence about your current residency statuses, such as student, employment contract, retired individual, or self-employed person. A document that proves that you have resided in Spain for five years – this could be a property deed or a rental agreement. Providing a registration document issued by the city’s police department where the applicant resides. A document that proves your ongoing residency in Spain, such as a rental contract, utility bills, etc. Proof of income, investments, or financial means of support, such as bank statements, tax returns, payroll, etc. Provide a certificate of your health and medical insurance in Spain. In some critical circumstances, you should be asked to submit a criminal record certificate, as well as a divorce or marriage certificate. The consulate general will inform you formally if your application is accepted. Once your application is approved, the police department in Spain will contact you to come and submit your fingerprints and finish the procedure. It may take around one month for your Permanent Resident Card to be issued. Don’t miss out on the chance to call Spain your permanent home. Get in touch with us for help with applying for Permanent Residency today. Contact Us Cost of Applying for Permanent Residency in Spain The cost of applying for Permanent Residency in Spain is relatively low compared to other visa charges. The exact amount required by the Spanish immigration authorities varies depending on a number of factors including the cost of getting documents translated if they are not originally in Spanish. However, you can expect to pay around 80 euros to submit the application. Renewing Permanent Residency in Spain Once your application for Permanent Residency has been approved then you will be issued with a residency card that is valid for five years. You must apply to renew this card before it expires otherwise you could risk your immigration status in Spain. To renew you will need to complete the appropriate form and submit with the following documents: Proof of address in Spain Original residency card Passport You are also required to resubmit your fingerprints and pay the Permanent Residency renewal fee. When you apply to renew your Permanent Resident status you are not required to prove you have lived in the country for the five years preceding the renewal. However, you may have your application to renewl your Permanent Residency card refused it you have spent more than 12 months outside of Spain or another EU member country. What if Your Permanent Residency Application is Rejected? If your application for Permanent Residency in Spain is rejected then you may be able to appeal the decision if you feel that you have met all the requirements and can demonstrate so. You will need to file an appeal with the High Court of Justice in Madrid and you must do this within two months of being notified that your application has been refused. This could be a potentially lengthy process so you should seek advice from Spanish immigration experts to ensure you complete the appeal process correctly and increase your chances of a successful outcome.","[question] What are the most common pathways to allow me to obtain permanent residency in Spain without any significant time or financial commitments required from me? ===================== [text] Overview of Spain Permanent Residence Permit There are substantial benefits of living in Spain and having Permanent Residency status. Advantages of getting a Permanent Residency card in Spain include having many of the same rights as Spanish citizens. With Permanent Residency you are entitled to work, study and access healthcare. It does not give you the right to vote in national elections or hold a Spanish passport – these rights are only available to those who hold full Spanish citizenship. However, obtaining Permanent Residency is a major step towards eventually obtaining citizenship of Spain. Qualifying for Permanent Residency in Spain There are conditions that must be met before applying for Permanent Residency in Spain. You should ensure you meet all the criteria before applying otherwise you could risk refusal – which can be costly and impact on future immigration applications. If you are unclear if you do qualify for Permanent Residency then you may want to consider contacting an immigration specialist to seek advice. The following are able to acquire the right of permanent residence once five years of continuous living legally in Spain has been reached: Citizens of a EU state and family members who not EU state nationals Workers or those self-employed who have reached pension age – as long as they have worked in Spain for the previous 12 months. Self-employed workers who opt for early retirement – although they must have been working in Spain for the previous year before applying. Workers or self-employed who worked in Spain but have had to stop working due to permanent incapacity to work. Workers or self-employed workers who have worked and lived in Spain for three years and have then worked in another EU country but have continued to have a place of residence in Spain which they have returned to at least once a week. Non-EU national family members of a Spanish citizen or EU citizen who have been living in Spain for five years as long as the family relationship still exists – or if the relationship has ended due to dealth, annulment or divorce. Documents Required When Applying For Residency in Spain In order to be eligible for the benefits associated with gaining a Permanent Residency in Spain, the candidate must provide documentation attesting to their legal residency during the previous five years. When you have completed the necessary duration of time in Spain, you can apply for a Permanent Residency visa. You must go to the appropriate police station in Spain with the application form and required paperwork, as well as the funds to pay the processing fee. You must submit your application for Permanent Residence at least three months prior to your present visa or permission expiration. You will be asked to provide the following documents: A completed application form. Provide evidence about your current residency statuses, such as student, employment contract, retired individual, or self-employed person. A document that proves that you have resided in Spain for five years – this could be a property deed or a rental agreement. Providing a registration document issued by the city’s police department where the applicant resides. A document that proves your ongoing residency in Spain, such as a rental contract, utility bills, etc. Proof of income, investments, or financial means of support, such as bank statements, tax returns, payroll, etc. Provide a certificate of your health and medical insurance in Spain. In some critical circumstances, you should be asked to submit a criminal record certificate, as well as a divorce or marriage certificate. The consulate general will inform you formally if your application is accepted. Once your application is approved, the police department in Spain will contact you to come and submit your fingerprints and finish the procedure. It may take around one month for your Permanent Resident Card to be issued. Don’t miss out on the chance to call Spain your permanent home. Get in touch with us for help with applying for Permanent Residency today. Contact Us Cost of Applying for Permanent Residency in Spain The cost of applying for Permanent Residency in Spain is relatively low compared to other visa charges. The exact amount required by the Spanish immigration authorities varies depending on a number of factors including the cost of getting documents translated if they are not originally in Spanish. However, you can expect to pay around 80 euros to submit the application. Renewing Permanent Residency in Spain Once your application for Permanent Residency has been approved then you will be issued with a residency card that is valid for five years. You must apply to renew this card before it expires otherwise you could risk your immigration status in Spain. To renew you will need to complete the appropriate form and submit with the following documents: Proof of address in Spain Original residency card Passport You are also required to resubmit your fingerprints and pay the Permanent Residency renewal fee. When you apply to renew your Permanent Resident status you are not required to prove you have lived in the country for the five years preceding the renewal. However, you may have your application to renewl your Permanent Residency card refused it you have spent more than 12 months outside of Spain or another EU member country. What if Your Permanent Residency Application is Rejected? If your application for Permanent Residency in Spain is rejected then you may be able to appeal the decision if you feel that you have met all the requirements and can demonstrate so. You will need to file an appeal with the High Court of Justice in Madrid and you must do this within two months of being notified that your application has been refused. This could be a potentially lengthy process so you should seek advice from Spanish immigration experts to ensure you complete the appeal process correctly and increase your chances of a successful outcome. https://iasservices.org.uk/es/residency/permanent-residency-in-spain/ ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.","[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
+
+EVIDENCE:
+Overview of Spain Permanent Residence Permit There are substantial benefits of living in Spain and having Permanent Residency status. Advantages of getting a Permanent Residency card in Spain include having many of the same rights as Spanish citizens. With Permanent Residency you are entitled to work, study and access healthcare. It does not give you the right to vote in national elections or hold a Spanish passport – these rights are only available to those who hold full Spanish citizenship. However, obtaining Permanent Residency is a major step towards eventually obtaining citizenship of Spain. Qualifying for Permanent Residency in Spain There are conditions that must be met before applying for Permanent Residency in Spain. You should ensure you meet all the criteria before applying otherwise you could risk refusal – which can be costly and impact on future immigration applications. If you are unclear if you do qualify for Permanent Residency then you may want to consider contacting an immigration specialist to seek advice. The following are able to acquire the right of permanent residence once five years of continuous living legally in Spain has been reached: Citizens of a EU state and family members who not EU state nationals Workers or those self-employed who have reached pension age – as long as they have worked in Spain for the previous 12 months. Self-employed workers who opt for early retirement – although they must have been working in Spain for the previous year before applying. Workers or self-employed who worked in Spain but have had to stop working due to permanent incapacity to work. Workers or self-employed workers who have worked and lived in Spain for three years and have then worked in another EU country but have continued to have a place of residence in Spain which they have returned to at least once a week. Non-EU national family members of a Spanish citizen or EU citizen who have been living in Spain for five years as long as the family relationship still exists – or if the relationship has ended due to dealth, annulment or divorce. Documents Required When Applying For Residency in Spain In order to be eligible for the benefits associated with gaining a Permanent Residency in Spain, the candidate must provide documentation attesting to their legal residency during the previous five years. When you have completed the necessary duration of time in Spain, you can apply for a Permanent Residency visa. You must go to the appropriate police station in Spain with the application form and required paperwork, as well as the funds to pay the processing fee. You must submit your application for Permanent Residence at least three months prior to your present visa or permission expiration. You will be asked to provide the following documents: A completed application form. Provide evidence about your current residency statuses, such as student, employment contract, retired individual, or self-employed person. A document that proves that you have resided in Spain for five years – this could be a property deed or a rental agreement. Providing a registration document issued by the city’s police department where the applicant resides. A document that proves your ongoing residency in Spain, such as a rental contract, utility bills, etc. Proof of income, investments, or financial means of support, such as bank statements, tax returns, payroll, etc. Provide a certificate of your health and medical insurance in Spain. In some critical circumstances, you should be asked to submit a criminal record certificate, as well as a divorce or marriage certificate. The consulate general will inform you formally if your application is accepted. Once your application is approved, the police department in Spain will contact you to come and submit your fingerprints and finish the procedure. It may take around one month for your Permanent Resident Card to be issued. Don’t miss out on the chance to call Spain your permanent home. Get in touch with us for help with applying for Permanent Residency today. Contact Us Cost of Applying for Permanent Residency in Spain The cost of applying for Permanent Residency in Spain is relatively low compared to other visa charges. The exact amount required by the Spanish immigration authorities varies depending on a number of factors including the cost of getting documents translated if they are not originally in Spanish. However, you can expect to pay around 80 euros to submit the application. Renewing Permanent Residency in Spain Once your application for Permanent Residency has been approved then you will be issued with a residency card that is valid for five years. You must apply to renew this card before it expires otherwise you could risk your immigration status in Spain. To renew you will need to complete the appropriate form and submit with the following documents: Proof of address in Spain Original residency card Passport You are also required to resubmit your fingerprints and pay the Permanent Residency renewal fee. When you apply to renew your Permanent Resident status you are not required to prove you have lived in the country for the five years preceding the renewal. However, you may have your application to renewl your Permanent Residency card refused it you have spent more than 12 months outside of Spain or another EU member country. What if Your Permanent Residency Application is Rejected? If your application for Permanent Residency in Spain is rejected then you may be able to appeal the decision if you feel that you have met all the requirements and can demonstrate so. You will need to file an appeal with the High Court of Justice in Madrid and you must do this within two months of being notified that your application has been refused. This could be a potentially lengthy process so you should seek advice from Spanish immigration experts to ensure you complete the appeal process correctly and increase your chances of a successful outcome.
+
+USER:
+What are the most common pathways to allow me to obtain permanent residency in Spain without any significant time or financial commitments required from me?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,28,25,982,,35
+This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any alternative sources of information.,Summarize how venous eczema affects the human body.,"VENOUS ECZEMA What are the aims of this leaflet? This leaflet has been written to help you understand more about venous eczema. It tells you what it is, what causes it, what can be done about it, and where you can find out more about it. What is venous eczema? Venous eczema is also known as varicose or stasis eczema and is the name given to a type of eczema on the lower leg. The word eczema (or dermatitis) refers to a common inflammatory skin condition. Venous eczema is more common as people get older and occurs more often in women than in men. What causes it? Venous eczema occurs when valves in the leg veins do not work properly, reducing drainage of blood from the legs. This leads to an increase in the pressure inside the leg veins. This congestion then causes damage to the overlying skin. The exact reason why the resulting skin changes occur is unclear, but is likely to be due to the increase in pressure pushing blood and blood products from the veins into the surrounding tissue. This then triggers inflammation in the skin. Being overweight, immobility, leg swelling, varicose veins, previous clots in the leg (venous thrombosis) and previous cellulitis are possible contributory factors. Is it hereditary? No. What are the features? Venous eczema occurs on the lower legs. The features vary depending on the severity and range from changes in skin colouring and dryness of the skin to areas of inflamed eczema with red spots, scaling, weeping and/or crusting. The eczema is often very itchy and can sometimes be painful. Swelling of the legs and varicose veins may also be present. In severe cases, white patches of skin, thinning and scarring (atrophie blanche) may be seen. Sometimes thickening of large areas of skin on the lower leg (lipodermatosclerosis) can occur and may be painful. Leg ulcers can also develop. Sometimes, venous eczema can trigger the development of eczema elsewhere on the body; this is known as secondary eczema. How is venous eczema diagnosed? It is usually a clinical diagnosis, based on its typical appearance and associated features. There are some other causes of a rash on the lower leg, such as allergic contact dermatitis (when a person develops an allergy to substances or treatments used on the skin) and irritant contact dermatitis (when the skin becomes irritated by secretions, bacteria or certain treatments). Doctors and nurses who regularly look after patients with venous eczema are usually able to identify which of these rashes is the most likely. On some occasions it may be necessary to carry out further investigations when the diagnosis is not clear. Can it be cured? Unfortunately, the problem of the valves in the veins not working properly cannot be cured; this means that venous eczema does not clear up completely if left untreated. However, simple measures to improve the function of the valves and treatments for the active eczema can greatly improve the skin and associated symptoms, keep the eczema under control and help to prevent complications such as leg swelling, infection and lipodermatosclerosis. How is it treated? Simple measures are very important in helping to reduce pressure in the veins. These include ensuring your weight is within the normal range and keeping physically active. Due to the effect of gravity exerting additional pressure on the veins, venous eczema can be made worse by spending long periods of time standing still or sitting, for example by sleeping in a chair. For this reason, it is recommended that when possible you raise your legs for at least part of the day; ideally above the level of your heart by lying down. Elevating the foot of the bed overnight can also be helpful. Care also needs to be taken to avoid damaging the skin on the leg, for example it is important to avoid knocking or hitting the leg on hard objects (such as supermarket shelves, trolleys, doors of kitchen cupboards, etc.). Such relatively minor injuries often take months to heal and can significantly impair healing of the eczema. Bandaging and compression stockings are another simple measure that help to reduce the pressure in the leg veins. Bandaging may be used when leg swelling is severe; once this swelling is reduced and the eczema is improved, compression stockings are used to maintain this. Compression stockings are available on prescription and should be worn long-term at all times during the day in order to support the veins. Compression stockings should not be used in patients with arterial disease in the legs. Your dermatologist or doctor can advise you about this and a simple test measuring your leg circulation is often performed before using compression stockings. Topical emollients (moisturisers) should be used at least daily to all the skin on the lower leg, whether affected or not; these make the skin more supple and can help to prevent the skin breaking down. Emollients should also be used as a soap substitute. Steroid ointments are often recommended to treat itchy flares in venous eczema; these should be applied to the affected patches of skin only. CAUTION: This leaflet mentions ‘emollients’ (moisturisers). When paraffincontaining emollient products get in contact with dressings, clothing, bed linen or hair, there is a danger that a naked flame or cigarette smoking could cause these to catch fire. To reduce the fire risk, patients using paraffin-containing skincare or haircare products are advised to avoid naked flames completely, including smoking cigarettes and being near people who are smoking or using naked flames. It is also advisable to wash clothing and bed linen regularly, preferably daily. In some situations a varicose vein operation may be helpful. In general, the responses to the above measures are good if they are used every day on a long-term basis. If the response is poor despite doing these treatments every day, it may be necessary to seek advice from your GP or dermatologist in case there is another cause for the leg rash, for example, a fungal skin or toe nail infection, or the development of a contact allergy to different topical agents used. Where can I find out more about venous eczema? Web links to detailed leaflets: www.cks.nhs.uk/venous_eczema_and_lipodermatosclerosis www.patient.co.uk/doctor/Varicose-Eczema.htm www.dermnetnz.org/dermatitis/venous-eczema.html For details of source materials used please contact the Clinical Standards Unit (clinicalstandards@bad.org.uk). This leaflet aims to provide accurate information about the subject and is a consensus of the views held by representatives of the British Association of Dermatologists: individual patient circumstances may differ, which might alter both the advice and course of therapy given to you by your doctor.","System Instructions: This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any alternative sources of information. Question: Summarize how venous eczema affects the human body. Context Block: VENOUS ECZEMA What are the aims of this leaflet? This leaflet has been written to help you understand more about venous eczema. It tells you what it is, what causes it, what can be done about it, and where you can find out more about it. What is venous eczema? Venous eczema is also known as varicose or stasis eczema and is the name given to a type of eczema on the lower leg. The word eczema (or dermatitis) refers to a common inflammatory skin condition. Venous eczema is more common as people get older and occurs more often in women than in men. What causes it? Venous eczema occurs when valves in the leg veins do not work properly, reducing drainage of blood from the legs. This leads to an increase in the pressure inside the leg veins. This congestion then causes damage to the overlying skin. The exact reason why the resulting skin changes occur is unclear, but is likely to be due to the increase in pressure pushing blood and blood products from the veins into the surrounding tissue. This then triggers inflammation in the skin. Being overweight, immobility, leg swelling, varicose veins, previous clots in the leg (venous thrombosis) and previous cellulitis are possible contributory factors. Is it hereditary? No. What are the features? Venous eczema occurs on the lower legs. The features vary depending on the severity and range from changes in skin colouring and dryness of the skin to areas of inflamed eczema with red spots, scaling, weeping and/or crusting. The eczema is often very itchy and can sometimes be painful. Swelling of the legs and varicose veins may also be present. In severe cases, white patches of skin, thinning and scarring (atrophie blanche) may be seen. Sometimes thickening of large areas of skin on the lower leg (lipodermatosclerosis) can occur and may be painful. Leg ulcers can also develop. Sometimes, venous eczema can trigger the development of eczema elsewhere on the body; this is known as secondary eczema. How is venous eczema diagnosed? It is usually a clinical diagnosis, based on its typical appearance and associated features. There are some other causes of a rash on the lower leg, such as allergic contact dermatitis (when a person develops an allergy to substances or treatments used on the skin) and irritant contact dermatitis (when the skin becomes irritated by secretions, bacteria or certain treatments). Doctors and nurses who regularly look after patients with venous eczema are usually able to identify which of these rashes is the most likely. On some occasions it may be necessary to carry out further investigations when the diagnosis is not clear. Can it be cured? Unfortunately, the problem of the valves in the veins not working properly cannot be cured; this means that venous eczema does not clear up completely if left untreated. However, simple measures to improve the function of the valves and treatments for the active eczema can greatly improve the skin and associated symptoms, keep the eczema under control and help to prevent complications such as leg swelling, infection and lipodermatosclerosis. How is it treated? Simple measures are very important in helping to reduce pressure in the veins. These include ensuring your weight is within the normal range and keeping physically active. Due to the effect of gravity exerting additional pressure on the veins, venous eczema can be made worse by spending long periods of time standing still or sitting, for example by sleeping in a chair. For this reason, it is recommended that when possible you raise your legs for at least part of the day; ideally above the level of your heart by lying down. Elevating the foot of the bed overnight can also be helpful. Care also needs to be taken to avoid damaging the skin on the leg, for example it is important to avoid knocking or hitting the leg on hard objects (such as supermarket shelves, trolleys, doors of kitchen cupboards, etc.). Such relatively minor injuries often take months to heal and can significantly impair healing of the eczema. Bandaging and compression stockings are another simple measure that help to reduce the pressure in the leg veins. Bandaging may be used when leg swelling is severe; once this swelling is reduced and the eczema is improved, compression stockings are used to maintain this. Compression stockings are available on prescription and should be worn long-term at all times during the day in order to support the veins. Compression stockings should not be used in patients with arterial disease in the legs. Your dermatologist or doctor can advise you about this and a simple test measuring your leg circulation is often performed before using compression stockings. Topical emollients (moisturisers) should be used at least daily to all the skin on the lower leg, whether affected or not; these make the skin more supple and can help to prevent the skin breaking down. Emollients should also be used as a soap substitute. Steroid ointments are often recommended to treat itchy flares in venous eczema; these should be applied to the affected patches of skin only. CAUTION: This leaflet mentions ‘emollients’ (moisturisers). When paraffincontaining emollient products get in contact with dressings, clothing, bed linen or hair, there is a danger that a naked flame or cigarette smoking could cause these to catch fire. To reduce the fire risk, patients using paraffin-containing skincare or haircare products are advised to avoid naked flames completely, including smoking cigarettes and being near people who are smoking or using naked flames. It is also advisable to wash clothing and bed linen regularly, preferably daily. In some situations a varicose vein operation may be helpful. In general, the responses to the above measures are good if they are used every day on a long-term basis. If the response is poor despite doing these treatments every day, it may be necessary to seek advice from your GP or dermatologist in case there is another cause for the leg rash, for example, a fungal skin or toe nail infection, or the development of a contact allergy to different topical agents used. Where can I find out more about venous eczema? Web links to detailed leaflets: www.cks.nhs.uk/venous_eczema_and_lipodermatosclerosis www.patient.co.uk/doctor/Varicose-Eczema.htm www.dermnetnz.org/dermatitis/venous-eczema.html For details of source materials used please contact the Clinical Standards Unit (clinicalstandards@bad.org.uk). This leaflet aims to provide accurate information about the subject and is a consensus of the views held by representatives of the British Association of Dermatologists: individual patient circumstances may differ, which might alter both the advice and course of therapy given to you by your doctor.","This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any alternative sources of information.
+
+EVIDENCE:
+VENOUS ECZEMA What are the aims of this leaflet? This leaflet has been written to help you understand more about venous eczema. It tells you what it is, what causes it, what can be done about it, and where you can find out more about it. What is venous eczema? Venous eczema is also known as varicose or stasis eczema and is the name given to a type of eczema on the lower leg. The word eczema (or dermatitis) refers to a common inflammatory skin condition. Venous eczema is more common as people get older and occurs more often in women than in men. What causes it? Venous eczema occurs when valves in the leg veins do not work properly, reducing drainage of blood from the legs. This leads to an increase in the pressure inside the leg veins. This congestion then causes damage to the overlying skin. The exact reason why the resulting skin changes occur is unclear, but is likely to be due to the increase in pressure pushing blood and blood products from the veins into the surrounding tissue. This then triggers inflammation in the skin. Being overweight, immobility, leg swelling, varicose veins, previous clots in the leg (venous thrombosis) and previous cellulitis are possible contributory factors. Is it hereditary? No. What are the features? Venous eczema occurs on the lower legs. The features vary depending on the severity and range from changes in skin colouring and dryness of the skin to areas of inflamed eczema with red spots, scaling, weeping and/or crusting. The eczema is often very itchy and can sometimes be painful. Swelling of the legs and varicose veins may also be present. In severe cases, white patches of skin, thinning and scarring (atrophie blanche) may be seen. Sometimes thickening of large areas of skin on the lower leg (lipodermatosclerosis) can occur and may be painful. Leg ulcers can also develop. Sometimes, venous eczema can trigger the development of eczema elsewhere on the body; this is known as secondary eczema. How is venous eczema diagnosed? It is usually a clinical diagnosis, based on its typical appearance and associated features. There are some other causes of a rash on the lower leg, such as allergic contact dermatitis (when a person develops an allergy to substances or treatments used on the skin) and irritant contact dermatitis (when the skin becomes irritated by secretions, bacteria or certain treatments). Doctors and nurses who regularly look after patients with venous eczema are usually able to identify which of these rashes is the most likely. On some occasions it may be necessary to carry out further investigations when the diagnosis is not clear. Can it be cured? Unfortunately, the problem of the valves in the veins not working properly cannot be cured; this means that venous eczema does not clear up completely if left untreated. However, simple measures to improve the function of the valves and treatments for the active eczema can greatly improve the skin and associated symptoms, keep the eczema under control and help to prevent complications such as leg swelling, infection and lipodermatosclerosis. How is it treated? Simple measures are very important in helping to reduce pressure in the veins. These include ensuring your weight is within the normal range and keeping physically active. Due to the effect of gravity exerting additional pressure on the veins, venous eczema can be made worse by spending long periods of time standing still or sitting, for example by sleeping in a chair. For this reason, it is recommended that when possible you raise your legs for at least part of the day; ideally above the level of your heart by lying down. Elevating the foot of the bed overnight can also be helpful. Care also needs to be taken to avoid damaging the skin on the leg, for example it is important to avoid knocking or hitting the leg on hard objects (such as supermarket shelves, trolleys, doors of kitchen cupboards, etc.). Such relatively minor injuries often take months to heal and can significantly impair healing of the eczema. Bandaging and compression stockings are another simple measure that help to reduce the pressure in the leg veins. Bandaging may be used when leg swelling is severe; once this swelling is reduced and the eczema is improved, compression stockings are used to maintain this. Compression stockings are available on prescription and should be worn long-term at all times during the day in order to support the veins. Compression stockings should not be used in patients with arterial disease in the legs. Your dermatologist or doctor can advise you about this and a simple test measuring your leg circulation is often performed before using compression stockings. Topical emollients (moisturisers) should be used at least daily to all the skin on the lower leg, whether affected or not; these make the skin more supple and can help to prevent the skin breaking down. Emollients should also be used as a soap substitute. Steroid ointments are often recommended to treat itchy flares in venous eczema; these should be applied to the affected patches of skin only. CAUTION: This leaflet mentions ‘emollients’ (moisturisers). When paraffincontaining emollient products get in contact with dressings, clothing, bed linen or hair, there is a danger that a naked flame or cigarette smoking could cause these to catch fire. To reduce the fire risk, patients using paraffin-containing skincare or haircare products are advised to avoid naked flames completely, including smoking cigarettes and being near people who are smoking or using naked flames. It is also advisable to wash clothing and bed linen regularly, preferably daily. In some situations a varicose vein operation may be helpful. In general, the responses to the above measures are good if they are used every day on a long-term basis. If the response is poor despite doing these treatments every day, it may be necessary to seek advice from your GP or dermatologist in case there is another cause for the leg rash, for example, a fungal skin or toe nail infection, or the development of a contact allergy to different topical agents used. Where can I find out more about venous eczema? Web links to detailed leaflets: www.cks.nhs.uk/venous_eczema_and_lipodermatosclerosis www.patient.co.uk/doctor/Varicose-Eczema.htm www.dermnetnz.org/dermatitis/venous-eczema.html For details of source materials used please contact the Clinical Standards Unit (clinicalstandards@bad.org.uk). This leaflet aims to provide accurate information about the subject and is a consensus of the views held by representatives of the British Association of Dermatologists: individual patient circumstances may differ, which might alter both the advice and course of therapy given to you by your doctor.
+
+USER:
+Summarize how venous eczema affects the human body.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,27,8,1095,,415
+[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.,"I recently got a credit card that offers cash back when I shop in certain places but I'm new to the concept. In 200 words or less, what are some great ways that it can be used? Additionally, what other credit card would be great for me when it comes to retail deals through the card?","Take advantage of issuers’ shopping portals Before you shop, whether in-person or online, look for card-linked offers from your credit card issuer. If you have the Chase Freedom Flex or Chase Freedom Unlimited, for example, check the Shop through Chase portal to earn more cash back on all your purchases. Although the stores in the Chase shopping portal vary, they frequently include options like Walmart, Sephora, Best Buy and Macy’s. Other issues have their own portals — with Barclaycard you can shop on RewardsBoost, and with a Capital One card you get access to Capital One Shopping. Some issuers offer additional rewards opportunities as well. American Express, Chase, and Capital One have programs — Amex Offers, Chase Offers and Capital One Offers, respectively — through which you can opt in to earn additional cash back from select retailers. For example, with the Capital One QuicksilverOne Cash Rewards Credit Card, you can earn more cash back with particular retailers. To do so, log in to your Capital One account and navigate to the offers portal. In the portal, click “Get this deal” to be taken to a retailer’s site to shop and earn additional rewards at check out. Generally speaking, these offers are found in your online account, have limited redemption windows and must be accepted individually. Cash back percentages vary from store to store, and there are usually limits that cap how much additional cash back you can earn. Make the most of cash back apps If you want to earn more cash back for online purchases, you often can increase your earnings through the use of cash back apps. Cash back apps and sites like Dosh, Ibotta and Rakuten (formerly Ebates) give you a percentage of your spending back on qualifying purchases — on top of the cash back you’re earning on your credit card. For example, Rakuten lets you earn additional cash back when you click through the website before you shop with stores like Kohl’s, Macy’s, Nordstrom, Old Navy and Priceline.com. Use your cash back wisely While maximizing cash back earned on spending always makes sense, that’s only part of the equation. You also need to redeem your cash back in ways that make sense for your goals, whether you want to reduce the amount you owe on your credit card bill, you want to splurge for a fun purchase or you hope to utilize rewards to improve your finances in some way. Consider the following tips to get the most out of your cash back rewards each year: Redeem your cash back as statement credits One of the easiest ways to redeem cash back is for statement credits to your account. This redemption effectively lowers the amount you owe on your credit card bill, thus helping you save money over time. If you sign up for the Wells Fargo Active Cash® Card to earn 2% cash back on all purchases and redeem your rewards for cash back, for example, you would ultimately save 2% on everything you buy with your card. Just remember that rewards only get you “ahead” if you pay your credit card bill in full each month and avoid interest. If you’re paying 20% in credit card interest or more to earn 2% cash back, you’re not doing yourself any favors. Save your cash back for a big purchase You can also save up your rewards for a purchase you want to make down the line, whether it’s a splurge purchase you don’t want to cover in cash or you need to buy something for your everyday life. In either case, most cash back credit cards let you grow your rewards balance over time until you’re ready to use it. Keep in mind: Using rewards for merchandise won't always get you the best value, and that you'll want to be strategic if you go this route. As an example, cash back credit cards from Chase offer 1 cent per point for statement credit redemptions but only 0.8 cents per point for purchases through Amazon.com or PayPal. If you wanted to use rewards for an Amazon or PayPal purchase, it would make more sense to pay for the purchase with your card outright then redeem rewards for statement credits after the fact. Use your cash back to pay down debt You can also use rewards to pay off some types of debt, either directly depending on the card you have or indirectly by redeeming for cash back. In terms of options that let you redeem rewards for debt payments, some Wells Fargo credit cards (including the Wells Fargo Active Cash® Card) let you redeem cash back toward a Wells Fargo mortgage in addition to options like gift cards and statement credits. Many cash back credit cards also let you redeem rewards for a check in the mail, which you could deposit into a bank account and use for debt payments.","[question] I recently got a credit card that offers cash back when I shop in certain places but I'm new to the concept. In 200 words or less, what are some great ways that it can be used? Additionally, what other credit card would be great for me when it comes to retail deals through the card? ===================== [text] Take advantage of issuers’ shopping portals Before you shop, whether in-person or online, look for card-linked offers from your credit card issuer. If you have the Chase Freedom Flex or Chase Freedom Unlimited, for example, check the Shop through Chase portal to earn more cash back on all your purchases. Although the stores in the Chase shopping portal vary, they frequently include options like Walmart, Sephora, Best Buy and Macy’s. Other issues have their own portals — with Barclaycard you can shop on RewardsBoost, and with a Capital One card you get access to Capital One Shopping. Some issuers offer additional rewards opportunities as well. American Express, Chase, and Capital One have programs — Amex Offers, Chase Offers and Capital One Offers, respectively — through which you can opt in to earn additional cash back from select retailers. For example, with the Capital One QuicksilverOne Cash Rewards Credit Card, you can earn more cash back with particular retailers. To do so, log in to your Capital One account and navigate to the offers portal. In the portal, click “Get this deal” to be taken to a retailer’s site to shop and earn additional rewards at check out. Generally speaking, these offers are found in your online account, have limited redemption windows and must be accepted individually. Cash back percentages vary from store to store, and there are usually limits that cap how much additional cash back you can earn. Make the most of cash back apps If you want to earn more cash back for online purchases, you often can increase your earnings through the use of cash back apps. Cash back apps and sites like Dosh, Ibotta and Rakuten (formerly Ebates) give you a percentage of your spending back on qualifying purchases — on top of the cash back you’re earning on your credit card. For example, Rakuten lets you earn additional cash back when you click through the website before you shop with stores like Kohl’s, Macy’s, Nordstrom, Old Navy and Priceline.com. Use your cash back wisely While maximizing cash back earned on spending always makes sense, that’s only part of the equation. You also need to redeem your cash back in ways that make sense for your goals, whether you want to reduce the amount you owe on your credit card bill, you want to splurge for a fun purchase or you hope to utilize rewards to improve your finances in some way. Consider the following tips to get the most out of your cash back rewards each year: Redeem your cash back as statement credits One of the easiest ways to redeem cash back is for statement credits to your account. This redemption effectively lowers the amount you owe on your credit card bill, thus helping you save money over time. If you sign up for the Wells Fargo Active Cash® Card to earn 2% cash back on all purchases and redeem your rewards for cash back, for example, you would ultimately save 2% on everything you buy with your card. Just remember that rewards only get you “ahead” if you pay your credit card bill in full each month and avoid interest. If you’re paying 20% in credit card interest or more to earn 2% cash back, you’re not doing yourself any favors. Save your cash back for a big purchase You can also save up your rewards for a purchase you want to make down the line, whether it’s a splurge purchase you don’t want to cover in cash or you need to buy something for your everyday life. In either case, most cash back credit cards let you grow your rewards balance over time until you’re ready to use it. Keep in mind: Using rewards for merchandise won't always get you the best value, and that you'll want to be strategic if you go this route. As an example, cash back credit cards from Chase offer 1 cent per point for statement credit redemptions but only 0.8 cents per point for purchases through Amazon.com or PayPal. If you wanted to use rewards for an Amazon or PayPal purchase, it would make more sense to pay for the purchase with your card outright then redeem rewards for statement credits after the fact. Use your cash back to pay down debt You can also use rewards to pay off some types of debt, either directly depending on the card you have or indirectly by redeeming for cash back. In terms of options that let you redeem rewards for debt payments, some Wells Fargo credit cards (including the Wells Fargo Active Cash® Card) let you redeem cash back toward a Wells Fargo mortgage in addition to options like gift cards and statement credits. Many cash back credit cards also let you redeem rewards for a check in the mail, which you could deposit into a bank account and use for debt payments. https://www.bankrate.com/credit-cards/cash-back/maximize-cash-back-strategy/ ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.","[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.
+
+EVIDENCE:
+Take advantage of issuers’ shopping portals Before you shop, whether in-person or online, look for card-linked offers from your credit card issuer. If you have the Chase Freedom Flex or Chase Freedom Unlimited, for example, check the Shop through Chase portal to earn more cash back on all your purchases. Although the stores in the Chase shopping portal vary, they frequently include options like Walmart, Sephora, Best Buy and Macy’s. Other issues have their own portals — with Barclaycard you can shop on RewardsBoost, and with a Capital One card you get access to Capital One Shopping. Some issuers offer additional rewards opportunities as well. American Express, Chase, and Capital One have programs — Amex Offers, Chase Offers and Capital One Offers, respectively — through which you can opt in to earn additional cash back from select retailers. For example, with the Capital One QuicksilverOne Cash Rewards Credit Card, you can earn more cash back with particular retailers. To do so, log in to your Capital One account and navigate to the offers portal. In the portal, click “Get this deal” to be taken to a retailer’s site to shop and earn additional rewards at check out. Generally speaking, these offers are found in your online account, have limited redemption windows and must be accepted individually. Cash back percentages vary from store to store, and there are usually limits that cap how much additional cash back you can earn. Make the most of cash back apps If you want to earn more cash back for online purchases, you often can increase your earnings through the use of cash back apps. Cash back apps and sites like Dosh, Ibotta and Rakuten (formerly Ebates) give you a percentage of your spending back on qualifying purchases — on top of the cash back you’re earning on your credit card. For example, Rakuten lets you earn additional cash back when you click through the website before you shop with stores like Kohl’s, Macy’s, Nordstrom, Old Navy and Priceline.com. Use your cash back wisely While maximizing cash back earned on spending always makes sense, that’s only part of the equation. You also need to redeem your cash back in ways that make sense for your goals, whether you want to reduce the amount you owe on your credit card bill, you want to splurge for a fun purchase or you hope to utilize rewards to improve your finances in some way. Consider the following tips to get the most out of your cash back rewards each year: Redeem your cash back as statement credits One of the easiest ways to redeem cash back is for statement credits to your account. This redemption effectively lowers the amount you owe on your credit card bill, thus helping you save money over time. If you sign up for the Wells Fargo Active Cash® Card to earn 2% cash back on all purchases and redeem your rewards for cash back, for example, you would ultimately save 2% on everything you buy with your card. Just remember that rewards only get you “ahead” if you pay your credit card bill in full each month and avoid interest. If you’re paying 20% in credit card interest or more to earn 2% cash back, you’re not doing yourself any favors. Save your cash back for a big purchase You can also save up your rewards for a purchase you want to make down the line, whether it’s a splurge purchase you don’t want to cover in cash or you need to buy something for your everyday life. In either case, most cash back credit cards let you grow your rewards balance over time until you’re ready to use it. Keep in mind: Using rewards for merchandise won't always get you the best value, and that you'll want to be strategic if you go this route. As an example, cash back credit cards from Chase offer 1 cent per point for statement credit redemptions but only 0.8 cents per point for purchases through Amazon.com or PayPal. If you wanted to use rewards for an Amazon or PayPal purchase, it would make more sense to pay for the purchase with your card outright then redeem rewards for statement credits after the fact. Use your cash back to pay down debt You can also use rewards to pay off some types of debt, either directly depending on the card you have or indirectly by redeeming for cash back. In terms of options that let you redeem rewards for debt payments, some Wells Fargo credit cards (including the Wells Fargo Active Cash® Card) let you redeem cash back toward a Wells Fargo mortgage in addition to options like gift cards and statement credits. Many cash back credit cards also let you redeem rewards for a check in the mail, which you could deposit into a bank account and use for debt payments.
+
+USER:
+I recently got a credit card that offers cash back when I shop in certain places but I'm new to the concept. In 200 words or less, what are some great ways that it can be used? Additionally, what other credit card would be great for me when it comes to retail deals through the card?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,28,56,816,,513
+"Only use this document as a source, do not use any outside knowledge.",What impact did Bratz doll have on Mattel?,"**Mattel: Overcoming Marketing and Manufacturing Challenges** It all started in a California garage workshop when Ruth and Elliot Handler and Matt Matson founded Mattel in 1945. The company started out making picture frames, but the founders soon recognized the profitability of the toy industry and switched their emphasis. Mattel became a publicly owned company in 1960, with sales exceeding $100 million by 1965. Over the next 40 years, Mattel went on to become the world’s largest toy company in terms of revenue. Today, Mattel, Inc. is a world leader in the design, manufacture, and marketing of family products. Well-known for toy brands such as Barbie, Fisher-Price, Disney, Hot Wheels, Matchbox, Tyco, Cabbage Patch Kids, and board games such as Scrabble, the company boasts nearly $6 billion in annual revenue. Headquartered in El Segundo, California, with offices in 36 countries, Mattel markets its products in more than 150 nations. In spite of its overall success, Mattel has had its share of losses over its history. During the mid to late 1990s, Mattel lost millions due to declining sales and bad business acquisitions. In January 1997, Jill Barad took over as Mattel’s CEO. Barad’s management style was characterized as strict, and her tenure at the helm proved challenging for many employees. Although Barad had been successful in building the Barbie brand to $2 billion near the end of the twentieth century, growth slowed rapidly after that time. Declining sales at outlets such as Toys ‘‘R’’ Us and the mismanaged acquisition of The Learning Company marked the start of some difficulties for the toy maker, including a dramatic 60 percent drop in stock price under Barad’s three-year stint as CEO. Barad accepted responsibility for these problems and resigned in 2000. The company soon installed Robert Eckert, a 23-year Kraft veteran, as chairman and CEO. During Eckert’s first three years on the job, the company’s stock price increased to over $20 per share, and Mattel was ranked fortieth on Business Week’s list of top-performing companies. Implementing techniques used by consumer-product companies, Eckert adopted a mission to bring stability and predictability to Mattel. He sold unprofitable units, streamlined work processes, and improved relations with retailers. Under Eckert, Mattel was granted the highly sought-after licensing agreement for products related to the Harry Potter series of books and movies. The company continued to flourish and build its reputation, even earning the Corporate Responsibility Award from UNICEF in 2003. By 2008, Mattel had fully realized a turnaround and was recognized as one of Fortune magazine’s ‘‘100 Best Companies to Work For’’ and Forbes magazine’s ‘‘100 Most Trustworthy U.S. Companies.’’ Mattel’s Core Products Barbie Among its many lines of popular toy products, Mattel is famous for owning top girls’ brands. In 1959, Mattel made the move that would establish them at the forefront of the toy industry. After seeing her daughter’s fascination with cutout paper dolls, Ruth suggested that a three-dimensional doll should be produced so that young girls could live out their dreams and fantasies. This doll was named ‘‘Barbie,’’ the nickname of Ruth and Elliot Handler’s daughter. The first Barbie doll sported open-toed shoes, a ponytail, sunglasses, earrings, and a zebra-striped bathing suit. Fashions and accessories were also available for the doll. Although buyers at the annual Toy Fair in New York took no interest in the Barbie doll, little girls of the time certainly did. The intense demand seen at the retail stores was insufficiently met for several years. Mattel just could not produce the Barbie dolls fast enough. Today, Barbie is Mattel’s flagship brand and its number one seller—routinely accounting for approximately half of Mattel’s sales revenue. This makes Barbie the best-selling fashion doll in most global markets. The Barbie line today includes dolls, accessories, Barbie software, and a broad assortment of licensed products such as books, apparel, food, home furnishings, home electronics, and movies. Although Barbie was introduced as a teenage fashion model, she has taken on almost every possible profession. She has also acquired numerous male and female friends and family over the years. Ken, Midge, Skipper, Christie, and others were introduced from the mid-1960s on. The Barbie line has even seen a disabled friend in a wheelchair: Share a Smile Becky. Barbie’s popularity has even broken stereotypes. Retrofitted versions of Barbie dolls, on sale in select San Francisco stores, feature ‘‘Hooker’’ Barbie, ‘‘Trailer Trash’’ Barbie, and ‘‘Drag Queen’’ Barbie. There are also numerous ‘‘alternative’’ Barbies, such as ‘‘Big Dyke’’ Barbie, but Mattel does not want the Barbie name to be used in these sales. Redressed and accessorized Barbies are okay with Mattel as long as no one practices trademark infringement. Barbie’s Popularity Slips Although Barbie remains a blockbuster by any standard, Barbie’s popularity has slipped over the past decade. There are two major reasons for Barbie’s slump. First, the changing lifestyles of today’s young girls are a concern for Mattel. Many young girls prefer to spend time with music, movies, or the Internet than play with traditional toys like dolls. Second, Barbie has suffered at the hands of new and innovative competition, including the Bratz doll line that gained significant market share during the early 2000s. The dolls, which featured contemporary, ethnic designs and skimpy clothes, were a stark contrast to Barbie and an immediate hit with young girls. In an attempt to recover, Mattel introduced the new line of My Scene dolls aimed at ‘‘tweens.’’ These dolls are trendier, look younger, and are considered to be more hip for this age group who is on the cusp of outgrowing playing with dolls. A website (http://www.myscene.com) engages girls in a variety of fun, engaging, and promotional activities. Barbie’s Legal Battle with MGA Entertainment Since 2004, Mattel has been embroiled in a bitter intellectual property battle with former employee Carter Bryant and MGA Entertainment, Inc., over rights to MGA’s popular Bratz dolls. Carter Bryant, an onagain/off-again Mattel employee, designed the Bratz dolls and pitched them to MGA. A few months after the pitch, Bryant left Mattel to work at MGA, which began producing Bratz in 2001. In 2002, Mattel launched an investigation into whether Bryant had designed the Bratz dolls while employed with Mattel. After two years of investigation, Mattel sued Bryant. A year later MGA fired off a suit of its own, claiming that Mattel’s My Scene dolls were an attempt to copy the Bratz line. Mattel answered by expanding its own lawsuit to include MGA and its CEO, Isaac Larian. For decades, Barbie had reigned supreme in the doll market. However, Bratz dolls gave Barbie a run for her money. In 2005, four years after the brand’s debut, Bratz sales were at $2 billion. By 2009, Barbie’s worldwide sales had fallen by 15 percent, although Bratz was not immune to sluggish sales either once consumers began to cut back on spending during the 2008–2009 recession. Much evidence points toward Bryant having conceived of Bratz dolls while at Mattel. Four years after the initial suit was filed, Bryant settled with Mattel under an undisclosed set of terms. However, although some decisions were made, the battle between Mattel and MGA has continued. In July 2008, a jury deemed MGA and its CEO liable for what it termed ‘‘intentional interference’’ regarding Bryant’s contract with Mattel. In August 2008, Mattel received damages of $100 million. Although Mattel first requested damages of $1.8 billion, the company was pleased with the principle behind the victory. MGA is appealing the decision. In December 2008, Mattel appeared to win another victory when a California judge banned MGA from making or selling Bratz dolls. The decision was devastating to the Bratz line, as retailers have avoided the brand in anticipation of Mattel’s takeover. Many industry analysts, however, expect Mattel to work out a deal with MGA in which MGA can continue to sell Bratz dolls as long as Mattel shares in the profits. MGA plans to appeal the court ruling. Whatever the outcome, Mattel has managed to gain some control over Barbie’s toughest competition. American Girl In 1998, Mattel acquired Pleasant Company, maker of the American Girl collection—a well-known line of historical dolls, books, and accessories. Originally, American Girl products were sold exclusively through catalogs. Mattel extended that base by selling American Girl accessories (not the dolls) in major chain stores like Walmart and Target. More recent efforts to increase brand awareness include the opening of American Girl Place shops in New York, Chicago, Los Angeles, Atlanta, Dallas, Boston, and Minneapolis. The New York store features three floors of dolls, accessories, and books in the heart of the 5th Avenue shopping district. The store also offers a cafe where girls can dine with their dolls and a stage production where young actresses bring American Girl stories to life. The American Girl collection is wildly popular with girls in the 7- to 12-year-old demographic. The dolls have a wholesome and educational image—the antithesis to Barbie. This move by Mattel represented a long-term strategy to reduce reliance on traditional products and to take away the stigma surrounding the ‘‘perfect image’’ of Barbie. Each American Girl doll lives during a specific time in American history, and all have stories that describe the hardships they face while maturing into young adults. For example, Felicity’s stories describe life in 1774 just prior to the Revolutionary War. Likewise, Josephina lives in New Mexico in 1824 during the rapid growth of the American West. Other dolls include Kaya (a Native American girl growing up in 1764), Elizabeth (Colonial Virginia), Kirsten (pioneer life in 1854), Addy (1864 during the Civil War), Samantha and Nellie (1904 New York), Kit (1934 during the Great Depression), Molly (1944 during World War II), and Emily (a British girl who comes to America during World War II). The American Girl brand includes several book series, accessories, clothing for dolls and girls, and a magazine that ranks in the top 10 American children’s magazines. Hot Wheels Hot Wheels roared into the toy world in 1968. More than 40 years later, the brand is hotter than ever and includes high-end collectibles, NASCAR (National Association for Stock Car Auto Racing) and Formula One models for adults, high-performance cars, track sets, and play sets for children of all ages. The brand is connected with racing circuits worldwide. More than 15 million boys ages 5 to 15 are avid collectors, each owning an average of 41 cars.","{Query} ================== What impact did Bratz doll have on Mattel? {Instructions} ================== Only use this document as a source, do not use any outside knowledge. {Text Passage} ================== **Mattel: Overcoming Marketing and Manufacturing Challenges** It all started in a California garage workshop when Ruth and Elliot Handler and Matt Matson founded Mattel in 1945. The company started out making picture frames, but the founders soon recognized the profitability of the toy industry and switched their emphasis. Mattel became a publicly owned company in 1960, with sales exceeding $100 million by 1965. Over the next 40 years, Mattel went on to become the world’s largest toy company in terms of revenue. Today, Mattel, Inc. is a world leader in the design, manufacture, and marketing of family products. Well-known for toy brands such as Barbie, Fisher-Price, Disney, Hot Wheels, Matchbox, Tyco, Cabbage Patch Kids, and board games such as Scrabble, the company boasts nearly $6 billion in annual revenue. Headquartered in El Segundo, California, with offices in 36 countries, Mattel markets its products in more than 150 nations. In spite of its overall success, Mattel has had its share of losses over its history. During the mid to late 1990s, Mattel lost millions due to declining sales and bad business acquisitions. In January 1997, Jill Barad took over as Mattel’s CEO. Barad’s management style was characterized as strict, and her tenure at the helm proved challenging for many employees. Although Barad had been successful in building the Barbie brand to $2 billion near the end of the twentieth century, growth slowed rapidly after that time. Declining sales at outlets such as Toys ‘‘R’’ Us and the mismanaged acquisition of The Learning Company marked the start of some difficulties for the toy maker, including a dramatic 60 percent drop in stock price under Barad’s three-year stint as CEO. Barad accepted responsibility for these problems and resigned in 2000. The company soon installed Robert Eckert, a 23-year Kraft veteran, as chairman and CEO. During Eckert’s first three years on the job, the company’s stock price increased to over $20 per share, and Mattel was ranked fortieth on Business Week’s list of top-performing companies. Implementing techniques used by consumer-product companies, Eckert adopted a mission to bring stability and predictability to Mattel. He sold unprofitable units, streamlined work processes, and improved relations with retailers. Under Eckert, Mattel was granted the highly sought-after licensing agreement for products related to the Harry Potter series of books and movies. The company continued to flourish and build its reputation, even earning the Corporate Responsibility Award from UNICEF in 2003. By 2008, Mattel had fully realized a turnaround and was recognized as one of Fortune magazine’s ‘‘100 Best Companies to Work For’’ and Forbes magazine’s ‘‘100 Most Trustworthy U.S. Companies.’’ Mattel’s Core Products Barbie Among its many lines of popular toy products, Mattel is famous for owning top girls’ brands. In 1959, Mattel made the move that would establish them at the forefront of the toy industry. After seeing her daughter’s fascination with cutout paper dolls, Ruth suggested that a three-dimensional doll should be produced so that young girls could live out their dreams and fantasies. This doll was named ‘‘Barbie,’’ the nickname of Ruth and Elliot Handler’s daughter. The first Barbie doll sported open-toed shoes, a ponytail, sunglasses, earrings, and a zebra-striped bathing suit. Fashions and accessories were also available for the doll. Although buyers at the annual Toy Fair in New York took no interest in the Barbie doll, little girls of the time certainly did. The intense demand seen at the retail stores was insufficiently met for several years. Mattel just could not produce the Barbie dolls fast enough. Today, Barbie is Mattel’s flagship brand and its number one seller—routinely accounting for approximately half of Mattel’s sales revenue. This makes Barbie the best-selling fashion doll in most global markets. The Barbie line today includes dolls, accessories, Barbie software, and a broad assortment of licensed products such as books, apparel, food, home furnishings, home electronics, and movies. Although Barbie was introduced as a teenage fashion model, she has taken on almost every possible profession. She has also acquired numerous male and female friends and family over the years. Ken, Midge, Skipper, Christie, and others were introduced from the mid-1960s on. The Barbie line has even seen a disabled friend in a wheelchair: Share a Smile Becky. Barbie’s popularity has even broken stereotypes. Retrofitted versions of Barbie dolls, on sale in select San Francisco stores, feature ‘‘Hooker’’ Barbie, ‘‘Trailer Trash’’ Barbie, and ‘‘Drag Queen’’ Barbie. There are also numerous ‘‘alternative’’ Barbies, such as ‘‘Big Dyke’’ Barbie, but Mattel does not want the Barbie name to be used in these sales. Redressed and accessorized Barbies are okay with Mattel as long as no one practices trademark infringement. Barbie’s Popularity Slips Although Barbie remains a blockbuster by any standard, Barbie’s popularity has slipped over the past decade. There are two major reasons for Barbie’s slump. First, the changing lifestyles of today’s young girls are a concern for Mattel. Many young girls prefer to spend time with music, movies, or the Internet than play with traditional toys like dolls. Second, Barbie has suffered at the hands of new and innovative competition, including the Bratz doll line that gained significant market share during the early 2000s. The dolls, which featured contemporary, ethnic designs and skimpy clothes, were a stark contrast to Barbie and an immediate hit with young girls. In an attempt to recover, Mattel introduced the new line of My Scene dolls aimed at ‘‘tweens.’’ These dolls are trendier, look younger, and are considered to be more hip for this age group who is on the cusp of outgrowing playing with dolls. A website (http://www.myscene.com) engages girls in a variety of fun, engaging, and promotional activities. Barbie’s Legal Battle with MGA Entertainment Since 2004, Mattel has been embroiled in a bitter intellectual property battle with former employee Carter Bryant and MGA Entertainment, Inc., over rights to MGA’s popular Bratz dolls. Carter Bryant, an onagain/off-again Mattel employee, designed the Bratz dolls and pitched them to MGA. A few months after the pitch, Bryant left Mattel to work at MGA, which began producing Bratz in 2001. In 2002, Mattel launched an investigation into whether Bryant had designed the Bratz dolls while employed with Mattel. After two years of investigation, Mattel sued Bryant. A year later MGA fired off a suit of its own, claiming that Mattel’s My Scene dolls were an attempt to copy the Bratz line. Mattel answered by expanding its own lawsuit to include MGA and its CEO, Isaac Larian. For decades, Barbie had reigned supreme in the doll market. However, Bratz dolls gave Barbie a run for her money. In 2005, four years after the brand’s debut, Bratz sales were at $2 billion. By 2009, Barbie’s worldwide sales had fallen by 15 percent, although Bratz was not immune to sluggish sales either once consumers began to cut back on spending during the 2008–2009 recession. Much evidence points toward Bryant having conceived of Bratz dolls while at Mattel. Four years after the initial suit was filed, Bryant settled with Mattel under an undisclosed set of terms. However, although some decisions were made, the battle between Mattel and MGA has continued. In July 2008, a jury deemed MGA and its CEO liable for what it termed ‘‘intentional interference’’ regarding Bryant’s contract with Mattel. In August 2008, Mattel received damages of $100 million. Although Mattel first requested damages of $1.8 billion, the company was pleased with the principle behind the victory. MGA is appealing the decision. In December 2008, Mattel appeared to win another victory when a California judge banned MGA from making or selling Bratz dolls. The decision was devastating to the Bratz line, as retailers have avoided the brand in anticipation of Mattel’s takeover. Many industry analysts, however, expect Mattel to work out a deal with MGA in which MGA can continue to sell Bratz dolls as long as Mattel shares in the profits. MGA plans to appeal the court ruling. Whatever the outcome, Mattel has managed to gain some control over Barbie’s toughest competition. American Girl In 1998, Mattel acquired Pleasant Company, maker of the American Girl collection—a well-known line of historical dolls, books, and accessories. Originally, American Girl products were sold exclusively through catalogs. Mattel extended that base by selling American Girl accessories (not the dolls) in major chain stores like Walmart and Target. More recent efforts to increase brand awareness include the opening of American Girl Place shops in New York, Chicago, Los Angeles, Atlanta, Dallas, Boston, and Minneapolis. The New York store features three floors of dolls, accessories, and books in the heart of the 5th Avenue shopping district. The store also offers a cafe where girls can dine with their dolls and a stage production where young actresses bring American Girl stories to life. The American Girl collection is wildly popular with girls in the 7- to 12-year-old demographic. The dolls have a wholesome and educational image—the antithesis to Barbie. This move by Mattel represented a long-term strategy to reduce reliance on traditional products and to take away the stigma surrounding the ‘‘perfect image’’ of Barbie. Each American Girl doll lives during a specific time in American history, and all have stories that describe the hardships they face while maturing into young adults. For example, Felicity’s stories describe life in 1774 just prior to the Revolutionary War. Likewise, Josephina lives in New Mexico in 1824 during the rapid growth of the American West. Other dolls include Kaya (a Native American girl growing up in 1764), Elizabeth (Colonial Virginia), Kirsten (pioneer life in 1854), Addy (1864 during the Civil War), Samantha and Nellie (1904 New York), Kit (1934 during the Great Depression), Molly (1944 during World War II), and Emily (a British girl who comes to America during World War II). The American Girl brand includes several book series, accessories, clothing for dolls and girls, and a magazine that ranks in the top 10 American children’s magazines. Hot Wheels Hot Wheels roared into the toy world in 1968. More than 40 years later, the brand is hotter than ever and includes high-end collectibles, NASCAR (National Association for Stock Car Auto Racing) and Formula One models for adults, high-performance cars, track sets, and play sets for children of all ages. The brand is connected with racing circuits worldwide. More than 15 million boys ages 5 to 15 are avid collectors, each owning an average of 41 cars.","Only use this document as a source, do not use any outside knowledge.
+
+EVIDENCE:
+**Mattel: Overcoming Marketing and Manufacturing Challenges** It all started in a California garage workshop when Ruth and Elliot Handler and Matt Matson founded Mattel in 1945. The company started out making picture frames, but the founders soon recognized the profitability of the toy industry and switched their emphasis. Mattel became a publicly owned company in 1960, with sales exceeding $100 million by 1965. Over the next 40 years, Mattel went on to become the world’s largest toy company in terms of revenue. Today, Mattel, Inc. is a world leader in the design, manufacture, and marketing of family products. Well-known for toy brands such as Barbie, Fisher-Price, Disney, Hot Wheels, Matchbox, Tyco, Cabbage Patch Kids, and board games such as Scrabble, the company boasts nearly $6 billion in annual revenue. Headquartered in El Segundo, California, with offices in 36 countries, Mattel markets its products in more than 150 nations. In spite of its overall success, Mattel has had its share of losses over its history. During the mid to late 1990s, Mattel lost millions due to declining sales and bad business acquisitions. In January 1997, Jill Barad took over as Mattel’s CEO. Barad’s management style was characterized as strict, and her tenure at the helm proved challenging for many employees. Although Barad had been successful in building the Barbie brand to $2 billion near the end of the twentieth century, growth slowed rapidly after that time. Declining sales at outlets such as Toys ‘‘R’’ Us and the mismanaged acquisition of The Learning Company marked the start of some difficulties for the toy maker, including a dramatic 60 percent drop in stock price under Barad’s three-year stint as CEO. Barad accepted responsibility for these problems and resigned in 2000. The company soon installed Robert Eckert, a 23-year Kraft veteran, as chairman and CEO. During Eckert’s first three years on the job, the company’s stock price increased to over $20 per share, and Mattel was ranked fortieth on Business Week’s list of top-performing companies. Implementing techniques used by consumer-product companies, Eckert adopted a mission to bring stability and predictability to Mattel. He sold unprofitable units, streamlined work processes, and improved relations with retailers. Under Eckert, Mattel was granted the highly sought-after licensing agreement for products related to the Harry Potter series of books and movies. The company continued to flourish and build its reputation, even earning the Corporate Responsibility Award from UNICEF in 2003. By 2008, Mattel had fully realized a turnaround and was recognized as one of Fortune magazine’s ‘‘100 Best Companies to Work For’’ and Forbes magazine’s ‘‘100 Most Trustworthy U.S. Companies.’’ Mattel’s Core Products Barbie Among its many lines of popular toy products, Mattel is famous for owning top girls’ brands. In 1959, Mattel made the move that would establish them at the forefront of the toy industry. After seeing her daughter’s fascination with cutout paper dolls, Ruth suggested that a three-dimensional doll should be produced so that young girls could live out their dreams and fantasies. This doll was named ‘‘Barbie,’’ the nickname of Ruth and Elliot Handler’s daughter. The first Barbie doll sported open-toed shoes, a ponytail, sunglasses, earrings, and a zebra-striped bathing suit. Fashions and accessories were also available for the doll. Although buyers at the annual Toy Fair in New York took no interest in the Barbie doll, little girls of the time certainly did. The intense demand seen at the retail stores was insufficiently met for several years. Mattel just could not produce the Barbie dolls fast enough. Today, Barbie is Mattel’s flagship brand and its number one seller—routinely accounting for approximately half of Mattel’s sales revenue. This makes Barbie the best-selling fashion doll in most global markets. The Barbie line today includes dolls, accessories, Barbie software, and a broad assortment of licensed products such as books, apparel, food, home furnishings, home electronics, and movies. Although Barbie was introduced as a teenage fashion model, she has taken on almost every possible profession. She has also acquired numerous male and female friends and family over the years. Ken, Midge, Skipper, Christie, and others were introduced from the mid-1960s on. The Barbie line has even seen a disabled friend in a wheelchair: Share a Smile Becky. Barbie’s popularity has even broken stereotypes. Retrofitted versions of Barbie dolls, on sale in select San Francisco stores, feature ‘‘Hooker’’ Barbie, ‘‘Trailer Trash’’ Barbie, and ‘‘Drag Queen’’ Barbie. There are also numerous ‘‘alternative’’ Barbies, such as ‘‘Big Dyke’’ Barbie, but Mattel does not want the Barbie name to be used in these sales. Redressed and accessorized Barbies are okay with Mattel as long as no one practices trademark infringement. Barbie’s Popularity Slips Although Barbie remains a blockbuster by any standard, Barbie’s popularity has slipped over the past decade. There are two major reasons for Barbie’s slump. First, the changing lifestyles of today’s young girls are a concern for Mattel. Many young girls prefer to spend time with music, movies, or the Internet than play with traditional toys like dolls. Second, Barbie has suffered at the hands of new and innovative competition, including the Bratz doll line that gained significant market share during the early 2000s. The dolls, which featured contemporary, ethnic designs and skimpy clothes, were a stark contrast to Barbie and an immediate hit with young girls. In an attempt to recover, Mattel introduced the new line of My Scene dolls aimed at ‘‘tweens.’’ These dolls are trendier, look younger, and are considered to be more hip for this age group who is on the cusp of outgrowing playing with dolls. A website (http://www.myscene.com) engages girls in a variety of fun, engaging, and promotional activities. Barbie’s Legal Battle with MGA Entertainment Since 2004, Mattel has been embroiled in a bitter intellectual property battle with former employee Carter Bryant and MGA Entertainment, Inc., over rights to MGA’s popular Bratz dolls. Carter Bryant, an onagain/off-again Mattel employee, designed the Bratz dolls and pitched them to MGA. A few months after the pitch, Bryant left Mattel to work at MGA, which began producing Bratz in 2001. In 2002, Mattel launched an investigation into whether Bryant had designed the Bratz dolls while employed with Mattel. After two years of investigation, Mattel sued Bryant. A year later MGA fired off a suit of its own, claiming that Mattel’s My Scene dolls were an attempt to copy the Bratz line. Mattel answered by expanding its own lawsuit to include MGA and its CEO, Isaac Larian. For decades, Barbie had reigned supreme in the doll market. However, Bratz dolls gave Barbie a run for her money. In 2005, four years after the brand’s debut, Bratz sales were at $2 billion. By 2009, Barbie’s worldwide sales had fallen by 15 percent, although Bratz was not immune to sluggish sales either once consumers began to cut back on spending during the 2008–2009 recession. Much evidence points toward Bryant having conceived of Bratz dolls while at Mattel. Four years after the initial suit was filed, Bryant settled with Mattel under an undisclosed set of terms. However, although some decisions were made, the battle between Mattel and MGA has continued. In July 2008, a jury deemed MGA and its CEO liable for what it termed ‘‘intentional interference’’ regarding Bryant’s contract with Mattel. In August 2008, Mattel received damages of $100 million. Although Mattel first requested damages of $1.8 billion, the company was pleased with the principle behind the victory. MGA is appealing the decision. In December 2008, Mattel appeared to win another victory when a California judge banned MGA from making or selling Bratz dolls. The decision was devastating to the Bratz line, as retailers have avoided the brand in anticipation of Mattel’s takeover. Many industry analysts, however, expect Mattel to work out a deal with MGA in which MGA can continue to sell Bratz dolls as long as Mattel shares in the profits. MGA plans to appeal the court ruling. Whatever the outcome, Mattel has managed to gain some control over Barbie’s toughest competition. American Girl In 1998, Mattel acquired Pleasant Company, maker of the American Girl collection—a well-known line of historical dolls, books, and accessories. Originally, American Girl products were sold exclusively through catalogs. Mattel extended that base by selling American Girl accessories (not the dolls) in major chain stores like Walmart and Target. More recent efforts to increase brand awareness include the opening of American Girl Place shops in New York, Chicago, Los Angeles, Atlanta, Dallas, Boston, and Minneapolis. The New York store features three floors of dolls, accessories, and books in the heart of the 5th Avenue shopping district. The store also offers a cafe where girls can dine with their dolls and a stage production where young actresses bring American Girl stories to life. The American Girl collection is wildly popular with girls in the 7- to 12-year-old demographic. The dolls have a wholesome and educational image—the antithesis to Barbie. This move by Mattel represented a long-term strategy to reduce reliance on traditional products and to take away the stigma surrounding the ‘‘perfect image’’ of Barbie. Each American Girl doll lives during a specific time in American history, and all have stories that describe the hardships they face while maturing into young adults. For example, Felicity’s stories describe life in 1774 just prior to the Revolutionary War. Likewise, Josephina lives in New Mexico in 1824 during the rapid growth of the American West. Other dolls include Kaya (a Native American girl growing up in 1764), Elizabeth (Colonial Virginia), Kirsten (pioneer life in 1854), Addy (1864 during the Civil War), Samantha and Nellie (1904 New York), Kit (1934 during the Great Depression), Molly (1944 during World War II), and Emily (a British girl who comes to America during World War II). The American Girl brand includes several book series, accessories, clothing for dolls and girls, and a magazine that ranks in the top 10 American children’s magazines. Hot Wheels Hot Wheels roared into the toy world in 1968. More than 40 years later, the brand is hotter than ever and includes high-end collectibles, NASCAR (National Association for Stock Car Auto Racing) and Formula One models for adults, high-performance cars, track sets, and play sets for children of all ages. The brand is connected with racing circuits worldwide. More than 15 million boys ages 5 to 15 are avid collectors, each owning an average of 41 cars.
+
+USER:
+What impact did Bratz doll have on Mattel?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",True,13,8,1719,,45
+"""================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",My cousin in South Dakota wants to sell me his 1977 triple wide manufactured home that he has on a lot in a mobile home park there. I will move it to my improved land in New York and live there. Can I finance this home using a FHA mortgage loan?,"II. ORIGINATION THROUGH POST-CLOSING/ENDORSEMENT B. Title II Insured Housing Programs Reverse Mortgages 2. Origination/Processing Handbook 4000.1 589 Last Revised: 05/20/2024 Mortgagee must determine whether the recorded Declaration and/or CC&Rs require prior approval by the association of any non-purchase money mortgage that will encumber the Property. In those situations where such a requirement exists, the Mortgagee must obtain the approval of the association in writing prior to origination of the HECM. Documentation concerning this approval must be maintained by the Mortgagee and made available to HUD upon request. (7) Property Assessed Clean Energy (a) Definition Property Assessed Clean Energy (PACE) refers to an alternative means of financing energy and other PACE-allowed improvements to residential properties using financing provided by private enterprises in conjunction with state and local governments. Generally, the repayment of the PACE obligation is collected in the same manner as a special assessment tax; it is collected by the local government rather than paid directly by the Borrower to the party providing the PACE financing. Generally, the PACE obligation is also secured in the same manner as a special assessment against the property. (b) Standard Properties which will remain encumbered with a PACE obligation are not eligible for an FHA-insured HECM. To be eligible for FHA insurance, the PACE obligation must be paid off in full prior to or at closing. The Borrower may use HECM proceeds to satisfy the PACE obligation. For HECM for Purchase transactions, see the Property Assessed Clean Energy section of the product sheet. (B) Property Types FHA’s programs differ from one another primarily in terms of what types of Properties and financing are eligible. Except as otherwise stated in this Handbook 4000.1, HECMs are limited to one- to four-unit Single Family Properties where the Borrower occupies one unit as their Principal Residence. FHA insures HECM financing on Real Property secured by: • detached or semi-detached dwellings • Manufactured Housing • townhouses or row houses • Condominium Units and Site Condominiums FHA will not insure HECMs secured by: • commercial enterprises • cooperative units • boarding houses • hotels, motels, and condotels II. ORIGINATION THROUGH POST-CLOSING/ENDORSEMENT B. Title II Insured Housing Programs Reverse Mortgages 2. Origination/Processing Handbook 4000.1 590 Last Revised: 05/20/2024 • tourist houses • private clubs • bed and breakfast establishments • other transient housing • Vacation Homes • fraternity and sorority houses (1) One-Unit A one-unit Property is a Single Family residential Property with a single Dwelling Unit, or with a single Dwelling Unit and a single ADU. (2) Two-Unit (a) Definition A two-unit Property is a Single Family residential Property with two individual dwellings. (b) Standard The Mortgagee must obtain a completed form HUD-92561. (3) Three- to Four-Unit A three- to four-unit Property is either: • a Single Family residential Property with three to four individual Dwelling Units; or • a Single Family residential Property with two individual Dwelling Units and one ADU or three individual Dwelling Units and one ADU. The Mortgagee must obtain a completed form HUD-92561. (4) Accessory Dwelling Unit (a) Definition An Accessory Dwelling Unit (ADU) refers to a single habitable living unit with means of separate ingress and egress that meets the minimum requirements for a living unit. An ADU is a private space that is subordinate in size and within, or detached from a primary one-unit Single Family dwelling, which together constitute a single interest in real estate. (b) Standard A Single Family residential one-unit Property with a single ADU remains a one-unit Property. For any Single Family residential Property with two or II. ORIGINATION THROUGH POST-CLOSING/ENDORSEMENT B. Title II Insured Housing Programs Reverse Mortgages 2. Origination/Processing Handbook 4000.1 591 Last Revised: 05/20/2024 more units, a separate additional Dwelling Unit must be considered as an additional unit. (5) Condominium Unit (a) Definitions A Condominium Unit refers to real estate consisting of a one-family Dwelling Unit in a Condominium Project. Condominium Project refers to a project in which one-family Dwelling Units are attached, semi-detached, detached, or Manufactured Home units, and in which owners hold an undivided interest in Common Elements. (b) Standard A Condominium Unit must be either located within an FHA-approved Condominium Project, meet FHA’s definition of a Site Condominium, or have completed the FHA Single-Unit Approval process before a Mortgage can be insured. (6) Site Condominiums (a) Definition A Site Condominium refers to: • a Condominium Project that consists entirely of Single Family detached dwellings that have no shared garages, or any other attached buildings; or • a Condominium Project that:  consists of Single Family detached or horizontally attached (townhouse-style) dwellings where the Unit consists of the dwelling and land;  does not contain any Manufactured Housing Units; and  is encumbered by a declaration of condominium covenants or a condominium form of ownership. (b) Standard Manufactured Housing condominium units may not be processed as Site Condominiums. The Unit owner must be responsible for all required insurance and maintenance costs associated with the Unit dwelling, excluding landscaping, of the Site Condominium. II. ORIGINATION THROUGH POST-CLOSING/ENDORSEMENT B. Title II Insured Housing Programs Reverse Mortgages 2. Origination/Processing Handbook 4000.1 592 Last Revised: 05/20/2024 Site Condominiums do not require Condominium Project Approval or Single- Unit Approval. Manufactured Housing (a) Definition Manufactured Housing is a Structure that is transportable in one or more sections. It may be part of a Condominium Project, provided the project meets applicable FHA requirements. (b) Standard To be eligible for FHA mortgage insurance as a Single Family Title II HECM, all Manufactured Housing must: • be designed as a one-family dwelling; • have a floor area of not less than 400 square feet; • have the HUD Certification Label affixed or have obtained a letter of label verification issued on behalf of HUD, evidencing the house was constructed on or after June 15, 1976, in compliance with the Federal Manufactured Home Construction and Safety Standards; • be classified as real estate (but need not be treated as real estate for purposes of state taxation); • be built and remain on a permanent chassis; • be designed to be used as a dwelling with a permanent foundation built in accordance with the Permanent Foundations Guide for Manufactured Housing (PFGMH); and • have been directly transported from the manufacturer or the dealership to the site. (c) Required Documentation (i) HUD Certification Label If the appraisal indicates the HUD Certification Label is missing from the Manufactured Housing unit, the Mortgagee must obtain label verification from the Institute for Building Technology and Safety (IBTS). (ii) PFGMH Certification The Mortgagee must obtain a certification by an engineer or architect, who is licensed/registered in the state where the Manufactured Home is located, attesting to compliance with the PFGMH. The Mortgagee may obtain a copy of the foundation certification from a previous FHA-insured Mortgage, showing that the foundation met the guidelines published in the PFGMH that were in effect at the time of II. ORIGINATION THROUGH POST-CLOSING/ENDORSEMENT B. Title II Insured Housing Programs Reverse Mortgages 2. Origination/Processing Handbook 4000.1 593 Last Revised: 05/20/2024 certification, provided there are no alterations and/or observable damage to the foundation since the date of the original certification. If the Appraiser notes additions or alterations to the Manufactured Housing unit, the Mortgagee must ensure the addition was addressed in the foundation certification. If the additions or alterations were not addressed in the foundation certification, the Mortgagee must obtain: • an inspection by the state administrative agency that inspects Manufactured Housing for compliance; or • certification of the structural integrity from a licensed structural engineer if the state does not employ inspectors","""================ <TEXT PASSAGE> ======= II. ORIGINATION THROUGH POST-CLOSING/ENDORSEMENT B. Title II Insured Housing Programs Reverse Mortgages 2. Origination/Processing Handbook 4000.1 589 Last Revised: 05/20/2024 Mortgagee must determine whether the recorded Declaration and/or CC&Rs require prior approval by the association of any non-purchase money mortgage that will encumber the Property. In those situations where such a requirement exists, the Mortgagee must obtain the approval of the association in writing prior to origination of the HECM. Documentation concerning this approval must be maintained by the Mortgagee and made available to HUD upon request. (7) Property Assessed Clean Energy (a) Definition Property Assessed Clean Energy (PACE) refers to an alternative means of financing energy and other PACE-allowed improvements to residential properties using financing provided by private enterprises in conjunction with state and local governments. Generally, the repayment of the PACE obligation is collected in the same manner as a special assessment tax; it is collected by the local government rather than paid directly by the Borrower to the party providing the PACE financing. Generally, the PACE obligation is also secured in the same manner as a special assessment against the property. (b) Standard Properties which will remain encumbered with a PACE obligation are not eligible for an FHA-insured HECM. To be eligible for FHA insurance, the PACE obligation must be paid off in full prior to or at closing. The Borrower may use HECM proceeds to satisfy the PACE obligation. For HECM for Purchase transactions, see the Property Assessed Clean Energy section of the product sheet. (B) Property Types FHA’s programs differ from one another primarily in terms of what types of Properties and financing are eligible. Except as otherwise stated in this Handbook 4000.1, HECMs are limited to one- to four-unit Single Family Properties where the Borrower occupies one unit as their Principal Residence. FHA insures HECM financing on Real Property secured by: • detached or semi-detached dwellings • Manufactured Housing • townhouses or row houses • Condominium Units and Site Condominiums FHA will not insure HECMs secured by: • commercial enterprises • cooperative units • boarding houses • hotels, motels, and condotels II. ORIGINATION THROUGH POST-CLOSING/ENDORSEMENT B. Title II Insured Housing Programs Reverse Mortgages 2. Origination/Processing Handbook 4000.1 590 Last Revised: 05/20/2024 • tourist houses • private clubs • bed and breakfast establishments • other transient housing • Vacation Homes • fraternity and sorority houses (1) One-Unit A one-unit Property is a Single Family residential Property with a single Dwelling Unit, or with a single Dwelling Unit and a single ADU. (2) Two-Unit (a) Definition A two-unit Property is a Single Family residential Property with two individual dwellings. (b) Standard The Mortgagee must obtain a completed form HUD-92561. (3) Three- to Four-Unit A three- to four-unit Property is either: • a Single Family residential Property with three to four individual Dwelling Units; or • a Single Family residential Property with two individual Dwelling Units and one ADU or three individual Dwelling Units and one ADU. The Mortgagee must obtain a completed form HUD-92561. (4) Accessory Dwelling Unit (a) Definition An Accessory Dwelling Unit (ADU) refers to a single habitable living unit with means of separate ingress and egress that meets the minimum requirements for a living unit. An ADU is a private space that is subordinate in size and within, or detached from a primary one-unit Single Family dwelling, which together constitute a single interest in real estate. (b) Standard A Single Family residential one-unit Property with a single ADU remains a one-unit Property. For any Single Family residential Property with two or II. ORIGINATION THROUGH POST-CLOSING/ENDORSEMENT B. Title II Insured Housing Programs Reverse Mortgages 2. Origination/Processing Handbook 4000.1 591 Last Revised: 05/20/2024 more units, a separate additional Dwelling Unit must be considered as an additional unit. (5) Condominium Unit (a) Definitions A Condominium Unit refers to real estate consisting of a one-family Dwelling Unit in a Condominium Project. Condominium Project refers to a project in which one-family Dwelling Units are attached, semi-detached, detached, or Manufactured Home units, and in which owners hold an undivided interest in Common Elements. (b) Standard A Condominium Unit must be either located within an FHA-approved Condominium Project, meet FHA’s definition of a Site Condominium, or have completed the FHA Single-Unit Approval process before a Mortgage can be insured. (6) Site Condominiums (a) Definition A Site Condominium refers to: • a Condominium Project that consists entirely of Single Family detached dwellings that have no shared garages, or any other attached buildings; or • a Condominium Project that:  consists of Single Family detached or horizontally attached (townhouse-style) dwellings where the Unit consists of the dwelling and land;  does not contain any Manufactured Housing Units; and  is encumbered by a declaration of condominium covenants or a condominium form of ownership. (b) Standard Manufactured Housing condominium units may not be processed as Site Condominiums. The Unit owner must be responsible for all required insurance and maintenance costs associated with the Unit dwelling, excluding landscaping, of the Site Condominium. II. ORIGINATION THROUGH POST-CLOSING/ENDORSEMENT B. Title II Insured Housing Programs Reverse Mortgages 2. Origination/Processing Handbook 4000.1 592 Last Revised: 05/20/2024 Site Condominiums do not require Condominium Project Approval or Single- Unit Approval. Manufactured Housing (a) Definition Manufactured Housing is a Structure that is transportable in one or more sections. It may be part of a Condominium Project, provided the project meets applicable FHA requirements. (b) Standard To be eligible for FHA mortgage insurance as a Single Family Title II HECM, all Manufactured Housing must: • be designed as a one-family dwelling; • have a floor area of not less than 400 square feet; • have the HUD Certification Label affixed or have obtained a letter of label verification issued on behalf of HUD, evidencing the house was constructed on or after June 15, 1976, in compliance with the Federal Manufactured Home Construction and Safety Standards; • be classified as real estate (but need not be treated as real estate for purposes of state taxation); • be built and remain on a permanent chassis; • be designed to be used as a dwelling with a permanent foundation built in accordance with the Permanent Foundations Guide for Manufactured Housing (PFGMH); and • have been directly transported from the manufacturer or the dealership to the site. (c) Required Documentation (i) HUD Certification Label If the appraisal indicates the HUD Certification Label is missing from the Manufactured Housing unit, the Mortgagee must obtain label verification from the Institute for Building Technology and Safety (IBTS). (ii) PFGMH Certification The Mortgagee must obtain a certification by an engineer or architect, who is licensed/registered in the state where the Manufactured Home is located, attesting to compliance with the PFGMH. The Mortgagee may obtain a copy of the foundation certification from a previous FHA-insured Mortgage, showing that the foundation met the guidelines published in the PFGMH that were in effect at the time of II. ORIGINATION THROUGH POST-CLOSING/ENDORSEMENT B. Title II Insured Housing Programs Reverse Mortgages 2. Origination/Processing Handbook 4000.1 593 Last Revised: 05/20/2024 certification, provided there are no alterations and/or observable damage to the foundation since the date of the original certification. If the Appraiser notes additions or alterations to the Manufactured Housing unit, the Mortgagee must ensure the addition was addressed in the foundation certification. If the additions or alterations were not addressed in the foundation certification, the Mortgagee must obtain: • an inspection by the state administrative agency that inspects Manufactured Housing for compliance; or • certification of the structural integrity from a licensed structural engineer if the state does not employ inspectors https://www.hud.gov/sites/dfiles/OCHCO/documents/40001-hsgh-update15-052024.pdf ================ <QUESTION> ======= My cousin in South Dakota wants to sell me his 1977 triple wide manufactured home that he has on a lot in a mobile home park there. I will move it to my improved land in New York and live there. Can I finance this home using a FHA mortgage loan? ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""","""================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""
+
+EVIDENCE:
+II. ORIGINATION THROUGH POST-CLOSING/ENDORSEMENT B. Title II Insured Housing Programs Reverse Mortgages 2. Origination/Processing Handbook 4000.1 589 Last Revised: 05/20/2024 Mortgagee must determine whether the recorded Declaration and/or CC&Rs require prior approval by the association of any non-purchase money mortgage that will encumber the Property. In those situations where such a requirement exists, the Mortgagee must obtain the approval of the association in writing prior to origination of the HECM. Documentation concerning this approval must be maintained by the Mortgagee and made available to HUD upon request. (7) Property Assessed Clean Energy (a) Definition Property Assessed Clean Energy (PACE) refers to an alternative means of financing energy and other PACE-allowed improvements to residential properties using financing provided by private enterprises in conjunction with state and local governments. Generally, the repayment of the PACE obligation is collected in the same manner as a special assessment tax; it is collected by the local government rather than paid directly by the Borrower to the party providing the PACE financing. Generally, the PACE obligation is also secured in the same manner as a special assessment against the property. (b) Standard Properties which will remain encumbered with a PACE obligation are not eligible for an FHA-insured HECM. To be eligible for FHA insurance, the PACE obligation must be paid off in full prior to or at closing. The Borrower may use HECM proceeds to satisfy the PACE obligation. For HECM for Purchase transactions, see the Property Assessed Clean Energy section of the product sheet. (B) Property Types FHA’s programs differ from one another primarily in terms of what types of Properties and financing are eligible. Except as otherwise stated in this Handbook 4000.1, HECMs are limited to one- to four-unit Single Family Properties where the Borrower occupies one unit as their Principal Residence. FHA insures HECM financing on Real Property secured by: • detached or semi-detached dwellings • Manufactured Housing • townhouses or row houses • Condominium Units and Site Condominiums FHA will not insure HECMs secured by: • commercial enterprises • cooperative units • boarding houses • hotels, motels, and condotels II. ORIGINATION THROUGH POST-CLOSING/ENDORSEMENT B. Title II Insured Housing Programs Reverse Mortgages 2. Origination/Processing Handbook 4000.1 590 Last Revised: 05/20/2024 • tourist houses • private clubs • bed and breakfast establishments • other transient housing • Vacation Homes • fraternity and sorority houses (1) One-Unit A one-unit Property is a Single Family residential Property with a single Dwelling Unit, or with a single Dwelling Unit and a single ADU. (2) Two-Unit (a) Definition A two-unit Property is a Single Family residential Property with two individual dwellings. (b) Standard The Mortgagee must obtain a completed form HUD-92561. (3) Three- to Four-Unit A three- to four-unit Property is either: • a Single Family residential Property with three to four individual Dwelling Units; or • a Single Family residential Property with two individual Dwelling Units and one ADU or three individual Dwelling Units and one ADU. The Mortgagee must obtain a completed form HUD-92561. (4) Accessory Dwelling Unit (a) Definition An Accessory Dwelling Unit (ADU) refers to a single habitable living unit with means of separate ingress and egress that meets the minimum requirements for a living unit. An ADU is a private space that is subordinate in size and within, or detached from a primary one-unit Single Family dwelling, which together constitute a single interest in real estate. (b) Standard A Single Family residential one-unit Property with a single ADU remains a one-unit Property. For any Single Family residential Property with two or II. ORIGINATION THROUGH POST-CLOSING/ENDORSEMENT B. Title II Insured Housing Programs Reverse Mortgages 2. Origination/Processing Handbook 4000.1 591 Last Revised: 05/20/2024 more units, a separate additional Dwelling Unit must be considered as an additional unit. (5) Condominium Unit (a) Definitions A Condominium Unit refers to real estate consisting of a one-family Dwelling Unit in a Condominium Project. Condominium Project refers to a project in which one-family Dwelling Units are attached, semi-detached, detached, or Manufactured Home units, and in which owners hold an undivided interest in Common Elements. (b) Standard A Condominium Unit must be either located within an FHA-approved Condominium Project, meet FHA’s definition of a Site Condominium, or have completed the FHA Single-Unit Approval process before a Mortgage can be insured. (6) Site Condominiums (a) Definition A Site Condominium refers to: • a Condominium Project that consists entirely of Single Family detached dwellings that have no shared garages, or any other attached buildings; or • a Condominium Project that:  consists of Single Family detached or horizontally attached (townhouse-style) dwellings where the Unit consists of the dwelling and land;  does not contain any Manufactured Housing Units; and  is encumbered by a declaration of condominium covenants or a condominium form of ownership. (b) Standard Manufactured Housing condominium units may not be processed as Site Condominiums. The Unit owner must be responsible for all required insurance and maintenance costs associated with the Unit dwelling, excluding landscaping, of the Site Condominium. II. ORIGINATION THROUGH POST-CLOSING/ENDORSEMENT B. Title II Insured Housing Programs Reverse Mortgages 2. Origination/Processing Handbook 4000.1 592 Last Revised: 05/20/2024 Site Condominiums do not require Condominium Project Approval or Single- Unit Approval. Manufactured Housing (a) Definition Manufactured Housing is a Structure that is transportable in one or more sections. It may be part of a Condominium Project, provided the project meets applicable FHA requirements. (b) Standard To be eligible for FHA mortgage insurance as a Single Family Title II HECM, all Manufactured Housing must: • be designed as a one-family dwelling; • have a floor area of not less than 400 square feet; • have the HUD Certification Label affixed or have obtained a letter of label verification issued on behalf of HUD, evidencing the house was constructed on or after June 15, 1976, in compliance with the Federal Manufactured Home Construction and Safety Standards; • be classified as real estate (but need not be treated as real estate for purposes of state taxation); • be built and remain on a permanent chassis; • be designed to be used as a dwelling with a permanent foundation built in accordance with the Permanent Foundations Guide for Manufactured Housing (PFGMH); and • have been directly transported from the manufacturer or the dealership to the site. (c) Required Documentation (i) HUD Certification Label If the appraisal indicates the HUD Certification Label is missing from the Manufactured Housing unit, the Mortgagee must obtain label verification from the Institute for Building Technology and Safety (IBTS). (ii) PFGMH Certification The Mortgagee must obtain a certification by an engineer or architect, who is licensed/registered in the state where the Manufactured Home is located, attesting to compliance with the PFGMH. The Mortgagee may obtain a copy of the foundation certification from a previous FHA-insured Mortgage, showing that the foundation met the guidelines published in the PFGMH that were in effect at the time of II. ORIGINATION THROUGH POST-CLOSING/ENDORSEMENT B. Title II Insured Housing Programs Reverse Mortgages 2. Origination/Processing Handbook 4000.1 593 Last Revised: 05/20/2024 certification, provided there are no alterations and/or observable damage to the foundation since the date of the original certification. If the Appraiser notes additions or alterations to the Manufactured Housing unit, the Mortgagee must ensure the addition was addressed in the foundation certification. If the additions or alterations were not addressed in the foundation certification, the Mortgagee must obtain: • an inspection by the state administrative agency that inspects Manufactured Housing for compliance; or • certification of the structural integrity from a licensed structural engineer if the state does not employ inspectors
+
+USER:
+My cousin in South Dakota wants to sell me his 1977 triple wide manufactured home that he has on a lot in a mobile home park there. I will move it to my improved land in New York and live there. Can I finance this home using a FHA mortgage loan?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,49,51,1256,,199
+"Use only information from the following context to answer the eventual question; do not use any information that isn't in the context. Bold any words that both: 1. Are specifically what's being asked about, and 2. Explicitly exist, verbatim, in both the context and the user's question. For example, if I asked: ""What is a hotdog?,"" then the thing I'm asking about would be a ""hotdog,"" so if the text also explicitly said the word ""hotdog,"" you would bold any instance of the word ""hotdog"" in your response.",Summarize what this text is saying about machines.,"Ambiguity is celebrated in human language. It is a central feature of literature, poetry, and humor. Ambiguity is anathema to computer language. An ambiguous computer language is a nonsensical concept because the predictability of computers is what gives part of their value; imagine a computer that was asked, “what is 1 and 1” it randomly returned either “two” or “11”. Although it is debatable whether every contract can be translated into machine language, many of them can be.73 When lawyers or the programmers they hire write contracts in code, there is less of a chance for ambiguity than in natural language if only for the simple fact that artificial language must be complete and predefined, whereas natural language is infinite.74 That is to say a person can walk around and verbally recite lines of code and people can at least understand what he is saying; a machine cannot understand human language that it is not programmed to understand. All of this is simply to say that the problem of ambiguity is reduced in the smart contract context. Finally, all of the usual defenses to formation of a contract also apply in the realm of smart contracts, although as will be seen later, enforcing the remedy against a strong smart contract may prove problematic to a court. Take unconscionability and illegality, for instance. If a vending machine were to sell alcohol to minors or sell alcohol in a dry jurisdiction, then the contract could be voided as illegal.75 As will be discussed, the remedies will be either ex post through legal action or ex ante through regulation. In this instance, the illegal contract can either be policed through a prohibition on alcoholic vending machines76 or a system of preclearance where a driver’s license scanner or some mechanism are required to ensure compliance with age requirements. Similarly, suppose the vending machine charged $1,000 for a can of Coke and a court were to find this to be substantively unconscionable. The remedies would again either be in damages or in policing the use of such vending machines before the contract could be formed.","Use only information from the following context to answer the eventual question; do not use any information that isn't in the context. Bold any words that both: 1. Are specifically what's being asked about, and 2. Explicitly exist, verbatim, in both the context and the user's question. For example, if I asked: ""What is a hotdog?,"" then the thing I'm asking about would be a ""hotdog,"" so if the text also explicitly said the word ""hotdog,"" you would bold any instance of the word ""hotdog"" in your response. Ambiguity is celebrated in human language. It is a central feature of literature, poetry, and humor. Ambiguity is anathema to computer language. An ambiguous computer language is a nonsensical concept because the predictability of computers is what gives part of their value; imagine a computer that was asked, “what is 1 and 1” it randomly returned either “two” or “11”. Although it is debatable whether every contract can be translated into machine language, many of them can be.73 When lawyers or the programmers they hire write contracts in code, there is less of a chance for ambiguity than in natural language if only for the simple fact that artificial language must be complete and predefined, whereas natural language is infinite.74 That is to say a person can walk around and verbally recite lines of code and people can at least understand what he is saying; a machine cannot understand human language that it is not programmed to understand. All of this is simply to say that the problem of ambiguity is reduced in the smart contract context. Finally, all of the usual defenses to formation of a contract also apply in the realm of smart contracts, although as will be seen later, enforcing the remedy against a strong smart contract may prove problematic to a court. Take unconscionability and illegality, for instance. If a vending machine were to sell alcohol to minors or sell alcohol in a dry jurisdiction, then the contract could be voided as illegal.75 As will be discussed, the remedies will be either ex post through legal action or ex ante through regulation. In this instance, the illegal contract can either be policed through a prohibition on alcoholic vending machines76 or a system of preclearance where a driver’s license scanner or some mechanism are required to ensure compliance with age requirements. Similarly, suppose the vending machine charged $1,000 for a can of Coke and a court were to find this to be substantively unconscionable. The remedies would again either be in damages or in policing the use of such vending machines before the contract could be formed. Summarize what this text is saying about machines.","Use only information from the following context to answer the eventual question; do not use any information that isn't in the context. Bold any words that both: 1. Are specifically what's being asked about, and 2. Explicitly exist, verbatim, in both the context and the user's question. For example, if I asked: ""What is a hotdog?,"" then the thing I'm asking about would be a ""hotdog,"" so if the text also explicitly said the word ""hotdog,"" you would bold any instance of the word ""hotdog"" in your response.
+
+EVIDENCE:
+Ambiguity is celebrated in human language. It is a central feature of literature, poetry, and humor. Ambiguity is anathema to computer language. An ambiguous computer language is a nonsensical concept because the predictability of computers is what gives part of their value; imagine a computer that was asked, “what is 1 and 1” it randomly returned either “two” or “11”. Although it is debatable whether every contract can be translated into machine language, many of them can be.73 When lawyers or the programmers they hire write contracts in code, there is less of a chance for ambiguity than in natural language if only for the simple fact that artificial language must be complete and predefined, whereas natural language is infinite.74 That is to say a person can walk around and verbally recite lines of code and people can at least understand what he is saying; a machine cannot understand human language that it is not programmed to understand. All of this is simply to say that the problem of ambiguity is reduced in the smart contract context. Finally, all of the usual defenses to formation of a contract also apply in the realm of smart contracts, although as will be seen later, enforcing the remedy against a strong smart contract may prove problematic to a court. Take unconscionability and illegality, for instance. If a vending machine were to sell alcohol to minors or sell alcohol in a dry jurisdiction, then the contract could be voided as illegal.75 As will be discussed, the remedies will be either ex post through legal action or ex ante through regulation. In this instance, the illegal contract can either be policed through a prohibition on alcoholic vending machines76 or a system of preclearance where a driver’s license scanner or some mechanism are required to ensure compliance with age requirements. Similarly, suppose the vending machine charged $1,000 for a can of Coke and a court were to find this to be substantively unconscionable. The remedies would again either be in damages or in policing the use of such vending machines before the contract could be formed.
+
+USER:
+Summarize what this text is saying about machines.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,88,8,350,,673
+Give an answer using only the context provided.,"Can you provide a summary of the key points discussed in the document segment given, regarding infrastructure inequity and its impact on racial disparities?","It should be obvious that a broad and deep investment in the nation’s long-neglected and now failing infrastructure is necessary to ensure the United States continues to be a leading, prosperous democracy among nations. A sound infrastructure helps us all – individuals, communities, businesses, and government— urban and rural. For those of us who have been long disadvantaged in this nation through structural racism and discrimination, however, a sound infrastructure in every community is especially critical as a bulwark against the pernicious harms of discrimination and segregation. Having a solid infrastructure on which everyone stands helps counter structural inequities driven by segregation and longstanding differences in investments in communities based on race. Unequal investment is one of two types of inequities stemming from our historic and current infrastructure policies and practices. There is inequity directly via unequal and inadequate investments in Black communities, and there is also an indirect inequity because the harm from failing infrastructure is more severe for Black communities. Black communities are disproportionately low-wealth communities, and people with little wealth commonly lack the resources to protect themselves and to recover quickly from disasters resulting from infrastructure failures. When we fail to make adequate infrastructure investments, we subject African Americans to high risks of harm from infrastructure failures. This brief provides an overview of the need for a broad range of infrastructure investments and provides examples of both types of inequities. While it focuses on African Americans, it should be clear that other groups, particularly Latinos, Native Americans, and low-wealth individuals, are also disproportionately harmed by our failure to invest adequately in America’s infrastructure. A Comprehensive Approach to Sound Infrastructure Is an Important Counter to Historic Racial Inequity TMI BRIEFS AUGUST 2021 MORE THAN ROADS AND BRIDGES Electronic copy available at: https://ssrn.com/abstract=4722017 2 | TMI Brief | More than Roads and Bridges | tminstituteldf.org When people hear the word “infrastructure,” they often think of roads and bridges. There is no question that roads and bridges are infrastructure, but as civil rights leaders have urged the nation to recognize, infrastructure entails far more than just these two things. Some argue that infrastructure only encompasses roads, bridges, tunnels, and railroads and while those are all vital, this definition is woefully inadequate. Infrastructure includes sewer systems, water lines, waste facilities, and telecommunications. It also includes parks, housing, public squares, economic centers, and schools.1 Every four years, the American Society of Civil Engineers (ASCE) assesses America’s infrastructure and produces a report card. ASCE evaluates 17 types of infrastructure and is beginning to recognize the importance of broadband.2 Roads and bridges are only two of the 17. We argue for an even broader conception of infrastructure than ASCE and recognize that each form of infrastructure is important to the future of the United States broadly, but also of particular importance to African Americans. We will illustrate this point by focusing on ten types of infrastructure considered by ASCE and their relevance for African Americans. We will also address two types of infrastructure not evaluated by ACSE: affordable housing and the care economy. Roads and Bridges, and a Whole Lot More TMI BRIEFS AUGUST 2021 Electronic copy available at: https://ssrn.com/abstract=4722017 3 | TMI Brief | More than Roads and Bridges | tminstituteldf.org DAMS ASCE’s current overall rating of America’s infrastructure is a C-minus.3 A C grade means that the infrastructure “shows general signs of deterioration and requires attention.”4 A D grade means that the infrastructure has “many elements approaching the end of their service life.”5 A C-minus grade, therefore, suggests that much of America’s infrastructure is deteriorating, and some of it is near the end of its service life. ASCE estimates that the country needs to invest $2.59 trillion over the next ten years to bring all of the country’s infrastructure to a good condition.6 This expenditure is an investment that will contribute to future economic growth and not an expense that will simply drain our resources. If we fail to make these investments by 2039, ASCE estimates that our economy will lose $10 trillion in GDP, more than three million jobs, and $2.4 trillion in exports.7 These numbers do not account for the lives lost, the life expectancies reduced, and the suffering that is caused by poor infrastructure. AVIATION D+ LEVEES ENERGY ROADS PUBLIC PARKS INLAND WATERWAYS SOLID WASTE TRANSIT BRIDGES PORTS HAZARDOUS WASTE SCHOOLS DRINKING WATER RAIL DRINKING WATER STORMWATER WASTEWATER C D CD+ D D+ D C+ DCD+ D BB D+ D D+ SOURCE: ASCE 2021 Report Card for America's Infrastructure Electronic copy available at: https://ssrn.com/abstract=4722017 4 | TMI Brief | More than Roads and Bridges | tminstituteldf.org To appreciate the importance of roads and bridges for African Americans, it is useful to look at Mississippi, which is the state with the largest share of African American residents,8 at nearly 40%.9 ASCE gives the nation’s roads a D grade and the nation’s bridges a C grade.10 Mississippi’s roads and bridges are considerably worse than the national average, with both rated D-minus.11 ASCE finds that only 24% of Mississippi’s major roads and highways are in good condition. Forty-three percent are in poor condition, and the remaining 33% are in mediocre or fair condition.12 Bad roads impose costs on motorists. For example, in Southaven, Mississippi, ASCE estimates that damage from bad roads costs the average driver $1,870 a year.13 This amounts to 6% of the median household income for Black Mississippians, and 3% for White residents of the state.14 ASCE values the lost time due to drivers being stuck in traffic in Southaven at an additional $1,080 per driver.15 Many Americans would struggle to pay for a vehicle repair bill of $1,870—or even half as much.16 For Black Mississippians, who have lower incomes than both average Americans and White Mississippians 17 the struggle is likely to be considerably harder.18 These repair bills could easily cause lasting damage to Black households in the state. When people are unable to use their vehicles, there is considerable hardship because, for much of America, Mississippi included, many day-to-day activities Roads and Bridges: Costly and Unsafe MISSISSIPPI’S MAJOR ROADS AND HIGHWAYS CONDITION 24% 43% 33% GOOD POOR FAIR TMI BRIEFS AUGUST 2021 Electronic copy available at: https://ssrn.com/abstract=4722017 5 | TMI Brief | More than Roads and Bridges | tminstituteldf.org condition, and 9% of them need substantial repairs.20 Over 400 Mississippi bridges have been closed because they are unsafe. There are many weight-restricted bridges that cannot support a load heavier than a pickup truck.21 As illustrated, roads and bridges are important to African Americans, but these are not their only important infrastructure needs. require access to a private vehicle. The loss of access to a vehicle could lead to the loss of a job, the inability to access health care, or the inability to vote. Individuals might need to turn to high-interest loans to pay for repairs, leading to substantial debt. Alternatively, individuals might be forced to drive an unsafe vehicle and put their health and the health of others at risk. There is another health risk from Mississippi’s bad roads. Mississippi has one of the highest automotive fatality rates in the country. The state’s bad roads are implicated in about a third of the deaths.19 As mentioned above, Mississippi’s bridges also received a D-minus grade. Among the reasons Mississippi’s bridges earn such a poor grade is because only 63% of them are in good condition. More than a quarter of them (28%) are in fair MISSISSIPPI’S BRIDGES HAVE BEEN CLOSED BECAUSE THEY ARE UNSAFE Lawrence Sawyer/Getty Images Electronic copy available at: https://ssrn.com/abstract=4722017 6 | TMI Brief | More than Roads and Bridges | tminstituteldf.org While Black people do not comprise a large percentage of the population of Texas, by the numbers, more Black people live in Texas than in any other state.22 This year, a severe winter storm shut down the electrical grid in Texas, causing many people to go without heat and water for several days.23 This caused a severe crisis, resulting in almost 200 deaths, including people freezing to death, dying from carbon monoxide poisoning when they were forced to rely on dangerous sources of heat, and people dying when their medical devices failed, or they were unable to get life-saving medical treatment.24 The Houston Chronicle reported that [t]he deaths come from 57 counties in all regions of the state but are disproportionately centered on the Houston area, which at times during the crisis accounted for nearly half of all power outages. Of the known ages, races and ethnicities of the victims, 74 percent were people of color. Half were at least 65. Six were children.25 Energy: The Need to Move Away from Fossil Fuels TMI BRIEFS AUGUST 2021 HOUSTON, Feb. 15, 2021 -- A highway is closed due to snow and ice in Houston, Texas, the United States, on Feb. 15, 2021. Up to 2.5 million customers were without power in the U.S. state of Texas Monday morning as the state's power generation capacity is impacted by an ongoing winter storm brought by Arctic blast. Photo by Chengyue Lao/Xinhua via Getty Images Electronic copy available at: https://ssrn.com/abstract=4722017 7 | TMI Brief | More than Roads and Bridges | tminstituteldf.org The Texas blackout during a severe winter storm is a foreshadowing of future catastrophes, as climate change will bring more extreme weather.26 Power failures have increased by more than 60% across the nation since 2015.27 A sustained power failure during a heatwave could be more deadly than one during extremely cold weather.28 Already, in early June 2021, the Electric Reliability Council of Texas urged Texans “to turn down thermostats and cut back electricity use” after the reserve of available electricity had shrunk to near critical levels.29 Our energy systems—our engines and our power plants—mainly rely on fossil fuels that produce greenhouse gases that lead to climate change. Climate change causes extreme weather events that are expected to exceed the capacity of our infrastructure.30 To address this problem, we need to move away from fossils fuels to help limit the damage from climate change,31 and we need to design our infrastructure with the awareness that weather that used to be seen as extreme will be increasingly normal. 32 Climate change will be more harmful to African Americans. The negative economic impact from climate change is expected to be most severe in the Southern United States, where the Black population is concentrated.33 Additionally, White Americans have greater wealth to endure natural disasters stemming from climate change,34 and the requirements for receiving government aid in disaster areas are structured in ways to disproportionately benefit wealthy White homeowners.35 Consequently, researchers are finding that natural disasters widen existing inequalities.36 While there is much damage from climate change expected in the future, African Americans have been living with the harm from the pollution and toxins from burning fossil fuels for generations. African Americans are more likely to live near fossil-fuel power plants, and they are “exposed to 1.5 times as much of the sooty pollution that comes from burning fossil fuels as the population at large.”37 Exposure to fossil-fuel pollutants increases the risk of preterm births, asthma, cancer, and other ailments.38 Moving to clean renewable energy will bring significant health benefits to African Americans.39 TMI BRIEFS AUGUST 2021 Climate change will be more harmful to African Americans.","Give an answer using only the context provided. Can you provide a summary of the key points discussed in the document segment given, regarding infrastructure inequity and its impact on racial disparities? It should be obvious that a broad and deep investment in the nation’s long-neglected and now failing infrastructure is necessary to ensure the United States continues to be a leading, prosperous democracy among nations. A sound infrastructure helps us all – individuals, communities, businesses, and government— urban and rural. For those of us who have been long disadvantaged in this nation through structural racism and discrimination, however, a sound infrastructure in every community is especially critical as a bulwark against the pernicious harms of discrimination and segregation. Having a solid infrastructure on which everyone stands helps counter structural inequities driven by segregation and longstanding differences in investments in communities based on race. Unequal investment is one of two types of inequities stemming from our historic and current infrastructure policies and practices. There is inequity directly via unequal and inadequate investments in Black communities, and there is also an indirect inequity because the harm from failing infrastructure is more severe for Black communities. Black communities are disproportionately low-wealth communities, and people with little wealth commonly lack the resources to protect themselves and to recover quickly from disasters resulting from infrastructure failures. When we fail to make adequate infrastructure investments, we subject African Americans to high risks of harm from infrastructure failures. This brief provides an overview of the need for a broad range of infrastructure investments and provides examples of both types of inequities. While it focuses on African Americans, it should be clear that other groups, particularly Latinos, Native Americans, and low-wealth individuals, are also disproportionately harmed by our failure to invest adequately in America’s infrastructure. A Comprehensive Approach to Sound Infrastructure Is an Important Counter to Historic Racial Inequity TMI BRIEFS AUGUST 2021 MORE THAN ROADS AND BRIDGES Electronic copy available at: https://ssrn.com/abstract=4722017 2 | TMI Brief | More than Roads and Bridges | tminstituteldf.org When people hear the word “infrastructure,” they often think of roads and bridges. There is no question that roads and bridges are infrastructure, but as civil rights leaders have urged the nation to recognize, infrastructure entails far more than just these two things. Some argue that infrastructure only encompasses roads, bridges, tunnels, and railroads and while those are all vital, this definition is woefully inadequate. Infrastructure includes sewer systems, water lines, waste facilities, and telecommunications. It also includes parks, housing, public squares, economic centers, and schools.1 Every four years, the American Society of Civil Engineers (ASCE) assesses America’s infrastructure and produces a report card. ASCE evaluates 17 types of infrastructure and is beginning to recognize the importance of broadband.2 Roads and bridges are only two of the 17. We argue for an even broader conception of infrastructure than ASCE and recognize that each form of infrastructure is important to the future of the United States broadly, but also of particular importance to African Americans. We will illustrate this point by focusing on ten types of infrastructure considered by ASCE and their relevance for African Americans. We will also address two types of infrastructure not evaluated by ACSE: affordable housing and the care economy. Roads and Bridges, and a Whole Lot More TMI BRIEFS AUGUST 2021 Electronic copy available at: https://ssrn.com/abstract=4722017 3 | TMI Brief | More than Roads and Bridges | tminstituteldf.org DAMS ASCE’s current overall rating of America’s infrastructure is a C-minus.3 A C grade means that the infrastructure “shows general signs of deterioration and requires attention.”4 A D grade means that the infrastructure has “many elements approaching the end of their service life.”5 A C-minus grade, therefore, suggests that much of America’s infrastructure is deteriorating, and some of it is near the end of its service life. ASCE estimates that the country needs to invest $2.59 trillion over the next ten years to bring all of the country’s infrastructure to a good condition.6 This expenditure is an investment that will contribute to future economic growth and not an expense that will simply drain our resources. If we fail to make these investments by 2039, ASCE estimates that our economy will lose $10 trillion in GDP, more than three million jobs, and $2.4 trillion in exports.7 These numbers do not account for the lives lost, the life expectancies reduced, and the suffering that is caused by poor infrastructure. AVIATION D+ LEVEES ENERGY ROADS PUBLIC PARKS INLAND WATERWAYS SOLID WASTE TRANSIT BRIDGES PORTS HAZARDOUS WASTE SCHOOLS DRINKING WATER RAIL DRINKING WATER STORMWATER WASTEWATER C D CD+ D D+ D C+ DCD+ D BB D+ D D+ SOURCE: ASCE 2021 Report Card for America's Infrastructure Electronic copy available at: https://ssrn.com/abstract=4722017 4 | TMI Brief | More than Roads and Bridges | tminstituteldf.org To appreciate the importance of roads and bridges for African Americans, it is useful to look at Mississippi, which is the state with the largest share of African American residents,8 at nearly 40%.9 ASCE gives the nation’s roads a D grade and the nation’s bridges a C grade.10 Mississippi’s roads and bridges are considerably worse than the national average, with both rated D-minus.11 ASCE finds that only 24% of Mississippi’s major roads and highways are in good condition. Forty-three percent are in poor condition, and the remaining 33% are in mediocre or fair condition.12 Bad roads impose costs on motorists. For example, in Southaven, Mississippi, ASCE estimates that damage from bad roads costs the average driver $1,870 a year.13 This amounts to 6% of the median household income for Black Mississippians, and 3% for White residents of the state.14 ASCE values the lost time due to drivers being stuck in traffic in Southaven at an additional $1,080 per driver.15 Many Americans would struggle to pay for a vehicle repair bill of $1,870—or even half as much.16 For Black Mississippians, who have lower incomes than both average Americans and White Mississippians 17 the struggle is likely to be considerably harder.18 These repair bills could easily cause lasting damage to Black households in the state. When people are unable to use their vehicles, there is considerable hardship because, for much of America, Mississippi included, many day-to-day activities Roads and Bridges: Costly and Unsafe MISSISSIPPI’S MAJOR ROADS AND HIGHWAYS CONDITION 24% 43% 33% GOOD POOR FAIR TMI BRIEFS AUGUST 2021 Electronic copy available at: https://ssrn.com/abstract=4722017 5 | TMI Brief | More than Roads and Bridges | tminstituteldf.org condition, and 9% of them need substantial repairs.20 Over 400 Mississippi bridges have been closed because they are unsafe. There are many weight-restricted bridges that cannot support a load heavier than a pickup truck.21 As illustrated, roads and bridges are important to African Americans, but these are not their only important infrastructure needs. require access to a private vehicle. The loss of access to a vehicle could lead to the loss of a job, the inability to access health care, or the inability to vote. Individuals might need to turn to high-interest loans to pay for repairs, leading to substantial debt. Alternatively, individuals might be forced to drive an unsafe vehicle and put their health and the health of others at risk. There is another health risk from Mississippi’s bad roads. Mississippi has one of the highest automotive fatality rates in the country. The state’s bad roads are implicated in about a third of the deaths.19 As mentioned above, Mississippi’s bridges also received a D-minus grade. Among the reasons Mississippi’s bridges earn such a poor grade is because only 63% of them are in good condition. More than a quarter of them (28%) are in fair MISSISSIPPI’S BRIDGES HAVE BEEN CLOSED BECAUSE THEY ARE UNSAFE Lawrence Sawyer/Getty Images Electronic copy available at: https://ssrn.com/abstract=4722017 6 | TMI Brief | More than Roads and Bridges | tminstituteldf.org While Black people do not comprise a large percentage of the population of Texas, by the numbers, more Black people live in Texas than in any other state.22 This year, a severe winter storm shut down the electrical grid in Texas, causing many people to go without heat and water for several days.23 This caused a severe crisis, resulting in almost 200 deaths, including people freezing to death, dying from carbon monoxide poisoning when they were forced to rely on dangerous sources of heat, and people dying when their medical devices failed, or they were unable to get life-saving medical treatment.24 The Houston Chronicle reported that [t]he deaths come from 57 counties in all regions of the state but are disproportionately centered on the Houston area, which at times during the crisis accounted for nearly half of all power outages. Of the known ages, races and ethnicities of the victims, 74 percent were people of color. Half were at least 65. Six were children.25 Energy: The Need to Move Away from Fossil Fuels TMI BRIEFS AUGUST 2021 HOUSTON, Feb. 15, 2021 -- A highway is closed due to snow and ice in Houston, Texas, the United States, on Feb. 15, 2021. Up to 2.5 million customers were without power in the U.S. state of Texas Monday morning as the state's power generation capacity is impacted by an ongoing winter storm brought by Arctic blast. Photo by Chengyue Lao/Xinhua via Getty Images Electronic copy available at: https://ssrn.com/abstract=4722017 7 | TMI Brief | More than Roads and Bridges | tminstituteldf.org The Texas blackout during a severe winter storm is a foreshadowing of future catastrophes, as climate change will bring more extreme weather.26 Power failures have increased by more than 60% across the nation since 2015.27 A sustained power failure during a heatwave could be more deadly than one during extremely cold weather.28 Already, in early June 2021, the Electric Reliability Council of Texas urged Texans “to turn down thermostats and cut back electricity use” after the reserve of available electricity had shrunk to near critical levels.29 Our energy systems—our engines and our power plants—mainly rely on fossil fuels that produce greenhouse gases that lead to climate change. Climate change causes extreme weather events that are expected to exceed the capacity of our infrastructure.30 To address this problem, we need to move away from fossils fuels to help limit the damage from climate change,31 and we need to design our infrastructure with the awareness that weather that used to be seen as extreme will be increasingly normal. 32 Climate change will be more harmful to African Americans. The negative economic impact from climate change is expected to be most severe in the Southern United States, where the Black population is concentrated.33 Additionally, White Americans have greater wealth to endure natural disasters stemming from climate change,34 and the requirements for receiving government aid in disaster areas are structured in ways to disproportionately benefit wealthy White homeowners.35 Consequently, researchers are finding that natural disasters widen existing inequalities.36 While there is much damage from climate change expected in the future, African Americans have been living with the harm from the pollution and toxins from burning fossil fuels for generations. African Americans are more likely to live near fossil-fuel power plants, and they are “exposed to 1.5 times as much of the sooty pollution that comes from burning fossil fuels as the population at large.”37 Exposure to fossil-fuel pollutants increases the risk of preterm births, asthma, cancer, and other ailments.38 Moving to clean renewable energy will bring significant health benefits to African Americans.39 TMI BRIEFS AUGUST 2021 Climate change will be more harmful to African Americans.","Give an answer using only the context provided.
+
+EVIDENCE:
+It should be obvious that a broad and deep investment in the nation’s long-neglected and now failing infrastructure is necessary to ensure the United States continues to be a leading, prosperous democracy among nations. A sound infrastructure helps us all – individuals, communities, businesses, and government— urban and rural. For those of us who have been long disadvantaged in this nation through structural racism and discrimination, however, a sound infrastructure in every community is especially critical as a bulwark against the pernicious harms of discrimination and segregation. Having a solid infrastructure on which everyone stands helps counter structural inequities driven by segregation and longstanding differences in investments in communities based on race. Unequal investment is one of two types of inequities stemming from our historic and current infrastructure policies and practices. There is inequity directly via unequal and inadequate investments in Black communities, and there is also an indirect inequity because the harm from failing infrastructure is more severe for Black communities. Black communities are disproportionately low-wealth communities, and people with little wealth commonly lack the resources to protect themselves and to recover quickly from disasters resulting from infrastructure failures. When we fail to make adequate infrastructure investments, we subject African Americans to high risks of harm from infrastructure failures. This brief provides an overview of the need for a broad range of infrastructure investments and provides examples of both types of inequities. While it focuses on African Americans, it should be clear that other groups, particularly Latinos, Native Americans, and low-wealth individuals, are also disproportionately harmed by our failure to invest adequately in America’s infrastructure. A Comprehensive Approach to Sound Infrastructure Is an Important Counter to Historic Racial Inequity TMI BRIEFS AUGUST 2021 MORE THAN ROADS AND BRIDGES Electronic copy available at: https://ssrn.com/abstract=4722017 2 | TMI Brief | More than Roads and Bridges | tminstituteldf.org When people hear the word “infrastructure,” they often think of roads and bridges. There is no question that roads and bridges are infrastructure, but as civil rights leaders have urged the nation to recognize, infrastructure entails far more than just these two things. Some argue that infrastructure only encompasses roads, bridges, tunnels, and railroads and while those are all vital, this definition is woefully inadequate. Infrastructure includes sewer systems, water lines, waste facilities, and telecommunications. It also includes parks, housing, public squares, economic centers, and schools.1 Every four years, the American Society of Civil Engineers (ASCE) assesses America’s infrastructure and produces a report card. ASCE evaluates 17 types of infrastructure and is beginning to recognize the importance of broadband.2 Roads and bridges are only two of the 17. We argue for an even broader conception of infrastructure than ASCE and recognize that each form of infrastructure is important to the future of the United States broadly, but also of particular importance to African Americans. We will illustrate this point by focusing on ten types of infrastructure considered by ASCE and their relevance for African Americans. We will also address two types of infrastructure not evaluated by ACSE: affordable housing and the care economy. Roads and Bridges, and a Whole Lot More TMI BRIEFS AUGUST 2021 Electronic copy available at: https://ssrn.com/abstract=4722017 3 | TMI Brief | More than Roads and Bridges | tminstituteldf.org DAMS ASCE’s current overall rating of America’s infrastructure is a C-minus.3 A C grade means that the infrastructure “shows general signs of deterioration and requires attention.”4 A D grade means that the infrastructure has “many elements approaching the end of their service life.”5 A C-minus grade, therefore, suggests that much of America’s infrastructure is deteriorating, and some of it is near the end of its service life. ASCE estimates that the country needs to invest $2.59 trillion over the next ten years to bring all of the country’s infrastructure to a good condition.6 This expenditure is an investment that will contribute to future economic growth and not an expense that will simply drain our resources. If we fail to make these investments by 2039, ASCE estimates that our economy will lose $10 trillion in GDP, more than three million jobs, and $2.4 trillion in exports.7 These numbers do not account for the lives lost, the life expectancies reduced, and the suffering that is caused by poor infrastructure. AVIATION D+ LEVEES ENERGY ROADS PUBLIC PARKS INLAND WATERWAYS SOLID WASTE TRANSIT BRIDGES PORTS HAZARDOUS WASTE SCHOOLS DRINKING WATER RAIL DRINKING WATER STORMWATER WASTEWATER C D CD+ D D+ D C+ DCD+ D BB D+ D D+ SOURCE: ASCE 2021 Report Card for America's Infrastructure Electronic copy available at: https://ssrn.com/abstract=4722017 4 | TMI Brief | More than Roads and Bridges | tminstituteldf.org To appreciate the importance of roads and bridges for African Americans, it is useful to look at Mississippi, which is the state with the largest share of African American residents,8 at nearly 40%.9 ASCE gives the nation’s roads a D grade and the nation’s bridges a C grade.10 Mississippi’s roads and bridges are considerably worse than the national average, with both rated D-minus.11 ASCE finds that only 24% of Mississippi’s major roads and highways are in good condition. Forty-three percent are in poor condition, and the remaining 33% are in mediocre or fair condition.12 Bad roads impose costs on motorists. For example, in Southaven, Mississippi, ASCE estimates that damage from bad roads costs the average driver $1,870 a year.13 This amounts to 6% of the median household income for Black Mississippians, and 3% for White residents of the state.14 ASCE values the lost time due to drivers being stuck in traffic in Southaven at an additional $1,080 per driver.15 Many Americans would struggle to pay for a vehicle repair bill of $1,870—or even half as much.16 For Black Mississippians, who have lower incomes than both average Americans and White Mississippians 17 the struggle is likely to be considerably harder.18 These repair bills could easily cause lasting damage to Black households in the state. When people are unable to use their vehicles, there is considerable hardship because, for much of America, Mississippi included, many day-to-day activities Roads and Bridges: Costly and Unsafe MISSISSIPPI’S MAJOR ROADS AND HIGHWAYS CONDITION 24% 43% 33% GOOD POOR FAIR TMI BRIEFS AUGUST 2021 Electronic copy available at: https://ssrn.com/abstract=4722017 5 | TMI Brief | More than Roads and Bridges | tminstituteldf.org condition, and 9% of them need substantial repairs.20 Over 400 Mississippi bridges have been closed because they are unsafe. There are many weight-restricted bridges that cannot support a load heavier than a pickup truck.21 As illustrated, roads and bridges are important to African Americans, but these are not their only important infrastructure needs. require access to a private vehicle. The loss of access to a vehicle could lead to the loss of a job, the inability to access health care, or the inability to vote. Individuals might need to turn to high-interest loans to pay for repairs, leading to substantial debt. Alternatively, individuals might be forced to drive an unsafe vehicle and put their health and the health of others at risk. There is another health risk from Mississippi’s bad roads. Mississippi has one of the highest automotive fatality rates in the country. The state’s bad roads are implicated in about a third of the deaths.19 As mentioned above, Mississippi’s bridges also received a D-minus grade. Among the reasons Mississippi’s bridges earn such a poor grade is because only 63% of them are in good condition. More than a quarter of them (28%) are in fair MISSISSIPPI’S BRIDGES HAVE BEEN CLOSED BECAUSE THEY ARE UNSAFE Lawrence Sawyer/Getty Images Electronic copy available at: https://ssrn.com/abstract=4722017 6 | TMI Brief | More than Roads and Bridges | tminstituteldf.org While Black people do not comprise a large percentage of the population of Texas, by the numbers, more Black people live in Texas than in any other state.22 This year, a severe winter storm shut down the electrical grid in Texas, causing many people to go without heat and water for several days.23 This caused a severe crisis, resulting in almost 200 deaths, including people freezing to death, dying from carbon monoxide poisoning when they were forced to rely on dangerous sources of heat, and people dying when their medical devices failed, or they were unable to get life-saving medical treatment.24 The Houston Chronicle reported that [t]he deaths come from 57 counties in all regions of the state but are disproportionately centered on the Houston area, which at times during the crisis accounted for nearly half of all power outages. Of the known ages, races and ethnicities of the victims, 74 percent were people of color. Half were at least 65. Six were children.25 Energy: The Need to Move Away from Fossil Fuels TMI BRIEFS AUGUST 2021 HOUSTON, Feb. 15, 2021 -- A highway is closed due to snow and ice in Houston, Texas, the United States, on Feb. 15, 2021. Up to 2.5 million customers were without power in the U.S. state of Texas Monday morning as the state's power generation capacity is impacted by an ongoing winter storm brought by Arctic blast. Photo by Chengyue Lao/Xinhua via Getty Images Electronic copy available at: https://ssrn.com/abstract=4722017 7 | TMI Brief | More than Roads and Bridges | tminstituteldf.org The Texas blackout during a severe winter storm is a foreshadowing of future catastrophes, as climate change will bring more extreme weather.26 Power failures have increased by more than 60% across the nation since 2015.27 A sustained power failure during a heatwave could be more deadly than one during extremely cold weather.28 Already, in early June 2021, the Electric Reliability Council of Texas urged Texans “to turn down thermostats and cut back electricity use” after the reserve of available electricity had shrunk to near critical levels.29 Our energy systems—our engines and our power plants—mainly rely on fossil fuels that produce greenhouse gases that lead to climate change. Climate change causes extreme weather events that are expected to exceed the capacity of our infrastructure.30 To address this problem, we need to move away from fossils fuels to help limit the damage from climate change,31 and we need to design our infrastructure with the awareness that weather that used to be seen as extreme will be increasingly normal. 32 Climate change will be more harmful to African Americans. The negative economic impact from climate change is expected to be most severe in the Southern United States, where the Black population is concentrated.33 Additionally, White Americans have greater wealth to endure natural disasters stemming from climate change,34 and the requirements for receiving government aid in disaster areas are structured in ways to disproportionately benefit wealthy White homeowners.35 Consequently, researchers are finding that natural disasters widen existing inequalities.36 While there is much damage from climate change expected in the future, African Americans have been living with the harm from the pollution and toxins from burning fossil fuels for generations. African Americans are more likely to live near fossil-fuel power plants, and they are “exposed to 1.5 times as much of the sooty pollution that comes from burning fossil fuels as the population at large.”37 Exposure to fossil-fuel pollutants increases the risk of preterm births, asthma, cancer, and other ailments.38 Moving to clean renewable energy will bring significant health benefits to African Americans.39 TMI BRIEFS AUGUST 2021 Climate change will be more harmful to African Americans.
+
+USER:
+Can you provide a summary of the key points discussed in the document segment given, regarding infrastructure inequity and its impact on racial disparities?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",True,8,24,1875,,681
+Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document],"In less than 250 words. Explain what I Bacillus cereus. Provide where the bacteria is found mostly. What temperature does it multiply quickly in and does it form a toxin? If so, what area of the body will contain the illness from the toxin? What are the symptoms of B cereus.","Bacillus cereus is a toxin-producing facultatively anaerobic gram-positive bacterium. The bacteria are commonly found in the environment and can contaminate food. It can quickly multiply at room temperature with an abundantly present preformed toxin. When ingested, this toxin can cause gastrointestinal illness, which is the commonly known manifestation of the disease. Gastrointestinal syndromes associated with B cereus include diarrheal illness without significant upper intestinal symptoms and a predominantly upper GI syndrome with nausea and vomiting without diarrhea. B cereus has also been implicated in infections of the eye, respiratory tract, and wounds. The pathogenicity of B cereus, whether intestinal or nonintestinal, is intimately associated with the production of tissue-destructive exoenzymes. Among these secreted toxins are hemolysins, phospholipases, and proteases.[1][2] B cereus is a common bacterium, present ubiquitously in the environment. It can form spores which allows it to survive longer in extremes of temperature. Consequently, it is found as a contaminant of various foods, ie, beef, turkey, rice, beans, and vegetables. The diarrheal illness is often related to meats, milk, vegetables, and fish. The emetic illness is most often associated with rice products, but it has also been associated with other types of starchy products such as potatoes, pasta, and cheese. Some food mixtures (sauces, puddings, soups, casseroles, pastries, and salads, have been associated with food-borne illness in general.[3][4] Bacillus cereus is caused by the ingestion of food contaminated with enterotoxigenic B cereus or the emetic toxin. In non-gastrointestinal illness, reports of respiratory infections similar to respiratory anthrax have been attributed to B. cereus strains harboring B anthracis toxin genes. The United States Centers for Disease Control and Prevention website states that there were 619 confirmed outbreaks of Bacillus-related poisoning from 1998 through 2015, involving 7385 illnesses. In this timeframe, there were 75 illnesses and three deaths due to confirmed Bacillus-related illnesses. The website states that there were 19,119 outbreaks overall and 373,531 illnesses. It refers to 14,681 hospitalizations and 337 deaths during this timeframe. These statistics refer to all Bacillus-related illnesses, and not just B cereus-related illnesses.[5][6] The United States Food and Drug Administration's ""Bad Bug Book"" further breaks this down and states that there are an estimated 63,400 episodes of B cereus illness annually in the United States. From 2005 to 2007, there were 13 confirmed outbreaks and 37.6 suspected outbreaks involving over 1000 people. Everyone is susceptible to B. cereus infection; however, mortality related to this illness is rare. The emetic enterotoxin has been associated with a few cases of liver failure and death in otherwise healthy people. The infective dose or the number of organisms most commonly associated with human illness is 105 to 108 organisms/gram, but pathogenicity arises from the preformed toxin, not the bacteria themselves. The pathogenicity of B cereus, whether inside or outside the gastrointestinal tract, is associated with exoenzyme production Among the secreted toxins are 4 hemolysins, 3 distinct phospholipases, and 3 pore-forming enterotoxins. The enterotoxins that activate the nod-like receptor protein-3 (NLRP3) are hemolysin BL, nonhemolytic enterotoxin (NHE), and cytotoxin K. In the small intestine, vegetative cells, ingested as viable cells or spores, produce and secrete a protein enterotoxin and induce diarrheal syndrome. Cereulide is a plasmid-encoded cyclic peptide, which is produced in food products and ingested as a formed toxin. In rabbit ligated ileal-loop assays, culture filtrates of enterotoxigenic strains induced fluid accumulation and hemolytic, cytotoxic, dermonecrosis, and increased vascular permeability in rabbit skin.[7] The enterotoxin is composed of a binding component (B) and 2 hemolytic components, designated HBL. In the diarrheal form of the disease, a nonhemolytic 3-component enterotoxin, designated NHE, has been identified. The NHE from Bacillus cereus activates the nod-like NLRP3 inflammasome and pyroptosis. This leads to programmed cell death initiated by the activation of inflammatory caspases of the infected tissue.[8]","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. In less than 250 words. Explain what I Bacillus cereus. Provide where the bacteria is found mostly. What temperature does it multiply quickly in and does it form a toxin? If so, what area of the body will contain the illness from the toxin? What are the symptoms of B cereus. Bacillus cereus is a toxin-producing facultatively anaerobic gram-positive bacterium. The bacteria are commonly found in the environment and can contaminate food. It can quickly multiply at room temperature with an abundantly present preformed toxin. When ingested, this toxin can cause gastrointestinal illness, which is the commonly known manifestation of the disease. Gastrointestinal syndromes associated with B cereus include diarrheal illness without significant upper intestinal symptoms and a predominantly upper GI syndrome with nausea and vomiting without diarrhea. B cereus has also been implicated in infections of the eye, respiratory tract, and wounds. The pathogenicity of B cereus, whether intestinal or nonintestinal, is intimately associated with the production of tissue-destructive exoenzymes. Among these secreted toxins are hemolysins, phospholipases, and proteases.[1][2] B cereus is a common bacterium, present ubiquitously in the environment. It can form spores which allows it to survive longer in extremes of temperature. Consequently, it is found as a contaminant of various foods, ie, beef, turkey, rice, beans, and vegetables. The diarrheal illness is often related to meats, milk, vegetables, and fish. The emetic illness is most often associated with rice products, but it has also been associated with other types of starchy products such as potatoes, pasta, and cheese. Some food mixtures (sauces, puddings, soups, casseroles, pastries, and salads, have been associated with food-borne illness in general.[3][4] Bacillus cereus is caused by the ingestion of food contaminated with enterotoxigenic B cereus or the emetic toxin. In non-gastrointestinal illness, reports of respiratory infections similar to respiratory anthrax have been attributed to B. cereus strains harboring B anthracis toxin genes. The United States Centers for Disease Control and Prevention website states that there were 619 confirmed outbreaks of Bacillus-related poisoning from 1998 through 2015, involving 7385 illnesses. In this timeframe, there were 75 illnesses and three deaths due to confirmed Bacillus-related illnesses. The website states that there were 19,119 outbreaks overall and 373,531 illnesses. It refers to 14,681 hospitalizations and 337 deaths during this timeframe. These statistics refer to all Bacillus-related illnesses, and not just B cereus-related illnesses.[5][6] The United States Food and Drug Administration's ""Bad Bug Book"" further breaks this down and states that there are an estimated 63,400 episodes of B cereus illness annually in the United States. From 2005 to 2007, there were 13 confirmed outbreaks and 37.6 suspected outbreaks involving over 1000 people. Everyone is susceptible to B. cereus infection; however, mortality related to this illness is rare. The emetic enterotoxin has been associated with a few cases of liver failure and death in otherwise healthy people. The infective dose or the number of organisms most commonly associated with human illness is 105 to 108 organisms/gram, but pathogenicity arises from the preformed toxin, not the bacteria themselves. The pathogenicity of B cereus, whether inside or outside the gastrointestinal tract, is associated with exoenzyme production Among the secreted toxins are 4 hemolysins, 3 distinct phospholipases, and 3 pore-forming enterotoxins. The enterotoxins that activate the nod-like receptor protein-3 (NLRP3) are hemolysin BL, nonhemolytic enterotoxin (NHE), and cytotoxin K. In the small intestine, vegetative cells, ingested as viable cells or spores, produce and secrete a protein enterotoxin and induce diarrheal syndrome. Cereulide is a plasmid-encoded cyclic peptide, which is produced in food products and ingested as a formed toxin. In rabbit ligated ileal-loop assays, culture filtrates of enterotoxigenic strains induced fluid accumulation and hemolytic, cytotoxic, dermonecrosis, and increased vascular permeability in rabbit skin.[7] The enterotoxin is composed of a binding component (B) and 2 hemolytic components, designated HBL. In the diarrheal form of the disease, a nonhemolytic 3-component enterotoxin, designated NHE, has been identified. The NHE from Bacillus cereus activates the nod-like NLRP3 inflammasome and pyroptosis. This leads to programmed cell death initiated by the activation of inflammatory caspases of the infected tissue.[8] https://www.ncbi.nlm.nih.gov/books/NBK459121/","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]
+
+EVIDENCE:
+Bacillus cereus is a toxin-producing facultatively anaerobic gram-positive bacterium. The bacteria are commonly found in the environment and can contaminate food. It can quickly multiply at room temperature with an abundantly present preformed toxin. When ingested, this toxin can cause gastrointestinal illness, which is the commonly known manifestation of the disease. Gastrointestinal syndromes associated with B cereus include diarrheal illness without significant upper intestinal symptoms and a predominantly upper GI syndrome with nausea and vomiting without diarrhea. B cereus has also been implicated in infections of the eye, respiratory tract, and wounds. The pathogenicity of B cereus, whether intestinal or nonintestinal, is intimately associated with the production of tissue-destructive exoenzymes. Among these secreted toxins are hemolysins, phospholipases, and proteases.[1][2] B cereus is a common bacterium, present ubiquitously in the environment. It can form spores which allows it to survive longer in extremes of temperature. Consequently, it is found as a contaminant of various foods, ie, beef, turkey, rice, beans, and vegetables. The diarrheal illness is often related to meats, milk, vegetables, and fish. The emetic illness is most often associated with rice products, but it has also been associated with other types of starchy products such as potatoes, pasta, and cheese. Some food mixtures (sauces, puddings, soups, casseroles, pastries, and salads, have been associated with food-borne illness in general.[3][4] Bacillus cereus is caused by the ingestion of food contaminated with enterotoxigenic B cereus or the emetic toxin. In non-gastrointestinal illness, reports of respiratory infections similar to respiratory anthrax have been attributed to B. cereus strains harboring B anthracis toxin genes. The United States Centers for Disease Control and Prevention website states that there were 619 confirmed outbreaks of Bacillus-related poisoning from 1998 through 2015, involving 7385 illnesses. In this timeframe, there were 75 illnesses and three deaths due to confirmed Bacillus-related illnesses. The website states that there were 19,119 outbreaks overall and 373,531 illnesses. It refers to 14,681 hospitalizations and 337 deaths during this timeframe. These statistics refer to all Bacillus-related illnesses, and not just B cereus-related illnesses.[5][6] The United States Food and Drug Administration's ""Bad Bug Book"" further breaks this down and states that there are an estimated 63,400 episodes of B cereus illness annually in the United States. From 2005 to 2007, there were 13 confirmed outbreaks and 37.6 suspected outbreaks involving over 1000 people. Everyone is susceptible to B. cereus infection; however, mortality related to this illness is rare. The emetic enterotoxin has been associated with a few cases of liver failure and death in otherwise healthy people. The infective dose or the number of organisms most commonly associated with human illness is 105 to 108 organisms/gram, but pathogenicity arises from the preformed toxin, not the bacteria themselves. The pathogenicity of B cereus, whether inside or outside the gastrointestinal tract, is associated with exoenzyme production Among the secreted toxins are 4 hemolysins, 3 distinct phospholipases, and 3 pore-forming enterotoxins. The enterotoxins that activate the nod-like receptor protein-3 (NLRP3) are hemolysin BL, nonhemolytic enterotoxin (NHE), and cytotoxin K. In the small intestine, vegetative cells, ingested as viable cells or spores, produce and secrete a protein enterotoxin and induce diarrheal syndrome. Cereulide is a plasmid-encoded cyclic peptide, which is produced in food products and ingested as a formed toxin. In rabbit ligated ileal-loop assays, culture filtrates of enterotoxigenic strains induced fluid accumulation and hemolytic, cytotoxic, dermonecrosis, and increased vascular permeability in rabbit skin.[7] The enterotoxin is composed of a binding component (B) and 2 hemolytic components, designated HBL. In the diarrheal form of the disease, a nonhemolytic 3-component enterotoxin, designated NHE, has been identified. The NHE from Bacillus cereus activates the nod-like NLRP3 inflammasome and pyroptosis. This leads to programmed cell death initiated by the activation of inflammatory caspases of the infected tissue.[8]
+
+USER:
+In less than 250 words. Explain what I Bacillus cereus. Provide where the bacteria is found mostly. What temperature does it multiply quickly in and does it form a toxin? If so, what area of the body will contain the illness from the toxin? What are the symptoms of B cereus.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,24,51,624,,281
+You must answer the prompt by only using the information from the provided context.,What types of risk does Northrup Grumman face within the cyber threat landscape?,"Item 1C. Cybersecurity We recognize the critical importance of maintaining the safety and security of our systems and data and have a holistic process for overseeing and managing cybersecurity and related risks. This process is supported by both management and our Board of Directors. The Chief Information Office, which maintains our cybersecurity function, is led by our Chief Information Officer (CIO), who reports to our CEO. The Chief Information Security Officer (CISO) reports to the CIO and generally is responsible for management of cybersecurity risk and the protection and defense of our networks and systems. The CISO manages a team of cybersecurity professionals with broad experience and expertise, including in cybersecurity threat assessments and detection, mitigation technologies, cybersecurity training, incident response, cyber forensics, insider threats and regulatory compliance. Our Board of Directors is responsible for overseeing our enterprise risk management activities in general, and each of our Board committees assists the Board in the role of risk oversight. The full Board receives an update on the Company’s risk management process and the risk trends related to cybersecurity at least annually. The Audit and Risk Committee specifically assists the Board in its oversight of risks related to cybersecurity. To help ensure effective oversight, the Audit and Risk Committee receives reports on information security and cybersecurity from the CISO at least four times a year. In addition, the Company’s Enterprise Risk Management Council (ERMC) considers risks relating to cybersecurity, among other significant risks, and applicable mitigation plans to address such risks. The ERMC is comprised of the Executive Leadership Team, as well as the Chief Accounting Officer, Chief Compliance Officer, Corporate Secretary, Chief Sustainability Officer, Treasurer and Vice President, Internal Audit. The CIO and CISO attend each ERMC meeting. The ERMC meets during the year and receives periodic updates on cybersecurity risks from the CIO and CISO. We have an established process and playbook led by our CISO governing our assessment, response and notifications internally and externally upon the occurrence of a cybersecurity incident. Depending on the nature and severity of an incident, this process provides for escalating notification to our CEO and the Board (including our Lead Independent Director and the Audit and Risk Committee chair). NORTHROP GRUMMAN CORPORATION -22- Our approach to cybersecurity risk management includes the following key elements: • Multi-Layered Defense and Continuous Monitoring – We work to protect our computing environments and products from cybersecurity threats through multi-layered defenses and apply lessons learned from our defense and monitoring efforts to help prevent future attacks. We utilize data analytics to detect anomalies and search for cyber threats. Our Cybersecurity Operations Center provides comprehensive cyber threat detection and response capabilities and maintains a 24x7 monitoring system which complements the technology, processes and threat detection techniques we use to monitor, manage and mitigate cybersecurity threats. From time to time, we engage third party consultants or other advisors to assist in assessing, identifying and/or managing cybersecurity threats. We also periodically use our Internal Audit function to conduct additional reviews and assessments. • Insider Threats – We maintain an insider threat program designed to identify, assess, and address potential risks from within our Company. Our program evaluates potential risks consistent with industry practices, customer requirements and applicable law, including privacy and other considerations. • Information Sharing and Collaboration – We work with government, customer, industry and/or supplier partners, such as the National Defense Information Sharing and Analysis Center and other governmentindustry partnerships, to gather and develop best practices and share information to address cyber threats. These relationships enable the rapid sharing of threat and vulnerability mitigation information across the defense industrial base and supply chain. • Third Party Risk Assessments – We conduct information security assessments before sharing or allowing the hosting of sensitive data in computing environments managed by third parties, and our standard terms and conditions contain contractual provisions requiring certain security protections. • Training and Awareness – We provide awareness training to our employees to help identify, avoid and mitigate cybersecurity threats. Our employees with network access participate annually in required training, including spear phishing and other awareness training. We also periodically host tabletop exercises with management and other employees to practice rapid cyber incident response. • Supplier Engagement – We provide training and other resources to our suppliers to support cybersecurity resiliency in our supply chain. We also require our suppliers to comply with our standard information security terms and conditions, in addition to any requirements from our customers, as a condition of doing business with us, and require them to complete information security questionnaires to review and assess any potential cyber-related risks depending on the nature of the services being provided. While we have experienced cybersecurity incidents in the past, to date none have materially affected the Company or our financial position, results of operations and/or cash flows. We continue to invest in the cybersecurity and resiliency of our networks and to enhance our internal controls and processes, which are designed to help protect our systems and infrastructure, and the information they contain. For more information regarding the risks we face from cybersecurity threats, please see “Risk Factors.” FORWARD-LOOKING STATEMENTS AND PROJECTIONS This Annual Report on Form 10-K and the information we are incorporating by reference contain statements that constitute “forward-looking statements” within the meaning of the Private Securities Litigation Reform Act of 1995. Words such as “will,” “expect,” “anticipate,” “intend,” “may,” “could,” “should,” “plan,” “project,” “forecast,” “believe,” “estimate,” “guidance,” “outlook,” “trends,” “goals” and similar expressions generally identify these forward-looking statements. Forward-looking statements include, among other things, statements relating to our future financial condition, results of operations and/or cash flows. Forward-looking statements are based upon assumptions, expectations, plans and projections that we believe to be reasonable when made, but which may change over time. These statements are not guarantees of future performance and inherently involve a wide range of risks and uncertainties that are difficult to predict. Specific risks that could cause actual results to differ materially from those expressed or implied in these forward-looking statements include, but are not limited to, those identified under “Risk Factors” and other important factors disclosed in this report and from time to time in our other SEC filings. These risks and uncertainties are amplified by the global macroeconomic, security and political environments, including inflationary pressures, labor and supply chain challenges, which have caused and will continue to cause significant challenges, instability and uncertainty. They include: Industry and Economic Risks • our dependence on the U.S. government for a substantial portion of our business NORTHROP GRUMMAN CORPORATION","You must answer the prompt by only using the information from the provided context. What types of risk does Northrup Grumman face within the cyber threat landscape? Item 1C. Cybersecurity We recognize the critical importance of maintaining the safety and security of our systems and data and have a holistic process for overseeing and managing cybersecurity and related risks. This process is supported by both management and our Board of Directors. The Chief Information Office, which maintains our cybersecurity function, is led by our Chief Information Officer (CIO), who reports to our CEO. The Chief Information Security Officer (CISO) reports to the CIO and generally is responsible for management of cybersecurity risk and the protection and defense of our networks and systems. The CISO manages a team of cybersecurity professionals with broad experience and expertise, including in cybersecurity threat assessments and detection, mitigation technologies, cybersecurity training, incident response, cyber forensics, insider threats and regulatory compliance. Our Board of Directors is responsible for overseeing our enterprise risk management activities in general, and each of our Board committees assists the Board in the role of risk oversight. The full Board receives an update on the Company’s risk management process and the risk trends related to cybersecurity at least annually. The Audit and Risk Committee specifically assists the Board in its oversight of risks related to cybersecurity. To help ensure effective oversight, the Audit and Risk Committee receives reports on information security and cybersecurity from the CISO at least four times a year. In addition, the Company’s Enterprise Risk Management Council (ERMC) considers risks relating to cybersecurity, among other significant risks, and applicable mitigation plans to address such risks. The ERMC is comprised of the Executive Leadership Team, as well as the Chief Accounting Officer, Chief Compliance Officer, Corporate Secretary, Chief Sustainability Officer, Treasurer and Vice President, Internal Audit. The CIO and CISO attend each ERMC meeting. The ERMC meets during the year and receives periodic updates on cybersecurity risks from the CIO and CISO. We have an established process and playbook led by our CISO governing our assessment, response and notifications internally and externally upon the occurrence of a cybersecurity incident. Depending on the nature and severity of an incident, this process provides for escalating notification to our CEO and the Board (including our Lead Independent Director and the Audit and Risk Committee chair). NORTHROP GRUMMAN CORPORATION -22- Our approach to cybersecurity risk management includes the following key elements: • Multi-Layered Defense and Continuous Monitoring – We work to protect our computing environments and products from cybersecurity threats through multi-layered defenses and apply lessons learned from our defense and monitoring efforts to help prevent future attacks. We utilize data analytics to detect anomalies and search for cyber threats. Our Cybersecurity Operations Center provides comprehensive cyber threat detection and response capabilities and maintains a 24x7 monitoring system which complements the technology, processes and threat detection techniques we use to monitor, manage and mitigate cybersecurity threats. From time to time, we engage third party consultants or other advisors to assist in assessing, identifying and/or managing cybersecurity threats. We also periodically use our Internal Audit function to conduct additional reviews and assessments. • Insider Threats – We maintain an insider threat program designed to identify, assess, and address potential risks from within our Company. Our program evaluates potential risks consistent with industry practices, customer requirements and applicable law, including privacy and other considerations. • Information Sharing and Collaboration – We work with government, customer, industry and/or supplier partners, such as the National Defense Information Sharing and Analysis Center and other governmentindustry partnerships, to gather and develop best practices and share information to address cyber threats. These relationships enable the rapid sharing of threat and vulnerability mitigation information across the defense industrial base and supply chain. • Third Party Risk Assessments – We conduct information security assessments before sharing or allowing the hosting of sensitive data in computing environments managed by third parties, and our standard terms and conditions contain contractual provisions requiring certain security protections. • Training and Awareness – We provide awareness training to our employees to help identify, avoid and mitigate cybersecurity threats. Our employees with network access participate annually in required training, including spear phishing and other awareness training. We also periodically host tabletop exercises with management and other employees to practice rapid cyber incident response. • Supplier Engagement – We provide training and other resources to our suppliers to support cybersecurity resiliency in our supply chain. We also require our suppliers to comply with our standard information security terms and conditions, in addition to any requirements from our customers, as a condition of doing business with us, and require them to complete information security questionnaires to review and assess any potential cyber-related risks depending on the nature of the services being provided. While we have experienced cybersecurity incidents in the past, to date none have materially affected the Company or our financial position, results of operations and/or cash flows. We continue to invest in the cybersecurity and resiliency of our networks and to enhance our internal controls and processes, which are designed to help protect our systems and infrastructure, and the information they contain. For more information regarding the risks we face from cybersecurity threats, please see “Risk Factors.” FORWARD-LOOKING STATEMENTS AND PROJECTIONS This Annual Report on Form 10-K and the information we are incorporating by reference contain statements that constitute “forward-looking statements” within the meaning of the Private Securities Litigation Reform Act of 1995. Words such as “will,” “expect,” “anticipate,” “intend,” “may,” “could,” “should,” “plan,” “project,” “forecast,” “believe,” “estimate,” “guidance,” “outlook,” “trends,” “goals” and similar expressions generally identify these forward-looking statements. Forward-looking statements include, among other things, statements relating to our future financial condition, results of operations and/or cash flows. Forward-looking statements are based upon assumptions, expectations, plans and projections that we believe to be reasonable when made, but which may change over time. These statements are not guarantees of future performance and inherently involve a wide range of risks and uncertainties that are difficult to predict. Specific risks that could cause actual results to differ materially from those expressed or implied in these forward-looking statements include, but are not limited to, those identified under “Risk Factors” and other important factors disclosed in this report and from time to time in our other SEC filings. These risks and uncertainties are amplified by the global macroeconomic, security and political environments, including inflationary pressures, labor and supply chain challenges, which have caused and will continue to cause significant challenges, instability and uncertainty. They include: Industry and Economic Risks • our dependence on the U.S. government for a substantial portion of our business NORTHROP GRUMMAN CORPORATION","You must answer the prompt by only using the information from the provided context.
+
+EVIDENCE:
+Item 1C. Cybersecurity We recognize the critical importance of maintaining the safety and security of our systems and data and have a holistic process for overseeing and managing cybersecurity and related risks. This process is supported by both management and our Board of Directors. The Chief Information Office, which maintains our cybersecurity function, is led by our Chief Information Officer (CIO), who reports to our CEO. The Chief Information Security Officer (CISO) reports to the CIO and generally is responsible for management of cybersecurity risk and the protection and defense of our networks and systems. The CISO manages a team of cybersecurity professionals with broad experience and expertise, including in cybersecurity threat assessments and detection, mitigation technologies, cybersecurity training, incident response, cyber forensics, insider threats and regulatory compliance. Our Board of Directors is responsible for overseeing our enterprise risk management activities in general, and each of our Board committees assists the Board in the role of risk oversight. The full Board receives an update on the Company’s risk management process and the risk trends related to cybersecurity at least annually. The Audit and Risk Committee specifically assists the Board in its oversight of risks related to cybersecurity. To help ensure effective oversight, the Audit and Risk Committee receives reports on information security and cybersecurity from the CISO at least four times a year. In addition, the Company’s Enterprise Risk Management Council (ERMC) considers risks relating to cybersecurity, among other significant risks, and applicable mitigation plans to address such risks. The ERMC is comprised of the Executive Leadership Team, as well as the Chief Accounting Officer, Chief Compliance Officer, Corporate Secretary, Chief Sustainability Officer, Treasurer and Vice President, Internal Audit. The CIO and CISO attend each ERMC meeting. The ERMC meets during the year and receives periodic updates on cybersecurity risks from the CIO and CISO. We have an established process and playbook led by our CISO governing our assessment, response and notifications internally and externally upon the occurrence of a cybersecurity incident. Depending on the nature and severity of an incident, this process provides for escalating notification to our CEO and the Board (including our Lead Independent Director and the Audit and Risk Committee chair). NORTHROP GRUMMAN CORPORATION -22- Our approach to cybersecurity risk management includes the following key elements: • Multi-Layered Defense and Continuous Monitoring – We work to protect our computing environments and products from cybersecurity threats through multi-layered defenses and apply lessons learned from our defense and monitoring efforts to help prevent future attacks. We utilize data analytics to detect anomalies and search for cyber threats. Our Cybersecurity Operations Center provides comprehensive cyber threat detection and response capabilities and maintains a 24x7 monitoring system which complements the technology, processes and threat detection techniques we use to monitor, manage and mitigate cybersecurity threats. From time to time, we engage third party consultants or other advisors to assist in assessing, identifying and/or managing cybersecurity threats. We also periodically use our Internal Audit function to conduct additional reviews and assessments. • Insider Threats – We maintain an insider threat program designed to identify, assess, and address potential risks from within our Company. Our program evaluates potential risks consistent with industry practices, customer requirements and applicable law, including privacy and other considerations. • Information Sharing and Collaboration – We work with government, customer, industry and/or supplier partners, such as the National Defense Information Sharing and Analysis Center and other governmentindustry partnerships, to gather and develop best practices and share information to address cyber threats. These relationships enable the rapid sharing of threat and vulnerability mitigation information across the defense industrial base and supply chain. • Third Party Risk Assessments – We conduct information security assessments before sharing or allowing the hosting of sensitive data in computing environments managed by third parties, and our standard terms and conditions contain contractual provisions requiring certain security protections. • Training and Awareness – We provide awareness training to our employees to help identify, avoid and mitigate cybersecurity threats. Our employees with network access participate annually in required training, including spear phishing and other awareness training. We also periodically host tabletop exercises with management and other employees to practice rapid cyber incident response. • Supplier Engagement – We provide training and other resources to our suppliers to support cybersecurity resiliency in our supply chain. We also require our suppliers to comply with our standard information security terms and conditions, in addition to any requirements from our customers, as a condition of doing business with us, and require them to complete information security questionnaires to review and assess any potential cyber-related risks depending on the nature of the services being provided. While we have experienced cybersecurity incidents in the past, to date none have materially affected the Company or our financial position, results of operations and/or cash flows. We continue to invest in the cybersecurity and resiliency of our networks and to enhance our internal controls and processes, which are designed to help protect our systems and infrastructure, and the information they contain. For more information regarding the risks we face from cybersecurity threats, please see “Risk Factors.” FORWARD-LOOKING STATEMENTS AND PROJECTIONS This Annual Report on Form 10-K and the information we are incorporating by reference contain statements that constitute “forward-looking statements” within the meaning of the Private Securities Litigation Reform Act of 1995. Words such as “will,” “expect,” “anticipate,” “intend,” “may,” “could,” “should,” “plan,” “project,” “forecast,” “believe,” “estimate,” “guidance,” “outlook,” “trends,” “goals” and similar expressions generally identify these forward-looking statements. Forward-looking statements include, among other things, statements relating to our future financial condition, results of operations and/or cash flows. Forward-looking statements are based upon assumptions, expectations, plans and projections that we believe to be reasonable when made, but which may change over time. These statements are not guarantees of future performance and inherently involve a wide range of risks and uncertainties that are difficult to predict. Specific risks that could cause actual results to differ materially from those expressed or implied in these forward-looking statements include, but are not limited to, those identified under “Risk Factors” and other important factors disclosed in this report and from time to time in our other SEC filings. These risks and uncertainties are amplified by the global macroeconomic, security and political environments, including inflationary pressures, labor and supply chain challenges, which have caused and will continue to cause significant challenges, instability and uncertainty. They include: Industry and Economic Risks • our dependence on the U.S. government for a substantial portion of our business NORTHROP GRUMMAN CORPORATION
+
+USER:
+What types of risk does Northrup Grumman face within the cyber threat landscape?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,14,13,1086,,516
+"{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]","What is SpaceX about? What are its achievements, missions, and prospects if any mentioned? Summarize all these in a bulleted list of about 500 words.","SpaceX, American aerospace company founded in 2002 that helped usher in the era of commercial spaceflight. It was the first private company to successfully launch and return a spacecraft from Earth orbit and the first to launch a crewed spacecraft and dock it with the International Space Station (ISS). Headquarters are in Hawthorne, California. SpaceX was formed by entrepreneur Elon Musk in the hopes of revolutionizing the aerospace industry and making affordable spaceflight a reality. The company entered the arena with the Falcon 1 rocket, a two-stage liquid-fueled craft designed to send small satellites into orbit. The Falcon 1 was vastly cheaper to build and operate than its competitors, a field largely populated by spacecraft built by publicly owned and government-funded companies such as Lockheed Martin and Boeing. Part of the rocket’s cost-effectiveness was made possible by the SpaceX-developed Merlin engine, a cheaper alternative to those used by other companies. SpaceX also focused on making reusable rockets (other launch vehicles are generally made for one-time use). Falcon 1 rocketLaunch of a Falcon 1 rocket from the SpaceX launch site on Kwajalein Atoll, Marshall Islands, September 28, 2008. Dragon on recovery shipThe SpaceX Dragon spacecraft secured aboard the deck of a recovery ship after its first successful orbital flight, December 8, 2010. In March 2006 SpaceX made its first Falcon 1 launch, which began successfully but ended prematurely because of a fuel leak and fire. By this time, however, the company had already earned millions of dollars in launching orders, many of them from the U.S. government. In August of that year SpaceX was a winner of a NASA competition for funds to build and demonstrate spacecraft that could potentially service the ISS after the decommissioning of the space shuttle. Falcon 1 launches that failed to attain Earth orbit followed in March 2007 and August 2008, but in September 2008 SpaceX became the first privately owned company to send a liquid-fueled rocket into orbit. Three months later it won a NASA contract for servicing the ISS that was worth more than $1 billion. Witness the launch of the SpaceX Dragon capsule, May 25, 2012 Witness the launch of the SpaceX Dragon capsule, May 25, 2012Video released by spacecraft maker SpaceX celebrating its Dragon capsule, which on May 25, 2012, became the first commercial spacecraft to dock with the International Space Station. See all videos for this article Learn about SpaceX, the first private company in history to send a spacecraft, which it named Dragon, to the International Space Station Learn about SpaceX, the first private company in history to send a spacecraft, which it named Dragon, to the International Space StationVideo released by the spacecraft maker SpaceX in August 2012 after it won a contract with NASA to prepare its Dragon spacecraft to carry astronauts into space. See all videos for this article In 2010 SpaceX first launched its Falcon 9, a bigger craft so named for its use of nine engines, and the following year it broke ground on a launch site for the Falcon Heavy, a craft the company hoped would be the first to break the $1,000-per-pound-to-orbit cost barrier and that might one day be used to transport astronauts into deep space. In December 2010 the company reached another milestone, becoming the first commercial company to release a spacecraft—the Dragon capsule—into orbit and successfully return it to Earth. Dragon again made history on May 25, 2012, when it became the first commercial spacecraft to dock with the ISS, to which it successfully delivered cargo. In August that year, SpaceX announced that it had won a contract from NASA to develop a successor to the space shuttle that would transport astronauts into space. Falcon 9 first-stage landingThe landing of a Falcon 9 first stage at Cape Canaveral, Florida, December 21, 2015. This was the first time a rocket stage launched a spacecraft into orbit and then returned to a landing on Earth. SpaceX: Falcon Heavy rocketLaunch of the SpaceX Falcon Heavy rocket from the Kennedy Space Center, Cape Canaveral, Florida, February 6, 2018. The Falcon 9 was designed so that its first stage could be reused. In 2015 a Falcon 9 first stage successfully returned to Earth near its launch site. Beginning in 2016, SpaceX also began using drone ships for rocket stage landings. A rocket stage that had returned to Earth was successfully reused in a 2017 launch. That same year, a Dragon capsule was reused on a flight to the ISS. The Falcon Heavy rocket had its first test flight in 2018. Two of the three first stages landed successfully; the third hit the water near the drone ship. That Falcon Heavy did not carry a satellite but instead placed into orbit around the Sun a Tesla Roadster with a mannequin in a space suit buckled into the driver’s seat. The first operational flight of the Falcon Heavy launched on April 11, 2019. In 2019 SpaceX began launching satellites for its Starlink megaconstellation, which provides satellite Internet service. About 50 Starlink satellites are launched at a time on a Falcon 9 flight. As of 2023, Starlink had 3,660 active satellites, half of all active satellites in orbit. A further 7,500 satellites have been approved by the U.S. Federal Communications Commission, and SpaceX ultimately seeks to have 29,988 satellites orbiting between 340 and 614 km (211 and 381 miles) above Earth. The first crewed flight of a Dragon capsule to the ISS launched on May 30, 2020, with astronauts Doug Hurley and Robert Behnken. SpaceX also announced the successor to the Falcon 9 and the Falcon Heavy: the Super Heavy–Starship system (originally called the BFR [Big Falcon Rocket]). The Super Heavy first stage would be capable of lifting 100,000 kg (220,000 pounds) to low Earth orbit. The payload would be the Starship, a spacecraft designed for several purposes, including providing fast transportation between cities on Earth and building bases on the Moon and Mars. SpaceX planned to use the Starship for a flight around the Moon carrying Japanese businessman Maezawa Yusaku and several artists in 2023, for flights to land astronauts on the Moon as part of NASA’s Artemis program, and eventually to launch settlers to Mars.","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== What is SpaceX about? What are its achievements, missions, and prospects if any mentioned? Summarize all these in a bulleted list of about 500 words. {passage 0} ========== SpaceX, American aerospace company founded in 2002 that helped usher in the era of commercial spaceflight. It was the first private company to successfully launch and return a spacecraft from Earth orbit and the first to launch a crewed spacecraft and dock it with the International Space Station (ISS). Headquarters are in Hawthorne, California. SpaceX was formed by entrepreneur Elon Musk in the hopes of revolutionizing the aerospace industry and making affordable spaceflight a reality. The company entered the arena with the Falcon 1 rocket, a two-stage liquid-fueled craft designed to send small satellites into orbit. The Falcon 1 was vastly cheaper to build and operate than its competitors, a field largely populated by spacecraft built by publicly owned and government-funded companies such as Lockheed Martin and Boeing. Part of the rocket’s cost-effectiveness was made possible by the SpaceX-developed Merlin engine, a cheaper alternative to those used by other companies. SpaceX also focused on making reusable rockets (other launch vehicles are generally made for one-time use). Falcon 1 rocketLaunch of a Falcon 1 rocket from the SpaceX launch site on Kwajalein Atoll, Marshall Islands, September 28, 2008. Dragon on recovery shipThe SpaceX Dragon spacecraft secured aboard the deck of a recovery ship after its first successful orbital flight, December 8, 2010. In March 2006 SpaceX made its first Falcon 1 launch, which began successfully but ended prematurely because of a fuel leak and fire. By this time, however, the company had already earned millions of dollars in launching orders, many of them from the U.S. government. In August of that year SpaceX was a winner of a NASA competition for funds to build and demonstrate spacecraft that could potentially service the ISS after the decommissioning of the space shuttle. Falcon 1 launches that failed to attain Earth orbit followed in March 2007 and August 2008, but in September 2008 SpaceX became the first privately owned company to send a liquid-fueled rocket into orbit. Three months later it won a NASA contract for servicing the ISS that was worth more than $1 billion. Witness the launch of the SpaceX Dragon capsule, May 25, 2012 Witness the launch of the SpaceX Dragon capsule, May 25, 2012Video released by spacecraft maker SpaceX celebrating its Dragon capsule, which on May 25, 2012, became the first commercial spacecraft to dock with the International Space Station. See all videos for this article Learn about SpaceX, the first private company in history to send a spacecraft, which it named Dragon, to the International Space Station Learn about SpaceX, the first private company in history to send a spacecraft, which it named Dragon, to the International Space StationVideo released by the spacecraft maker SpaceX in August 2012 after it won a contract with NASA to prepare its Dragon spacecraft to carry astronauts into space. See all videos for this article In 2010 SpaceX first launched its Falcon 9, a bigger craft so named for its use of nine engines, and the following year it broke ground on a launch site for the Falcon Heavy, a craft the company hoped would be the first to break the $1,000-per-pound-to-orbit cost barrier and that might one day be used to transport astronauts into deep space. In December 2010 the company reached another milestone, becoming the first commercial company to release a spacecraft—the Dragon capsule—into orbit and successfully return it to Earth. Dragon again made history on May 25, 2012, when it became the first commercial spacecraft to dock with the ISS, to which it successfully delivered cargo. In August that year, SpaceX announced that it had won a contract from NASA to develop a successor to the space shuttle that would transport astronauts into space. Falcon 9 first-stage landingThe landing of a Falcon 9 first stage at Cape Canaveral, Florida, December 21, 2015. This was the first time a rocket stage launched a spacecraft into orbit and then returned to a landing on Earth. SpaceX: Falcon Heavy rocketLaunch of the SpaceX Falcon Heavy rocket from the Kennedy Space Center, Cape Canaveral, Florida, February 6, 2018. The Falcon 9 was designed so that its first stage could be reused. In 2015 a Falcon 9 first stage successfully returned to Earth near its launch site. Beginning in 2016, SpaceX also began using drone ships for rocket stage landings. A rocket stage that had returned to Earth was successfully reused in a 2017 launch. That same year, a Dragon capsule was reused on a flight to the ISS. The Falcon Heavy rocket had its first test flight in 2018. Two of the three first stages landed successfully; the third hit the water near the drone ship. That Falcon Heavy did not carry a satellite but instead placed into orbit around the Sun a Tesla Roadster with a mannequin in a space suit buckled into the driver’s seat. The first operational flight of the Falcon Heavy launched on April 11, 2019. In 2019 SpaceX began launching satellites for its Starlink megaconstellation, which provides satellite Internet service. About 50 Starlink satellites are launched at a time on a Falcon 9 flight. As of 2023, Starlink had 3,660 active satellites, half of all active satellites in orbit. A further 7,500 satellites have been approved by the U.S. Federal Communications Commission, and SpaceX ultimately seeks to have 29,988 satellites orbiting between 340 and 614 km (211 and 381 miles) above Earth. The first crewed flight of a Dragon capsule to the ISS launched on May 30, 2020, with astronauts Doug Hurley and Robert Behnken. SpaceX also announced the successor to the Falcon 9 and the Falcon Heavy: the Super Heavy–Starship system (originally called the BFR [Big Falcon Rocket]). The Super Heavy first stage would be capable of lifting 100,000 kg (220,000 pounds) to low Earth orbit. The payload would be the Starship, a spacecraft designed for several purposes, including providing fast transportation between cities on Earth and building bases on the Moon and Mars. SpaceX planned to use the Starship for a flight around the Moon carrying Japanese businessman Maezawa Yusaku and several artists in 2023, for flights to land astronauts on the Moon as part of NASA’s Artemis program, and eventually to launch settlers to Mars. https://www.britannica.com/topic/SpaceX","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]
+
+EVIDENCE:
+SpaceX, American aerospace company founded in 2002 that helped usher in the era of commercial spaceflight. It was the first private company to successfully launch and return a spacecraft from Earth orbit and the first to launch a crewed spacecraft and dock it with the International Space Station (ISS). Headquarters are in Hawthorne, California. SpaceX was formed by entrepreneur Elon Musk in the hopes of revolutionizing the aerospace industry and making affordable spaceflight a reality. The company entered the arena with the Falcon 1 rocket, a two-stage liquid-fueled craft designed to send small satellites into orbit. The Falcon 1 was vastly cheaper to build and operate than its competitors, a field largely populated by spacecraft built by publicly owned and government-funded companies such as Lockheed Martin and Boeing. Part of the rocket’s cost-effectiveness was made possible by the SpaceX-developed Merlin engine, a cheaper alternative to those used by other companies. SpaceX also focused on making reusable rockets (other launch vehicles are generally made for one-time use). Falcon 1 rocketLaunch of a Falcon 1 rocket from the SpaceX launch site on Kwajalein Atoll, Marshall Islands, September 28, 2008. Dragon on recovery shipThe SpaceX Dragon spacecraft secured aboard the deck of a recovery ship after its first successful orbital flight, December 8, 2010. In March 2006 SpaceX made its first Falcon 1 launch, which began successfully but ended prematurely because of a fuel leak and fire. By this time, however, the company had already earned millions of dollars in launching orders, many of them from the U.S. government. In August of that year SpaceX was a winner of a NASA competition for funds to build and demonstrate spacecraft that could potentially service the ISS after the decommissioning of the space shuttle. Falcon 1 launches that failed to attain Earth orbit followed in March 2007 and August 2008, but in September 2008 SpaceX became the first privately owned company to send a liquid-fueled rocket into orbit. Three months later it won a NASA contract for servicing the ISS that was worth more than $1 billion. Witness the launch of the SpaceX Dragon capsule, May 25, 2012 Witness the launch of the SpaceX Dragon capsule, May 25, 2012Video released by spacecraft maker SpaceX celebrating its Dragon capsule, which on May 25, 2012, became the first commercial spacecraft to dock with the International Space Station. See all videos for this article Learn about SpaceX, the first private company in history to send a spacecraft, which it named Dragon, to the International Space Station Learn about SpaceX, the first private company in history to send a spacecraft, which it named Dragon, to the International Space StationVideo released by the spacecraft maker SpaceX in August 2012 after it won a contract with NASA to prepare its Dragon spacecraft to carry astronauts into space. See all videos for this article In 2010 SpaceX first launched its Falcon 9, a bigger craft so named for its use of nine engines, and the following year it broke ground on a launch site for the Falcon Heavy, a craft the company hoped would be the first to break the $1,000-per-pound-to-orbit cost barrier and that might one day be used to transport astronauts into deep space. In December 2010 the company reached another milestone, becoming the first commercial company to release a spacecraft—the Dragon capsule—into orbit and successfully return it to Earth. Dragon again made history on May 25, 2012, when it became the first commercial spacecraft to dock with the ISS, to which it successfully delivered cargo. In August that year, SpaceX announced that it had won a contract from NASA to develop a successor to the space shuttle that would transport astronauts into space. Falcon 9 first-stage landingThe landing of a Falcon 9 first stage at Cape Canaveral, Florida, December 21, 2015. This was the first time a rocket stage launched a spacecraft into orbit and then returned to a landing on Earth. SpaceX: Falcon Heavy rocketLaunch of the SpaceX Falcon Heavy rocket from the Kennedy Space Center, Cape Canaveral, Florida, February 6, 2018. The Falcon 9 was designed so that its first stage could be reused. In 2015 a Falcon 9 first stage successfully returned to Earth near its launch site. Beginning in 2016, SpaceX also began using drone ships for rocket stage landings. A rocket stage that had returned to Earth was successfully reused in a 2017 launch. That same year, a Dragon capsule was reused on a flight to the ISS. The Falcon Heavy rocket had its first test flight in 2018. Two of the three first stages landed successfully; the third hit the water near the drone ship. That Falcon Heavy did not carry a satellite but instead placed into orbit around the Sun a Tesla Roadster with a mannequin in a space suit buckled into the driver’s seat. The first operational flight of the Falcon Heavy launched on April 11, 2019. In 2019 SpaceX began launching satellites for its Starlink megaconstellation, which provides satellite Internet service. About 50 Starlink satellites are launched at a time on a Falcon 9 flight. As of 2023, Starlink had 3,660 active satellites, half of all active satellites in orbit. A further 7,500 satellites have been approved by the U.S. Federal Communications Commission, and SpaceX ultimately seeks to have 29,988 satellites orbiting between 340 and 614 km (211 and 381 miles) above Earth. The first crewed flight of a Dragon capsule to the ISS launched on May 30, 2020, with astronauts Doug Hurley and Robert Behnken. SpaceX also announced the successor to the Falcon 9 and the Falcon Heavy: the Super Heavy–Starship system (originally called the BFR [Big Falcon Rocket]). The Super Heavy first stage would be capable of lifting 100,000 kg (220,000 pounds) to low Earth orbit. The payload would be the Starship, a spacecraft designed for several purposes, including providing fast transportation between cities on Earth and building bases on the Moon and Mars. SpaceX planned to use the Starship for a flight around the Moon carrying Japanese businessman Maezawa Yusaku and several artists in 2023, for flights to land astronauts on the Moon as part of NASA’s Artemis program, and eventually to launch settlers to Mars.
+
+USER:
+What is SpaceX about? What are its achievements, missions, and prospects if any mentioned? Summarize all these in a bulleted list of about 500 words.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,26,25,1029,,561
+Avoid using information outside of the provided text.,What are the benefits of high-quality staff?,"Financial intermediaries reduce transaction, information and search costs mainly by exploiting economies of scale. By increasing the volume of transactions, the cost per unit of transaction decreases. Moreover, by focusing on growing in size, financial intermediaries are able to draw standardised contracts and monitor customers so that they enforce these contracts. They also train high-quality staff to assist in the process of finding and monitoring suitable units in deficit (borrowers). It would be very difficult, time-consuming and costly for an individual to do so. Financial intermediaries can reduce risks by ‘pooling’, or aggregating, individual risks so that in normal circumstances, surplus units will be depositing money as deficit units make withdrawals. This enables banks, for instance, to collect relatively liquid deposits and invest most of them in long-term assets. Another way to look at this situation is that large groups of depositors are able to obtain liquidity from the banks while investing savings in illiquid but more profitable investments (Diamond and Dybvig, 1983).","Avoid using information outside of the provided text. Financial intermediaries reduce transaction, information and search costs mainly by exploiting economies of scale. By increasing the volume of transactions, the cost per unit of transaction decreases. Moreover, by focusing on growing in size, financial intermediaries are able to draw standardised contracts and monitor customers so that they enforce these contracts. They also train high-quality staff to assist in the process of finding and monitoring suitable units in deficit (borrowers). It would be very difficult, time-consuming and costly for an individual to do so. Financial intermediaries can reduce risks by ‘pooling’, or aggregating, individual risks so that in normal circumstances, surplus units will be depositing money as deficit units make withdrawals. This enables banks, for instance, to collect relatively liquid deposits and invest most of them in long-term assets. Another way to look at this situation is that large groups of depositors are able to obtain liquidity from the banks while investing savings in illiquid but more profitable investments (Diamond and Dybvig, 1983). What are the benefits of high-quality staff?","Avoid using information outside of the provided text.
+
+EVIDENCE:
+Financial intermediaries reduce transaction, information and search costs mainly by exploiting economies of scale. By increasing the volume of transactions, the cost per unit of transaction decreases. Moreover, by focusing on growing in size, financial intermediaries are able to draw standardised contracts and monitor customers so that they enforce these contracts. They also train high-quality staff to assist in the process of finding and monitoring suitable units in deficit (borrowers). It would be very difficult, time-consuming and costly for an individual to do so. Financial intermediaries can reduce risks by ‘pooling’, or aggregating, individual risks so that in normal circumstances, surplus units will be depositing money as deficit units make withdrawals. This enables banks, for instance, to collect relatively liquid deposits and invest most of them in long-term assets. Another way to look at this situation is that large groups of depositors are able to obtain liquidity from the banks while investing savings in illiquid but more profitable investments (Diamond and Dybvig, 1983).
+
+USER:
+What are the benefits of high-quality staff?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,8,7,163,,476
+"Only provide the opinions that were given in the context document. If you cannot answer a question using the provided context alone, then say ""I'm sorry, but I do not have the context to answer this question.""","Based on the document provided, how does the user make the shortcuts menu appear while playing music?","User Manual Version 1.1 Table of Contents Get started 7 What's in the box 7 Charge your watch 8 Set up Versa 3 9 Connect to Wi-Fi 9 See your data in the Fitbit app 10 Unlock Fitbit Premium 11 Advanced health metrics 11 Premium health and wellness reminders 12 Wear Versa 3 13 Placement for all-day wear vs. exercise 13 Fasten the band 14 Handedness 15 Wear and care tips 16 Change the band 16 Remove a band 16 Attach a band 17 Basics 18 Navigate Versa 3 18 Basic navigation 18 Button shortcuts 19 Widgets 22 Adjust settings 23 Display 24 Vibration & audio 24 Goal reminders 24 Quiet modes 24 Shortcuts 25 Check battery level 25 Set up device lock 26 2 Adjust always-on display 26 Turn off the screen 28 Care for Versa 3 28 Apps and Clock Faces 29 Change the clock face 29 Open apps 30 Organize apps 30 Download additional apps 30 Remove apps 30 Update apps 31 Adjust app settings and permissions 31 Voice Assistant 32 Set up Amazon Alexa Built-in 32 Interact with Alexa 32 Check Alexa alarms, reminders, and timers 34 Lifestyle 35 Starbucks 35 Agenda 35 Weather 35 Check the weather 36 Add or remove a city 36 Find Phone 36 Notifications from your phone 38 Set up notifications 38 See incoming notifications 38 Manage notifications 39 Turn off notifications 39 Answer or reject phone calls 40 Respond to messages (Android phones) 41 Timekeeping 42 Use the Alarms app 42 Dismiss or snooze an alarm 42 3 Use the Timer app 43 Activity and Wellness 44 See your stats 44 Track a daily activity goal 45 Choose a goal 45 Track your hourly activity 45 Track your sleep 46 Set a sleep goal 46 Learn about your sleep habits 46 Practice guided breathing 47 Exercise and Heart Health 48 Track your exercise automatically 48 Track and analyze exercise with the Exercise app 49 Track an exercise 49 Customize your exercise settings 50 Check your workout summary 51 Check your heart rate 51 Custom heart-rate zones 53 Earn Active Zone Minutes 53 View your cardio fitness score 53 Work out with Fitbit Coach 54 Share your activity 54 Music 55 Connect Bluetooth headphones or speakers 55 Control music with Versa 3 55 Choose the music source 56 Control music 56 Control music with the Spotify - Connect & Control app 56 Listen to music with the Pandora app (United States only) 57 Listen to music with the Deezer app 57 Fitbit Pay 58 Use credit and debit cards 58 4 Set up Fitbit Pay 58 Make purchases 59 Change your default card 60 Pay for transit 60 Update, Restart, and Erase 62 Update Versa 3 62 Restart Versa 3 62 Shutdown Versa 3 63 Erase Versa 3 63 Troubleshooting 64 Heart-rate signal missing 64 GPS signal missing 64 Can't connect to Wi-Fi 65 Other issues 66 General Info and Specifications 67 Sensors and Components 67 Materials 67 Wireless technology 68 Haptic feedback 68 Battery 68 Memory 68 Display 68 Band size 68 Environmental conditions 69 Learn more 69 Return policy and warranty 69 Regulatory and Safety Notices 70 USA: Federal Communications Commission (FCC) statement 70 Canada: Industry Canada (IC) statement 71 European Union (EU) 72 IP Rating 73 Argentina 74 5 Australia and New Zealand 74 Belarus 74 Botswana 75 China 75 Customs Union 77 Indonesia 77 Israel 77 Japan 77 Kingdom of Saudi Arabia 78 Mexico 78 Moldova 78 Morocco 79 Nigeria 79 Oman 79 Pakistan 79 Philippines 80 Serbia 80 Singapore 80 South Korea 80 Taiwan 82 United Arab Emirates 84 Vietnam 85 Zambia 85 Safety Statement 85 6 Get started Meet Fitbit Versa 3, the health and fitness smartwatch with built-in GPS, Active Zone Minutes, 20+ exercise modes, and music experiences to keep you motivated to move. Take a moment to review our complete safety information at fitbit.com/safety. Versa 3 is not intended to provide medical or scientific data. What's in the box Your Versa 3 box includes: Watch with small band (color and material varies) Charging cable Additional large band The detachable bands on Versa 3 come in a variety of colors and materials, sold separately. 7 Charge your watch A fully-charged Versa 3 has a battery life of 6+ days. Battery life and charge cycles vary with use and other factors; actual results will vary. To charge Versa 3: 1. Plug the charging cable into the USB port on your computer, a UL-certified USB wall charger, or another low-energy charging device. 2. Hold the other end of the charging cable near the port on the back of the watch until it attaches magnetically. Make sure the pins on the charging cable align with the port on the back of your watch. Charge Versa 3 for 12 minutes for 24 hours of battery life. While the watch charges, tap the screen twice or press the button to turn the screen on. The battery level appears for several seconds, then disappears so you can use your watch while it charges. Charging fully takes about 1-2 hours. 8 Set up Versa 3 Set up Versa 3 with the Fitbit app for iPhones and iPads or Android phones. The Fitbit app is compatible with most popular phones and tablets. See fitbit.com/devices to check if your phone or tablet is compatible. To get started: 1. Download the Fitbit app: l Apple App Store for iPhones and iPads l Google Play Store for Android phones 2. Install the app, and open it. l If you already have a Fitbit account, log in to your account > tap the Today tab > your profile picture > Set Up a Device. l If you don't have a Fitbit account, tap Join Fitbit to be guided through a series of questions to create a Fitbit account. 3. Continue to follow the on-screen instructions to connect Versa 3 to your account. When you're done with setup, read through the guide to learn more about your new watch and then explore the Fitbit app. For more information, see help.fitbit.com. Connect to Wi-Fi During setup, you're prompted to connect Versa 3 to your Wi-Fi network. Versa 3 uses Wi-Fi to more quickly transfer music from Pandora or Deezer, download apps 9 from the Fitbit App Gallery, and for faster, more reliable OS updates. Versa 3 can connect to open, WEP, WPA personal, and WPA2 personal Wi-Fi networks. Your watch won't connect to 5GHz, WPA enterprise, or public Wi-Fi networks that require more than a password to connect—for example, logins, subscriptions, or profiles. If you see fields for a username or domain when connecting to the Wi-Fi network on a computer, the network isn't supported. For best results, connect Versa 3 to your home Wi-Fi network. Make sure you know the network password before connecting. For more information, see help.fitbit.com. See your data in the Fitbit app Open the Fitbit app on your phone or tablet to view your activity and sleep data, log food and water, participate in challenges, and more. 10 Unlock Fitbit Premium Fitbit Premium helps you build healthy habits by offering tailored workouts, insights into how your behavior impacts your health, and personalized plans to help you reach your goals. A Fitbit Premium subscription includes health insights and guidance, advanced health metrics, sleep details, customized programs, and 150+ workouts from fitness brands. New Fitbit Premium customers can redeem a free trial. For more information, see help.fitbit.com. Advanced health metrics Know your body better with health metrics in the Fitbit app. This feature helps you view key metrics tracked by your Fitbit device over time so that you can see trends and assess what’s changed. Metrics include: l Oxygen saturation (SpO2) l Skin temperature variation l Heart rate variability l Resting heart rate l Breathing rate Note: This feature is not intended to diagnose or treat any medical condition and should not be relied on for any medical purposes. It is intended to provide information that can help you manage your well-being. If you have any concerns about your health, please talk to a healthcare provider. If you believe you are experiencing a medical emergency, call emergency services. For more information, see help.fitbit.com. 11 Premium health and wellness reminders Set up Premium health and wellness reminders in the Fitbit app, and receive reminders on your watch that encourage you to form and maintain healthy behaviors. For more information, see help.fitbit.com. 12 Wear Versa 3 Wear Versa 3 around your wrist. If you need to attach a different size band, or if you purchased another band, see the instructions in ""Change the band"" on page 16. Placement for all-day wear vs. exercise When you're not exercising, wear Versa 3 a finger's width above your wrist bone. In general, it's always important to give your wrist a break on a regular basis by removing your watch for around an hour after extended wear. We recommend removing your watch while you shower. Although you can shower while wearing your watch, not doing so reduces the potential for exposure to soaps, shampoos, and conditioners, which can cause long-term damage to your watch and may cause skin irritation. For optimized heart-rate tracking while exercising: l During workouts, try moving the band higher on your wrist to get a better fit. If you experience any discomfort, loosen the band, and if it persists give your wrist a break by taking it off. 13 l Wear your watch on top of your wrist, and make sure the back of the device is in contact with your skin. Fasten the band 1. Place Versa 3 around your wrist. 2. Slide the bottom band through the first loop in the top band. 14 3. Tighten the band until it fits comfortably, and press the peg through one of the holes in the band. 4. Slide the loose end of the band through the second loop until it lies flat on your wrist. Make sure the band isn’t too tight. Wear the band loosely enough that it can move back and forth on your wrist. Handedness For greater accuracy, you must specify whether you wear Versa 3 on your dominant or non-dominant hand. Your dominant hand is the one you use for writing and eating. To start, the Wrist setting is set to non-dominant. If you wear Versa 3 on your dominant hand, change the Wrist setting in the Fitbit app: From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile > Wrist > Dominant. 15 Wear and care tips l Clean your band and wrist regularly with a soap-free cleanser. l If your watch gets wet, remove and dry it completely after your activity. l Take your watch off from time to time. l If you notice skin irritation, remove your watch and contact customer support. For more information, see fitbit.com/productcare. Change the band Versa 3 comes with a small band attached and an additional large, bottom band in the box. Both the top and bottom bands can be swapped with accessory bands, sold separately on fitbit.com. For band measurements, see ""Band size"" on page 68. Fitbit Sense bands are compatible with Versa 3. Remove a band 1. Turn over Versa 3 and find the band latches. 2. To release the latch, slide the flat button toward the band. 16 3. Gently pull the band away from the watch to release it. 4. Repeat on the other side. Attach a band To attach a band, press it into the end of the watch until you hear a click and it snaps into place. The band with the loops and peg attaches to the top of the watch. 17 Basics Learn how to manage settings, set a personal PIN code, navigate the screen, and care for your watch. Navigate Versa 3 Versa 3 has a color AMOLED touchscreen display and 1 button. Navigate Versa 3 by tapping the screen, swiping side to side and up and down, or pressing the button. To preserve battery, the watch’s screen turns off when not in use, unless you turn on the always-on display setting. For more information, see ""Adjust always-on display"" on page 26. Basic navigation The home screen is the clock. l Swipe down to see notifications. l Swipe up to see widgets, such as your daily stats, the weather, and a shortcut to start the Relax app. l Swipe left to see the apps on your watch. l Swipe right to open quick settings or return to the previous screen in an app. l Press the button to return to the clock face. 18 Button shortcuts Use the button to quickly access Fitbit Pay, voice assistant, quick settings, or your favorite apps. Press and hold the button Hold the button for 2 seconds to activate a feature of your choice. The first time you use the button shortcut, select which feature it activates. To change which feature activates when you hold the button, open the Settings app on your watch and tap Shortcuts. Tap Press & hold, and select the app you want. 19 Double-press the button Double-press the button to open shortcuts to 4 apps or features. To start, the 4 shortcuts are music controls , quick settings , your voice assistant, and Fitbit Pay . To change these shortcuts, open the Settings app on your watch and tap Shortcuts. Under Double Press, tap the shortcut you want to change. Quick settings Swipe right from the clock face on your watch to access quick settings. 20 Do Not Disturb When the do not disturb setting is on: l Notifications, goal celebrations, and reminders are muted. l The do not disturb icon illuminates in quick settings. You can't turn on do not disturb and sleep mode at the same time. Sleep Mode When the sleep mode setting is on: l Notifications, goal celebrations, and reminders are muted. l The screen's brightness is set to dim. l The Always-On Display clock face is turned off. l The screen stays dark when you turn your wrist. l The sleep mode icon illuminates in quick settings. Sleep mode turns off automatically when you set a sleep schedule. To set a schedule: 1. Open the Settings app and tap Quiet modes. 2. Under Sleep mode, tap Schedule mode > Off- hours. 3. Tap the start or stop time to adjust when the mode turns on and off. Swipe up or down to change the time, and tap the time to select it. Sleep mode automatically turns off at the time you schedule, even if you manually turned it on. You can't turn on do not disturb and sleep mode at the same time. Screen Wake When you set screen wake to automatic , the screen turns on each time you turn your wrist. 21 When you set screen wake to manual, press the button or tap the screen to turn on the display. Brightness Adjust the screen brightness. Always-On Display Turn always-on display on or off. For more information, see ""Adjust always-on display"" on page 26. Music Volume Adjust the volume of music playing through headphones or speakers paired to your watch. For more information, see ""Connect Bluetooth headphones or speakers"" on page 55. Widgets Add widgets to your watch to see your daily stats, log your water intake or weight, check the weather forecast, and start a session in the Relax app, and more. To see your widgets, swipe up from the clock face. To add a new widget: 22 1. From the clock face, swipe up to the bottom of the widgets, and tap Manage. 2. Under More Widgets, tap the icon next to the widget you want to add. 3. Swipe up to the bottom of the page, and tap Done. To turn off a widget: 1. From the clock face, swipe up to the bottom of the widgets, and tap Manage. 2. Tap the > icon next to the widget you want to adjust. 3. Tap the switch icon next to Show Widget to turn it off. 4. Swipe up to the bottom of the page, and tap Done. To adjust the information you see on a widget: 1. From the clock face, swipe up to the bottom of the widgets, and tap Manage. 2. Tap the > icon next to the widget you want to adjust. 3. Adjust any settings you want to change. 4. Swipe up to the bottom of the page, and tap Done. To change the order of widgets: 1. From the clock face, swipe up to the bottom of the widgets, and tap Manage. 2. Press and hold the widget you want to move, and drag it up or down in the list of widgets. When it's in the correct new location, lift your finger. 3. Swipe up to the bottom of the page, and tap Done. Adjust settings Manage basic settings in the Settings app : 23 Display Brightness Change the screen's brightness. Screen wake Change whether the screen turns on when you turn your wrist. Screen timeout Adjust the amount of time before the screen turns off or switches to the always-on display clock face. Always-on display Turn always-on display on or off, and change the type of clock face shown. Vibration & audio Vibration Adjust your watch's vibration strength. Microphone Choose whether your watch can access the microphone. Bluetooth Manage connected Bluetooth devices. Goal reminders Active Zone Minutes goal Turn Active Zone Minutes weekly goal notifications on or off. Quiet modes Focus mode Turn off notifications while using the Exercise app . Do not disturb Turn off all notifications. Sleep mode Adjust sleep mode settings, including setting a schedule for the mode to automatically turn on and off. Alexa notifications Turn Amazon Alexa notifications off. 24 Shortcuts Press & hold Choose the app or feature you want to open when you press and hold the button. Double Press Choose 4 apps or features to appear as shortcuts when you double-press the button. Tap a setting to adjust it. Swipe up to see the full list of settings. Check battery level From the clock face, swipe right. The battery level icon is at the top of the screen. Wi-Fi won't work on Versa 3 when the battery is 25% or less, and you'll be unable to update your device. If your watch's battery is low (fewer than 24 hours remaining), a red battery indicator appears on the clock face. If your watch's battery is critically low (fewer than 4 hours remaining), the battery indicator flashes. When the battery is low: l The screen brightness is set to dim l The vibration strength is set to light l If you’re tracking an exercise with GPS, GPS tracking turns off l Always-on display is turned off l You can't use the voice assistant feature l You can't use quick replies 25 l You can't use music controls l You won't receive notifications from your phone Charge Versa 3 to use or adjust these features. Set up device lock To help keep your watch secure, turn on device lock in the Fitbit app, which prompts you to enter a personal 4-digit PIN code to unlock your watch. If you set up Fitbit Pay to make contactless payments from your watch, device lock is turned on automatically and you're required to set a code. If you don't use Fitbit Pay, device lock is optional. Turn on device lock or reset your PIN code in the Fitbit app: From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile > Device Lock. For more information, see help.fitbit.com. Adjust always-on display Turn on always-on display to show the time on your watch, even when you're not interacting with the screen. Many clock faces and certain apps have an always-on display mode. 26 To turn always-on display on or off, swipe right from the clock face to open quick settings. Tap the always-on display icon . Note that turning on this feature impacts your watch's battery life. When always-on display is turned on, Versa 3 requires more frequent charging. Clock faces without an always-on display mode use a default always-on display clock face. Choose between an analog or digital clock face. Open the Settings app > Display. In the Always-on display section, tap Analog or Digital. Always-on display automatically turns off when your watch's battery is critically low. For more information, see help.fitbit.com. 27 Turn off the screen To turn off your watch's screen when not in use, briefly cover the watch face with your opposite hand, press the buttons, or turn your wrist away from your body. Note that if you turn on the always-on display setting, the screen won't turn off. Care for Versa 3 It's important to clean and dry Versa 3 regularly. For more information, see fitbit.com/productcare. 28 Apps and Clock Faces The Fitbit Gallery offers apps and clock faces to personalize your watch and meet a variety of health, fitness, timekeeping, and everyday needs. Change the clock face The Fitbit Clock Gallery offers a variety of clock faces to personalize your watch. 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap Clock Faces > All Clocks. 3. Browse the available clock faces. Tap a clock face to see a detailed view. 4. Tap Select to add the clock face to Versa 3. Save up to 5 clock faces to switch between them: l When you select a new clock face, it’s automatically saved unless you already have 5 saved clock faces. l To see your saved clock faces from your watch, open the Clocks app and swipe to find the clock face you want to use. Tap to select it. l To see your saved clock faces in the Fitbit app, tap the Today tab > your profile picture > your device image > Clock Faces. See your saved clock faces in My Clock Faces. 29 l To remove a clock face, tap the clock face > Remove clock face. l To switch to a saved clock face, tap the clock face > Select. Open apps From the clock face, swipe left to see the apps installed on your watch. To open an app, tap it. Organize apps To change the placement of an app on Versa 3, press and hold an app until it's selected, and drag it to a new location. The app is selected when the icon increases slightly in size and the watch vibrates. Download additional apps 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap Apps > All Apps. 3. Browse the available apps. When you find one you want to install, tap it. 4. Tap Install to add the app to Versa 3. For more information, see help.fitbit.com. Remove apps You can remove most apps installed on Versa 3: 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap Apps. 3. In the My Apps tab, tap the app you want to remove. You may have to swipe up to find it. 4. Tap Remove. 30 Update apps Apps update over Wi-Fi as needed. Versa 3 searches for updates when plugged into the charger and in range of your Wi-Fi network. You can also manually update apps: 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap Apps. 3. In the My Apps tab, find the app you want to update. You may have to swipe up to find it. 4. Tap the pink Update button next to the app. Adjust app settings and permissions Many apps include options to adjust the notifications, allow certain permissions, and customize what it displays. Note that turning off any app permissions might cause the app to stop functioning. To access these settings: 1. With your watch nearby, in the Fitbit app, tap the Today tab > your profile picture > your device image. 2. Tap Apps or Clock Faces. 3. Tap the app or clock face whose settings you want to change. You may have to swipe up to see some apps. 4. Tap Settings or Permissions. 5. Tap Back or Details when you're done making changes. 31 Voice Assistant Check the weather, set timers and alarms, control your smart home devices, and more by speaking to your watch. Set up Amazon Alexa Built-in 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap Amazon Alexa > Sign in with Amazon. 3. Tap Get Started. 4. Log in to your Amazon account or create one if necessary. 5. Follow the on-screen instructions and read about what Alexa can do, and tap Close to return to your device settings in the Fitbit app. To change the language Alexa recognizes or disconnect your Amazon account: 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap Amazon Alexa. 3. Tap the current language to change it, or tap Logout to stop using Alexa on your watch. Interact with Alexa 1. Open the Alexa app on your watch. Note that the Fitbit app must be running in the background on your phone. 2. Say your request. 32 You don't need to say ""Alexa"" before speaking your request. For example: l Set a timer for 10 minutes. l Set an alarm for 8:00 a.m. l What's the temperature outside? l Remind me to make dinner at 6:00 p.m. l How much protein is in an egg? l Ask Fitbit to start a run.* l Start a bike ride with Fitbit.* *To ask Alexa to open the Exercise app on your watch, you must first set up the Fitbit skill for Alexa. For more information, see help.fitbit.com. These commands are currently available in English, German, French, Italian, Spanish, and Japanese. Amazon Alexa not available in all countries. For more information, see fitbit.com/voice. Note that saying “Alexa” doesn’t activate Alexa on your watch—you must open the Alexa app on your watch before the microphone turns on. The microphone turns off when you close Alexa, or when your watch’s screen turns off. For added functionality, install the Amazon Alexa app on your phone. With the app, your watch can access additional Alexa skills. For more information, see help.fitbit.com. 33 Check Alexa alarms, reminders, and timers 1. Open the Alexa app on your watch. 2. Tap the alerts icon and swipe up to view your alarms, reminders, and timers. 3. Tap an alarm to turn it on or off. To adjust or cancel a reminder or timer, tap the Alexa icon and say your request. Note that Alexa's alarms and timers are separate from those you set in the Alarms app or Timer app . 34 Lifestyle Use apps to stay connected to what you care about most. See ""Apps and Clock Faces"" on page 29 for instructions on how to add and delete apps. For more information, see help.fitbit.com. Starbucks Add your Starbucks card or Starbucks Rewards program number in the Fitbit App Gallery in the Fitbit app, and then use the Starbucks app to pay from your wrist. For more information, see help.fitbit.com. Agenda Connect your phone's calendar in the Fitbit app to see upcoming calendar events for today and tomorrow in the Agenda app on your watch. For more information, see help.fitbit.com. Weather See the weather in your current location, as well as 2 additional locations you choose, in the Weather app on your watch. 35 Check the weather Open the Weather app to see conditions in your current location. Swipe up to view the weather in other locations you added. Tap a location to see a more detailed report. You can also add a weather widget to your watch. For more information, see ""Widgets"" on page 22. If the weather for your current location doesn't appear, check that you turned on location services for the Fitbit app. If you change locations or don't see updated data for your current location, sync your watch to see your new location and latest data in the Weather app or widget. Choose your unit of temperature in the Fitbit app. For more information, see help.fitbit.com. Add or remove a city 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap Apps. 3. In the My Apps tab, tap the gear icon next to Weather. You may need to swipe up to find the app. 4. Tap Add city to add up to 2 additional locations or tap Edit > the X icon to delete a location. Note that you can't delete your current location. Find Phone Use the Find Phone app to locate your phone. Requirements: 36 l Your watch must be connected (“paired”) to the phone you want to locate. l Your phone must have Bluetooth turned on and be within 30 feet (10m) of your Fitbit device. l The Fitbit app must be running in the background on your phone. l Your phone must be turned on. To find your phone: l Open the Find Phone app on your watch. l Tap Find Phone. Your phone rings loudly. l When you locate your phone, tap Cancel to end the ringtone. 37 Notifications from your phone Versa 3 can show call, text, calendar, and app notifications from your phone to keep you informed. Keep your watch within 30 feet of your phone to receive notifications. Set up notifications Check that Bluetooth on your phone is on and that your phone can receive notifications (often under Settings > Notifications). Then set up notifications: 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap Notifications. 3. Follow the on-screen instructions to pair your watch if you haven't already. Call, text, and calendar notifications are turned on automatically. 4. To turn on notifications from apps installed on your phone, including Fitbit and WhatsApp, tap App Notifications and turn on the notifications you want to see. Note that if you have an iPhone or iPad, Versa 3 shows notifications from all calendars synced to the Calendar app. If you have an Android phone, Versa 3 shows calendar notifications from the calendar app you chose during setup. For more information, see help.fitbit.com. See incoming notifications A notification causes your watch to vibrate. If you don't read the notification when it arrives, you can check it later by swiping down from the top of the screen. 38 If your watch's battery is critically low, notifications won't cause Versa 3 to vibrate or the screen to turn on. Manage notifications Versa 3 stores up to 30 notifications, after which the oldest are replaced as you receive new ones. To manage notifications: l Swipe down from the top of the screen to see your notifications and tap any notification to expand it. l To delete a notification, tap to expand it, then swipe to the bottom and tap Clear. l To delete all notifications at once, swipe to the top of your notifications and tap Clear All. Turn off notifications Turn off certain notifications in the Fitbit app, or turn off all notifications in quick settings on Versa 3. When you turn off all notifications, your watch won't vibrate and the screen won't turn on when your phone receives a notification. To turn off certain notifications: 1. From the Today tab in the Fitbit app on your phone, tap your profile picture > Versa 3 tile > Notifications. 39 2. Turn off the notifications you no longer want to receive on your watch. To turn off all notifications: 1. From the clock face, swipe right to access quick settings. 2. Tap the do not disturb icon . All notifications, including goal celebrations and reminders, are turned off. Note that if you use the do not disturb setting on your phone, you don't receive notifications on your watch until you turn off this setting. Answer or reject phone calls If paired to an iPhone or Android (8.0+) phone, Versa 3 lets you accept or reject incoming phone calls. If your phone is running an older version of the Android OS, you can reject, but not accept, calls on your watch. To accept a call, tap the green phone icon on your watch's screen. Note that you can't speak into the watch—accepting a phone call answers the call on your nearby phone. To reject a call, tap the red phone icon to send the caller to voicemail. The caller's name appears if that person is in your contacts list; otherwise you see a phone number. 40 Respond to messages (Android phones) Respond directly to text messages and notifications from certain apps on your watch with preset quick replies or by speaking your reply into Versa 3. Keep your phone nearby with the Fitbit app running in the background to respond to messages from your watch. To respond to a message: 1. Open the notification you want to respond to. 2. Choose how to reply to the message: l Tap the microphone icon to respond to the message using voice-to- text. To change the language recognized by the microphone, tap Language. After you speak your reply, tap Send, or tap Retry to try again. If you notice a mistake after you send the message, tap Undo within 3 seconds to cancel the message. l Tap the text icon to respond to a message from a list of quick replies. l Tap the emoji icon to respond to the message with an emoji. For more information, including how to customize quick replies, see help.fitbit.com. 41 Timekeeping Alarms vibrate to wake or alert you at a time you set. Set up to 8 alarms to occur once or on multiple days of the week. You can also time events with the stopwatch or set a countdown timer. Note that alarms and timers you set with a voice assistant are separate from the ones you set in the Alarms app and Timer app. For more information, see ""Voice Assistant"" on page 32. Use the Alarms app Set one-time or recurring alarms with the Alarms app . When an alarm goes off, your watch vibrates. When setting an alarm, turn on Smart Wake to allow your watch to find the best time to wake you starting 30 minutes before the alarm time you set. It avoids waking you during deep sleep so you're more likely to wake up feeling refreshed. If Smart Wake can’t find the best time to wake you, your alarm alerts you at the set time. For more information, see help.fitbit.com. Dismiss or snooze an alarm When an alarm goes off, your watch vibrates. To dismiss the alarm, tap the alarm icon . To snooze the alarm for 9 minutes, tap the snooze icon . Snooze the alarm as many times as you want. Versa 3 automatically goes into snooze mode if you ignore the alarm for more than 1 minute. 42 Use the Timer app Time events with the stopwatch or set a countdown timer with the Timer app on your watch. You can run the stopwatch and countdown timer at the same time. When the screen turns off, your watch continues to display the stopwatch or countdown timer until it ends or you exit the app. For more information, see help.fitbit.com. 43 Activity and Wellness Versa 3 continuously tracks a variety of stats whenever you wear it, including hourly activity, heart rate, and sleep. Data automatically syncs with the Fitbit app throughout the day. See your stats Open the Today app or swipe up from the clock face to see your daily stats, including: Steps Steps taken today and progress toward your daily goal Heart rate Current heart rate and either your heart-rate zone or resting heart rate (if not in a zone) Calories burned Calories burned today and progress toward your daily goal Floors Floors climbed today and progress toward your daily goal Distance Distance covered today and progress toward your daily goal Active Zone Minutes Active Zone Minutes earned today and the number of Active Zone Minutes you're currently earning per minute Exercise Number of days you met your exercise goal this week Sleep Sleep duration and sleep score Hourly activity The number of hours today you met your hourly activity goal Food Calories eaten and calories remaining today Menstrual health Information on the current stage of your menstrual cycle, if applicable Water Water intake logged today and progress toward your daily goal Weight Current weight and your progress toward your weight goal Core temp Your most recent logged temperature 44 Tap a tile to view more details or log an entry (for water, weight, and core temperature). Find your complete history and other information detected by your watch in the Fitbit app. Track a daily activity goal Versa 3 tracks your progress toward a daily activity goal of your choice. When you reach your goal, your watch vibrates and shows a celebration. Choose a goal Set a goal to help you get started on your health and fitness journey. To begin, your goal is to take 10,000 steps per day. Choose to change the number of steps, or pick a different activity goal depending on your device. For more information, see help.fitbit.com. Track progress toward your goal on Versa 3. For more information, see ""See your stats"" on the previous page. Track your hourly activity Versa 3 helps you stay active throughout the day by keeping track of when you're stationary and reminding you to move. Reminders nudge you to walk at least 250 steps each hour. You feel a vibration and see a reminder on your screen at 10 minutes before the hour if you haven't walked 250 steps. When you meet the 250-step goal after receiving the reminder, you feel a second vibration and see a congratulatory message. 45 For more information, see help.fitbit.com. Track your sleep Wear Versa 3 to bed to automatically track basic stats about your sleep, including your time asleep, sleep stages (time spent in REM, light sleep, and deep sleep), and sleep score (the quality of your sleep). Versa 3 also tracks your estimated oxygen variation throughout the night to help you uncover potential breathing disturbances. To see your sleep stats, sync your watch when you wake up and check the Fitbit app, or swipe up from the clock face on your watch to see your sleep stats. For more information, see help.fitbit.com. Set a sleep goal To start, you have a sleep goal of 8 hours of sleep per night. Customize this goal to meet your needs. For more information, see help.fitbit.com. Learn about your sleep habits With a Fitbit Premium subscription, see more details about your sleep score and how you compare to your peers, which can help you build a better sleep routine and wake up feeling refreshed. For more information, see help.fitbit.com. 46 Practice guided breathing The Relax app on Versa 3 provides personalized guided breathing sessions to help you find moments of calm throughout the day. All notifications are automatically disabled during the session. 1. On Versa 3, open the Relax app . 2. Tap Edit to change the duration of the session or turn off the optional vibration. 3. Tap Start to begin the session. Follow the on-screen instructions. 4. When the session ends, tap Log It to reflect on how you feel, or tap Skip to skip this step. 5. View your summary, and tap Done to close the app. For more information, see help.fitbit.com. 47 Exercise and Heart Health Track activity with the Exercise app and complete guided workouts with the Fitbit Coach app right on your wrist. Check the Fitbit app to share your activity with friends and family, see how your overall fitness level compares to your peers, and more. During a workout, you can play music through the Pandora app or Deezer app on your watch, control music playing in Spotify using the Spotify - Connect & Control app , or control music playing on your phone. 1. Start music playing in an app or on your phone. 2. Open the Exercise or Coach app and start a workout. To control music playing while you exercise, double-press the button. Your shortcuts appear. 3. Tap the music controls icon . 4. To return to your workout, press the button. Note that you need to pair a Bluetooth audio device, such as headphones or a speaker, to Versa 3 to hear music stored on your watch. For more information, see ""Music"" on page 55. Track your exercise automatically Versa 3 automatically recognizes and records many high-movement activities which are at least 15 minutes long. See basic stats about your activity in the Fitbit app on your phone. From the Today tab , tap the Exercise tile. For more information, see help.fitbit.com. 48 Track and analyze exercise with the Exercise app Track specific exercises with the Exercise app on Versa 3 to see real-time stats, including heart-rate data, calories burned, elapsed time, and a post-workout summary on your wrist. For complete workout stats, and a workout intensity map if you used GPS, tap the Exercise tile in the Fitbit app. Track an exercise 1. On Versa 3, open the Exercise app and swipe to find an exercise. 2. Tap the exercise to choose it. If the exercise uses GPS, you can wait for the signal to connect, or start the exercise and GPS will connect when a signal is available. Note that GPS can take a few minutes to connect. 3. Tap the play icon to begin the exercise, or swipe up to choose an exercise goal or adjust the settings. For more information on the settings, see ""Customize your exercise settings"" on the next page. 4. Tap the large stat to scroll through your real-time stats. To pause your workout, swipe up and tap the pause icon . 5. When you're done with your workout, swipe up and tap the end icon > End. Your workout summary appears. 6. Tap Done to close the summary screen. Notes: l If you set an exercise goal, your watch alerts you when you’re halfway to your goal and when you reach the goal. l If the exercise uses GPS, ""GPS connecting..."" appears at the top of the screen. When the screen says ""GPS connected"" and Versa 3 vibrates, GPS is connected. 49 Using built-in GPS impacts your watch's battery life. When GPS tracking is turned on, Versa 3 can track up to 12 hours of continuous exercise. Customize your exercise settings Customize settings for each exercise type on your watch. Settings include: Heart Zone Notifications Receive notifications when you hit target heart-rate zones during your workout. For more information, see help.fitbit.com Laps Receive notifications when you reach certain milestones during your workout Show Stats Choose what stats you want to see when tracking an exercise GPS Track your route using GPS Auto-Pause Automatically pause a run or bike ride when you stop moving Run Detect Track runs automatically without opening the Exercise app Always-on Display Keep the screen on during exercise Pool Length Set the length of your pool Interval Adjust the move and rest intervals used during interval training 1. On Versa 3, open the Exercise app . 2. Swipe to find an exercise. 50 3. Swipe up from the bottom of the screen, then swipe up through the list of settings. 4. Tap a setting to adjust it. 5. When you're done, swipe down until you see the play icon . Check your workout summary After you complete a workout, Versa 3 shows a summary of your stats. Check the Exercise tile in the Fitbit app to see additional stats and a workout intensity map if you used GPS. Check your heart rate Versa 3 personalizes your heart-rate zones using your heart rate reserve, which is the difference between your maximum heart rate and your resting heart rate. To help you target the training intensity of your choice, check your heart rate and heart-rate zone on your watch during exercise. Versa 3 notifies you when you enter a heart-rate zone. 51 Icon Zone Calculation Description Below Zone Below 40% of your heart rate reserve Below the fat burn zone, your heart beats at a slower pace. Fat Burn Zone Between 40% and 59% of your heart rate reserve In the fat burn zone, you’re likely in a moderate activity such as a brisk walk. Your heart rate and breathing might be elevated, but you can still carry on a conversation. Cardio Zone Between 60% and 84% of your heart rate reserve In the cardio zone, you’re likely doing a vigorous activity such as running or spinning. Peak Zone Greater than 85% of your heart rate reserve In the peak zone, you’re likely doing a short, intense activity that improves performance and speed, such as sprinting or high-intensity interval training. 52 Custom heart-rate zones Instead of using these heart-rate zones, you can create a custom zone in the Fitbit app to target a specific heart-rate range. For more information, see help.fitbit.com. Earn Active Zone Minutes Earn Active Zone Minutes for time spent in the fat burn, cardio, or peak heart-rate zones. To help you maximize your time, you earn 2 Active Zone Minutes for each minute you’re in the cardio or peak zones. 1 minute in the fat burn zone = 1 Active Zone Minute 1 minute in the cardio or peak zones = 2 Active Zone Minutes A few moments after you enter a different heart-rate zone during your exercise, your watch buzzes so that you know how hard you’re working. The number of times your watch vibrates indicates which zone you’re in: 1 buzz = below zone 2 buzzes = fat burn zone 3 buzzes = cardio zone 4 buzzes = peak zone To start, your weekly goal is set to 150 Active Zone Minutes. You’ll receive notifications as you reach your goal. For more information, see help.fitbit.com. View your cardio fitness score View your overall cardiovascular fitness in the Fitbit app. See your cardio fitness score and cardio fitness level, which shows how you compare to your peers. 53 In the Fitbit app, tap the Heart-rate tile and swipe left on your heart-rate graph to see your detailed cardio fitness stats. For more information, see help.fitbit.com. Work out with Fitbit Coach The Fitbit Coach app provides guided bodyweight workouts on your wrist to help you stay fit anywhere. 1. On Versa 3, open the Fitbit Coach app . 2. Swipe to find a workout. 3. Tap the workout you want. To preview the workout, tap the menu icon . Press the button to return to the workout. 4. Tap Start. For more information, see help.fitbit.com. Share your activity After you complete a workout, open the Fitbit app to share your stats with friends and family. For more information, see help.fitbit.com. 54 Music Use apps on your watch to listen to music with Bluetooth headphones or speakers. Connect Bluetooth headphones or speakers Connect up to 8 Bluetooth audio devices to listen to music from your watch. To pair a new Bluetooth audio device: 1. Activate pairing mode on your Bluetooth headphones or speaker. 2. On Versa 3, open the Settings app > Vibration & audio. 3. In the Bluetooth section, tap Manage devices. 4. Swipe up to see the Other devices section. Versa 3 searches for nearby devices. 5. When Versa 3 finds nearby Bluetooth audio devices, it shows a list on the screen. Tap the name of the device you want to pair. When pairing is complete, a check mark appears on the screen. To listen to music with a different Bluetooth device: 1. On Versa 3, open the Settings app > Vibration & audio. 2. In the Bluetooth section, tap the device you want to use, or pair a new device. Then wait for a moment for the device to connect. For more information, see help.fitbit.com. Control music with Versa 3 Control music playing in an app on Versa 3 or on your phone. 55 Choose the music source 1. Double-press the button on Versa 3. Your shortcuts appear. 2. Tap the music controls icon . 3. The icon in the top-left corner shows whether the music source is currently set to your phone or your watch . Tap it to change the music source, then press the button to return to your music controls. Control music 1. While music is playing, double-press the button. Your shortcuts appear. 2. Tap the music controls icon . 3. Play, pause, or tap the arrow icons to skip to the next track or previous track. Tap the volume icon to adjust the volume. Control music with the Spotify - Connect & Control app Use the Spotify - Connect & Control app on Versa 3 to control Spotify on your phone, computer, or other Spotify Connect device. Navigate between playlists, like songs, and switch between devices from your watch. Note that at this time, the Spotify - Connect & Control app only controls music playing on your paired device, so your device must remain nearby and connected to the internet. You need a 56 Spotify Premium subscription to use this app. For more information about Spotify Premium, see spotify.com. For instructions, see help.fitbit.com. Listen to music with the Pandora app (United States only) With the Pandora app on Versa 3, download up to 3 of your most-played Pandora stations or popular curated Workout stations directly to your watch. Note that you need a paid subscription to Pandora and a Wi-Fi connection to download stations. For more information about Pandora subscriptions, see help.pandora.com. For instructions, see help.fitbit.com. Listen to music with the Deezer app With the Deezer app on Versa 3, download your Deezer playlists and Flow directly to your watch. Note that you need a paid subscription to Deezer and a Wi- Fi connection to download music. For more information about Deezer subscriptions, see support.deezer.com. For instructions, see help.fitbit.com. 57 Fitbit Pay Versa 3 includes a built-in NFC chip, which lets you use your credit and debit cards on your watch. Use credit and debit cards Set up Fitbit Pay in the Wallet section of the Fitbit app, and use your watch to make purchases in stores that accept contactless payments. We’re always adding new locations and card issuers to our list of partners. To see if your payment card works with Fitbit Pay, see fitbit.com/fitbit-pay/banks. Set up Fitbit Pay To use Fitbit Pay, add at least 1 credit or debit card from a participating bank to the Wallet section of the Fitbit app. The Wallet is where you add and remove payment cards, set a default card for your watch, edit a payment method, and review recent purchases. 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap the Wallet tile. 3. Follow the on-screen instructions to add a payment card. In some cases, your bank might require additional verification. If you're adding a card for the first time, you might be prompted to set a 4-digit PIN code for your watch. Note that you also need passcode protection enabled for your phone. 4. After you add a card, follow the on-screen instructions to turn on notifications for your phone (if you haven't already done so) to complete the setup. You can add up to 6 payment cards to the Wallet and choose which card to set as the default payment option. 58 Make purchases Make purchases using Fitbit Pay at any store that accepts contactless payments. To determine if the store accepts Fitbit Pay, look for the symbol below on the payment terminal: 1. Open the Wallet app on your watch. 2. If prompted, enter your 4-digit watch PIN code. Your default card appears on the screen. 3. To pay with your default card, hold your wrist near the payment terminal. To pay with a different card, swipe to find the card you want to use, and hold your wrist near the payment terminal. 59 When the payment succeeds, your watch vibrates and you see a confirmation on the screen. If the payment terminal doesn't recognize Fitbit Pay, make sure the watch face is near the reader and that the cashier knows you're using a contactless payment. For added security, you must wear Versa 3 on your wrist to use Fitbit Pay. For more information, see help.fitbit.com. Change your default card 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap the Wallet tile. 3. Find the card you want to set as the default option. 4. Tap Set as Default on Versa 3. Pay for transit Use Fitbit Pay to tap on and off at transit readers that accept contactless credit or debit card payments. To pay with your watch, follow the steps listed in ""Use credit and debit cards"" on page 58. 60 Pay with the same card on your Fitbit watch when you tap the transit reader at the start and end of your trip. Make sure your device is charged before beginning your trip. 61 Update, Restart, and Erase Some troubleshooting steps may require you to restart your watch, while erasing it is useful if you want to give Versa 3 to another person. Update your watch to receive new Fitbit OS updates. Update Versa 3 Update your watch to get the latest feature enhancements and product updates. When an update is available, a notification appears in the Fitbit app. After you start the update, follow the progress bars on Versa 3 and in the Fitbit app until the update is complete. Keep your watch and phone close to each other during the update. Updating Versa 3 takes several minutes and may be demanding on the battery. We recommend plugging your watch into the charger before starting the update. For more information, see help.fitbit.com. Restart Versa 3 If you can’t sync Versa 3 or you have trouble with tracking your stats or receiving notifications, restart your watch from your wrist: To restart your watch, press and hold the button for 10 seconds until you see the Fitbit logo on the screen, and then release the button. Restarting your watch reboots the device but doesn't delete any data. Versa 3 has small holes on the device for the altimeter, speaker, and microphone. Don’t attempt to restart your device by inserting any items, such as paper clips, into these holes as you can damage Versa 3. 62 Shutdown Versa 3 To turn off your watch, open the Settings app > Shut down. To turn on your watch, press the button. For information about how to store Versa 3 long term, see help.fitbit.com. Erase Versa 3 If you want to give Versa 3 to another person or wish to return it, first clear your personal data: On Versa 3, open the Settings app > About Versa 3 > Factory reset. 63 Troubleshooting If Versa 3 isn't working properly, see our troubleshooting steps below. Visit help.fitbit.com for more information. Heart-rate signal missing Versa 3 continuously tracks your heart rate while you're exercising and throughout the day. If the heart-rate sensor on your watch has difficulty detecting a signal, dashed lines appear. If your watch doesn't detect a heart-rate signal, make sure you're wearing your watch correctly, either by moving it higher or lower on your wrist or by tightening or loosening the band. Versa 3 should be in contact with your skin. After holding your arm still and straight for a short time, you should see your heart rate again. For more information, see help.fitbit.com. GPS signal missing Environmental factors including tall buildings, dense forest, steep hills, and thick cloud cover can interfere with your watch's ability to connect to GPS satellites. If your watch is searching for a GPS signal during an exercise, you’ll see “ GPS connecting ” appear at the top of the screen. If Versa 3 can't connect to a 64 GPS satellite, the watch stops trying to connect until the next time you start a GPS exercise. For best results, wait for Versa 3 to find the signal before you start your workout. If Versa 3 loses the GPS signal during your workout, ""GPS lost signal"" appears at the top of the screen. Your watch will attempt to reconnect. For more information, see help.fitbit.com. Can't connect to Wi-Fi If Versa 3 can't connect to Wi-Fi, you might have entered an incorrect password, or the password might have changed: 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap Wi-Fi Settings > Next. 3. Tap the network you want to use > Remove. 65 4. Tap Add Network and follow the on-screen instructions to reconnect the Wi- Fi network. To check if your Wi-Fi network is working correctly, connect another device to your network; if it connects successfully, try again to connect your watch. If Versa 3 still won't connect to Wi-Fi, make sure that you're attempting to connect your watch to a compatible network. For best results, use your home Wi-Fi network. Versa 3 can't connect to 5GHz Wi-Fi, WPA enterprise, or public networks that require logins, subscriptions, or profiles. For a list of compatible network types, see ""Connect to Wi-Fi"" on page 9. After you verify the network is compatible, restart your watch and try connecting to Wi-Fi again. If you see other networks appear in the list of available networks, but not your preferred network, move your watch closer to your router. For more information, see help.fitbit.com. Other issues If you experience any of the following issues, restart your watch: l Won't sync l Won't respond to taps, swipes, or button press l Won't track steps or other data l Won't show notifications For instructions, see ""Restart Versa 3"" on page 62. For more information, see help.fitbit.com. 66 General Info and Specifications Sensors and Components Fitbit Versa 3 contains the following sensors and motors: l 3-axis accelerometer, which tracks motion patterns l Altimeter, which tracks altitude changes l Built-in GPS receiver + GLONASS, which tracks your location during a workout l Optical heart-rate tracker l Device temperature sensor (skin temperature variation available through Premium only) l Ambient light sensor l Microphone l Speaker l Vibration motor Materials The band that comes with Versa 3 is made of a flexible, durable elastomer material similar to that used in many sports watches. The housing and buckle on Versa 3 are made of anodized aluminum. While anodized aluminum can contain traces of nickel, which can cause an allergic reaction in someone with nickel sensitivity, the amount of nickel in all Fitbit products meets the European Union's stringent Nickel Directive. Our products may contain trace amounts of acrylates and methacrylates from adhesives used in those products but we work to ensure our products adhere to rigorous design specifications and meet extensive test requirements so as to minimum the potential for reaction to these adhesives. 67 Wireless technology Versa 3 contains a Bluetooth 5.0 radio transceiver, Wi-Fi chip, and NFC chip. Haptic feedback Versa 3 contains a vibration motor for alarms, goals, notifications, reminders, and apps. Battery Versa 3 contains a rechargeable lithium-polymer battery. Memory Versa 3 stores your data, including daily stats, sleep information, and exercise history, for 7 days. See your historical data in the Fitbit app. Display Versa 3 has a color AMOLED display. Band size Band sizes are shown below. Note that accessory bands sold separately may vary slightly. Small band Fits a wrist between 5.5 - 7.1 inches (140 mm - 180 mm) in circumference Large band Fits a wrist between 7.1 - 8.7 inches (180 mm - 220 mm) in circumference 68 Environmental conditions Operating temperature 14° to 113° F (-10° to 45° C) Non-operating temperature -4° to 14° F (-20° to -10° C) 113° to 140°F (45° to 60° C) Charging temperature 32° to 95° F (0° to 35° C) Water resistance Water resistant up to 50 meters Maximum operating altitude 28,000 feet (8,534 m) Learn more To learn more about your watch, how to track your progress in the Fitbit app, and how to build healthy habits with Fitbit Premium, visit help.fitbit.com. Return policy and warranty Find warranty information and the fitbit.com return policy on our website. 69 Regulatory and Safety Notices Notice to the User: Regulatory content for certain regions can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info USA: Federal Communications Commission (FCC) statement Model FB511 FCC ID: XRAFB511 Notice to the User: The FCC ID can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info Supplier's Declaration of Conformity Unique Identifier: FB511 Responsible Party – U.S. Contact Information 199 Fremont Street, 14th Floor San Francisco, CA 94105 United States 877-623-4997 FCC Compliance Statement (for products subject to Part 15) This device complies with Part 15 of the FCC Rules. Operation is subject to the following two conditions: 70 1. This device may not cause harmful interference and 2. This device must accept any interference, including interference that may cause undesired operation of the device. FCC Warning Changes or modifications not expressly approved by the party responsible for compliance could void the user’s authority to operate the equipment. Note: This equipment has been tested and found to comply with the limits for a Class B digital device, pursuant to part 15 of the FCC Rules. These limits are designed to provide reasonable protection against harmful interference in a residential installation. This equipment generates, uses and can radiate radio frequency energy and, if not installed and used in accordance with the instructions, may cause harmful interference to radio communications. However, there is no guarantee that interference will not occur in a particular installation. If this equipment does cause harmful interference to radio or television reception, which can be determined by turning the equipment off and on, the user is encouraged to try to correct the interference by one or more of the following measures: l Reorient or relocate the receiving antenna. l Increase the separation between the equipment and receiver. l Connect the equipment into an outlet on a circuit different from that to which the receiver is connected. l Consult the dealer or an experienced radio/TV technician for help. This device meets the FCC and IC requirements for RF exposure in public or uncontrolled environments. Canada: Industry Canada (IC) statement Model/Modèle FB511 IC: 8542A-FB511 Notice to the User: The IC ID can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info 71 Avis à l'utilisateur: L'ID de l'IC peut également être consulté sur votre appareil. Pour voir le contenu: Paramètres > À propos de Versa 3 > Mentions légales This device meets the IC requirements for RF exposure in public or uncontrolled environments. Cet appareil est conforme aux conditions de la IC en matière de RF dans des environnements publics ou incontrôlée IC Notice to Users English/French in accordance with current issue of RSS GEN: This device complies with Industry Canada license exempt RSS standard(s). Operation is subject to the following two conditions: 1. this device may not cause interference, and 2. this device must accept any interference, including interference that may cause undesired operation of the device. Cet appareil est conforme avec Industrie Canada RSS standard exempts de licence (s). Son utilisation est soumise à Les deux conditions suivantes: 1. cet appareil ne peut pas provoquer d’interférences et 2. cet appareil doit accepter Toute interférence, y compris les interférences qui peuvent causer un mauvais fonctionnement du dispositif European Union (EU) Simplified EU Declaration of Conformity Hereby, Fitbit, Inc. declares that the radio equipment type Model FB511 is in compliance with Directive 2014/53/EU. The full text of the EU declaration of conformity is available at the following internet address: www.fitbit.com/safety Vereinfachte EU-Konformitätserklärung 72 Fitbit, Inc. erklärt hiermit, dass die Funkgerättypen Modell FB511 die Richtlinie 2014/53/EU erfüllen. Der vollständige Wortlaut der EU-Konformitätserklärungen kann unter folgender Internetadresse abgerufen werden: www.fitbit.com/safety Declaración UE de Conformidad simplificada Por la presente, Fitbit, Inc. declara que el tipo de dispositivo de radio Modelo FB511 cumple con la Directiva 2014/53/UE. El texto completo de la declaración de conformidad de la UE está disponible en la siguiente dirección de Internet: www.fitbit.com/safety Déclaration UE de conformité simplifiée Fitbit, Inc. déclare par la présente que les modèles d’appareils radio FB511 sont conformes à la Directive 2014/53/UE. Les déclarations UE de conformité sont disponibles dans leur intégralité sur le site suivant : www.fitbit.com/safety Dichiarazione di conformità UE semplificata Fitbit, Inc. dichiara che il tipo di apparecchiatura radio Modello FB511 è conforme alla Direttiva 2014/53/UE. Il testo completo della dichiarazione di conformità UE è disponibile al seguente indirizzo Internet: www.fitbit.com/safety IP Rating Model FB511 has a water resistance rating of IPX8 under IEC standard 60529, up to a depth of 50 meters. Model FB511 has a dust ingress rating of IP6X under IEC standard 60529 which indicates the device is dust-tight. Please refer to the beginning of this section for instructions on how to access your product’s IP rating. 73 Argentina C-25002 Australia and New Zealand Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info Belarus Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info 74 Botswana Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory Info China Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory Info 75 China RoHS 部件名称 Part Name 有毒和危险品 Toxic and Hazardous Substances or Elements Model FB511 铅 (Pb) 水银 (Hg) 镉 (Cd) 六价铬 (Cr(VI)) 多溴化苯 (PBB) 多溴化二苯 醚 (PBDE) 表带和表扣 (Strap and Buckle) O O O O O O 电子 (Electronics) -- O O O O O 电池 (Battery) O O O O O O 充电线 (Charging Cable) O O O O O O 本表格依据 SJ/T 11364 的规定编制 O = 表示该有害物质在该部件所有均质材料中的含量均在 GB/T 26572规定的限量要求以下 (indicates that the content of the toxic and hazardous substance in all the Homogeneous Materials of the part is below the concentration limit requirement as described in GB/T 26572). X = 表示该有害物质至少在该部件的某一均质材料中的含量超出 GB/T 26572规定的限量要 求 (indicates that the content of the toxic and hazardous substance in at least one Homogeneous Material of the part exceeds the concentration limit requirement as described in GB/T 26572). CMIIT ID 2020DJ7882 76 Frequency band: 2400-2483.5 MHz NFC: 13.56MHz Transmitted power: Max EIRP, 14.4dBm Occupied bandwidth: BLE: BLE: 2MHz, BT: 1MHz, NFC: 2.3 kHz, WiFi: 20MHz Modulation system: BLE: GFSK, BT: GFSK (BDR), n/4-DQPSK (EDR), 8PSK (EDR), NFC: ASK, WiFi: DSSS, OFDM CMIIT ID displayed: On packaging Customs Union Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info Indonesia 69814/SDPPI/2020 3788 Israel מספראישוראלחוטישלמשרדהתקשורתהוא.74746-51 אסורלהחליףאתהאנטנההמקוריתשלהמכשירולאלעשותבוכלשינויטכניאחר Japan Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info 77 201-200606 Kingdom of Saudi Arabia Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info Mexico Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info La operación de este equipo está sujeta a las siguientes dos condiciones: 1. Es posible que este equipo o dispositivo no cause interferencia perjudicial y 2. Este equipo o dispositivo debe aceptar cualquier interferencia, incluyendo la que pueda causar su operación no deseada Moldova Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info 78 Morocco AGREE PAR L’ANRT MAROC Numéro d’agrément: MR00025102ANRT2020 Date d’agrément: 02/08/2020 Nigeria Connection and use of this communications equipment is permitted by the Nigerian Communications Commission. Oman TRA/TA-R/9745/20 D090258 Pakistan PTA Approved Model No.: FB511 TAC No.: 9.687/2020 Device Type: Smart Watch 79 Philippines Type Accepted No: ESD-RCE-2023407 Serbia Singapore Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info South Korea Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info 80 본 제품의 전자파흡수율은 과학기술정보통신부의「전자파 인체보호기준」을 만족합니 다. 본 제품은 국립전파연구원의「전자파흡수율 측정기준」에 따라 최대출력 조건에서 머리 에 근접하여 시험되었으며, 최대 전자파흡수율 측정값은 다음과같습니다. 모델명 (Model) 머리 전자파흡수율 (Head SAR) FB511 0.089 W/kg 클래스 B 장치 (가정 사용을위한 방송 통신 기기) : EMC 등록 주로 가정용 (B 급)으로하고, 모 든 지역에서 사용할 수 있습니다 얻을이 장치. Translation: Class B devices (broadcast communications equipment for home use): EMC registration is mainly for household use (B class) and can be used in all areas get this device. 81 Taiwan 用戶注意：某些地區的法規內容也可以在您的設備上查看。要查看內容： 設定 > 關於 Versa 3 > 法規資訊 Translation: Notice to the User: Regulatory content can also be viewed on your device. Instructions to view content from your menu: Settings > About Versa 3 > Regulatory info 低功率警語: l 取得審驗證明之低功率射頻器材，非經核准，公司、商號或使用者均不得擅自變更 頻率、加大功率或變更原設計之特性及功能。 l 低功率射頻器材之使用不得影響飛航安全及干擾合法通信；經發現有干擾現象時， 應立即停用，並改善至無干擾時方得繼續使用。前述合法通信，指依電信管理法規 定作業之無線電通信。低功率射頻器材須忍受合法通信或工業、科學及醫療用電波 輻射性電機設備之干擾。 Translation: Warning Statement for Low Power Radios: l Without permission granted by the NCC, no company, enterprise, or user is allowed to change the frequency of an approved low power radio-frequency device, enhance its transmitting power or alter original characteristics or performance. l The use of low power RF devices must not affect flight safety or interfere with legal communications: when interference is found, it should be immediately stopped and ameliorated not to interfere before continuing to use it. The legal communications mentioned here refer to radio communications operating in accordance with the provisions of the Telecommunication Law. Low power RF devices need to bear with interference from legal communications or industrial, scientific and medical radio wave radiating equipment 電池警語： 82 此裝置使用鋰電池。 若未遵照下列準則，則裝置內的鋰離子電池壽命可能會縮短或有損壞裝置、發生火災、化學 品灼傷、電解液洩漏及／或受傷的風險。 l 請勿拆解、鑿孔或損壞裝置或電池。 l 請勿取出或嘗試取出使用者不可自行更換的電池。 l 請勿將電池曝露於火焰、爆炸或其他危險中。 l 請勿使用尖銳物品取出電池。 Translation: Battery warning: This device uses a lithium-ion battery. If the following guidelines are not followed, the life of the lithium-ion battery in the device may be shortened or there is a risk of damage to the device, fire, chemical burn, electrolyte leakage and / or injury.. l Do not disassemble, puncture or damage the device or battery. l Do not remove or try to remove the battery that the user cannot replace. l Do not expose the battery to flames, explosions or other hazards. l Do not use sharp objects to remove the battery. Vision Warning 使用過度恐傷害視力 警語 • 使用過度恐傷害視力 注意事項 • 使用30分鐘請休息10分鐘。未滿2歲幼兒不看螢幕，2歲以上每天看螢幕不要超過1 小時 Translation: Excessive use may damage vision 83 Warning: l Excessive use may damage vision Attention: l Rest for 10 minutes after every 30 minutes. l Children under 2 years old should stay away from this product. Children 2 years old or more should not see the screen for more than 1 hour a day. Taiwan RoHS United Arab Emirates Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info 84 TRA – United Arab Emirates Dealer ID: DA35294/14 TA RTTE: ER88790/ 20 Model: FB511 Type: Smartwatch Vietnam Zambia ZMB / ZICTA / TA / 2020 / 9 / 78 Safety Statement This equipment has been tested to comply with safety certification in accordance with the specifications of EN Standard: EN60950-1:2006 + A11:2009 + A1:2010 + A12:2011 + A2:2013 & EN62368-1:2014 + A11:2017. 85 ©2020 Fitbit, Inc. All rights reserved. Fitbit and the Fitbit logo are trademarks or registered trademarks of Fitbit in the US and other countries. A more complete list of Fitbit trademarks can be found at http://www.fitbit.com/legal/trademark-list. Third-party trademarks mentioned are the property of their respective owners.","Only provide the opinions that were given in the context document. If you cannot answer a question using the provided context alone, then say ""I'm sorry, but I do not have the context to answer this question."" Based on the document provided, how does the user make the shortcuts menu appear while playing music? User Manual Version 1.1 Table of Contents Get started 7 What's in the box 7 Charge your watch 8 Set up Versa 3 9 Connect to Wi-Fi 9 See your data in the Fitbit app 10 Unlock Fitbit Premium 11 Advanced health metrics 11 Premium health and wellness reminders 12 Wear Versa 3 13 Placement for all-day wear vs. exercise 13 Fasten the band 14 Handedness 15 Wear and care tips 16 Change the band 16 Remove a band 16 Attach a band 17 Basics 18 Navigate Versa 3 18 Basic navigation 18 Button shortcuts 19 Widgets 22 Adjust settings 23 Display 24 Vibration & audio 24 Goal reminders 24 Quiet modes 24 Shortcuts 25 Check battery level 25 Set up device lock 26 2 Adjust always-on display 26 Turn off the screen 28 Care for Versa 3 28 Apps and Clock Faces 29 Change the clock face 29 Open apps 30 Organize apps 30 Download additional apps 30 Remove apps 30 Update apps 31 Adjust app settings and permissions 31 Voice Assistant 32 Set up Amazon Alexa Built-in 32 Interact with Alexa 32 Check Alexa alarms, reminders, and timers 34 Lifestyle 35 Starbucks 35 Agenda 35 Weather 35 Check the weather 36 Add or remove a city 36 Find Phone 36 Notifications from your phone 38 Set up notifications 38 See incoming notifications 38 Manage notifications 39 Turn off notifications 39 Answer or reject phone calls 40 Respond to messages (Android phones) 41 Timekeeping 42 Use the Alarms app 42 Dismiss or snooze an alarm 42 3 Use the Timer app 43 Activity and Wellness 44 See your stats 44 Track a daily activity goal 45 Choose a goal 45 Track your hourly activity 45 Track your sleep 46 Set a sleep goal 46 Learn about your sleep habits 46 Practice guided breathing 47 Exercise and Heart Health 48 Track your exercise automatically 48 Track and analyze exercise with the Exercise app 49 Track an exercise 49 Customize your exercise settings 50 Check your workout summary 51 Check your heart rate 51 Custom heart-rate zones 53 Earn Active Zone Minutes 53 View your cardio fitness score 53 Work out with Fitbit Coach 54 Share your activity 54 Music 55 Connect Bluetooth headphones or speakers 55 Control music with Versa 3 55 Choose the music source 56 Control music 56 Control music with the Spotify - Connect & Control app 56 Listen to music with the Pandora app (United States only) 57 Listen to music with the Deezer app 57 Fitbit Pay 58 Use credit and debit cards 58 4 Set up Fitbit Pay 58 Make purchases 59 Change your default card 60 Pay for transit 60 Update, Restart, and Erase 62 Update Versa 3 62 Restart Versa 3 62 Shutdown Versa 3 63 Erase Versa 3 63 Troubleshooting 64 Heart-rate signal missing 64 GPS signal missing 64 Can't connect to Wi-Fi 65 Other issues 66 General Info and Specifications 67 Sensors and Components 67 Materials 67 Wireless technology 68 Haptic feedback 68 Battery 68 Memory 68 Display 68 Band size 68 Environmental conditions 69 Learn more 69 Return policy and warranty 69 Regulatory and Safety Notices 70 USA: Federal Communications Commission (FCC) statement 70 Canada: Industry Canada (IC) statement 71 European Union (EU) 72 IP Rating 73 Argentina 74 5 Australia and New Zealand 74 Belarus 74 Botswana 75 China 75 Customs Union 77 Indonesia 77 Israel 77 Japan 77 Kingdom of Saudi Arabia 78 Mexico 78 Moldova 78 Morocco 79 Nigeria 79 Oman 79 Pakistan 79 Philippines 80 Serbia 80 Singapore 80 South Korea 80 Taiwan 82 United Arab Emirates 84 Vietnam 85 Zambia 85 Safety Statement 85 6 Get started Meet Fitbit Versa 3, the health and fitness smartwatch with built-in GPS, Active Zone Minutes, 20+ exercise modes, and music experiences to keep you motivated to move. Take a moment to review our complete safety information at fitbit.com/safety. Versa 3 is not intended to provide medical or scientific data. What's in the box Your Versa 3 box includes: Watch with small band (color and material varies) Charging cable Additional large band The detachable bands on Versa 3 come in a variety of colors and materials, sold separately. 7 Charge your watch A fully-charged Versa 3 has a battery life of 6+ days. Battery life and charge cycles vary with use and other factors; actual results will vary. To charge Versa 3: 1. Plug the charging cable into the USB port on your computer, a UL-certified USB wall charger, or another low-energy charging device. 2. Hold the other end of the charging cable near the port on the back of the watch until it attaches magnetically. Make sure the pins on the charging cable align with the port on the back of your watch. Charge Versa 3 for 12 minutes for 24 hours of battery life. While the watch charges, tap the screen twice or press the button to turn the screen on. The battery level appears for several seconds, then disappears so you can use your watch while it charges. Charging fully takes about 1-2 hours. 8 Set up Versa 3 Set up Versa 3 with the Fitbit app for iPhones and iPads or Android phones. The Fitbit app is compatible with most popular phones and tablets. See fitbit.com/devices to check if your phone or tablet is compatible. To get started: 1. Download the Fitbit app: l Apple App Store for iPhones and iPads l Google Play Store for Android phones 2. Install the app, and open it. l If you already have a Fitbit account, log in to your account > tap the Today tab > your profile picture > Set Up a Device. l If you don't have a Fitbit account, tap Join Fitbit to be guided through a series of questions to create a Fitbit account. 3. Continue to follow the on-screen instructions to connect Versa 3 to your account. When you're done with setup, read through the guide to learn more about your new watch and then explore the Fitbit app. For more information, see help.fitbit.com. Connect to Wi-Fi During setup, you're prompted to connect Versa 3 to your Wi-Fi network. Versa 3 uses Wi-Fi to more quickly transfer music from Pandora or Deezer, download apps 9 from the Fitbit App Gallery, and for faster, more reliable OS updates. Versa 3 can connect to open, WEP, WPA personal, and WPA2 personal Wi-Fi networks. Your watch won't connect to 5GHz, WPA enterprise, or public Wi-Fi networks that require more than a password to connect—for example, logins, subscriptions, or profiles. If you see fields for a username or domain when connecting to the Wi-Fi network on a computer, the network isn't supported. For best results, connect Versa 3 to your home Wi-Fi network. Make sure you know the network password before connecting. For more information, see help.fitbit.com. See your data in the Fitbit app Open the Fitbit app on your phone or tablet to view your activity and sleep data, log food and water, participate in challenges, and more. 10 Unlock Fitbit Premium Fitbit Premium helps you build healthy habits by offering tailored workouts, insights into how your behavior impacts your health, and personalized plans to help you reach your goals. A Fitbit Premium subscription includes health insights and guidance, advanced health metrics, sleep details, customized programs, and 150+ workouts from fitness brands. New Fitbit Premium customers can redeem a free trial. For more information, see help.fitbit.com. Advanced health metrics Know your body better with health metrics in the Fitbit app. This feature helps you view key metrics tracked by your Fitbit device over time so that you can see trends and assess what’s changed. Metrics include: l Oxygen saturation (SpO2) l Skin temperature variation l Heart rate variability l Resting heart rate l Breathing rate Note: This feature is not intended to diagnose or treat any medical condition and should not be relied on for any medical purposes. It is intended to provide information that can help you manage your well-being. If you have any concerns about your health, please talk to a healthcare provider. If you believe you are experiencing a medical emergency, call emergency services. For more information, see help.fitbit.com. 11 Premium health and wellness reminders Set up Premium health and wellness reminders in the Fitbit app, and receive reminders on your watch that encourage you to form and maintain healthy behaviors. For more information, see help.fitbit.com. 12 Wear Versa 3 Wear Versa 3 around your wrist. If you need to attach a different size band, or if you purchased another band, see the instructions in ""Change the band"" on page 16. Placement for all-day wear vs. exercise When you're not exercising, wear Versa 3 a finger's width above your wrist bone. In general, it's always important to give your wrist a break on a regular basis by removing your watch for around an hour after extended wear. We recommend removing your watch while you shower. Although you can shower while wearing your watch, not doing so reduces the potential for exposure to soaps, shampoos, and conditioners, which can cause long-term damage to your watch and may cause skin irritation. For optimized heart-rate tracking while exercising: l During workouts, try moving the band higher on your wrist to get a better fit. If you experience any discomfort, loosen the band, and if it persists give your wrist a break by taking it off. 13 l Wear your watch on top of your wrist, and make sure the back of the device is in contact with your skin. Fasten the band 1. Place Versa 3 around your wrist. 2. Slide the bottom band through the first loop in the top band. 14 3. Tighten the band until it fits comfortably, and press the peg through one of the holes in the band. 4. Slide the loose end of the band through the second loop until it lies flat on your wrist. Make sure the band isn’t too tight. Wear the band loosely enough that it can move back and forth on your wrist. Handedness For greater accuracy, you must specify whether you wear Versa 3 on your dominant or non-dominant hand. Your dominant hand is the one you use for writing and eating. To start, the Wrist setting is set to non-dominant. If you wear Versa 3 on your dominant hand, change the Wrist setting in the Fitbit app: From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile > Wrist > Dominant. 15 Wear and care tips l Clean your band and wrist regularly with a soap-free cleanser. l If your watch gets wet, remove and dry it completely after your activity. l Take your watch off from time to time. l If you notice skin irritation, remove your watch and contact customer support. For more information, see fitbit.com/productcare. Change the band Versa 3 comes with a small band attached and an additional large, bottom band in the box. Both the top and bottom bands can be swapped with accessory bands, sold separately on fitbit.com. For band measurements, see ""Band size"" on page 68. Fitbit Sense bands are compatible with Versa 3. Remove a band 1. Turn over Versa 3 and find the band latches. 2. To release the latch, slide the flat button toward the band. 16 3. Gently pull the band away from the watch to release it. 4. Repeat on the other side. Attach a band To attach a band, press it into the end of the watch until you hear a click and it snaps into place. The band with the loops and peg attaches to the top of the watch. 17 Basics Learn how to manage settings, set a personal PIN code, navigate the screen, and care for your watch. Navigate Versa 3 Versa 3 has a color AMOLED touchscreen display and 1 button. Navigate Versa 3 by tapping the screen, swiping side to side and up and down, or pressing the button. To preserve battery, the watch’s screen turns off when not in use, unless you turn on the always-on display setting. For more information, see ""Adjust always-on display"" on page 26. Basic navigation The home screen is the clock. l Swipe down to see notifications. l Swipe up to see widgets, such as your daily stats, the weather, and a shortcut to start the Relax app. l Swipe left to see the apps on your watch. l Swipe right to open quick settings or return to the previous screen in an app. l Press the button to return to the clock face. 18 Button shortcuts Use the button to quickly access Fitbit Pay, voice assistant, quick settings, or your favorite apps. Press and hold the button Hold the button for 2 seconds to activate a feature of your choice. The first time you use the button shortcut, select which feature it activates. To change which feature activates when you hold the button, open the Settings app on your watch and tap Shortcuts. Tap Press & hold, and select the app you want. 19 Double-press the button Double-press the button to open shortcuts to 4 apps or features. To start, the 4 shortcuts are music controls , quick settings , your voice assistant, and Fitbit Pay . To change these shortcuts, open the Settings app on your watch and tap Shortcuts. Under Double Press, tap the shortcut you want to change. Quick settings Swipe right from the clock face on your watch to access quick settings. 20 Do Not Disturb When the do not disturb setting is on: l Notifications, goal celebrations, and reminders are muted. l The do not disturb icon illuminates in quick settings. You can't turn on do not disturb and sleep mode at the same time. Sleep Mode When the sleep mode setting is on: l Notifications, goal celebrations, and reminders are muted. l The screen's brightness is set to dim. l The Always-On Display clock face is turned off. l The screen stays dark when you turn your wrist. l The sleep mode icon illuminates in quick settings. Sleep mode turns off automatically when you set a sleep schedule. To set a schedule: 1. Open the Settings app and tap Quiet modes. 2. Under Sleep mode, tap Schedule mode > Off- hours. 3. Tap the start or stop time to adjust when the mode turns on and off. Swipe up or down to change the time, and tap the time to select it. Sleep mode automatically turns off at the time you schedule, even if you manually turned it on. You can't turn on do not disturb and sleep mode at the same time. Screen Wake When you set screen wake to automatic , the screen turns on each time you turn your wrist. 21 When you set screen wake to manual, press the button or tap the screen to turn on the display. Brightness Adjust the screen brightness. Always-On Display Turn always-on display on or off. For more information, see ""Adjust always-on display"" on page 26. Music Volume Adjust the volume of music playing through headphones or speakers paired to your watch. For more information, see ""Connect Bluetooth headphones or speakers"" on page 55. Widgets Add widgets to your watch to see your daily stats, log your water intake or weight, check the weather forecast, and start a session in the Relax app, and more. To see your widgets, swipe up from the clock face. To add a new widget: 22 1. From the clock face, swipe up to the bottom of the widgets, and tap Manage. 2. Under More Widgets, tap the icon next to the widget you want to add. 3. Swipe up to the bottom of the page, and tap Done. To turn off a widget: 1. From the clock face, swipe up to the bottom of the widgets, and tap Manage. 2. Tap the > icon next to the widget you want to adjust. 3. Tap the switch icon next to Show Widget to turn it off. 4. Swipe up to the bottom of the page, and tap Done. To adjust the information you see on a widget: 1. From the clock face, swipe up to the bottom of the widgets, and tap Manage. 2. Tap the > icon next to the widget you want to adjust. 3. Adjust any settings you want to change. 4. Swipe up to the bottom of the page, and tap Done. To change the order of widgets: 1. From the clock face, swipe up to the bottom of the widgets, and tap Manage. 2. Press and hold the widget you want to move, and drag it up or down in the list of widgets. When it's in the correct new location, lift your finger. 3. Swipe up to the bottom of the page, and tap Done. Adjust settings Manage basic settings in the Settings app : 23 Display Brightness Change the screen's brightness. Screen wake Change whether the screen turns on when you turn your wrist. Screen timeout Adjust the amount of time before the screen turns off or switches to the always-on display clock face. Always-on display Turn always-on display on or off, and change the type of clock face shown. Vibration & audio Vibration Adjust your watch's vibration strength. Microphone Choose whether your watch can access the microphone. Bluetooth Manage connected Bluetooth devices. Goal reminders Active Zone Minutes goal Turn Active Zone Minutes weekly goal notifications on or off. Quiet modes Focus mode Turn off notifications while using the Exercise app . Do not disturb Turn off all notifications. Sleep mode Adjust sleep mode settings, including setting a schedule for the mode to automatically turn on and off. Alexa notifications Turn Amazon Alexa notifications off. 24 Shortcuts Press & hold Choose the app or feature you want to open when you press and hold the button. Double Press Choose 4 apps or features to appear as shortcuts when you double-press the button. Tap a setting to adjust it. Swipe up to see the full list of settings. Check battery level From the clock face, swipe right. The battery level icon is at the top of the screen. Wi-Fi won't work on Versa 3 when the battery is 25% or less, and you'll be unable to update your device. If your watch's battery is low (fewer than 24 hours remaining), a red battery indicator appears on the clock face. If your watch's battery is critically low (fewer than 4 hours remaining), the battery indicator flashes. When the battery is low: l The screen brightness is set to dim l The vibration strength is set to light l If you’re tracking an exercise with GPS, GPS tracking turns off l Always-on display is turned off l You can't use the voice assistant feature l You can't use quick replies 25 l You can't use music controls l You won't receive notifications from your phone Charge Versa 3 to use or adjust these features. Set up device lock To help keep your watch secure, turn on device lock in the Fitbit app, which prompts you to enter a personal 4-digit PIN code to unlock your watch. If you set up Fitbit Pay to make contactless payments from your watch, device lock is turned on automatically and you're required to set a code. If you don't use Fitbit Pay, device lock is optional. Turn on device lock or reset your PIN code in the Fitbit app: From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile > Device Lock. For more information, see help.fitbit.com. Adjust always-on display Turn on always-on display to show the time on your watch, even when you're not interacting with the screen. Many clock faces and certain apps have an always-on display mode. 26 To turn always-on display on or off, swipe right from the clock face to open quick settings. Tap the always-on display icon . Note that turning on this feature impacts your watch's battery life. When always-on display is turned on, Versa 3 requires more frequent charging. Clock faces without an always-on display mode use a default always-on display clock face. Choose between an analog or digital clock face. Open the Settings app > Display. In the Always-on display section, tap Analog or Digital. Always-on display automatically turns off when your watch's battery is critically low. For more information, see help.fitbit.com. 27 Turn off the screen To turn off your watch's screen when not in use, briefly cover the watch face with your opposite hand, press the buttons, or turn your wrist away from your body. Note that if you turn on the always-on display setting, the screen won't turn off. Care for Versa 3 It's important to clean and dry Versa 3 regularly. For more information, see fitbit.com/productcare. 28 Apps and Clock Faces The Fitbit Gallery offers apps and clock faces to personalize your watch and meet a variety of health, fitness, timekeeping, and everyday needs. Change the clock face The Fitbit Clock Gallery offers a variety of clock faces to personalize your watch. 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap Clock Faces > All Clocks. 3. Browse the available clock faces. Tap a clock face to see a detailed view. 4. Tap Select to add the clock face to Versa 3. Save up to 5 clock faces to switch between them: l When you select a new clock face, it’s automatically saved unless you already have 5 saved clock faces. l To see your saved clock faces from your watch, open the Clocks app and swipe to find the clock face you want to use. Tap to select it. l To see your saved clock faces in the Fitbit app, tap the Today tab > your profile picture > your device image > Clock Faces. See your saved clock faces in My Clock Faces. 29 l To remove a clock face, tap the clock face > Remove clock face. l To switch to a saved clock face, tap the clock face > Select. Open apps From the clock face, swipe left to see the apps installed on your watch. To open an app, tap it. Organize apps To change the placement of an app on Versa 3, press and hold an app until it's selected, and drag it to a new location. The app is selected when the icon increases slightly in size and the watch vibrates. Download additional apps 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap Apps > All Apps. 3. Browse the available apps. When you find one you want to install, tap it. 4. Tap Install to add the app to Versa 3. For more information, see help.fitbit.com. Remove apps You can remove most apps installed on Versa 3: 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap Apps. 3. In the My Apps tab, tap the app you want to remove. You may have to swipe up to find it. 4. Tap Remove. 30 Update apps Apps update over Wi-Fi as needed. Versa 3 searches for updates when plugged into the charger and in range of your Wi-Fi network. You can also manually update apps: 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap Apps. 3. In the My Apps tab, find the app you want to update. You may have to swipe up to find it. 4. Tap the pink Update button next to the app. Adjust app settings and permissions Many apps include options to adjust the notifications, allow certain permissions, and customize what it displays. Note that turning off any app permissions might cause the app to stop functioning. To access these settings: 1. With your watch nearby, in the Fitbit app, tap the Today tab > your profile picture > your device image. 2. Tap Apps or Clock Faces. 3. Tap the app or clock face whose settings you want to change. You may have to swipe up to see some apps. 4. Tap Settings or Permissions. 5. Tap Back or Details when you're done making changes. 31 Voice Assistant Check the weather, set timers and alarms, control your smart home devices, and more by speaking to your watch. Set up Amazon Alexa Built-in 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap Amazon Alexa > Sign in with Amazon. 3. Tap Get Started. 4. Log in to your Amazon account or create one if necessary. 5. Follow the on-screen instructions and read about what Alexa can do, and tap Close to return to your device settings in the Fitbit app. To change the language Alexa recognizes or disconnect your Amazon account: 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap Amazon Alexa. 3. Tap the current language to change it, or tap Logout to stop using Alexa on your watch. Interact with Alexa 1. Open the Alexa app on your watch. Note that the Fitbit app must be running in the background on your phone. 2. Say your request. 32 You don't need to say ""Alexa"" before speaking your request. For example: l Set a timer for 10 minutes. l Set an alarm for 8:00 a.m. l What's the temperature outside? l Remind me to make dinner at 6:00 p.m. l How much protein is in an egg? l Ask Fitbit to start a run.* l Start a bike ride with Fitbit.* *To ask Alexa to open the Exercise app on your watch, you must first set up the Fitbit skill for Alexa. For more information, see help.fitbit.com. These commands are currently available in English, German, French, Italian, Spanish, and Japanese. Amazon Alexa not available in all countries. For more information, see fitbit.com/voice. Note that saying “Alexa” doesn’t activate Alexa on your watch—you must open the Alexa app on your watch before the microphone turns on. The microphone turns off when you close Alexa, or when your watch’s screen turns off. For added functionality, install the Amazon Alexa app on your phone. With the app, your watch can access additional Alexa skills. For more information, see help.fitbit.com. 33 Check Alexa alarms, reminders, and timers 1. Open the Alexa app on your watch. 2. Tap the alerts icon and swipe up to view your alarms, reminders, and timers. 3. Tap an alarm to turn it on or off. To adjust or cancel a reminder or timer, tap the Alexa icon and say your request. Note that Alexa's alarms and timers are separate from those you set in the Alarms app or Timer app . 34 Lifestyle Use apps to stay connected to what you care about most. See ""Apps and Clock Faces"" on page 29 for instructions on how to add and delete apps. For more information, see help.fitbit.com. Starbucks Add your Starbucks card or Starbucks Rewards program number in the Fitbit App Gallery in the Fitbit app, and then use the Starbucks app to pay from your wrist. For more information, see help.fitbit.com. Agenda Connect your phone's calendar in the Fitbit app to see upcoming calendar events for today and tomorrow in the Agenda app on your watch. For more information, see help.fitbit.com. Weather See the weather in your current location, as well as 2 additional locations you choose, in the Weather app on your watch. 35 Check the weather Open the Weather app to see conditions in your current location. Swipe up to view the weather in other locations you added. Tap a location to see a more detailed report. You can also add a weather widget to your watch. For more information, see ""Widgets"" on page 22. If the weather for your current location doesn't appear, check that you turned on location services for the Fitbit app. If you change locations or don't see updated data for your current location, sync your watch to see your new location and latest data in the Weather app or widget. Choose your unit of temperature in the Fitbit app. For more information, see help.fitbit.com. Add or remove a city 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap Apps. 3. In the My Apps tab, tap the gear icon next to Weather. You may need to swipe up to find the app. 4. Tap Add city to add up to 2 additional locations or tap Edit > the X icon to delete a location. Note that you can't delete your current location. Find Phone Use the Find Phone app to locate your phone. Requirements: 36 l Your watch must be connected (“paired”) to the phone you want to locate. l Your phone must have Bluetooth turned on and be within 30 feet (10m) of your Fitbit device. l The Fitbit app must be running in the background on your phone. l Your phone must be turned on. To find your phone: l Open the Find Phone app on your watch. l Tap Find Phone. Your phone rings loudly. l When you locate your phone, tap Cancel to end the ringtone. 37 Notifications from your phone Versa 3 can show call, text, calendar, and app notifications from your phone to keep you informed. Keep your watch within 30 feet of your phone to receive notifications. Set up notifications Check that Bluetooth on your phone is on and that your phone can receive notifications (often under Settings > Notifications). Then set up notifications: 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap Notifications. 3. Follow the on-screen instructions to pair your watch if you haven't already. Call, text, and calendar notifications are turned on automatically. 4. To turn on notifications from apps installed on your phone, including Fitbit and WhatsApp, tap App Notifications and turn on the notifications you want to see. Note that if you have an iPhone or iPad, Versa 3 shows notifications from all calendars synced to the Calendar app. If you have an Android phone, Versa 3 shows calendar notifications from the calendar app you chose during setup. For more information, see help.fitbit.com. See incoming notifications A notification causes your watch to vibrate. If you don't read the notification when it arrives, you can check it later by swiping down from the top of the screen. 38 If your watch's battery is critically low, notifications won't cause Versa 3 to vibrate or the screen to turn on. Manage notifications Versa 3 stores up to 30 notifications, after which the oldest are replaced as you receive new ones. To manage notifications: l Swipe down from the top of the screen to see your notifications and tap any notification to expand it. l To delete a notification, tap to expand it, then swipe to the bottom and tap Clear. l To delete all notifications at once, swipe to the top of your notifications and tap Clear All. Turn off notifications Turn off certain notifications in the Fitbit app, or turn off all notifications in quick settings on Versa 3. When you turn off all notifications, your watch won't vibrate and the screen won't turn on when your phone receives a notification. To turn off certain notifications: 1. From the Today tab in the Fitbit app on your phone, tap your profile picture > Versa 3 tile > Notifications. 39 2. Turn off the notifications you no longer want to receive on your watch. To turn off all notifications: 1. From the clock face, swipe right to access quick settings. 2. Tap the do not disturb icon . All notifications, including goal celebrations and reminders, are turned off. Note that if you use the do not disturb setting on your phone, you don't receive notifications on your watch until you turn off this setting. Answer or reject phone calls If paired to an iPhone or Android (8.0+) phone, Versa 3 lets you accept or reject incoming phone calls. If your phone is running an older version of the Android OS, you can reject, but not accept, calls on your watch. To accept a call, tap the green phone icon on your watch's screen. Note that you can't speak into the watch—accepting a phone call answers the call on your nearby phone. To reject a call, tap the red phone icon to send the caller to voicemail. The caller's name appears if that person is in your contacts list; otherwise you see a phone number. 40 Respond to messages (Android phones) Respond directly to text messages and notifications from certain apps on your watch with preset quick replies or by speaking your reply into Versa 3. Keep your phone nearby with the Fitbit app running in the background to respond to messages from your watch. To respond to a message: 1. Open the notification you want to respond to. 2. Choose how to reply to the message: l Tap the microphone icon to respond to the message using voice-to- text. To change the language recognized by the microphone, tap Language. After you speak your reply, tap Send, or tap Retry to try again. If you notice a mistake after you send the message, tap Undo within 3 seconds to cancel the message. l Tap the text icon to respond to a message from a list of quick replies. l Tap the emoji icon to respond to the message with an emoji. For more information, including how to customize quick replies, see help.fitbit.com. 41 Timekeeping Alarms vibrate to wake or alert you at a time you set. Set up to 8 alarms to occur once or on multiple days of the week. You can also time events with the stopwatch or set a countdown timer. Note that alarms and timers you set with a voice assistant are separate from the ones you set in the Alarms app and Timer app. For more information, see ""Voice Assistant"" on page 32. Use the Alarms app Set one-time or recurring alarms with the Alarms app . When an alarm goes off, your watch vibrates. When setting an alarm, turn on Smart Wake to allow your watch to find the best time to wake you starting 30 minutes before the alarm time you set. It avoids waking you during deep sleep so you're more likely to wake up feeling refreshed. If Smart Wake can’t find the best time to wake you, your alarm alerts you at the set time. For more information, see help.fitbit.com. Dismiss or snooze an alarm When an alarm goes off, your watch vibrates. To dismiss the alarm, tap the alarm icon . To snooze the alarm for 9 minutes, tap the snooze icon . Snooze the alarm as many times as you want. Versa 3 automatically goes into snooze mode if you ignore the alarm for more than 1 minute. 42 Use the Timer app Time events with the stopwatch or set a countdown timer with the Timer app on your watch. You can run the stopwatch and countdown timer at the same time. When the screen turns off, your watch continues to display the stopwatch or countdown timer until it ends or you exit the app. For more information, see help.fitbit.com. 43 Activity and Wellness Versa 3 continuously tracks a variety of stats whenever you wear it, including hourly activity, heart rate, and sleep. Data automatically syncs with the Fitbit app throughout the day. See your stats Open the Today app or swipe up from the clock face to see your daily stats, including: Steps Steps taken today and progress toward your daily goal Heart rate Current heart rate and either your heart-rate zone or resting heart rate (if not in a zone) Calories burned Calories burned today and progress toward your daily goal Floors Floors climbed today and progress toward your daily goal Distance Distance covered today and progress toward your daily goal Active Zone Minutes Active Zone Minutes earned today and the number of Active Zone Minutes you're currently earning per minute Exercise Number of days you met your exercise goal this week Sleep Sleep duration and sleep score Hourly activity The number of hours today you met your hourly activity goal Food Calories eaten and calories remaining today Menstrual health Information on the current stage of your menstrual cycle, if applicable Water Water intake logged today and progress toward your daily goal Weight Current weight and your progress toward your weight goal Core temp Your most recent logged temperature 44 Tap a tile to view more details or log an entry (for water, weight, and core temperature). Find your complete history and other information detected by your watch in the Fitbit app. Track a daily activity goal Versa 3 tracks your progress toward a daily activity goal of your choice. When you reach your goal, your watch vibrates and shows a celebration. Choose a goal Set a goal to help you get started on your health and fitness journey. To begin, your goal is to take 10,000 steps per day. Choose to change the number of steps, or pick a different activity goal depending on your device. For more information, see help.fitbit.com. Track progress toward your goal on Versa 3. For more information, see ""See your stats"" on the previous page. Track your hourly activity Versa 3 helps you stay active throughout the day by keeping track of when you're stationary and reminding you to move. Reminders nudge you to walk at least 250 steps each hour. You feel a vibration and see a reminder on your screen at 10 minutes before the hour if you haven't walked 250 steps. When you meet the 250-step goal after receiving the reminder, you feel a second vibration and see a congratulatory message. 45 For more information, see help.fitbit.com. Track your sleep Wear Versa 3 to bed to automatically track basic stats about your sleep, including your time asleep, sleep stages (time spent in REM, light sleep, and deep sleep), and sleep score (the quality of your sleep). Versa 3 also tracks your estimated oxygen variation throughout the night to help you uncover potential breathing disturbances. To see your sleep stats, sync your watch when you wake up and check the Fitbit app, or swipe up from the clock face on your watch to see your sleep stats. For more information, see help.fitbit.com. Set a sleep goal To start, you have a sleep goal of 8 hours of sleep per night. Customize this goal to meet your needs. For more information, see help.fitbit.com. Learn about your sleep habits With a Fitbit Premium subscription, see more details about your sleep score and how you compare to your peers, which can help you build a better sleep routine and wake up feeling refreshed. For more information, see help.fitbit.com. 46 Practice guided breathing The Relax app on Versa 3 provides personalized guided breathing sessions to help you find moments of calm throughout the day. All notifications are automatically disabled during the session. 1. On Versa 3, open the Relax app . 2. Tap Edit to change the duration of the session or turn off the optional vibration. 3. Tap Start to begin the session. Follow the on-screen instructions. 4. When the session ends, tap Log It to reflect on how you feel, or tap Skip to skip this step. 5. View your summary, and tap Done to close the app. For more information, see help.fitbit.com. 47 Exercise and Heart Health Track activity with the Exercise app and complete guided workouts with the Fitbit Coach app right on your wrist. Check the Fitbit app to share your activity with friends and family, see how your overall fitness level compares to your peers, and more. During a workout, you can play music through the Pandora app or Deezer app on your watch, control music playing in Spotify using the Spotify - Connect & Control app , or control music playing on your phone. 1. Start music playing in an app or on your phone. 2. Open the Exercise or Coach app and start a workout. To control music playing while you exercise, double-press the button. Your shortcuts appear. 3. Tap the music controls icon . 4. To return to your workout, press the button. Note that you need to pair a Bluetooth audio device, such as headphones or a speaker, to Versa 3 to hear music stored on your watch. For more information, see ""Music"" on page 55. Track your exercise automatically Versa 3 automatically recognizes and records many high-movement activities which are at least 15 minutes long. See basic stats about your activity in the Fitbit app on your phone. From the Today tab , tap the Exercise tile. For more information, see help.fitbit.com. 48 Track and analyze exercise with the Exercise app Track specific exercises with the Exercise app on Versa 3 to see real-time stats, including heart-rate data, calories burned, elapsed time, and a post-workout summary on your wrist. For complete workout stats, and a workout intensity map if you used GPS, tap the Exercise tile in the Fitbit app. Track an exercise 1. On Versa 3, open the Exercise app and swipe to find an exercise. 2. Tap the exercise to choose it. If the exercise uses GPS, you can wait for the signal to connect, or start the exercise and GPS will connect when a signal is available. Note that GPS can take a few minutes to connect. 3. Tap the play icon to begin the exercise, or swipe up to choose an exercise goal or adjust the settings. For more information on the settings, see ""Customize your exercise settings"" on the next page. 4. Tap the large stat to scroll through your real-time stats. To pause your workout, swipe up and tap the pause icon . 5. When you're done with your workout, swipe up and tap the end icon > End. Your workout summary appears. 6. Tap Done to close the summary screen. Notes: l If you set an exercise goal, your watch alerts you when you’re halfway to your goal and when you reach the goal. l If the exercise uses GPS, ""GPS connecting..."" appears at the top of the screen. When the screen says ""GPS connected"" and Versa 3 vibrates, GPS is connected. 49 Using built-in GPS impacts your watch's battery life. When GPS tracking is turned on, Versa 3 can track up to 12 hours of continuous exercise. Customize your exercise settings Customize settings for each exercise type on your watch. Settings include: Heart Zone Notifications Receive notifications when you hit target heart-rate zones during your workout. For more information, see help.fitbit.com Laps Receive notifications when you reach certain milestones during your workout Show Stats Choose what stats you want to see when tracking an exercise GPS Track your route using GPS Auto-Pause Automatically pause a run or bike ride when you stop moving Run Detect Track runs automatically without opening the Exercise app Always-on Display Keep the screen on during exercise Pool Length Set the length of your pool Interval Adjust the move and rest intervals used during interval training 1. On Versa 3, open the Exercise app . 2. Swipe to find an exercise. 50 3. Swipe up from the bottom of the screen, then swipe up through the list of settings. 4. Tap a setting to adjust it. 5. When you're done, swipe down until you see the play icon . Check your workout summary After you complete a workout, Versa 3 shows a summary of your stats. Check the Exercise tile in the Fitbit app to see additional stats and a workout intensity map if you used GPS. Check your heart rate Versa 3 personalizes your heart-rate zones using your heart rate reserve, which is the difference between your maximum heart rate and your resting heart rate. To help you target the training intensity of your choice, check your heart rate and heart-rate zone on your watch during exercise. Versa 3 notifies you when you enter a heart-rate zone. 51 Icon Zone Calculation Description Below Zone Below 40% of your heart rate reserve Below the fat burn zone, your heart beats at a slower pace. Fat Burn Zone Between 40% and 59% of your heart rate reserve In the fat burn zone, you’re likely in a moderate activity such as a brisk walk. Your heart rate and breathing might be elevated, but you can still carry on a conversation. Cardio Zone Between 60% and 84% of your heart rate reserve In the cardio zone, you’re likely doing a vigorous activity such as running or spinning. Peak Zone Greater than 85% of your heart rate reserve In the peak zone, you’re likely doing a short, intense activity that improves performance and speed, such as sprinting or high-intensity interval training. 52 Custom heart-rate zones Instead of using these heart-rate zones, you can create a custom zone in the Fitbit app to target a specific heart-rate range. For more information, see help.fitbit.com. Earn Active Zone Minutes Earn Active Zone Minutes for time spent in the fat burn, cardio, or peak heart-rate zones. To help you maximize your time, you earn 2 Active Zone Minutes for each minute you’re in the cardio or peak zones. 1 minute in the fat burn zone = 1 Active Zone Minute 1 minute in the cardio or peak zones = 2 Active Zone Minutes A few moments after you enter a different heart-rate zone during your exercise, your watch buzzes so that you know how hard you’re working. The number of times your watch vibrates indicates which zone you’re in: 1 buzz = below zone 2 buzzes = fat burn zone 3 buzzes = cardio zone 4 buzzes = peak zone To start, your weekly goal is set to 150 Active Zone Minutes. You’ll receive notifications as you reach your goal. For more information, see help.fitbit.com. View your cardio fitness score View your overall cardiovascular fitness in the Fitbit app. See your cardio fitness score and cardio fitness level, which shows how you compare to your peers. 53 In the Fitbit app, tap the Heart-rate tile and swipe left on your heart-rate graph to see your detailed cardio fitness stats. For more information, see help.fitbit.com. Work out with Fitbit Coach The Fitbit Coach app provides guided bodyweight workouts on your wrist to help you stay fit anywhere. 1. On Versa 3, open the Fitbit Coach app . 2. Swipe to find a workout. 3. Tap the workout you want. To preview the workout, tap the menu icon . Press the button to return to the workout. 4. Tap Start. For more information, see help.fitbit.com. Share your activity After you complete a workout, open the Fitbit app to share your stats with friends and family. For more information, see help.fitbit.com. 54 Music Use apps on your watch to listen to music with Bluetooth headphones or speakers. Connect Bluetooth headphones or speakers Connect up to 8 Bluetooth audio devices to listen to music from your watch. To pair a new Bluetooth audio device: 1. Activate pairing mode on your Bluetooth headphones or speaker. 2. On Versa 3, open the Settings app > Vibration & audio. 3. In the Bluetooth section, tap Manage devices. 4. Swipe up to see the Other devices section. Versa 3 searches for nearby devices. 5. When Versa 3 finds nearby Bluetooth audio devices, it shows a list on the screen. Tap the name of the device you want to pair. When pairing is complete, a check mark appears on the screen. To listen to music with a different Bluetooth device: 1. On Versa 3, open the Settings app > Vibration & audio. 2. In the Bluetooth section, tap the device you want to use, or pair a new device. Then wait for a moment for the device to connect. For more information, see help.fitbit.com. Control music with Versa 3 Control music playing in an app on Versa 3 or on your phone. 55 Choose the music source 1. Double-press the button on Versa 3. Your shortcuts appear. 2. Tap the music controls icon . 3. The icon in the top-left corner shows whether the music source is currently set to your phone or your watch . Tap it to change the music source, then press the button to return to your music controls. Control music 1. While music is playing, double-press the button. Your shortcuts appear. 2. Tap the music controls icon . 3. Play, pause, or tap the arrow icons to skip to the next track or previous track. Tap the volume icon to adjust the volume. Control music with the Spotify - Connect & Control app Use the Spotify - Connect & Control app on Versa 3 to control Spotify on your phone, computer, or other Spotify Connect device. Navigate between playlists, like songs, and switch between devices from your watch. Note that at this time, the Spotify - Connect & Control app only controls music playing on your paired device, so your device must remain nearby and connected to the internet. You need a 56 Spotify Premium subscription to use this app. For more information about Spotify Premium, see spotify.com. For instructions, see help.fitbit.com. Listen to music with the Pandora app (United States only) With the Pandora app on Versa 3, download up to 3 of your most-played Pandora stations or popular curated Workout stations directly to your watch. Note that you need a paid subscription to Pandora and a Wi-Fi connection to download stations. For more information about Pandora subscriptions, see help.pandora.com. For instructions, see help.fitbit.com. Listen to music with the Deezer app With the Deezer app on Versa 3, download your Deezer playlists and Flow directly to your watch. Note that you need a paid subscription to Deezer and a Wi- Fi connection to download music. For more information about Deezer subscriptions, see support.deezer.com. For instructions, see help.fitbit.com. 57 Fitbit Pay Versa 3 includes a built-in NFC chip, which lets you use your credit and debit cards on your watch. Use credit and debit cards Set up Fitbit Pay in the Wallet section of the Fitbit app, and use your watch to make purchases in stores that accept contactless payments. We’re always adding new locations and card issuers to our list of partners. To see if your payment card works with Fitbit Pay, see fitbit.com/fitbit-pay/banks. Set up Fitbit Pay To use Fitbit Pay, add at least 1 credit or debit card from a participating bank to the Wallet section of the Fitbit app. The Wallet is where you add and remove payment cards, set a default card for your watch, edit a payment method, and review recent purchases. 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap the Wallet tile. 3. Follow the on-screen instructions to add a payment card. In some cases, your bank might require additional verification. If you're adding a card for the first time, you might be prompted to set a 4-digit PIN code for your watch. Note that you also need passcode protection enabled for your phone. 4. After you add a card, follow the on-screen instructions to turn on notifications for your phone (if you haven't already done so) to complete the setup. You can add up to 6 payment cards to the Wallet and choose which card to set as the default payment option. 58 Make purchases Make purchases using Fitbit Pay at any store that accepts contactless payments. To determine if the store accepts Fitbit Pay, look for the symbol below on the payment terminal: 1. Open the Wallet app on your watch. 2. If prompted, enter your 4-digit watch PIN code. Your default card appears on the screen. 3. To pay with your default card, hold your wrist near the payment terminal. To pay with a different card, swipe to find the card you want to use, and hold your wrist near the payment terminal. 59 When the payment succeeds, your watch vibrates and you see a confirmation on the screen. If the payment terminal doesn't recognize Fitbit Pay, make sure the watch face is near the reader and that the cashier knows you're using a contactless payment. For added security, you must wear Versa 3 on your wrist to use Fitbit Pay. For more information, see help.fitbit.com. Change your default card 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap the Wallet tile. 3. Find the card you want to set as the default option. 4. Tap Set as Default on Versa 3. Pay for transit Use Fitbit Pay to tap on and off at transit readers that accept contactless credit or debit card payments. To pay with your watch, follow the steps listed in ""Use credit and debit cards"" on page 58. 60 Pay with the same card on your Fitbit watch when you tap the transit reader at the start and end of your trip. Make sure your device is charged before beginning your trip. 61 Update, Restart, and Erase Some troubleshooting steps may require you to restart your watch, while erasing it is useful if you want to give Versa 3 to another person. Update your watch to receive new Fitbit OS updates. Update Versa 3 Update your watch to get the latest feature enhancements and product updates. When an update is available, a notification appears in the Fitbit app. After you start the update, follow the progress bars on Versa 3 and in the Fitbit app until the update is complete. Keep your watch and phone close to each other during the update. Updating Versa 3 takes several minutes and may be demanding on the battery. We recommend plugging your watch into the charger before starting the update. For more information, see help.fitbit.com. Restart Versa 3 If you can’t sync Versa 3 or you have trouble with tracking your stats or receiving notifications, restart your watch from your wrist: To restart your watch, press and hold the button for 10 seconds until you see the Fitbit logo on the screen, and then release the button. Restarting your watch reboots the device but doesn't delete any data. Versa 3 has small holes on the device for the altimeter, speaker, and microphone. Don’t attempt to restart your device by inserting any items, such as paper clips, into these holes as you can damage Versa 3. 62 Shutdown Versa 3 To turn off your watch, open the Settings app > Shut down. To turn on your watch, press the button. For information about how to store Versa 3 long term, see help.fitbit.com. Erase Versa 3 If you want to give Versa 3 to another person or wish to return it, first clear your personal data: On Versa 3, open the Settings app > About Versa 3 > Factory reset. 63 Troubleshooting If Versa 3 isn't working properly, see our troubleshooting steps below. Visit help.fitbit.com for more information. Heart-rate signal missing Versa 3 continuously tracks your heart rate while you're exercising and throughout the day. If the heart-rate sensor on your watch has difficulty detecting a signal, dashed lines appear. If your watch doesn't detect a heart-rate signal, make sure you're wearing your watch correctly, either by moving it higher or lower on your wrist or by tightening or loosening the band. Versa 3 should be in contact with your skin. After holding your arm still and straight for a short time, you should see your heart rate again. For more information, see help.fitbit.com. GPS signal missing Environmental factors including tall buildings, dense forest, steep hills, and thick cloud cover can interfere with your watch's ability to connect to GPS satellites. If your watch is searching for a GPS signal during an exercise, you’ll see “ GPS connecting ” appear at the top of the screen. If Versa 3 can't connect to a 64 GPS satellite, the watch stops trying to connect until the next time you start a GPS exercise. For best results, wait for Versa 3 to find the signal before you start your workout. If Versa 3 loses the GPS signal during your workout, ""GPS lost signal"" appears at the top of the screen. Your watch will attempt to reconnect. For more information, see help.fitbit.com. Can't connect to Wi-Fi If Versa 3 can't connect to Wi-Fi, you might have entered an incorrect password, or the password might have changed: 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap Wi-Fi Settings > Next. 3. Tap the network you want to use > Remove. 65 4. Tap Add Network and follow the on-screen instructions to reconnect the Wi- Fi network. To check if your Wi-Fi network is working correctly, connect another device to your network; if it connects successfully, try again to connect your watch. If Versa 3 still won't connect to Wi-Fi, make sure that you're attempting to connect your watch to a compatible network. For best results, use your home Wi-Fi network. Versa 3 can't connect to 5GHz Wi-Fi, WPA enterprise, or public networks that require logins, subscriptions, or profiles. For a list of compatible network types, see ""Connect to Wi-Fi"" on page 9. After you verify the network is compatible, restart your watch and try connecting to Wi-Fi again. If you see other networks appear in the list of available networks, but not your preferred network, move your watch closer to your router. For more information, see help.fitbit.com. Other issues If you experience any of the following issues, restart your watch: l Won't sync l Won't respond to taps, swipes, or button press l Won't track steps or other data l Won't show notifications For instructions, see ""Restart Versa 3"" on page 62. For more information, see help.fitbit.com. 66 General Info and Specifications Sensors and Components Fitbit Versa 3 contains the following sensors and motors: l 3-axis accelerometer, which tracks motion patterns l Altimeter, which tracks altitude changes l Built-in GPS receiver + GLONASS, which tracks your location during a workout l Optical heart-rate tracker l Device temperature sensor (skin temperature variation available through Premium only) l Ambient light sensor l Microphone l Speaker l Vibration motor Materials The band that comes with Versa 3 is made of a flexible, durable elastomer material similar to that used in many sports watches. The housing and buckle on Versa 3 are made of anodized aluminum. While anodized aluminum can contain traces of nickel, which can cause an allergic reaction in someone with nickel sensitivity, the amount of nickel in all Fitbit products meets the European Union's stringent Nickel Directive. Our products may contain trace amounts of acrylates and methacrylates from adhesives used in those products but we work to ensure our products adhere to rigorous design specifications and meet extensive test requirements so as to minimum the potential for reaction to these adhesives. 67 Wireless technology Versa 3 contains a Bluetooth 5.0 radio transceiver, Wi-Fi chip, and NFC chip. Haptic feedback Versa 3 contains a vibration motor for alarms, goals, notifications, reminders, and apps. Battery Versa 3 contains a rechargeable lithium-polymer battery. Memory Versa 3 stores your data, including daily stats, sleep information, and exercise history, for 7 days. See your historical data in the Fitbit app. Display Versa 3 has a color AMOLED display. Band size Band sizes are shown below. Note that accessory bands sold separately may vary slightly. Small band Fits a wrist between 5.5 - 7.1 inches (140 mm - 180 mm) in circumference Large band Fits a wrist between 7.1 - 8.7 inches (180 mm - 220 mm) in circumference 68 Environmental conditions Operating temperature 14° to 113° F (-10° to 45° C) Non-operating temperature -4° to 14° F (-20° to -10° C) 113° to 140°F (45° to 60° C) Charging temperature 32° to 95° F (0° to 35° C) Water resistance Water resistant up to 50 meters Maximum operating altitude 28,000 feet (8,534 m) Learn more To learn more about your watch, how to track your progress in the Fitbit app, and how to build healthy habits with Fitbit Premium, visit help.fitbit.com. Return policy and warranty Find warranty information and the fitbit.com return policy on our website. 69 Regulatory and Safety Notices Notice to the User: Regulatory content for certain regions can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info USA: Federal Communications Commission (FCC) statement Model FB511 FCC ID: XRAFB511 Notice to the User: The FCC ID can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info Supplier's Declaration of Conformity Unique Identifier: FB511 Responsible Party – U.S. Contact Information 199 Fremont Street, 14th Floor San Francisco, CA 94105 United States 877-623-4997 FCC Compliance Statement (for products subject to Part 15) This device complies with Part 15 of the FCC Rules. Operation is subject to the following two conditions: 70 1. This device may not cause harmful interference and 2. This device must accept any interference, including interference that may cause undesired operation of the device. FCC Warning Changes or modifications not expressly approved by the party responsible for compliance could void the user’s authority to operate the equipment. Note: This equipment has been tested and found to comply with the limits for a Class B digital device, pursuant to part 15 of the FCC Rules. These limits are designed to provide reasonable protection against harmful interference in a residential installation. This equipment generates, uses and can radiate radio frequency energy and, if not installed and used in accordance with the instructions, may cause harmful interference to radio communications. However, there is no guarantee that interference will not occur in a particular installation. If this equipment does cause harmful interference to radio or television reception, which can be determined by turning the equipment off and on, the user is encouraged to try to correct the interference by one or more of the following measures: l Reorient or relocate the receiving antenna. l Increase the separation between the equipment and receiver. l Connect the equipment into an outlet on a circuit different from that to which the receiver is connected. l Consult the dealer or an experienced radio/TV technician for help. This device meets the FCC and IC requirements for RF exposure in public or uncontrolled environments. Canada: Industry Canada (IC) statement Model/Modèle FB511 IC: 8542A-FB511 Notice to the User: The IC ID can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info 71 Avis à l'utilisateur: L'ID de l'IC peut également être consulté sur votre appareil. Pour voir le contenu: Paramètres > À propos de Versa 3 > Mentions légales This device meets the IC requirements for RF exposure in public or uncontrolled environments. Cet appareil est conforme aux conditions de la IC en matière de RF dans des environnements publics ou incontrôlée IC Notice to Users English/French in accordance with current issue of RSS GEN: This device complies with Industry Canada license exempt RSS standard(s). Operation is subject to the following two conditions: 1. this device may not cause interference, and 2. this device must accept any interference, including interference that may cause undesired operation of the device. Cet appareil est conforme avec Industrie Canada RSS standard exempts de licence (s). Son utilisation est soumise à Les deux conditions suivantes: 1. cet appareil ne peut pas provoquer d’interférences et 2. cet appareil doit accepter Toute interférence, y compris les interférences qui peuvent causer un mauvais fonctionnement du dispositif European Union (EU) Simplified EU Declaration of Conformity Hereby, Fitbit, Inc. declares that the radio equipment type Model FB511 is in compliance with Directive 2014/53/EU. The full text of the EU declaration of conformity is available at the following internet address: www.fitbit.com/safety Vereinfachte EU-Konformitätserklärung 72 Fitbit, Inc. erklärt hiermit, dass die Funkgerättypen Modell FB511 die Richtlinie 2014/53/EU erfüllen. Der vollständige Wortlaut der EU-Konformitätserklärungen kann unter folgender Internetadresse abgerufen werden: www.fitbit.com/safety Declaración UE de Conformidad simplificada Por la presente, Fitbit, Inc. declara que el tipo de dispositivo de radio Modelo FB511 cumple con la Directiva 2014/53/UE. El texto completo de la declaración de conformidad de la UE está disponible en la siguiente dirección de Internet: www.fitbit.com/safety Déclaration UE de conformité simplifiée Fitbit, Inc. déclare par la présente que les modèles d’appareils radio FB511 sont conformes à la Directive 2014/53/UE. Les déclarations UE de conformité sont disponibles dans leur intégralité sur le site suivant : www.fitbit.com/safety Dichiarazione di conformità UE semplificata Fitbit, Inc. dichiara che il tipo di apparecchiatura radio Modello FB511 è conforme alla Direttiva 2014/53/UE. Il testo completo della dichiarazione di conformità UE è disponibile al seguente indirizzo Internet: www.fitbit.com/safety IP Rating Model FB511 has a water resistance rating of IPX8 under IEC standard 60529, up to a depth of 50 meters. Model FB511 has a dust ingress rating of IP6X under IEC standard 60529 which indicates the device is dust-tight. Please refer to the beginning of this section for instructions on how to access your product’s IP rating. 73 Argentina C-25002 Australia and New Zealand Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info Belarus Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info 74 Botswana Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory Info China Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory Info 75 China RoHS 部件名称 Part Name 有毒和危险品 Toxic and Hazardous Substances or Elements Model FB511 铅 (Pb) 水银 (Hg) 镉 (Cd) 六价铬 (Cr(VI)) 多溴化苯 (PBB) 多溴化二苯 醚 (PBDE) 表带和表扣 (Strap and Buckle) O O O O O O 电子 (Electronics) -- O O O O O 电池 (Battery) O O O O O O 充电线 (Charging Cable) O O O O O O 本表格依据 SJ/T 11364 的规定编制 O = 表示该有害物质在该部件所有均质材料中的含量均在 GB/T 26572规定的限量要求以下 (indicates that the content of the toxic and hazardous substance in all the Homogeneous Materials of the part is below the concentration limit requirement as described in GB/T 26572). X = 表示该有害物质至少在该部件的某一均质材料中的含量超出 GB/T 26572规定的限量要 求 (indicates that the content of the toxic and hazardous substance in at least one Homogeneous Material of the part exceeds the concentration limit requirement as described in GB/T 26572). CMIIT ID 2020DJ7882 76 Frequency band: 2400-2483.5 MHz NFC: 13.56MHz Transmitted power: Max EIRP, 14.4dBm Occupied bandwidth: BLE: BLE: 2MHz, BT: 1MHz, NFC: 2.3 kHz, WiFi: 20MHz Modulation system: BLE: GFSK, BT: GFSK (BDR), n/4-DQPSK (EDR), 8PSK (EDR), NFC: ASK, WiFi: DSSS, OFDM CMIIT ID displayed: On packaging Customs Union Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info Indonesia 69814/SDPPI/2020 3788 Israel מספראישוראלחוטישלמשרדהתקשורתהוא.74746-51 אסורלהחליףאתהאנטנההמקוריתשלהמכשירולאלעשותבוכלשינויטכניאחר Japan Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info 77 201-200606 Kingdom of Saudi Arabia Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info Mexico Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info La operación de este equipo está sujeta a las siguientes dos condiciones: 1. Es posible que este equipo o dispositivo no cause interferencia perjudicial y 2. Este equipo o dispositivo debe aceptar cualquier interferencia, incluyendo la que pueda causar su operación no deseada Moldova Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info 78 Morocco AGREE PAR L’ANRT MAROC Numéro d’agrément: MR00025102ANRT2020 Date d’agrément: 02/08/2020 Nigeria Connection and use of this communications equipment is permitted by the Nigerian Communications Commission. Oman TRA/TA-R/9745/20 D090258 Pakistan PTA Approved Model No.: FB511 TAC No.: 9.687/2020 Device Type: Smart Watch 79 Philippines Type Accepted No: ESD-RCE-2023407 Serbia Singapore Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info South Korea Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info 80 본 제품의 전자파흡수율은 과학기술정보통신부의「전자파 인체보호기준」을 만족합니 다. 본 제품은 국립전파연구원의「전자파흡수율 측정기준」에 따라 최대출력 조건에서 머리 에 근접하여 시험되었으며, 최대 전자파흡수율 측정값은 다음과같습니다. 모델명 (Model) 머리 전자파흡수율 (Head SAR) FB511 0.089 W/kg 클래스 B 장치 (가정 사용을위한 방송 통신 기기) : EMC 등록 주로 가정용 (B 급)으로하고, 모 든 지역에서 사용할 수 있습니다 얻을이 장치. Translation: Class B devices (broadcast communications equipment for home use): EMC registration is mainly for household use (B class) and can be used in all areas get this device. 81 Taiwan 用戶注意：某些地區的法規內容也可以在您的設備上查看。要查看內容： 設定 > 關於 Versa 3 > 法規資訊 Translation: Notice to the User: Regulatory content can also be viewed on your device. Instructions to view content from your menu: Settings > About Versa 3 > Regulatory info 低功率警語: l 取得審驗證明之低功率射頻器材，非經核准，公司、商號或使用者均不得擅自變更 頻率、加大功率或變更原設計之特性及功能。 l 低功率射頻器材之使用不得影響飛航安全及干擾合法通信；經發現有干擾現象時， 應立即停用，並改善至無干擾時方得繼續使用。前述合法通信，指依電信管理法規 定作業之無線電通信。低功率射頻器材須忍受合法通信或工業、科學及醫療用電波 輻射性電機設備之干擾。 Translation: Warning Statement for Low Power Radios: l Without permission granted by the NCC, no company, enterprise, or user is allowed to change the frequency of an approved low power radio-frequency device, enhance its transmitting power or alter original characteristics or performance. l The use of low power RF devices must not affect flight safety or interfere with legal communications: when interference is found, it should be immediately stopped and ameliorated not to interfere before continuing to use it. The legal communications mentioned here refer to radio communications operating in accordance with the provisions of the Telecommunication Law. Low power RF devices need to bear with interference from legal communications or industrial, scientific and medical radio wave radiating equipment 電池警語： 82 此裝置使用鋰電池。 若未遵照下列準則，則裝置內的鋰離子電池壽命可能會縮短或有損壞裝置、發生火災、化學 品灼傷、電解液洩漏及／或受傷的風險。 l 請勿拆解、鑿孔或損壞裝置或電池。 l 請勿取出或嘗試取出使用者不可自行更換的電池。 l 請勿將電池曝露於火焰、爆炸或其他危險中。 l 請勿使用尖銳物品取出電池。 Translation: Battery warning: This device uses a lithium-ion battery. If the following guidelines are not followed, the life of the lithium-ion battery in the device may be shortened or there is a risk of damage to the device, fire, chemical burn, electrolyte leakage and / or injury.. l Do not disassemble, puncture or damage the device or battery. l Do not remove or try to remove the battery that the user cannot replace. l Do not expose the battery to flames, explosions or other hazards. l Do not use sharp objects to remove the battery. Vision Warning 使用過度恐傷害視力 警語 • 使用過度恐傷害視力 注意事項 • 使用30分鐘請休息10分鐘。未滿2歲幼兒不看螢幕，2歲以上每天看螢幕不要超過1 小時 Translation: Excessive use may damage vision 83 Warning: l Excessive use may damage vision Attention: l Rest for 10 minutes after every 30 minutes. l Children under 2 years old should stay away from this product. Children 2 years old or more should not see the screen for more than 1 hour a day. Taiwan RoHS United Arab Emirates Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info 84 TRA – United Arab Emirates Dealer ID: DA35294/14 TA RTTE: ER88790/ 20 Model: FB511 Type: Smartwatch Vietnam Zambia ZMB / ZICTA / TA / 2020 / 9 / 78 Safety Statement This equipment has been tested to comply with safety certification in accordance with the specifications of EN Standard: EN60950-1:2006 + A11:2009 + A1:2010 + A12:2011 + A2:2013 & EN62368-1:2014 + A11:2017. 85 ©2020 Fitbit, Inc. All rights reserved. Fitbit and the Fitbit logo are trademarks or registered trademarks of Fitbit in the US and other countries. A more complete list of Fitbit trademarks can be found at http://www.fitbit.com/legal/trademark-list. Third-party trademarks mentioned are the property of their respective owners.","Only provide the opinions that were given in the context document. If you cannot answer a question using the provided context alone, then say ""I'm sorry, but I do not have the context to answer this question.""
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+EVIDENCE:
+User Manual Version 1.1 Table of Contents Get started 7 What's in the box 7 Charge your watch 8 Set up Versa 3 9 Connect to Wi-Fi 9 See your data in the Fitbit app 10 Unlock Fitbit Premium 11 Advanced health metrics 11 Premium health and wellness reminders 12 Wear Versa 3 13 Placement for all-day wear vs. exercise 13 Fasten the band 14 Handedness 15 Wear and care tips 16 Change the band 16 Remove a band 16 Attach a band 17 Basics 18 Navigate Versa 3 18 Basic navigation 18 Button shortcuts 19 Widgets 22 Adjust settings 23 Display 24 Vibration & audio 24 Goal reminders 24 Quiet modes 24 Shortcuts 25 Check battery level 25 Set up device lock 26 2 Adjust always-on display 26 Turn off the screen 28 Care for Versa 3 28 Apps and Clock Faces 29 Change the clock face 29 Open apps 30 Organize apps 30 Download additional apps 30 Remove apps 30 Update apps 31 Adjust app settings and permissions 31 Voice Assistant 32 Set up Amazon Alexa Built-in 32 Interact with Alexa 32 Check Alexa alarms, reminders, and timers 34 Lifestyle 35 Starbucks 35 Agenda 35 Weather 35 Check the weather 36 Add or remove a city 36 Find Phone 36 Notifications from your phone 38 Set up notifications 38 See incoming notifications 38 Manage notifications 39 Turn off notifications 39 Answer or reject phone calls 40 Respond to messages (Android phones) 41 Timekeeping 42 Use the Alarms app 42 Dismiss or snooze an alarm 42 3 Use the Timer app 43 Activity and Wellness 44 See your stats 44 Track a daily activity goal 45 Choose a goal 45 Track your hourly activity 45 Track your sleep 46 Set a sleep goal 46 Learn about your sleep habits 46 Practice guided breathing 47 Exercise and Heart Health 48 Track your exercise automatically 48 Track and analyze exercise with the Exercise app 49 Track an exercise 49 Customize your exercise settings 50 Check your workout summary 51 Check your heart rate 51 Custom heart-rate zones 53 Earn Active Zone Minutes 53 View your cardio fitness score 53 Work out with Fitbit Coach 54 Share your activity 54 Music 55 Connect Bluetooth headphones or speakers 55 Control music with Versa 3 55 Choose the music source 56 Control music 56 Control music with the Spotify - Connect & Control app 56 Listen to music with the Pandora app (United States only) 57 Listen to music with the Deezer app 57 Fitbit Pay 58 Use credit and debit cards 58 4 Set up Fitbit Pay 58 Make purchases 59 Change your default card 60 Pay for transit 60 Update, Restart, and Erase 62 Update Versa 3 62 Restart Versa 3 62 Shutdown Versa 3 63 Erase Versa 3 63 Troubleshooting 64 Heart-rate signal missing 64 GPS signal missing 64 Can't connect to Wi-Fi 65 Other issues 66 General Info and Specifications 67 Sensors and Components 67 Materials 67 Wireless technology 68 Haptic feedback 68 Battery 68 Memory 68 Display 68 Band size 68 Environmental conditions 69 Learn more 69 Return policy and warranty 69 Regulatory and Safety Notices 70 USA: Federal Communications Commission (FCC) statement 70 Canada: Industry Canada (IC) statement 71 European Union (EU) 72 IP Rating 73 Argentina 74 5 Australia and New Zealand 74 Belarus 74 Botswana 75 China 75 Customs Union 77 Indonesia 77 Israel 77 Japan 77 Kingdom of Saudi Arabia 78 Mexico 78 Moldova 78 Morocco 79 Nigeria 79 Oman 79 Pakistan 79 Philippines 80 Serbia 80 Singapore 80 South Korea 80 Taiwan 82 United Arab Emirates 84 Vietnam 85 Zambia 85 Safety Statement 85 6 Get started Meet Fitbit Versa 3, the health and fitness smartwatch with built-in GPS, Active Zone Minutes, 20+ exercise modes, and music experiences to keep you motivated to move. Take a moment to review our complete safety information at fitbit.com/safety. Versa 3 is not intended to provide medical or scientific data. What's in the box Your Versa 3 box includes: Watch with small band (color and material varies) Charging cable Additional large band The detachable bands on Versa 3 come in a variety of colors and materials, sold separately. 7 Charge your watch A fully-charged Versa 3 has a battery life of 6+ days. Battery life and charge cycles vary with use and other factors; actual results will vary. To charge Versa 3: 1. Plug the charging cable into the USB port on your computer, a UL-certified USB wall charger, or another low-energy charging device. 2. Hold the other end of the charging cable near the port on the back of the watch until it attaches magnetically. Make sure the pins on the charging cable align with the port on the back of your watch. Charge Versa 3 for 12 minutes for 24 hours of battery life. While the watch charges, tap the screen twice or press the button to turn the screen on. The battery level appears for several seconds, then disappears so you can use your watch while it charges. Charging fully takes about 1-2 hours. 8 Set up Versa 3 Set up Versa 3 with the Fitbit app for iPhones and iPads or Android phones. The Fitbit app is compatible with most popular phones and tablets. See fitbit.com/devices to check if your phone or tablet is compatible. To get started: 1. Download the Fitbit app: l Apple App Store for iPhones and iPads l Google Play Store for Android phones 2. Install the app, and open it. l If you already have a Fitbit account, log in to your account > tap the Today tab > your profile picture > Set Up a Device. l If you don't have a Fitbit account, tap Join Fitbit to be guided through a series of questions to create a Fitbit account. 3. Continue to follow the on-screen instructions to connect Versa 3 to your account. When you're done with setup, read through the guide to learn more about your new watch and then explore the Fitbit app. For more information, see help.fitbit.com. Connect to Wi-Fi During setup, you're prompted to connect Versa 3 to your Wi-Fi network. Versa 3 uses Wi-Fi to more quickly transfer music from Pandora or Deezer, download apps 9 from the Fitbit App Gallery, and for faster, more reliable OS updates. Versa 3 can connect to open, WEP, WPA personal, and WPA2 personal Wi-Fi networks. Your watch won't connect to 5GHz, WPA enterprise, or public Wi-Fi networks that require more than a password to connect—for example, logins, subscriptions, or profiles. If you see fields for a username or domain when connecting to the Wi-Fi network on a computer, the network isn't supported. For best results, connect Versa 3 to your home Wi-Fi network. Make sure you know the network password before connecting. For more information, see help.fitbit.com. See your data in the Fitbit app Open the Fitbit app on your phone or tablet to view your activity and sleep data, log food and water, participate in challenges, and more. 10 Unlock Fitbit Premium Fitbit Premium helps you build healthy habits by offering tailored workouts, insights into how your behavior impacts your health, and personalized plans to help you reach your goals. A Fitbit Premium subscription includes health insights and guidance, advanced health metrics, sleep details, customized programs, and 150+ workouts from fitness brands. New Fitbit Premium customers can redeem a free trial. For more information, see help.fitbit.com. Advanced health metrics Know your body better with health metrics in the Fitbit app. This feature helps you view key metrics tracked by your Fitbit device over time so that you can see trends and assess what’s changed. Metrics include: l Oxygen saturation (SpO2) l Skin temperature variation l Heart rate variability l Resting heart rate l Breathing rate Note: This feature is not intended to diagnose or treat any medical condition and should not be relied on for any medical purposes. It is intended to provide information that can help you manage your well-being. If you have any concerns about your health, please talk to a healthcare provider. If you believe you are experiencing a medical emergency, call emergency services. For more information, see help.fitbit.com. 11 Premium health and wellness reminders Set up Premium health and wellness reminders in the Fitbit app, and receive reminders on your watch that encourage you to form and maintain healthy behaviors. For more information, see help.fitbit.com. 12 Wear Versa 3 Wear Versa 3 around your wrist. If you need to attach a different size band, or if you purchased another band, see the instructions in ""Change the band"" on page 16. Placement for all-day wear vs. exercise When you're not exercising, wear Versa 3 a finger's width above your wrist bone. In general, it's always important to give your wrist a break on a regular basis by removing your watch for around an hour after extended wear. We recommend removing your watch while you shower. Although you can shower while wearing your watch, not doing so reduces the potential for exposure to soaps, shampoos, and conditioners, which can cause long-term damage to your watch and may cause skin irritation. For optimized heart-rate tracking while exercising: l During workouts, try moving the band higher on your wrist to get a better fit. If you experience any discomfort, loosen the band, and if it persists give your wrist a break by taking it off. 13 l Wear your watch on top of your wrist, and make sure the back of the device is in contact with your skin. Fasten the band 1. Place Versa 3 around your wrist. 2. Slide the bottom band through the first loop in the top band. 14 3. Tighten the band until it fits comfortably, and press the peg through one of the holes in the band. 4. Slide the loose end of the band through the second loop until it lies flat on your wrist. Make sure the band isn’t too tight. Wear the band loosely enough that it can move back and forth on your wrist. Handedness For greater accuracy, you must specify whether you wear Versa 3 on your dominant or non-dominant hand. Your dominant hand is the one you use for writing and eating. To start, the Wrist setting is set to non-dominant. If you wear Versa 3 on your dominant hand, change the Wrist setting in the Fitbit app: From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile > Wrist > Dominant. 15 Wear and care tips l Clean your band and wrist regularly with a soap-free cleanser. l If your watch gets wet, remove and dry it completely after your activity. l Take your watch off from time to time. l If you notice skin irritation, remove your watch and contact customer support. For more information, see fitbit.com/productcare. Change the band Versa 3 comes with a small band attached and an additional large, bottom band in the box. Both the top and bottom bands can be swapped with accessory bands, sold separately on fitbit.com. For band measurements, see ""Band size"" on page 68. Fitbit Sense bands are compatible with Versa 3. Remove a band 1. Turn over Versa 3 and find the band latches. 2. To release the latch, slide the flat button toward the band. 16 3. Gently pull the band away from the watch to release it. 4. Repeat on the other side. Attach a band To attach a band, press it into the end of the watch until you hear a click and it snaps into place. The band with the loops and peg attaches to the top of the watch. 17 Basics Learn how to manage settings, set a personal PIN code, navigate the screen, and care for your watch. Navigate Versa 3 Versa 3 has a color AMOLED touchscreen display and 1 button. Navigate Versa 3 by tapping the screen, swiping side to side and up and down, or pressing the button. To preserve battery, the watch’s screen turns off when not in use, unless you turn on the always-on display setting. For more information, see ""Adjust always-on display"" on page 26. Basic navigation The home screen is the clock. l Swipe down to see notifications. l Swipe up to see widgets, such as your daily stats, the weather, and a shortcut to start the Relax app. l Swipe left to see the apps on your watch. l Swipe right to open quick settings or return to the previous screen in an app. l Press the button to return to the clock face. 18 Button shortcuts Use the button to quickly access Fitbit Pay, voice assistant, quick settings, or your favorite apps. Press and hold the button Hold the button for 2 seconds to activate a feature of your choice. The first time you use the button shortcut, select which feature it activates. To change which feature activates when you hold the button, open the Settings app on your watch and tap Shortcuts. Tap Press & hold, and select the app you want. 19 Double-press the button Double-press the button to open shortcuts to 4 apps or features. To start, the 4 shortcuts are music controls , quick settings , your voice assistant, and Fitbit Pay . To change these shortcuts, open the Settings app on your watch and tap Shortcuts. Under Double Press, tap the shortcut you want to change. Quick settings Swipe right from the clock face on your watch to access quick settings. 20 Do Not Disturb When the do not disturb setting is on: l Notifications, goal celebrations, and reminders are muted. l The do not disturb icon illuminates in quick settings. You can't turn on do not disturb and sleep mode at the same time. Sleep Mode When the sleep mode setting is on: l Notifications, goal celebrations, and reminders are muted. l The screen's brightness is set to dim. l The Always-On Display clock face is turned off. l The screen stays dark when you turn your wrist. l The sleep mode icon illuminates in quick settings. Sleep mode turns off automatically when you set a sleep schedule. To set a schedule: 1. Open the Settings app and tap Quiet modes. 2. Under Sleep mode, tap Schedule mode > Off- hours. 3. Tap the start or stop time to adjust when the mode turns on and off. Swipe up or down to change the time, and tap the time to select it. Sleep mode automatically turns off at the time you schedule, even if you manually turned it on. You can't turn on do not disturb and sleep mode at the same time. Screen Wake When you set screen wake to automatic , the screen turns on each time you turn your wrist. 21 When you set screen wake to manual, press the button or tap the screen to turn on the display. Brightness Adjust the screen brightness. Always-On Display Turn always-on display on or off. For more information, see ""Adjust always-on display"" on page 26. Music Volume Adjust the volume of music playing through headphones or speakers paired to your watch. For more information, see ""Connect Bluetooth headphones or speakers"" on page 55. Widgets Add widgets to your watch to see your daily stats, log your water intake or weight, check the weather forecast, and start a session in the Relax app, and more. To see your widgets, swipe up from the clock face. To add a new widget: 22 1. From the clock face, swipe up to the bottom of the widgets, and tap Manage. 2. Under More Widgets, tap the icon next to the widget you want to add. 3. Swipe up to the bottom of the page, and tap Done. To turn off a widget: 1. From the clock face, swipe up to the bottom of the widgets, and tap Manage. 2. Tap the > icon next to the widget you want to adjust. 3. Tap the switch icon next to Show Widget to turn it off. 4. Swipe up to the bottom of the page, and tap Done. To adjust the information you see on a widget: 1. From the clock face, swipe up to the bottom of the widgets, and tap Manage. 2. Tap the > icon next to the widget you want to adjust. 3. Adjust any settings you want to change. 4. Swipe up to the bottom of the page, and tap Done. To change the order of widgets: 1. From the clock face, swipe up to the bottom of the widgets, and tap Manage. 2. Press and hold the widget you want to move, and drag it up or down in the list of widgets. When it's in the correct new location, lift your finger. 3. Swipe up to the bottom of the page, and tap Done. Adjust settings Manage basic settings in the Settings app : 23 Display Brightness Change the screen's brightness. Screen wake Change whether the screen turns on when you turn your wrist. Screen timeout Adjust the amount of time before the screen turns off or switches to the always-on display clock face. Always-on display Turn always-on display on or off, and change the type of clock face shown. Vibration & audio Vibration Adjust your watch's vibration strength. Microphone Choose whether your watch can access the microphone. Bluetooth Manage connected Bluetooth devices. Goal reminders Active Zone Minutes goal Turn Active Zone Minutes weekly goal notifications on or off. Quiet modes Focus mode Turn off notifications while using the Exercise app . Do not disturb Turn off all notifications. Sleep mode Adjust sleep mode settings, including setting a schedule for the mode to automatically turn on and off. Alexa notifications Turn Amazon Alexa notifications off. 24 Shortcuts Press & hold Choose the app or feature you want to open when you press and hold the button. Double Press Choose 4 apps or features to appear as shortcuts when you double-press the button. Tap a setting to adjust it. Swipe up to see the full list of settings. Check battery level From the clock face, swipe right. The battery level icon is at the top of the screen. Wi-Fi won't work on Versa 3 when the battery is 25% or less, and you'll be unable to update your device. If your watch's battery is low (fewer than 24 hours remaining), a red battery indicator appears on the clock face. If your watch's battery is critically low (fewer than 4 hours remaining), the battery indicator flashes. When the battery is low: l The screen brightness is set to dim l The vibration strength is set to light l If you’re tracking an exercise with GPS, GPS tracking turns off l Always-on display is turned off l You can't use the voice assistant feature l You can't use quick replies 25 l You can't use music controls l You won't receive notifications from your phone Charge Versa 3 to use or adjust these features. Set up device lock To help keep your watch secure, turn on device lock in the Fitbit app, which prompts you to enter a personal 4-digit PIN code to unlock your watch. If you set up Fitbit Pay to make contactless payments from your watch, device lock is turned on automatically and you're required to set a code. If you don't use Fitbit Pay, device lock is optional. Turn on device lock or reset your PIN code in the Fitbit app: From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile > Device Lock. For more information, see help.fitbit.com. Adjust always-on display Turn on always-on display to show the time on your watch, even when you're not interacting with the screen. Many clock faces and certain apps have an always-on display mode. 26 To turn always-on display on or off, swipe right from the clock face to open quick settings. Tap the always-on display icon . Note that turning on this feature impacts your watch's battery life. When always-on display is turned on, Versa 3 requires more frequent charging. Clock faces without an always-on display mode use a default always-on display clock face. Choose between an analog or digital clock face. Open the Settings app > Display. In the Always-on display section, tap Analog or Digital. Always-on display automatically turns off when your watch's battery is critically low. For more information, see help.fitbit.com. 27 Turn off the screen To turn off your watch's screen when not in use, briefly cover the watch face with your opposite hand, press the buttons, or turn your wrist away from your body. Note that if you turn on the always-on display setting, the screen won't turn off. Care for Versa 3 It's important to clean and dry Versa 3 regularly. For more information, see fitbit.com/productcare. 28 Apps and Clock Faces The Fitbit Gallery offers apps and clock faces to personalize your watch and meet a variety of health, fitness, timekeeping, and everyday needs. Change the clock face The Fitbit Clock Gallery offers a variety of clock faces to personalize your watch. 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap Clock Faces > All Clocks. 3. Browse the available clock faces. Tap a clock face to see a detailed view. 4. Tap Select to add the clock face to Versa 3. Save up to 5 clock faces to switch between them: l When you select a new clock face, it’s automatically saved unless you already have 5 saved clock faces. l To see your saved clock faces from your watch, open the Clocks app and swipe to find the clock face you want to use. Tap to select it. l To see your saved clock faces in the Fitbit app, tap the Today tab > your profile picture > your device image > Clock Faces. See your saved clock faces in My Clock Faces. 29 l To remove a clock face, tap the clock face > Remove clock face. l To switch to a saved clock face, tap the clock face > Select. Open apps From the clock face, swipe left to see the apps installed on your watch. To open an app, tap it. Organize apps To change the placement of an app on Versa 3, press and hold an app until it's selected, and drag it to a new location. The app is selected when the icon increases slightly in size and the watch vibrates. Download additional apps 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap Apps > All Apps. 3. Browse the available apps. When you find one you want to install, tap it. 4. Tap Install to add the app to Versa 3. For more information, see help.fitbit.com. Remove apps You can remove most apps installed on Versa 3: 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap Apps. 3. In the My Apps tab, tap the app you want to remove. You may have to swipe up to find it. 4. Tap Remove. 30 Update apps Apps update over Wi-Fi as needed. Versa 3 searches for updates when plugged into the charger and in range of your Wi-Fi network. You can also manually update apps: 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap Apps. 3. In the My Apps tab, find the app you want to update. You may have to swipe up to find it. 4. Tap the pink Update button next to the app. Adjust app settings and permissions Many apps include options to adjust the notifications, allow certain permissions, and customize what it displays. Note that turning off any app permissions might cause the app to stop functioning. To access these settings: 1. With your watch nearby, in the Fitbit app, tap the Today tab > your profile picture > your device image. 2. Tap Apps or Clock Faces. 3. Tap the app or clock face whose settings you want to change. You may have to swipe up to see some apps. 4. Tap Settings or Permissions. 5. Tap Back or Details when you're done making changes. 31 Voice Assistant Check the weather, set timers and alarms, control your smart home devices, and more by speaking to your watch. Set up Amazon Alexa Built-in 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap Amazon Alexa > Sign in with Amazon. 3. Tap Get Started. 4. Log in to your Amazon account or create one if necessary. 5. Follow the on-screen instructions and read about what Alexa can do, and tap Close to return to your device settings in the Fitbit app. To change the language Alexa recognizes or disconnect your Amazon account: 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap Amazon Alexa. 3. Tap the current language to change it, or tap Logout to stop using Alexa on your watch. Interact with Alexa 1. Open the Alexa app on your watch. Note that the Fitbit app must be running in the background on your phone. 2. Say your request. 32 You don't need to say ""Alexa"" before speaking your request. For example: l Set a timer for 10 minutes. l Set an alarm for 8:00 a.m. l What's the temperature outside? l Remind me to make dinner at 6:00 p.m. l How much protein is in an egg? l Ask Fitbit to start a run.* l Start a bike ride with Fitbit.* *To ask Alexa to open the Exercise app on your watch, you must first set up the Fitbit skill for Alexa. For more information, see help.fitbit.com. These commands are currently available in English, German, French, Italian, Spanish, and Japanese. Amazon Alexa not available in all countries. For more information, see fitbit.com/voice. Note that saying “Alexa” doesn’t activate Alexa on your watch—you must open the Alexa app on your watch before the microphone turns on. The microphone turns off when you close Alexa, or when your watch’s screen turns off. For added functionality, install the Amazon Alexa app on your phone. With the app, your watch can access additional Alexa skills. For more information, see help.fitbit.com. 33 Check Alexa alarms, reminders, and timers 1. Open the Alexa app on your watch. 2. Tap the alerts icon and swipe up to view your alarms, reminders, and timers. 3. Tap an alarm to turn it on or off. To adjust or cancel a reminder or timer, tap the Alexa icon and say your request. Note that Alexa's alarms and timers are separate from those you set in the Alarms app or Timer app . 34 Lifestyle Use apps to stay connected to what you care about most. See ""Apps and Clock Faces"" on page 29 for instructions on how to add and delete apps. For more information, see help.fitbit.com. Starbucks Add your Starbucks card or Starbucks Rewards program number in the Fitbit App Gallery in the Fitbit app, and then use the Starbucks app to pay from your wrist. For more information, see help.fitbit.com. Agenda Connect your phone's calendar in the Fitbit app to see upcoming calendar events for today and tomorrow in the Agenda app on your watch. For more information, see help.fitbit.com. Weather See the weather in your current location, as well as 2 additional locations you choose, in the Weather app on your watch. 35 Check the weather Open the Weather app to see conditions in your current location. Swipe up to view the weather in other locations you added. Tap a location to see a more detailed report. You can also add a weather widget to your watch. For more information, see ""Widgets"" on page 22. If the weather for your current location doesn't appear, check that you turned on location services for the Fitbit app. If you change locations or don't see updated data for your current location, sync your watch to see your new location and latest data in the Weather app or widget. Choose your unit of temperature in the Fitbit app. For more information, see help.fitbit.com. Add or remove a city 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap Apps. 3. In the My Apps tab, tap the gear icon next to Weather. You may need to swipe up to find the app. 4. Tap Add city to add up to 2 additional locations or tap Edit > the X icon to delete a location. Note that you can't delete your current location. Find Phone Use the Find Phone app to locate your phone. Requirements: 36 l Your watch must be connected (“paired”) to the phone you want to locate. l Your phone must have Bluetooth turned on and be within 30 feet (10m) of your Fitbit device. l The Fitbit app must be running in the background on your phone. l Your phone must be turned on. To find your phone: l Open the Find Phone app on your watch. l Tap Find Phone. Your phone rings loudly. l When you locate your phone, tap Cancel to end the ringtone. 37 Notifications from your phone Versa 3 can show call, text, calendar, and app notifications from your phone to keep you informed. Keep your watch within 30 feet of your phone to receive notifications. Set up notifications Check that Bluetooth on your phone is on and that your phone can receive notifications (often under Settings > Notifications). Then set up notifications: 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap Notifications. 3. Follow the on-screen instructions to pair your watch if you haven't already. Call, text, and calendar notifications are turned on automatically. 4. To turn on notifications from apps installed on your phone, including Fitbit and WhatsApp, tap App Notifications and turn on the notifications you want to see. Note that if you have an iPhone or iPad, Versa 3 shows notifications from all calendars synced to the Calendar app. If you have an Android phone, Versa 3 shows calendar notifications from the calendar app you chose during setup. For more information, see help.fitbit.com. See incoming notifications A notification causes your watch to vibrate. If you don't read the notification when it arrives, you can check it later by swiping down from the top of the screen. 38 If your watch's battery is critically low, notifications won't cause Versa 3 to vibrate or the screen to turn on. Manage notifications Versa 3 stores up to 30 notifications, after which the oldest are replaced as you receive new ones. To manage notifications: l Swipe down from the top of the screen to see your notifications and tap any notification to expand it. l To delete a notification, tap to expand it, then swipe to the bottom and tap Clear. l To delete all notifications at once, swipe to the top of your notifications and tap Clear All. Turn off notifications Turn off certain notifications in the Fitbit app, or turn off all notifications in quick settings on Versa 3. When you turn off all notifications, your watch won't vibrate and the screen won't turn on when your phone receives a notification. To turn off certain notifications: 1. From the Today tab in the Fitbit app on your phone, tap your profile picture > Versa 3 tile > Notifications. 39 2. Turn off the notifications you no longer want to receive on your watch. To turn off all notifications: 1. From the clock face, swipe right to access quick settings. 2. Tap the do not disturb icon . All notifications, including goal celebrations and reminders, are turned off. Note that if you use the do not disturb setting on your phone, you don't receive notifications on your watch until you turn off this setting. Answer or reject phone calls If paired to an iPhone or Android (8.0+) phone, Versa 3 lets you accept or reject incoming phone calls. If your phone is running an older version of the Android OS, you can reject, but not accept, calls on your watch. To accept a call, tap the green phone icon on your watch's screen. Note that you can't speak into the watch—accepting a phone call answers the call on your nearby phone. To reject a call, tap the red phone icon to send the caller to voicemail. The caller's name appears if that person is in your contacts list; otherwise you see a phone number. 40 Respond to messages (Android phones) Respond directly to text messages and notifications from certain apps on your watch with preset quick replies or by speaking your reply into Versa 3. Keep your phone nearby with the Fitbit app running in the background to respond to messages from your watch. To respond to a message: 1. Open the notification you want to respond to. 2. Choose how to reply to the message: l Tap the microphone icon to respond to the message using voice-to- text. To change the language recognized by the microphone, tap Language. After you speak your reply, tap Send, or tap Retry to try again. If you notice a mistake after you send the message, tap Undo within 3 seconds to cancel the message. l Tap the text icon to respond to a message from a list of quick replies. l Tap the emoji icon to respond to the message with an emoji. For more information, including how to customize quick replies, see help.fitbit.com. 41 Timekeeping Alarms vibrate to wake or alert you at a time you set. Set up to 8 alarms to occur once or on multiple days of the week. You can also time events with the stopwatch or set a countdown timer. Note that alarms and timers you set with a voice assistant are separate from the ones you set in the Alarms app and Timer app. For more information, see ""Voice Assistant"" on page 32. Use the Alarms app Set one-time or recurring alarms with the Alarms app . When an alarm goes off, your watch vibrates. When setting an alarm, turn on Smart Wake to allow your watch to find the best time to wake you starting 30 minutes before the alarm time you set. It avoids waking you during deep sleep so you're more likely to wake up feeling refreshed. If Smart Wake can’t find the best time to wake you, your alarm alerts you at the set time. For more information, see help.fitbit.com. Dismiss or snooze an alarm When an alarm goes off, your watch vibrates. To dismiss the alarm, tap the alarm icon . To snooze the alarm for 9 minutes, tap the snooze icon . Snooze the alarm as many times as you want. Versa 3 automatically goes into snooze mode if you ignore the alarm for more than 1 minute. 42 Use the Timer app Time events with the stopwatch or set a countdown timer with the Timer app on your watch. You can run the stopwatch and countdown timer at the same time. When the screen turns off, your watch continues to display the stopwatch or countdown timer until it ends or you exit the app. For more information, see help.fitbit.com. 43 Activity and Wellness Versa 3 continuously tracks a variety of stats whenever you wear it, including hourly activity, heart rate, and sleep. Data automatically syncs with the Fitbit app throughout the day. See your stats Open the Today app or swipe up from the clock face to see your daily stats, including: Steps Steps taken today and progress toward your daily goal Heart rate Current heart rate and either your heart-rate zone or resting heart rate (if not in a zone) Calories burned Calories burned today and progress toward your daily goal Floors Floors climbed today and progress toward your daily goal Distance Distance covered today and progress toward your daily goal Active Zone Minutes Active Zone Minutes earned today and the number of Active Zone Minutes you're currently earning per minute Exercise Number of days you met your exercise goal this week Sleep Sleep duration and sleep score Hourly activity The number of hours today you met your hourly activity goal Food Calories eaten and calories remaining today Menstrual health Information on the current stage of your menstrual cycle, if applicable Water Water intake logged today and progress toward your daily goal Weight Current weight and your progress toward your weight goal Core temp Your most recent logged temperature 44 Tap a tile to view more details or log an entry (for water, weight, and core temperature). Find your complete history and other information detected by your watch in the Fitbit app. Track a daily activity goal Versa 3 tracks your progress toward a daily activity goal of your choice. When you reach your goal, your watch vibrates and shows a celebration. Choose a goal Set a goal to help you get started on your health and fitness journey. To begin, your goal is to take 10,000 steps per day. Choose to change the number of steps, or pick a different activity goal depending on your device. For more information, see help.fitbit.com. Track progress toward your goal on Versa 3. For more information, see ""See your stats"" on the previous page. Track your hourly activity Versa 3 helps you stay active throughout the day by keeping track of when you're stationary and reminding you to move. Reminders nudge you to walk at least 250 steps each hour. You feel a vibration and see a reminder on your screen at 10 minutes before the hour if you haven't walked 250 steps. When you meet the 250-step goal after receiving the reminder, you feel a second vibration and see a congratulatory message. 45 For more information, see help.fitbit.com. Track your sleep Wear Versa 3 to bed to automatically track basic stats about your sleep, including your time asleep, sleep stages (time spent in REM, light sleep, and deep sleep), and sleep score (the quality of your sleep). Versa 3 also tracks your estimated oxygen variation throughout the night to help you uncover potential breathing disturbances. To see your sleep stats, sync your watch when you wake up and check the Fitbit app, or swipe up from the clock face on your watch to see your sleep stats. For more information, see help.fitbit.com. Set a sleep goal To start, you have a sleep goal of 8 hours of sleep per night. Customize this goal to meet your needs. For more information, see help.fitbit.com. Learn about your sleep habits With a Fitbit Premium subscription, see more details about your sleep score and how you compare to your peers, which can help you build a better sleep routine and wake up feeling refreshed. For more information, see help.fitbit.com. 46 Practice guided breathing The Relax app on Versa 3 provides personalized guided breathing sessions to help you find moments of calm throughout the day. All notifications are automatically disabled during the session. 1. On Versa 3, open the Relax app . 2. Tap Edit to change the duration of the session or turn off the optional vibration. 3. Tap Start to begin the session. Follow the on-screen instructions. 4. When the session ends, tap Log It to reflect on how you feel, or tap Skip to skip this step. 5. View your summary, and tap Done to close the app. For more information, see help.fitbit.com. 47 Exercise and Heart Health Track activity with the Exercise app and complete guided workouts with the Fitbit Coach app right on your wrist. Check the Fitbit app to share your activity with friends and family, see how your overall fitness level compares to your peers, and more. During a workout, you can play music through the Pandora app or Deezer app on your watch, control music playing in Spotify using the Spotify - Connect & Control app , or control music playing on your phone. 1. Start music playing in an app or on your phone. 2. Open the Exercise or Coach app and start a workout. To control music playing while you exercise, double-press the button. Your shortcuts appear. 3. Tap the music controls icon . 4. To return to your workout, press the button. Note that you need to pair a Bluetooth audio device, such as headphones or a speaker, to Versa 3 to hear music stored on your watch. For more information, see ""Music"" on page 55. Track your exercise automatically Versa 3 automatically recognizes and records many high-movement activities which are at least 15 minutes long. See basic stats about your activity in the Fitbit app on your phone. From the Today tab , tap the Exercise tile. For more information, see help.fitbit.com. 48 Track and analyze exercise with the Exercise app Track specific exercises with the Exercise app on Versa 3 to see real-time stats, including heart-rate data, calories burned, elapsed time, and a post-workout summary on your wrist. For complete workout stats, and a workout intensity map if you used GPS, tap the Exercise tile in the Fitbit app. Track an exercise 1. On Versa 3, open the Exercise app and swipe to find an exercise. 2. Tap the exercise to choose it. If the exercise uses GPS, you can wait for the signal to connect, or start the exercise and GPS will connect when a signal is available. Note that GPS can take a few minutes to connect. 3. Tap the play icon to begin the exercise, or swipe up to choose an exercise goal or adjust the settings. For more information on the settings, see ""Customize your exercise settings"" on the next page. 4. Tap the large stat to scroll through your real-time stats. To pause your workout, swipe up and tap the pause icon . 5. When you're done with your workout, swipe up and tap the end icon > End. Your workout summary appears. 6. Tap Done to close the summary screen. Notes: l If you set an exercise goal, your watch alerts you when you’re halfway to your goal and when you reach the goal. l If the exercise uses GPS, ""GPS connecting..."" appears at the top of the screen. When the screen says ""GPS connected"" and Versa 3 vibrates, GPS is connected. 49 Using built-in GPS impacts your watch's battery life. When GPS tracking is turned on, Versa 3 can track up to 12 hours of continuous exercise. Customize your exercise settings Customize settings for each exercise type on your watch. Settings include: Heart Zone Notifications Receive notifications when you hit target heart-rate zones during your workout. For more information, see help.fitbit.com Laps Receive notifications when you reach certain milestones during your workout Show Stats Choose what stats you want to see when tracking an exercise GPS Track your route using GPS Auto-Pause Automatically pause a run or bike ride when you stop moving Run Detect Track runs automatically without opening the Exercise app Always-on Display Keep the screen on during exercise Pool Length Set the length of your pool Interval Adjust the move and rest intervals used during interval training 1. On Versa 3, open the Exercise app . 2. Swipe to find an exercise. 50 3. Swipe up from the bottom of the screen, then swipe up through the list of settings. 4. Tap a setting to adjust it. 5. When you're done, swipe down until you see the play icon . Check your workout summary After you complete a workout, Versa 3 shows a summary of your stats. Check the Exercise tile in the Fitbit app to see additional stats and a workout intensity map if you used GPS. Check your heart rate Versa 3 personalizes your heart-rate zones using your heart rate reserve, which is the difference between your maximum heart rate and your resting heart rate. To help you target the training intensity of your choice, check your heart rate and heart-rate zone on your watch during exercise. Versa 3 notifies you when you enter a heart-rate zone. 51 Icon Zone Calculation Description Below Zone Below 40% of your heart rate reserve Below the fat burn zone, your heart beats at a slower pace. Fat Burn Zone Between 40% and 59% of your heart rate reserve In the fat burn zone, you’re likely in a moderate activity such as a brisk walk. Your heart rate and breathing might be elevated, but you can still carry on a conversation. Cardio Zone Between 60% and 84% of your heart rate reserve In the cardio zone, you’re likely doing a vigorous activity such as running or spinning. Peak Zone Greater than 85% of your heart rate reserve In the peak zone, you’re likely doing a short, intense activity that improves performance and speed, such as sprinting or high-intensity interval training. 52 Custom heart-rate zones Instead of using these heart-rate zones, you can create a custom zone in the Fitbit app to target a specific heart-rate range. For more information, see help.fitbit.com. Earn Active Zone Minutes Earn Active Zone Minutes for time spent in the fat burn, cardio, or peak heart-rate zones. To help you maximize your time, you earn 2 Active Zone Minutes for each minute you’re in the cardio or peak zones. 1 minute in the fat burn zone = 1 Active Zone Minute 1 minute in the cardio or peak zones = 2 Active Zone Minutes A few moments after you enter a different heart-rate zone during your exercise, your watch buzzes so that you know how hard you’re working. The number of times your watch vibrates indicates which zone you’re in: 1 buzz = below zone 2 buzzes = fat burn zone 3 buzzes = cardio zone 4 buzzes = peak zone To start, your weekly goal is set to 150 Active Zone Minutes. You’ll receive notifications as you reach your goal. For more information, see help.fitbit.com. View your cardio fitness score View your overall cardiovascular fitness in the Fitbit app. See your cardio fitness score and cardio fitness level, which shows how you compare to your peers. 53 In the Fitbit app, tap the Heart-rate tile and swipe left on your heart-rate graph to see your detailed cardio fitness stats. For more information, see help.fitbit.com. Work out with Fitbit Coach The Fitbit Coach app provides guided bodyweight workouts on your wrist to help you stay fit anywhere. 1. On Versa 3, open the Fitbit Coach app . 2. Swipe to find a workout. 3. Tap the workout you want. To preview the workout, tap the menu icon . Press the button to return to the workout. 4. Tap Start. For more information, see help.fitbit.com. Share your activity After you complete a workout, open the Fitbit app to share your stats with friends and family. For more information, see help.fitbit.com. 54 Music Use apps on your watch to listen to music with Bluetooth headphones or speakers. Connect Bluetooth headphones or speakers Connect up to 8 Bluetooth audio devices to listen to music from your watch. To pair a new Bluetooth audio device: 1. Activate pairing mode on your Bluetooth headphones or speaker. 2. On Versa 3, open the Settings app > Vibration & audio. 3. In the Bluetooth section, tap Manage devices. 4. Swipe up to see the Other devices section. Versa 3 searches for nearby devices. 5. When Versa 3 finds nearby Bluetooth audio devices, it shows a list on the screen. Tap the name of the device you want to pair. When pairing is complete, a check mark appears on the screen. To listen to music with a different Bluetooth device: 1. On Versa 3, open the Settings app > Vibration & audio. 2. In the Bluetooth section, tap the device you want to use, or pair a new device. Then wait for a moment for the device to connect. For more information, see help.fitbit.com. Control music with Versa 3 Control music playing in an app on Versa 3 or on your phone. 55 Choose the music source 1. Double-press the button on Versa 3. Your shortcuts appear. 2. Tap the music controls icon . 3. The icon in the top-left corner shows whether the music source is currently set to your phone or your watch . Tap it to change the music source, then press the button to return to your music controls. Control music 1. While music is playing, double-press the button. Your shortcuts appear. 2. Tap the music controls icon . 3. Play, pause, or tap the arrow icons to skip to the next track or previous track. Tap the volume icon to adjust the volume. Control music with the Spotify - Connect & Control app Use the Spotify - Connect & Control app on Versa 3 to control Spotify on your phone, computer, or other Spotify Connect device. Navigate between playlists, like songs, and switch between devices from your watch. Note that at this time, the Spotify - Connect & Control app only controls music playing on your paired device, so your device must remain nearby and connected to the internet. You need a 56 Spotify Premium subscription to use this app. For more information about Spotify Premium, see spotify.com. For instructions, see help.fitbit.com. Listen to music with the Pandora app (United States only) With the Pandora app on Versa 3, download up to 3 of your most-played Pandora stations or popular curated Workout stations directly to your watch. Note that you need a paid subscription to Pandora and a Wi-Fi connection to download stations. For more information about Pandora subscriptions, see help.pandora.com. For instructions, see help.fitbit.com. Listen to music with the Deezer app With the Deezer app on Versa 3, download your Deezer playlists and Flow directly to your watch. Note that you need a paid subscription to Deezer and a Wi- Fi connection to download music. For more information about Deezer subscriptions, see support.deezer.com. For instructions, see help.fitbit.com. 57 Fitbit Pay Versa 3 includes a built-in NFC chip, which lets you use your credit and debit cards on your watch. Use credit and debit cards Set up Fitbit Pay in the Wallet section of the Fitbit app, and use your watch to make purchases in stores that accept contactless payments. We’re always adding new locations and card issuers to our list of partners. To see if your payment card works with Fitbit Pay, see fitbit.com/fitbit-pay/banks. Set up Fitbit Pay To use Fitbit Pay, add at least 1 credit or debit card from a participating bank to the Wallet section of the Fitbit app. The Wallet is where you add and remove payment cards, set a default card for your watch, edit a payment method, and review recent purchases. 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap the Wallet tile. 3. Follow the on-screen instructions to add a payment card. In some cases, your bank might require additional verification. If you're adding a card for the first time, you might be prompted to set a 4-digit PIN code for your watch. Note that you also need passcode protection enabled for your phone. 4. After you add a card, follow the on-screen instructions to turn on notifications for your phone (if you haven't already done so) to complete the setup. You can add up to 6 payment cards to the Wallet and choose which card to set as the default payment option. 58 Make purchases Make purchases using Fitbit Pay at any store that accepts contactless payments. To determine if the store accepts Fitbit Pay, look for the symbol below on the payment terminal: 1. Open the Wallet app on your watch. 2. If prompted, enter your 4-digit watch PIN code. Your default card appears on the screen. 3. To pay with your default card, hold your wrist near the payment terminal. To pay with a different card, swipe to find the card you want to use, and hold your wrist near the payment terminal. 59 When the payment succeeds, your watch vibrates and you see a confirmation on the screen. If the payment terminal doesn't recognize Fitbit Pay, make sure the watch face is near the reader and that the cashier knows you're using a contactless payment. For added security, you must wear Versa 3 on your wrist to use Fitbit Pay. For more information, see help.fitbit.com. Change your default card 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap the Wallet tile. 3. Find the card you want to set as the default option. 4. Tap Set as Default on Versa 3. Pay for transit Use Fitbit Pay to tap on and off at transit readers that accept contactless credit or debit card payments. To pay with your watch, follow the steps listed in ""Use credit and debit cards"" on page 58. 60 Pay with the same card on your Fitbit watch when you tap the transit reader at the start and end of your trip. Make sure your device is charged before beginning your trip. 61 Update, Restart, and Erase Some troubleshooting steps may require you to restart your watch, while erasing it is useful if you want to give Versa 3 to another person. Update your watch to receive new Fitbit OS updates. Update Versa 3 Update your watch to get the latest feature enhancements and product updates. When an update is available, a notification appears in the Fitbit app. After you start the update, follow the progress bars on Versa 3 and in the Fitbit app until the update is complete. Keep your watch and phone close to each other during the update. Updating Versa 3 takes several minutes and may be demanding on the battery. We recommend plugging your watch into the charger before starting the update. For more information, see help.fitbit.com. Restart Versa 3 If you can’t sync Versa 3 or you have trouble with tracking your stats or receiving notifications, restart your watch from your wrist: To restart your watch, press and hold the button for 10 seconds until you see the Fitbit logo on the screen, and then release the button. Restarting your watch reboots the device but doesn't delete any data. Versa 3 has small holes on the device for the altimeter, speaker, and microphone. Don’t attempt to restart your device by inserting any items, such as paper clips, into these holes as you can damage Versa 3. 62 Shutdown Versa 3 To turn off your watch, open the Settings app > Shut down. To turn on your watch, press the button. For information about how to store Versa 3 long term, see help.fitbit.com. Erase Versa 3 If you want to give Versa 3 to another person or wish to return it, first clear your personal data: On Versa 3, open the Settings app > About Versa 3 > Factory reset. 63 Troubleshooting If Versa 3 isn't working properly, see our troubleshooting steps below. Visit help.fitbit.com for more information. Heart-rate signal missing Versa 3 continuously tracks your heart rate while you're exercising and throughout the day. If the heart-rate sensor on your watch has difficulty detecting a signal, dashed lines appear. If your watch doesn't detect a heart-rate signal, make sure you're wearing your watch correctly, either by moving it higher or lower on your wrist or by tightening or loosening the band. Versa 3 should be in contact with your skin. After holding your arm still and straight for a short time, you should see your heart rate again. For more information, see help.fitbit.com. GPS signal missing Environmental factors including tall buildings, dense forest, steep hills, and thick cloud cover can interfere with your watch's ability to connect to GPS satellites. If your watch is searching for a GPS signal during an exercise, you’ll see “ GPS connecting ” appear at the top of the screen. If Versa 3 can't connect to a 64 GPS satellite, the watch stops trying to connect until the next time you start a GPS exercise. For best results, wait for Versa 3 to find the signal before you start your workout. If Versa 3 loses the GPS signal during your workout, ""GPS lost signal"" appears at the top of the screen. Your watch will attempt to reconnect. For more information, see help.fitbit.com. Can't connect to Wi-Fi If Versa 3 can't connect to Wi-Fi, you might have entered an incorrect password, or the password might have changed: 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap Wi-Fi Settings > Next. 3. Tap the network you want to use > Remove. 65 4. Tap Add Network and follow the on-screen instructions to reconnect the Wi- Fi network. To check if your Wi-Fi network is working correctly, connect another device to your network; if it connects successfully, try again to connect your watch. If Versa 3 still won't connect to Wi-Fi, make sure that you're attempting to connect your watch to a compatible network. For best results, use your home Wi-Fi network. Versa 3 can't connect to 5GHz Wi-Fi, WPA enterprise, or public networks that require logins, subscriptions, or profiles. For a list of compatible network types, see ""Connect to Wi-Fi"" on page 9. After you verify the network is compatible, restart your watch and try connecting to Wi-Fi again. If you see other networks appear in the list of available networks, but not your preferred network, move your watch closer to your router. For more information, see help.fitbit.com. Other issues If you experience any of the following issues, restart your watch: l Won't sync l Won't respond to taps, swipes, or button press l Won't track steps or other data l Won't show notifications For instructions, see ""Restart Versa 3"" on page 62. For more information, see help.fitbit.com. 66 General Info and Specifications Sensors and Components Fitbit Versa 3 contains the following sensors and motors: l 3-axis accelerometer, which tracks motion patterns l Altimeter, which tracks altitude changes l Built-in GPS receiver + GLONASS, which tracks your location during a workout l Optical heart-rate tracker l Device temperature sensor (skin temperature variation available through Premium only) l Ambient light sensor l Microphone l Speaker l Vibration motor Materials The band that comes with Versa 3 is made of a flexible, durable elastomer material similar to that used in many sports watches. The housing and buckle on Versa 3 are made of anodized aluminum. While anodized aluminum can contain traces of nickel, which can cause an allergic reaction in someone with nickel sensitivity, the amount of nickel in all Fitbit products meets the European Union's stringent Nickel Directive. Our products may contain trace amounts of acrylates and methacrylates from adhesives used in those products but we work to ensure our products adhere to rigorous design specifications and meet extensive test requirements so as to minimum the potential for reaction to these adhesives. 67 Wireless technology Versa 3 contains a Bluetooth 5.0 radio transceiver, Wi-Fi chip, and NFC chip. Haptic feedback Versa 3 contains a vibration motor for alarms, goals, notifications, reminders, and apps. Battery Versa 3 contains a rechargeable lithium-polymer battery. Memory Versa 3 stores your data, including daily stats, sleep information, and exercise history, for 7 days. See your historical data in the Fitbit app. Display Versa 3 has a color AMOLED display. Band size Band sizes are shown below. Note that accessory bands sold separately may vary slightly. Small band Fits a wrist between 5.5 - 7.1 inches (140 mm - 180 mm) in circumference Large band Fits a wrist between 7.1 - 8.7 inches (180 mm - 220 mm) in circumference 68 Environmental conditions Operating temperature 14° to 113° F (-10° to 45° C) Non-operating temperature -4° to 14° F (-20° to -10° C) 113° to 140°F (45° to 60° C) Charging temperature 32° to 95° F (0° to 35° C) Water resistance Water resistant up to 50 meters Maximum operating altitude 28,000 feet (8,534 m) Learn more To learn more about your watch, how to track your progress in the Fitbit app, and how to build healthy habits with Fitbit Premium, visit help.fitbit.com. Return policy and warranty Find warranty information and the fitbit.com return policy on our website. 69 Regulatory and Safety Notices Notice to the User: Regulatory content for certain regions can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info USA: Federal Communications Commission (FCC) statement Model FB511 FCC ID: XRAFB511 Notice to the User: The FCC ID can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info Supplier's Declaration of Conformity Unique Identifier: FB511 Responsible Party – U.S. Contact Information 199 Fremont Street, 14th Floor San Francisco, CA 94105 United States 877-623-4997 FCC Compliance Statement (for products subject to Part 15) This device complies with Part 15 of the FCC Rules. Operation is subject to the following two conditions: 70 1. This device may not cause harmful interference and 2. This device must accept any interference, including interference that may cause undesired operation of the device. FCC Warning Changes or modifications not expressly approved by the party responsible for compliance could void the user’s authority to operate the equipment. Note: This equipment has been tested and found to comply with the limits for a Class B digital device, pursuant to part 15 of the FCC Rules. These limits are designed to provide reasonable protection against harmful interference in a residential installation. This equipment generates, uses and can radiate radio frequency energy and, if not installed and used in accordance with the instructions, may cause harmful interference to radio communications. However, there is no guarantee that interference will not occur in a particular installation. If this equipment does cause harmful interference to radio or television reception, which can be determined by turning the equipment off and on, the user is encouraged to try to correct the interference by one or more of the following measures: l Reorient or relocate the receiving antenna. l Increase the separation between the equipment and receiver. l Connect the equipment into an outlet on a circuit different from that to which the receiver is connected. l Consult the dealer or an experienced radio/TV technician for help. This device meets the FCC and IC requirements for RF exposure in public or uncontrolled environments. Canada: Industry Canada (IC) statement Model/Modèle FB511 IC: 8542A-FB511 Notice to the User: The IC ID can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info 71 Avis à l'utilisateur: L'ID de l'IC peut également être consulté sur votre appareil. Pour voir le contenu: Paramètres > À propos de Versa 3 > Mentions légales This device meets the IC requirements for RF exposure in public or uncontrolled environments. Cet appareil est conforme aux conditions de la IC en matière de RF dans des environnements publics ou incontrôlée IC Notice to Users English/French in accordance with current issue of RSS GEN: This device complies with Industry Canada license exempt RSS standard(s). Operation is subject to the following two conditions: 1. this device may not cause interference, and 2. this device must accept any interference, including interference that may cause undesired operation of the device. Cet appareil est conforme avec Industrie Canada RSS standard exempts de licence (s). Son utilisation est soumise à Les deux conditions suivantes: 1. cet appareil ne peut pas provoquer d’interférences et 2. cet appareil doit accepter Toute interférence, y compris les interférences qui peuvent causer un mauvais fonctionnement du dispositif European Union (EU) Simplified EU Declaration of Conformity Hereby, Fitbit, Inc. declares that the radio equipment type Model FB511 is in compliance with Directive 2014/53/EU. The full text of the EU declaration of conformity is available at the following internet address: www.fitbit.com/safety Vereinfachte EU-Konformitätserklärung 72 Fitbit, Inc. erklärt hiermit, dass die Funkgerättypen Modell FB511 die Richtlinie 2014/53/EU erfüllen. Der vollständige Wortlaut der EU-Konformitätserklärungen kann unter folgender Internetadresse abgerufen werden: www.fitbit.com/safety Declaración UE de Conformidad simplificada Por la presente, Fitbit, Inc. declara que el tipo de dispositivo de radio Modelo FB511 cumple con la Directiva 2014/53/UE. El texto completo de la declaración de conformidad de la UE está disponible en la siguiente dirección de Internet: www.fitbit.com/safety Déclaration UE de conformité simplifiée Fitbit, Inc. déclare par la présente que les modèles d’appareils radio FB511 sont conformes à la Directive 2014/53/UE. Les déclarations UE de conformité sont disponibles dans leur intégralité sur le site suivant : www.fitbit.com/safety Dichiarazione di conformità UE semplificata Fitbit, Inc. dichiara che il tipo di apparecchiatura radio Modello FB511 è conforme alla Direttiva 2014/53/UE. Il testo completo della dichiarazione di conformità UE è disponibile al seguente indirizzo Internet: www.fitbit.com/safety IP Rating Model FB511 has a water resistance rating of IPX8 under IEC standard 60529, up to a depth of 50 meters. Model FB511 has a dust ingress rating of IP6X under IEC standard 60529 which indicates the device is dust-tight. Please refer to the beginning of this section for instructions on how to access your product’s IP rating. 73 Argentina C-25002 Australia and New Zealand Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info Belarus Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info 74 Botswana Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory Info China Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory Info 75 China RoHS 部件名称 Part Name 有毒和危险品 Toxic and Hazardous Substances or Elements Model FB511 铅 (Pb) 水银 (Hg) 镉 (Cd) 六价铬 (Cr(VI)) 多溴化苯 (PBB) 多溴化二苯 醚 (PBDE) 表带和表扣 (Strap and Buckle) O O O O O O 电子 (Electronics) -- O O O O O 电池 (Battery) O O O O O O 充电线 (Charging Cable) O O O O O O 本表格依据 SJ/T 11364 的规定编制 O = 表示该有害物质在该部件所有均质材料中的含量均在 GB/T 26572规定的限量要求以下 (indicates that the content of the toxic and hazardous substance in all the Homogeneous Materials of the part is below the concentration limit requirement as described in GB/T 26572). X = 表示该有害物质至少在该部件的某一均质材料中的含量超出 GB/T 26572规定的限量要 求 (indicates that the content of the toxic and hazardous substance in at least one Homogeneous Material of the part exceeds the concentration limit requirement as described in GB/T 26572). CMIIT ID 2020DJ7882 76 Frequency band: 2400-2483.5 MHz NFC: 13.56MHz Transmitted power: Max EIRP, 14.4dBm Occupied bandwidth: BLE: BLE: 2MHz, BT: 1MHz, NFC: 2.3 kHz, WiFi: 20MHz Modulation system: BLE: GFSK, BT: GFSK (BDR), n/4-DQPSK (EDR), 8PSK (EDR), NFC: ASK, WiFi: DSSS, OFDM CMIIT ID displayed: On packaging Customs Union Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info Indonesia 69814/SDPPI/2020 3788 Israel מספראישוראלחוטישלמשרדהתקשורתהוא.74746-51 אסורלהחליףאתהאנטנההמקוריתשלהמכשירולאלעשותבוכלשינויטכניאחר Japan Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info 77 201-200606 Kingdom of Saudi Arabia Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info Mexico Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info La operación de este equipo está sujeta a las siguientes dos condiciones: 1. Es posible que este equipo o dispositivo no cause interferencia perjudicial y 2. Este equipo o dispositivo debe aceptar cualquier interferencia, incluyendo la que pueda causar su operación no deseada Moldova Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info 78 Morocco AGREE PAR L’ANRT MAROC Numéro d’agrément: MR00025102ANRT2020 Date d’agrément: 02/08/2020 Nigeria Connection and use of this communications equipment is permitted by the Nigerian Communications Commission. Oman TRA/TA-R/9745/20 D090258 Pakistan PTA Approved Model No.: FB511 TAC No.: 9.687/2020 Device Type: Smart Watch 79 Philippines Type Accepted No: ESD-RCE-2023407 Serbia Singapore Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info South Korea Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info 80 본 제품의 전자파흡수율은 과학기술정보통신부의「전자파 인체보호기준」을 만족합니 다. 본 제품은 국립전파연구원의「전자파흡수율 측정기준」에 따라 최대출력 조건에서 머리 에 근접하여 시험되었으며, 최대 전자파흡수율 측정값은 다음과같습니다. 모델명 (Model) 머리 전자파흡수율 (Head SAR) FB511 0.089 W/kg 클래스 B 장치 (가정 사용을위한 방송 통신 기기) : EMC 등록 주로 가정용 (B 급)으로하고, 모 든 지역에서 사용할 수 있습니다 얻을이 장치. Translation: Class B devices (broadcast communications equipment for home use): EMC registration is mainly for household use (B class) and can be used in all areas get this device. 81 Taiwan 用戶注意：某些地區的法規內容也可以在您的設備上查看。要查看內容： 設定 > 關於 Versa 3 > 法規資訊 Translation: Notice to the User: Regulatory content can also be viewed on your device. Instructions to view content from your menu: Settings > About Versa 3 > Regulatory info 低功率警語: l 取得審驗證明之低功率射頻器材，非經核准，公司、商號或使用者均不得擅自變更 頻率、加大功率或變更原設計之特性及功能。 l 低功率射頻器材之使用不得影響飛航安全及干擾合法通信；經發現有干擾現象時， 應立即停用，並改善至無干擾時方得繼續使用。前述合法通信，指依電信管理法規 定作業之無線電通信。低功率射頻器材須忍受合法通信或工業、科學及醫療用電波 輻射性電機設備之干擾。 Translation: Warning Statement for Low Power Radios: l Without permission granted by the NCC, no company, enterprise, or user is allowed to change the frequency of an approved low power radio-frequency device, enhance its transmitting power or alter original characteristics or performance. l The use of low power RF devices must not affect flight safety or interfere with legal communications: when interference is found, it should be immediately stopped and ameliorated not to interfere before continuing to use it. The legal communications mentioned here refer to radio communications operating in accordance with the provisions of the Telecommunication Law. Low power RF devices need to bear with interference from legal communications or industrial, scientific and medical radio wave radiating equipment 電池警語： 82 此裝置使用鋰電池。 若未遵照下列準則，則裝置內的鋰離子電池壽命可能會縮短或有損壞裝置、發生火災、化學 品灼傷、電解液洩漏及／或受傷的風險。 l 請勿拆解、鑿孔或損壞裝置或電池。 l 請勿取出或嘗試取出使用者不可自行更換的電池。 l 請勿將電池曝露於火焰、爆炸或其他危險中。 l 請勿使用尖銳物品取出電池。 Translation: Battery warning: This device uses a lithium-ion battery. If the following guidelines are not followed, the life of the lithium-ion battery in the device may be shortened or there is a risk of damage to the device, fire, chemical burn, electrolyte leakage and / or injury.. l Do not disassemble, puncture or damage the device or battery. l Do not remove or try to remove the battery that the user cannot replace. l Do not expose the battery to flames, explosions or other hazards. l Do not use sharp objects to remove the battery. Vision Warning 使用過度恐傷害視力 警語 • 使用過度恐傷害視力 注意事項 • 使用30分鐘請休息10分鐘。未滿2歲幼兒不看螢幕，2歲以上每天看螢幕不要超過1 小時 Translation: Excessive use may damage vision 83 Warning: l Excessive use may damage vision Attention: l Rest for 10 minutes after every 30 minutes. l Children under 2 years old should stay away from this product. Children 2 years old or more should not see the screen for more than 1 hour a day. Taiwan RoHS United Arab Emirates Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info 84 TRA – United Arab Emirates Dealer ID: DA35294/14 TA RTTE: ER88790/ 20 Model: FB511 Type: Smartwatch Vietnam Zambia ZMB / ZICTA / TA / 2020 / 9 / 78 Safety Statement This equipment has been tested to comply with safety certification in accordance with the specifications of EN Standard: EN60950-1:2006 + A11:2009 + A1:2010 + A12:2011 + A2:2013 & EN62368-1:2014 + A11:2017. 85 ©2020 Fitbit, Inc. All rights reserved. Fitbit and the Fitbit logo are trademarks or registered trademarks of Fitbit in the US and other countries. A more complete list of Fitbit trademarks can be found at http://www.fitbit.com/legal/trademark-list. Third-party trademarks mentioned are the property of their respective owners.
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+USER:
+Based on the document provided, how does the user make the shortcuts menu appear while playing music?
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+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",True,37,17,12084,,305
+"You can only respond to the prompt using information in the context block. Give your answer in bullet points. If you cannot answer using the context alone, say ""I cannot determine the answer to that due to lack of context""","What actions did the UN Secretary General, U Thant, take in response to the trial of Sheikh Mujibur Rahman in August 1971?","See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/381796770 The United Nations' Involvement in Bangladesh's Liberation War: A Detailed Analysis Article in International Journal of Politics & Social Sciences Review (IJPSSR) · June 2024 CITATIONS 0 3 authors, including: Md. Ruhul Amin Comilla University 33 PUBLICATIONS 9 CITATIONS SEE PROFILE All content following this page was uploaded by Md. Ruhul Amin on 28 June 2024. The user has requested enhancement of the downloaded file. ISSN 2959-6467 (Online) :: ISSN 2959-6459 (Print) ISSN 2959-6459 (ISSN-L) Vol. 3, Issue I, 2024 (January – June) International Journal of Politics & Social Sciences Review (IJPSSR) Website: https://ijpssr.org.pk/ OJS: https://ojs.ijpssr.org.pk/ Email: info@ijpssr.org.pk Page | 10 The United Nations' Involvement in Bangladesh's Liberation War: A Detailed Analysis Md. Firoz Al Mamun 1 , Md. Mehbub Hasan 2 & Md. Ruhul Amin, PhD 3 1 Assistant Professor, Department of Political Science, Islamic University, Kushtia, Bangladesh 2 Researcher and Student, Department of Government and Politics, Jahangirnagar University, Savar, Dhaka1342 3 (Corresponding Author), Associate Professor, Department of Public Administration, Comilla University, Cumilla, Bangladesh Abstract Liberation War, Bangladesh, United Nations, International Intervention, Conflict Resolution. Introduction The 1971 Bengali nation's armed struggle for independence took on an international dimension; as the conflict came to an end, India and Pakistan got directly involved, and the major powers and their powerful allies started to actively compete with one another to establish an independent state of Bangladesh. This effort included international and multinational aspects in addition to bilateral and regional forms (Jahan, 2008:245). The bigger forum in this instance, where the major powers and stakeholders participated in various capacities, was the UN. The major powers usually agree on decisions made and carried out by the United Nations, a global institution. The decision-making process is primarily a reflection of how the major powers see a given situation. The UN Security Council may reach an impasse, in which case the General Assembly may adopt certain restricted actions. Everything that occurred in 1971 took place during the Bangladesh crisis (Matin, 1990: 23). With Bangladesh's ascent on December 16, the subcontinent's map underwent a reconfiguration. Furthermore, the United Nations' involvement in these matters has primarily been restricted to humanitarian efforts and relief activities. The Pakistan military attempted to stifle the calls for freedom of the people of East Pakistan by genocide and ethnic oppression, which was thwarted by the On March 26, 1971, the Bangladeshi independence struggle against domestic imperialism and ethnic discrimination in Pakistan got underway. March 26, 1971, saw the start of the Bangladeshi independence movement against domestic imperialism and ethnic discrimination in Pakistan. The United Nations gave relief and humanitarian activities first priority starting in the Liberation War and continuing until November. The UN Security Council was called in when India and Pakistan entered the Liberation War on December 3. The Security Council meetings continued as different suggestions and counterproposals were presented. In the Security Council, there was a clash between the USSR and US. While the USSR helped Bangladesh, China and the US helped Pakistan. Keeping their positions neutral, France and Britain did not cast votes in the Security Council. The Security Council could not therefore come to an agreement. On December 6, after discussion and an official decision, the Security Council sent the agenda to the General Assembly. On December 7, a resolution headed ""Unity Formula for Peace"" was overwhelmingly approved at the General Assembly. As India and Bangladesh rejected this idea, the US called a second Security Council session. Sessions of the Security Council were held at various intervals between December 12 and 21. Everything changed dramatically when Bangladesh gained its independence on December 16. The protracted Bangladesh war was essentially resolved on December 21 when the Security Council unanimously approved a ceasefire resolution. International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 11 establishment of Bangladesh, under the standard pretexts of national integrity, internal affairs, etc. For this reason, it is plausible to argue that Bangladesh's establishment following the dissolution of the post-World War II state structure was a highly justifiable event. Following its declaration of independence, Bangladesh joined a number of UN bodies in 1972 and attained full membership status in 1974 (Hussain, 2012:189). There is a dearth of scholarship on the United Nations' involvement in the Great War of Liberation. The discussion research is highly significant, and the author has logically made a concentrated effort to examine and unearth material on the role of the organization in charge of maintaining world peace and security throughout the Great War of Liberation. Research Methodology The article titled 'The Role of the United Nations in the Great Liberation War of Bangladesh: An Analysis' has all of the basic aspects of social research. Data was gathered from secondary sources for research purposes. The research was done using both qualitative and quantitative methods. The research paper titled 'Role of the United Nations in the Great Liberation War of Bangladesh - An Analysis' was analyzed using the 'Content Analysis Methodology'. Basically, the study effort was done using secondary sources to acquire and analyze data and information. The research relies on secondary sources, either directly or indirectly. The study was done by gathering information from worldwide media coverage, UN documents, publications, research papers, reports, archives relating to the liberation war, and records housed in the museum during Bangladesh's War of Liberation (1971). The Role of the United Nations in the early stages of the Liberation War All UN employees were evacuated from Dhaka on March 25, 1971, the night the Pakistani armed forces declared the liberation war through ""Operation Searchlight."" But it has not moved to halt the atrocities against human rights and genocide in East Pakistan. On April 1st, nonetheless, the Secretary General sent an emergency humanitarian offer to the Pakistani government for the inhabitants of East Pakistan. Nevertheless, the Pakistani government turned down the offer of humanitarian assistance and even forbade the Red Cross relief aircraft from landing in Dhaka (Hossein, 2012: 150). President Yahya Khan gave the UN authorization to carry out rescue operations after the UN Secretary General appealed to the Pakistani government on April 22 for immediate humanitarian aid. Beginning on June 7, 1971, the United Nations started assistance efforts in East Pakistan. The acronym UNROD stood for the United Nations Relief and Works Agency for East Pakistan. United Nations recognized the name ""Bangladesh"" on December 21 and dubbed the rescue agency ""UNROD"" (Time Magazine, January 1, 1971). The surge of refugees entering India on April 23 was the reason the Indian government made its first plea for outside assistance since the start of the liberation struggle. Coordination in this respect was taken up by the United Nations High Commissioner for Refugees (UNHCR). Other than UNHCR, UNICEF and WFP are involved in Indian refugee camps actively. The World Bank estimates that the Indian government spent $1 billion on refugees overall up to December, of which just $215 million came from UN assistance. By far the biggest airlift in UN history (International Herald Tribune, July 8, 1971). India's committed and received monies from the UN and other sources up to June were: International Aid to India (June, 1971) United Nation Other Sources Total 9,80,00,000 16,50,00,000 26,30,00,000 Source: International Herald Tribune, 8 July, 1971. United Nations product aid to India Topics Quantity 1. Food Aid 6267 tons 2. Vehicles 2200 piece 3. Medical supplies 700 tons 4. Polythene for making shelters What is needed for 3 million refugees Source: Rahman, Hasan Hafizur (ed.) (1984) Bangladesh Liberation War Documents, Volume- 13, Dhaka: Ministry of Liberation War Affairs, Government of the People's Republic of Bangladesh, page 783-87. Though the UN participated in the relief effort, until September, no talks on matters like the liberation struggle in Bangladesh, genocide, abuses of human rights, etc. were held in the UN. Even Bangladesh was left from the September UN Annual General Discussion agenda. Still, throughout their statements, the leaders of several nations brought up Bangladesh. International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 12 Proposal for deployment of United Nations observers in East Pakistan Early in the Liberation War, India asked the UN to step in and handle the refugee crisis and put an end to the genocide in East Pakistan. Yet, at first, Pakistan opposed the UN's intervention in the refugee crisis, viewing any UN action as meddling in its domestic affairs (Hasan, 1994: 251–53). However, Yahya Khan consented to embrace all UN measures as of May on US advice. Pakistan started participating actively in diplomatic efforts in a number of UN forums during this period, with support from Muslim nations and the United States. In order for India to be compelled to cease aiding Bangladesh's independence movement as a result of UN pressure. Acknowledging this, India vehemently objected to the UN's political role, which it concealed behind humanitarian endeavors. Despite the fact that the UN Secretary General has mostly been mute on ending genocide and breaches of human rights since the start of the Liberation War, on July 19 he suggested that ""UN peacekeepers or observers be deployed on the India-Pakistan border to resolve the refugee problem."" But the UN Secretary General's plan to send out troops or monitors was shelved after the Mujibnagar administration and India turned down this offer (Hossein, 2012: 87). According to Article 99 of the United Nations, the initiative of the Secretary General The UN Secretary-General, U Thant, submitted a memorandum under Article 99 to the president of the Security Council and member nations on July 20, 1971, the day following the request for the deployment of observers. There were eight paragraphs or suggestions in the Secretary General's letter. ""Obviously, it is for the members of the Security Council themselves to decide whether such consideration should be taken place formally or informally, in public or private,"" he stated in the note (UN Doc, A/8401). India, the primary backer of Bangladesh's independence movement, was put in a humiliating position by the Secretary General's suggestions. The Soviet Union supported India in this circumstance. India's principal foreign benefactor in the wake of the Soviet-Indian alliance's signature was the Soviet Union. The Soviet Union asked the Secretary-General on August 20th not to call a meeting of the Security Council to discuss the East Pakistan issue. As a result, the Security Council did not meet, even on the Secretary General's suggestion. Major nations and interested parties maintained their diplomatic efforts in anticipation of the United Nations General Assembly's 26th session, which is scheduled to take place on September 21 (The Year Book of World Affairs, 1972). United Nations Intervention in the Question of Bangabandhu's Trial Sheikh Mujibur Rahman is set to face trial for treason in the final week of July, as reported by many media sources. The Mujibnagar government promptly raised alarm following the publication of this news. Sheikh Mujib is the unquestionable leader of Bangladesh's liberation movement. Consequently, the Mujibnagar government formally requested the international community and influential nations to ensure the safety and well-being of Sheikh Mujib's life (Joy Bangla, July 30, 1971). The trial of Sheikh Mujibur Rahman commenced on August 9, 1971, under the authority of the Pakistani government. On August 10, U Thant, the Secretary General of the United Nations, intervened in the Pakistani military junta's attempt to bring Sheikh Mujibur Rahman to trial. The Secretary General stated clearly that the topic at hand is highly sensitive and delicate, and it is the responsibility of the legal system of Pakistan, as a member state, to handle it. It is also a subject of great curiosity and worry in several spheres, encompassing both humanitarian and political domains. The Secretary General has been regularly receiving expressions of grave concern from government representatives regarding the situation in East Pakistan. It is widely believed that unless some form of agreement is reached, the restoration of peace and normalcy in the region is unlikely. The Secretary General concurs with several members that any advancements about the destiny of Sheikh Mujibur Rahman would undoubtedly have repercussions beyond the borders of Pakistan. The article is from The International Herald Tribune, dated August 10, 1971. Delegation of Bangladesh to the United Nations The United Nations General Assembly meets every September. On September 21, the Mujibnagar administration (1st government of independent Bangladesh) agreed to dispatch a 16-member team led by Justice Abu Saeed stationed in London. On September 25, the Bangladesh delegation convened and nominated Fakir Shahabuddin as the party's member secretary. Bangladesh was not a member of the United Nations before then. In this situation, the delegation had a tough time entering the UN building. Pakistan, in particular, tried to label the delegation as'rebellious elements. Even in this International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 13 hostile climate, this group continued to engage in creative and intellectual activities as the Mujibnagar government's representation on the United Nations premises. Currently, the President of the United Nations Association of Journalists. Yogendranath Banerjee assisted the team in entering the United Nations building. at October, the Bangladesh delegation conducted a plenary news conference at a space at the Church Center, located on the west side of 777 United Nations Plaza. As a result, the Bangladeshi representation to the United Nations actively participated in mobilizing global opinion on Bangladesh's favor. The 26th meeting of the General Assembly The latter portion of the September 1971 UN headquarters conference focused on the membership of the People's Republic of China and the status of Bangladesh. The 26th session failed to resolve the issue of the 'Bangladesh dilemma'. Bangladesh has been cited in the annual report of the Secretary General and in remarks made by national representatives. In his report, UN Secretary-General U Thant emphasized the imperative for the international community to provide comprehensive assistance to governments and peoples in the event of a large-scale disaster. In UN Document A/8411, I have asserted that the only viable resolution to the underlying issue lies in a political approach centered around reconciliation and humanitarian principles. This session's official and informal assembly of country representatives at the UN headquarters focused on China's UN membership and Bangladesh. New Zealand, Madagascar, Luxembourg, Belgium, Norway, and Sweden stressed the subcontinental situation before the UN General Assembly and demanded a quick settlement. Pakistan was told to restore a popular administration in East Pakistan by France and Britain. The Soviet Union no longer regarded the situation a Pakistani issue. Pakistan only had ambivalence and leniency from the US. Luxembourg's delegate asked, ""When we witness millions of people suffering indescribably, being brutally punished in the guise of national security, and civilized society's weakest losing their rights, In the sake of national sovereignty and security, should such cruelty continue? On Sept. 29, Canadian Foreign Minister Michelle Sharpe said, 'When an internal conflict is moving so many nations so directly, would it be right to consider it an internal matter?' Pakistan was advised to be flexible by Sweden. He remarked that ""it would behove Pakistan to respect human rights and accept the public opinion declared through voting"". The US sessionally backed Pakistan and said, ""Pakistan's internal issues will be dealt with by the people and government of Pakistan."" The East Pakistan problem had generated a worldwide catastrophe, and Pakistan's ruthlessness had caused millions of refugees to cross the border and seek asylum in other nations. In session, the French foreign minister remarked, ""If this injustice cannot be corrected at the root, the flow of refugees will not stop."" Belgians repeated Schumann's query, ""Will the return of the refugees be possible?"" He noted ""a political and constitutional solution to this crisis must be found”. This remedy should come from public opinion. Only when they are confident in the future that human rights will not be abused will refugees return home. British Foreign Secretary Sir Alec Hume was clear about the solution (Muhith, 2014). The statements of these countries are arranged in a table and some important questions are answered for it. These are: a. States that have identified the Bangladesh question as a political issue; b. b. States that have termed it only as a humanitarian problem; c. States that have identified the matter as Pakistan's internal affairs; d. Only those countries that have spoken of genocide and human rights violations; Country Problem description References to both political and humanitarian aspects Paying attention to humanitarian issues Internal Affairs of Pakistan Genocide and human rights violations Afghanistan * * Albania Algeria * * Argentina * * * Australia * * * Austria * * Bahrain Barbados Belgium * * Bhutan International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 14 Bolivia Botswana Brazil Bulgaria Burma Burundi Belarus Cameroon Canada Central African Republic Sri Lanka (Ceylon) * * Chad Chile * * China * * Colombia Congo Costa Rica Cuba Cyprus * * Czechoslovakia Secretary General's Good Office Proposal At the 26th General Session, governments, the international media, and the people put pressure on UN Secretary General ""U Thant"" to take a new crisis action for Bangladesh. On October 20, he gave India and Pakistan his good office. The Secretary General said, ""In this potentially very dangerous situation, I feel that it is my duty as Secretary General to do everything I can to help the government immediately concerned avoid any disaster."" I want you to know that my offices are always open if you need help (UN Doc, S/10410:6). This letter of the Secretary General implies that he views the matter as an India-Pakistan war. President Yahya Khan also wanted a Pak-India confrontation. Yahya Khan informed the Secretary General a day later that Pakistan had accepted this idea. I appreciate your willingness to provide your good offices and hope you can visit India and Pakistan immediately to negotiate force withdrawal. I am convinced this will benefit and advance peace. UN Doc, S/10410: 7 However, India did not reject the UN Secretary General's 'good office'. According to the status of UN Secretary General and diplomatic etiquette, India could not reject this plan outright, therefore it rejected it indirectly. The Secretary General's recommendation came as Indira Gandhi was touring the world to promote Bangladesh's liberation fight. Upon returning from abroad, he informed the Secretary General on November 16 that the military rule of Pakistan was a severe threat to national life and security. Indira Gandhi said that Pakistan wants to make problems within Pakistan into problems between India and Pakistan. Second, we can't ignore the reason why people are crossing borders as refugees. Indira Gandhi kindly told the Secretary General that instead of India and Pakistan meeting, Yahya Khan and the leaders of the Awami League should do it. ""It's always nice to meet you and talk about our ideas,"" she said. We will back your efforts to find a political solution in East Bengal that meets the stated needs of the people, as long as you are ready to look at the situation in a broader context (Keesings, 1972). In his response, the Indian Prime Minister said that the UN Secretary-General was guilty. In order to protect the Pakistani junta, the Secretary General is avoiding the main problem. In a message to the Prime Minister of India on November 22, the Secretary-General denied the charges, saying that good office requires everyone to work together. In this very important and complicated case, there doesn't seem to be a reason for the Secretary General to help. 10 (UN Doc S/10410). The UN Secretary-General's ""Good Office"" project in the subcontinent stopped when this message was sent. 1606th Session of the Security Council (December 4, 1971) On December 3, India entered the Pakistan War, threatening peace and stability in one of the world's most populated areas. Both nations reported the incident to the UN Secretary General on December 4. After thoroughly evaluating the problem, the Secretary-General requested a Security Council session from Council President Jakob Malik (Soviet Union) (The New York Times, 4 December 1971). International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 15 The 1606th Security Council session (5 permanents—US, Soviet Union, China, UK, France— and 10 non-permanents—Argentina, Belgium, Burundi, Italy, Japan, Nicaragua, Sierra Leone, Somalia, Syria) meets on December 4, 1971. Justice Abu Saeed Chowdhury, the Bangladesh delegation leader, asked the Security Council President to advocate for the Mujibnagar administration before the meeting. The Security Council President proposed listening to Justice Abu Saeed Chowdhury's remarks as Bangladesh's envoy at the start of the meeting. A lengthy Security Council debate on hearing Justice Abu Saeed Chowdhury's remarks from Bangladesh. The council president presented two ideas in response to criticism. a. Permit the letter to be circulated as a Security Council document from Justice Abu Saeed Chowdhury, the representative of Bangladesh. b. The council should allow Justice Abu Saeed Chowdhury to speak as a representative of the people of Bangladesh. The majority of nations did not object to the speech's delivery on the grounds of principle, thus the Council President issued an order granting the request to present the resolution. However, because to a lack of required support, the President rejected Justice Chowdhury's second motion to join the Security Council debate (UN Doc, S/PV/1606). The Security Council extended an invitation to the representatives of India and Pakistan to make remarks. The first speaker was Agha Shahi, Pakistan's Permanent Representative to the UN. He charged India with breaking Articles 2(4) and 2(7) of the UN Charter in his long statement, and he called on the UN to take responsibility for safeguarding Pakistan's territorial integrity (UN Doc, S/PV/1606: 49–148). In his remarks, Samar Sen, India's Permanent Representative to the UN, stated, ""The enemy is sidestepping the core problem and falsely condemning India. According to him, this problem has resulted from the strategy of putting seven crore Bengalis under weapons control. Despite the fact that Sheikh Mujib was predicted by Yahya Khan to become Pakistan's prime minister, nobody is certain of his current whereabouts. Bengalis have won elections but have not been granted authority, which is why Samar Sen supports their independence. This led them to launch nonviolent movements as well, but these were also put down by massacres. They are therefore quite justified in demanding their right to self-determination. According to UN Doc, S/PV/1606: 150–85, he stated that the ceasefire should be between the Pakistan Army and Bangladesh, not between India and Pakistan. 1. The United States of America's Security Council Resolution (S/10416) Following the keynote addresses by the Indian and Pakistani delegates, US Representative George Bush Sr. charged India of aggressiveness. 'Immediate ceasefire between India and Pakistan, withdrawal of the armies of both countries to their respective borders, deployment of United Nations observers on the India-Pakistan border, taking all necessary steps for the repatriation of refugees' (UN Doc, S/10416) was one of the seven points of his resolution. Every Security Council member participated in the discussion of the US proposal. 2. Belgium, Italy, and Japan's Proposals (S/10417) Belgium, Italy, and Japan submitted a five-point draft resolution to the Security Council in response to the US proposal. In line with the UN Charter's tenets, the draft resolution calls on ""the governments of both countries to immediately cease hostilities and all forms of hostilities and to take necessary measures for the rapid and voluntary repatriation of refugees"" (UN Doc, S/10417). 3. The Soviet Union's Security Council Resolution (S/10418) At opposition to the American plan, the Soviet Union put out a two-point draft resolution at the UN Security Council's 1606th resolution calling for an end to hostilities in East Pakistan. ""A political solution in East Pakistan, which would end hostilities there and at the same time stop all terrorist activities by the Pakistan Army in East Pakistan,"" was what the Soviet proposal demanded (UN Doc, S/10418). 4. The Argentine, Nicaraguan, Sierra Leonean, and Somalian proposals (S/10419) Argentina, Nicaragua, Sierra Leone, and Somalia sent the Security Council a two-point draft resolution (S/10419) at the Soviet Union's advice. Under the draft resolution (UN Doc, S/10416), both nations must ""immediately ceasefire and withdraw"" and the Secretary-General is to ""keep the Security Council regularly informed of the situation."" The Security Council heard four resolutions during its 1606th meeting. Following a thorough discussion and debate, the president of the Security Council presented the US proposal—one of four draft proposals—for voting among the Security Council's member nations for acceptance. International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 16 1 st veto of the Soviet Union in favor of Bangladesh in the Security Council (S/10416) In favor of the US proposal Abstain from voting Against the US proposal Belgium, Burundi, Italy, Japan, Nicaragua, Sierra Leone, Somalia, Syria. United Kingdom, France Soviet Union, Poland When the US accused India of withdrawing soldiers in the Security Council, 11 voted yes and the Soviets and Poland no. Neither the UK nor France voted. Permanent Security Council member the Soviet Union vetoed the motion. Soviet Union's 106th UN Security Council veto (UN Doc, S/PV/1606: 357-71). 1607th Emergency Session of the Security Council (December 5, 1971) The Security Council convened its 1607th session on December 4 at 2.30 p.m. on December 5. The fact that Tunisia from Africa and Saudi Arabia from Asia, neither Security Council members, can speak makes this session unique. They attended at the Security Council President's request. I.B. Tarlor-Kamara (Sierra Leone) chaired this Security Council session (UN Doc, S/PV/1607). The Resolution of China (S/10421) This session featured a Chinese resolution draft. China's plan termed India an aggressor and chastised it for establishing Bangladesh. China ""demands the unconditional and immediate withdrawal of the Indian army occupying Pakistani territory"" (UN Doc, S/10421). After China's draft proposal, the Tunisian ambassador spoke for Africa. He said, ""The Security Council should also call for a ceasefire, so that peace can be established according to the various clauses of the Charter"". The Asian Saudi representative then spoke. According to Saudi envoy Jamil Baroodi, ""He called for a meeting of Asian heads of state on the subcontinent to get rid of the politics of the big powers."" After the Saudi delegate, the Soviet representative mentioned a draft proposal (S/10422, December 5, 1971). The Soviet Union said a 'ceasefire may be a temporary solution but a permanent one would need a political accord between India and Pakistan'. The Soviet delegate accused the US and China of disregarding two major issues for ""temporary interests"". Pakistan and India spoke in the Security Council after the Soviet representative. After Pakistan and India spoke, the Council President informed the Security Council that the Council now has three resolutions: S/10418 (Soviet Union), S/10421 (China), and S/10423 (8 Nations). S/10417 and S/10419 are no longer before the House since the same state presented the 8-nation resolution (S/10423), which complements them. The Council President voted on the Soviet proposal first (UN Doc, S/PV/1607:75-201). Consequences of the Soviet Union's (S/10418) proposal In favor of the Soviet Union Abstain from voting Against the proposal Soviet Union Soviet Union, Poland United States, United Kingdom, France, Argentina, Belgium, Burundi, Italy, Japan, Nicaragua, Sierra Leone, Somalia, Syria China The Chinese veto caused the idea to be rejected. The majority of members were not convinced by this suggestion either. Furthermore, throughout the speech, those who chose not to vote expressed their opposition to the idea. When the Chinese proposal (S/10421) was put to a vote by the Council President following the vote on the Soviet proposal, the Chinese delegate stated that they were still in consultation with other Council members. No vote was held on the Chinese proposal as China indicated no interest in holding a vote on it. The eight-nation draft proposal, headed by Argentina, was then put to a vote by the Council President. 2 nd veto of the Soviet Union in favor of Bangladesh in the Security Council (S/10423) In favor of the 8 nation proposal Abstain from voting Against the US proposal USA, China, Argentina, Belgium, Burundi, Italy, Japan, Nicaragua, Sierra Leone, Somalia, Syria. United Kingdom, France Soviet Union, Poland This idea received 11 votes. UK and France refused to vote. Soviet and Polish votes were no. After the Soviet Union vetoed it again, the eight-nation armistice failed (UN Doc, S/PV/1607: 230- 331). The French delegate called such motions and counter-motions 'presumptive' after the 8 Nations' resolution voting. After voting on the 8 Nations resolution, the Council President notified the Council of two further resolutions (S/10421) and (S/10425). The Security Council President exhorted member nations to find a solution and postponed the discussion until 3.30 pm the next day. International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 17 The Proposals by 8 Nations (S/10423) In this session of the Security Council, the 8 member states of the Provisional Council (Argentina, Belgium, Burundi, Italy, Japan, Nicaragua, Sierra Leone and Somalia) led by Argentina put forward a proposal of three points. The resolution called for a ceasefire and the creation of an environment for refugee return (UN Doc, S/10423). The Proposals by 6 Nations (S/10425) At the 1607th session of the Security Council, six nations—Belgium, Italy, Japan, Nicaragua, Sierra Leone and Tunisia—proposed another three-point resolution. This proposal statesa. Urges governments to immediately implement a cease-fire. b. Request the Secretary General to update the Council on the resolution's implementation. c. The UN Doc, S/10425, recommends continuing to consider methods to restore peace in the region. 1608th meeting of the Security Council (December 6, 1971) The 1608th Security Council session was place at 3.30 pm on December 6, 1971. This session, like the previous ones, allowed India, Pakistan, and Tunisia from Africa and Saudi Arabia from Asia to debate. I.B. Tarlor Kamara (Sierra Leone) convened this Security Council session (UN Doc, S/PV/1608:1-5). Soviet Union Resolution (S/10426) Soviet delegate offered a new resolution with two revisions to the six-nation draft resolution (S/10425) early in this session. (In operative paragraph 1, replace ‘the Governments concerned’ with 'all parties concerned' and add 'and cessation of all hostilities'). Peace Proposal Unity Formula (S/10429) In the wake of Security Council impasse, the 11 member nations discussed bringing the issue to the General Assembly informally. Following discussions, Argentina, Somalia, Nicaragua, Sierra Leone, Burundi, and Japan presented a draft resolution (S/10429) to the Security Council, recommending a special session of the UN General Assembly if permanent members failed to reach consensus at the 1606th and 1607th meetings. This proposal followed the 3 November 1950 General Assembly decision [377 A (V)]. Many call it 'Unity for Peace Exercise'. Since the UN Security Council is deadlocked, the General Assembly implements portions of this formula for world peace and security. Soviet Union Resolution (S/10428) The Soviet Union introduced another draft resolution late in this session. In a five-point draft resolution, the USSR urged that ""all parties concerned should immediately cease hostilities and implement a cease-fire."" The 1970 elections called for a political solution in Pakistan to cease hostilities. The UN Secretary-General should execute this decision and continue peace talks in the area. After briefly discussing the draft resolutions in the Security Council, the President decided to vote for the Unity Formula for Peace resolution (S/10429) to take initiative because the Soviet and Chinese resolutions (S/10428) and (S/10421) would fail. Consequences of the Unity Formula for Peace proposal in the Security Council In favor of the US proposal Abstain from voting Against the US proposal USA, China, Argentina, Belgium, Burundi, Italy, Japan, Nicaragua, Sierra Leone, Somalia, Syria *** United Kingdom, France, Soviet Union, Poland After this proposal was passed, the United Nations started to implement the Unity Formula for Peace (UN Doc, S/PV/1608) with the aim of ending the war in the subcontinent. To protect Pakistan, China took the initiative to send this proposal to the UN General Assembly. 26th (Special Session) of the General Assembly According to the Security Council's December 6 decision, the 26th extraordinary session of the General Assembly was convened at the UN on December 7. The 26th Special Session of the General Assembly saw three proposals: A. Proposal by 13 nations (A/L/647). B. The 34-nation Argentine-led plan (A/L/647 Rev.) and Soviet proposal (A/L/646) were detailed. For 12 hours on December 7, the General Assembly considered 3 draft proposals. debate included 58 of 131 General Assembly nations. The Resolution of 13 States to the General Assembly (A/L/647) Thirteen member states introduced a draft resolution for General Assembly debate at the start of this session. The 13 states' suggestions mainly included the following: International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 18 a. Urge Pakistan and India to immediately halt hostilities and return their soldiers to their respective boundaries. b. Boost attempts to repatriate refugees. c. (c) The Secretary-General will urge that decisions of the Security Council and the General Assembly be implemented. d. In view of the existing resolution (UN Doc, A/L 647), urge the Security Council to respond appropriately. The Resolution of 34 States to the General Assembly (A/L/647 Rev-1) The General Assembly received a draft resolution from 34 governments, chaired by Argentina and backed by the US, Muslim nations, and China. 'Immediately effective Indo-Pakistani ceasefire and evacuation of Indian troops from East Pakistan, respecting the concept of the integrity of Pakistan' was the 34-state resolution's heart. The Resolution of Soviet Union (A/L/648) The Soviet Union's proposal states, ""Ceasefire may be a temporary solution, but a permanent solution requires a political agreement between India and Pakistan"" (UN Doc, A/L 648). Countries Participating in the Debate in the Special Session (26th) of the United Nations General Assembly Asia Africa Europe Middle and South America Others Bhutan Algeria Albania Argentina Australia Sri Lanka Burundi Bulgaria Brazil Fiji China Chad Czechoslovakia Chile New Zealand Cyprus Gabon Denmark Ecuador United States India Ghana France Mexico Indonesia Ivory Coast Greece Nicaragua Iran Madagascar Italy Peru Japan Mauritania Netherlands Uruguay Lebanon Sierra Leone Poland Malaysia Somalia Portugal Mongolia Sudan Soviet Union Nepal Tanzania Sweden Pakistan Togo Britain Saudi Arabia Tunisia Yugoslavia Turkey Hungary Jordan Quake 17 country 14 country 15 country 8 country 4 country Source: Prepared by reviewing various UN documents. Following deliberation in the General Assembly, the President of the Assembly, Adam Malik (former Minister of Foreign Affairs of Indonesia), approved the motion put up by 34 nations, spearheaded by Argentina, for vote in the General Assembly (amended). This decision was made in accordance with Rule 93 of the Rules of Procedure, which governs the process. Voting results on 34 state resolutions in the General Assembly 34 in favor of the State proposal Abstain from voting Against the proposal of 34 states 104 states 11 states 16 states It was supported by 104 nations, Negative vote from 16 nations and 11 nations cast no votes. General Assembly resolution sent to Security Council for execution same day. UN Under-SecretaryGeneral telegraphed India and Pakistan of the General Assembly's resolution (UNGA Resolution, 2793). 1611th Meeting of the Security Council (December 12, 1971) While the UN General Assembly adopted the ceasefire resolution, the battle continued and Pakistan soldiers in Dhaka fell. On December 12, George Bush (Senior) requested a quick ceasefire from the Secretary General in the Security Council (S/10444). Thus, the 1611th Security Council meeting took place at 4 p.m. A large delegation from India led by Foreign Minister Sardar Swaran Singh attended this summit. Pakistan sent a mission led by recently appointed Deputy Prime Minister and Foreign Minister Zulfiqar Ali Bhutto to boost diplomatic efforts (UN Doc, S/PV/1611). International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 19 The Resolution of the United States (S/10446) The US proposed a draft resolution to a Security Council emergency meeting on 12 December. The seven-point resolution demanded 'prompt ceasefire and army withdrawal' (UN Doc, S/10446). In this Security Council resolution, the US and USSR had opposite stances. The US and China publicly supported Pakistan. The council president adjourned the meeting at 12.35 pm to meet again the next day. 1613th meeting of the Security Council (December 13, 1971) The Security Council had its 1613th session at 3 p.m. on December 13. In addition to Security Council members, India, Pakistan, Saudi Arabia, and Tunisia attended this meeting. The meeting opened with US draft resolution (S/10446) talks. The Council president let Poland's representative speak first. George Bush, US representative, said, India bears the major responsibility for broadening the crisis by rejecting the UN's efforts to become involved, even in a humanitarian way, in relation to the refugees, rejecting proposals like our Secretary General's offer of good offices, which could have defused the crisis, and rejecting proposals that could have started a political dialogue. (UN Doc, A/PV 2002: 130-141). Chinese envoy Chiao remarked, ""India conspires with Bengali refugees like Tibetan refugees."" He called India a ""outright aggressor"" pursuing South Asian domination. He further said the Soviet Union is the principal backer of Indian aggression. China wants a ceasefire and the evacuation of both nations' forces (UN). Doc, A/PV 2002: 141-146). In his speech, the Soviet Union delegate observed, 'The businesspeople and fanatics who brought this subject before the General Assembly have blinded their eyes to the true situation in the Indian subcontinent. They are concealing the major reasons of the dispute without examining the issue. He dubbed this project China-US Collude. China asserts it uses the forum for anti-Soviet propaganda (UN Doc, A/PV 2003: 173-185). The President of the Council voted on the United States' updated draft resolution (S/10446/Rev.1) for Security Council approval after debate. The third veto by the Soviet Union, a permanent UN Security Council member, reversed the cease-fire resolution (UN Doc, S/PV/1613: 174). 3 rd veto of the Soviet Union in favor of Bangladesh in the Security Council (S/10446/Rev.1) In favor of the US proposal Abstain from voting Against the US proposal USA, China, Argentina, Belgium, Burundi, Italy, Japan, Nicaragua, Sierra Leone, Somalia, Syria United Kingdom, France Soviet Union, Poland The Proposal by Italy and Japan (S/10451) After voting on the US proposal, Italy and Japan jointly presented another draft resolution at this session of the Security Council. There were total of nine points in this proposal. The main point of the resolution was to 'maintain the national integrity of Pakistan and reach a comprehensive political solution to this crisis' (UN Doc, S/10451). The 1614th meeting of the Security Council took place on December 14, 1971. The 1614th Security Council meeting commenced at 12.10 pm on December 14th. The meeting did not achieve a consensus. Britain engaged in discussions with other members of the Council, namely France, in order to develop a new proposal that would meet the approval of all parties involved. Poland has presented a draft resolution (S/10453) to the President of the Council, outlining a six-point plan for a ceasefire. Here, the Security Council meeting system was addressed. After discussing their recommendations, Britain and Poland requested that the conference be deferred until the next day for government orders. All Council members agreed, save China's moderate reservations. To permit formal deliberations on the British-French and Polish proposals, the Council President postponed the meeting (UN Doc, S/PV/1614: 49). 1615th meeting of the Security Council (December 15, 1971) The 1615th Security Council meeting was conducted at 7.20 pm on December 15. At the Council President's request, India and Pakistan delegates attended this meeting. Meeting attendees discussed four draft suggestions. Polish proposal (UN Doc, S/10453/Rev-1), France and Britain's resolution, Syria's resolution, and Soviet Union's resolution. Polish proposals included 'ceasefire and departure of West Pakistani soldiers from East Pakistan'. ""Pakistani political prisoners should be released, so that they can implement their mandate in East Pakistan"" declared the Syrian draft resolution. After negotiations, the UK and France proposed a Syrian-like draft resolution. The concept addresses International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 20 ceasefire in the east and west of the subcontinent individually. The idea called for political settlement discussions with elected officials. Britain, France, and the Soviet Union made similar proposals. The Soviet Union demanded a thorough political solution with East Pakistan's elected representatives. A cease-fire must also be announced (UN Doc, S/PV/1615). The Chinese representative began with a speech. China's representative said, 'The Security Council should respect Pakistan's independence, sovereignty, national unity and geographical integrity' (UN Doc, S/PV/1615: 13). The President of the Council asked the Sri Lankan representative to speak after the Chinese speaker (UN Doc, S/PV/1615: 13). The Council President invited the Sri Lankan delegate to speak after the Chinese representative. Sri Lankan representative: ""Sri Lanka seeks a neutral solution. He said, 'This solution should be one where triumph is devoid of difficulties, loss is without consequence and above all peace prevails' (UN Doc, S/PV/1615: 22). Pakistan's Deputy Prime Minister and Foreign Minister Zulfikar Ali Bhutto's statement on these suggestions was spectacular. The Security Council was strongly criticized in his passionate address. He called the Security Council stage of deceit and farce' He instructed the Security Council to legitimize every unlawful occurrence until December 15, establish a harsher treaty than Versailles, and legalize the occupation. We will fight without me. I shall withdraw but fight again. My country calls. Why waste time on the Security Council? I refuse to participate in such a disgraceful surrender of my nation. He urged the General and Security Council to remove the ‘monument of failure' He concluded his Security Council remarks. They rip up draft resolutions of four nations, including Poland, and I go (UN Doc, S/PV/1615: 84). Pakistani delegates left the Security Council. Pakistani delegates left the Security Council. Accepting Poland's suggestion (UN Doc, S/10453) may have benefited Pakistan. India 'although grudgingly' approved the idea with Soviet help. The Pakistani military would not have surrendered humiliatingly if the delegates had accepted the idea. The Council President called Poland's proposal timely out of 4 drafts. The Security Council discussed four draft ideas, but none of the member nations indicated interest in voting. Instead, they continued to deliberate. Thus, the Council President adjourned the meeting till 10.30 am on December 16 (UN Doc, S/PV/1615:139). 1616th meeting of the Security Council (December 16, 1971) The 1616th Security Council meeting was conducted at 10:30 am on December 16. The Security Council President invited Indian Foreign Minister Sardar Swaran Singh, Saudi Ambassador Mr. Jamal Baroodi, Tunisian representative, and Sri Lankan representative to this meeting. The President stated that five draft resolutions await decision before the Council: Italy and Japan (S/10451), Poland (UN Doc, S/10453/Rev-1), Syria (UN Doc, S/10456), France and Britain (UN Doc, S/10455), and the Soviet Union (UN Doc, S/10457). The Chinese and Soviet draft resolutions (S/10421) and (S/10428) were not vetoed (UN Doc, S/PV/1616: 3). Indian External Affairs Minister Sardar Swaran Singh read Indira Gandhi's statement after the President's opening remarks. This statement included two main points. a. Pakistani army surrendering in Dhaka created Bangladesh. b. India's Western Front ceasefire (UN Doc, S/PV/1616:5). At 1.10 pm, the 1616th Security Council meeting finished. 1617th meeting of the Security Council (December 16, 1971) The Foreign Minister of India proclaimed the creation of Bangladesh via the surrender of Pakistani soldiers in Dhaka at 3.00 pm in the 1616th and 1617th Security Council meetings. Besides Security Council members, India, Pakistan, Tunisia, and Saudi Arabia attended this meeting. A Soviet draft resolution (S/10458) welcomed India's ceasefire proposal during this conference. Japan and the US presented a seven-point draft resolution (S/10450) on Geneva Conventions (1949) compliance, including refugee safe return, during the conference. It then proposed S/10459/Rev.1, revising this plan. Meeting terminated at 9.45 pm without Security Council resolution (UN Doc, S/PV/1617). 1620th meeting (Final meeting) of the Security Council (December 21, 1971) The UN Security Council was unable to achieve a compromise despite the increasing tensions in Bangladesh and the unilateral ceasefire declared by India. Argentina, Burundi, Italy, Japan, Nicaragua, Sierra Leone, and Somalia together presented Security Council resolution S/10465 on December 21. The resolution sought to 'monitor a cessation of hostilities and encourage all relevant parties to comply with the provisions of the Geneva Conventions'. During the plenary session, the International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 21 resolution received support from 13 states, but the Soviet Union and Poland chose not to vote (UN Doc, S/PV/1620). Consequences of the provisional 7 state resolution of the Security Council In favor of the proposal Abstain from voting Against the proposal United States, China, United Kingdom, France, Argentina, Belgium, Burundi, Italy, Japan, Nicaragua, Sierra Leone, Somalia, Syria Soviet Union, Poland *** The Security Council eventually approved the ceasefire. The eventful 26th (special) General Assembly session ended on 22 December after the Security Council passed the resolution. Bangladesh attained independence without UN assistance. Conclusion The Bengali liberation war with Pakistani forces in besieged Bangladesh lasted from March 26 to December 16, 1971. The UN did nothing to address genocide and human rights in East Pakistan during the Liberation War. Due to its dependency on the US, the UN could not address East Pakistan's genocide and human rights abuses. The UN's good contribution in alleviating refugees' immediate concerns in India has always been noted. The UN's greatest refugee aid effort in Bangladesh occurred in 1971. At the time, the UN did not prioritize political issues in establishing a lasting refugee solution. Major nations preferred geopolitical and national solutions outside the UN. Bangladesh has not been resolved by the UN Security and General Assembly. The US and China had a 'leaning strategy' toward Pakistan and the USSR toward India. The Soviet Union's veto has frequently thwarted China-US Security Council efforts to unify Pakistan and prevent Bangladesh's accession. Pakistan's statehood was supported by 104–11 votes in the UN General Assembly's Bangladesh resolution. The vote supported national integration (United Pakistan) in 1971. However, superpowers like France and Britain remained neutral, helping Bangladesh gain independence. Bangladesh became independent on December 21, 1971, when the Security Council passed an anti-war resolution (S/10465) without UN involvement. References Ayoob, M. (1972). The United Nations and the India-Pakistan Conflict. Asian Survey, 12(11), 977- 988. https://doi.org/10.2307/2642776 Azad, A. K. (2013). Bangladesh: From Nationhood to Security State. International Journal of Asian Social Science, 3(7), 1516-1529. Bina, D. (2011). The Role of External Powers in Bangladesh's Liberation War. Journal of South Asian and Middle Eastern Studies, 35(2), 27-42. Hossain, K. (2014). International Legal Aspects of the Bangladesh Liberation War of 1971. Journal of Asian and African Studies, 49(5), 613-628. https://doi.org/10.1177/0021909613490131 Islam, S. M. (2012). The United Nations and the Bangladesh Crisis of 1971: A Legal Perspective. Asian Journal of International Law, 2(2), 401-421. https://doi.org/10.1017/S2044251312000 172 Mookherjee, N. (2011). The Bangladesh Genocide: The Plight of Women during the 1971 Liberation War. Gender, Technology and Development, 15(1), 101-114. https://doi.org/10.1177/097185 241001500105 Raghavan, S. (2013). 1971: A Global History of the Creation of Bangladesh. Harvard University Press. Sisson, R., & Rose, L. E. (1991). War and Secession: Pakistan, India, and the Creation of Bangladesh. University of California Press. Sobhan, R. (1982). The Crisis of External Dependence: The Political Economy of Foreign Aid to Bangladesh. University Press Limited. Tahmina, Q. (2001). The UN and the Bangladesh Liberation War of 1971: Interventions and Consequences. Journal of International Affairs, 55(2), 453-469.UN Doc, S/10410, Para 6-10. UN Doc, S/PV/1606, Para 1-371, 5 December, 1971. UN Doc, S/10416, 4 December, 1971. UN Doc, S/10417, 4 December, 1971. UN Doc, S/10418, 4 December, 1971. UN Doc, S/10419, 4 December, 1971. UN Doc, S/PV/1607, Para 1-234, 5 December, 1971. International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 22 UN Doc, S/10421, 5 December, 1971. UN Doc, S/10423, 5 December, 1971. UN Doc, S/10425, 5 December, 1971. UN Doc, S/PV/1608, Para 1-187, 6 December, 1971. UN Doc, S/10426, 6 December, 1971. UN Doc, S/10428, 6 December, 1971. UN Doc, S/10429, 6 December, 1971. UN Doc, A/L 647, 7 December 1971. UN Doc, A/L 647/Rev-1, 7 December 1971. UN Doc, A/L 648, 7 December 1971. UN General Assembly Resolution 2793, Vol- XXVI. UN Doc, S/PV/1611, 12 December 1971. UN Doc, S/10446, 12 December 1971. UN Doc, S/PV/1613, Para1-174, 13 December 1971. UN Doc, A/PV 2002, PP.130-146. UN Doc, A/PV 2003, PP.173-185. UN Doc, S/10451, 13 December 1971. UN Doc, S/PV/1614, Para1-49, 14 December 1971. View publication stats","You can only respond to the prompt using information in the context block. Give your answer in bullet points. If you cannot answer using the context alone, say ""I cannot determine the answer to that due to lack of context"" See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/381796770 The United Nations' Involvement in Bangladesh's Liberation War: A Detailed Analysis Article in International Journal of Politics & Social Sciences Review (IJPSSR) · June 2024 CITATIONS 0 3 authors, including: Md. Ruhul Amin Comilla University 33 PUBLICATIONS 9 CITATIONS SEE PROFILE All content following this page was uploaded by Md. Ruhul Amin on 28 June 2024. The user has requested enhancement of the downloaded file. ISSN 2959-6467 (Online) :: ISSN 2959-6459 (Print) ISSN 2959-6459 (ISSN-L) Vol. 3, Issue I, 2024 (January – June) International Journal of Politics & Social Sciences Review (IJPSSR) Website: https://ijpssr.org.pk/ OJS: https://ojs.ijpssr.org.pk/ Email: info@ijpssr.org.pk Page | 10 The United Nations' Involvement in Bangladesh's Liberation War: A Detailed Analysis Md. Firoz Al Mamun 1 , Md. Mehbub Hasan 2 & Md. Ruhul Amin, PhD 3 1 Assistant Professor, Department of Political Science, Islamic University, Kushtia, Bangladesh 2 Researcher and Student, Department of Government and Politics, Jahangirnagar University, Savar, Dhaka1342 3 (Corresponding Author), Associate Professor, Department of Public Administration, Comilla University, Cumilla, Bangladesh Abstract Liberation War, Bangladesh, United Nations, International Intervention, Conflict Resolution. Introduction The 1971 Bengali nation's armed struggle for independence took on an international dimension; as the conflict came to an end, India and Pakistan got directly involved, and the major powers and their powerful allies started to actively compete with one another to establish an independent state of Bangladesh. This effort included international and multinational aspects in addition to bilateral and regional forms (Jahan, 2008:245). The bigger forum in this instance, where the major powers and stakeholders participated in various capacities, was the UN. The major powers usually agree on decisions made and carried out by the United Nations, a global institution. The decision-making process is primarily a reflection of how the major powers see a given situation. The UN Security Council may reach an impasse, in which case the General Assembly may adopt certain restricted actions. Everything that occurred in 1971 took place during the Bangladesh crisis (Matin, 1990: 23). With Bangladesh's ascent on December 16, the subcontinent's map underwent a reconfiguration. Furthermore, the United Nations' involvement in these matters has primarily been restricted to humanitarian efforts and relief activities. The Pakistan military attempted to stifle the calls for freedom of the people of East Pakistan by genocide and ethnic oppression, which was thwarted by the On March 26, 1971, the Bangladeshi independence struggle against domestic imperialism and ethnic discrimination in Pakistan got underway. March 26, 1971, saw the start of the Bangladeshi independence movement against domestic imperialism and ethnic discrimination in Pakistan. The United Nations gave relief and humanitarian activities first priority starting in the Liberation War and continuing until November. The UN Security Council was called in when India and Pakistan entered the Liberation War on December 3. The Security Council meetings continued as different suggestions and counterproposals were presented. In the Security Council, there was a clash between the USSR and US. While the USSR helped Bangladesh, China and the US helped Pakistan. Keeping their positions neutral, France and Britain did not cast votes in the Security Council. The Security Council could not therefore come to an agreement. On December 6, after discussion and an official decision, the Security Council sent the agenda to the General Assembly. On December 7, a resolution headed ""Unity Formula for Peace"" was overwhelmingly approved at the General Assembly. As India and Bangladesh rejected this idea, the US called a second Security Council session. Sessions of the Security Council were held at various intervals between December 12 and 21. Everything changed dramatically when Bangladesh gained its independence on December 16. The protracted Bangladesh war was essentially resolved on December 21 when the Security Council unanimously approved a ceasefire resolution. International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 11 establishment of Bangladesh, under the standard pretexts of national integrity, internal affairs, etc. For this reason, it is plausible to argue that Bangladesh's establishment following the dissolution of the post-World War II state structure was a highly justifiable event. Following its declaration of independence, Bangladesh joined a number of UN bodies in 1972 and attained full membership status in 1974 (Hussain, 2012:189). There is a dearth of scholarship on the United Nations' involvement in the Great War of Liberation. The discussion research is highly significant, and the author has logically made a concentrated effort to examine and unearth material on the role of the organization in charge of maintaining world peace and security throughout the Great War of Liberation. Research Methodology The article titled 'The Role of the United Nations in the Great Liberation War of Bangladesh: An Analysis' has all of the basic aspects of social research. Data was gathered from secondary sources for research purposes. The research was done using both qualitative and quantitative methods. The research paper titled 'Role of the United Nations in the Great Liberation War of Bangladesh - An Analysis' was analyzed using the 'Content Analysis Methodology'. Basically, the study effort was done using secondary sources to acquire and analyze data and information. The research relies on secondary sources, either directly or indirectly. The study was done by gathering information from worldwide media coverage, UN documents, publications, research papers, reports, archives relating to the liberation war, and records housed in the museum during Bangladesh's War of Liberation (1971). The Role of the United Nations in the early stages of the Liberation War All UN employees were evacuated from Dhaka on March 25, 1971, the night the Pakistani armed forces declared the liberation war through ""Operation Searchlight."" But it has not moved to halt the atrocities against human rights and genocide in East Pakistan. On April 1st, nonetheless, the Secretary General sent an emergency humanitarian offer to the Pakistani government for the inhabitants of East Pakistan. Nevertheless, the Pakistani government turned down the offer of humanitarian assistance and even forbade the Red Cross relief aircraft from landing in Dhaka (Hossein, 2012: 150). President Yahya Khan gave the UN authorization to carry out rescue operations after the UN Secretary General appealed to the Pakistani government on April 22 for immediate humanitarian aid. Beginning on June 7, 1971, the United Nations started assistance efforts in East Pakistan. The acronym UNROD stood for the United Nations Relief and Works Agency for East Pakistan. United Nations recognized the name ""Bangladesh"" on December 21 and dubbed the rescue agency ""UNROD"" (Time Magazine, January 1, 1971). The surge of refugees entering India on April 23 was the reason the Indian government made its first plea for outside assistance since the start of the liberation struggle. Coordination in this respect was taken up by the United Nations High Commissioner for Refugees (UNHCR). Other than UNHCR, UNICEF and WFP are involved in Indian refugee camps actively. The World Bank estimates that the Indian government spent $1 billion on refugees overall up to December, of which just $215 million came from UN assistance. By far the biggest airlift in UN history (International Herald Tribune, July 8, 1971). India's committed and received monies from the UN and other sources up to June were: International Aid to India (June, 1971) United Nation Other Sources Total 9,80,00,000 16,50,00,000 26,30,00,000 Source: International Herald Tribune, 8 July, 1971. United Nations product aid to India Topics Quantity 1. Food Aid 6267 tons 2. Vehicles 2200 piece 3. Medical supplies 700 tons 4. Polythene for making shelters What is needed for 3 million refugees Source: Rahman, Hasan Hafizur (ed.) (1984) Bangladesh Liberation War Documents, Volume- 13, Dhaka: Ministry of Liberation War Affairs, Government of the People's Republic of Bangladesh, page 783-87. Though the UN participated in the relief effort, until September, no talks on matters like the liberation struggle in Bangladesh, genocide, abuses of human rights, etc. were held in the UN. Even Bangladesh was left from the September UN Annual General Discussion agenda. Still, throughout their statements, the leaders of several nations brought up Bangladesh. International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 12 Proposal for deployment of United Nations observers in East Pakistan Early in the Liberation War, India asked the UN to step in and handle the refugee crisis and put an end to the genocide in East Pakistan. Yet, at first, Pakistan opposed the UN's intervention in the refugee crisis, viewing any UN action as meddling in its domestic affairs (Hasan, 1994: 251–53). However, Yahya Khan consented to embrace all UN measures as of May on US advice. Pakistan started participating actively in diplomatic efforts in a number of UN forums during this period, with support from Muslim nations and the United States. In order for India to be compelled to cease aiding Bangladesh's independence movement as a result of UN pressure. Acknowledging this, India vehemently objected to the UN's political role, which it concealed behind humanitarian endeavors. Despite the fact that the UN Secretary General has mostly been mute on ending genocide and breaches of human rights since the start of the Liberation War, on July 19 he suggested that ""UN peacekeepers or observers be deployed on the India-Pakistan border to resolve the refugee problem."" But the UN Secretary General's plan to send out troops or monitors was shelved after the Mujibnagar administration and India turned down this offer (Hossein, 2012: 87). According to Article 99 of the United Nations, the initiative of the Secretary General The UN Secretary-General, U Thant, submitted a memorandum under Article 99 to the president of the Security Council and member nations on July 20, 1971, the day following the request for the deployment of observers. There were eight paragraphs or suggestions in the Secretary General's letter. ""Obviously, it is for the members of the Security Council themselves to decide whether such consideration should be taken place formally or informally, in public or private,"" he stated in the note (UN Doc, A/8401). India, the primary backer of Bangladesh's independence movement, was put in a humiliating position by the Secretary General's suggestions. The Soviet Union supported India in this circumstance. India's principal foreign benefactor in the wake of the Soviet-Indian alliance's signature was the Soviet Union. The Soviet Union asked the Secretary-General on August 20th not to call a meeting of the Security Council to discuss the East Pakistan issue. As a result, the Security Council did not meet, even on the Secretary General's suggestion. Major nations and interested parties maintained their diplomatic efforts in anticipation of the United Nations General Assembly's 26th session, which is scheduled to take place on September 21 (The Year Book of World Affairs, 1972). United Nations Intervention in the Question of Bangabandhu's Trial Sheikh Mujibur Rahman is set to face trial for treason in the final week of July, as reported by many media sources. The Mujibnagar government promptly raised alarm following the publication of this news. Sheikh Mujib is the unquestionable leader of Bangladesh's liberation movement. Consequently, the Mujibnagar government formally requested the international community and influential nations to ensure the safety and well-being of Sheikh Mujib's life (Joy Bangla, July 30, 1971). The trial of Sheikh Mujibur Rahman commenced on August 9, 1971, under the authority of the Pakistani government. On August 10, U Thant, the Secretary General of the United Nations, intervened in the Pakistani military junta's attempt to bring Sheikh Mujibur Rahman to trial. The Secretary General stated clearly that the topic at hand is highly sensitive and delicate, and it is the responsibility of the legal system of Pakistan, as a member state, to handle it. It is also a subject of great curiosity and worry in several spheres, encompassing both humanitarian and political domains. The Secretary General has been regularly receiving expressions of grave concern from government representatives regarding the situation in East Pakistan. It is widely believed that unless some form of agreement is reached, the restoration of peace and normalcy in the region is unlikely. The Secretary General concurs with several members that any advancements about the destiny of Sheikh Mujibur Rahman would undoubtedly have repercussions beyond the borders of Pakistan. The article is from The International Herald Tribune, dated August 10, 1971. Delegation of Bangladesh to the United Nations The United Nations General Assembly meets every September. On September 21, the Mujibnagar administration (1st government of independent Bangladesh) agreed to dispatch a 16-member team led by Justice Abu Saeed stationed in London. On September 25, the Bangladesh delegation convened and nominated Fakir Shahabuddin as the party's member secretary. Bangladesh was not a member of the United Nations before then. In this situation, the delegation had a tough time entering the UN building. Pakistan, in particular, tried to label the delegation as'rebellious elements. Even in this International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 13 hostile climate, this group continued to engage in creative and intellectual activities as the Mujibnagar government's representation on the United Nations premises. Currently, the President of the United Nations Association of Journalists. Yogendranath Banerjee assisted the team in entering the United Nations building. at October, the Bangladesh delegation conducted a plenary news conference at a space at the Church Center, located on the west side of 777 United Nations Plaza. As a result, the Bangladeshi representation to the United Nations actively participated in mobilizing global opinion on Bangladesh's favor. The 26th meeting of the General Assembly The latter portion of the September 1971 UN headquarters conference focused on the membership of the People's Republic of China and the status of Bangladesh. The 26th session failed to resolve the issue of the 'Bangladesh dilemma'. Bangladesh has been cited in the annual report of the Secretary General and in remarks made by national representatives. In his report, UN Secretary-General U Thant emphasized the imperative for the international community to provide comprehensive assistance to governments and peoples in the event of a large-scale disaster. In UN Document A/8411, I have asserted that the only viable resolution to the underlying issue lies in a political approach centered around reconciliation and humanitarian principles. This session's official and informal assembly of country representatives at the UN headquarters focused on China's UN membership and Bangladesh. New Zealand, Madagascar, Luxembourg, Belgium, Norway, and Sweden stressed the subcontinental situation before the UN General Assembly and demanded a quick settlement. Pakistan was told to restore a popular administration in East Pakistan by France and Britain. The Soviet Union no longer regarded the situation a Pakistani issue. Pakistan only had ambivalence and leniency from the US. Luxembourg's delegate asked, ""When we witness millions of people suffering indescribably, being brutally punished in the guise of national security, and civilized society's weakest losing their rights, In the sake of national sovereignty and security, should such cruelty continue? On Sept. 29, Canadian Foreign Minister Michelle Sharpe said, 'When an internal conflict is moving so many nations so directly, would it be right to consider it an internal matter?' Pakistan was advised to be flexible by Sweden. He remarked that ""it would behove Pakistan to respect human rights and accept the public opinion declared through voting"". The US sessionally backed Pakistan and said, ""Pakistan's internal issues will be dealt with by the people and government of Pakistan."" The East Pakistan problem had generated a worldwide catastrophe, and Pakistan's ruthlessness had caused millions of refugees to cross the border and seek asylum in other nations. In session, the French foreign minister remarked, ""If this injustice cannot be corrected at the root, the flow of refugees will not stop."" Belgians repeated Schumann's query, ""Will the return of the refugees be possible?"" He noted ""a political and constitutional solution to this crisis must be found”. This remedy should come from public opinion. Only when they are confident in the future that human rights will not be abused will refugees return home. British Foreign Secretary Sir Alec Hume was clear about the solution (Muhith, 2014). The statements of these countries are arranged in a table and some important questions are answered for it. These are: a. States that have identified the Bangladesh question as a political issue; b. b. States that have termed it only as a humanitarian problem; c. States that have identified the matter as Pakistan's internal affairs; d. Only those countries that have spoken of genocide and human rights violations; Country Problem description References to both political and humanitarian aspects Paying attention to humanitarian issues Internal Affairs of Pakistan Genocide and human rights violations Afghanistan * * Albania Algeria * * Argentina * * * Australia * * * Austria * * Bahrain Barbados Belgium * * Bhutan International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 14 Bolivia Botswana Brazil Bulgaria Burma Burundi Belarus Cameroon Canada Central African Republic Sri Lanka (Ceylon) * * Chad Chile * * China * * Colombia Congo Costa Rica Cuba Cyprus * * Czechoslovakia Secretary General's Good Office Proposal At the 26th General Session, governments, the international media, and the people put pressure on UN Secretary General ""U Thant"" to take a new crisis action for Bangladesh. On October 20, he gave India and Pakistan his good office. The Secretary General said, ""In this potentially very dangerous situation, I feel that it is my duty as Secretary General to do everything I can to help the government immediately concerned avoid any disaster."" I want you to know that my offices are always open if you need help (UN Doc, S/10410:6). This letter of the Secretary General implies that he views the matter as an India-Pakistan war. President Yahya Khan also wanted a Pak-India confrontation. Yahya Khan informed the Secretary General a day later that Pakistan had accepted this idea. I appreciate your willingness to provide your good offices and hope you can visit India and Pakistan immediately to negotiate force withdrawal. I am convinced this will benefit and advance peace. UN Doc, S/10410: 7 However, India did not reject the UN Secretary General's 'good office'. According to the status of UN Secretary General and diplomatic etiquette, India could not reject this plan outright, therefore it rejected it indirectly. The Secretary General's recommendation came as Indira Gandhi was touring the world to promote Bangladesh's liberation fight. Upon returning from abroad, he informed the Secretary General on November 16 that the military rule of Pakistan was a severe threat to national life and security. Indira Gandhi said that Pakistan wants to make problems within Pakistan into problems between India and Pakistan. Second, we can't ignore the reason why people are crossing borders as refugees. Indira Gandhi kindly told the Secretary General that instead of India and Pakistan meeting, Yahya Khan and the leaders of the Awami League should do it. ""It's always nice to meet you and talk about our ideas,"" she said. We will back your efforts to find a political solution in East Bengal that meets the stated needs of the people, as long as you are ready to look at the situation in a broader context (Keesings, 1972). In his response, the Indian Prime Minister said that the UN Secretary-General was guilty. In order to protect the Pakistani junta, the Secretary General is avoiding the main problem. In a message to the Prime Minister of India on November 22, the Secretary-General denied the charges, saying that good office requires everyone to work together. In this very important and complicated case, there doesn't seem to be a reason for the Secretary General to help. 10 (UN Doc S/10410). The UN Secretary-General's ""Good Office"" project in the subcontinent stopped when this message was sent. 1606th Session of the Security Council (December 4, 1971) On December 3, India entered the Pakistan War, threatening peace and stability in one of the world's most populated areas. Both nations reported the incident to the UN Secretary General on December 4. After thoroughly evaluating the problem, the Secretary-General requested a Security Council session from Council President Jakob Malik (Soviet Union) (The New York Times, 4 December 1971). International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 15 The 1606th Security Council session (5 permanents—US, Soviet Union, China, UK, France— and 10 non-permanents—Argentina, Belgium, Burundi, Italy, Japan, Nicaragua, Sierra Leone, Somalia, Syria) meets on December 4, 1971. Justice Abu Saeed Chowdhury, the Bangladesh delegation leader, asked the Security Council President to advocate for the Mujibnagar administration before the meeting. The Security Council President proposed listening to Justice Abu Saeed Chowdhury's remarks as Bangladesh's envoy at the start of the meeting. A lengthy Security Council debate on hearing Justice Abu Saeed Chowdhury's remarks from Bangladesh. The council president presented two ideas in response to criticism. a. Permit the letter to be circulated as a Security Council document from Justice Abu Saeed Chowdhury, the representative of Bangladesh. b. The council should allow Justice Abu Saeed Chowdhury to speak as a representative of the people of Bangladesh. The majority of nations did not object to the speech's delivery on the grounds of principle, thus the Council President issued an order granting the request to present the resolution. However, because to a lack of required support, the President rejected Justice Chowdhury's second motion to join the Security Council debate (UN Doc, S/PV/1606). The Security Council extended an invitation to the representatives of India and Pakistan to make remarks. The first speaker was Agha Shahi, Pakistan's Permanent Representative to the UN. He charged India with breaking Articles 2(4) and 2(7) of the UN Charter in his long statement, and he called on the UN to take responsibility for safeguarding Pakistan's territorial integrity (UN Doc, S/PV/1606: 49–148). In his remarks, Samar Sen, India's Permanent Representative to the UN, stated, ""The enemy is sidestepping the core problem and falsely condemning India. According to him, this problem has resulted from the strategy of putting seven crore Bengalis under weapons control. Despite the fact that Sheikh Mujib was predicted by Yahya Khan to become Pakistan's prime minister, nobody is certain of his current whereabouts. Bengalis have won elections but have not been granted authority, which is why Samar Sen supports their independence. This led them to launch nonviolent movements as well, but these were also put down by massacres. They are therefore quite justified in demanding their right to self-determination. According to UN Doc, S/PV/1606: 150–85, he stated that the ceasefire should be between the Pakistan Army and Bangladesh, not between India and Pakistan. 1. The United States of America's Security Council Resolution (S/10416) Following the keynote addresses by the Indian and Pakistani delegates, US Representative George Bush Sr. charged India of aggressiveness. 'Immediate ceasefire between India and Pakistan, withdrawal of the armies of both countries to their respective borders, deployment of United Nations observers on the India-Pakistan border, taking all necessary steps for the repatriation of refugees' (UN Doc, S/10416) was one of the seven points of his resolution. Every Security Council member participated in the discussion of the US proposal. 2. Belgium, Italy, and Japan's Proposals (S/10417) Belgium, Italy, and Japan submitted a five-point draft resolution to the Security Council in response to the US proposal. In line with the UN Charter's tenets, the draft resolution calls on ""the governments of both countries to immediately cease hostilities and all forms of hostilities and to take necessary measures for the rapid and voluntary repatriation of refugees"" (UN Doc, S/10417). 3. The Soviet Union's Security Council Resolution (S/10418) At opposition to the American plan, the Soviet Union put out a two-point draft resolution at the UN Security Council's 1606th resolution calling for an end to hostilities in East Pakistan. ""A political solution in East Pakistan, which would end hostilities there and at the same time stop all terrorist activities by the Pakistan Army in East Pakistan,"" was what the Soviet proposal demanded (UN Doc, S/10418). 4. The Argentine, Nicaraguan, Sierra Leonean, and Somalian proposals (S/10419) Argentina, Nicaragua, Sierra Leone, and Somalia sent the Security Council a two-point draft resolution (S/10419) at the Soviet Union's advice. Under the draft resolution (UN Doc, S/10416), both nations must ""immediately ceasefire and withdraw"" and the Secretary-General is to ""keep the Security Council regularly informed of the situation."" The Security Council heard four resolutions during its 1606th meeting. Following a thorough discussion and debate, the president of the Security Council presented the US proposal—one of four draft proposals—for voting among the Security Council's member nations for acceptance. International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 16 1 st veto of the Soviet Union in favor of Bangladesh in the Security Council (S/10416) In favor of the US proposal Abstain from voting Against the US proposal Belgium, Burundi, Italy, Japan, Nicaragua, Sierra Leone, Somalia, Syria. United Kingdom, France Soviet Union, Poland When the US accused India of withdrawing soldiers in the Security Council, 11 voted yes and the Soviets and Poland no. Neither the UK nor France voted. Permanent Security Council member the Soviet Union vetoed the motion. Soviet Union's 106th UN Security Council veto (UN Doc, S/PV/1606: 357-71). 1607th Emergency Session of the Security Council (December 5, 1971) The Security Council convened its 1607th session on December 4 at 2.30 p.m. on December 5. The fact that Tunisia from Africa and Saudi Arabia from Asia, neither Security Council members, can speak makes this session unique. They attended at the Security Council President's request. I.B. Tarlor-Kamara (Sierra Leone) chaired this Security Council session (UN Doc, S/PV/1607). The Resolution of China (S/10421) This session featured a Chinese resolution draft. China's plan termed India an aggressor and chastised it for establishing Bangladesh. China ""demands the unconditional and immediate withdrawal of the Indian army occupying Pakistani territory"" (UN Doc, S/10421). After China's draft proposal, the Tunisian ambassador spoke for Africa. He said, ""The Security Council should also call for a ceasefire, so that peace can be established according to the various clauses of the Charter"". The Asian Saudi representative then spoke. According to Saudi envoy Jamil Baroodi, ""He called for a meeting of Asian heads of state on the subcontinent to get rid of the politics of the big powers."" After the Saudi delegate, the Soviet representative mentioned a draft proposal (S/10422, December 5, 1971). The Soviet Union said a 'ceasefire may be a temporary solution but a permanent one would need a political accord between India and Pakistan'. The Soviet delegate accused the US and China of disregarding two major issues for ""temporary interests"". Pakistan and India spoke in the Security Council after the Soviet representative. After Pakistan and India spoke, the Council President informed the Security Council that the Council now has three resolutions: S/10418 (Soviet Union), S/10421 (China), and S/10423 (8 Nations). S/10417 and S/10419 are no longer before the House since the same state presented the 8-nation resolution (S/10423), which complements them. The Council President voted on the Soviet proposal first (UN Doc, S/PV/1607:75-201). Consequences of the Soviet Union's (S/10418) proposal In favor of the Soviet Union Abstain from voting Against the proposal Soviet Union Soviet Union, Poland United States, United Kingdom, France, Argentina, Belgium, Burundi, Italy, Japan, Nicaragua, Sierra Leone, Somalia, Syria China The Chinese veto caused the idea to be rejected. The majority of members were not convinced by this suggestion either. Furthermore, throughout the speech, those who chose not to vote expressed their opposition to the idea. When the Chinese proposal (S/10421) was put to a vote by the Council President following the vote on the Soviet proposal, the Chinese delegate stated that they were still in consultation with other Council members. No vote was held on the Chinese proposal as China indicated no interest in holding a vote on it. The eight-nation draft proposal, headed by Argentina, was then put to a vote by the Council President. 2 nd veto of the Soviet Union in favor of Bangladesh in the Security Council (S/10423) In favor of the 8 nation proposal Abstain from voting Against the US proposal USA, China, Argentina, Belgium, Burundi, Italy, Japan, Nicaragua, Sierra Leone, Somalia, Syria. United Kingdom, France Soviet Union, Poland This idea received 11 votes. UK and France refused to vote. Soviet and Polish votes were no. After the Soviet Union vetoed it again, the eight-nation armistice failed (UN Doc, S/PV/1607: 230- 331). The French delegate called such motions and counter-motions 'presumptive' after the 8 Nations' resolution voting. After voting on the 8 Nations resolution, the Council President notified the Council of two further resolutions (S/10421) and (S/10425). The Security Council President exhorted member nations to find a solution and postponed the discussion until 3.30 pm the next day. International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 17 The Proposals by 8 Nations (S/10423) In this session of the Security Council, the 8 member states of the Provisional Council (Argentina, Belgium, Burundi, Italy, Japan, Nicaragua, Sierra Leone and Somalia) led by Argentina put forward a proposal of three points. The resolution called for a ceasefire and the creation of an environment for refugee return (UN Doc, S/10423). The Proposals by 6 Nations (S/10425) At the 1607th session of the Security Council, six nations—Belgium, Italy, Japan, Nicaragua, Sierra Leone and Tunisia—proposed another three-point resolution. This proposal statesa. Urges governments to immediately implement a cease-fire. b. Request the Secretary General to update the Council on the resolution's implementation. c. The UN Doc, S/10425, recommends continuing to consider methods to restore peace in the region. 1608th meeting of the Security Council (December 6, 1971) The 1608th Security Council session was place at 3.30 pm on December 6, 1971. This session, like the previous ones, allowed India, Pakistan, and Tunisia from Africa and Saudi Arabia from Asia to debate. I.B. Tarlor Kamara (Sierra Leone) convened this Security Council session (UN Doc, S/PV/1608:1-5). Soviet Union Resolution (S/10426) Soviet delegate offered a new resolution with two revisions to the six-nation draft resolution (S/10425) early in this session. (In operative paragraph 1, replace ‘the Governments concerned’ with 'all parties concerned' and add 'and cessation of all hostilities'). Peace Proposal Unity Formula (S/10429) In the wake of Security Council impasse, the 11 member nations discussed bringing the issue to the General Assembly informally. Following discussions, Argentina, Somalia, Nicaragua, Sierra Leone, Burundi, and Japan presented a draft resolution (S/10429) to the Security Council, recommending a special session of the UN General Assembly if permanent members failed to reach consensus at the 1606th and 1607th meetings. This proposal followed the 3 November 1950 General Assembly decision [377 A (V)]. Many call it 'Unity for Peace Exercise'. Since the UN Security Council is deadlocked, the General Assembly implements portions of this formula for world peace and security. Soviet Union Resolution (S/10428) The Soviet Union introduced another draft resolution late in this session. In a five-point draft resolution, the USSR urged that ""all parties concerned should immediately cease hostilities and implement a cease-fire."" The 1970 elections called for a political solution in Pakistan to cease hostilities. The UN Secretary-General should execute this decision and continue peace talks in the area. After briefly discussing the draft resolutions in the Security Council, the President decided to vote for the Unity Formula for Peace resolution (S/10429) to take initiative because the Soviet and Chinese resolutions (S/10428) and (S/10421) would fail. Consequences of the Unity Formula for Peace proposal in the Security Council In favor of the US proposal Abstain from voting Against the US proposal USA, China, Argentina, Belgium, Burundi, Italy, Japan, Nicaragua, Sierra Leone, Somalia, Syria *** United Kingdom, France, Soviet Union, Poland After this proposal was passed, the United Nations started to implement the Unity Formula for Peace (UN Doc, S/PV/1608) with the aim of ending the war in the subcontinent. To protect Pakistan, China took the initiative to send this proposal to the UN General Assembly. 26th (Special Session) of the General Assembly According to the Security Council's December 6 decision, the 26th extraordinary session of the General Assembly was convened at the UN on December 7. The 26th Special Session of the General Assembly saw three proposals: A. Proposal by 13 nations (A/L/647). B. The 34-nation Argentine-led plan (A/L/647 Rev.) and Soviet proposal (A/L/646) were detailed. For 12 hours on December 7, the General Assembly considered 3 draft proposals. debate included 58 of 131 General Assembly nations. The Resolution of 13 States to the General Assembly (A/L/647) Thirteen member states introduced a draft resolution for General Assembly debate at the start of this session. The 13 states' suggestions mainly included the following: International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 18 a. Urge Pakistan and India to immediately halt hostilities and return their soldiers to their respective boundaries. b. Boost attempts to repatriate refugees. c. (c) The Secretary-General will urge that decisions of the Security Council and the General Assembly be implemented. d. In view of the existing resolution (UN Doc, A/L 647), urge the Security Council to respond appropriately. The Resolution of 34 States to the General Assembly (A/L/647 Rev-1) The General Assembly received a draft resolution from 34 governments, chaired by Argentina and backed by the US, Muslim nations, and China. 'Immediately effective Indo-Pakistani ceasefire and evacuation of Indian troops from East Pakistan, respecting the concept of the integrity of Pakistan' was the 34-state resolution's heart. The Resolution of Soviet Union (A/L/648) The Soviet Union's proposal states, ""Ceasefire may be a temporary solution, but a permanent solution requires a political agreement between India and Pakistan"" (UN Doc, A/L 648). Countries Participating in the Debate in the Special Session (26th) of the United Nations General Assembly Asia Africa Europe Middle and South America Others Bhutan Algeria Albania Argentina Australia Sri Lanka Burundi Bulgaria Brazil Fiji China Chad Czechoslovakia Chile New Zealand Cyprus Gabon Denmark Ecuador United States India Ghana France Mexico Indonesia Ivory Coast Greece Nicaragua Iran Madagascar Italy Peru Japan Mauritania Netherlands Uruguay Lebanon Sierra Leone Poland Malaysia Somalia Portugal Mongolia Sudan Soviet Union Nepal Tanzania Sweden Pakistan Togo Britain Saudi Arabia Tunisia Yugoslavia Turkey Hungary Jordan Quake 17 country 14 country 15 country 8 country 4 country Source: Prepared by reviewing various UN documents. Following deliberation in the General Assembly, the President of the Assembly, Adam Malik (former Minister of Foreign Affairs of Indonesia), approved the motion put up by 34 nations, spearheaded by Argentina, for vote in the General Assembly (amended). This decision was made in accordance with Rule 93 of the Rules of Procedure, which governs the process. Voting results on 34 state resolutions in the General Assembly 34 in favor of the State proposal Abstain from voting Against the proposal of 34 states 104 states 11 states 16 states It was supported by 104 nations, Negative vote from 16 nations and 11 nations cast no votes. General Assembly resolution sent to Security Council for execution same day. UN Under-SecretaryGeneral telegraphed India and Pakistan of the General Assembly's resolution (UNGA Resolution, 2793). 1611th Meeting of the Security Council (December 12, 1971) While the UN General Assembly adopted the ceasefire resolution, the battle continued and Pakistan soldiers in Dhaka fell. On December 12, George Bush (Senior) requested a quick ceasefire from the Secretary General in the Security Council (S/10444). Thus, the 1611th Security Council meeting took place at 4 p.m. A large delegation from India led by Foreign Minister Sardar Swaran Singh attended this summit. Pakistan sent a mission led by recently appointed Deputy Prime Minister and Foreign Minister Zulfiqar Ali Bhutto to boost diplomatic efforts (UN Doc, S/PV/1611). International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 19 The Resolution of the United States (S/10446) The US proposed a draft resolution to a Security Council emergency meeting on 12 December. The seven-point resolution demanded 'prompt ceasefire and army withdrawal' (UN Doc, S/10446). In this Security Council resolution, the US and USSR had opposite stances. The US and China publicly supported Pakistan. The council president adjourned the meeting at 12.35 pm to meet again the next day. 1613th meeting of the Security Council (December 13, 1971) The Security Council had its 1613th session at 3 p.m. on December 13. In addition to Security Council members, India, Pakistan, Saudi Arabia, and Tunisia attended this meeting. The meeting opened with US draft resolution (S/10446) talks. The Council president let Poland's representative speak first. George Bush, US representative, said, India bears the major responsibility for broadening the crisis by rejecting the UN's efforts to become involved, even in a humanitarian way, in relation to the refugees, rejecting proposals like our Secretary General's offer of good offices, which could have defused the crisis, and rejecting proposals that could have started a political dialogue. (UN Doc, A/PV 2002: 130-141). Chinese envoy Chiao remarked, ""India conspires with Bengali refugees like Tibetan refugees."" He called India a ""outright aggressor"" pursuing South Asian domination. He further said the Soviet Union is the principal backer of Indian aggression. China wants a ceasefire and the evacuation of both nations' forces (UN). Doc, A/PV 2002: 141-146). In his speech, the Soviet Union delegate observed, 'The businesspeople and fanatics who brought this subject before the General Assembly have blinded their eyes to the true situation in the Indian subcontinent. They are concealing the major reasons of the dispute without examining the issue. He dubbed this project China-US Collude. China asserts it uses the forum for anti-Soviet propaganda (UN Doc, A/PV 2003: 173-185). The President of the Council voted on the United States' updated draft resolution (S/10446/Rev.1) for Security Council approval after debate. The third veto by the Soviet Union, a permanent UN Security Council member, reversed the cease-fire resolution (UN Doc, S/PV/1613: 174). 3 rd veto of the Soviet Union in favor of Bangladesh in the Security Council (S/10446/Rev.1) In favor of the US proposal Abstain from voting Against the US proposal USA, China, Argentina, Belgium, Burundi, Italy, Japan, Nicaragua, Sierra Leone, Somalia, Syria United Kingdom, France Soviet Union, Poland The Proposal by Italy and Japan (S/10451) After voting on the US proposal, Italy and Japan jointly presented another draft resolution at this session of the Security Council. There were total of nine points in this proposal. The main point of the resolution was to 'maintain the national integrity of Pakistan and reach a comprehensive political solution to this crisis' (UN Doc, S/10451). The 1614th meeting of the Security Council took place on December 14, 1971. The 1614th Security Council meeting commenced at 12.10 pm on December 14th. The meeting did not achieve a consensus. Britain engaged in discussions with other members of the Council, namely France, in order to develop a new proposal that would meet the approval of all parties involved. Poland has presented a draft resolution (S/10453) to the President of the Council, outlining a six-point plan for a ceasefire. Here, the Security Council meeting system was addressed. After discussing their recommendations, Britain and Poland requested that the conference be deferred until the next day for government orders. All Council members agreed, save China's moderate reservations. To permit formal deliberations on the British-French and Polish proposals, the Council President postponed the meeting (UN Doc, S/PV/1614: 49). 1615th meeting of the Security Council (December 15, 1971) The 1615th Security Council meeting was conducted at 7.20 pm on December 15. At the Council President's request, India and Pakistan delegates attended this meeting. Meeting attendees discussed four draft suggestions. Polish proposal (UN Doc, S/10453/Rev-1), France and Britain's resolution, Syria's resolution, and Soviet Union's resolution. Polish proposals included 'ceasefire and departure of West Pakistani soldiers from East Pakistan'. ""Pakistani political prisoners should be released, so that they can implement their mandate in East Pakistan"" declared the Syrian draft resolution. After negotiations, the UK and France proposed a Syrian-like draft resolution. The concept addresses International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 20 ceasefire in the east and west of the subcontinent individually. The idea called for political settlement discussions with elected officials. Britain, France, and the Soviet Union made similar proposals. The Soviet Union demanded a thorough political solution with East Pakistan's elected representatives. A cease-fire must also be announced (UN Doc, S/PV/1615). The Chinese representative began with a speech. China's representative said, 'The Security Council should respect Pakistan's independence, sovereignty, national unity and geographical integrity' (UN Doc, S/PV/1615: 13). The President of the Council asked the Sri Lankan representative to speak after the Chinese speaker (UN Doc, S/PV/1615: 13). The Council President invited the Sri Lankan delegate to speak after the Chinese representative. Sri Lankan representative: ""Sri Lanka seeks a neutral solution. He said, 'This solution should be one where triumph is devoid of difficulties, loss is without consequence and above all peace prevails' (UN Doc, S/PV/1615: 22). Pakistan's Deputy Prime Minister and Foreign Minister Zulfikar Ali Bhutto's statement on these suggestions was spectacular. The Security Council was strongly criticized in his passionate address. He called the Security Council stage of deceit and farce' He instructed the Security Council to legitimize every unlawful occurrence until December 15, establish a harsher treaty than Versailles, and legalize the occupation. We will fight without me. I shall withdraw but fight again. My country calls. Why waste time on the Security Council? I refuse to participate in such a disgraceful surrender of my nation. He urged the General and Security Council to remove the ‘monument of failure' He concluded his Security Council remarks. They rip up draft resolutions of four nations, including Poland, and I go (UN Doc, S/PV/1615: 84). Pakistani delegates left the Security Council. Pakistani delegates left the Security Council. Accepting Poland's suggestion (UN Doc, S/10453) may have benefited Pakistan. India 'although grudgingly' approved the idea with Soviet help. The Pakistani military would not have surrendered humiliatingly if the delegates had accepted the idea. The Council President called Poland's proposal timely out of 4 drafts. The Security Council discussed four draft ideas, but none of the member nations indicated interest in voting. Instead, they continued to deliberate. Thus, the Council President adjourned the meeting till 10.30 am on December 16 (UN Doc, S/PV/1615:139). 1616th meeting of the Security Council (December 16, 1971) The 1616th Security Council meeting was conducted at 10:30 am on December 16. The Security Council President invited Indian Foreign Minister Sardar Swaran Singh, Saudi Ambassador Mr. Jamal Baroodi, Tunisian representative, and Sri Lankan representative to this meeting. The President stated that five draft resolutions await decision before the Council: Italy and Japan (S/10451), Poland (UN Doc, S/10453/Rev-1), Syria (UN Doc, S/10456), France and Britain (UN Doc, S/10455), and the Soviet Union (UN Doc, S/10457). The Chinese and Soviet draft resolutions (S/10421) and (S/10428) were not vetoed (UN Doc, S/PV/1616: 3). Indian External Affairs Minister Sardar Swaran Singh read Indira Gandhi's statement after the President's opening remarks. This statement included two main points. a. Pakistani army surrendering in Dhaka created Bangladesh. b. India's Western Front ceasefire (UN Doc, S/PV/1616:5). At 1.10 pm, the 1616th Security Council meeting finished. 1617th meeting of the Security Council (December 16, 1971) The Foreign Minister of India proclaimed the creation of Bangladesh via the surrender of Pakistani soldiers in Dhaka at 3.00 pm in the 1616th and 1617th Security Council meetings. Besides Security Council members, India, Pakistan, Tunisia, and Saudi Arabia attended this meeting. A Soviet draft resolution (S/10458) welcomed India's ceasefire proposal during this conference. Japan and the US presented a seven-point draft resolution (S/10450) on Geneva Conventions (1949) compliance, including refugee safe return, during the conference. It then proposed S/10459/Rev.1, revising this plan. Meeting terminated at 9.45 pm without Security Council resolution (UN Doc, S/PV/1617). 1620th meeting (Final meeting) of the Security Council (December 21, 1971) The UN Security Council was unable to achieve a compromise despite the increasing tensions in Bangladesh and the unilateral ceasefire declared by India. Argentina, Burundi, Italy, Japan, Nicaragua, Sierra Leone, and Somalia together presented Security Council resolution S/10465 on December 21. The resolution sought to 'monitor a cessation of hostilities and encourage all relevant parties to comply with the provisions of the Geneva Conventions'. During the plenary session, the International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 21 resolution received support from 13 states, but the Soviet Union and Poland chose not to vote (UN Doc, S/PV/1620). Consequences of the provisional 7 state resolution of the Security Council In favor of the proposal Abstain from voting Against the proposal United States, China, United Kingdom, France, Argentina, Belgium, Burundi, Italy, Japan, Nicaragua, Sierra Leone, Somalia, Syria Soviet Union, Poland *** The Security Council eventually approved the ceasefire. The eventful 26th (special) General Assembly session ended on 22 December after the Security Council passed the resolution. Bangladesh attained independence without UN assistance. Conclusion The Bengali liberation war with Pakistani forces in besieged Bangladesh lasted from March 26 to December 16, 1971. The UN did nothing to address genocide and human rights in East Pakistan during the Liberation War. Due to its dependency on the US, the UN could not address East Pakistan's genocide and human rights abuses. The UN's good contribution in alleviating refugees' immediate concerns in India has always been noted. The UN's greatest refugee aid effort in Bangladesh occurred in 1971. At the time, the UN did not prioritize political issues in establishing a lasting refugee solution. Major nations preferred geopolitical and national solutions outside the UN. Bangladesh has not been resolved by the UN Security and General Assembly. The US and China had a 'leaning strategy' toward Pakistan and the USSR toward India. The Soviet Union's veto has frequently thwarted China-US Security Council efforts to unify Pakistan and prevent Bangladesh's accession. Pakistan's statehood was supported by 104–11 votes in the UN General Assembly's Bangladesh resolution. The vote supported national integration (United Pakistan) in 1971. However, superpowers like France and Britain remained neutral, helping Bangladesh gain independence. Bangladesh became independent on December 21, 1971, when the Security Council passed an anti-war resolution (S/10465) without UN involvement. References Ayoob, M. (1972). The United Nations and the India-Pakistan Conflict. Asian Survey, 12(11), 977- 988. https://doi.org/10.2307/2642776 Azad, A. K. (2013). Bangladesh: From Nationhood to Security State. International Journal of Asian Social Science, 3(7), 1516-1529. Bina, D. (2011). The Role of External Powers in Bangladesh's Liberation War. Journal of South Asian and Middle Eastern Studies, 35(2), 27-42. Hossain, K. (2014). International Legal Aspects of the Bangladesh Liberation War of 1971. Journal of Asian and African Studies, 49(5), 613-628. https://doi.org/10.1177/0021909613490131 Islam, S. M. (2012). The United Nations and the Bangladesh Crisis of 1971: A Legal Perspective. Asian Journal of International Law, 2(2), 401-421. https://doi.org/10.1017/S2044251312000 172 Mookherjee, N. (2011). The Bangladesh Genocide: The Plight of Women during the 1971 Liberation War. Gender, Technology and Development, 15(1), 101-114. https://doi.org/10.1177/097185 241001500105 Raghavan, S. (2013). 1971: A Global History of the Creation of Bangladesh. Harvard University Press. Sisson, R., & Rose, L. E. (1991). War and Secession: Pakistan, India, and the Creation of Bangladesh. University of California Press. Sobhan, R. (1982). The Crisis of External Dependence: The Political Economy of Foreign Aid to Bangladesh. University Press Limited. Tahmina, Q. (2001). The UN and the Bangladesh Liberation War of 1971: Interventions and Consequences. Journal of International Affairs, 55(2), 453-469.UN Doc, S/10410, Para 6-10. UN Doc, S/PV/1606, Para 1-371, 5 December, 1971. UN Doc, S/10416, 4 December, 1971. UN Doc, S/10417, 4 December, 1971. UN Doc, S/10418, 4 December, 1971. UN Doc, S/10419, 4 December, 1971. UN Doc, S/PV/1607, Para 1-234, 5 December, 1971. International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 22 UN Doc, S/10421, 5 December, 1971. UN Doc, S/10423, 5 December, 1971. UN Doc, S/10425, 5 December, 1971. UN Doc, S/PV/1608, Para 1-187, 6 December, 1971. UN Doc, S/10426, 6 December, 1971. UN Doc, S/10428, 6 December, 1971. UN Doc, S/10429, 6 December, 1971. UN Doc, A/L 647, 7 December 1971. UN Doc, A/L 647/Rev-1, 7 December 1971. UN Doc, A/L 648, 7 December 1971. UN General Assembly Resolution 2793, Vol- XXVI. UN Doc, S/PV/1611, 12 December 1971. UN Doc, S/10446, 12 December 1971. UN Doc, S/PV/1613, Para1-174, 13 December 1971. UN Doc, A/PV 2002, PP.130-146. UN Doc, A/PV 2003, PP.173-185. UN Doc, S/10451, 13 December 1971. UN Doc, S/PV/1614, Para1-49, 14 December 1971. View publication stats What actions did the UN Secretary General, U Thant, take in response to the trial of Sheikh Mujibur Rahman in August 1971?","You can only respond to the prompt using information in the context block. Give your answer in bullet points. If you cannot answer using the context alone, say ""I cannot determine the answer to that due to lack of context""
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+See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/381796770 The United Nations' Involvement in Bangladesh's Liberation War: A Detailed Analysis Article in International Journal of Politics & Social Sciences Review (IJPSSR) · June 2024 CITATIONS 0 3 authors, including: Md. Ruhul Amin Comilla University 33 PUBLICATIONS 9 CITATIONS SEE PROFILE All content following this page was uploaded by Md. Ruhul Amin on 28 June 2024. The user has requested enhancement of the downloaded file. ISSN 2959-6467 (Online) :: ISSN 2959-6459 (Print) ISSN 2959-6459 (ISSN-L) Vol. 3, Issue I, 2024 (January – June) International Journal of Politics & Social Sciences Review (IJPSSR) Website: https://ijpssr.org.pk/ OJS: https://ojs.ijpssr.org.pk/ Email: info@ijpssr.org.pk Page | 10 The United Nations' Involvement in Bangladesh's Liberation War: A Detailed Analysis Md. Firoz Al Mamun 1 , Md. Mehbub Hasan 2 & Md. Ruhul Amin, PhD 3 1 Assistant Professor, Department of Political Science, Islamic University, Kushtia, Bangladesh 2 Researcher and Student, Department of Government and Politics, Jahangirnagar University, Savar, Dhaka1342 3 (Corresponding Author), Associate Professor, Department of Public Administration, Comilla University, Cumilla, Bangladesh Abstract Liberation War, Bangladesh, United Nations, International Intervention, Conflict Resolution. Introduction The 1971 Bengali nation's armed struggle for independence took on an international dimension; as the conflict came to an end, India and Pakistan got directly involved, and the major powers and their powerful allies started to actively compete with one another to establish an independent state of Bangladesh. This effort included international and multinational aspects in addition to bilateral and regional forms (Jahan, 2008:245). The bigger forum in this instance, where the major powers and stakeholders participated in various capacities, was the UN. The major powers usually agree on decisions made and carried out by the United Nations, a global institution. The decision-making process is primarily a reflection of how the major powers see a given situation. The UN Security Council may reach an impasse, in which case the General Assembly may adopt certain restricted actions. Everything that occurred in 1971 took place during the Bangladesh crisis (Matin, 1990: 23). With Bangladesh's ascent on December 16, the subcontinent's map underwent a reconfiguration. Furthermore, the United Nations' involvement in these matters has primarily been restricted to humanitarian efforts and relief activities. The Pakistan military attempted to stifle the calls for freedom of the people of East Pakistan by genocide and ethnic oppression, which was thwarted by the On March 26, 1971, the Bangladeshi independence struggle against domestic imperialism and ethnic discrimination in Pakistan got underway. March 26, 1971, saw the start of the Bangladeshi independence movement against domestic imperialism and ethnic discrimination in Pakistan. The United Nations gave relief and humanitarian activities first priority starting in the Liberation War and continuing until November. The UN Security Council was called in when India and Pakistan entered the Liberation War on December 3. The Security Council meetings continued as different suggestions and counterproposals were presented. In the Security Council, there was a clash between the USSR and US. While the USSR helped Bangladesh, China and the US helped Pakistan. Keeping their positions neutral, France and Britain did not cast votes in the Security Council. The Security Council could not therefore come to an agreement. On December 6, after discussion and an official decision, the Security Council sent the agenda to the General Assembly. On December 7, a resolution headed ""Unity Formula for Peace"" was overwhelmingly approved at the General Assembly. As India and Bangladesh rejected this idea, the US called a second Security Council session. Sessions of the Security Council were held at various intervals between December 12 and 21. Everything changed dramatically when Bangladesh gained its independence on December 16. The protracted Bangladesh war was essentially resolved on December 21 when the Security Council unanimously approved a ceasefire resolution. International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 11 establishment of Bangladesh, under the standard pretexts of national integrity, internal affairs, etc. For this reason, it is plausible to argue that Bangladesh's establishment following the dissolution of the post-World War II state structure was a highly justifiable event. Following its declaration of independence, Bangladesh joined a number of UN bodies in 1972 and attained full membership status in 1974 (Hussain, 2012:189). There is a dearth of scholarship on the United Nations' involvement in the Great War of Liberation. The discussion research is highly significant, and the author has logically made a concentrated effort to examine and unearth material on the role of the organization in charge of maintaining world peace and security throughout the Great War of Liberation. Research Methodology The article titled 'The Role of the United Nations in the Great Liberation War of Bangladesh: An Analysis' has all of the basic aspects of social research. Data was gathered from secondary sources for research purposes. The research was done using both qualitative and quantitative methods. The research paper titled 'Role of the United Nations in the Great Liberation War of Bangladesh - An Analysis' was analyzed using the 'Content Analysis Methodology'. Basically, the study effort was done using secondary sources to acquire and analyze data and information. The research relies on secondary sources, either directly or indirectly. The study was done by gathering information from worldwide media coverage, UN documents, publications, research papers, reports, archives relating to the liberation war, and records housed in the museum during Bangladesh's War of Liberation (1971). The Role of the United Nations in the early stages of the Liberation War All UN employees were evacuated from Dhaka on March 25, 1971, the night the Pakistani armed forces declared the liberation war through ""Operation Searchlight."" But it has not moved to halt the atrocities against human rights and genocide in East Pakistan. On April 1st, nonetheless, the Secretary General sent an emergency humanitarian offer to the Pakistani government for the inhabitants of East Pakistan. Nevertheless, the Pakistani government turned down the offer of humanitarian assistance and even forbade the Red Cross relief aircraft from landing in Dhaka (Hossein, 2012: 150). President Yahya Khan gave the UN authorization to carry out rescue operations after the UN Secretary General appealed to the Pakistani government on April 22 for immediate humanitarian aid. Beginning on June 7, 1971, the United Nations started assistance efforts in East Pakistan. The acronym UNROD stood for the United Nations Relief and Works Agency for East Pakistan. United Nations recognized the name ""Bangladesh"" on December 21 and dubbed the rescue agency ""UNROD"" (Time Magazine, January 1, 1971). The surge of refugees entering India on April 23 was the reason the Indian government made its first plea for outside assistance since the start of the liberation struggle. Coordination in this respect was taken up by the United Nations High Commissioner for Refugees (UNHCR). Other than UNHCR, UNICEF and WFP are involved in Indian refugee camps actively. The World Bank estimates that the Indian government spent $1 billion on refugees overall up to December, of which just $215 million came from UN assistance. By far the biggest airlift in UN history (International Herald Tribune, July 8, 1971). India's committed and received monies from the UN and other sources up to June were: International Aid to India (June, 1971) United Nation Other Sources Total 9,80,00,000 16,50,00,000 26,30,00,000 Source: International Herald Tribune, 8 July, 1971. United Nations product aid to India Topics Quantity 1. Food Aid 6267 tons 2. Vehicles 2200 piece 3. Medical supplies 700 tons 4. Polythene for making shelters What is needed for 3 million refugees Source: Rahman, Hasan Hafizur (ed.) (1984) Bangladesh Liberation War Documents, Volume- 13, Dhaka: Ministry of Liberation War Affairs, Government of the People's Republic of Bangladesh, page 783-87. Though the UN participated in the relief effort, until September, no talks on matters like the liberation struggle in Bangladesh, genocide, abuses of human rights, etc. were held in the UN. Even Bangladesh was left from the September UN Annual General Discussion agenda. Still, throughout their statements, the leaders of several nations brought up Bangladesh. International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 12 Proposal for deployment of United Nations observers in East Pakistan Early in the Liberation War, India asked the UN to step in and handle the refugee crisis and put an end to the genocide in East Pakistan. Yet, at first, Pakistan opposed the UN's intervention in the refugee crisis, viewing any UN action as meddling in its domestic affairs (Hasan, 1994: 251–53). However, Yahya Khan consented to embrace all UN measures as of May on US advice. Pakistan started participating actively in diplomatic efforts in a number of UN forums during this period, with support from Muslim nations and the United States. In order for India to be compelled to cease aiding Bangladesh's independence movement as a result of UN pressure. Acknowledging this, India vehemently objected to the UN's political role, which it concealed behind humanitarian endeavors. Despite the fact that the UN Secretary General has mostly been mute on ending genocide and breaches of human rights since the start of the Liberation War, on July 19 he suggested that ""UN peacekeepers or observers be deployed on the India-Pakistan border to resolve the refugee problem."" But the UN Secretary General's plan to send out troops or monitors was shelved after the Mujibnagar administration and India turned down this offer (Hossein, 2012: 87). According to Article 99 of the United Nations, the initiative of the Secretary General The UN Secretary-General, U Thant, submitted a memorandum under Article 99 to the president of the Security Council and member nations on July 20, 1971, the day following the request for the deployment of observers. There were eight paragraphs or suggestions in the Secretary General's letter. ""Obviously, it is for the members of the Security Council themselves to decide whether such consideration should be taken place formally or informally, in public or private,"" he stated in the note (UN Doc, A/8401). India, the primary backer of Bangladesh's independence movement, was put in a humiliating position by the Secretary General's suggestions. The Soviet Union supported India in this circumstance. India's principal foreign benefactor in the wake of the Soviet-Indian alliance's signature was the Soviet Union. The Soviet Union asked the Secretary-General on August 20th not to call a meeting of the Security Council to discuss the East Pakistan issue. As a result, the Security Council did not meet, even on the Secretary General's suggestion. Major nations and interested parties maintained their diplomatic efforts in anticipation of the United Nations General Assembly's 26th session, which is scheduled to take place on September 21 (The Year Book of World Affairs, 1972). United Nations Intervention in the Question of Bangabandhu's Trial Sheikh Mujibur Rahman is set to face trial for treason in the final week of July, as reported by many media sources. The Mujibnagar government promptly raised alarm following the publication of this news. Sheikh Mujib is the unquestionable leader of Bangladesh's liberation movement. Consequently, the Mujibnagar government formally requested the international community and influential nations to ensure the safety and well-being of Sheikh Mujib's life (Joy Bangla, July 30, 1971). The trial of Sheikh Mujibur Rahman commenced on August 9, 1971, under the authority of the Pakistani government. On August 10, U Thant, the Secretary General of the United Nations, intervened in the Pakistani military junta's attempt to bring Sheikh Mujibur Rahman to trial. The Secretary General stated clearly that the topic at hand is highly sensitive and delicate, and it is the responsibility of the legal system of Pakistan, as a member state, to handle it. It is also a subject of great curiosity and worry in several spheres, encompassing both humanitarian and political domains. The Secretary General has been regularly receiving expressions of grave concern from government representatives regarding the situation in East Pakistan. It is widely believed that unless some form of agreement is reached, the restoration of peace and normalcy in the region is unlikely. The Secretary General concurs with several members that any advancements about the destiny of Sheikh Mujibur Rahman would undoubtedly have repercussions beyond the borders of Pakistan. The article is from The International Herald Tribune, dated August 10, 1971. Delegation of Bangladesh to the United Nations The United Nations General Assembly meets every September. On September 21, the Mujibnagar administration (1st government of independent Bangladesh) agreed to dispatch a 16-member team led by Justice Abu Saeed stationed in London. On September 25, the Bangladesh delegation convened and nominated Fakir Shahabuddin as the party's member secretary. Bangladesh was not a member of the United Nations before then. In this situation, the delegation had a tough time entering the UN building. Pakistan, in particular, tried to label the delegation as'rebellious elements. Even in this International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 13 hostile climate, this group continued to engage in creative and intellectual activities as the Mujibnagar government's representation on the United Nations premises. Currently, the President of the United Nations Association of Journalists. Yogendranath Banerjee assisted the team in entering the United Nations building. at October, the Bangladesh delegation conducted a plenary news conference at a space at the Church Center, located on the west side of 777 United Nations Plaza. As a result, the Bangladeshi representation to the United Nations actively participated in mobilizing global opinion on Bangladesh's favor. The 26th meeting of the General Assembly The latter portion of the September 1971 UN headquarters conference focused on the membership of the People's Republic of China and the status of Bangladesh. The 26th session failed to resolve the issue of the 'Bangladesh dilemma'. Bangladesh has been cited in the annual report of the Secretary General and in remarks made by national representatives. In his report, UN Secretary-General U Thant emphasized the imperative for the international community to provide comprehensive assistance to governments and peoples in the event of a large-scale disaster. In UN Document A/8411, I have asserted that the only viable resolution to the underlying issue lies in a political approach centered around reconciliation and humanitarian principles. This session's official and informal assembly of country representatives at the UN headquarters focused on China's UN membership and Bangladesh. New Zealand, Madagascar, Luxembourg, Belgium, Norway, and Sweden stressed the subcontinental situation before the UN General Assembly and demanded a quick settlement. Pakistan was told to restore a popular administration in East Pakistan by France and Britain. The Soviet Union no longer regarded the situation a Pakistani issue. Pakistan only had ambivalence and leniency from the US. Luxembourg's delegate asked, ""When we witness millions of people suffering indescribably, being brutally punished in the guise of national security, and civilized society's weakest losing their rights, In the sake of national sovereignty and security, should such cruelty continue? On Sept. 29, Canadian Foreign Minister Michelle Sharpe said, 'When an internal conflict is moving so many nations so directly, would it be right to consider it an internal matter?' Pakistan was advised to be flexible by Sweden. He remarked that ""it would behove Pakistan to respect human rights and accept the public opinion declared through voting"". The US sessionally backed Pakistan and said, ""Pakistan's internal issues will be dealt with by the people and government of Pakistan."" The East Pakistan problem had generated a worldwide catastrophe, and Pakistan's ruthlessness had caused millions of refugees to cross the border and seek asylum in other nations. In session, the French foreign minister remarked, ""If this injustice cannot be corrected at the root, the flow of refugees will not stop."" Belgians repeated Schumann's query, ""Will the return of the refugees be possible?"" He noted ""a political and constitutional solution to this crisis must be found”. This remedy should come from public opinion. Only when they are confident in the future that human rights will not be abused will refugees return home. British Foreign Secretary Sir Alec Hume was clear about the solution (Muhith, 2014). The statements of these countries are arranged in a table and some important questions are answered for it. These are: a. States that have identified the Bangladesh question as a political issue; b. b. States that have termed it only as a humanitarian problem; c. States that have identified the matter as Pakistan's internal affairs; d. Only those countries that have spoken of genocide and human rights violations; Country Problem description References to both political and humanitarian aspects Paying attention to humanitarian issues Internal Affairs of Pakistan Genocide and human rights violations Afghanistan * * Albania Algeria * * Argentina * * * Australia * * * Austria * * Bahrain Barbados Belgium * * Bhutan International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 14 Bolivia Botswana Brazil Bulgaria Burma Burundi Belarus Cameroon Canada Central African Republic Sri Lanka (Ceylon) * * Chad Chile * * China * * Colombia Congo Costa Rica Cuba Cyprus * * Czechoslovakia Secretary General's Good Office Proposal At the 26th General Session, governments, the international media, and the people put pressure on UN Secretary General ""U Thant"" to take a new crisis action for Bangladesh. On October 20, he gave India and Pakistan his good office. The Secretary General said, ""In this potentially very dangerous situation, I feel that it is my duty as Secretary General to do everything I can to help the government immediately concerned avoid any disaster."" I want you to know that my offices are always open if you need help (UN Doc, S/10410:6). This letter of the Secretary General implies that he views the matter as an India-Pakistan war. President Yahya Khan also wanted a Pak-India confrontation. Yahya Khan informed the Secretary General a day later that Pakistan had accepted this idea. I appreciate your willingness to provide your good offices and hope you can visit India and Pakistan immediately to negotiate force withdrawal. I am convinced this will benefit and advance peace. UN Doc, S/10410: 7 However, India did not reject the UN Secretary General's 'good office'. According to the status of UN Secretary General and diplomatic etiquette, India could not reject this plan outright, therefore it rejected it indirectly. The Secretary General's recommendation came as Indira Gandhi was touring the world to promote Bangladesh's liberation fight. Upon returning from abroad, he informed the Secretary General on November 16 that the military rule of Pakistan was a severe threat to national life and security. Indira Gandhi said that Pakistan wants to make problems within Pakistan into problems between India and Pakistan. Second, we can't ignore the reason why people are crossing borders as refugees. Indira Gandhi kindly told the Secretary General that instead of India and Pakistan meeting, Yahya Khan and the leaders of the Awami League should do it. ""It's always nice to meet you and talk about our ideas,"" she said. We will back your efforts to find a political solution in East Bengal that meets the stated needs of the people, as long as you are ready to look at the situation in a broader context (Keesings, 1972). In his response, the Indian Prime Minister said that the UN Secretary-General was guilty. In order to protect the Pakistani junta, the Secretary General is avoiding the main problem. In a message to the Prime Minister of India on November 22, the Secretary-General denied the charges, saying that good office requires everyone to work together. In this very important and complicated case, there doesn't seem to be a reason for the Secretary General to help. 10 (UN Doc S/10410). The UN Secretary-General's ""Good Office"" project in the subcontinent stopped when this message was sent. 1606th Session of the Security Council (December 4, 1971) On December 3, India entered the Pakistan War, threatening peace and stability in one of the world's most populated areas. Both nations reported the incident to the UN Secretary General on December 4. After thoroughly evaluating the problem, the Secretary-General requested a Security Council session from Council President Jakob Malik (Soviet Union) (The New York Times, 4 December 1971). International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 15 The 1606th Security Council session (5 permanents—US, Soviet Union, China, UK, France— and 10 non-permanents—Argentina, Belgium, Burundi, Italy, Japan, Nicaragua, Sierra Leone, Somalia, Syria) meets on December 4, 1971. Justice Abu Saeed Chowdhury, the Bangladesh delegation leader, asked the Security Council President to advocate for the Mujibnagar administration before the meeting. The Security Council President proposed listening to Justice Abu Saeed Chowdhury's remarks as Bangladesh's envoy at the start of the meeting. A lengthy Security Council debate on hearing Justice Abu Saeed Chowdhury's remarks from Bangladesh. The council president presented two ideas in response to criticism. a. Permit the letter to be circulated as a Security Council document from Justice Abu Saeed Chowdhury, the representative of Bangladesh. b. The council should allow Justice Abu Saeed Chowdhury to speak as a representative of the people of Bangladesh. The majority of nations did not object to the speech's delivery on the grounds of principle, thus the Council President issued an order granting the request to present the resolution. However, because to a lack of required support, the President rejected Justice Chowdhury's second motion to join the Security Council debate (UN Doc, S/PV/1606). The Security Council extended an invitation to the representatives of India and Pakistan to make remarks. The first speaker was Agha Shahi, Pakistan's Permanent Representative to the UN. He charged India with breaking Articles 2(4) and 2(7) of the UN Charter in his long statement, and he called on the UN to take responsibility for safeguarding Pakistan's territorial integrity (UN Doc, S/PV/1606: 49–148). In his remarks, Samar Sen, India's Permanent Representative to the UN, stated, ""The enemy is sidestepping the core problem and falsely condemning India. According to him, this problem has resulted from the strategy of putting seven crore Bengalis under weapons control. Despite the fact that Sheikh Mujib was predicted by Yahya Khan to become Pakistan's prime minister, nobody is certain of his current whereabouts. Bengalis have won elections but have not been granted authority, which is why Samar Sen supports their independence. This led them to launch nonviolent movements as well, but these were also put down by massacres. They are therefore quite justified in demanding their right to self-determination. According to UN Doc, S/PV/1606: 150–85, he stated that the ceasefire should be between the Pakistan Army and Bangladesh, not between India and Pakistan. 1. The United States of America's Security Council Resolution (S/10416) Following the keynote addresses by the Indian and Pakistani delegates, US Representative George Bush Sr. charged India of aggressiveness. 'Immediate ceasefire between India and Pakistan, withdrawal of the armies of both countries to their respective borders, deployment of United Nations observers on the India-Pakistan border, taking all necessary steps for the repatriation of refugees' (UN Doc, S/10416) was one of the seven points of his resolution. Every Security Council member participated in the discussion of the US proposal. 2. Belgium, Italy, and Japan's Proposals (S/10417) Belgium, Italy, and Japan submitted a five-point draft resolution to the Security Council in response to the US proposal. In line with the UN Charter's tenets, the draft resolution calls on ""the governments of both countries to immediately cease hostilities and all forms of hostilities and to take necessary measures for the rapid and voluntary repatriation of refugees"" (UN Doc, S/10417). 3. The Soviet Union's Security Council Resolution (S/10418) At opposition to the American plan, the Soviet Union put out a two-point draft resolution at the UN Security Council's 1606th resolution calling for an end to hostilities in East Pakistan. ""A political solution in East Pakistan, which would end hostilities there and at the same time stop all terrorist activities by the Pakistan Army in East Pakistan,"" was what the Soviet proposal demanded (UN Doc, S/10418). 4. The Argentine, Nicaraguan, Sierra Leonean, and Somalian proposals (S/10419) Argentina, Nicaragua, Sierra Leone, and Somalia sent the Security Council a two-point draft resolution (S/10419) at the Soviet Union's advice. Under the draft resolution (UN Doc, S/10416), both nations must ""immediately ceasefire and withdraw"" and the Secretary-General is to ""keep the Security Council regularly informed of the situation."" The Security Council heard four resolutions during its 1606th meeting. Following a thorough discussion and debate, the president of the Security Council presented the US proposal—one of four draft proposals—for voting among the Security Council's member nations for acceptance. International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 16 1 st veto of the Soviet Union in favor of Bangladesh in the Security Council (S/10416) In favor of the US proposal Abstain from voting Against the US proposal Belgium, Burundi, Italy, Japan, Nicaragua, Sierra Leone, Somalia, Syria. United Kingdom, France Soviet Union, Poland When the US accused India of withdrawing soldiers in the Security Council, 11 voted yes and the Soviets and Poland no. Neither the UK nor France voted. Permanent Security Council member the Soviet Union vetoed the motion. Soviet Union's 106th UN Security Council veto (UN Doc, S/PV/1606: 357-71). 1607th Emergency Session of the Security Council (December 5, 1971) The Security Council convened its 1607th session on December 4 at 2.30 p.m. on December 5. The fact that Tunisia from Africa and Saudi Arabia from Asia, neither Security Council members, can speak makes this session unique. They attended at the Security Council President's request. I.B. Tarlor-Kamara (Sierra Leone) chaired this Security Council session (UN Doc, S/PV/1607). The Resolution of China (S/10421) This session featured a Chinese resolution draft. China's plan termed India an aggressor and chastised it for establishing Bangladesh. China ""demands the unconditional and immediate withdrawal of the Indian army occupying Pakistani territory"" (UN Doc, S/10421). After China's draft proposal, the Tunisian ambassador spoke for Africa. He said, ""The Security Council should also call for a ceasefire, so that peace can be established according to the various clauses of the Charter"". The Asian Saudi representative then spoke. According to Saudi envoy Jamil Baroodi, ""He called for a meeting of Asian heads of state on the subcontinent to get rid of the politics of the big powers."" After the Saudi delegate, the Soviet representative mentioned a draft proposal (S/10422, December 5, 1971). The Soviet Union said a 'ceasefire may be a temporary solution but a permanent one would need a political accord between India and Pakistan'. The Soviet delegate accused the US and China of disregarding two major issues for ""temporary interests"". Pakistan and India spoke in the Security Council after the Soviet representative. After Pakistan and India spoke, the Council President informed the Security Council that the Council now has three resolutions: S/10418 (Soviet Union), S/10421 (China), and S/10423 (8 Nations). S/10417 and S/10419 are no longer before the House since the same state presented the 8-nation resolution (S/10423), which complements them. The Council President voted on the Soviet proposal first (UN Doc, S/PV/1607:75-201). Consequences of the Soviet Union's (S/10418) proposal In favor of the Soviet Union Abstain from voting Against the proposal Soviet Union Soviet Union, Poland United States, United Kingdom, France, Argentina, Belgium, Burundi, Italy, Japan, Nicaragua, Sierra Leone, Somalia, Syria China The Chinese veto caused the idea to be rejected. The majority of members were not convinced by this suggestion either. Furthermore, throughout the speech, those who chose not to vote expressed their opposition to the idea. When the Chinese proposal (S/10421) was put to a vote by the Council President following the vote on the Soviet proposal, the Chinese delegate stated that they were still in consultation with other Council members. No vote was held on the Chinese proposal as China indicated no interest in holding a vote on it. The eight-nation draft proposal, headed by Argentina, was then put to a vote by the Council President. 2 nd veto of the Soviet Union in favor of Bangladesh in the Security Council (S/10423) In favor of the 8 nation proposal Abstain from voting Against the US proposal USA, China, Argentina, Belgium, Burundi, Italy, Japan, Nicaragua, Sierra Leone, Somalia, Syria. United Kingdom, France Soviet Union, Poland This idea received 11 votes. UK and France refused to vote. Soviet and Polish votes were no. After the Soviet Union vetoed it again, the eight-nation armistice failed (UN Doc, S/PV/1607: 230- 331). The French delegate called such motions and counter-motions 'presumptive' after the 8 Nations' resolution voting. After voting on the 8 Nations resolution, the Council President notified the Council of two further resolutions (S/10421) and (S/10425). The Security Council President exhorted member nations to find a solution and postponed the discussion until 3.30 pm the next day. International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 17 The Proposals by 8 Nations (S/10423) In this session of the Security Council, the 8 member states of the Provisional Council (Argentina, Belgium, Burundi, Italy, Japan, Nicaragua, Sierra Leone and Somalia) led by Argentina put forward a proposal of three points. The resolution called for a ceasefire and the creation of an environment for refugee return (UN Doc, S/10423). The Proposals by 6 Nations (S/10425) At the 1607th session of the Security Council, six nations—Belgium, Italy, Japan, Nicaragua, Sierra Leone and Tunisia—proposed another three-point resolution. This proposal statesa. Urges governments to immediately implement a cease-fire. b. Request the Secretary General to update the Council on the resolution's implementation. c. The UN Doc, S/10425, recommends continuing to consider methods to restore peace in the region. 1608th meeting of the Security Council (December 6, 1971) The 1608th Security Council session was place at 3.30 pm on December 6, 1971. This session, like the previous ones, allowed India, Pakistan, and Tunisia from Africa and Saudi Arabia from Asia to debate. I.B. Tarlor Kamara (Sierra Leone) convened this Security Council session (UN Doc, S/PV/1608:1-5). Soviet Union Resolution (S/10426) Soviet delegate offered a new resolution with two revisions to the six-nation draft resolution (S/10425) early in this session. (In operative paragraph 1, replace ‘the Governments concerned’ with 'all parties concerned' and add 'and cessation of all hostilities'). Peace Proposal Unity Formula (S/10429) In the wake of Security Council impasse, the 11 member nations discussed bringing the issue to the General Assembly informally. Following discussions, Argentina, Somalia, Nicaragua, Sierra Leone, Burundi, and Japan presented a draft resolution (S/10429) to the Security Council, recommending a special session of the UN General Assembly if permanent members failed to reach consensus at the 1606th and 1607th meetings. This proposal followed the 3 November 1950 General Assembly decision [377 A (V)]. Many call it 'Unity for Peace Exercise'. Since the UN Security Council is deadlocked, the General Assembly implements portions of this formula for world peace and security. Soviet Union Resolution (S/10428) The Soviet Union introduced another draft resolution late in this session. In a five-point draft resolution, the USSR urged that ""all parties concerned should immediately cease hostilities and implement a cease-fire."" The 1970 elections called for a political solution in Pakistan to cease hostilities. The UN Secretary-General should execute this decision and continue peace talks in the area. After briefly discussing the draft resolutions in the Security Council, the President decided to vote for the Unity Formula for Peace resolution (S/10429) to take initiative because the Soviet and Chinese resolutions (S/10428) and (S/10421) would fail. Consequences of the Unity Formula for Peace proposal in the Security Council In favor of the US proposal Abstain from voting Against the US proposal USA, China, Argentina, Belgium, Burundi, Italy, Japan, Nicaragua, Sierra Leone, Somalia, Syria *** United Kingdom, France, Soviet Union, Poland After this proposal was passed, the United Nations started to implement the Unity Formula for Peace (UN Doc, S/PV/1608) with the aim of ending the war in the subcontinent. To protect Pakistan, China took the initiative to send this proposal to the UN General Assembly. 26th (Special Session) of the General Assembly According to the Security Council's December 6 decision, the 26th extraordinary session of the General Assembly was convened at the UN on December 7. The 26th Special Session of the General Assembly saw three proposals: A. Proposal by 13 nations (A/L/647). B. The 34-nation Argentine-led plan (A/L/647 Rev.) and Soviet proposal (A/L/646) were detailed. For 12 hours on December 7, the General Assembly considered 3 draft proposals. debate included 58 of 131 General Assembly nations. The Resolution of 13 States to the General Assembly (A/L/647) Thirteen member states introduced a draft resolution for General Assembly debate at the start of this session. The 13 states' suggestions mainly included the following: International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 18 a. Urge Pakistan and India to immediately halt hostilities and return their soldiers to their respective boundaries. b. Boost attempts to repatriate refugees. c. (c) The Secretary-General will urge that decisions of the Security Council and the General Assembly be implemented. d. In view of the existing resolution (UN Doc, A/L 647), urge the Security Council to respond appropriately. The Resolution of 34 States to the General Assembly (A/L/647 Rev-1) The General Assembly received a draft resolution from 34 governments, chaired by Argentina and backed by the US, Muslim nations, and China. 'Immediately effective Indo-Pakistani ceasefire and evacuation of Indian troops from East Pakistan, respecting the concept of the integrity of Pakistan' was the 34-state resolution's heart. The Resolution of Soviet Union (A/L/648) The Soviet Union's proposal states, ""Ceasefire may be a temporary solution, but a permanent solution requires a political agreement between India and Pakistan"" (UN Doc, A/L 648). Countries Participating in the Debate in the Special Session (26th) of the United Nations General Assembly Asia Africa Europe Middle and South America Others Bhutan Algeria Albania Argentina Australia Sri Lanka Burundi Bulgaria Brazil Fiji China Chad Czechoslovakia Chile New Zealand Cyprus Gabon Denmark Ecuador United States India Ghana France Mexico Indonesia Ivory Coast Greece Nicaragua Iran Madagascar Italy Peru Japan Mauritania Netherlands Uruguay Lebanon Sierra Leone Poland Malaysia Somalia Portugal Mongolia Sudan Soviet Union Nepal Tanzania Sweden Pakistan Togo Britain Saudi Arabia Tunisia Yugoslavia Turkey Hungary Jordan Quake 17 country 14 country 15 country 8 country 4 country Source: Prepared by reviewing various UN documents. Following deliberation in the General Assembly, the President of the Assembly, Adam Malik (former Minister of Foreign Affairs of Indonesia), approved the motion put up by 34 nations, spearheaded by Argentina, for vote in the General Assembly (amended). This decision was made in accordance with Rule 93 of the Rules of Procedure, which governs the process. Voting results on 34 state resolutions in the General Assembly 34 in favor of the State proposal Abstain from voting Against the proposal of 34 states 104 states 11 states 16 states It was supported by 104 nations, Negative vote from 16 nations and 11 nations cast no votes. General Assembly resolution sent to Security Council for execution same day. UN Under-SecretaryGeneral telegraphed India and Pakistan of the General Assembly's resolution (UNGA Resolution, 2793). 1611th Meeting of the Security Council (December 12, 1971) While the UN General Assembly adopted the ceasefire resolution, the battle continued and Pakistan soldiers in Dhaka fell. On December 12, George Bush (Senior) requested a quick ceasefire from the Secretary General in the Security Council (S/10444). Thus, the 1611th Security Council meeting took place at 4 p.m. A large delegation from India led by Foreign Minister Sardar Swaran Singh attended this summit. Pakistan sent a mission led by recently appointed Deputy Prime Minister and Foreign Minister Zulfiqar Ali Bhutto to boost diplomatic efforts (UN Doc, S/PV/1611). International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 19 The Resolution of the United States (S/10446) The US proposed a draft resolution to a Security Council emergency meeting on 12 December. The seven-point resolution demanded 'prompt ceasefire and army withdrawal' (UN Doc, S/10446). In this Security Council resolution, the US and USSR had opposite stances. The US and China publicly supported Pakistan. The council president adjourned the meeting at 12.35 pm to meet again the next day. 1613th meeting of the Security Council (December 13, 1971) The Security Council had its 1613th session at 3 p.m. on December 13. In addition to Security Council members, India, Pakistan, Saudi Arabia, and Tunisia attended this meeting. The meeting opened with US draft resolution (S/10446) talks. The Council president let Poland's representative speak first. George Bush, US representative, said, India bears the major responsibility for broadening the crisis by rejecting the UN's efforts to become involved, even in a humanitarian way, in relation to the refugees, rejecting proposals like our Secretary General's offer of good offices, which could have defused the crisis, and rejecting proposals that could have started a political dialogue. (UN Doc, A/PV 2002: 130-141). Chinese envoy Chiao remarked, ""India conspires with Bengali refugees like Tibetan refugees."" He called India a ""outright aggressor"" pursuing South Asian domination. He further said the Soviet Union is the principal backer of Indian aggression. China wants a ceasefire and the evacuation of both nations' forces (UN). Doc, A/PV 2002: 141-146). In his speech, the Soviet Union delegate observed, 'The businesspeople and fanatics who brought this subject before the General Assembly have blinded their eyes to the true situation in the Indian subcontinent. They are concealing the major reasons of the dispute without examining the issue. He dubbed this project China-US Collude. China asserts it uses the forum for anti-Soviet propaganda (UN Doc, A/PV 2003: 173-185). The President of the Council voted on the United States' updated draft resolution (S/10446/Rev.1) for Security Council approval after debate. The third veto by the Soviet Union, a permanent UN Security Council member, reversed the cease-fire resolution (UN Doc, S/PV/1613: 174). 3 rd veto of the Soviet Union in favor of Bangladesh in the Security Council (S/10446/Rev.1) In favor of the US proposal Abstain from voting Against the US proposal USA, China, Argentina, Belgium, Burundi, Italy, Japan, Nicaragua, Sierra Leone, Somalia, Syria United Kingdom, France Soviet Union, Poland The Proposal by Italy and Japan (S/10451) After voting on the US proposal, Italy and Japan jointly presented another draft resolution at this session of the Security Council. There were total of nine points in this proposal. The main point of the resolution was to 'maintain the national integrity of Pakistan and reach a comprehensive political solution to this crisis' (UN Doc, S/10451). The 1614th meeting of the Security Council took place on December 14, 1971. The 1614th Security Council meeting commenced at 12.10 pm on December 14th. The meeting did not achieve a consensus. Britain engaged in discussions with other members of the Council, namely France, in order to develop a new proposal that would meet the approval of all parties involved. Poland has presented a draft resolution (S/10453) to the President of the Council, outlining a six-point plan for a ceasefire. Here, the Security Council meeting system was addressed. After discussing their recommendations, Britain and Poland requested that the conference be deferred until the next day for government orders. All Council members agreed, save China's moderate reservations. To permit formal deliberations on the British-French and Polish proposals, the Council President postponed the meeting (UN Doc, S/PV/1614: 49). 1615th meeting of the Security Council (December 15, 1971) The 1615th Security Council meeting was conducted at 7.20 pm on December 15. At the Council President's request, India and Pakistan delegates attended this meeting. Meeting attendees discussed four draft suggestions. Polish proposal (UN Doc, S/10453/Rev-1), France and Britain's resolution, Syria's resolution, and Soviet Union's resolution. Polish proposals included 'ceasefire and departure of West Pakistani soldiers from East Pakistan'. ""Pakistani political prisoners should be released, so that they can implement their mandate in East Pakistan"" declared the Syrian draft resolution. After negotiations, the UK and France proposed a Syrian-like draft resolution. The concept addresses International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 20 ceasefire in the east and west of the subcontinent individually. The idea called for political settlement discussions with elected officials. Britain, France, and the Soviet Union made similar proposals. The Soviet Union demanded a thorough political solution with East Pakistan's elected representatives. A cease-fire must also be announced (UN Doc, S/PV/1615). The Chinese representative began with a speech. China's representative said, 'The Security Council should respect Pakistan's independence, sovereignty, national unity and geographical integrity' (UN Doc, S/PV/1615: 13). The President of the Council asked the Sri Lankan representative to speak after the Chinese speaker (UN Doc, S/PV/1615: 13). The Council President invited the Sri Lankan delegate to speak after the Chinese representative. Sri Lankan representative: ""Sri Lanka seeks a neutral solution. He said, 'This solution should be one where triumph is devoid of difficulties, loss is without consequence and above all peace prevails' (UN Doc, S/PV/1615: 22). Pakistan's Deputy Prime Minister and Foreign Minister Zulfikar Ali Bhutto's statement on these suggestions was spectacular. The Security Council was strongly criticized in his passionate address. He called the Security Council stage of deceit and farce' He instructed the Security Council to legitimize every unlawful occurrence until December 15, establish a harsher treaty than Versailles, and legalize the occupation. We will fight without me. I shall withdraw but fight again. My country calls. Why waste time on the Security Council? I refuse to participate in such a disgraceful surrender of my nation. He urged the General and Security Council to remove the ‘monument of failure' He concluded his Security Council remarks. They rip up draft resolutions of four nations, including Poland, and I go (UN Doc, S/PV/1615: 84). Pakistani delegates left the Security Council. Pakistani delegates left the Security Council. Accepting Poland's suggestion (UN Doc, S/10453) may have benefited Pakistan. India 'although grudgingly' approved the idea with Soviet help. The Pakistani military would not have surrendered humiliatingly if the delegates had accepted the idea. The Council President called Poland's proposal timely out of 4 drafts. The Security Council discussed four draft ideas, but none of the member nations indicated interest in voting. Instead, they continued to deliberate. Thus, the Council President adjourned the meeting till 10.30 am on December 16 (UN Doc, S/PV/1615:139). 1616th meeting of the Security Council (December 16, 1971) The 1616th Security Council meeting was conducted at 10:30 am on December 16. The Security Council President invited Indian Foreign Minister Sardar Swaran Singh, Saudi Ambassador Mr. Jamal Baroodi, Tunisian representative, and Sri Lankan representative to this meeting. The President stated that five draft resolutions await decision before the Council: Italy and Japan (S/10451), Poland (UN Doc, S/10453/Rev-1), Syria (UN Doc, S/10456), France and Britain (UN Doc, S/10455), and the Soviet Union (UN Doc, S/10457). The Chinese and Soviet draft resolutions (S/10421) and (S/10428) were not vetoed (UN Doc, S/PV/1616: 3). Indian External Affairs Minister Sardar Swaran Singh read Indira Gandhi's statement after the President's opening remarks. This statement included two main points. a. Pakistani army surrendering in Dhaka created Bangladesh. b. India's Western Front ceasefire (UN Doc, S/PV/1616:5). At 1.10 pm, the 1616th Security Council meeting finished. 1617th meeting of the Security Council (December 16, 1971) The Foreign Minister of India proclaimed the creation of Bangladesh via the surrender of Pakistani soldiers in Dhaka at 3.00 pm in the 1616th and 1617th Security Council meetings. Besides Security Council members, India, Pakistan, Tunisia, and Saudi Arabia attended this meeting. A Soviet draft resolution (S/10458) welcomed India's ceasefire proposal during this conference. Japan and the US presented a seven-point draft resolution (S/10450) on Geneva Conventions (1949) compliance, including refugee safe return, during the conference. It then proposed S/10459/Rev.1, revising this plan. Meeting terminated at 9.45 pm without Security Council resolution (UN Doc, S/PV/1617). 1620th meeting (Final meeting) of the Security Council (December 21, 1971) The UN Security Council was unable to achieve a compromise despite the increasing tensions in Bangladesh and the unilateral ceasefire declared by India. Argentina, Burundi, Italy, Japan, Nicaragua, Sierra Leone, and Somalia together presented Security Council resolution S/10465 on December 21. The resolution sought to 'monitor a cessation of hostilities and encourage all relevant parties to comply with the provisions of the Geneva Conventions'. During the plenary session, the International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 21 resolution received support from 13 states, but the Soviet Union and Poland chose not to vote (UN Doc, S/PV/1620). Consequences of the provisional 7 state resolution of the Security Council In favor of the proposal Abstain from voting Against the proposal United States, China, United Kingdom, France, Argentina, Belgium, Burundi, Italy, Japan, Nicaragua, Sierra Leone, Somalia, Syria Soviet Union, Poland *** The Security Council eventually approved the ceasefire. The eventful 26th (special) General Assembly session ended on 22 December after the Security Council passed the resolution. Bangladesh attained independence without UN assistance. Conclusion The Bengali liberation war with Pakistani forces in besieged Bangladesh lasted from March 26 to December 16, 1971. The UN did nothing to address genocide and human rights in East Pakistan during the Liberation War. Due to its dependency on the US, the UN could not address East Pakistan's genocide and human rights abuses. The UN's good contribution in alleviating refugees' immediate concerns in India has always been noted. The UN's greatest refugee aid effort in Bangladesh occurred in 1971. At the time, the UN did not prioritize political issues in establishing a lasting refugee solution. Major nations preferred geopolitical and national solutions outside the UN. Bangladesh has not been resolved by the UN Security and General Assembly. The US and China had a 'leaning strategy' toward Pakistan and the USSR toward India. The Soviet Union's veto has frequently thwarted China-US Security Council efforts to unify Pakistan and prevent Bangladesh's accession. Pakistan's statehood was supported by 104–11 votes in the UN General Assembly's Bangladesh resolution. The vote supported national integration (United Pakistan) in 1971. However, superpowers like France and Britain remained neutral, helping Bangladesh gain independence. Bangladesh became independent on December 21, 1971, when the Security Council passed an anti-war resolution (S/10465) without UN involvement. References Ayoob, M. (1972). The United Nations and the India-Pakistan Conflict. Asian Survey, 12(11), 977- 988. https://doi.org/10.2307/2642776 Azad, A. K. (2013). Bangladesh: From Nationhood to Security State. International Journal of Asian Social Science, 3(7), 1516-1529. Bina, D. (2011). The Role of External Powers in Bangladesh's Liberation War. Journal of South Asian and Middle Eastern Studies, 35(2), 27-42. Hossain, K. (2014). International Legal Aspects of the Bangladesh Liberation War of 1971. Journal of Asian and African Studies, 49(5), 613-628. https://doi.org/10.1177/0021909613490131 Islam, S. M. (2012). The United Nations and the Bangladesh Crisis of 1971: A Legal Perspective. Asian Journal of International Law, 2(2), 401-421. https://doi.org/10.1017/S2044251312000 172 Mookherjee, N. (2011). The Bangladesh Genocide: The Plight of Women during the 1971 Liberation War. Gender, Technology and Development, 15(1), 101-114. https://doi.org/10.1177/097185 241001500105 Raghavan, S. (2013). 1971: A Global History of the Creation of Bangladesh. Harvard University Press. Sisson, R., & Rose, L. E. (1991). War and Secession: Pakistan, India, and the Creation of Bangladesh. University of California Press. Sobhan, R. (1982). The Crisis of External Dependence: The Political Economy of Foreign Aid to Bangladesh. University Press Limited. Tahmina, Q. (2001). The UN and the Bangladesh Liberation War of 1971: Interventions and Consequences. Journal of International Affairs, 55(2), 453-469.UN Doc, S/10410, Para 6-10. UN Doc, S/PV/1606, Para 1-371, 5 December, 1971. UN Doc, S/10416, 4 December, 1971. UN Doc, S/10417, 4 December, 1971. UN Doc, S/10418, 4 December, 1971. UN Doc, S/10419, 4 December, 1971. UN Doc, S/PV/1607, Para 1-234, 5 December, 1971. International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 22 UN Doc, S/10421, 5 December, 1971. UN Doc, S/10423, 5 December, 1971. UN Doc, S/10425, 5 December, 1971. UN Doc, S/PV/1608, Para 1-187, 6 December, 1971. UN Doc, S/10426, 6 December, 1971. UN Doc, S/10428, 6 December, 1971. UN Doc, S/10429, 6 December, 1971. UN Doc, A/L 647, 7 December 1971. UN Doc, A/L 647/Rev-1, 7 December 1971. UN Doc, A/L 648, 7 December 1971. UN General Assembly Resolution 2793, Vol- XXVI. UN Doc, S/PV/1611, 12 December 1971. UN Doc, S/10446, 12 December 1971. UN Doc, S/PV/1613, Para1-174, 13 December 1971. UN Doc, A/PV 2002, PP.130-146. UN Doc, A/PV 2003, PP.173-185. UN Doc, S/10451, 13 December 1971. UN Doc, S/PV/1614, Para1-49, 14 December 1971. View publication stats
+
+USER:
+What actions did the UN Secretary General, U Thant, take in response to the trial of Sheikh Mujibur Rahman in August 1971?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",True,40,22,8167,,601
+Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document],"I had to walk to the shop today and it was pouring down rain and it was freezing outside. I was dressed accordingly with a hat and a jacket, but I'm worried about getting sick. I've always heard that being outside in cold and wet weather results in colds. Will I get sick? I have a bit of a runny nose now.","Cold air cannot make you sick, but the odds of catching the common cold or influenza (the flu) are highest during the fall and winter. Although cold weather doesn't cause a cold or the flu, it can set the stage for certain factors that decrease your immunity and increase opportunities to catch these illnesses.1 This article explores the factors associated with cold weather that increase the chances of getting sick. There is some evidence to suggest that viruses spread more easily through cold, dry air. Temperature and humidity, therefore, may affect your risk of catching a virus. When it is cold outside, the air is drier both outdoors and inside (due to heating), drying out mucous membranes and making it easier for germs to take hold. The nose is an ideal host for many viruses due to its cooler temperature. The typical core body temperature is 98.6 degrees F, but the nasal cavity temperature is lower at 91.4 degrees F. Research suggests that rhinoviruses (viruses that cause the common cold) do not replicate efficiently at body temperature, but the cooler temperature in the nose may make it an ideal breeding ground for viruses.2 One study suggests colder temperatures on their own do not increase the spread of colds and flu, but temperature and humidity fluctuations do. Researchers cross-referenced confirmed cases of rhinovirus with weather data over a set period of time and discovered that decreases in either temperature or humidity over a three-day period increased the risk of rhinovirus infections.3 The study, which involved 892 men in the Finnish military, also suggests that breathing cold air may contribute to the spread of infection into the lungs. This is based on earlier research that found lung temperature can be lowered by inhaling cold air. However, researchers also noted that the risk of rhinovirus infection is reduced at subfreezing temperatures and higher humidity.3 Warmer air does not necessarily kill viruses, either, as is evidenced by the spread of colds and flu in tropical areas where it does not get cold. Cold and flu cases are more prevalent in tropical climates during the rainy season. This is likely due to people spending more time indoors when it's raining, putting them in closer contact with others than during the dry season. Reduced Immune Function People may also be more prone to catching a cold or flu in the winter due to lower immunity. Fewer daylight hours and less time spent outside mean less exposure to sunlight, which the body uses to make vitamin D. In addition, lack of activity during cold weather may also mean reduced immunity. Vitamin D Vitamin D plays a critical role in the immune system helping to keep you healthy. Vitamin D deficiency is linked to an increased risk of viral infections, including those in the respiratory tract.5 Researchers are studying whether vitamin D supplements can help improve immunity when vitamin D levels are low. A review of 25 studies concluded that vitamin D supplementation was safe and it protected against acute respiratory tract infection. People who were very vitamin D deficient and those not receiving high single doses of vitamin D experienced the most benefit.6 Lack of Exercise People also tend to be less active in cold weather. While it is not clear exactly if or how exercise increases your immunity to certain illnesses, and no solid evidence, there are several theories, about exercise, such as:7 It improves circulation, allowing white blood cells to detect and fight an infection faster. It increases body temperature during and right after a workout, which may work like a fever to prevent bacteria from growing. It may help to flush bacteria from the lungs and airways, reducing your chances of getting sick. It lowers levels of stress hormones, which may protect against illness. Close Contact During Colder Months Viruses rely on the cells of other organisms to live and replicate. They are transmitted from host to host when infected respiratory secretions make their way into the mucous membranes of a healthy person. How transmission occurs may include:8 Direct person-to-person contact, such as hugging, kissing, or shaking hands Inhaling small droplets in the air from a sneeze or cough Touching something that has the virus on it (like a doorknob, drinking glass, utensils, or toys) and then touching your mouth, nose, or eyes It logically follows, then, that the closer you are to people and the more you share a space, the more likely transmission is. In the winter, many people tend to take their outdoor activities inside. For example: School recess being held in a gym, rather than outside People walk around crowded shopping centers rather than on a track or neighborhood People staying indoors more hours of the day This close contact during colder months increases the likelihood of passing germs. Protection From Cold and Flu The most important thing to remember during cold and flu season is to protect yourself and stop the spread of these germs when you are around other people. Steps you can take to prevent cold and flu include:98 Wash your hands often or use an alcohol-based hand sanitizer if soap and water aren't available. Avoid close contact with people who are sick. Stay home when you are sick. Cover your mouth and nose with a tissue or the inside of your elbow when you cough or sneeze. Wear a face mask in crowded places. Try to avoid touching your eyes, nose, or mouth as much as possible, since that is how most respiratory germs enter the body. Clean and disinfect frequently touched surfaces at home, work, or school, especially when someone is sick. Get your yearly flu vaccine and any other recommended vaccines. Get enough sleep. Exercise regularly. Drink plenty of fluids. Follow a healthy diet.","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. I had to walk to the shop today and it was pouring down rain and it was freezing outside. I was dressed accordingly with a hat and a jacket, but I'm worried about getting sick. I've always heard that being outside in cold and wet weather results in colds. Will I get sick? I have a bit of a runny nose now. Cold air cannot make you sick, but the odds of catching the common cold or influenza (the flu) are highest during the fall and winter. Although cold weather doesn't cause a cold or the flu, it can set the stage for certain factors that decrease your immunity and increase opportunities to catch these illnesses.1 This article explores the factors associated with cold weather that increase the chances of getting sick. There is some evidence to suggest that viruses spread more easily through cold, dry air. Temperature and humidity, therefore, may affect your risk of catching a virus. When it is cold outside, the air is drier both outdoors and inside (due to heating), drying out mucous membranes and making it easier for germs to take hold. The nose is an ideal host for many viruses due to its cooler temperature. The typical core body temperature is 98.6 degrees F, but the nasal cavity temperature is lower at 91.4 degrees F. Research suggests that rhinoviruses (viruses that cause the common cold) do not replicate efficiently at body temperature, but the cooler temperature in the nose may make it an ideal breeding ground for viruses.2 One study suggests colder temperatures on their own do not increase the spread of colds and flu, but temperature and humidity fluctuations do. Researchers cross-referenced confirmed cases of rhinovirus with weather data over a set period of time and discovered that decreases in either temperature or humidity over a three-day period increased the risk of rhinovirus infections.3 The study, which involved 892 men in the Finnish military, also suggests that breathing cold air may contribute to the spread of infection into the lungs. This is based on earlier research that found lung temperature can be lowered by inhaling cold air. However, researchers also noted that the risk of rhinovirus infection is reduced at subfreezing temperatures and higher humidity.3 Warmer air does not necessarily kill viruses, either, as is evidenced by the spread of colds and flu in tropical areas where it does not get cold. Cold and flu cases are more prevalent in tropical climates during the rainy season. This is likely due to people spending more time indoors when it's raining, putting them in closer contact with others than during the dry season. Reduced Immune Function People may also be more prone to catching a cold or flu in the winter due to lower immunity. Fewer daylight hours and less time spent outside mean less exposure to sunlight, which the body uses to make vitamin D. In addition, lack of activity during cold weather may also mean reduced immunity. Vitamin D Vitamin D plays a critical role in the immune system helping to keep you healthy. Vitamin D deficiency is linked to an increased risk of viral infections, including those in the respiratory tract.5 Researchers are studying whether vitamin D supplements can help improve immunity when vitamin D levels are low. A review of 25 studies concluded that vitamin D supplementation was safe and it protected against acute respiratory tract infection. People who were very vitamin D deficient and those not receiving high single doses of vitamin D experienced the most benefit.6 Lack of Exercise People also tend to be less active in cold weather. While it is not clear exactly if or how exercise increases your immunity to certain illnesses, and no solid evidence, there are several theories, about exercise, such as:7 It improves circulation, allowing white blood cells to detect and fight an infection faster. It increases body temperature during and right after a workout, which may work like a fever to prevent bacteria from growing. It may help to flush bacteria from the lungs and airways, reducing your chances of getting sick. It lowers levels of stress hormones, which may protect against illness. Close Contact During Colder Months Viruses rely on the cells of other organisms to live and replicate. They are transmitted from host to host when infected respiratory secretions make their way into the mucous membranes of a healthy person. How transmission occurs may include:8 Direct person-to-person contact, such as hugging, kissing, or shaking hands Inhaling small droplets in the air from a sneeze or cough Touching something that has the virus on it (like a doorknob, drinking glass, utensils, or toys) and then touching your mouth, nose, or eyes It logically follows, then, that the closer you are to people and the more you share a space, the more likely transmission is. In the winter, many people tend to take their outdoor activities inside. For example: School recess being held in a gym, rather than outside People walk around crowded shopping centers rather than on a track or neighborhood People staying indoors more hours of the day This close contact during colder months increases the likelihood of passing germs. Protection From Cold and Flu The most important thing to remember during cold and flu season is to protect yourself and stop the spread of these germs when you are around other people. Steps you can take to prevent cold and flu include:98 Wash your hands often or use an alcohol-based hand sanitizer if soap and water aren't available. Avoid close contact with people who are sick. Stay home when you are sick. Cover your mouth and nose with a tissue or the inside of your elbow when you cough or sneeze. Wear a face mask in crowded places. Try to avoid touching your eyes, nose, or mouth as much as possible, since that is how most respiratory germs enter the body. Clean and disinfect frequently touched surfaces at home, work, or school, especially when someone is sick. Get your yearly flu vaccine and any other recommended vaccines. Get enough sleep. Exercise regularly. Drink plenty of fluids. Follow a healthy diet. https://www.verywellhealth.com/does-cold-weather-cause-the-cold-or-flu-770379","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]
+
+EVIDENCE:
+Cold air cannot make you sick, but the odds of catching the common cold or influenza (the flu) are highest during the fall and winter. Although cold weather doesn't cause a cold or the flu, it can set the stage for certain factors that decrease your immunity and increase opportunities to catch these illnesses.1 This article explores the factors associated with cold weather that increase the chances of getting sick. There is some evidence to suggest that viruses spread more easily through cold, dry air. Temperature and humidity, therefore, may affect your risk of catching a virus. When it is cold outside, the air is drier both outdoors and inside (due to heating), drying out mucous membranes and making it easier for germs to take hold. The nose is an ideal host for many viruses due to its cooler temperature. The typical core body temperature is 98.6 degrees F, but the nasal cavity temperature is lower at 91.4 degrees F. Research suggests that rhinoviruses (viruses that cause the common cold) do not replicate efficiently at body temperature, but the cooler temperature in the nose may make it an ideal breeding ground for viruses.2 One study suggests colder temperatures on their own do not increase the spread of colds and flu, but temperature and humidity fluctuations do. Researchers cross-referenced confirmed cases of rhinovirus with weather data over a set period of time and discovered that decreases in either temperature or humidity over a three-day period increased the risk of rhinovirus infections.3 The study, which involved 892 men in the Finnish military, also suggests that breathing cold air may contribute to the spread of infection into the lungs. This is based on earlier research that found lung temperature can be lowered by inhaling cold air. However, researchers also noted that the risk of rhinovirus infection is reduced at subfreezing temperatures and higher humidity.3 Warmer air does not necessarily kill viruses, either, as is evidenced by the spread of colds and flu in tropical areas where it does not get cold. Cold and flu cases are more prevalent in tropical climates during the rainy season. This is likely due to people spending more time indoors when it's raining, putting them in closer contact with others than during the dry season. Reduced Immune Function People may also be more prone to catching a cold or flu in the winter due to lower immunity. Fewer daylight hours and less time spent outside mean less exposure to sunlight, which the body uses to make vitamin D. In addition, lack of activity during cold weather may also mean reduced immunity. Vitamin D Vitamin D plays a critical role in the immune system helping to keep you healthy. Vitamin D deficiency is linked to an increased risk of viral infections, including those in the respiratory tract.5 Researchers are studying whether vitamin D supplements can help improve immunity when vitamin D levels are low. A review of 25 studies concluded that vitamin D supplementation was safe and it protected against acute respiratory tract infection. People who were very vitamin D deficient and those not receiving high single doses of vitamin D experienced the most benefit.6 Lack of Exercise People also tend to be less active in cold weather. While it is not clear exactly if or how exercise increases your immunity to certain illnesses, and no solid evidence, there are several theories, about exercise, such as:7 It improves circulation, allowing white blood cells to detect and fight an infection faster. It increases body temperature during and right after a workout, which may work like a fever to prevent bacteria from growing. It may help to flush bacteria from the lungs and airways, reducing your chances of getting sick. It lowers levels of stress hormones, which may protect against illness. Close Contact During Colder Months Viruses rely on the cells of other organisms to live and replicate. They are transmitted from host to host when infected respiratory secretions make their way into the mucous membranes of a healthy person. How transmission occurs may include:8 Direct person-to-person contact, such as hugging, kissing, or shaking hands Inhaling small droplets in the air from a sneeze or cough Touching something that has the virus on it (like a doorknob, drinking glass, utensils, or toys) and then touching your mouth, nose, or eyes It logically follows, then, that the closer you are to people and the more you share a space, the more likely transmission is. In the winter, many people tend to take their outdoor activities inside. For example: School recess being held in a gym, rather than outside People walk around crowded shopping centers rather than on a track or neighborhood People staying indoors more hours of the day This close contact during colder months increases the likelihood of passing germs. Protection From Cold and Flu The most important thing to remember during cold and flu season is to protect yourself and stop the spread of these germs when you are around other people. Steps you can take to prevent cold and flu include:98 Wash your hands often or use an alcohol-based hand sanitizer if soap and water aren't available. Avoid close contact with people who are sick. Stay home when you are sick. Cover your mouth and nose with a tissue or the inside of your elbow when you cough or sneeze. Wear a face mask in crowded places. Try to avoid touching your eyes, nose, or mouth as much as possible, since that is how most respiratory germs enter the body. Clean and disinfect frequently touched surfaces at home, work, or school, especially when someone is sick. Get your yearly flu vaccine and any other recommended vaccines. Get enough sleep. Exercise regularly. Drink plenty of fluids. Follow a healthy diet.
+
+USER:
+I had to walk to the shop today and it was pouring down rain and it was freezing outside. I was dressed accordingly with a hat and a jacket, but I'm worried about getting sick. I've always heard that being outside in cold and wet weather results in colds. Will I get sick? I have a bit of a runny nose now.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,24,62,960,,278
+You must only use information contained in the included context block to answer the question. Your answer should be limited to no more than three paragraphs and no more than 200 words.,How did the Interim Final Rule change the Head Start rules that govern child safety?,"47. Before November 30, 2021, Head Start rules (45 C.F.R. § 1302.94(a)) governed volunteer health only to the following limited extent: (a) A program must ensure regular volunteers have been screened for appropriate communicable diseases in accordance with state, tribal or local laws. In the absence of state, tribal or local law, the Health Services Advisory Committee must be consulted regarding the need for such screenings. 48. But now the Interim Final Rule revises paragraph (a) to read as follows: (a) A program must ensure volunteers have been screened for appropriate communicable diseases in accordance with state, tribal or local laws. In the absence of state, tribal, or local law, the Health Services Advisory Committee must be consulted regarding the need for such screenings. (1) All volunteers in classrooms or working directly with children other than their own must be fully vaccinated for COVID-19, other than those volunteers: (i) For whom a vaccine is medically contraindicated; (ii) For whom medical necessity requires a delay in vaccination; or (iii) Who are legally entitled to an accommodation with regard to the COVID19 vaccination requirements based on an applicable Federal law. (2) Those granted an accommodation outlined in paragraph (a)(1) of this section must undergo SARS-CoV-2 testing for current infection at least weekly with those who have negative test results to remain in the classroom or work directly with children. Those with positive test results must be immediately excluded from the facility, so they are away from children and staff until they are determined to no longer be infectious. 86 Fed. Reg. at 68,101. 49. The new paragraphs require volunteers to be vaccinated, and to get tested weekly if granted an accommodation against being vaccinated. No such requirement existed in the prior version. 50. Before November 30, 2021, Head Start rules (45 C.F.R. § 1302.47(b)(5)) governed child safety only to the following limited extent: (5) Safety practices. All staff and consultants follow appropriate practices to keep children safe during all activities, including, at a minimum: (i) Reporting of suspected or known child abuse and neglect, including that staff comply with applicable federal, state, local, and tribal laws; (ii) Safe sleep practices, including ensuring that all sleeping arrangements for children under 18 months of age use firm mattresses or cots, as appropriate, and for children under 12 months, soft bedding materials or toys must not be used; (iii) Appropriate indoor and outdoor supervision of children at all times; (iv) Only releasing children to an authorized adult, and; (v) All standards of conduct described in § 1302.90(c). 9 51. The Interim Final Rule adds paragraph (b)(5)(vi) to read as follows: (vi) Masking, using masks recommended by CDC, for all individuals 2 years of age or older when there are two or more individuals in a vehicle owned, leased, or arranged by the Head Start program; indoors in a setting when Head Start services are provided; and for those not fully vaccinated, outdoors in crowded settings or during activities that involve sustained close contact with other people, except: (A) Children or adults when they are either eating or drinking; (B) Children when they are napping; (C) When a person cannot wear a mask, or cannot safely wear a mask, because of a disability as defined by the Americans with Disabilities Act; or (D) When a child’s health care provider advises an alternative face covering to accommodate the child’s special health care needs. 86 Fed. Reg. at 68,101. 52. The new paragraph requires masking. No such requirement existed in the prior version. 53. Paragraph (vi) applies to all “individuals 2 years of age or older” who are “indoors in a setting when Head Start services are provided” and “outdoors in crowded settings or during activities that involve sustained close contact with other people” According to the Interim Final Rule, “The Office of Head Start notes that being outdoors with children inherently includes sustained close contact for the purposes of caring for and supervising children.” 86 Fed. Reg. at 68,060. Thus, the Mask Mandate appears to also apply to parents who enter a Head Start facility (either when dropping off or picking up their child or at any other time) and to parents are outside with their children (either when dropping them off, picking them up, or at any other time), since being outside with children “inherently includes sustained close contact.”","System Instructions: You must only use information contained in the included context block to answer the question. Your answer should be limited to no more than three paragraphs and no more than 200 words. Context Block: 47. Before November 30, 2021, Head Start rules (45 C.F.R. § 1302.94(a)) governed volunteer health only to the following limited extent: (a) A program must ensure regular volunteers have been screened for appropriate communicable diseases in accordance with state, tribal or local laws. In the absence of state, tribal or local law, the Health Services Advisory Committee must be consulted regarding the need for such screenings. 48. But now the Interim Final Rule revises paragraph (a) to read as follows: (a) A program must ensure volunteers have been screened for appropriate communicable diseases in accordance with state, tribal or local laws. In the absence of state, tribal, or local law, the Health Services Advisory Committee must be consulted regarding the need for such screenings. (1) All volunteers in classrooms or working directly with children other than their own must be fully vaccinated for COVID-19, other than those volunteers: (i) For whom a vaccine is medically contraindicated; (ii) For whom medical necessity requires a delay in vaccination; or (iii) Who are legally entitled to an accommodation with regard to the COVID19 vaccination requirements based on an applicable Federal law. (2) Those granted an accommodation outlined in paragraph (a)(1) of this section must undergo SARS-CoV-2 testing for current infection at least weekly with those who have negative test results to remain in the classroom or work directly with children. Those with positive test results must be immediately excluded from the facility, so they are away from children and staff until they are determined to no longer be infectious. 86 Fed. Reg. at 68,101. 49. The new paragraphs require volunteers to be vaccinated, and to get tested weekly if granted an accommodation against being vaccinated. No such requirement existed in the prior version. 50. Before November 30, 2021, Head Start rules (45 C.F.R. § 1302.47(b)(5)) governed child safety only to the following limited extent: (5) Safety practices. All staff and consultants follow appropriate practices to keep children safe during all activities, including, at a minimum: (i) Reporting of suspected or known child abuse and neglect, including that staff comply with applicable federal, state, local, and tribal laws; (ii) Safe sleep practices, including ensuring that all sleeping arrangements for children under 18 months of age use firm mattresses or cots, as appropriate, and for children under 12 months, soft bedding materials or toys must not be used; (iii) Appropriate indoor and outdoor supervision of children at all times; (iv) Only releasing children to an authorized adult, and; (v) All standards of conduct described in § 1302.90(c). 9 51. The Interim Final Rule adds paragraph (b)(5)(vi) to read as follows: (vi) Masking, using masks recommended by CDC, for all individuals 2 years of age or older when there are two or more individuals in a vehicle owned, leased, or arranged by the Head Start program; indoors in a setting when Head Start services are provided; and for those not fully vaccinated, outdoors in crowded settings or during activities that involve sustained close contact with other people, except: (A) Children or adults when they are either eating or drinking; (B) Children when they are napping; (C) When a person cannot wear a mask, or cannot safely wear a mask, because of a disability as defined by the Americans with Disabilities Act; or (D) When a child’s health care provider advises an alternative face covering to accommodate the child’s special health care needs. 86 Fed. Reg. at 68,101. 52. The new paragraph requires masking. No such requirement existed in the prior version. 53. Paragraph (vi) applies to all “individuals 2 years of age or older” who are “indoors in a setting when Head Start services are provided” and “outdoors in crowded settings or during activities that involve sustained close contact with other people” According to the Interim Final Rule, “The Office of Head Start notes that being outdoors with children inherently includes sustained close contact for the purposes of caring for and supervising children.” 86 Fed. Reg. at 68,060. Thus, the Mask Mandate appears to also apply to parents who enter a Head Start facility (either when dropping off or picking up their child or at any other time) and to parents are outside with their children (either when dropping them off, picking them up, or at any other time), since being outside with children “inherently includes sustained close contact.” Question: How did the Interim Final Rule change the Head Start rules that govern child safety?","You must only use information contained in the included context block to answer the question. Your answer should be limited to no more than three paragraphs and no more than 200 words.
+
+EVIDENCE:
+47. Before November 30, 2021, Head Start rules (45 C.F.R. § 1302.94(a)) governed volunteer health only to the following limited extent: (a) A program must ensure regular volunteers have been screened for appropriate communicable diseases in accordance with state, tribal or local laws. In the absence of state, tribal or local law, the Health Services Advisory Committee must be consulted regarding the need for such screenings. 48. But now the Interim Final Rule revises paragraph (a) to read as follows: (a) A program must ensure volunteers have been screened for appropriate communicable diseases in accordance with state, tribal or local laws. In the absence of state, tribal, or local law, the Health Services Advisory Committee must be consulted regarding the need for such screenings. (1) All volunteers in classrooms or working directly with children other than their own must be fully vaccinated for COVID-19, other than those volunteers: (i) For whom a vaccine is medically contraindicated; (ii) For whom medical necessity requires a delay in vaccination; or (iii) Who are legally entitled to an accommodation with regard to the COVID19 vaccination requirements based on an applicable Federal law. (2) Those granted an accommodation outlined in paragraph (a)(1) of this section must undergo SARS-CoV-2 testing for current infection at least weekly with those who have negative test results to remain in the classroom or work directly with children. Those with positive test results must be immediately excluded from the facility, so they are away from children and staff until they are determined to no longer be infectious. 86 Fed. Reg. at 68,101. 49. The new paragraphs require volunteers to be vaccinated, and to get tested weekly if granted an accommodation against being vaccinated. No such requirement existed in the prior version. 50. Before November 30, 2021, Head Start rules (45 C.F.R. § 1302.47(b)(5)) governed child safety only to the following limited extent: (5) Safety practices. All staff and consultants follow appropriate practices to keep children safe during all activities, including, at a minimum: (i) Reporting of suspected or known child abuse and neglect, including that staff comply with applicable federal, state, local, and tribal laws; (ii) Safe sleep practices, including ensuring that all sleeping arrangements for children under 18 months of age use firm mattresses or cots, as appropriate, and for children under 12 months, soft bedding materials or toys must not be used; (iii) Appropriate indoor and outdoor supervision of children at all times; (iv) Only releasing children to an authorized adult, and; (v) All standards of conduct described in § 1302.90(c). 9 51. The Interim Final Rule adds paragraph (b)(5)(vi) to read as follows: (vi) Masking, using masks recommended by CDC, for all individuals 2 years of age or older when there are two or more individuals in a vehicle owned, leased, or arranged by the Head Start program; indoors in a setting when Head Start services are provided; and for those not fully vaccinated, outdoors in crowded settings or during activities that involve sustained close contact with other people, except: (A) Children or adults when they are either eating or drinking; (B) Children when they are napping; (C) When a person cannot wear a mask, or cannot safely wear a mask, because of a disability as defined by the Americans with Disabilities Act; or (D) When a child’s health care provider advises an alternative face covering to accommodate the child’s special health care needs. 86 Fed. Reg. at 68,101. 52. The new paragraph requires masking. No such requirement existed in the prior version. 53. Paragraph (vi) applies to all “individuals 2 years of age or older” who are “indoors in a setting when Head Start services are provided” and “outdoors in crowded settings or during activities that involve sustained close contact with other people” According to the Interim Final Rule, “The Office of Head Start notes that being outdoors with children inherently includes sustained close contact for the purposes of caring for and supervising children.” 86 Fed. Reg. at 68,060. Thus, the Mask Mandate appears to also apply to parents who enter a Head Start facility (either when dropping off or picking up their child or at any other time) and to parents are outside with their children (either when dropping them off, picking them up, or at any other time), since being outside with children “inherently includes sustained close contact.”
+
+USER:
+How did the Interim Final Rule change the Head Start rules that govern child safety?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,32,15,723,,28
+"{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]",My teen wants headphones for her birthday. She likes to listen to loud music and I'm worried about her hearing if she uses headphones. How can she safely use headphones?,"Is anyone listening? Monitoring your teen's headphone volume can help avoid hearing loss As a parent, do you often find yourself asking your child to remove their headphones? You may want to consider doing it even more often. If you’re the parent of a teenager, you likely have concerns about the link between headphones and hearing loss. Today, 1 in 5 teens will experience some form of hearing loss—a rate about 30% higher than it was 20 years ago. Many experts believe the escalation is due, in part, to increased use of headphones. According to James E. Foy, DO, an osteopathic pediatrician from Vallejo, California, listening through headphones at a high volume for extended periods of time can result in lifelong hearing loss for children and teens. “Even a mild hearing loss due to excessive noise could lead to developmental delays in speech and language,” he cautions. Doctors of Osteopathic Medicine, or DOs, look beyond your symptoms to understand how lifestyle and environmental factors affect your wellbeing. They listen and partner with you to help prevent injury and encourage your body’s natural tendency toward self-healing. How loud is too loud? Most MP3 players today can produce sounds up to 120 decibels, equivalent to a sound level at a rock concert. At that level, hearing loss can occur after only about an hour and 15 minutes, warns Dr. Foy. “I stress to my patients and their parents that if you can’t hear anything going on around you when listening to headphones, the decibel level is too high,” he says. Dr. Foy advises that people should not exceed 60% of maximum volume when listening through headphones. How long is too long? Duration of exposure to noise is also a major factor when examining headphones and hearing loss. “As a rule of thumb, you should only use MP3 devices at levels up to 60% of maximum volume for a total of 60 minutes a day,” says Dr. Foy. “The louder the volume, the shorter your duration should be. At maximum volume, you should listen for only about five minutes a day.” What are the signs of hearing loss? “The type of hearing loss due to headphone use is typically gradual, cumulative and without obvious warning signs,” explains Dr. Foy. “A hearing test and a medical examination are the only way to truly diagnose hearing damage.” However, if you or your child experiences any of the following symptoms, Dr. Foy recommends a visit to a physician immediately: Ringing, roaring, hissing or buzzing in the ear. Difficulty understanding speech in noisy places or places with poor acoustics. Muffled sounds and a feeling that your ear is plugged. Listening to the TV or radio at a higher volume than in the past. What is the treatment for hearing loss? “Unfortunately, the type of hearing loss caused by over exposure to very loud noise is irreversible, making prevention paramount,” says Dr. Foy. “Hearing aids and implants can help in amplifying sounds and making it easier to hear, but they are merely compensating for the damaged or nonworking parts of the ear.” How can I prevent hearing loss? “First and foremost, follow the 60/60 rule in regards to percentage of maximum volume and duration of time,” says Dr. Foy. Additionally, he suggests using older style, larger headphones that rest over the ear opening instead of earphones that are placed directly in your ear. “Whether using headphones or earphones, moderation is key,” says Dr. Foy. “Avoiding excessive use of listening devices altogether will go a long way in preventing hearing loss.”","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== My teen wants headphones for her birthday. She likes to listen to loud music and I'm worried about her hearing if she uses headphones. How can she safely use headphones? {passage 0} ========== Is anyone listening? Monitoring your teen's headphone volume can help avoid hearing loss As a parent, do you often find yourself asking your child to remove their headphones? You may want to consider doing it even more often. If you’re the parent of a teenager, you likely have concerns about the link between headphones and hearing loss. Today, 1 in 5 teens will experience some form of hearing loss—a rate about 30% higher than it was 20 years ago. Many experts believe the escalation is due, in part, to increased use of headphones. According to James E. Foy, DO, an osteopathic pediatrician from Vallejo, California, listening through headphones at a high volume for extended periods of time can result in lifelong hearing loss for children and teens. “Even a mild hearing loss due to excessive noise could lead to developmental delays in speech and language,” he cautions. Doctors of Osteopathic Medicine, or DOs, look beyond your symptoms to understand how lifestyle and environmental factors affect your wellbeing. They listen and partner with you to help prevent injury and encourage your body’s natural tendency toward self-healing. How loud is too loud? Most MP3 players today can produce sounds up to 120 decibels, equivalent to a sound level at a rock concert. At that level, hearing loss can occur after only about an hour and 15 minutes, warns Dr. Foy. “I stress to my patients and their parents that if you can’t hear anything going on around you when listening to headphones, the decibel level is too high,” he says. Dr. Foy advises that people should not exceed 60% of maximum volume when listening through headphones. How long is too long? Duration of exposure to noise is also a major factor when examining headphones and hearing loss. “As a rule of thumb, you should only use MP3 devices at levels up to 60% of maximum volume for a total of 60 minutes a day,” says Dr. Foy. “The louder the volume, the shorter your duration should be. At maximum volume, you should listen for only about five minutes a day.” What are the signs of hearing loss? “The type of hearing loss due to headphone use is typically gradual, cumulative and without obvious warning signs,” explains Dr. Foy. “A hearing test and a medical examination are the only way to truly diagnose hearing damage.” However, if you or your child experiences any of the following symptoms, Dr. Foy recommends a visit to a physician immediately: Ringing, roaring, hissing or buzzing in the ear. Difficulty understanding speech in noisy places or places with poor acoustics. Muffled sounds and a feeling that your ear is plugged. Listening to the TV or radio at a higher volume than in the past. What is the treatment for hearing loss? “Unfortunately, the type of hearing loss caused by over exposure to very loud noise is irreversible, making prevention paramount,” says Dr. Foy. “Hearing aids and implants can help in amplifying sounds and making it easier to hear, but they are merely compensating for the damaged or nonworking parts of the ear.” How can I prevent hearing loss? “First and foremost, follow the 60/60 rule in regards to percentage of maximum volume and duration of time,” says Dr. Foy. Additionally, he suggests using older style, larger headphones that rest over the ear opening instead of earphones that are placed directly in your ear. “Whether using headphones or earphones, moderation is key,” says Dr. Foy. “Avoiding excessive use of listening devices altogether will go a long way in preventing hearing loss.” https://osteopathic.org/what-is-osteopathic-medicine/headphones-hearing-loss/","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]
+
+EVIDENCE:
+Is anyone listening? Monitoring your teen's headphone volume can help avoid hearing loss As a parent, do you often find yourself asking your child to remove their headphones? You may want to consider doing it even more often. If you’re the parent of a teenager, you likely have concerns about the link between headphones and hearing loss. Today, 1 in 5 teens will experience some form of hearing loss—a rate about 30% higher than it was 20 years ago. Many experts believe the escalation is due, in part, to increased use of headphones. According to James E. Foy, DO, an osteopathic pediatrician from Vallejo, California, listening through headphones at a high volume for extended periods of time can result in lifelong hearing loss for children and teens. “Even a mild hearing loss due to excessive noise could lead to developmental delays in speech and language,” he cautions. Doctors of Osteopathic Medicine, or DOs, look beyond your symptoms to understand how lifestyle and environmental factors affect your wellbeing. They listen and partner with you to help prevent injury and encourage your body’s natural tendency toward self-healing. How loud is too loud? Most MP3 players today can produce sounds up to 120 decibels, equivalent to a sound level at a rock concert. At that level, hearing loss can occur after only about an hour and 15 minutes, warns Dr. Foy. “I stress to my patients and their parents that if you can’t hear anything going on around you when listening to headphones, the decibel level is too high,” he says. Dr. Foy advises that people should not exceed 60% of maximum volume when listening through headphones. How long is too long? Duration of exposure to noise is also a major factor when examining headphones and hearing loss. “As a rule of thumb, you should only use MP3 devices at levels up to 60% of maximum volume for a total of 60 minutes a day,” says Dr. Foy. “The louder the volume, the shorter your duration should be. At maximum volume, you should listen for only about five minutes a day.” What are the signs of hearing loss? “The type of hearing loss due to headphone use is typically gradual, cumulative and without obvious warning signs,” explains Dr. Foy. “A hearing test and a medical examination are the only way to truly diagnose hearing damage.” However, if you or your child experiences any of the following symptoms, Dr. Foy recommends a visit to a physician immediately: Ringing, roaring, hissing or buzzing in the ear. Difficulty understanding speech in noisy places or places with poor acoustics. Muffled sounds and a feeling that your ear is plugged. Listening to the TV or radio at a higher volume than in the past. What is the treatment for hearing loss? “Unfortunately, the type of hearing loss caused by over exposure to very loud noise is irreversible, making prevention paramount,” says Dr. Foy. “Hearing aids and implants can help in amplifying sounds and making it easier to hear, but they are merely compensating for the damaged or nonworking parts of the ear.” How can I prevent hearing loss? “First and foremost, follow the 60/60 rule in regards to percentage of maximum volume and duration of time,” says Dr. Foy. Additionally, he suggests using older style, larger headphones that rest over the ear opening instead of earphones that are placed directly in your ear. “Whether using headphones or earphones, moderation is key,” says Dr. Foy. “Avoiding excessive use of listening devices altogether will go a long way in preventing hearing loss.”
+
+USER:
+My teen wants headphones for her birthday. She likes to listen to loud music and I'm worried about her hearing if she uses headphones. How can she safely use headphones?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,26,30,592,,417
+Use only the Context Block to answer the Question. Your audience is people with limited tech knowledge.,What is the example provided for the importance of Alert Verification in Intrusion Detection Systems?,"Abstract This chapter describes security threats that systems face when they are connected to the Internet. We discuss their security requirements, potential security threats and different mechanisms to combat these. In addition, the text presents the two most popular protocols (SSL and its successor TLS) to secure data transmitted over the Internet. Finally, we describe wellknown applications such as Secure Shell (ssh) and Secure File Transfer Protocol (sftp) that provide a reasonable level of security for common tasks. They may be utilized as underlying building blocks to create secure, Internet enabled applications. In order to provide useful services or to allow people to perform tasks more conveniently, computer systems are attached to networks and get interconnected. This resulted in the world-wide collection of local and wide-area networks known as the Internet. Unfortunately, the extended access possibilities also entail increased security risks as it opens additional avenues for an attacker. For a closed, local system, the attacker was required to be physically present at the network in order to perform unauthorized actions. In the networked case, each host that can send packets to the victim can be potentially utilized. As certain services (such as web or name servers) need to be publicly available, each machine on the Internet might be the originator of malicious activity. This fact makes attacks very likely to happen on a regularly basis. The following text attempts to give a systematic overview of security requirements of Internetbased systems and potential means to satisfy them. We define properties of a secure system and provide a classification of potential threats to them. We also introduce mechanisms to defend against attacks that attempt to violate desired properties. The most widely used means to secure application data against tampering and eavesdropping, the Secure Sockets Layer (SSL) and its successor, the Transport Layer Security (TLS) protocol are discussed. Finally, we briefly describe popular application programs that can act as building blocks for securing custom applications. Before one can evaluate attacks against a system and decide on appropriate mechanisms against them, it is necessary to specify a security policy [23]. A security policy defines the desired properties for each part of a secure computer system. It is a decision that has to take into account the value of the assets that should be protected, the expected threats and the cost of proper protection mechanisms. A security policy that is sufficient for the data of a normal user at home may not be sufficient for bank applications, as these systems are obviously a more likely target and have to protect more valuable resources. Although often neglected, the formulation of an adequate security policy is a prerequisite before one can identify threats and appropriate mechanisms to face them. Security Attacks and Security Properties For the following discussion, we assume that the function of a system that is the target of an attack is to provide information. In general, there is a flow of data from a source (e.g. host, file, memory) to a destination (e.g. remote host, other file, user) over a communication channel (e.g. wire, data bus). The task of the security system is to restrict access to this information to only those parties (persons or processes) that are authorized to have access according to the security policy in use. In the case of an automation system which is remotely connected to the Internet, the information flow is from/to a control application that manages sensors and actuators via communication lines of the public Internet and the network of the automation system (e.g. a field-bus). The normal information flow and several categories of attacks that target it are shown in Figure 1 and explained below (according to [22]). 1. Interruption: An asset of the system gets destroyed or becomes unavailable. This attack targets the source or the communication channel and prevents information from reaching its intended target (e.g. cut the wire, overload the link so that the information gets dropped because of congestion). Attacks in this category attempt to perform a kind of denial-of-service (DOS). 2. Interception: An unauthorized party gets access to the information by eavesdropping into the communication channel (e.g. wiretapping). 3. Modification: The information is not only intercepted, but modified by an unauthorized party while in transit from the source to the destination. By tampering with the information, it is actively altered (e.g. modifying message content). 4. Fabrication: An attacker inserts counterfeit objects into the system without having the sender doing anything. When a previously intercepted object is inserted, this processes is called replaying. When the attacker pretends to be the legitimate source and inserts his desired information, the attack is called masquerading (e.g. replay an authentication message, add records to a file). The four classes of attacks listed above violate different security properties of the computer system. A security property describes a desired feature of a system with regards to a certain type of attack. A common classification following [5, 13] is listed below. • Confidentiality: This property covers the protection of transmitted data against its release to non-authorized parties. In addition to the protection of the content itself, the information flow should also be resistant against traffic analysis. Traffic analysis is used to gather other information than the transmitted values themselves from the data flow (e.g. timing data, frequency of messages). • Authentication: Authentication is concerned with making sure that the information is authentic. A system implementing the authentication property assures the recipient that the data is from the source that it claims to be. The system must make sure that no third party can masquerade successfully as another source. • Non-repudiation: This property describes the feature that prevents either sender or receiver from denying a transmitted message. When a message has been transferred, the sender can prove that it has been received. Similarly, the receiver can prove that the message has actually been sent. • Availability: Availability characterizes a system whose resources are always ready to be used. Whenever information needs to be transmitted, the communication channel is available and the receiver can cope with the incoming data. This property makes sure that attacks cannot prevent resources from being used for their intended purpose. • Integrity: Integrity protects transmitted information against modifications. This property assures that a single message reaches the receiver as it has left the sender, but integrity also extends to a stream of messages. It means that no messages are lost, duplicated or reordered and it makes sure that messages cannot be replayed. As destruction is also covered under this property, all data must arrive at the receiver. Integrity is not only important as a security property, but also as a property for network protocols. Message integrity must also be ensured in case of random faults, not only in case of malicious modifications. Security Mechanisms Different security mechanisms can be used to enforce the security properties defined in a given security policy. Depending on the anticipated attacks, different means have to be applied to satisfy the desired properties. We divide these measures against attacks into three different classes, namely attack prevention, attack avoidance and attack detection. Attack Prevention Attack prevention is a class of security mechanisms that contains ways of preventing or defending against certain attacks before they can actually reach and affect the target. An important element in this category is access control, a mechanism which can be applied at different levels such as the operating system, the network or the application layer. Access control [23] limits and regulates the access to critical resources. This is done by identifying or authenticating the party that requests a resource and checking its permissions against the rights specified for the demanded object. It is assumed that an attacker is not legitimately permitted to use the target object and is therefore denied access to the resource. As access is a prerequisite for an attack, any possible interference is prevented. The most common form of access control used in multi-user computer systems are access control lists for resources that are based on the user identity of the process that attempts to use them. The identity of a user is determined by an initial authentication process that usually requires a name and a password. The login process retrieves the stored copy of the password corresponding to the user name and compares it with the presented one. When both match, the system grants the user the appropriate user credentials. When a resource should be accessed, the system looks up the user and group in the access control list and grants or denies access as appropriate. An example of this kind of access control is a secure web server. A secure web server delivers certain resources only to clients that have authenticated themselves and that posses sufficient credentials for the desired resource. The authentication process is usually handled by the web client such as the Microsoft Internet Explorer or Mozilla by prompting the user for his name and password. The most important access control system at the network layer is a firewall [4]. The idea of a firewall is based on the separation of a trusted inside network of computers under single administrative control from a potential hostile outside network. The firewall is a central choke point that allows enforcement of access control for services that may run at the inside or outside. The firewall prevents attacks from the outside against the machines in the inside network by denying connection attempts from unauthorized parties located outside. In addition, a firewall may also be utilized to prevent users behind the firewall from using certain services that are outside (e.g. surfing web sites containing pornographic material). For certain installations, a single firewall is not suitable. Networks that consist of several server machines which need to be publicly accessible and workstations that should be completely protected against connections from the outside would benefit from a separation between these two groups. When an attacker compromises a server machine behind a single firewall, all other machines can be attacked from this new base without restrictions. To prevent this, one can use two firewalls and the concept of a demilitarized zone (DMZ) [4] in between as shown in Figure 2. In this setup, one firewall separates the outside network from a segment (DMZ) with the server machines while a second one separates this area from the rest of the network. The second firewall can be configured in a way that denies all incoming connection attempts. Whenever an intruder compromises a server, he is now unable to immediately attack a workstation located in the inside network. The following design goals for firewalls are identified in [4]. 1. All traffic from inside to outside, and vice versa, must pass through the firewall. This is achieved by physically blocking all access to the internal network except via the firewall. 2. Only authorized traffic, as defined by the local security policy, will be allowed to pass. 3. The firewall itself should be immune to penetration. This implies the use of a trusted system with a secure operating system. A trusted, secure operating system is often purpose-built, has heightened security features and only provides the minimal functionality necessary to run the desired applications. These goals can be reached by using a number of general techniques for controlling access. The most common is called service control and determines Internet services that can be accessed. Traffic on the Internet is currently filtered on basis of IP addresses and TCP/UDP port numbers. In addition, there may be proxy software that receives and interprets each service request before passing it on. Direction control is a simple mechanism to control the direction in which particular service requests may be initiated and permitted to flow through. User control grants access to a service based on user credentials similar to the technique used in a multi-user operating system. Controlling external users requires secure authentication over the network (e.g. such as provided in IPSec [10]). A more declarative approach in contrast to the operational variants mentioned above is behavior control. This technique determines how particular services are used. It may be utilized to filter e-mail to eliminate spam or to allow external access to only part of the local web pages. A summary of capabilities and limitations of firewalls is given in [22]. The following benefits can be expected. • A firewall defines a single choke point that keeps unauthorized users out of the protected network. The use of such a point also simplifies security management. • It provides a location for monitoring security related events. Audits, logs and alarms can be implemented on the firewall directly. In addition, it forms a convenient platform for some non-security related functions such as address translation and network management. • A firewall may serve as a platform to implement a virtual private network (e.g. by using IPSec). The list below enumerates the limits of the firewall access control mechanism. • A firewall cannot protect against attacks that bypass it, for example, via a direct dial-up link from the protected network to an ISP (Internet Service Provider). It also does not protect against internal threats from an inside hacker or an insider cooperating with an outside attacker. • A firewall does not help when attacks are against targets whose access has to be permitted. • It cannot protect against the transfer of virus-infected programs or files. It would be impossible, in practice, for the firewall to scan all incoming files and e-mails for viruses. Firewalls can be divided into two main categories. A Packet-Filtering Router, or short packet filter, is an extended router that applies certain rules to the packets which are forwarded. Usually, traffic in each direction (in- and outgoing) is checked against a rule set which determines whether a packet is permitted to continue or should be dropped. The packet filter rules operate on the header fields used by the underlying communication protocols, for the Internet almost always IP, TCP and UDP. Packet filters have the advantage that they are cheap as they can often be built on existing hardware. In addition, they offer a good performance for high traffic loads. An example for a packet filter is the iptables package which is implemented as part of the Linux 2.4 routing software. A different approach is followed by an Application-Level Gateway, also called proxy server. This type of firewall does not forward packets on the network layer but acts as a relay on the application level. The user contacts the gateway which in turn opens a connection to the intended target (on behalf of the user). A gateway completely separates the inside and outside networks at the network level and only provides a certain set of application services. This allows authentication of the user who requests a connection and session-oriented scanning of the exchanged traffic up to the application level data. This feature makes application gateways more secure than packet filters and offers a broader range of log facilities. On the downside, the overhead of such a setup may cause performance problems under heavy load. Another important element in the set of attack prevention mechanisms is system hardening. System hardening is used to describe all steps that are taken to make a computer system more secure. It usually refers to changing the default configuration to a more secure one, possible at the expense of ease-of-use. Vendors usually pre-install a large set of development tools and utilities, which, although beneficial to the new user, might also contain vulnerabilities. The initial configuration changes that are part of system hardening include the removal of services, applications and accounts that are not needed and the enabling of operating system auditing mechanisms (e.g., Event Log in Windows). Hardening also involves a vulnerability assessment of the system. Numerous open-source tools such as network (e.g., nmap [8]) and vulnerability scanners (e.g., Nessus [12]) can help to check a system for open ports and known vulnerabilities. This knowledge then helps to remedy these vulnerabilities and close unnecessary ports. An important and ongoing effort in system hardening is patching. Patching describes a method of updating a file that replaces only the parts being changed, rather than the entire file. It is used to replace parts of a (source or binary) file that contains a vulnerability that is exploitable by an attacker. To be able to patch, it is necessary that the system administrators keep up to date with security advisories that are issued by vendors to inform about security related problems in their products. Attack Avoidance Security mechanisms in this category assume that an intruder may access the desired resource but the information is modified in a way that makes it unusable for the attacker. The information is pre-processed at the sender before it is transmitted over the communication channel and postprocessed at the receiver. While the information is transported over the communication channel, it resists attacks by being nearly useless for an intruder. One notable exception are attacks against the availability of the information as an attacker could still interrupt the message. During the processing step at the receiver, modifications or errors that might have previously occurred can be detected (usually because the information can not be correctly reconstructed). When no modification has taken place, the information at the receiver is identical to the one at the sender before the pre-processing step. The most important member in this category is cryptography which is defined as the science of keeping messages secure [18]. It allows the sender to transform information into a random data stream from the point of view of an attacker but to have it recovered by an authorized receiver (see Figure 3). The original message is called plain text (sometimes clear text). The process of converting it through the application of some transformation rules into a format that hides its substance is called encryption. The corresponding disguised message is denoted cipher text and the operation of turning it back into clear text is called decryption. It is important to notice that the conversion from plain to cipher text has to be loss-less in order to be able to recover the original message at the receiver under all circumstances. The transformation rules are described by a cryptographic algorithm. The function of this algorithm is based on two main principles: substitution and transposition. In the case of substitution, each element of the plain text (e.g. bit, block) is mapped into another element of the used alphabet. Transposition describes the process where elements of the plain text are rearranged. Most systems involve multiple steps (called rounds) of transposition and substitution to be more resistant against cryptanalysis. Cryptanalysis is the science of breaking the cipher, i.e. discovering the substance of the message behind its disguise. When the transformation rules process the input elements one at a time the mechanism is called a stream cipher, in case of operating on fixed-sized input blocks it is called a block cipher. If the security of an algorithm is based on keeping the way how the algorithm works (i.e. the transformation rules) secret, it is called a restricted algorithm. Those algorithms are no longer of any interest today because they don’t allow standardization or public quality control. In addition, when a large group of users is involved, such an approach cannot be used. A single person leaving the group makes it necessary for everyone else to change the algorithm. Modern cryptosystems solve this problem by basing the ability of the receiver to recover encrypted information on the fact that he possesses a secret piece of information (usually called the key). Both encryption and decryption functions have to use a key and they are heavily dependent on it. When the security of the cryptosystem is completely based on the security of the key, the algorithm itself may be revealed. Although the security does not rely on the fact that the algorithm is unknown, the cryptographic function itself and the used key together with its length must be chosen with care. A common assumption is that the attacker has the fastest commercially available hardware at his disposal in his attempt to break the cipher text. The most common attack, called known plain text attack, is executed by obtaining cipher text together with its corresponding plain text. The encryption algorithm must be so complex that even if the code breaker is equipped with plenty of such pairs and powerful machines, it is infeasible for him to retrieve the key. An attack is infeasible when the cost of breaking the cipher exceeds the value of the information or the time it takes to break it exceeds the lifespan of the information. Given pairs of corresponding cipher and plain text, it is obvious that a simple key guessing algorithm will succeed after some time. The approach of successively trying different key values until the correct one is found is called brute force attack because no information about the algorithm is utilized whatsoever. In order to be useful, it is a necessary condition for an encryption algorithm that brute force attacks are infeasible. Depending on the keys that are used, one can distinguish two major cryptographic approaches - public and secret key cryptosystems. Secret Key Cryptography This is the kind of cryptography that has been used for the transmission of secret information for centuries, long before the advent of computers. These algorithms require that the sender and the receiver agree on a key before communication is started. It is common for this variant (which is also called single key or symmetric encryption) that a single secret key is shared between the sender and the receiver. It needs to be communicated in a secure way before the actual encrypted communication can start and has to remain secret as long as the information is to remain secret. Encryption is achieved by applying an agreed function to the plain text using the secret key. Decryption is performed by applying the inverse function using the same key. The classic example of a secret key block cipher which is widely deployed today is the Data Encryption Standard (DES) [6]. DES has been developed in 1977 by IBM and adopted as a standard by the US government for administrative and business use. Recently, it has been replaced by the Advanced Encryption Standard (AES - Rijndael) [1]. It is a block cipher that operates on 64-bit plain text blocks and utilizes a key with 56-bits length. The algorithm uses 16 rounds that are key dependent. During each round 48 key bits are selected and combined with the block that is encrypted. Then, the resulting block is piped through a substitution and a permutation phase (which use known values and are independent of the key) to make cryptanalysis harder. Although there is no known weakness of the DES algorithm itself, its security has been much debated. The small key length makes brute force attacks possible and several cases have occurred where DES protected information has been cracked. A suggested improvement called 3DES uses three rounds of the simple DES with three different keys. This extends the key length to 168 bits while still resting on the very secure DES base. A well known stream cipher that has been debated recently is RC4 [16] which has been developed by RSA. It is used to secure the transmission in wireless networks that follow the IEEE 802.11 standard and forms the core of the WEP (wired equivalent protection) mechanism. Although the cipher itself has not been broken, current implementations are flawed and reduce the security of RC4 down to a level where the used key can be recovered by statistical analysis within a few hours. Public Key Cryptography Since the advent of public key cryptography, the knowledge of the key that is used to encrypt a plain text also allowed the inverse process, the decryption of the cipher text. In 1976, this paradigm of cryptography was changed by Diffie and Hellman [7] when they described their public key approach. Public key cryptography utilizes two different keys, one called the public key, the other one called the private key. The public key is used to encrypt a message while the corresponding private key is used to do the opposite. Their innovation was the fact that it is infeasible to retrieve the private key given the public key. This makes it possible to remove the weakness of secure key transmission from the sender to the receiver. The receiver can simply generate his public/private key pair and announce the public key without fear. Anyone can obtain this key and use it to encrypt messages that only the receiver with his private key is able to decrypt. Mathematically, the process is based on the trap door of one-way functions. A one-way function is a function that is easy to compute but very hard to inverse. That means that given x it is easy to determine f(x) but given f(x) it is hard to get x. Hard is defined as computationally infeasible in the context of cryptographically strong one-way functions. Although it is obvious that some functions are easier to compute than their inverse (e.g. square of a value in contrast to its square root) there is no mathematical proof or definition of one-way functions. There are a number of problems that are considered difficult enough to act as one-way functions but it is more an agreement among crypto analysts than a rigorously defined set (e.g. factorization of large numbers). A one-way function is not directly usable for cryptography, but it becomes so when a trap door exists. A trap door is a mechanism that allows one to easily calculate x from f(x) when an additional information y is provided. A common misunderstanding about public key cryptography is thinking that it makes secret key systems obsolete, either because it is more secure or because it does not have the problem of secretly exchanging keys. As the security of a cryptosystem depends on the length of the used key and the utilized transformation rules, there is no automatic advantage of one approach over the other. Although the key exchange problem is elegantly solved with a public key, the process itself is very slow and has its own problems. Secret key systems are usually a factor of 1000 (see [18] for exact numbers) faster than their public key counterparts. Therefore, most communication is stilled secured using secret key systems and public key systems are only utilized for exchanging the secret key for later communication. This hybrid approach is the common design to benefit from the high-speed of conventional cryptography (which is often implemented directly in hardware) and from a secure key exchange. A problem in public key systems is the authenticity of the public key. An attacker may offer the sender his own public key and pretend that it origins from the legitimate receiver. The sender then uses the faked public key to perform his encryption and the attacker can simply decrypt the message using his private key. In order to thwart an attacker that attempts to substitute his public key for the victim’s one, certificates are used. A certificate combines user information with the user’s public key and the digital signature of a trusted third party that guarantees that the key belongs to the mentioned person. The trusted third party is usually called a certification authority (CA). The certificate of a CA itself is usually verified by a higher level CA that confirms that the CA’s certificate is genuine and contains its public key. The chain of third parties that verify their respective lower level CAs has to end at a certain point which is called the root CA. A user that wants to verify the authenticity of a public key and all involved CAs needs to obtain the self-signed certificate of the root CA via an external channel. Web browsers (e.g. Netscape Navigator, Internet Explorer) usually ship with a number of certificates of globally known root CAs. A framework that implements the distribution of certificates is called a public key infrastructure (PKI). An important protocol for key management is X.509 [25]. Another important issue is revocation, the invalidation of a certificate when the key has been compromised. The best known public key algorithm and textbook classic is RSA [17], named after its inventors Rivest, Shamir and Adleman at MIT. It is a block cipher that is still utilized for the majority of current systems, although the key length has been increased over recent years. This has put a heavier processing load on applications, a burden that has ramifications especially for sites doing electronic commerce. A competitive approach that promises similar security as RSA using far smaller key lengths is elliptic curve cryptography. However, as these systems are new and have not been subject to sustained cryptanalysis, the confidence level in them in not yet as high as in RSA. Authentication and Digital Signatures An interesting and important feature of public key cryptography is its possible use for authentication. In addition to making the information unusable for attackers, a sender may utilize cryptography to prove his identity to the receiver. This feature is realized by digital signatures. A digital signature must have similar properties as a normal handwritten signature. It must be hard to forge and it has to be bound to a certain document. In addition, one has to make sure that a valid signature cannot be used by an attacker to replay the same (or different) messages at a later time. A way to realize such a digital signature is by using the sender’s private key to encrypt a message. When the receiver is capable of successfully decrypting the cipher text with the sender’s public key, he can be sure that the message is authentic. This approach obviously requires a cryptosystem that allows encryption with the private key, but many (such as RSA) offer this option. It is easy for a receiver to verify that a message has been successfully decrypted when the plain text is in a human readable format. For binary data, a checksum or similar integrity checking footer can be added to verify a successful decryption. Replay attacks are prevented by adding a time-stamp to the message (e.g. Kerberos [11] uses timestamps to prevent that messages to the ticket granting service are replayed). Usually, the storage and processing overhead for encrypting a whole document is too high to be practical. This is solved by one-way hash functions. These are functions that map the content of a message onto a short value (called message digest). Similar to one-way functions it is difficult to create a message when given only the hash value itself. Instead of encrypting the whole message, it is enough to simply encrypt the message digest and send it together with the original message. The receiver can then apply the known hash function (e.g. MD5 [15]) to the document and compare it to the decrypted digest. When both values match, the messages is authentic. Attack and Intrusion Detection Attack detection assumes that an attacker can obtain access to his desired targets and is successful in violating a given security policy. Mechanisms in this class are based on the optimistic assumption that most of the time the information is transferred without interference. When undesired actions occur, attack detection has the task of reporting that something went wrong and then to react in an appropriate way. In addition, it is often desirable to identify the exact type of attack. An important facet of attack detection is recovery. Often it is enough to just report that malicious activity has been found, but some systems require that the effect of the attack has to be reverted or that an ongoing and discovered attack is stopped. On the one hand, attack detection has the advantage that it operates under the worst case assumption that the attacker gains access to the communication channel and is able to use or modify the resource. On the other hand, detection is not effective in providing confidentiality of information. When the security policy specifies that interception of information has a serious security impact, then attack detection is not an applicable mechanism. The most important members of the attack detection class, which have received an increasing amount of attention in the last few years, are intrusion detection systems (aka IDS). Intrusion Detection [2, 3] is the process of identifying and responding to malicious activities targeted at computing and network resources. This definition introduces the notion of intrusion detection as a process, which involves technology, people and tools. An intrusion detection system basically monitors and collects data from a target system that should be protected, processes and correlates the gathered information and initiate responses, when evidence for an intrusion is detected. IDS are traditionally classified as anomaly or signature-based. Signature-based systems act similar to virus scanners and look for known, suspicious patterns in their input data. Anomaly- based systems watch for deviations of actual from expected behavior and classify all ‘abnormal’ activities as malicious. The advantage of signature-based designs is the fact that they can identify attacks with an acceptable accuracy and tend to produce fewer false alarms (i.e. classifying an action as malicious when in fact it is not) than their anomaly-based cousins. The systems are more intuitive to build and easier to install and configure, especially in large production networks. Because of this, nearly all commercial systems and most deployed installations utilize signature-based detection. Although anomaly-based variants offer the advantage of being able to find prior unknown intrusions, the costs of having to deal with an order of magnitude more false alarms is often prohibitive. Depending on their source of input data, IDS can be classified as either network or host-based. Network-based systems collect data from network traffic (e.g. packets by network interfaces in promiscuous mode) while host-based systems monitor events at operating system level such as system calls or receive input from applications (e.g. via log files). Host-based designs can collect high quality data directly from the affected system and are not influenced by encrypted network traffic. Nevertheless, they often seriously impact performance of the machines they are running on. Network-based IDS, on the other hand, can be set up in a non-intrusive manner - often as an appliance box without interfering with the existing infrastructure. In many cases, this makes them the preferred choice. As many vendors and research centers have developed their own intrusion detection system versions, the IETF has created the intrusion detection working group [9] to coordinate international standardization efforts. The aim is to allow intrusion detection systems to share information and to communicate via well defined interfaces by proposing a generic architectural description and a message specification and exchange format (IDMEF). A major issue when deploying intrusion detection systems in large network installations are the huge numbers of alerts that are produced. These alerts have to be analyzed by system administrators who have to decide on the appropriate countermeasures. Given the current state-of-the-art of intrusion detection, however, many of the reported incidents are in fact false alerts. This makes the analysis process for the system administrator cumbersome and frustrating, resulting in the problem that IDSs are often disabled or ignored. To address this issue, two new techniques have been proposed: alert correlation and alert verification. Alert correlation is an analysis process that takes as input the alerts produced by intrusion detection systems and produces compact reports on the security status of the network under surveillance. By reducing the total number of individual alerts and aggregating related incidents into a single report, is is easier for a system administrator to distinguish actual and bogus alarms. In addition, alert correlation offers the benefit of recognizing higher-level patterns in an alert stream, helping the administrator to obtain a better overview of the activities on the network. Alert verification is a technique that is directly aimed at the problem that intrusion detection systems often have to analyze data without sufficient contextual information. The classic example is the scenario of a Code Red worm that attacks a Linux web server. It is a valid attack that is seen on the network, however, the alert that an IDS raises is of no use because the Linux server is not vulnerable (as Code Red can only exploit vulnerabilities in Microsoft’s IIS web server). The intrusion detection system would require more information to determine that this attack cannot possibly succeed than available from only looking at network packets. Alert verification is a term that is used for all mechanisms that use additional information or means to determine whether an attack was successful or not. In the example above, the alert verification mechanism could supply the IDS with the knowledge that the attacked Linux server is not vulnerable to a Code Red attack. As a consequence, the IDS can react accordingly and suppress the alert or reduce its priority and thus reduce the workload of the administrator. Secure Network Protocols After the general concepts and mechanisms of network security have been introduced, the following section concentrates on two actual instances of secure network protocols, namely the Secure Sockets Layer (SSL, [20]) and the Transport Layer Security (TLS, [24]) protocol. The idea of secure network protocols is to create an additional layer between the application and the transport/network layer to provide services for a secure end-to-end communication channel. TCP/IP are almost always used as transport/network layer protocols on the Internet and their task is to provide a reliable end-to-end connection between remote tasks on different machines that intend to communicate. The services on that level are usually directly utilized by application protocols to exchange data, for example HTTP (Hypertext Transfer Protocol) for web services. Unfortunately, the network layer transmits this data unencrypted, leaving it vulnerable to eavesdropping or tampering attacks. In addition, the authentication mechanisms of TCP/IP are only minimal, thereby allowing a malicious user to hijack connections and redirect traffic to his machine as well as to impersonate legitimate services. These threats are mitigated by secure network protocols that provide privacy and data integrity between two communicating applications by creating an encrypted and authenticated channel. SSL has emerged as the de-facto standard for secure network protocols. Originally developed by Netscape, its latest version SSL 3.0 is also the base for the standard proposed by the IETF under the name TLS. Both protocols are quite similar and share common ideas, but they unfortunately can not inter-operate. The following discussion will mainly concentrate on SSL and only briefly explain the extensions implemented in TLS. The SSL protocol [21] usually runs above TCP/IP (although it could use any transport protocol) and below higher-level protocols such as HTTP. It uses TCP/IP on behalf of the higher-level protocols, and in the process allows an SSL-enabled server to authenticate itself to an SSL-enabled client, allows the client to authenticate itself to the server, and allows both machines to establish an encrypted connection. These capabilities address fundamental concerns about communication over the Internet and other TCP/IP networks and give protection against message tampering, eavesdropping and spoofing. • SSL server authentication allows a user to confirm a server’s identity. SSL-enabled client software can use standard techniques of public-key cryptography to check that a server’s certificate and public key are valid and have been issued by a certification authority (CA) listed in the client’s list of trusted CAs. This confirmation might be important if the user, for example, is sending a credit card number over the network and wants to check the receiving server’s identity. • SSL client authentication allows a server to confirm a user’s identity. Using the same techniques as those used for server authentication, SSL-enabled server software can check that a client’s certificate and public key are valid and have been issued by a certification authority (CA) listed in the server’s list of trusted CAs. This confirmation might be important if the server, for example, is a bank sending confidential financial information to a customer and wants to check the recipient’s identity. • An encrypted SSL connection requires all information sent between a client and a server to be encrypted by the sending software and decrypted by the receiving software, thus providing a high degree of confidentiality. Confidentiality is important for both parties to any private transaction. In addition, all data sent over an encrypted SSL connection is protected with a mechanism for detecting tampering – that is, for automatically determining whether the data has been altered in transit. SSL uses X.509 certificates for authentication, RSA as its public-key cipher and one of RC4-128, RC2-128, DES, Triple DES or IDEA as its bulk symmetric cipher. The SSL protocol includes two sub-protocols, namely the SSL Record Protocol and the SSL Handshake Protocol. The SSL Record Protocol simply defines the format used to transmit data. The SSL Handshake Protocol (using the SSL Record Protocol) is utilized to exchange a series of messages between an SSL-enabled server and an SSL-enabled client when they first establish an SSL connection. This exchange of messages is designed to facilitate the following actions. • Authenticate the server to the client. • Allow the client and server to select the cryptographic algorithms, or ciphers, that they both support. • Optionally authenticate the client to the server. • Use public-key encryption techniques to generate shared secrets. • Establish an encrypted SSL connection based on the previously exchanged shared secret. The SSL Handshake Protocol is composed of two phases. Phase 1 deals with the selection of a cipher, the exchange of a secret key and the authentication of the server. Phase 2 handles client authentication, if requested and finishes the handshaking. After the handshake stage is complete, the data transfer between client and server begins. All messages during handshaking and after, are sent over the SSL Record Protocol layer. Optionally, session identifiers can be used to re-established a secure connection that has been previously set up. Figure 4 lists in a slightly simplified form the messages that are exchanged between the client C and the server S during a handshake when neither client authentication nor session identifiers are involved. In this figure, {data}key means that data has been encrypted with key. The message exchanges shows that the client first sends a challenge to the server which responds with a X.509 certificate containing its public key. The client then creates a secret key and uses RSA with the server’s public key to encrypt it, sending the result back to the server. Only the server is capable of decrypting that message with its private key and can retrieve the shared, secret key. I order to prove to the client that the secret key has been successfully decrypted, the server encrypts the client’s challenge with the secret key and returns it. When the client is able to decrypt this message and successfully retrieves the original challenge by using the secret key, it can be certain that the server has access to the private key corresponding to its certificate. From this point on, all communication is encrypted using the chosen cipher and the shared secret key. TLS uses the same two protocols shown above and a similar handshake mechanism. Nevertheless, the algorithms for calculating message authentication codes (MACs) and secret keys have been modified to make them cryptographically more secure. In addition, the constraints on padding a message up to the next block size have been relaxed for TLS. This leads to an incompatibility between both protocols. SSL/TLS is widely used to secure web and mail traffic. HTTP as well as the current mail protocols IMAP (Internet Message Access Protocol) and POP3 (post office protocol, version 3) transmit user credential information as well as application data unencrypted. By building them on top of a secure network protocol such as SSL/TLS, they can benefit from secured channels without modifications. The secure communication protocols simply utilize different well-known destination ports (443 for HTTPS, 993 for IMAPS and 995 for POP3S) than their insecure cousins. Secure Applications A variety of popular tools that allow access to remote hosts (such as telnet, rsh and rlogin) or that provide means for file transfer (such as rcp or ftp) exchange user credentials and data in plain text. This makes them vulnerable to eavesdropping, tampering and spoofing attacks. Although the tools mentioned above could have also been built upon SSL/TLS, a different protocol suite called Secure Shell (SSH) [19] has been developed which follows partial overlapping goals. The SSH Transport and User Authentication protocols have features similar to those of SSL/TLS. However, they are different in the following ways. • TLS server authentication is optional and the protocol supports fully anonymous operation, in which neither side is authenticated. As such connections are inherently vulnerable to man-in-the-middle attacks, SSH requires server authentication. • TLS does not provide the range of client authentication options that SSH does - public-key via RSA is the only option. • Most importantly, TLS does not have the extra features provided by the SSH Connection Protocol. The SSH Connection Protocol uses the underlying connection, aka secure tunnel, which has been established by the SSH Transport and User Authentication protocols between two hosts. It provides interactive login sessions, remote execution of commands and forwarded TCP/IP as well as X11 connections. All these terminal sessions and forwarded connections are realized as different logical channels that may be opened by either side on top of the secure tunnel. Channels are flow-controlled which means that no data may be sent to a channel until a message is received to indicate that window space is available. The current version of the SSH protocol is SSH 2. It represents a complete rewrite of SSH 1 and improves some of its structural weaknesses. As it encrypts packets in a different way and has abandoned the notion of server and host keys in favor of host keys only, the protocols are incompatible. For applications built from scratch, SSH 2 should always be the preferred choice. Using the means of logical channels for interactive login sessions and remote execution, a complete replacement for telnet, rsh and rlogin could be easily implemented. A popular site that lists open-source implementations which are freely available for many different platforms can be found under [14]. Recently, a secure file transfer (sftp) application has been developed that makes the use of regular FTP based programs obsolete. Notice that it is possible to tunnel arbitrary application traffic over a connection that has been previously set up by the SSH protocols. Similar to SSL/TLS, web and mail traffic could be securely transmitted over a SSH connection before reaching the server port at the destination host. The difference is that SSH requires that a secure tunnel is created in advance which is bound to a certain port at the destination host. The set up of this secure channel, however, requires that the client that is initiating the connection has to log into the server. Usually, this makes it necessary that the user has an account at the destination host. After the tunnel has been established, all traffic sent into by the client gets forwarded to the desired port at the target machine. Obviously, the connection is encrypted. In contrast to that, SSL/TLS connects directly to a certain point without prior logging into the destination host. The encryption is set up directly between the client and the service listening at the destination port without a prior redirection via the SSH server. The technique of tunneling application traffic is often utilized for mail transactions when the mail server does not support SSL/TLS directly (as users have accounts at the mail server anyway), but it is less common for web traffic. Summary This chapter discuses security threats that systems face when they are connected to the Internet. In order to achieve the security properties that are required by the security policy in use, three different classes of mechanisms can be adopted. The first is attack prevention, which attempts to stop the attacker before it can reach its desired goals. Such techniques fall into the category of access control and firewalls. The second approach aims to make the data unusable for unauthorized persons by applying cryptographic means. Secret key as well as public keys mechanism can be utilized. The third class of mechanisms contains attack detection approaches. They attempt to detect malicious behavior and recover after undesired activity has been identified. The text also covers secure network protocols and applications. SSL/TLS as well as SSH are introduced and its most common fields of operations are highlighted. These protocols form the base of securing traffic that is sent over the Internet in behalf of a variety of different applications.","Use only the Context Block to answer the Question. Your audience is people with limited tech knowledge. What is the example provided for the importance of Alert Verification in Intrusion Detection Systems? Abstract This chapter describes security threats that systems face when they are connected to the Internet. We discuss their security requirements, potential security threats and different mechanisms to combat these. In addition, the text presents the two most popular protocols (SSL and its successor TLS) to secure data transmitted over the Internet. Finally, we describe wellknown applications such as Secure Shell (ssh) and Secure File Transfer Protocol (sftp) that provide a reasonable level of security for common tasks. They may be utilized as underlying building blocks to create secure, Internet enabled applications. In order to provide useful services or to allow people to perform tasks more conveniently, computer systems are attached to networks and get interconnected. This resulted in the world-wide collection of local and wide-area networks known as the Internet. Unfortunately, the extended access possibilities also entail increased security risks as it opens additional avenues for an attacker. For a closed, local system, the attacker was required to be physically present at the network in order to perform unauthorized actions. In the networked case, each host that can send packets to the victim can be potentially utilized. As certain services (such as web or name servers) need to be publicly available, each machine on the Internet might be the originator of malicious activity. This fact makes attacks very likely to happen on a regularly basis. The following text attempts to give a systematic overview of security requirements of Internetbased systems and potential means to satisfy them. We define properties of a secure system and provide a classification of potential threats to them. We also introduce mechanisms to defend against attacks that attempt to violate desired properties. The most widely used means to secure application data against tampering and eavesdropping, the Secure Sockets Layer (SSL) and its successor, the Transport Layer Security (TLS) protocol are discussed. Finally, we briefly describe popular application programs that can act as building blocks for securing custom applications. Before one can evaluate attacks against a system and decide on appropriate mechanisms against them, it is necessary to specify a security policy [23]. A security policy defines the desired properties for each part of a secure computer system. It is a decision that has to take into account the value of the assets that should be protected, the expected threats and the cost of proper protection mechanisms. A security policy that is sufficient for the data of a normal user at home may not be sufficient for bank applications, as these systems are obviously a more likely target and have to protect more valuable resources. Although often neglected, the formulation of an adequate security policy is a prerequisite before one can identify threats and appropriate mechanisms to face them. Security Attacks and Security Properties For the following discussion, we assume that the function of a system that is the target of an attack is to provide information. In general, there is a flow of data from a source (e.g. host, file, memory) to a destination (e.g. remote host, other file, user) over a communication channel (e.g. wire, data bus). The task of the security system is to restrict access to this information to only those parties (persons or processes) that are authorized to have access according to the security policy in use. In the case of an automation system which is remotely connected to the Internet, the information flow is from/to a control application that manages sensors and actuators via communication lines of the public Internet and the network of the automation system (e.g. a field-bus). The normal information flow and several categories of attacks that target it are shown in Figure 1 and explained below (according to [22]). 1. Interruption: An asset of the system gets destroyed or becomes unavailable. This attack targets the source or the communication channel and prevents information from reaching its intended target (e.g. cut the wire, overload the link so that the information gets dropped because of congestion). Attacks in this category attempt to perform a kind of denial-of-service (DOS). 2. Interception: An unauthorized party gets access to the information by eavesdropping into the communication channel (e.g. wiretapping). 3. Modification: The information is not only intercepted, but modified by an unauthorized party while in transit from the source to the destination. By tampering with the information, it is actively altered (e.g. modifying message content). 4. Fabrication: An attacker inserts counterfeit objects into the system without having the sender doing anything. When a previously intercepted object is inserted, this processes is called replaying. When the attacker pretends to be the legitimate source and inserts his desired information, the attack is called masquerading (e.g. replay an authentication message, add records to a file). The four classes of attacks listed above violate different security properties of the computer system. A security property describes a desired feature of a system with regards to a certain type of attack. A common classification following [5, 13] is listed below. • Confidentiality: This property covers the protection of transmitted data against its release to non-authorized parties. In addition to the protection of the content itself, the information flow should also be resistant against traffic analysis. Traffic analysis is used to gather other information than the transmitted values themselves from the data flow (e.g. timing data, frequency of messages). • Authentication: Authentication is concerned with making sure that the information is authentic. A system implementing the authentication property assures the recipient that the data is from the source that it claims to be. The system must make sure that no third party can masquerade successfully as another source. • Non-repudiation: This property describes the feature that prevents either sender or receiver from denying a transmitted message. When a message has been transferred, the sender can prove that it has been received. Similarly, the receiver can prove that the message has actually been sent. • Availability: Availability characterizes a system whose resources are always ready to be used. Whenever information needs to be transmitted, the communication channel is available and the receiver can cope with the incoming data. This property makes sure that attacks cannot prevent resources from being used for their intended purpose. • Integrity: Integrity protects transmitted information against modifications. This property assures that a single message reaches the receiver as it has left the sender, but integrity also extends to a stream of messages. It means that no messages are lost, duplicated or reordered and it makes sure that messages cannot be replayed. As destruction is also covered under this property, all data must arrive at the receiver. Integrity is not only important as a security property, but also as a property for network protocols. Message integrity must also be ensured in case of random faults, not only in case of malicious modifications. Security Mechanisms Different security mechanisms can be used to enforce the security properties defined in a given security policy. Depending on the anticipated attacks, different means have to be applied to satisfy the desired properties. We divide these measures against attacks into three different classes, namely attack prevention, attack avoidance and attack detection. Attack Prevention Attack prevention is a class of security mechanisms that contains ways of preventing or defending against certain attacks before they can actually reach and affect the target. An important element in this category is access control, a mechanism which can be applied at different levels such as the operating system, the network or the application layer. Access control [23] limits and regulates the access to critical resources. This is done by identifying or authenticating the party that requests a resource and checking its permissions against the rights specified for the demanded object. It is assumed that an attacker is not legitimately permitted to use the target object and is therefore denied access to the resource. As access is a prerequisite for an attack, any possible interference is prevented. The most common form of access control used in multi-user computer systems are access control lists for resources that are based on the user identity of the process that attempts to use them. The identity of a user is determined by an initial authentication process that usually requires a name and a password. The login process retrieves the stored copy of the password corresponding to the user name and compares it with the presented one. When both match, the system grants the user the appropriate user credentials. When a resource should be accessed, the system looks up the user and group in the access control list and grants or denies access as appropriate. An example of this kind of access control is a secure web server. A secure web server delivers certain resources only to clients that have authenticated themselves and that posses sufficient credentials for the desired resource. The authentication process is usually handled by the web client such as the Microsoft Internet Explorer or Mozilla by prompting the user for his name and password. The most important access control system at the network layer is a firewall [4]. The idea of a firewall is based on the separation of a trusted inside network of computers under single administrative control from a potential hostile outside network. The firewall is a central choke point that allows enforcement of access control for services that may run at the inside or outside. The firewall prevents attacks from the outside against the machines in the inside network by denying connection attempts from unauthorized parties located outside. In addition, a firewall may also be utilized to prevent users behind the firewall from using certain services that are outside (e.g. surfing web sites containing pornographic material). For certain installations, a single firewall is not suitable. Networks that consist of several server machines which need to be publicly accessible and workstations that should be completely protected against connections from the outside would benefit from a separation between these two groups. When an attacker compromises a server machine behind a single firewall, all other machines can be attacked from this new base without restrictions. To prevent this, one can use two firewalls and the concept of a demilitarized zone (DMZ) [4] in between as shown in Figure 2. In this setup, one firewall separates the outside network from a segment (DMZ) with the server machines while a second one separates this area from the rest of the network. The second firewall can be configured in a way that denies all incoming connection attempts. Whenever an intruder compromises a server, he is now unable to immediately attack a workstation located in the inside network. The following design goals for firewalls are identified in [4]. 1. All traffic from inside to outside, and vice versa, must pass through the firewall. This is achieved by physically blocking all access to the internal network except via the firewall. 2. Only authorized traffic, as defined by the local security policy, will be allowed to pass. 3. The firewall itself should be immune to penetration. This implies the use of a trusted system with a secure operating system. A trusted, secure operating system is often purpose-built, has heightened security features and only provides the minimal functionality necessary to run the desired applications. These goals can be reached by using a number of general techniques for controlling access. The most common is called service control and determines Internet services that can be accessed. Traffic on the Internet is currently filtered on basis of IP addresses and TCP/UDP port numbers. In addition, there may be proxy software that receives and interprets each service request before passing it on. Direction control is a simple mechanism to control the direction in which particular service requests may be initiated and permitted to flow through. User control grants access to a service based on user credentials similar to the technique used in a multi-user operating system. Controlling external users requires secure authentication over the network (e.g. such as provided in IPSec [10]). A more declarative approach in contrast to the operational variants mentioned above is behavior control. This technique determines how particular services are used. It may be utilized to filter e-mail to eliminate spam or to allow external access to only part of the local web pages. A summary of capabilities and limitations of firewalls is given in [22]. The following benefits can be expected. • A firewall defines a single choke point that keeps unauthorized users out of the protected network. The use of such a point also simplifies security management. • It provides a location for monitoring security related events. Audits, logs and alarms can be implemented on the firewall directly. In addition, it forms a convenient platform for some non-security related functions such as address translation and network management. • A firewall may serve as a platform to implement a virtual private network (e.g. by using IPSec). The list below enumerates the limits of the firewall access control mechanism. • A firewall cannot protect against attacks that bypass it, for example, via a direct dial-up link from the protected network to an ISP (Internet Service Provider). It also does not protect against internal threats from an inside hacker or an insider cooperating with an outside attacker. • A firewall does not help when attacks are against targets whose access has to be permitted. • It cannot protect against the transfer of virus-infected programs or files. It would be impossible, in practice, for the firewall to scan all incoming files and e-mails for viruses. Firewalls can be divided into two main categories. A Packet-Filtering Router, or short packet filter, is an extended router that applies certain rules to the packets which are forwarded. Usually, traffic in each direction (in- and outgoing) is checked against a rule set which determines whether a packet is permitted to continue or should be dropped. The packet filter rules operate on the header fields used by the underlying communication protocols, for the Internet almost always IP, TCP and UDP. Packet filters have the advantage that they are cheap as they can often be built on existing hardware. In addition, they offer a good performance for high traffic loads. An example for a packet filter is the iptables package which is implemented as part of the Linux 2.4 routing software. A different approach is followed by an Application-Level Gateway, also called proxy server. This type of firewall does not forward packets on the network layer but acts as a relay on the application level. The user contacts the gateway which in turn opens a connection to the intended target (on behalf of the user). A gateway completely separates the inside and outside networks at the network level and only provides a certain set of application services. This allows authentication of the user who requests a connection and session-oriented scanning of the exchanged traffic up to the application level data. This feature makes application gateways more secure than packet filters and offers a broader range of log facilities. On the downside, the overhead of such a setup may cause performance problems under heavy load. Another important element in the set of attack prevention mechanisms is system hardening. System hardening is used to describe all steps that are taken to make a computer system more secure. It usually refers to changing the default configuration to a more secure one, possible at the expense of ease-of-use. Vendors usually pre-install a large set of development tools and utilities, which, although beneficial to the new user, might also contain vulnerabilities. The initial configuration changes that are part of system hardening include the removal of services, applications and accounts that are not needed and the enabling of operating system auditing mechanisms (e.g., Event Log in Windows). Hardening also involves a vulnerability assessment of the system. Numerous open-source tools such as network (e.g., nmap [8]) and vulnerability scanners (e.g., Nessus [12]) can help to check a system for open ports and known vulnerabilities. This knowledge then helps to remedy these vulnerabilities and close unnecessary ports. An important and ongoing effort in system hardening is patching. Patching describes a method of updating a file that replaces only the parts being changed, rather than the entire file. It is used to replace parts of a (source or binary) file that contains a vulnerability that is exploitable by an attacker. To be able to patch, it is necessary that the system administrators keep up to date with security advisories that are issued by vendors to inform about security related problems in their products. Attack Avoidance Security mechanisms in this category assume that an intruder may access the desired resource but the information is modified in a way that makes it unusable for the attacker. The information is pre-processed at the sender before it is transmitted over the communication channel and postprocessed at the receiver. While the information is transported over the communication channel, it resists attacks by being nearly useless for an intruder. One notable exception are attacks against the availability of the information as an attacker could still interrupt the message. During the processing step at the receiver, modifications or errors that might have previously occurred can be detected (usually because the information can not be correctly reconstructed). When no modification has taken place, the information at the receiver is identical to the one at the sender before the pre-processing step. The most important member in this category is cryptography which is defined as the science of keeping messages secure [18]. It allows the sender to transform information into a random data stream from the point of view of an attacker but to have it recovered by an authorized receiver (see Figure 3). The original message is called plain text (sometimes clear text). The process of converting it through the application of some transformation rules into a format that hides its substance is called encryption. The corresponding disguised message is denoted cipher text and the operation of turning it back into clear text is called decryption. It is important to notice that the conversion from plain to cipher text has to be loss-less in order to be able to recover the original message at the receiver under all circumstances. The transformation rules are described by a cryptographic algorithm. The function of this algorithm is based on two main principles: substitution and transposition. In the case of substitution, each element of the plain text (e.g. bit, block) is mapped into another element of the used alphabet. Transposition describes the process where elements of the plain text are rearranged. Most systems involve multiple steps (called rounds) of transposition and substitution to be more resistant against cryptanalysis. Cryptanalysis is the science of breaking the cipher, i.e. discovering the substance of the message behind its disguise. When the transformation rules process the input elements one at a time the mechanism is called a stream cipher, in case of operating on fixed-sized input blocks it is called a block cipher. If the security of an algorithm is based on keeping the way how the algorithm works (i.e. the transformation rules) secret, it is called a restricted algorithm. Those algorithms are no longer of any interest today because they don’t allow standardization or public quality control. In addition, when a large group of users is involved, such an approach cannot be used. A single person leaving the group makes it necessary for everyone else to change the algorithm. Modern cryptosystems solve this problem by basing the ability of the receiver to recover encrypted information on the fact that he possesses a secret piece of information (usually called the key). Both encryption and decryption functions have to use a key and they are heavily dependent on it. When the security of the cryptosystem is completely based on the security of the key, the algorithm itself may be revealed. Although the security does not rely on the fact that the algorithm is unknown, the cryptographic function itself and the used key together with its length must be chosen with care. A common assumption is that the attacker has the fastest commercially available hardware at his disposal in his attempt to break the cipher text. The most common attack, called known plain text attack, is executed by obtaining cipher text together with its corresponding plain text. The encryption algorithm must be so complex that even if the code breaker is equipped with plenty of such pairs and powerful machines, it is infeasible for him to retrieve the key. An attack is infeasible when the cost of breaking the cipher exceeds the value of the information or the time it takes to break it exceeds the lifespan of the information. Given pairs of corresponding cipher and plain text, it is obvious that a simple key guessing algorithm will succeed after some time. The approach of successively trying different key values until the correct one is found is called brute force attack because no information about the algorithm is utilized whatsoever. In order to be useful, it is a necessary condition for an encryption algorithm that brute force attacks are infeasible. Depending on the keys that are used, one can distinguish two major cryptographic approaches - public and secret key cryptosystems. Secret Key Cryptography This is the kind of cryptography that has been used for the transmission of secret information for centuries, long before the advent of computers. These algorithms require that the sender and the receiver agree on a key before communication is started. It is common for this variant (which is also called single key or symmetric encryption) that a single secret key is shared between the sender and the receiver. It needs to be communicated in a secure way before the actual encrypted communication can start and has to remain secret as long as the information is to remain secret. Encryption is achieved by applying an agreed function to the plain text using the secret key. Decryption is performed by applying the inverse function using the same key. The classic example of a secret key block cipher which is widely deployed today is the Data Encryption Standard (DES) [6]. DES has been developed in 1977 by IBM and adopted as a standard by the US government for administrative and business use. Recently, it has been replaced by the Advanced Encryption Standard (AES - Rijndael) [1]. It is a block cipher that operates on 64-bit plain text blocks and utilizes a key with 56-bits length. The algorithm uses 16 rounds that are key dependent. During each round 48 key bits are selected and combined with the block that is encrypted. Then, the resulting block is piped through a substitution and a permutation phase (which use known values and are independent of the key) to make cryptanalysis harder. Although there is no known weakness of the DES algorithm itself, its security has been much debated. The small key length makes brute force attacks possible and several cases have occurred where DES protected information has been cracked. A suggested improvement called 3DES uses three rounds of the simple DES with three different keys. This extends the key length to 168 bits while still resting on the very secure DES base. A well known stream cipher that has been debated recently is RC4 [16] which has been developed by RSA. It is used to secure the transmission in wireless networks that follow the IEEE 802.11 standard and forms the core of the WEP (wired equivalent protection) mechanism. Although the cipher itself has not been broken, current implementations are flawed and reduce the security of RC4 down to a level where the used key can be recovered by statistical analysis within a few hours. Public Key Cryptography Since the advent of public key cryptography, the knowledge of the key that is used to encrypt a plain text also allowed the inverse process, the decryption of the cipher text. In 1976, this paradigm of cryptography was changed by Diffie and Hellman [7] when they described their public key approach. Public key cryptography utilizes two different keys, one called the public key, the other one called the private key. The public key is used to encrypt a message while the corresponding private key is used to do the opposite. Their innovation was the fact that it is infeasible to retrieve the private key given the public key. This makes it possible to remove the weakness of secure key transmission from the sender to the receiver. The receiver can simply generate his public/private key pair and announce the public key without fear. Anyone can obtain this key and use it to encrypt messages that only the receiver with his private key is able to decrypt. Mathematically, the process is based on the trap door of one-way functions. A one-way function is a function that is easy to compute but very hard to inverse. That means that given x it is easy to determine f(x) but given f(x) it is hard to get x. Hard is defined as computationally infeasible in the context of cryptographically strong one-way functions. Although it is obvious that some functions are easier to compute than their inverse (e.g. square of a value in contrast to its square root) there is no mathematical proof or definition of one-way functions. There are a number of problems that are considered difficult enough to act as one-way functions but it is more an agreement among crypto analysts than a rigorously defined set (e.g. factorization of large numbers). A one-way function is not directly usable for cryptography, but it becomes so when a trap door exists. A trap door is a mechanism that allows one to easily calculate x from f(x) when an additional information y is provided. A common misunderstanding about public key cryptography is thinking that it makes secret key systems obsolete, either because it is more secure or because it does not have the problem of secretly exchanging keys. As the security of a cryptosystem depends on the length of the used key and the utilized transformation rules, there is no automatic advantage of one approach over the other. Although the key exchange problem is elegantly solved with a public key, the process itself is very slow and has its own problems. Secret key systems are usually a factor of 1000 (see [18] for exact numbers) faster than their public key counterparts. Therefore, most communication is stilled secured using secret key systems and public key systems are only utilized for exchanging the secret key for later communication. This hybrid approach is the common design to benefit from the high-speed of conventional cryptography (which is often implemented directly in hardware) and from a secure key exchange. A problem in public key systems is the authenticity of the public key. An attacker may offer the sender his own public key and pretend that it origins from the legitimate receiver. The sender then uses the faked public key to perform his encryption and the attacker can simply decrypt the message using his private key. In order to thwart an attacker that attempts to substitute his public key for the victim’s one, certificates are used. A certificate combines user information with the user’s public key and the digital signature of a trusted third party that guarantees that the key belongs to the mentioned person. The trusted third party is usually called a certification authority (CA). The certificate of a CA itself is usually verified by a higher level CA that confirms that the CA’s certificate is genuine and contains its public key. The chain of third parties that verify their respective lower level CAs has to end at a certain point which is called the root CA. A user that wants to verify the authenticity of a public key and all involved CAs needs to obtain the self-signed certificate of the root CA via an external channel. Web browsers (e.g. Netscape Navigator, Internet Explorer) usually ship with a number of certificates of globally known root CAs. A framework that implements the distribution of certificates is called a public key infrastructure (PKI). An important protocol for key management is X.509 [25]. Another important issue is revocation, the invalidation of a certificate when the key has been compromised. The best known public key algorithm and textbook classic is RSA [17], named after its inventors Rivest, Shamir and Adleman at MIT. It is a block cipher that is still utilized for the majority of current systems, although the key length has been increased over recent years. This has put a heavier processing load on applications, a burden that has ramifications especially for sites doing electronic commerce. A competitive approach that promises similar security as RSA using far smaller key lengths is elliptic curve cryptography. However, as these systems are new and have not been subject to sustained cryptanalysis, the confidence level in them in not yet as high as in RSA. Authentication and Digital Signatures An interesting and important feature of public key cryptography is its possible use for authentication. In addition to making the information unusable for attackers, a sender may utilize cryptography to prove his identity to the receiver. This feature is realized by digital signatures. A digital signature must have similar properties as a normal handwritten signature. It must be hard to forge and it has to be bound to a certain document. In addition, one has to make sure that a valid signature cannot be used by an attacker to replay the same (or different) messages at a later time. A way to realize such a digital signature is by using the sender’s private key to encrypt a message. When the receiver is capable of successfully decrypting the cipher text with the sender’s public key, he can be sure that the message is authentic. This approach obviously requires a cryptosystem that allows encryption with the private key, but many (such as RSA) offer this option. It is easy for a receiver to verify that a message has been successfully decrypted when the plain text is in a human readable format. For binary data, a checksum or similar integrity checking footer can be added to verify a successful decryption. Replay attacks are prevented by adding a time-stamp to the message (e.g. Kerberos [11] uses timestamps to prevent that messages to the ticket granting service are replayed). Usually, the storage and processing overhead for encrypting a whole document is too high to be practical. This is solved by one-way hash functions. These are functions that map the content of a message onto a short value (called message digest). Similar to one-way functions it is difficult to create a message when given only the hash value itself. Instead of encrypting the whole message, it is enough to simply encrypt the message digest and send it together with the original message. The receiver can then apply the known hash function (e.g. MD5 [15]) to the document and compare it to the decrypted digest. When both values match, the messages is authentic. Attack and Intrusion Detection Attack detection assumes that an attacker can obtain access to his desired targets and is successful in violating a given security policy. Mechanisms in this class are based on the optimistic assumption that most of the time the information is transferred without interference. When undesired actions occur, attack detection has the task of reporting that something went wrong and then to react in an appropriate way. In addition, it is often desirable to identify the exact type of attack. An important facet of attack detection is recovery. Often it is enough to just report that malicious activity has been found, but some systems require that the effect of the attack has to be reverted or that an ongoing and discovered attack is stopped. On the one hand, attack detection has the advantage that it operates under the worst case assumption that the attacker gains access to the communication channel and is able to use or modify the resource. On the other hand, detection is not effective in providing confidentiality of information. When the security policy specifies that interception of information has a serious security impact, then attack detection is not an applicable mechanism. The most important members of the attack detection class, which have received an increasing amount of attention in the last few years, are intrusion detection systems (aka IDS). Intrusion Detection [2, 3] is the process of identifying and responding to malicious activities targeted at computing and network resources. This definition introduces the notion of intrusion detection as a process, which involves technology, people and tools. An intrusion detection system basically monitors and collects data from a target system that should be protected, processes and correlates the gathered information and initiate responses, when evidence for an intrusion is detected. IDS are traditionally classified as anomaly or signature-based. Signature-based systems act similar to virus scanners and look for known, suspicious patterns in their input data. Anomaly- based systems watch for deviations of actual from expected behavior and classify all ‘abnormal’ activities as malicious. The advantage of signature-based designs is the fact that they can identify attacks with an acceptable accuracy and tend to produce fewer false alarms (i.e. classifying an action as malicious when in fact it is not) than their anomaly-based cousins. The systems are more intuitive to build and easier to install and configure, especially in large production networks. Because of this, nearly all commercial systems and most deployed installations utilize signature-based detection. Although anomaly-based variants offer the advantage of being able to find prior unknown intrusions, the costs of having to deal with an order of magnitude more false alarms is often prohibitive. Depending on their source of input data, IDS can be classified as either network or host-based. Network-based systems collect data from network traffic (e.g. packets by network interfaces in promiscuous mode) while host-based systems monitor events at operating system level such as system calls or receive input from applications (e.g. via log files). Host-based designs can collect high quality data directly from the affected system and are not influenced by encrypted network traffic. Nevertheless, they often seriously impact performance of the machines they are running on. Network-based IDS, on the other hand, can be set up in a non-intrusive manner - often as an appliance box without interfering with the existing infrastructure. In many cases, this makes them the preferred choice. As many vendors and research centers have developed their own intrusion detection system versions, the IETF has created the intrusion detection working group [9] to coordinate international standardization efforts. The aim is to allow intrusion detection systems to share information and to communicate via well defined interfaces by proposing a generic architectural description and a message specification and exchange format (IDMEF). A major issue when deploying intrusion detection systems in large network installations are the huge numbers of alerts that are produced. These alerts have to be analyzed by system administrators who have to decide on the appropriate countermeasures. Given the current state-of-the-art of intrusion detection, however, many of the reported incidents are in fact false alerts. This makes the analysis process for the system administrator cumbersome and frustrating, resulting in the problem that IDSs are often disabled or ignored. To address this issue, two new techniques have been proposed: alert correlation and alert verification. Alert correlation is an analysis process that takes as input the alerts produced by intrusion detection systems and produces compact reports on the security status of the network under surveillance. By reducing the total number of individual alerts and aggregating related incidents into a single report, is is easier for a system administrator to distinguish actual and bogus alarms. In addition, alert correlation offers the benefit of recognizing higher-level patterns in an alert stream, helping the administrator to obtain a better overview of the activities on the network. Alert verification is a technique that is directly aimed at the problem that intrusion detection systems often have to analyze data without sufficient contextual information. The classic example is the scenario of a Code Red worm that attacks a Linux web server. It is a valid attack that is seen on the network, however, the alert that an IDS raises is of no use because the Linux server is not vulnerable (as Code Red can only exploit vulnerabilities in Microsoft’s IIS web server). The intrusion detection system would require more information to determine that this attack cannot possibly succeed than available from only looking at network packets. Alert verification is a term that is used for all mechanisms that use additional information or means to determine whether an attack was successful or not. In the example above, the alert verification mechanism could supply the IDS with the knowledge that the attacked Linux server is not vulnerable to a Code Red attack. As a consequence, the IDS can react accordingly and suppress the alert or reduce its priority and thus reduce the workload of the administrator. Secure Network Protocols After the general concepts and mechanisms of network security have been introduced, the following section concentrates on two actual instances of secure network protocols, namely the Secure Sockets Layer (SSL, [20]) and the Transport Layer Security (TLS, [24]) protocol. The idea of secure network protocols is to create an additional layer between the application and the transport/network layer to provide services for a secure end-to-end communication channel. TCP/IP are almost always used as transport/network layer protocols on the Internet and their task is to provide a reliable end-to-end connection between remote tasks on different machines that intend to communicate. The services on that level are usually directly utilized by application protocols to exchange data, for example HTTP (Hypertext Transfer Protocol) for web services. Unfortunately, the network layer transmits this data unencrypted, leaving it vulnerable to eavesdropping or tampering attacks. In addition, the authentication mechanisms of TCP/IP are only minimal, thereby allowing a malicious user to hijack connections and redirect traffic to his machine as well as to impersonate legitimate services. These threats are mitigated by secure network protocols that provide privacy and data integrity between two communicating applications by creating an encrypted and authenticated channel. SSL has emerged as the de-facto standard for secure network protocols. Originally developed by Netscape, its latest version SSL 3.0 is also the base for the standard proposed by the IETF under the name TLS. Both protocols are quite similar and share common ideas, but they unfortunately can not inter-operate. The following discussion will mainly concentrate on SSL and only briefly explain the extensions implemented in TLS. The SSL protocol [21] usually runs above TCP/IP (although it could use any transport protocol) and below higher-level protocols such as HTTP. It uses TCP/IP on behalf of the higher-level protocols, and in the process allows an SSL-enabled server to authenticate itself to an SSL-enabled client, allows the client to authenticate itself to the server, and allows both machines to establish an encrypted connection. These capabilities address fundamental concerns about communication over the Internet and other TCP/IP networks and give protection against message tampering, eavesdropping and spoofing. • SSL server authentication allows a user to confirm a server’s identity. SSL-enabled client software can use standard techniques of public-key cryptography to check that a server’s certificate and public key are valid and have been issued by a certification authority (CA) listed in the client’s list of trusted CAs. This confirmation might be important if the user, for example, is sending a credit card number over the network and wants to check the receiving server’s identity. • SSL client authentication allows a server to confirm a user’s identity. Using the same techniques as those used for server authentication, SSL-enabled server software can check that a client’s certificate and public key are valid and have been issued by a certification authority (CA) listed in the server’s list of trusted CAs. This confirmation might be important if the server, for example, is a bank sending confidential financial information to a customer and wants to check the recipient’s identity. • An encrypted SSL connection requires all information sent between a client and a server to be encrypted by the sending software and decrypted by the receiving software, thus providing a high degree of confidentiality. Confidentiality is important for both parties to any private transaction. In addition, all data sent over an encrypted SSL connection is protected with a mechanism for detecting tampering – that is, for automatically determining whether the data has been altered in transit. SSL uses X.509 certificates for authentication, RSA as its public-key cipher and one of RC4-128, RC2-128, DES, Triple DES or IDEA as its bulk symmetric cipher. The SSL protocol includes two sub-protocols, namely the SSL Record Protocol and the SSL Handshake Protocol. The SSL Record Protocol simply defines the format used to transmit data. The SSL Handshake Protocol (using the SSL Record Protocol) is utilized to exchange a series of messages between an SSL-enabled server and an SSL-enabled client when they first establish an SSL connection. This exchange of messages is designed to facilitate the following actions. • Authenticate the server to the client. • Allow the client and server to select the cryptographic algorithms, or ciphers, that they both support. • Optionally authenticate the client to the server. • Use public-key encryption techniques to generate shared secrets. • Establish an encrypted SSL connection based on the previously exchanged shared secret. The SSL Handshake Protocol is composed of two phases. Phase 1 deals with the selection of a cipher, the exchange of a secret key and the authentication of the server. Phase 2 handles client authentication, if requested and finishes the handshaking. After the handshake stage is complete, the data transfer between client and server begins. All messages during handshaking and after, are sent over the SSL Record Protocol layer. Optionally, session identifiers can be used to re-established a secure connection that has been previously set up. Figure 4 lists in a slightly simplified form the messages that are exchanged between the client C and the server S during a handshake when neither client authentication nor session identifiers are involved. In this figure, {data}key means that data has been encrypted with key. The message exchanges shows that the client first sends a challenge to the server which responds with a X.509 certificate containing its public key. The client then creates a secret key and uses RSA with the server’s public key to encrypt it, sending the result back to the server. Only the server is capable of decrypting that message with its private key and can retrieve the shared, secret key. I order to prove to the client that the secret key has been successfully decrypted, the server encrypts the client’s challenge with the secret key and returns it. When the client is able to decrypt this message and successfully retrieves the original challenge by using the secret key, it can be certain that the server has access to the private key corresponding to its certificate. From this point on, all communication is encrypted using the chosen cipher and the shared secret key. TLS uses the same two protocols shown above and a similar handshake mechanism. Nevertheless, the algorithms for calculating message authentication codes (MACs) and secret keys have been modified to make them cryptographically more secure. In addition, the constraints on padding a message up to the next block size have been relaxed for TLS. This leads to an incompatibility between both protocols. SSL/TLS is widely used to secure web and mail traffic. HTTP as well as the current mail protocols IMAP (Internet Message Access Protocol) and POP3 (post office protocol, version 3) transmit user credential information as well as application data unencrypted. By building them on top of a secure network protocol such as SSL/TLS, they can benefit from secured channels without modifications. The secure communication protocols simply utilize different well-known destination ports (443 for HTTPS, 993 for IMAPS and 995 for POP3S) than their insecure cousins. Secure Applications A variety of popular tools that allow access to remote hosts (such as telnet, rsh and rlogin) or that provide means for file transfer (such as rcp or ftp) exchange user credentials and data in plain text. This makes them vulnerable to eavesdropping, tampering and spoofing attacks. Although the tools mentioned above could have also been built upon SSL/TLS, a different protocol suite called Secure Shell (SSH) [19] has been developed which follows partial overlapping goals. The SSH Transport and User Authentication protocols have features similar to those of SSL/TLS. However, they are different in the following ways. • TLS server authentication is optional and the protocol supports fully anonymous operation, in which neither side is authenticated. As such connections are inherently vulnerable to man-in-the-middle attacks, SSH requires server authentication. • TLS does not provide the range of client authentication options that SSH does - public-key via RSA is the only option. • Most importantly, TLS does not have the extra features provided by the SSH Connection Protocol. The SSH Connection Protocol uses the underlying connection, aka secure tunnel, which has been established by the SSH Transport and User Authentication protocols between two hosts. It provides interactive login sessions, remote execution of commands and forwarded TCP/IP as well as X11 connections. All these terminal sessions and forwarded connections are realized as different logical channels that may be opened by either side on top of the secure tunnel. Channels are flow-controlled which means that no data may be sent to a channel until a message is received to indicate that window space is available. The current version of the SSH protocol is SSH 2. It represents a complete rewrite of SSH 1 and improves some of its structural weaknesses. As it encrypts packets in a different way and has abandoned the notion of server and host keys in favor of host keys only, the protocols are incompatible. For applications built from scratch, SSH 2 should always be the preferred choice. Using the means of logical channels for interactive login sessions and remote execution, a complete replacement for telnet, rsh and rlogin could be easily implemented. A popular site that lists open-source implementations which are freely available for many different platforms can be found under [14]. Recently, a secure file transfer (sftp) application has been developed that makes the use of regular FTP based programs obsolete. Notice that it is possible to tunnel arbitrary application traffic over a connection that has been previously set up by the SSH protocols. Similar to SSL/TLS, web and mail traffic could be securely transmitted over a SSH connection before reaching the server port at the destination host. The difference is that SSH requires that a secure tunnel is created in advance which is bound to a certain port at the destination host. The set up of this secure channel, however, requires that the client that is initiating the connection has to log into the server. Usually, this makes it necessary that the user has an account at the destination host. After the tunnel has been established, all traffic sent into by the client gets forwarded to the desired port at the target machine. Obviously, the connection is encrypted. In contrast to that, SSL/TLS connects directly to a certain point without prior logging into the destination host. The encryption is set up directly between the client and the service listening at the destination port without a prior redirection via the SSH server. The technique of tunneling application traffic is often utilized for mail transactions when the mail server does not support SSL/TLS directly (as users have accounts at the mail server anyway), but it is less common for web traffic. Summary This chapter discuses security threats that systems face when they are connected to the Internet. In order to achieve the security properties that are required by the security policy in use, three different classes of mechanisms can be adopted. The first is attack prevention, which attempts to stop the attacker before it can reach its desired goals. Such techniques fall into the category of access control and firewalls. The second approach aims to make the data unusable for unauthorized persons by applying cryptographic means. Secret key as well as public keys mechanism can be utilized. The third class of mechanisms contains attack detection approaches. They attempt to detect malicious behavior and recover after undesired activity has been identified. The text also covers secure network protocols and applications. SSL/TLS as well as SSH are introduced and its most common fields of operations are highlighted. These protocols form the base of securing traffic that is sent over the Internet in behalf of a variety of different applications.","Use only the Context Block to answer the Question. Your audience is people with limited tech knowledge.
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+Abstract This chapter describes security threats that systems face when they are connected to the Internet. We discuss their security requirements, potential security threats and different mechanisms to combat these. In addition, the text presents the two most popular protocols (SSL and its successor TLS) to secure data transmitted over the Internet. Finally, we describe wellknown applications such as Secure Shell (ssh) and Secure File Transfer Protocol (sftp) that provide a reasonable level of security for common tasks. They may be utilized as underlying building blocks to create secure, Internet enabled applications. In order to provide useful services or to allow people to perform tasks more conveniently, computer systems are attached to networks and get interconnected. This resulted in the world-wide collection of local and wide-area networks known as the Internet. Unfortunately, the extended access possibilities also entail increased security risks as it opens additional avenues for an attacker. For a closed, local system, the attacker was required to be physically present at the network in order to perform unauthorized actions. In the networked case, each host that can send packets to the victim can be potentially utilized. As certain services (such as web or name servers) need to be publicly available, each machine on the Internet might be the originator of malicious activity. This fact makes attacks very likely to happen on a regularly basis. The following text attempts to give a systematic overview of security requirements of Internetbased systems and potential means to satisfy them. We define properties of a secure system and provide a classification of potential threats to them. We also introduce mechanisms to defend against attacks that attempt to violate desired properties. The most widely used means to secure application data against tampering and eavesdropping, the Secure Sockets Layer (SSL) and its successor, the Transport Layer Security (TLS) protocol are discussed. Finally, we briefly describe popular application programs that can act as building blocks for securing custom applications. Before one can evaluate attacks against a system and decide on appropriate mechanisms against them, it is necessary to specify a security policy [23]. A security policy defines the desired properties for each part of a secure computer system. It is a decision that has to take into account the value of the assets that should be protected, the expected threats and the cost of proper protection mechanisms. A security policy that is sufficient for the data of a normal user at home may not be sufficient for bank applications, as these systems are obviously a more likely target and have to protect more valuable resources. Although often neglected, the formulation of an adequate security policy is a prerequisite before one can identify threats and appropriate mechanisms to face them. Security Attacks and Security Properties For the following discussion, we assume that the function of a system that is the target of an attack is to provide information. In general, there is a flow of data from a source (e.g. host, file, memory) to a destination (e.g. remote host, other file, user) over a communication channel (e.g. wire, data bus). The task of the security system is to restrict access to this information to only those parties (persons or processes) that are authorized to have access according to the security policy in use. In the case of an automation system which is remotely connected to the Internet, the information flow is from/to a control application that manages sensors and actuators via communication lines of the public Internet and the network of the automation system (e.g. a field-bus). The normal information flow and several categories of attacks that target it are shown in Figure 1 and explained below (according to [22]). 1. Interruption: An asset of the system gets destroyed or becomes unavailable. This attack targets the source or the communication channel and prevents information from reaching its intended target (e.g. cut the wire, overload the link so that the information gets dropped because of congestion). Attacks in this category attempt to perform a kind of denial-of-service (DOS). 2. Interception: An unauthorized party gets access to the information by eavesdropping into the communication channel (e.g. wiretapping). 3. Modification: The information is not only intercepted, but modified by an unauthorized party while in transit from the source to the destination. By tampering with the information, it is actively altered (e.g. modifying message content). 4. Fabrication: An attacker inserts counterfeit objects into the system without having the sender doing anything. When a previously intercepted object is inserted, this processes is called replaying. When the attacker pretends to be the legitimate source and inserts his desired information, the attack is called masquerading (e.g. replay an authentication message, add records to a file). The four classes of attacks listed above violate different security properties of the computer system. A security property describes a desired feature of a system with regards to a certain type of attack. A common classification following [5, 13] is listed below. • Confidentiality: This property covers the protection of transmitted data against its release to non-authorized parties. In addition to the protection of the content itself, the information flow should also be resistant against traffic analysis. Traffic analysis is used to gather other information than the transmitted values themselves from the data flow (e.g. timing data, frequency of messages). • Authentication: Authentication is concerned with making sure that the information is authentic. A system implementing the authentication property assures the recipient that the data is from the source that it claims to be. The system must make sure that no third party can masquerade successfully as another source. • Non-repudiation: This property describes the feature that prevents either sender or receiver from denying a transmitted message. When a message has been transferred, the sender can prove that it has been received. Similarly, the receiver can prove that the message has actually been sent. • Availability: Availability characterizes a system whose resources are always ready to be used. Whenever information needs to be transmitted, the communication channel is available and the receiver can cope with the incoming data. This property makes sure that attacks cannot prevent resources from being used for their intended purpose. • Integrity: Integrity protects transmitted information against modifications. This property assures that a single message reaches the receiver as it has left the sender, but integrity also extends to a stream of messages. It means that no messages are lost, duplicated or reordered and it makes sure that messages cannot be replayed. As destruction is also covered under this property, all data must arrive at the receiver. Integrity is not only important as a security property, but also as a property for network protocols. Message integrity must also be ensured in case of random faults, not only in case of malicious modifications. Security Mechanisms Different security mechanisms can be used to enforce the security properties defined in a given security policy. Depending on the anticipated attacks, different means have to be applied to satisfy the desired properties. We divide these measures against attacks into three different classes, namely attack prevention, attack avoidance and attack detection. Attack Prevention Attack prevention is a class of security mechanisms that contains ways of preventing or defending against certain attacks before they can actually reach and affect the target. An important element in this category is access control, a mechanism which can be applied at different levels such as the operating system, the network or the application layer. Access control [23] limits and regulates the access to critical resources. This is done by identifying or authenticating the party that requests a resource and checking its permissions against the rights specified for the demanded object. It is assumed that an attacker is not legitimately permitted to use the target object and is therefore denied access to the resource. As access is a prerequisite for an attack, any possible interference is prevented. The most common form of access control used in multi-user computer systems are access control lists for resources that are based on the user identity of the process that attempts to use them. The identity of a user is determined by an initial authentication process that usually requires a name and a password. The login process retrieves the stored copy of the password corresponding to the user name and compares it with the presented one. When both match, the system grants the user the appropriate user credentials. When a resource should be accessed, the system looks up the user and group in the access control list and grants or denies access as appropriate. An example of this kind of access control is a secure web server. A secure web server delivers certain resources only to clients that have authenticated themselves and that posses sufficient credentials for the desired resource. The authentication process is usually handled by the web client such as the Microsoft Internet Explorer or Mozilla by prompting the user for his name and password. The most important access control system at the network layer is a firewall [4]. The idea of a firewall is based on the separation of a trusted inside network of computers under single administrative control from a potential hostile outside network. The firewall is a central choke point that allows enforcement of access control for services that may run at the inside or outside. The firewall prevents attacks from the outside against the machines in the inside network by denying connection attempts from unauthorized parties located outside. In addition, a firewall may also be utilized to prevent users behind the firewall from using certain services that are outside (e.g. surfing web sites containing pornographic material). For certain installations, a single firewall is not suitable. Networks that consist of several server machines which need to be publicly accessible and workstations that should be completely protected against connections from the outside would benefit from a separation between these two groups. When an attacker compromises a server machine behind a single firewall, all other machines can be attacked from this new base without restrictions. To prevent this, one can use two firewalls and the concept of a demilitarized zone (DMZ) [4] in between as shown in Figure 2. In this setup, one firewall separates the outside network from a segment (DMZ) with the server machines while a second one separates this area from the rest of the network. The second firewall can be configured in a way that denies all incoming connection attempts. Whenever an intruder compromises a server, he is now unable to immediately attack a workstation located in the inside network. The following design goals for firewalls are identified in [4]. 1. All traffic from inside to outside, and vice versa, must pass through the firewall. This is achieved by physically blocking all access to the internal network except via the firewall. 2. Only authorized traffic, as defined by the local security policy, will be allowed to pass. 3. The firewall itself should be immune to penetration. This implies the use of a trusted system with a secure operating system. A trusted, secure operating system is often purpose-built, has heightened security features and only provides the minimal functionality necessary to run the desired applications. These goals can be reached by using a number of general techniques for controlling access. The most common is called service control and determines Internet services that can be accessed. Traffic on the Internet is currently filtered on basis of IP addresses and TCP/UDP port numbers. In addition, there may be proxy software that receives and interprets each service request before passing it on. Direction control is a simple mechanism to control the direction in which particular service requests may be initiated and permitted to flow through. User control grants access to a service based on user credentials similar to the technique used in a multi-user operating system. Controlling external users requires secure authentication over the network (e.g. such as provided in IPSec [10]). A more declarative approach in contrast to the operational variants mentioned above is behavior control. This technique determines how particular services are used. It may be utilized to filter e-mail to eliminate spam or to allow external access to only part of the local web pages. A summary of capabilities and limitations of firewalls is given in [22]. The following benefits can be expected. • A firewall defines a single choke point that keeps unauthorized users out of the protected network. The use of such a point also simplifies security management. • It provides a location for monitoring security related events. Audits, logs and alarms can be implemented on the firewall directly. In addition, it forms a convenient platform for some non-security related functions such as address translation and network management. • A firewall may serve as a platform to implement a virtual private network (e.g. by using IPSec). The list below enumerates the limits of the firewall access control mechanism. • A firewall cannot protect against attacks that bypass it, for example, via a direct dial-up link from the protected network to an ISP (Internet Service Provider). It also does not protect against internal threats from an inside hacker or an insider cooperating with an outside attacker. • A firewall does not help when attacks are against targets whose access has to be permitted. • It cannot protect against the transfer of virus-infected programs or files. It would be impossible, in practice, for the firewall to scan all incoming files and e-mails for viruses. Firewalls can be divided into two main categories. A Packet-Filtering Router, or short packet filter, is an extended router that applies certain rules to the packets which are forwarded. Usually, traffic in each direction (in- and outgoing) is checked against a rule set which determines whether a packet is permitted to continue or should be dropped. The packet filter rules operate on the header fields used by the underlying communication protocols, for the Internet almost always IP, TCP and UDP. Packet filters have the advantage that they are cheap as they can often be built on existing hardware. In addition, they offer a good performance for high traffic loads. An example for a packet filter is the iptables package which is implemented as part of the Linux 2.4 routing software. A different approach is followed by an Application-Level Gateway, also called proxy server. This type of firewall does not forward packets on the network layer but acts as a relay on the application level. The user contacts the gateway which in turn opens a connection to the intended target (on behalf of the user). A gateway completely separates the inside and outside networks at the network level and only provides a certain set of application services. This allows authentication of the user who requests a connection and session-oriented scanning of the exchanged traffic up to the application level data. This feature makes application gateways more secure than packet filters and offers a broader range of log facilities. On the downside, the overhead of such a setup may cause performance problems under heavy load. Another important element in the set of attack prevention mechanisms is system hardening. System hardening is used to describe all steps that are taken to make a computer system more secure. It usually refers to changing the default configuration to a more secure one, possible at the expense of ease-of-use. Vendors usually pre-install a large set of development tools and utilities, which, although beneficial to the new user, might also contain vulnerabilities. The initial configuration changes that are part of system hardening include the removal of services, applications and accounts that are not needed and the enabling of operating system auditing mechanisms (e.g., Event Log in Windows). Hardening also involves a vulnerability assessment of the system. Numerous open-source tools such as network (e.g., nmap [8]) and vulnerability scanners (e.g., Nessus [12]) can help to check a system for open ports and known vulnerabilities. This knowledge then helps to remedy these vulnerabilities and close unnecessary ports. An important and ongoing effort in system hardening is patching. Patching describes a method of updating a file that replaces only the parts being changed, rather than the entire file. It is used to replace parts of a (source or binary) file that contains a vulnerability that is exploitable by an attacker. To be able to patch, it is necessary that the system administrators keep up to date with security advisories that are issued by vendors to inform about security related problems in their products. Attack Avoidance Security mechanisms in this category assume that an intruder may access the desired resource but the information is modified in a way that makes it unusable for the attacker. The information is pre-processed at the sender before it is transmitted over the communication channel and postprocessed at the receiver. While the information is transported over the communication channel, it resists attacks by being nearly useless for an intruder. One notable exception are attacks against the availability of the information as an attacker could still interrupt the message. During the processing step at the receiver, modifications or errors that might have previously occurred can be detected (usually because the information can not be correctly reconstructed). When no modification has taken place, the information at the receiver is identical to the one at the sender before the pre-processing step. The most important member in this category is cryptography which is defined as the science of keeping messages secure [18]. It allows the sender to transform information into a random data stream from the point of view of an attacker but to have it recovered by an authorized receiver (see Figure 3). The original message is called plain text (sometimes clear text). The process of converting it through the application of some transformation rules into a format that hides its substance is called encryption. The corresponding disguised message is denoted cipher text and the operation of turning it back into clear text is called decryption. It is important to notice that the conversion from plain to cipher text has to be loss-less in order to be able to recover the original message at the receiver under all circumstances. The transformation rules are described by a cryptographic algorithm. The function of this algorithm is based on two main principles: substitution and transposition. In the case of substitution, each element of the plain text (e.g. bit, block) is mapped into another element of the used alphabet. Transposition describes the process where elements of the plain text are rearranged. Most systems involve multiple steps (called rounds) of transposition and substitution to be more resistant against cryptanalysis. Cryptanalysis is the science of breaking the cipher, i.e. discovering the substance of the message behind its disguise. When the transformation rules process the input elements one at a time the mechanism is called a stream cipher, in case of operating on fixed-sized input blocks it is called a block cipher. If the security of an algorithm is based on keeping the way how the algorithm works (i.e. the transformation rules) secret, it is called a restricted algorithm. Those algorithms are no longer of any interest today because they don’t allow standardization or public quality control. In addition, when a large group of users is involved, such an approach cannot be used. A single person leaving the group makes it necessary for everyone else to change the algorithm. Modern cryptosystems solve this problem by basing the ability of the receiver to recover encrypted information on the fact that he possesses a secret piece of information (usually called the key). Both encryption and decryption functions have to use a key and they are heavily dependent on it. When the security of the cryptosystem is completely based on the security of the key, the algorithm itself may be revealed. Although the security does not rely on the fact that the algorithm is unknown, the cryptographic function itself and the used key together with its length must be chosen with care. A common assumption is that the attacker has the fastest commercially available hardware at his disposal in his attempt to break the cipher text. The most common attack, called known plain text attack, is executed by obtaining cipher text together with its corresponding plain text. The encryption algorithm must be so complex that even if the code breaker is equipped with plenty of such pairs and powerful machines, it is infeasible for him to retrieve the key. An attack is infeasible when the cost of breaking the cipher exceeds the value of the information or the time it takes to break it exceeds the lifespan of the information. Given pairs of corresponding cipher and plain text, it is obvious that a simple key guessing algorithm will succeed after some time. The approach of successively trying different key values until the correct one is found is called brute force attack because no information about the algorithm is utilized whatsoever. In order to be useful, it is a necessary condition for an encryption algorithm that brute force attacks are infeasible. Depending on the keys that are used, one can distinguish two major cryptographic approaches - public and secret key cryptosystems. Secret Key Cryptography This is the kind of cryptography that has been used for the transmission of secret information for centuries, long before the advent of computers. These algorithms require that the sender and the receiver agree on a key before communication is started. It is common for this variant (which is also called single key or symmetric encryption) that a single secret key is shared between the sender and the receiver. It needs to be communicated in a secure way before the actual encrypted communication can start and has to remain secret as long as the information is to remain secret. Encryption is achieved by applying an agreed function to the plain text using the secret key. Decryption is performed by applying the inverse function using the same key. The classic example of a secret key block cipher which is widely deployed today is the Data Encryption Standard (DES) [6]. DES has been developed in 1977 by IBM and adopted as a standard by the US government for administrative and business use. Recently, it has been replaced by the Advanced Encryption Standard (AES - Rijndael) [1]. It is a block cipher that operates on 64-bit plain text blocks and utilizes a key with 56-bits length. The algorithm uses 16 rounds that are key dependent. During each round 48 key bits are selected and combined with the block that is encrypted. Then, the resulting block is piped through a substitution and a permutation phase (which use known values and are independent of the key) to make cryptanalysis harder. Although there is no known weakness of the DES algorithm itself, its security has been much debated. The small key length makes brute force attacks possible and several cases have occurred where DES protected information has been cracked. A suggested improvement called 3DES uses three rounds of the simple DES with three different keys. This extends the key length to 168 bits while still resting on the very secure DES base. A well known stream cipher that has been debated recently is RC4 [16] which has been developed by RSA. It is used to secure the transmission in wireless networks that follow the IEEE 802.11 standard and forms the core of the WEP (wired equivalent protection) mechanism. Although the cipher itself has not been broken, current implementations are flawed and reduce the security of RC4 down to a level where the used key can be recovered by statistical analysis within a few hours. Public Key Cryptography Since the advent of public key cryptography, the knowledge of the key that is used to encrypt a plain text also allowed the inverse process, the decryption of the cipher text. In 1976, this paradigm of cryptography was changed by Diffie and Hellman [7] when they described their public key approach. Public key cryptography utilizes two different keys, one called the public key, the other one called the private key. The public key is used to encrypt a message while the corresponding private key is used to do the opposite. Their innovation was the fact that it is infeasible to retrieve the private key given the public key. This makes it possible to remove the weakness of secure key transmission from the sender to the receiver. The receiver can simply generate his public/private key pair and announce the public key without fear. Anyone can obtain this key and use it to encrypt messages that only the receiver with his private key is able to decrypt. Mathematically, the process is based on the trap door of one-way functions. A one-way function is a function that is easy to compute but very hard to inverse. That means that given x it is easy to determine f(x) but given f(x) it is hard to get x. Hard is defined as computationally infeasible in the context of cryptographically strong one-way functions. Although it is obvious that some functions are easier to compute than their inverse (e.g. square of a value in contrast to its square root) there is no mathematical proof or definition of one-way functions. There are a number of problems that are considered difficult enough to act as one-way functions but it is more an agreement among crypto analysts than a rigorously defined set (e.g. factorization of large numbers). A one-way function is not directly usable for cryptography, but it becomes so when a trap door exists. A trap door is a mechanism that allows one to easily calculate x from f(x) when an additional information y is provided. A common misunderstanding about public key cryptography is thinking that it makes secret key systems obsolete, either because it is more secure or because it does not have the problem of secretly exchanging keys. As the security of a cryptosystem depends on the length of the used key and the utilized transformation rules, there is no automatic advantage of one approach over the other. Although the key exchange problem is elegantly solved with a public key, the process itself is very slow and has its own problems. Secret key systems are usually a factor of 1000 (see [18] for exact numbers) faster than their public key counterparts. Therefore, most communication is stilled secured using secret key systems and public key systems are only utilized for exchanging the secret key for later communication. This hybrid approach is the common design to benefit from the high-speed of conventional cryptography (which is often implemented directly in hardware) and from a secure key exchange. A problem in public key systems is the authenticity of the public key. An attacker may offer the sender his own public key and pretend that it origins from the legitimate receiver. The sender then uses the faked public key to perform his encryption and the attacker can simply decrypt the message using his private key. In order to thwart an attacker that attempts to substitute his public key for the victim’s one, certificates are used. A certificate combines user information with the user’s public key and the digital signature of a trusted third party that guarantees that the key belongs to the mentioned person. The trusted third party is usually called a certification authority (CA). The certificate of a CA itself is usually verified by a higher level CA that confirms that the CA’s certificate is genuine and contains its public key. The chain of third parties that verify their respective lower level CAs has to end at a certain point which is called the root CA. A user that wants to verify the authenticity of a public key and all involved CAs needs to obtain the self-signed certificate of the root CA via an external channel. Web browsers (e.g. Netscape Navigator, Internet Explorer) usually ship with a number of certificates of globally known root CAs. A framework that implements the distribution of certificates is called a public key infrastructure (PKI). An important protocol for key management is X.509 [25]. Another important issue is revocation, the invalidation of a certificate when the key has been compromised. The best known public key algorithm and textbook classic is RSA [17], named after its inventors Rivest, Shamir and Adleman at MIT. It is a block cipher that is still utilized for the majority of current systems, although the key length has been increased over recent years. This has put a heavier processing load on applications, a burden that has ramifications especially for sites doing electronic commerce. A competitive approach that promises similar security as RSA using far smaller key lengths is elliptic curve cryptography. However, as these systems are new and have not been subject to sustained cryptanalysis, the confidence level in them in not yet as high as in RSA. Authentication and Digital Signatures An interesting and important feature of public key cryptography is its possible use for authentication. In addition to making the information unusable for attackers, a sender may utilize cryptography to prove his identity to the receiver. This feature is realized by digital signatures. A digital signature must have similar properties as a normal handwritten signature. It must be hard to forge and it has to be bound to a certain document. In addition, one has to make sure that a valid signature cannot be used by an attacker to replay the same (or different) messages at a later time. A way to realize such a digital signature is by using the sender’s private key to encrypt a message. When the receiver is capable of successfully decrypting the cipher text with the sender’s public key, he can be sure that the message is authentic. This approach obviously requires a cryptosystem that allows encryption with the private key, but many (such as RSA) offer this option. It is easy for a receiver to verify that a message has been successfully decrypted when the plain text is in a human readable format. For binary data, a checksum or similar integrity checking footer can be added to verify a successful decryption. Replay attacks are prevented by adding a time-stamp to the message (e.g. Kerberos [11] uses timestamps to prevent that messages to the ticket granting service are replayed). Usually, the storage and processing overhead for encrypting a whole document is too high to be practical. This is solved by one-way hash functions. These are functions that map the content of a message onto a short value (called message digest). Similar to one-way functions it is difficult to create a message when given only the hash value itself. Instead of encrypting the whole message, it is enough to simply encrypt the message digest and send it together with the original message. The receiver can then apply the known hash function (e.g. MD5 [15]) to the document and compare it to the decrypted digest. When both values match, the messages is authentic. Attack and Intrusion Detection Attack detection assumes that an attacker can obtain access to his desired targets and is successful in violating a given security policy. Mechanisms in this class are based on the optimistic assumption that most of the time the information is transferred without interference. When undesired actions occur, attack detection has the task of reporting that something went wrong and then to react in an appropriate way. In addition, it is often desirable to identify the exact type of attack. An important facet of attack detection is recovery. Often it is enough to just report that malicious activity has been found, but some systems require that the effect of the attack has to be reverted or that an ongoing and discovered attack is stopped. On the one hand, attack detection has the advantage that it operates under the worst case assumption that the attacker gains access to the communication channel and is able to use or modify the resource. On the other hand, detection is not effective in providing confidentiality of information. When the security policy specifies that interception of information has a serious security impact, then attack detection is not an applicable mechanism. The most important members of the attack detection class, which have received an increasing amount of attention in the last few years, are intrusion detection systems (aka IDS). Intrusion Detection [2, 3] is the process of identifying and responding to malicious activities targeted at computing and network resources. This definition introduces the notion of intrusion detection as a process, which involves technology, people and tools. An intrusion detection system basically monitors and collects data from a target system that should be protected, processes and correlates the gathered information and initiate responses, when evidence for an intrusion is detected. IDS are traditionally classified as anomaly or signature-based. Signature-based systems act similar to virus scanners and look for known, suspicious patterns in their input data. Anomaly- based systems watch for deviations of actual from expected behavior and classify all ‘abnormal’ activities as malicious. The advantage of signature-based designs is the fact that they can identify attacks with an acceptable accuracy and tend to produce fewer false alarms (i.e. classifying an action as malicious when in fact it is not) than their anomaly-based cousins. The systems are more intuitive to build and easier to install and configure, especially in large production networks. Because of this, nearly all commercial systems and most deployed installations utilize signature-based detection. Although anomaly-based variants offer the advantage of being able to find prior unknown intrusions, the costs of having to deal with an order of magnitude more false alarms is often prohibitive. Depending on their source of input data, IDS can be classified as either network or host-based. Network-based systems collect data from network traffic (e.g. packets by network interfaces in promiscuous mode) while host-based systems monitor events at operating system level such as system calls or receive input from applications (e.g. via log files). Host-based designs can collect high quality data directly from the affected system and are not influenced by encrypted network traffic. Nevertheless, they often seriously impact performance of the machines they are running on. Network-based IDS, on the other hand, can be set up in a non-intrusive manner - often as an appliance box without interfering with the existing infrastructure. In many cases, this makes them the preferred choice. As many vendors and research centers have developed their own intrusion detection system versions, the IETF has created the intrusion detection working group [9] to coordinate international standardization efforts. The aim is to allow intrusion detection systems to share information and to communicate via well defined interfaces by proposing a generic architectural description and a message specification and exchange format (IDMEF). A major issue when deploying intrusion detection systems in large network installations are the huge numbers of alerts that are produced. These alerts have to be analyzed by system administrators who have to decide on the appropriate countermeasures. Given the current state-of-the-art of intrusion detection, however, many of the reported incidents are in fact false alerts. This makes the analysis process for the system administrator cumbersome and frustrating, resulting in the problem that IDSs are often disabled or ignored. To address this issue, two new techniques have been proposed: alert correlation and alert verification. Alert correlation is an analysis process that takes as input the alerts produced by intrusion detection systems and produces compact reports on the security status of the network under surveillance. By reducing the total number of individual alerts and aggregating related incidents into a single report, is is easier for a system administrator to distinguish actual and bogus alarms. In addition, alert correlation offers the benefit of recognizing higher-level patterns in an alert stream, helping the administrator to obtain a better overview of the activities on the network. Alert verification is a technique that is directly aimed at the problem that intrusion detection systems often have to analyze data without sufficient contextual information. The classic example is the scenario of a Code Red worm that attacks a Linux web server. It is a valid attack that is seen on the network, however, the alert that an IDS raises is of no use because the Linux server is not vulnerable (as Code Red can only exploit vulnerabilities in Microsoft’s IIS web server). The intrusion detection system would require more information to determine that this attack cannot possibly succeed than available from only looking at network packets. Alert verification is a term that is used for all mechanisms that use additional information or means to determine whether an attack was successful or not. In the example above, the alert verification mechanism could supply the IDS with the knowledge that the attacked Linux server is not vulnerable to a Code Red attack. As a consequence, the IDS can react accordingly and suppress the alert or reduce its priority and thus reduce the workload of the administrator. Secure Network Protocols After the general concepts and mechanisms of network security have been introduced, the following section concentrates on two actual instances of secure network protocols, namely the Secure Sockets Layer (SSL, [20]) and the Transport Layer Security (TLS, [24]) protocol. The idea of secure network protocols is to create an additional layer between the application and the transport/network layer to provide services for a secure end-to-end communication channel. TCP/IP are almost always used as transport/network layer protocols on the Internet and their task is to provide a reliable end-to-end connection between remote tasks on different machines that intend to communicate. The services on that level are usually directly utilized by application protocols to exchange data, for example HTTP (Hypertext Transfer Protocol) for web services. Unfortunately, the network layer transmits this data unencrypted, leaving it vulnerable to eavesdropping or tampering attacks. In addition, the authentication mechanisms of TCP/IP are only minimal, thereby allowing a malicious user to hijack connections and redirect traffic to his machine as well as to impersonate legitimate services. These threats are mitigated by secure network protocols that provide privacy and data integrity between two communicating applications by creating an encrypted and authenticated channel. SSL has emerged as the de-facto standard for secure network protocols. Originally developed by Netscape, its latest version SSL 3.0 is also the base for the standard proposed by the IETF under the name TLS. Both protocols are quite similar and share common ideas, but they unfortunately can not inter-operate. The following discussion will mainly concentrate on SSL and only briefly explain the extensions implemented in TLS. The SSL protocol [21] usually runs above TCP/IP (although it could use any transport protocol) and below higher-level protocols such as HTTP. It uses TCP/IP on behalf of the higher-level protocols, and in the process allows an SSL-enabled server to authenticate itself to an SSL-enabled client, allows the client to authenticate itself to the server, and allows both machines to establish an encrypted connection. These capabilities address fundamental concerns about communication over the Internet and other TCP/IP networks and give protection against message tampering, eavesdropping and spoofing. • SSL server authentication allows a user to confirm a server’s identity. SSL-enabled client software can use standard techniques of public-key cryptography to check that a server’s certificate and public key are valid and have been issued by a certification authority (CA) listed in the client’s list of trusted CAs. This confirmation might be important if the user, for example, is sending a credit card number over the network and wants to check the receiving server’s identity. • SSL client authentication allows a server to confirm a user’s identity. Using the same techniques as those used for server authentication, SSL-enabled server software can check that a client’s certificate and public key are valid and have been issued by a certification authority (CA) listed in the server’s list of trusted CAs. This confirmation might be important if the server, for example, is a bank sending confidential financial information to a customer and wants to check the recipient’s identity. • An encrypted SSL connection requires all information sent between a client and a server to be encrypted by the sending software and decrypted by the receiving software, thus providing a high degree of confidentiality. Confidentiality is important for both parties to any private transaction. In addition, all data sent over an encrypted SSL connection is protected with a mechanism for detecting tampering – that is, for automatically determining whether the data has been altered in transit. SSL uses X.509 certificates for authentication, RSA as its public-key cipher and one of RC4-128, RC2-128, DES, Triple DES or IDEA as its bulk symmetric cipher. The SSL protocol includes two sub-protocols, namely the SSL Record Protocol and the SSL Handshake Protocol. The SSL Record Protocol simply defines the format used to transmit data. The SSL Handshake Protocol (using the SSL Record Protocol) is utilized to exchange a series of messages between an SSL-enabled server and an SSL-enabled client when they first establish an SSL connection. This exchange of messages is designed to facilitate the following actions. • Authenticate the server to the client. • Allow the client and server to select the cryptographic algorithms, or ciphers, that they both support. • Optionally authenticate the client to the server. • Use public-key encryption techniques to generate shared secrets. • Establish an encrypted SSL connection based on the previously exchanged shared secret. The SSL Handshake Protocol is composed of two phases. Phase 1 deals with the selection of a cipher, the exchange of a secret key and the authentication of the server. Phase 2 handles client authentication, if requested and finishes the handshaking. After the handshake stage is complete, the data transfer between client and server begins. All messages during handshaking and after, are sent over the SSL Record Protocol layer. Optionally, session identifiers can be used to re-established a secure connection that has been previously set up. Figure 4 lists in a slightly simplified form the messages that are exchanged between the client C and the server S during a handshake when neither client authentication nor session identifiers are involved. In this figure, {data}key means that data has been encrypted with key. The message exchanges shows that the client first sends a challenge to the server which responds with a X.509 certificate containing its public key. The client then creates a secret key and uses RSA with the server’s public key to encrypt it, sending the result back to the server. Only the server is capable of decrypting that message with its private key and can retrieve the shared, secret key. I order to prove to the client that the secret key has been successfully decrypted, the server encrypts the client’s challenge with the secret key and returns it. When the client is able to decrypt this message and successfully retrieves the original challenge by using the secret key, it can be certain that the server has access to the private key corresponding to its certificate. From this point on, all communication is encrypted using the chosen cipher and the shared secret key. TLS uses the same two protocols shown above and a similar handshake mechanism. Nevertheless, the algorithms for calculating message authentication codes (MACs) and secret keys have been modified to make them cryptographically more secure. In addition, the constraints on padding a message up to the next block size have been relaxed for TLS. This leads to an incompatibility between both protocols. SSL/TLS is widely used to secure web and mail traffic. HTTP as well as the current mail protocols IMAP (Internet Message Access Protocol) and POP3 (post office protocol, version 3) transmit user credential information as well as application data unencrypted. By building them on top of a secure network protocol such as SSL/TLS, they can benefit from secured channels without modifications. The secure communication protocols simply utilize different well-known destination ports (443 for HTTPS, 993 for IMAPS and 995 for POP3S) than their insecure cousins. Secure Applications A variety of popular tools that allow access to remote hosts (such as telnet, rsh and rlogin) or that provide means for file transfer (such as rcp or ftp) exchange user credentials and data in plain text. This makes them vulnerable to eavesdropping, tampering and spoofing attacks. Although the tools mentioned above could have also been built upon SSL/TLS, a different protocol suite called Secure Shell (SSH) [19] has been developed which follows partial overlapping goals. The SSH Transport and User Authentication protocols have features similar to those of SSL/TLS. However, they are different in the following ways. • TLS server authentication is optional and the protocol supports fully anonymous operation, in which neither side is authenticated. As such connections are inherently vulnerable to man-in-the-middle attacks, SSH requires server authentication. • TLS does not provide the range of client authentication options that SSH does - public-key via RSA is the only option. • Most importantly, TLS does not have the extra features provided by the SSH Connection Protocol. The SSH Connection Protocol uses the underlying connection, aka secure tunnel, which has been established by the SSH Transport and User Authentication protocols between two hosts. It provides interactive login sessions, remote execution of commands and forwarded TCP/IP as well as X11 connections. All these terminal sessions and forwarded connections are realized as different logical channels that may be opened by either side on top of the secure tunnel. Channels are flow-controlled which means that no data may be sent to a channel until a message is received to indicate that window space is available. The current version of the SSH protocol is SSH 2. It represents a complete rewrite of SSH 1 and improves some of its structural weaknesses. As it encrypts packets in a different way and has abandoned the notion of server and host keys in favor of host keys only, the protocols are incompatible. For applications built from scratch, SSH 2 should always be the preferred choice. Using the means of logical channels for interactive login sessions and remote execution, a complete replacement for telnet, rsh and rlogin could be easily implemented. A popular site that lists open-source implementations which are freely available for many different platforms can be found under [14]. Recently, a secure file transfer (sftp) application has been developed that makes the use of regular FTP based programs obsolete. Notice that it is possible to tunnel arbitrary application traffic over a connection that has been previously set up by the SSH protocols. Similar to SSL/TLS, web and mail traffic could be securely transmitted over a SSH connection before reaching the server port at the destination host. The difference is that SSH requires that a secure tunnel is created in advance which is bound to a certain port at the destination host. The set up of this secure channel, however, requires that the client that is initiating the connection has to log into the server. Usually, this makes it necessary that the user has an account at the destination host. After the tunnel has been established, all traffic sent into by the client gets forwarded to the desired port at the target machine. Obviously, the connection is encrypted. In contrast to that, SSL/TLS connects directly to a certain point without prior logging into the destination host. The encryption is set up directly between the client and the service listening at the destination port without a prior redirection via the SSH server. The technique of tunneling application traffic is often utilized for mail transactions when the mail server does not support SSL/TLS directly (as users have accounts at the mail server anyway), but it is less common for web traffic. Summary This chapter discuses security threats that systems face when they are connected to the Internet. In order to achieve the security properties that are required by the security policy in use, three different classes of mechanisms can be adopted. The first is attack prevention, which attempts to stop the attacker before it can reach its desired goals. Such techniques fall into the category of access control and firewalls. The second approach aims to make the data unusable for unauthorized persons by applying cryptographic means. Secret key as well as public keys mechanism can be utilized. The third class of mechanisms contains attack detection approaches. They attempt to detect malicious behavior and recover after undesired activity has been identified. The text also covers secure network protocols and applications. SSL/TLS as well as SSH are introduced and its most common fields of operations are highlighted. These protocols form the base of securing traffic that is sent over the Internet in behalf of a variety of different applications.
+
+USER:
+What is the example provided for the importance of Alert Verification in Intrusion Detection Systems?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,17,15,8085,,479
+"Answer in one complete sentence. Add the relevant quoted piece of text from the context document in italics, at the end of your response.","As per this Technology Transfer Agreement between Merck KGaA and Nitec Pharma, what responsibilities regarding clinical and technical development in Germany and Austria does Nitec Pharma agree to?","** TECHNOLOGY TRANSFER AGREEMENT ** Technology Transfer Agreement between Merck KGaA (“Merck”), Frankfurter Strasse 250, 64271 Darmstadt and Nitec Pharma AG (“Nitec Pharma”) Switzerland Preamble Merck has been marketing corticoids (Fortecortin, Decortin, Decortin H, Solu Decortin H) successfully – primarily in Germany – for many years. In order to support the corticoid business Merck started developing Prednison Night Time Release in 1998, which is a novel galenic formulation using the active agent prednison. For the treatment of rheumatoid arthritis (“RA”) the Project (as defined hereinafter) has not yet entered phase 3 of clinical testing. Merck due to limited resources and its focus on other business areas is unable to develop the Project until it is ready for marketing or to obtain a legal pharmaceutical licence for the Project. Merck therefore internally has decided to discontinue the Project. It now appears that Nitec Pharma may be able to resume the Project at its own cost and risk, see it through phase III clinical testing and obtain a license to market the Merchandise (as defined below) in Germany, Austria and other countries. In light of this development Merck is willing to transfer the Project to Nitec Pharma by turning over to Nitec Pharma all know-how acquired within the framework of and in connection with the Project and all pertinent industrial property rights. In particular Merck is willing to grant Nitec Pharma access to all data, which have accrued within the framework of the Project development and which are still to accrue pending the conclusion of the successful “Mutual Recognition Procedure”. As provided herein Nitec Pharma is willing to undertake to use all of its Commercially Reasonable Efforts (as defined below) to continue the clinical and technical development of the Project on its own, in particular using its own financial resources and at its own company risk and to obtain legal pharmaceutical approvals for relevant markets that have been identified by Nitec Pharma as promising markets and to confirm that Merck shall, under the terms specified in greater detail in section 6 hereof retain the right to market the Merchandise on an exclusive or non-exclusive basis in Germany and Austria and that such right shall only pass to Nitec Pharma as set forth in section 6 hereof. For this purpose the parties stipulate as follows: 1. Definitions “Technology Transfer Agreement” or “TTA” refers to this Agreement between Merck and Nitec Pharma. “Clinical Development” refers to the implementation of all clinical trials aimed at obtaining licences to market the Merchandise in Germany, Austria and other countries. “Commercially Reasonable Efforts” means those efforts and resources that Nitec Pharma would use were it developing, manufacturing, promoting and detailing the Active Agents as its own pharmaceutical products but taking into account clinical development results (including all safety, efficacy and cost issues), product labeling, regulatory review and approval issues, market potential, past performance, market potential, economic return, the general regulatory environment and competitive market conditions in the therapeutic area, all as measured by the facts and circumstances at the time such efforts are due. “Technical Development” refers to the implementation of all technical activities aimed at obtaining licences to market the Merchandise in Germany, Austria and other countries. “Approval” refers to the date on which an approval to market the Merchandise is granted in Germany and/or Austria. “Launch” refers to the day on which the Merchandise is brought onto the market in Germany and/or Austria. “Access to Data” refers to access to all data within Merck or affiliated enterprises of Merck within the meaning of § 15 of the German Stock Corporation Act (“Merck Group”) concerning the Project as well as concerning the Project periphery (e.g. Decortin, Decortin H), which are required or useful within the framework of Nitec Pharma’s activities described in this Agreement. “Initial Application” is the date on which the first application for a legal pharmaceutical licence for the Project is filed in a country, which is a member of the European Union. “Ex-factory Price” is the list price of the product without discounts by Merck Group to each independent customer. “Production Costs” are all costs incurred by Nitec Pharma in the complete provision of Merchandise to one of Merck’s supply depots. “Patents” refer to all of Merck Group’s patents and/or applications and utility models with respect to the Project. “Project” refers to the galenic formulation containing Active Agents and which releases the latter in a delayed manner as more specifically described in Annex I. “Merchandise” refers to the primary and secondary project packed and released for marketing. “Bulk-Ware” refers to the galenic formulation approved for marketing, which still needs to undergo primary and secondary packing. 2 “Packing Instruments” comprises primary and secondary packing for Merchandise. “Rheumatoid Arthritis” refers to the indication for which Nitec Pharma initially endeavours to obtain Approval. “Active Agents” refer to Prednison, Prednisolon and Methylprednisolon. “Skye Pharma” shall mean Skye Pharma AG with its head office in Muttenz, Switzerland, is the company, which has participated in the development of the Project from the technical aspect and which is meant to undertake production of the bulk-ware at its Lyon production site. “Jagotec” shall mean Jagotec AG, a Swiss corporation having its head office at Eptingerstr. 51 in CH-6052 Hergiswil, Switzerland. “Option Area” are the national territories of Germany and Austria. 2. Third Party Contracts 2.1. Merck, subject only to the restriction set forth specifically in section 6 hereof, hereby assigns to Nitec Pharma the agreement attached hereto as Appendix 2.1 “Skye/Jagotec DLA”) between Merck and SkyePharma/Jagotec concerning the development and production of the Project, on the precondition that SkyePharma /Jagotec shall give its required consent thereto. For the purpose of said assignment, Merck shall continue the agreement until then. 2.2. The content of the agreement with SkyePharma/Jagotec is known to Nitec Pharma. All documents pertaining thereto, including correspondence concerning the agreement as well as other documents, which are useful for the implementation and interpretation thereof, shall be delivered to Nitec Pharma following the signing hereof. 3. Transfer of Rights and Know-How 3.1. Merck hereby sells, assigns and promises to otherwise transfer to and Nitec Pharma hereby purchases, accepts assignment and promises to accept delivery and/or transfer of the entire know-how obtained within the framework of the development of the Project to date, including all clinical test and stability patterns, experimental charges and all (also electronic) documents, including the correspondence to date (“Know-How”). Upon conclusion hereof the Know-How becomes the property of Nitec Pharma and shall be transferred promptly to Nitec Pharma after the signature of this Agreement to the extent that such transfer requires action beyond the signature of this Agreement. Insofar as it is set out in documents, on data carriers or represented in another manner (“Represented Know-How”), Merck shall store the Know-How in safe keeping for Nitec Pharma pending delivery thereof to the latter. In addition, Merck shall grant Nitec Pharma access to all of its know-how obtained with respect to the Active Agent. 3 3.2. Nitec Pharma shall assemble the Represented Know-How by 31st December 2004 at the latest at Merck’s premises, submit such know-how for Merck’s approval, and Merck shall thereupon deliver the same to Nitec Pharma promptly. 3.3. If the results of the development work performed hitherto are protected by copyrights or other industrial property rights, said rights are hereby assigned to Nitec Pharma and Nitec Pharma accepts such assignment. In the same manner, and subject to the condition precedent of the conferral of the required approval pursuant to section 13.4 of the Skye/Jagotec DLA, all of the industrial property rights acquired by Merck from Skye Pharma or from Jagotec on the basis of the Skye/Jagotec DLA within the framework of or in connection with the Skye/Jagotec DLA, are hereby assigned to Nitec Pharma and Nitec Pharma accepts such assignment. 3.4. The purchase price for such Know-How, Represented Know-How and the property rights as defined hereinabove shall be […***…]. Payment shall become due upon signature of this Agreement. 3.5. Should an assignment pursuant to section 3.1 and 3.3 hereof be impossible for legal reasons, Nitec Pharma is hereby granted […***…] a worldwide, exclusive, unlimited and unrestricted perpetual license to use these property rights (with the right to sublicense but subject to the following sentence). Said right of use shall not be transferable in connection with marketing and distributing Merchandise in the Option Area, but shall be transformed into a transferable right of use for such purpose as soon as Nitec Pharma becomes entitled to market and distribute or have marketed and distributed Merchandise in the Option Area in accordance with the provisions set forth in sec. 6 hereof. 3.6. Should the results of the development performed hitherto contain inventions or ideas capable of being protected, Nitec Pharma shall be entitled hereupon to apply for relevant protections in its own name and at its own costs – and where required by law, by naming the inventors pursuant to the statutory provisions in force from time to time - in any countries. 3.7. Should it be reasonably necessary or beneficial for the development and production of the Project to allow access to know-how and/or copyrights and/or industrial property rights from outside the development of the Project, whether owned or licensed or otherwise available to Merck or any other company within the Merck Group, Merck hereby grants Nitec Pharma and undertakes to use its best efforts to procure that Nitec Pharma is granted by any other company within the Merck Group a non-exclusive, […***…] license to use such know-how and/or copyrights and/or industrial property rights. The right to transfer such right shall be limited to affiliates of Nitec Pharma within the meaning of § 15 German Stock Corporation Act. Transfers to any other persons shall be limited to the following purposes:","Query: As per this Technology Transfer Agreement between Merck KGaA and Nitec Pharma, what responsibilities regarding clinical and technical development in Germany and Austria does Nitec Pharma agree to? Instruction: Answer in one complete sentence. Add the relevant quoted piece of text from the context document in italics, at the end of your response. Context: ** TECHNOLOGY TRANSFER AGREEMENT ** Technology Transfer Agreement between Merck KGaA (“Merck”), Frankfurter Strasse 250, 64271 Darmstadt and Nitec Pharma AG (“Nitec Pharma”) Switzerland Preamble Merck has been marketing corticoids (Fortecortin, Decortin, Decortin H, Solu Decortin H) successfully – primarily in Germany – for many years. In order to support the corticoid business Merck started developing Prednison Night Time Release in 1998, which is a novel galenic formulation using the active agent prednison. For the treatment of rheumatoid arthritis (“RA”) the Project (as defined hereinafter) has not yet entered phase 3 of clinical testing. Merck due to limited resources and its focus on other business areas is unable to develop the Project until it is ready for marketing or to obtain a legal pharmaceutical licence for the Project. Merck therefore internally has decided to discontinue the Project. It now appears that Nitec Pharma may be able to resume the Project at its own cost and risk, see it through phase III clinical testing and obtain a license to market the Merchandise (as defined below) in Germany, Austria and other countries. In light of this development Merck is willing to transfer the Project to Nitec Pharma by turning over to Nitec Pharma all know-how acquired within the framework of and in connection with the Project and all pertinent industrial property rights. In particular Merck is willing to grant Nitec Pharma access to all data, which have accrued within the framework of the Project development and which are still to accrue pending the conclusion of the successful “Mutual Recognition Procedure”. As provided herein Nitec Pharma is willing to undertake to use all of its Commercially Reasonable Efforts (as defined below) to continue the clinical and technical development of the Project on its own, in particular using its own financial resources and at its own company risk and to obtain legal pharmaceutical approvals for relevant markets that have been identified by Nitec Pharma as promising markets and to confirm that Merck shall, under the terms specified in greater detail in section 6 hereof retain the right to market the Merchandise on an exclusive or non-exclusive basis in Germany and Austria and that such right shall only pass to Nitec Pharma as set forth in section 6 hereof. For this purpose the parties stipulate as follows: 1. Definitions “Technology Transfer Agreement” or “TTA” refers to this Agreement between Merck and Nitec Pharma. “Clinical Development” refers to the implementation of all clinical trials aimed at obtaining licences to market the Merchandise in Germany, Austria and other countries. “Commercially Reasonable Efforts” means those efforts and resources that Nitec Pharma would use were it developing, manufacturing, promoting and detailing the Active Agents as its own pharmaceutical products but taking into account clinical development results (including all safety, efficacy and cost issues), product labeling, regulatory review and approval issues, market potential, past performance, market potential, economic return, the general regulatory environment and competitive market conditions in the therapeutic area, all as measured by the facts and circumstances at the time such efforts are due. “Technical Development” refers to the implementation of all technical activities aimed at obtaining licences to market the Merchandise in Germany, Austria and other countries. “Approval” refers to the date on which an approval to market the Merchandise is granted in Germany and/or Austria. “Launch” refers to the day on which the Merchandise is brought onto the market in Germany and/or Austria. “Access to Data” refers to access to all data within Merck or affiliated enterprises of Merck within the meaning of § 15 of the German Stock Corporation Act (“Merck Group”) concerning the Project as well as concerning the Project periphery (e.g. Decortin, Decortin H), which are required or useful within the framework of Nitec Pharma’s activities described in this Agreement. “Initial Application” is the date on which the first application for a legal pharmaceutical licence for the Project is filed in a country, which is a member of the European Union. “Ex-factory Price” is the list price of the product without discounts by Merck Group to each independent customer. “Production Costs” are all costs incurred by Nitec Pharma in the complete provision of Merchandise to one of Merck’s supply depots. “Patents” refer to all of Merck Group’s patents and/or applications and utility models with respect to the Project. “Project” refers to the galenic formulation containing Active Agents and which releases the latter in a delayed manner as more specifically described in Annex I. “Merchandise” refers to the primary and secondary project packed and released for marketing. “Bulk-Ware” refers to the galenic formulation approved for marketing, which still needs to undergo primary and secondary packing. 2 “Packing Instruments” comprises primary and secondary packing for Merchandise. “Rheumatoid Arthritis” refers to the indication for which Nitec Pharma initially endeavours to obtain Approval. “Active Agents” refer to Prednison, Prednisolon and Methylprednisolon. “Skye Pharma” shall mean Skye Pharma AG with its head office in Muttenz, Switzerland, is the company, which has participated in the development of the Project from the technical aspect and which is meant to undertake production of the bulk-ware at its Lyon production site. “Jagotec” shall mean Jagotec AG, a Swiss corporation having its head office at Eptingerstr. 51 in CH-6052 Hergiswil, Switzerland. “Option Area” are the national territories of Germany and Austria. 2. Third Party Contracts 2.1. Merck, subject only to the restriction set forth specifically in section 6 hereof, hereby assigns to Nitec Pharma the agreement attached hereto as Appendix 2.1 “Skye/Jagotec DLA”) between Merck and SkyePharma/Jagotec concerning the development and production of the Project, on the precondition that SkyePharma /Jagotec shall give its required consent thereto. For the purpose of said assignment, Merck shall continue the agreement until then. 2.2. The content of the agreement with SkyePharma/Jagotec is known to Nitec Pharma. All documents pertaining thereto, including correspondence concerning the agreement as well as other documents, which are useful for the implementation and interpretation thereof, shall be delivered to Nitec Pharma following the signing hereof. 3. Transfer of Rights and Know-How 3.1. Merck hereby sells, assigns and promises to otherwise transfer to and Nitec Pharma hereby purchases, accepts assignment and promises to accept delivery and/or transfer of the entire know-how obtained within the framework of the development of the Project to date, including all clinical test and stability patterns, experimental charges and all (also electronic) documents, including the correspondence to date (“Know-How”). Upon conclusion hereof the Know-How becomes the property of Nitec Pharma and shall be transferred promptly to Nitec Pharma after the signature of this Agreement to the extent that such transfer requires action beyond the signature of this Agreement. Insofar as it is set out in documents, on data carriers or represented in another manner (“Represented Know-How”), Merck shall store the Know-How in safe keeping for Nitec Pharma pending delivery thereof to the latter. In addition, Merck shall grant Nitec Pharma access to all of its know-how obtained with respect to the Active Agent. 3 3.2. Nitec Pharma shall assemble the Represented Know-How by 31st December 2004 at the latest at Merck’s premises, submit such know-how for Merck’s approval, and Merck shall thereupon deliver the same to Nitec Pharma promptly. 3.3. If the results of the development work performed hitherto are protected by copyrights or other industrial property rights, said rights are hereby assigned to Nitec Pharma and Nitec Pharma accepts such assignment. In the same manner, and subject to the condition precedent of the conferral of the required approval pursuant to section 13.4 of the Skye/Jagotec DLA, all of the industrial property rights acquired by Merck from Skye Pharma or from Jagotec on the basis of the Skye/Jagotec DLA within the framework of or in connection with the Skye/Jagotec DLA, are hereby assigned to Nitec Pharma and Nitec Pharma accepts such assignment. 3.4. The purchase price for such Know-How, Represented Know-How and the property rights as defined hereinabove shall be […***…]. Payment shall become due upon signature of this Agreement. 3.5. Should an assignment pursuant to section 3.1 and 3.3 hereof be impossible for legal reasons, Nitec Pharma is hereby granted […***…] a worldwide, exclusive, unlimited and unrestricted perpetual license to use these property rights (with the right to sublicense but subject to the following sentence). Said right of use shall not be transferable in connection with marketing and distributing Merchandise in the Option Area, but shall be transformed into a transferable right of use for such purpose as soon as Nitec Pharma becomes entitled to market and distribute or have marketed and distributed Merchandise in the Option Area in accordance with the provisions set forth in sec. 6 hereof. 3.6. Should the results of the development performed hitherto contain inventions or ideas capable of being protected, Nitec Pharma shall be entitled hereupon to apply for relevant protections in its own name and at its own costs – and where required by law, by naming the inventors pursuant to the statutory provisions in force from time to time - in any countries. 3.7. Should it be reasonably necessary or beneficial for the development and production of the Project to allow access to know-how and/or copyrights and/or industrial property rights from outside the development of the Project, whether owned or licensed or otherwise available to Merck or any other company within the Merck Group, Merck hereby grants Nitec Pharma and undertakes to use its best efforts to procure that Nitec Pharma is granted by any other company within the Merck Group a non-exclusive, […***…] license to use such know-how and/or copyrights and/or industrial property rights. The right to transfer such right shall be limited to affiliates of Nitec Pharma within the meaning of § 15 German Stock Corporation Act. Transfers to any other persons shall be limited to the following purposes:","Answer in one complete sentence. Add the relevant quoted piece of text from the context document in italics, at the end of your response.
+
+EVIDENCE:
+** TECHNOLOGY TRANSFER AGREEMENT ** Technology Transfer Agreement between Merck KGaA (“Merck”), Frankfurter Strasse 250, 64271 Darmstadt and Nitec Pharma AG (“Nitec Pharma”) Switzerland Preamble Merck has been marketing corticoids (Fortecortin, Decortin, Decortin H, Solu Decortin H) successfully – primarily in Germany – for many years. In order to support the corticoid business Merck started developing Prednison Night Time Release in 1998, which is a novel galenic formulation using the active agent prednison. For the treatment of rheumatoid arthritis (“RA”) the Project (as defined hereinafter) has not yet entered phase 3 of clinical testing. Merck due to limited resources and its focus on other business areas is unable to develop the Project until it is ready for marketing or to obtain a legal pharmaceutical licence for the Project. Merck therefore internally has decided to discontinue the Project. It now appears that Nitec Pharma may be able to resume the Project at its own cost and risk, see it through phase III clinical testing and obtain a license to market the Merchandise (as defined below) in Germany, Austria and other countries. In light of this development Merck is willing to transfer the Project to Nitec Pharma by turning over to Nitec Pharma all know-how acquired within the framework of and in connection with the Project and all pertinent industrial property rights. In particular Merck is willing to grant Nitec Pharma access to all data, which have accrued within the framework of the Project development and which are still to accrue pending the conclusion of the successful “Mutual Recognition Procedure”. As provided herein Nitec Pharma is willing to undertake to use all of its Commercially Reasonable Efforts (as defined below) to continue the clinical and technical development of the Project on its own, in particular using its own financial resources and at its own company risk and to obtain legal pharmaceutical approvals for relevant markets that have been identified by Nitec Pharma as promising markets and to confirm that Merck shall, under the terms specified in greater detail in section 6 hereof retain the right to market the Merchandise on an exclusive or non-exclusive basis in Germany and Austria and that such right shall only pass to Nitec Pharma as set forth in section 6 hereof. For this purpose the parties stipulate as follows: 1. Definitions “Technology Transfer Agreement” or “TTA” refers to this Agreement between Merck and Nitec Pharma. “Clinical Development” refers to the implementation of all clinical trials aimed at obtaining licences to market the Merchandise in Germany, Austria and other countries. “Commercially Reasonable Efforts” means those efforts and resources that Nitec Pharma would use were it developing, manufacturing, promoting and detailing the Active Agents as its own pharmaceutical products but taking into account clinical development results (including all safety, efficacy and cost issues), product labeling, regulatory review and approval issues, market potential, past performance, market potential, economic return, the general regulatory environment and competitive market conditions in the therapeutic area, all as measured by the facts and circumstances at the time such efforts are due. “Technical Development” refers to the implementation of all technical activities aimed at obtaining licences to market the Merchandise in Germany, Austria and other countries. “Approval” refers to the date on which an approval to market the Merchandise is granted in Germany and/or Austria. “Launch” refers to the day on which the Merchandise is brought onto the market in Germany and/or Austria. “Access to Data” refers to access to all data within Merck or affiliated enterprises of Merck within the meaning of § 15 of the German Stock Corporation Act (“Merck Group”) concerning the Project as well as concerning the Project periphery (e.g. Decortin, Decortin H), which are required or useful within the framework of Nitec Pharma’s activities described in this Agreement. “Initial Application” is the date on which the first application for a legal pharmaceutical licence for the Project is filed in a country, which is a member of the European Union. “Ex-factory Price” is the list price of the product without discounts by Merck Group to each independent customer. “Production Costs” are all costs incurred by Nitec Pharma in the complete provision of Merchandise to one of Merck’s supply depots. “Patents” refer to all of Merck Group’s patents and/or applications and utility models with respect to the Project. “Project” refers to the galenic formulation containing Active Agents and which releases the latter in a delayed manner as more specifically described in Annex I. “Merchandise” refers to the primary and secondary project packed and released for marketing. “Bulk-Ware” refers to the galenic formulation approved for marketing, which still needs to undergo primary and secondary packing. 2 “Packing Instruments” comprises primary and secondary packing for Merchandise. “Rheumatoid Arthritis” refers to the indication for which Nitec Pharma initially endeavours to obtain Approval. “Active Agents” refer to Prednison, Prednisolon and Methylprednisolon. “Skye Pharma” shall mean Skye Pharma AG with its head office in Muttenz, Switzerland, is the company, which has participated in the development of the Project from the technical aspect and which is meant to undertake production of the bulk-ware at its Lyon production site. “Jagotec” shall mean Jagotec AG, a Swiss corporation having its head office at Eptingerstr. 51 in CH-6052 Hergiswil, Switzerland. “Option Area” are the national territories of Germany and Austria. 2. Third Party Contracts 2.1. Merck, subject only to the restriction set forth specifically in section 6 hereof, hereby assigns to Nitec Pharma the agreement attached hereto as Appendix 2.1 “Skye/Jagotec DLA”) between Merck and SkyePharma/Jagotec concerning the development and production of the Project, on the precondition that SkyePharma /Jagotec shall give its required consent thereto. For the purpose of said assignment, Merck shall continue the agreement until then. 2.2. The content of the agreement with SkyePharma/Jagotec is known to Nitec Pharma. All documents pertaining thereto, including correspondence concerning the agreement as well as other documents, which are useful for the implementation and interpretation thereof, shall be delivered to Nitec Pharma following the signing hereof. 3. Transfer of Rights and Know-How 3.1. Merck hereby sells, assigns and promises to otherwise transfer to and Nitec Pharma hereby purchases, accepts assignment and promises to accept delivery and/or transfer of the entire know-how obtained within the framework of the development of the Project to date, including all clinical test and stability patterns, experimental charges and all (also electronic) documents, including the correspondence to date (“Know-How”). Upon conclusion hereof the Know-How becomes the property of Nitec Pharma and shall be transferred promptly to Nitec Pharma after the signature of this Agreement to the extent that such transfer requires action beyond the signature of this Agreement. Insofar as it is set out in documents, on data carriers or represented in another manner (“Represented Know-How”), Merck shall store the Know-How in safe keeping for Nitec Pharma pending delivery thereof to the latter. In addition, Merck shall grant Nitec Pharma access to all of its know-how obtained with respect to the Active Agent. 3 3.2. Nitec Pharma shall assemble the Represented Know-How by 31st December 2004 at the latest at Merck’s premises, submit such know-how for Merck’s approval, and Merck shall thereupon deliver the same to Nitec Pharma promptly. 3.3. If the results of the development work performed hitherto are protected by copyrights or other industrial property rights, said rights are hereby assigned to Nitec Pharma and Nitec Pharma accepts such assignment. In the same manner, and subject to the condition precedent of the conferral of the required approval pursuant to section 13.4 of the Skye/Jagotec DLA, all of the industrial property rights acquired by Merck from Skye Pharma or from Jagotec on the basis of the Skye/Jagotec DLA within the framework of or in connection with the Skye/Jagotec DLA, are hereby assigned to Nitec Pharma and Nitec Pharma accepts such assignment. 3.4. The purchase price for such Know-How, Represented Know-How and the property rights as defined hereinabove shall be […***…]. Payment shall become due upon signature of this Agreement. 3.5. Should an assignment pursuant to section 3.1 and 3.3 hereof be impossible for legal reasons, Nitec Pharma is hereby granted [���***…] a worldwide, exclusive, unlimited and unrestricted perpetual license to use these property rights (with the right to sublicense but subject to the following sentence). Said right of use shall not be transferable in connection with marketing and distributing Merchandise in the Option Area, but shall be transformed into a transferable right of use for such purpose as soon as Nitec Pharma becomes entitled to market and distribute or have marketed and distributed Merchandise in the Option Area in accordance with the provisions set forth in sec. 6 hereof. 3.6. Should the results of the development performed hitherto contain inventions or ideas capable of being protected, Nitec Pharma shall be entitled hereupon to apply for relevant protections in its own name and at its own costs – and where required by law, by naming the inventors pursuant to the statutory provisions in force from time to time - in any countries. 3.7. Should it be reasonably necessary or beneficial for the development and production of the Project to allow access to know-how and/or copyrights and/or industrial property rights from outside the development of the Project, whether owned or licensed or otherwise available to Merck or any other company within the Merck Group, Merck hereby grants Nitec Pharma and undertakes to use its best efforts to procure that Nitec Pharma is granted by any other company within the Merck Group a non-exclusive, […***…] license to use such know-how and/or copyrights and/or industrial property rights. The right to transfer such right shall be limited to affiliates of Nitec Pharma within the meaning of § 15 German Stock Corporation Act. Transfers to any other persons shall be limited to the following purposes:
+
+USER:
+As per this Technology Transfer Agreement between Merck KGaA and Nitec Pharma, what responsibilities regarding clinical and technical development in Germany and Austria does Nitec Pharma agree to?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,24,28,1621,,776
+Only rely on the provided text.,Which American made significant contributions to our understanding of the distribution of wealth?,"In the theory of distribution interest must be aasigned a quite different and much more important r61e than economists thus far have given to it. In classical economics the nature of interest and its place in distribution were not clearly understood. Distribution has been erroneously defined as the division of the income of society into “interest, rent, wages, and profits.” Rent and interest are merely two ways of measuring the same income ; rent, aa the yield per acre or other physical unit, and interest aa the same yield expressed aa a per cent of capital value. The value of the capital is derived from the income which it yields by capitalizing it at the prevailing rate of interest. To reverse this process by multiplying the capitd vdue by the rate of interest gives the original income, aa long aa the capital value remains stationary. It is not really a complex product of two factors, but, on the contrary, is the single original factor, namely, income, from which we started. As explained in previous chapters, it is this income which affords the basis for the determination of the &e of interest, and through the rate of interest, of capital value. The hal enjoyable income of society is the ultimate and basic fact from which all values are derived and c3311 THE THEORY OF INTEREST toward which all economic action is bent. All of this income is derived from capital wealth, if land and man are included in that term, or if not, from capital and man, or capital, land, and man, according to the terminology adopted. This income may all be capitalized, and hence all income (excluding capital gain) may be viewed as interest upon the capital value thus found. Viewed as above outlined interest is not a part, but the whole, of income (except for capital gain). It includes what is called rent and profits and even wages, for the income of the workman may be capitalized quite as truly as the income of land or machinery. Thus, instead of having interest, rent, wages, and profits as mutually exclusive portions of social income, interest may be regarded as including all four. If we prefer to exclude profits, the reason is because of the element of risk and not because profits are not discountable just as truly as rent and wages. The error of the classical economists and of their modern followers in regarding interest, rent, wages and profits as separate but coijrdinate incomes is partly due to the failure to perceive thzlt, whereas all income is produced from capital wealth, capital vdue can emerge only from man’s psychic evaluation and capitalization of that income in advance of its occurrence. Another oversight closely ltssociated with the last stated fallacy is that in which rent and wages are conceived aa determined independently of the rate of interest, whereas we have just seen that the rate of interest enters aa a vital element into the determination of both. The great defect in the theories propounded by the classical economists lay in their inability to conceive of a general equilibrium and the mutual dependence of sacrifice and enjoyment. C 332 3 THE PLACE OF INTEREST IN ECONOMICS In discueeing the theory of distribution, we shall, there fore, abandon the classical point of view entirely. The claasical concepts of distribution are quite inappropriate to explain the every day facts of life and the economic structure. The phrase distribution of wealth, as understood by the ordinary man, implies the problem of the relative wealth of individuals, the problem of the rich and the poor. But the separation of the aggregate income into four abstract magnitudes, even if correctly done, has littIe to do with the question of how much income the different individuals in society receive. Only on condition that society WM composed of four independent and mutually exclusive groups, laborers, landlords, enterprisers, and capitalists, would the fourfold division of the classical economists be even partially dequate to explain the actual distribution of income. In fact, the four classes all overlap. The enterpriser is almost invariably a genuine capitalist and usually also performs labor; the capitalist is frequently a landlord and laborer, and even the typical laborer is today often a amall capitalist and sometimes a landlord. It is true that a century ago in England the lines of social classification corresponded roughly to the abstract divisions proposed at that time by the classical economists. But this fact is of little significance except as explaining historically the origin of the classical theory of distrib~tion.~ $5. Interest and Personal Distribution The main problem of distribution, as I see it, is concerned with the determination and explanation of the amounts and values of capitala and incomes possemed don, P. 8. King dc Son, 1903. '&e Cannan, Edwin, Thoties of production and Dt&ibuticm. hCWI THE THEORY OF INTEREST by Merent individuah in society. It is astonishing how little economistg have contributed to resolving the problem of distribution EO conceived. A statistid beginning w&s made by Professor Pareto in his present&ion of interesting “curves of distribution of income.” For the United States, Professor W. I. King and the National Bureau of Economic Research ?, and for England, Sir Josiah Stamp have made and analyzed important statistical compilations on the amount and distribution of income and capital wealth by income groups and social classes. On the theory of distribution, especially the rcile of interest in distribution, John Rae seems to have contributed more than any other writer O. He showed in a vivid way that persons who had naturally what we have called in this book a low rate of impatience or preference for present over future income tended to accumulate savings, whereas those who had t,he opposite trait tended to spend their incomes and even their capitals. In previous chapters it is shown that the rates of preference among different individurtls are equalized by borrowing and lending or, what amounts to the same thing, ‘Pareto, Cam 82-k Politipue, Vol. 11, Book III. ‘King, W. I., The Wealth and Income of the People of the United State, New York, The Macmillan Co., 1915. ‘Mitchell, W. C., King, W. I., Mseaulay, F. R., Knauth, 0. W., Income in the United States. New York, National Bureau of Economic Reeearch, Inc., 1922. Knauth, 0. W., Dietribution of I~~come byi3tat-a in 1919. New York, Harcourt, Brace & Co., 1822. Leven, Maurice, and King, w. I., Income in the Vuriou8 &utes; Its sovceS and DietribzLtion, 1910, f9#, and 19tl. New York, National Bureau of Economic Resesrch, Inc., 1925. ‘Stamp, Sir Josiah, WeaUh and Tdle Capacily. London, P. 9. King & hn, La., 1922. Also, Btitieh Incomes and Prqperty. London, P. 8. King & Son, 1916. ’ Rae, The Socidogid Thew o? Capitd, Chapter XIII. 1WI. THE PLACE OF INTEREST IN ECONOMICS by buying and selling. An individual whose rate of preference for present enjoyment is unduly high wil contrive to modify his income stream by increasing it in the pment at the expense of the future. The effects upon incomes may be traced to capital by applying the principles explained in The Nature of Caplltal and Income, Chapter XIV.","Which American made significant contributions to our understanding of the distribution of wealth? Only rely on the provided text. In the theory of distribution interest must be aasigned a quite different and much more important r61e than economists thus far have given to it. In classical economics the nature of interest and its place in distribution were not clearly understood. Distribution has been erroneously defined as the division of the income of society into “interest, rent, wages, and profits.” Rent and interest are merely two ways of measuring the same income ; rent, aa the yield per acre or other physical unit, and interest aa the same yield expressed aa a per cent of capital value. The value of the capital is derived from the income which it yields by capitalizing it at the prevailing rate of interest. To reverse this process by multiplying the capitd vdue by the rate of interest gives the original income, aa long aa the capital value remains stationary. It is not really a complex product of two factors, but, on the contrary, is the single original factor, namely, income, from which we started. As explained in previous chapters, it is this income which affords the basis for the determination of the &e of interest, and through the rate of interest, of capital value. The hal enjoyable income of society is the ultimate and basic fact from which all values are derived and c3311 THE THEORY OF INTEREST toward which all economic action is bent. All of this income is derived from capital wealth, if land and man are included in that term, or if not, from capital and man, or capital, land, and man, according to the terminology adopted. This income may all be capitalized, and hence all income (excluding capital gain) may be viewed as interest upon the capital value thus found. Viewed as above outlined interest is not a part, but the whole, of income (except for capital gain). It includes what is called rent and profits and even wages, for the income of the workman may be capitalized quite as truly as the income of land or machinery. Thus, instead of having interest, rent, wages, and profits as mutually exclusive portions of social income, interest may be regarded as including all four. If we prefer to exclude profits, the reason is because of the element of risk and not because profits are not discountable just as truly as rent and wages. The error of the classical economists and of their modern followers in regarding interest, rent, wages and profits as separate but coijrdinate incomes is partly due to the failure to perceive thzlt, whereas all income is produced from capital wealth, capital vdue can emerge only from man’s psychic evaluation and capitalization of that income in advance of its occurrence. Another oversight closely ltssociated with the last stated fallacy is that in which rent and wages are conceived aa determined independently of the rate of interest, whereas we have just seen that the rate of interest enters aa a vital element into the determination of both. The great defect in the theories propounded by the classical economists lay in their inability to conceive of a general equilibrium and the mutual dependence of sacrifice and enjoyment. C 332 3 THE PLACE OF INTEREST IN ECONOMICS In discueeing the theory of distribution, we shall, there fore, abandon the classical point of view entirely. The claasical concepts of distribution are quite inappropriate to explain the every day facts of life and the economic structure. The phrase distribution of wealth, as understood by the ordinary man, implies the problem of the relative wealth of individuals, the problem of the rich and the poor. But the separation of the aggregate income into four abstract magnitudes, even if correctly done, has littIe to do with the question of how much income the different individuals in society receive. Only on condition that society WM composed of four independent and mutually exclusive groups, laborers, landlords, enterprisers, and capitalists, would the fourfold division of the classical economists be even partially dequate to explain the actual distribution of income. In fact, the four classes all overlap. The enterpriser is almost invariably a genuine capitalist and usually also performs labor; the capitalist is frequently a landlord and laborer, and even the typical laborer is today often a amall capitalist and sometimes a landlord. It is true that a century ago in England the lines of social classification corresponded roughly to the abstract divisions proposed at that time by the classical economists. But this fact is of little significance except as explaining historically the origin of the classical theory of distrib~tion.~ $5. Interest and Personal Distribution The main problem of distribution, as I see it, is concerned with the determination and explanation of the amounts and values of capitala and incomes possemed don, P. 8. King dc Son, 1903. '&e Cannan, Edwin, Thoties of production and Dt&ibuticm. hCWI THE THEORY OF INTEREST by Merent individuah in society. It is astonishing how little economistg have contributed to resolving the problem of distribution EO conceived. A statistid beginning w&s made by Professor Pareto in his present&ion of interesting “curves of distribution of income.” For the United States, Professor W. I. King and the National Bureau of Economic Research ?, and for England, Sir Josiah Stamp have made and analyzed important statistical compilations on the amount and distribution of income and capital wealth by income groups and social classes. On the theory of distribution, especially the rcile of interest in distribution, John Rae seems to have contributed more than any other writer O. He showed in a vivid way that persons who had naturally what we have called in this book a low rate of impatience or preference for present over future income tended to accumulate savings, whereas those who had t,he opposite trait tended to spend their incomes and even their capitals. In previous chapters it is shown that the rates of preference among different individurtls are equalized by borrowing and lending or, what amounts to the same thing, ‘Pareto, Cam 82-k Politipue, Vol. 11, Book III. ‘King, W. I., The Wealth and Income of the People of the United State, New York, The Macmillan Co., 1915. ‘Mitchell, W. C., King, W. I., Mseaulay, F. R., Knauth, 0. W., Income in the United States. New York, National Bureau of Economic Reeearch, Inc., 1922. Knauth, 0. W., Dietribution of I~~come byi3tat-a in 1919. New York, Harcourt, Brace & Co., 1822. Leven, Maurice, and King, w. I., Income in the Vuriou8 &utes; Its sovceS and DietribzLtion, 1910, f9#, and 19tl. New York, National Bureau of Economic Resesrch, Inc., 1925. ‘Stamp, Sir Josiah, WeaUh and Tdle Capacily. London, P. 9. King & hn, La., 1922. Also, Btitieh Incomes and Prqperty. London, P. 8. King & Son, 1916. ’ Rae, The Socidogid Thew o? Capitd, Chapter XIII. 1WI. THE PLACE OF INTEREST IN ECONOMICS by buying and selling. An individual whose rate of preference for present enjoyment is unduly high wil contrive to modify his income stream by increasing it in the pment at the expense of the future. The effects upon incomes may be traced to capital by applying the principles explained in The Nature of Caplltal and Income, Chapter XIV.","Only rely on the provided text.
+
+EVIDENCE:
+In the theory of distribution interest must be aasigned a quite different and much more important r61e than economists thus far have given to it. In classical economics the nature of interest and its place in distribution were not clearly understood. Distribution has been erroneously defined as the division of the income of society into “interest, rent, wages, and profits.” Rent and interest are merely two ways of measuring the same income ; rent, aa the yield per acre or other physical unit, and interest aa the same yield expressed aa a per cent of capital value. The value of the capital is derived from the income which it yields by capitalizing it at the prevailing rate of interest. To reverse this process by multiplying the capitd vdue by the rate of interest gives the original income, aa long aa the capital value remains stationary. It is not really a complex product of two factors, but, on the contrary, is the single original factor, namely, income, from which we started. As explained in previous chapters, it is this income which affords the basis for the determination of the &e of interest, and through the rate of interest, of capital value. The hal enjoyable income of society is the ultimate and basic fact from which all values are derived and c3311 THE THEORY OF INTEREST toward which all economic action is bent. All of this income is derived from capital wealth, if land and man are included in that term, or if not, from capital and man, or capital, land, and man, according to the terminology adopted. This income may all be capitalized, and hence all income (excluding capital gain) may be viewed as interest upon the capital value thus found. Viewed as above outlined interest is not a part, but the whole, of income (except for capital gain). It includes what is called rent and profits and even wages, for the income of the workman may be capitalized quite as truly as the income of land or machinery. Thus, instead of having interest, rent, wages, and profits as mutually exclusive portions of social income, interest may be regarded as including all four. If we prefer to exclude profits, the reason is because of the element of risk and not because profits are not discountable just as truly as rent and wages. The error of the classical economists and of their modern followers in regarding interest, rent, wages and profits as separate but coijrdinate incomes is partly due to the failure to perceive thzlt, whereas all income is produced from capital wealth, capital vdue can emerge only from man’s psychic evaluation and capitalization of that income in advance of its occurrence. Another oversight closely ltssociated with the last stated fallacy is that in which rent and wages are conceived aa determined independently of the rate of interest, whereas we have just seen that the rate of interest enters aa a vital element into the determination of both. The great defect in the theories propounded by the classical economists lay in their inability to conceive of a general equilibrium and the mutual dependence of sacrifice and enjoyment. C 332 3 THE PLACE OF INTEREST IN ECONOMICS In discueeing the theory of distribution, we shall, there fore, abandon the classical point of view entirely. The claasical concepts of distribution are quite inappropriate to explain the every day facts of life and the economic structure. The phrase distribution of wealth, as understood by the ordinary man, implies the problem of the relative wealth of individuals, the problem of the rich and the poor. But the separation of the aggregate income into four abstract magnitudes, even if correctly done, has littIe to do with the question of how much income the different individuals in society receive. Only on condition that society WM composed of four independent and mutually exclusive groups, laborers, landlords, enterprisers, and capitalists, would the fourfold division of the classical economists be even partially dequate to explain the actual distribution of income. In fact, the four classes all overlap. The enterpriser is almost invariably a genuine capitalist and usually also performs labor; the capitalist is frequently a landlord and laborer, and even the typical laborer is today often a amall capitalist and sometimes a landlord. It is true that a century ago in England the lines of social classification corresponded roughly to the abstract divisions proposed at that time by the classical economists. But this fact is of little significance except as explaining historically the origin of the classical theory of distrib~tion.~ $5. Interest and Personal Distribution The main problem of distribution, as I see it, is concerned with the determination and explanation of the amounts and values of capitala and incomes possemed don, P. 8. King dc Son, 1903. '&e Cannan, Edwin, Thoties of production and Dt&ibuticm. hCWI THE THEORY OF INTEREST by Merent individuah in society. It is astonishing how little economistg have contributed to resolving the problem of distribution EO conceived. A statistid beginning w&s made by Professor Pareto in his present&ion of interesting “curves of distribution of income.” For the United States, Professor W. I. King and the National Bureau of Economic Research ?, and for England, Sir Josiah Stamp have made and analyzed important statistical compilations on the amount and distribution of income and capital wealth by income groups and social classes. On the theory of distribution, especially the rcile of interest in distribution, John Rae seems to have contributed more than any other writer O. He showed in a vivid way that persons who had naturally what we have called in this book a low rate of impatience or preference for present over future income tended to accumulate savings, whereas those who had t,he opposite trait tended to spend their incomes and even their capitals. In previous chapters it is shown that the rates of preference among different individurtls are equalized by borrowing and lending or, what amounts to the same thing, ‘Pareto, Cam 82-k Politipue, Vol. 11, Book III. ‘King, W. I., The Wealth and Income of the People of the United State, New York, The Macmillan Co., 1915. ‘Mitchell, W. C., King, W. I., Mseaulay, F. R., Knauth, 0. W., Income in the United States. New York, National Bureau of Economic Reeearch, Inc., 1922. Knauth, 0. W., Dietribution of I~~come byi3tat-a in 1919. New York, Harcourt, Brace & Co., 1822. Leven, Maurice, and King, w. I., Income in the Vuriou8 &utes; Its sovceS and DietribzLtion, 1910, f9#, and 19tl. New York, National Bureau of Economic Resesrch, Inc., 1925. ‘Stamp, Sir Josiah, WeaUh and Tdle Capacily. London, P. 9. King & hn, La., 1922. Also, Btitieh Incomes and Prqperty. London, P. 8. King & Son, 1916. ’ Rae, The Socidogid Thew o? Capitd, Chapter XIII. 1WI. THE PLACE OF INTEREST IN ECONOMICS by buying and selling. An individual whose rate of preference for present enjoyment is unduly high wil contrive to modify his income stream by increasing it in the pment at the expense of the future. The effects upon incomes may be traced to capital by applying the principles explained in The Nature of Caplltal and Income, Chapter XIV.
+
+USER:
+Which American made significant contributions to our understanding of the distribution of wealth?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,6,13,1194,,420
+Answer in a single sentence. Use only the document as your source.,"According to this document, how many patients with COVID-19 had a history of stroke?","**COVID-19 and Stroke Incidence** Coronavirus disease 2019 (COVID-19) has been declared a pandemic for two years already.1,2 As of July 2022, more than 575 million people have been infected, of which around 6.39 million have died.3 Although its case fatality rate of »2% is lower compared to past influenza pandemics, its highly transmissible nature strains the health care systems leading to significant increases in mortalities and unfavorable morbidities even in highly urbanized countries.1,4 With the appearance of delta and other variants, the devastation induced by COVID-19 is not likely to end soon. While most COVID-19 patients present in the hospital with respiratory symptoms, other organ systems may also be affected.5,6 Around 0.8-6% will develop stroke among COVID-19 patients, while 2-3% of admitted stroke patients will harbor severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.7,8 These COVID-19 stroke patients have twice the risk of death and they have 20% more risk of having a moderate disability compared to patients with COVID-19 only.9 Nevertheless, COVID19 stroke patients were usually older and had similar risk factors as those patients with stroke alone, implying that the usual determinants for stroke may be the ones responsible for these increased risks and not COVID-19.1,7,9 However, in smaller case series and cross-sectional studies, COVID-19 patients with stroke were younger, with a cryptogenic type of stroke, and with no identifiable risk factors compared to those without COVID-19.9,10 Since SARS-CoV-2 infection affects organ systems by inducing thrombosis secondary to a hypercoagulable state, the incidence of stroke, especially the ischemic type, may plausibly be increased in COVID-19.10
12 While most large studies about the possible association of COVID-19 and stroke were done in high-income countries, only one study with a small sample size have been done in low- to middle-income countries (LMIC) like the Philippines.13 Developed countries have more organized and advanced health care systems and reliable national insurance services; hence, the incidence of stroke, its risk factors and mortality rate among COVID-19 patients may not be comparable to the true situation in LMIC.6,8 A recently concluded nationwide multicenter, comparative, retrospective cohort study was conducted from February to December 2020 to identify the different neurologic manifestations of COVID-19 in the Philippines.6 A total of 10,881 reverse transcriptase-polymerase chain reaction (RT-PCR) confirmed COVID-19 cases were collected.6 Our main objectives were a) to determine the risk factors of stroke among hospitalized COVID19 patients in the Philippines, b) to determine the possible association between these risk factors and stroke among the same cohort, and c) to determine if there is an association between mortality and stroke in this same group. Methodology Study design The data analyzed in this study were obtained from a previously published nationwide retrospective cohort study that identified the different neurologic manifestations of COVID-19 in the Philippines.6 Inclusion and exclusion criteria RT-PCR-confirmed adult COVID-19 patients, more than 18 years of age, with final hospital disposition, were included in the study. Those with pneumonia caused by other etiologies other than SARS-CoV-2 were excluded. A complete enumeration of all patients fulfilling these criteria, who were admitted to the hospitals from February until December 2020, was performed. The definition of neurological symptoms was based on the previously published protocol.6 A patient who developed focal sensory or motor deficit confirmed by either cranial computed tomography (CT) scan or magnetic resonance imaging (MRI) were recorded as a stroke patient, as seen on chart review. The imaging was the basis for classifying the patient as either infarct or hemorrhagic stroke. COVID-19 stroke patients comprised the cases while COVID-19 only patients constituted the control group. Study site Data collection was done in 37 referral hospitals for COVID-19. Identification of these sites and other information regarding methods for data collection were described in the published protocol.6 Study investigators This is a part of the Philippine CORONA Study which aimed to determine the incidence of the different neurological diseases and their association with different risk factors and outcomes in a large cohort of COVID-19 patients. This was headed by four steering committee members with 37 study site teams, of which the principal investigators were all neurologists.6 2 R.D.G. JAMORA ET AL. Data collection The method of data collection has already been published.6 In brief, all COVID-19 confirmed admissions with disposition (discharged or deceased) at the time of data collection were included in the study. A pre-made detailed abstraction form containing the variables of interest was filled out by the field physician by chart review. Possible risk factors for stroke or increased COVID-19 severity such as age, sex, smoking, hypertension, diabetes mellitus (DM), heart failure, coronary artery disease, chronic obstructive pulmonary disease (COPD), bronchial asthma, chronic kidney disease, liver disease, obesity, malignancy, and human immunodeficiency virus infection was obtained. For stroke, the neurologic symptoms and final diagnosis during admission, and different outcome measures like the severity of the disability, intensive care unit (ICU) admission, duration from admission to final disposition, mortality status, and final disposition were included in the form. Abstraction forms were then assessed for validity and inconsistencies before they were de-identified, encoded, and collated per hospital and sent to the Steering Committee of the Philippine CORONA study. Data analysis Age was presented as mean, while categorical data were presented as proportions. Standard deviation was used as measure of dispersion. Means and proportions were tested for significance using unpaired t-test and test of two proportions, respectively. Prevalence ratio, defined as the ratio of the proportion of patients with a particular risk factor in COVID-19 stroke patients divided by the proportion of patients with the same risk factor among COVID-19 only patients were computed separately. These were used as estimates of relative risks. The incidence of stroke among patients with COVID-19 was computed by dividing the number of stroke patients by the population (n = 10,881). Likewise, the incidence of different outcome measures like mortality, disability, and intensive care unit (ICU) admission in both COVID-19 stroke patients and COVID-19 patients only were obtained by dividing the number of each of these outcome measures by the number of patients who developed stroke and those who did not, respectively. Subsequently, relative risks were computed by dividing the incidence of each outcome measure among COVID-19 stroke patients by the incidence of outcome measure among those with COVID-19 patients only. To determine the association between stroke and different risk factors; and the different outcome measures and stroke among COVID-19 patients, a univariate logistic regression was done. Stroke and outcome measures were used as dependent variables separately, while risk factors for stroke, and stroke were used as their independent variables, respectively. An extended Cox proportional hazard survival analysis was also done using mortality status as the failure event and the duration from admission to either censoring or failure as survival time. Significant risk factors identified in the logistic regression was used as the predictor variables with presence of stroke as the focus. Since the presence of stroke was a time dependent variable based on the usage of scaled and unscaled Schoenfield residuals, an extended Cox model was used. All data were captured and analyzed using Stata Pro BE 17, with alpha set at < 0.05 as indicator of significance. Results Baseline characteristics There were 10,881 RT-PCR confirmed COVID-19 cases included in the Philippine CORONA Study. The patients were mostly males (n = 5780, 53.1%), with history of neurological disorder (n = 7560, 69.5%), with hypertension (n = 3647, 33.5%), and DM (n = 2191, 20.1%). Only 321 patients with COVID-19 (3%) had a history of stroke. The overall incidence of stroke among COVID-19 patients was 3.4% (n = 367). Of these, 262 (71.4%) had acute ischemic stroke (AIS) and 101 (27.5%) had acute hemorrhagic stroke (AHS). The incidence of AIS and AHS were 2.4% and 0.9%, respectively. A total of 1697 COVID-19 patients (15.6%) died due to various etiologies. Most patients who had neurologic symptoms were stable but had persistent deficits at discharge (71.7%). Only 1751 patients (16%) were admitted to the ICU primarily due to acute respiratory failure.","[Query] ================== According to this document, how many patients with COVID-19 had a history of stroke? ================ [Task] ================== Answer in a single sentence. Use only the document as your source. ================ [Text Passage] ================== **COVID-19 and Stroke Incidence** Coronavirus disease 2019 (COVID-19) has been declared a pandemic for two years already.1,2 As of July 2022, more than 575 million people have been infected, of which around 6.39 million have died.3 Although its case fatality rate of »2% is lower compared to past influenza pandemics, its highly transmissible nature strains the health care systems leading to significant increases in mortalities and unfavorable morbidities even in highly urbanized countries.1,4 With the appearance of delta and other variants, the devastation induced by COVID-19 is not likely to end soon. While most COVID-19 patients present in the hospital with respiratory symptoms, other organ systems may also be affected.5,6 Around 0.8-6% will develop stroke among COVID-19 patients, while 2-3% of admitted stroke patients will harbor severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.7,8 These COVID-19 stroke patients have twice the risk of death and they have 20% more risk of having a moderate disability compared to patients with COVID-19 only.9 Nevertheless, COVID19 stroke patients were usually older and had similar risk factors as those patients with stroke alone, implying that the usual determinants for stroke may be the ones responsible for these increased risks and not COVID-19.1,7,9 However, in smaller case series and cross-sectional studies, COVID-19 patients with stroke were younger, with a cryptogenic type of stroke, and with no identifiable risk factors compared to those without COVID-19.9,10 Since SARS-CoV-2 infection affects organ systems by inducing thrombosis secondary to a hypercoagulable state, the incidence of stroke, especially the ischemic type, may plausibly be increased in COVID-19.10
12 While most large studies about the possible association of COVID-19 and stroke were done in high-income countries, only one study with a small sample size have been done in low- to middle-income countries (LMIC) like the Philippines.13 Developed countries have more organized and advanced health care systems and reliable national insurance services; hence, the incidence of stroke, its risk factors and mortality rate among COVID-19 patients may not be comparable to the true situation in LMIC.6,8 A recently concluded nationwide multicenter, comparative, retrospective cohort study was conducted from February to December 2020 to identify the different neurologic manifestations of COVID-19 in the Philippines.6 A total of 10,881 reverse transcriptase-polymerase chain reaction (RT-PCR) confirmed COVID-19 cases were collected.6 Our main objectives were a) to determine the risk factors of stroke among hospitalized COVID19 patients in the Philippines, b) to determine the possible association between these risk factors and stroke among the same cohort, and c) to determine if there is an association between mortality and stroke in this same group. Methodology Study design The data analyzed in this study were obtained from a previously published nationwide retrospective cohort study that identified the different neurologic manifestations of COVID-19 in the Philippines.6 Inclusion and exclusion criteria RT-PCR-confirmed adult COVID-19 patients, more than 18 years of age, with final hospital disposition, were included in the study. Those with pneumonia caused by other etiologies other than SARS-CoV-2 were excluded. A complete enumeration of all patients fulfilling these criteria, who were admitted to the hospitals from February until December 2020, was performed. The definition of neurological symptoms was based on the previously published protocol.6 A patient who developed focal sensory or motor deficit confirmed by either cranial computed tomography (CT) scan or magnetic resonance imaging (MRI) were recorded as a stroke patient, as seen on chart review. The imaging was the basis for classifying the patient as either infarct or hemorrhagic stroke. COVID-19 stroke patients comprised the cases while COVID-19 only patients constituted the control group. Study site Data collection was done in 37 referral hospitals for COVID-19. Identification of these sites and other information regarding methods for data collection were described in the published protocol.6 Study investigators This is a part of the Philippine CORONA Study which aimed to determine the incidence of the different neurological diseases and their association with different risk factors and outcomes in a large cohort of COVID-19 patients. This was headed by four steering committee members with 37 study site teams, of which the principal investigators were all neurologists.6 2 R.D.G. JAMORA ET AL. Data collection The method of data collection has already been published.6 In brief, all COVID-19 confirmed admissions with disposition (discharged or deceased) at the time of data collection were included in the study. A pre-made detailed abstraction form containing the variables of interest was filled out by the field physician by chart review. Possible risk factors for stroke or increased COVID-19 severity such as age, sex, smoking, hypertension, diabetes mellitus (DM), heart failure, coronary artery disease, chronic obstructive pulmonary disease (COPD), bronchial asthma, chronic kidney disease, liver disease, obesity, malignancy, and human immunodeficiency virus infection was obtained. For stroke, the neurologic symptoms and final diagnosis during admission, and different outcome measures like the severity of the disability, intensive care unit (ICU) admission, duration from admission to final disposition, mortality status, and final disposition were included in the form. Abstraction forms were then assessed for validity and inconsistencies before they were de-identified, encoded, and collated per hospital and sent to the Steering Committee of the Philippine CORONA study. Data analysis Age was presented as mean, while categorical data were presented as proportions. Standard deviation was used as measure of dispersion. Means and proportions were tested for significance using unpaired t-test and test of two proportions, respectively. Prevalence ratio, defined as the ratio of the proportion of patients with a particular risk factor in COVID-19 stroke patients divided by the proportion of patients with the same risk factor among COVID-19 only patients were computed separately. These were used as estimates of relative risks. The incidence of stroke among patients with COVID-19 was computed by dividing the number of stroke patients by the population (n = 10,881). Likewise, the incidence of different outcome measures like mortality, disability, and intensive care unit (ICU) admission in both COVID-19 stroke patients and COVID-19 patients only were obtained by dividing the number of each of these outcome measures by the number of patients who developed stroke and those who did not, respectively. Subsequently, relative risks were computed by dividing the incidence of each outcome measure among COVID-19 stroke patients by the incidence of outcome measure among those with COVID-19 patients only. To determine the association between stroke and different risk factors; and the different outcome measures and stroke among COVID-19 patients, a univariate logistic regression was done. Stroke and outcome measures were used as dependent variables separately, while risk factors for stroke, and stroke were used as their independent variables, respectively. An extended Cox proportional hazard survival analysis was also done using mortality status as the failure event and the duration from admission to either censoring or failure as survival time. Significant risk factors identified in the logistic regression was used as the predictor variables with presence of stroke as the focus. Since the presence of stroke was a time dependent variable based on the usage of scaled and unscaled Schoenfield residuals, an extended Cox model was used. All data were captured and analyzed using Stata Pro BE 17, with alpha set at < 0.05 as indicator of significance. Results Baseline characteristics There were 10,881 RT-PCR confirmed COVID-19 cases included in the Philippine CORONA Study. The patients were mostly males (n = 5780, 53.1%), with history of neurological disorder (n = 7560, 69.5%), with hypertension (n = 3647, 33.5%), and DM (n = 2191, 20.1%). Only 321 patients with COVID-19 (3%) had a history of stroke. The overall incidence of stroke among COVID-19 patients was 3.4% (n = 367). Of these, 262 (71.4%) had acute ischemic stroke (AIS) and 101 (27.5%) had acute hemorrhagic stroke (AHS). The incidence of AIS and AHS were 2.4% and 0.9%, respectively. A total of 1697 COVID-19 patients (15.6%) died due to various etiologies. Most patients who had neurologic symptoms were stable but had persistent deficits at discharge (71.7%). Only 1751 patients (16%) were admitted to the ICU primarily due to acute respiratory failure.","Answer in a single sentence. Use only the document as your source.
+
+EVIDENCE:
+**COVID-19 and Stroke Incidence** Coronavirus disease 2019 (COVID-19) has been declared a pandemic for two years already.1,2 As of July 2022, more than 575 million people have been infected, of which around 6.39 million have died.3 Although its case fatality rate of »2% is lower compared to past influenza pandemics, its highly transmissible nature strains the health care systems leading to significant increases in mortalities and unfavorable morbidities even in highly urbanized countries.1,4 With the appearance of delta and other variants, the devastation induced by COVID-19 is not likely to end soon. While most COVID-19 patients present in the hospital with respiratory symptoms, other organ systems may also be affected.5,6 Around 0.8-6% will develop stroke among COVID-19 patients, while 2-3% of admitted stroke patients will harbor severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.7,8 These COVID-19 stroke patients have twice the risk of death and they have 20% more risk of having a moderate disability compared to patients with COVID-19 only.9 Nevertheless, COVID19 stroke patients were usually older and had similar risk factors as those patients with stroke alone, implying that the usual determinants for stroke may be the ones responsible for these increased risks and not COVID-19.1,7,9 However, in smaller case series and cross-sectional studies, COVID-19 patients with stroke were younger, with a cryptogenic type of stroke, and with no identifiable risk factors compared to those without COVID-19.9,10 Since SARS-CoV-2 infection affects organ systems by inducing thrombosis secondary to a hypercoagulable state, the incidence of stroke, especially the ischemic type, may plausibly be increased in COVID-19.10
12 While most large studies about the possible association of COVID-19 and stroke were done in high-income countries, only one study with a small sample size have been done in low- to middle-income countries (LMIC) like the Philippines.13 Developed countries have more organized and advanced health care systems and reliable national insurance services; hence, the incidence of stroke, its risk factors and mortality rate among COVID-19 patients may not be comparable to the true situation in LMIC.6,8 A recently concluded nationwide multicenter, comparative, retrospective cohort study was conducted from February to December 2020 to identify the different neurologic manifestations of COVID-19 in the Philippines.6 A total of 10,881 reverse transcriptase-polymerase chain reaction (RT-PCR) confirmed COVID-19 cases were collected.6 Our main objectives were a) to determine the risk factors of stroke among hospitalized COVID19 patients in the Philippines, b) to determine the possible association between these risk factors and stroke among the same cohort, and c) to determine if there is an association between mortality and stroke in this same group. Methodology Study design The data analyzed in this study were obtained from a previously published nationwide retrospective cohort study that identified the different neurologic manifestations of COVID-19 in the Philippines.6 Inclusion and exclusion criteria RT-PCR-confirmed adult COVID-19 patients, more than 18 years of age, with final hospital disposition, were included in the study. Those with pneumonia caused by other etiologies other than SARS-CoV-2 were excluded. A complete enumeration of all patients fulfilling these criteria, who were admitted to the hospitals from February until December 2020, was performed. The definition of neurological symptoms was based on the previously published protocol.6 A patient who developed focal sensory or motor deficit confirmed by either cranial computed tomography (CT) scan or magnetic resonance imaging (MRI) were recorded as a stroke patient, as seen on chart review. The imaging was the basis for classifying the patient as either infarct or hemorrhagic stroke. COVID-19 stroke patients comprised the cases while COVID-19 only patients constituted the control group. Study site Data collection was done in 37 referral hospitals for COVID-19. Identification of these sites and other information regarding methods for data collection were described in the published protocol.6 Study investigators This is a part of the Philippine CORONA Study which aimed to determine the incidence of the different neurological diseases and their association with different risk factors and outcomes in a large cohort of COVID-19 patients. This was headed by four steering committee members with 37 study site teams, of which the principal investigators were all neurologists.6 2 R.D.G. JAMORA ET AL. Data collection The method of data collection has already been published.6 In brief, all COVID-19 confirmed admissions with disposition (discharged or deceased) at the time of data collection were included in the study. A pre-made detailed abstraction form containing the variables of interest was filled out by the field physician by chart review. Possible risk factors for stroke or increased COVID-19 severity such as age, sex, smoking, hypertension, diabetes mellitus (DM), heart failure, coronary artery disease, chronic obstructive pulmonary disease (COPD), bronchial asthma, chronic kidney disease, liver disease, obesity, malignancy, and human immunodeficiency virus infection was obtained. For stroke, the neurologic symptoms and final diagnosis during admission, and different outcome measures like the severity of the disability, intensive care unit (ICU) admission, duration from admission to final disposition, mortality status, and final disposition were included in the form. Abstraction forms were then assessed for validity and inconsistencies before they were de-identified, encoded, and collated per hospital and sent to the Steering Committee of the Philippine CORONA study. Data analysis Age was presented as mean, while categorical data were presented as proportions. Standard deviation was used as measure of dispersion. Means and proportions were tested for significance using unpaired t-test and test of two proportions, respectively. Prevalence ratio, defined as the ratio of the proportion of patients with a particular risk factor in COVID-19 stroke patients divided by the proportion of patients with the same risk factor among COVID-19 only patients were computed separately. These were used as estimates of relative risks. The incidence of stroke among patients with COVID-19 was computed by dividing the number of stroke patients by the population (n = 10,881). Likewise, the incidence of different outcome measures like mortality, disability, and intensive care unit (ICU) admission in both COVID-19 stroke patients and COVID-19 patients only were obtained by dividing the number of each of these outcome measures by the number of patients who developed stroke and those who did not, respectively. Subsequently, relative risks were computed by dividing the incidence of each outcome measure among COVID-19 stroke patients by the incidence of outcome measure among those with COVID-19 patients only. To determine the association between stroke and different risk factors; and the different outcome measures and stroke among COVID-19 patients, a univariate logistic regression was done. Stroke and outcome measures were used as dependent variables separately, while risk factors for stroke, and stroke were used as their independent variables, respectively. An extended Cox proportional hazard survival analysis was also done using mortality status as the failure event and the duration from admission to either censoring or failure as survival time. Significant risk factors identified in the logistic regression was used as the predictor variables with presence of stroke as the focus. Since the presence of stroke was a time dependent variable based on the usage of scaled and unscaled Schoenfield residuals, an extended Cox model was used. All data were captured and analyzed using Stata Pro BE 17, with alpha set at < 0.05 as indicator of significance. Results Baseline characteristics There were 10,881 RT-PCR confirmed COVID-19 cases included in the Philippine CORONA Study. The patients were mostly males (n = 5780, 53.1%), with history of neurological disorder (n = 7560, 69.5%), with hypertension (n = 3647, 33.5%), and DM (n = 2191, 20.1%). Only 321 patients with COVID-19 (3%) had a history of stroke. The overall incidence of stroke among COVID-19 patients was 3.4% (n = 367). Of these, 262 (71.4%) had acute ischemic stroke (AIS) and 101 (27.5%) had acute hemorrhagic stroke (AHS). The incidence of AIS and AHS were 2.4% and 0.9%, respectively. A total of 1697 COVID-19 patients (15.6%) died due to various etiologies. Most patients who had neurologic symptoms were stable but had persistent deficits at discharge (71.7%). Only 1751 patients (16%) were admitted to the ICU primarily due to acute respiratory failure.
+
+USER:
+According to this document, how many patients with COVID-19 had a history of stroke?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,12,14,1323,,461
+"""================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Give me the differences between micronutrients and macronutrients in terms of their functions and the and the amount required in the body.For each give examples while explaining how they help the body. Respond with 500 words.,"What are the nutrients? The foods we eat contain nutrients. Nutrients are substances required by the body to perform its basic functions. Nutrients must be obtained from our diet since the human body can not make them. Nutrients have one or more of three basic functions: they provide energy, contribute to body structure, and/or regulate chemical processes in the body. These basic functions allow us to detect and respond to environmental surroundings, move, excrete wastes, breathe, grow, and reproduce. There are six classes of nutrients required for the body to function and maintain overall health. These are carbohydrates, lipids, proteins, water, vitamins, and minerals. Foods also contain non-nutrient that may be harmful such as natural toxins common in plant foods and additives like some dyes and preservatives or beneficial like antioxidants. Key Functions of the 6 Essential Nutrients Protein Necessary for tissue formation, cell reparation, and hormone and enzyme production. It is essential for building strong muscles and a healthy immune system. Carbohydrates Provide a ready source of energy for the body and provide structural constituents for the formation of cells. Fat Provides stored energy for the body, functions as structural components of cells, and signaling molecules for proper cellular communication. It provides insulation to vital organs and works to maintain body temperature. Vitamins Regulate body processes and promote normal body-system functions. Minerals Regulate body processes, are necessary for proper cellular function, and comprise body tissue. Water Transports essential nutrients to all body parts, transports waste products for disposal, and aids with body temperature maintenance. macronutrients Nutrients that are needed in large amounts are called macronutrients. There are three classes of macronutrients: carbohydrates, lipids, and proteins. These can be metabolically processed into cellular energy. The energy from macronutrients comes from their chemical bonds. This chemical energy is converted into cellular energy used to perform work, allowing our bodies to conduct their basic functions. A unit of measurement of food energy is the calorie. On nutrition food labels, the amount given for “calories” is actually equivalent to each calorie multiplied by one thousand. A kilocalorie (Calorie) is the amount of heat generated by a particular macronutrient that raises the temperature of 1 kilogram of water 1 degree Celsius. On the Nutrition Facts panel, the calories within a particular food are expressed as kilocalories, which is commonly denoted as “Calories” with a capital “C” (1 kcal = 1 Calorie = 1,000 calories). Water is also a macronutrient in the sense that you require a large amount of it, but unlike the other macronutrients, it does not provide calories. carbohydrates Carbohydrates are molecules composed of carbon, hydrogen, and oxygen. The major food sources of carbohydrates are grains, milk, fruits, and starchy vegetables, like potatoes. Non-starchy vegetables also contain carbohydrates but in lesser quantities. Carbohydrates are broadly classified into two forms based on their chemical structure: simple carbohydrates, simple sugars, and complex carbohydrates. Simple carbohydrates consist of one or two basic units. Examples of simple sugars include sucrose, the type of sugar you would have in a bowl on the breakfast table, and glucose, the type of sugar that circulates in your blood. Complex carbohydrates are long chains of simple sugars that can be unbranched or branched. During digestion, the body breaks down digestible complex carbohydrates into simple sugars, mostly glucose. Glucose is then transported to all our cells, stored, used to make energy, or used to build macromolecules. Fiber is also a complex carbohydrate, but digestive enzymes cannot break it down in the human intestine. As a result, it passes through the digestive tract undigested unless the bacteria that inhabit the colon or large intestine break it down. One gram of digestible carbohydrates yields four kilocalories of energy for the body’s cells to perform work. Besides providing energy and serving as building blocks for bigger macromolecules, carbohydrates are essential for the nervous system’s proper functioning, heart, and kidneys. As mentioned, glucose can be stored in the body for future use. In humans, the storage molecule of carbohydrates is called glycogen, and in plants, it is known as starch. Glycogen and starch are complex carbohydrates. protein Proteins are macromolecules composed of chains of subunits called amino acids. Amino acids are simple subunits composed of carbon, oxygen, hydrogen, and nitrogen. Food sources of proteins include meats, dairy products, seafood, and various plant-based foods, most notably soy. The word protein comes from a Greek word meaning “of primary importance,” which is an apt description of these macronutrients; they are also known colloquially as the “workhorses” of life. Proteins provide four kilocalories of energy per gram; however, providing energy is not protein’s most important function. Proteins provide structure to bones, muscles, and skin and play a role in conducting most of the chemical reactions that take place in the body. Scientists estimate that greater than one-hundred thousand different proteins exist within the human body. The genetic codes in DNA are basically protein recipes that determine the order in which 20 different amino acids are bound together to make thousands of specific proteins. lipids Lipids are also a family of molecules composed of carbon, hydrogen, and oxygen, but they are insoluble in water, unlike carbohydrates. Lipids are found predominantly in butter, oils, meats, dairy products, nuts, seeds, and processed foods. The three main types of lipids are triglycerides (triacylglycerols), phospholipids, and sterols. The main job of lipids is to provide or store energy. Lipids provide more energy per gram than carbohydrates (nine kilocalories per gram of lipids versus four kilocalories per gram of carbohydrates). In addition to energy storage, lipids serve as a major component of cell membranes, surround and protect organs (in fat-storing tissues), provide insulation to aid in temperature regulation, and regulate many other body functions. water There is one other nutrient that we must have in large quantities: water. Water does not contain carbon but is composed of two hydrogens and one oxygen per molecule of water. More than 60 percent of your total body weight is water. Without it, nothing could be transported in or out of the body, chemical reactions would not occur, organs would not be cushioned, and body temperature would fluctuate widely. On average, an adult consumes just over two liters of water per day from food and drink combined. Since water is so critical for life’s basic processes, the amount of water input and output is significant, a topic we will explore in detail micronutrients Micronutrients are nutrients required by the body in lesser amounts but are still essential for carrying out bodily functions. Micronutrients include all the essential minerals and vitamins. There are sixteen essential minerals and thirteen vitamins. In contrast to carbohydrates, lipids, and proteins, micronutrients are not sources of energy (calories), but they assist in the process as cofactors or components of enzymes (i.e., coenzymes). Enzymes are proteins that catalyze chemical reactions in the body and are involved in all aspects of body functions, from producing energy to digesting nutrients to building macromolecules. Micronutrients play many essential roles in the body. minerals Minerals are solid inorganic substances that form crystals and are classified depending on how much of them we need. Trace minerals, such as molybdenum, selenium, zinc, iron, and iodine, are only required in a few milligrams or less. Macrominerals, such as calcium, magnesium, potassium, sodium, and phosphorus, are required in hundreds of milligrams. Many minerals are critical for enzyme function. Others are used to maintain fluid balance, build bone tissue, synthesize hormones, transmit nerve impulses, contract and relax muscles, and protect against harmful free radicals in the body that can cause health problems such as cancer.","""================ <TEXT PASSAGE> ======= What are the nutrients? The foods we eat contain nutrients. Nutrients are substances required by the body to perform its basic functions. Nutrients must be obtained from our diet since the human body can not make them. Nutrients have one or more of three basic functions: they provide energy, contribute to body structure, and/or regulate chemical processes in the body. These basic functions allow us to detect and respond to environmental surroundings, move, excrete wastes, breathe, grow, and reproduce. There are six classes of nutrients required for the body to function and maintain overall health. These are carbohydrates, lipids, proteins, water, vitamins, and minerals. Foods also contain non-nutrient that may be harmful such as natural toxins common in plant foods and additives like some dyes and preservatives or beneficial like antioxidants. Key Functions of the 6 Essential Nutrients Protein Necessary for tissue formation, cell reparation, and hormone and enzyme production. It is essential for building strong muscles and a healthy immune system. Carbohydrates Provide a ready source of energy for the body and provide structural constituents for the formation of cells. Fat Provides stored energy for the body, functions as structural components of cells, and signaling molecules for proper cellular communication. It provides insulation to vital organs and works to maintain body temperature. Vitamins Regulate body processes and promote normal body-system functions. Minerals Regulate body processes, are necessary for proper cellular function, and comprise body tissue. Water Transports essential nutrients to all body parts, transports waste products for disposal, and aids with body temperature maintenance. macronutrients Nutrients that are needed in large amounts are called macronutrients. There are three classes of macronutrients: carbohydrates, lipids, and proteins. These can be metabolically processed into cellular energy. The energy from macronutrients comes from their chemical bonds. This chemical energy is converted into cellular energy used to perform work, allowing our bodies to conduct their basic functions. A unit of measurement of food energy is the calorie. On nutrition food labels, the amount given for “calories” is actually equivalent to each calorie multiplied by one thousand. A kilocalorie (Calorie) is the amount of heat generated by a particular macronutrient that raises the temperature of 1 kilogram of water 1 degree Celsius. On the Nutrition Facts panel, the calories within a particular food are expressed as kilocalories, which is commonly denoted as “Calories” with a capital “C” (1 kcal = 1 Calorie = 1,000 calories). Water is also a macronutrient in the sense that you require a large amount of it, but unlike the other macronutrients, it does not provide calories. carbohydrates Carbohydrates are molecules composed of carbon, hydrogen, and oxygen. The major food sources of carbohydrates are grains, milk, fruits, and starchy vegetables, like potatoes. Non-starchy vegetables also contain carbohydrates but in lesser quantities. Carbohydrates are broadly classified into two forms based on their chemical structure: simple carbohydrates, simple sugars, and complex carbohydrates. Simple carbohydrates consist of one or two basic units. Examples of simple sugars include sucrose, the type of sugar you would have in a bowl on the breakfast table, and glucose, the type of sugar that circulates in your blood. Complex carbohydrates are long chains of simple sugars that can be unbranched or branched. During digestion, the body breaks down digestible complex carbohydrates into simple sugars, mostly glucose. Glucose is then transported to all our cells, stored, used to make energy, or used to build macromolecules. Fiber is also a complex carbohydrate, but digestive enzymes cannot break it down in the human intestine. As a result, it passes through the digestive tract undigested unless the bacteria that inhabit the colon or large intestine break it down. One gram of digestible carbohydrates yields four kilocalories of energy for the body’s cells to perform work. Besides providing energy and serving as building blocks for bigger macromolecules, carbohydrates are essential for the nervous system’s proper functioning, heart, and kidneys. As mentioned, glucose can be stored in the body for future use. In humans, the storage molecule of carbohydrates is called glycogen, and in plants, it is known as starch. Glycogen and starch are complex carbohydrates. protein Proteins are macromolecules composed of chains of subunits called amino acids. Amino acids are simple subunits composed of carbon, oxygen, hydrogen, and nitrogen. Food sources of proteins include meats, dairy products, seafood, and various plant-based foods, most notably soy. The word protein comes from a Greek word meaning “of primary importance,” which is an apt description of these macronutrients; they are also known colloquially as the “workhorses” of life. Proteins provide four kilocalories of energy per gram; however, providing energy is not protein’s most important function. Proteins provide structure to bones, muscles, and skin and play a role in conducting most of the chemical reactions that take place in the body. Scientists estimate that greater than one-hundred thousand different proteins exist within the human body. The genetic codes in DNA are basically protein recipes that determine the order in which 20 different amino acids are bound together to make thousands of specific proteins. lipids Lipids are also a family of molecules composed of carbon, hydrogen, and oxygen, but they are insoluble in water, unlike carbohydrates. Lipids are found predominantly in butter, oils, meats, dairy products, nuts, seeds, and processed foods. The three main types of lipids are triglycerides (triacylglycerols), phospholipids, and sterols. The main job of lipids is to provide or store energy. Lipids provide more energy per gram than carbohydrates (nine kilocalories per gram of lipids versus four kilocalories per gram of carbohydrates). In addition to energy storage, lipids serve as a major component of cell membranes, surround and protect organs (in fat-storing tissues), provide insulation to aid in temperature regulation, and regulate many other body functions. water There is one other nutrient that we must have in large quantities: water. Water does not contain carbon but is composed of two hydrogens and one oxygen per molecule of water. More than 60 percent of your total body weight is water. Without it, nothing could be transported in or out of the body, chemical reactions would not occur, organs would not be cushioned, and body temperature would fluctuate widely. On average, an adult consumes just over two liters of water per day from food and drink combined. Since water is so critical for life’s basic processes, the amount of water input and output is significant, a topic we will explore in detail micronutrients Micronutrients are nutrients required by the body in lesser amounts but are still essential for carrying out bodily functions. Micronutrients include all the essential minerals and vitamins. There are sixteen essential minerals and thirteen vitamins. In contrast to carbohydrates, lipids, and proteins, micronutrients are not sources of energy (calories), but they assist in the process as cofactors or components of enzymes (i.e., coenzymes). Enzymes are proteins that catalyze chemical reactions in the body and are involved in all aspects of body functions, from producing energy to digesting nutrients to building macromolecules. Micronutrients play many essential roles in the body. minerals Minerals are solid inorganic substances that form crystals and are classified depending on how much of them we need. Trace minerals, such as molybdenum, selenium, zinc, iron, and iodine, are only required in a few milligrams or less. Macrominerals, such as calcium, magnesium, potassium, sodium, and phosphorus, are required in hundreds of milligrams. Many minerals are critical for enzyme function. Others are used to maintain fluid balance, build bone tissue, synthesize hormones, transmit nerve impulses, contract and relax muscles, and protect against harmful free radicals in the body that can cause health problems such as cancer. https://open.maricopa.edu/nutritionessentials/chapter/essential-nutrients/#:~:text=Nutrients%20have%20one%20or%20more,breathe%2C%20grow%2C%20and%20reproduce. ================ <QUESTION> ======= Give me the differences between micronutrients and macronutrients in terms of their functions and the and the amount required in the body.For each give examples while explaining how they help the body. Respond with 500 words. ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""","""================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""
+
+EVIDENCE:
+What are the nutrients? The foods we eat contain nutrients. Nutrients are substances required by the body to perform its basic functions. Nutrients must be obtained from our diet since the human body can not make them. Nutrients have one or more of three basic functions: they provide energy, contribute to body structure, and/or regulate chemical processes in the body. These basic functions allow us to detect and respond to environmental surroundings, move, excrete wastes, breathe, grow, and reproduce. There are six classes of nutrients required for the body to function and maintain overall health. These are carbohydrates, lipids, proteins, water, vitamins, and minerals. Foods also contain non-nutrient that may be harmful such as natural toxins common in plant foods and additives like some dyes and preservatives or beneficial like antioxidants. Key Functions of the 6 Essential Nutrients Protein Necessary for tissue formation, cell reparation, and hormone and enzyme production. It is essential for building strong muscles and a healthy immune system. Carbohydrates Provide a ready source of energy for the body and provide structural constituents for the formation of cells. Fat Provides stored energy for the body, functions as structural components of cells, and signaling molecules for proper cellular communication. It provides insulation to vital organs and works to maintain body temperature. Vitamins Regulate body processes and promote normal body-system functions. Minerals Regulate body processes, are necessary for proper cellular function, and comprise body tissue. Water Transports essential nutrients to all body parts, transports waste products for disposal, and aids with body temperature maintenance. macronutrients Nutrients that are needed in large amounts are called macronutrients. There are three classes of macronutrients: carbohydrates, lipids, and proteins. These can be metabolically processed into cellular energy. The energy from macronutrients comes from their chemical bonds. This chemical energy is converted into cellular energy used to perform work, allowing our bodies to conduct their basic functions. A unit of measurement of food energy is the calorie. On nutrition food labels, the amount given for “calories” is actually equivalent to each calorie multiplied by one thousand. A kilocalorie (Calorie) is the amount of heat generated by a particular macronutrient that raises the temperature of 1 kilogram of water 1 degree Celsius. On the Nutrition Facts panel, the calories within a particular food are expressed as kilocalories, which is commonly denoted as “Calories” with a capital “C” (1 kcal = 1 Calorie = 1,000 calories). Water is also a macronutrient in the sense that you require a large amount of it, but unlike the other macronutrients, it does not provide calories. carbohydrates Carbohydrates are molecules composed of carbon, hydrogen, and oxygen. The major food sources of carbohydrates are grains, milk, fruits, and starchy vegetables, like potatoes. Non-starchy vegetables also contain carbohydrates but in lesser quantities. Carbohydrates are broadly classified into two forms based on their chemical structure: simple carbohydrates, simple sugars, and complex carbohydrates. Simple carbohydrates consist of one or two basic units. Examples of simple sugars include sucrose, the type of sugar you would have in a bowl on the breakfast table, and glucose, the type of sugar that circulates in your blood. Complex carbohydrates are long chains of simple sugars that can be unbranched or branched. During digestion, the body breaks down digestible complex carbohydrates into simple sugars, mostly glucose. Glucose is then transported to all our cells, stored, used to make energy, or used to build macromolecules. Fiber is also a complex carbohydrate, but digestive enzymes cannot break it down in the human intestine. As a result, it passes through the digestive tract undigested unless the bacteria that inhabit the colon or large intestine break it down. One gram of digestible carbohydrates yields four kilocalories of energy for the body’s cells to perform work. Besides providing energy and serving as building blocks for bigger macromolecules, carbohydrates are essential for the nervous system’s proper functioning, heart, and kidneys. As mentioned, glucose can be stored in the body for future use. In humans, the storage molecule of carbohydrates is called glycogen, and in plants, it is known as starch. Glycogen and starch are complex carbohydrates. protein Proteins are macromolecules composed of chains of subunits called amino acids. Amino acids are simple subunits composed of carbon, oxygen, hydrogen, and nitrogen. Food sources of proteins include meats, dairy products, seafood, and various plant-based foods, most notably soy. The word protein comes from a Greek word meaning “of primary importance,” which is an apt description of these macronutrients; they are also known colloquially as the “workhorses” of life. Proteins provide four kilocalories of energy per gram; however, providing energy is not protein’s most important function. Proteins provide structure to bones, muscles, and skin and play a role in conducting most of the chemical reactions that take place in the body. Scientists estimate that greater than one-hundred thousand different proteins exist within the human body. The genetic codes in DNA are basically protein recipes that determine the order in which 20 different amino acids are bound together to make thousands of specific proteins. lipids Lipids are also a family of molecules composed of carbon, hydrogen, and oxygen, but they are insoluble in water, unlike carbohydrates. Lipids are found predominantly in butter, oils, meats, dairy products, nuts, seeds, and processed foods. The three main types of lipids are triglycerides (triacylglycerols), phospholipids, and sterols. The main job of lipids is to provide or store energy. Lipids provide more energy per gram than carbohydrates (nine kilocalories per gram of lipids versus four kilocalories per gram of carbohydrates). In addition to energy storage, lipids serve as a major component of cell membranes, surround and protect organs (in fat-storing tissues), provide insulation to aid in temperature regulation, and regulate many other body functions. water There is one other nutrient that we must have in large quantities: water. Water does not contain carbon but is composed of two hydrogens and one oxygen per molecule of water. More than 60 percent of your total body weight is water. Without it, nothing could be transported in or out of the body, chemical reactions would not occur, organs would not be cushioned, and body temperature would fluctuate widely. On average, an adult consumes just over two liters of water per day from food and drink combined. Since water is so critical for life’s basic processes, the amount of water input and output is significant, a topic we will explore in detail micronutrients Micronutrients are nutrients required by the body in lesser amounts but are still essential for carrying out bodily functions. Micronutrients include all the essential minerals and vitamins. There are sixteen essential minerals and thirteen vitamins. In contrast to carbohydrates, lipids, and proteins, micronutrients are not sources of energy (calories), but they assist in the process as cofactors or components of enzymes (i.e., coenzymes). Enzymes are proteins that catalyze chemical reactions in the body and are involved in all aspects of body functions, from producing energy to digesting nutrients to building macromolecules. Micronutrients play many essential roles in the body. minerals Minerals are solid inorganic substances that form crystals and are classified depending on how much of them we need. Trace minerals, such as molybdenum, selenium, zinc, iron, and iodine, are only required in a few milligrams or less. Macrominerals, such as calcium, magnesium, potassium, sodium, and phosphorus, are required in hundreds of milligrams. Many minerals are critical for enzyme function. Others are used to maintain fluid balance, build bone tissue, synthesize hormones, transmit nerve impulses, contract and relax muscles, and protect against harmful free radicals in the body that can cause health problems such as cancer.
+
+USER:
+Give me the differences between micronutrients and macronutrients in terms of their functions and the and the amount required in the body.For each give examples while explaining how they help the body. Respond with 500 words.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,49,36,1261,,361
+"{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]","i've been cooking more and more for my husband since he was hospitalized after a heart attack last july, but it's getting to be too complicated. i'm looking for a cookbook that will have recipes with affordable ingredients that i can use, as well as a meal plan guide for like 4 weeks that will help me plan recipes for him in a smart way. do you have a recommendation?","Book Cover of Bobby Parrish, Dessi Parrish - FlavCity's 5 Ingredient Meals: 50 Easy & Tasty Recipes Using the Best Ingredients from the Grocery Store (Heart Healthy Budget Cooking) FlavCity's 5 Ingredient Meals 50 Easy & Tasty Recipes Using the Best Ingredients from the Grocery Store By Bobby Parrish - Passionate home cook & Food Network champion + 1 more 4.72 |2020|208 Pages StraightforwardInformativeEducational FlavCity Five Ingredient Meals For Easy Weeknight Dinners and More! #1 Bestseller in Slow Cooker Recipes, Heart Healthy Cooking, Diets & Weight Loss, Gluten-Free Diets, Budget Cooking, Green Housekeeping, and Allergies, Special Conditions, Cooking Methods, Regional & International, Soul Food, and Quick & Easy. You don’t have to be a chef to create delicious food. In fact, it only takes a handful of ingredients to make mouthwatering and easy weeknight dinners. This cookbook by Bobby and Dessi Parrish is packed full of simple, healthy dinner ideas that even newbie cooks find easy to make. An introduction to easy meals and cooking. ...more Recommended for: Home cooks seeking simple, healthy dinner ideas with minimal ingredients. Beginner to Intermediate readers. You will: Create delicious food with a handful of ingredients Cooking doesn’t have to be complicated Tips for smarter grocery shopping Cooking with a combination of store-bought and fresh items Insight into healthier food choices and product selection Reviews: Simple Recipes Healthy Ingredients Quick Tips Family Passion Grocery Shopping Tips Small Text Missing App #16 Best Seller in Budget Cooking on Amazon Added to Reading List by Nepluz Nepluz Read Amazon reviews | Rate or write a review 2 Book Cover of Ingrid Lamarr - The 15-Minute Air Fryer Cookbook for Beginners: 1800+ Days of Super Easy, Tasty and Budget-Friendly, Low-fat, Air Fryer Recipes for Weight Loss & Eating Healthier. Tips for Perfect Frying and Baking The 15-Minute Air Fryer Cookbook for Beginners 1800+ Days of Super Easy, Tasty and Budget-Friendly, Low-fat, Air Fryer Recipes for Weight Loss & Eating Healthier. Tips for Perfect Frying and Baking By Ingrid Lamarr - Renowned best-selling author and culinary enthusiast 4.66 |2024|111 Pages 🎁 Discover now the 4 EXCLUSIVE BONUSES included: a complete meal prep guide, a conversion chart, Air Fryer maintenance, and a guide to avoiding common mistakes! 🎁. ⭐ ""Transform your kitchen and diet in just 15 minutes with the Air Fryer!"" ⭐. Are you ready to say goodbye to excess oil and effortlessly prepare healthy and delicious meals? Do you want to discover the secret to crispy, flavorful dishes while keeping calorie intake and costs under control? Revolutionize your kitchen with ""The 15-Minute Air Fryer Cookbook for Beginners"" by Ingrid Lamarr, now enriched with an innovative visual experience through QR codes! ...more Recommended for: Culinary enthusiasts seeking healthy, simple, and economical cooking solutions. Beginner to Intermediate readers. Reviews: Tasty Recipes Healthy Meals Budget-Friendly Meal Prep Guide Conversion Chart Light Print Hard to Discern Photos #50 Best Seller in Fryer Recipes on Amazon Read Amazon reviews | Rate or write a review 3 Book Cover of Rosy Luke - Budget-Friendly Diabetic Cookbook for Beginners: Low-Carb, Quick & Tasty Recipes to Master Pre-Diabetes, Type 1 & 2 Diabetes with Ease. Includes 4-Week Smart Meal Plan with Affordable Ingredients Budget-Friendly Diabetic Cookbook for Beginners Low-Carb, Quick & Tasty Recipes to Master Pre-Diabetes, Type 1 & 2 Diabetes with Ease. Includes 4-Week Smart Meal Plan with Affordable Ingredients By Rosy Luke - Passionate advocate for healthy living and delicious food 4.61 |2024|65 Pages EducationalInformativePractical 🎁 Unlock Exclusive EXTRA CONTENTS! 🎁📘 1# Medication Log Books: Stay organized and on track with your diabetes medications effortlessly. 📝 2# Food Journal Log Book: Track your daily meals and snacks to stay mindful of your dietary choices. 📈 3# Blood Sugar Log Book: Monitor and manage your blood sugar levels effectively with my handy log book. 🍽️ 4# Recipe Remix: Transform your favorite dishes into diabetic-friendly delights with my expert tips. 🌟 5# Dine Out Smart Guide: Master the art of dining out while keeping your blood sugar levels in check with my essential tips. Check within your book how to get them! ...more Recommended for: Healthy living enthusiasts seeking delicious and budget-friendly diabetic recipes. Beginner to Intermediate readers. You will: Empower yourself with basic diabetes education and nutritional insights. Save time in the kitchen with quick and easy recipes tailored to busy lifestyles. Use common, affordable ingredients easily found in regular supermarkets. Explore a diverse range of mouthwatering recipes designed to satisfy your taste buds. Prepare recipes suitable for the entire family, reducing the need to cook separate meals. Reviews: Educational Value No-Stress Recipes Cost-Effective Solutions Variety and Taste Family-Friendly Options Too much education High-carb recipes Read Amazon reviews | Rate or write a review Rate or write a review LOW CHOLESTEROL DIET COOKBOOK ON A BUDGET FOR BEGINNERS A Complete guide to Heart Healthy Budget-Friendly recipes with a 30 days meal plan By ALLISON WINSTON 4.16 |2024|90 Pages Have you ever wondered if you could go on a gastronomic journey that satisfied your palate and filled your heart at the same time? Welcome to ""LOW CHOLESTEROL DIET COOKBOOK ON A BUDGET FOR BEGINNERS,"" a cookbook that aims to refute the stereotype that eating a healthy diet is monotonous or constrictive. We want you to challenge the conventional wisdom about what it means to enjoy food that loves you back as we turn the pages of this culinary adventure. Uncover Delicious Health: Indulge in a selection of 30 delectable days, each chock-full of meals that skillfully combine taste and nutrient-denseness. Every meal on the heart-healthy menu, from the refreshing crispness of Cucumber Mint Infused Water to the cozy embrace of Lentil and Vegetable Soup, is a tribute to the variety of flavors that are accessible. Advantages That Go Beyond Taste:. Enhanced Vitality: Fuel your days with meals high in nutrients that promote your general health. Cost-Effective Genius: Acquire the skill of astute supermarket shopping and cost-effective food preparation without sacrificing flavor. Empowered Eating: Take control of your health and rediscover the pleasure of cooking, one delicious meal at a time. Embrace Your Passion for Cooking:. This cookbook is more than simply a collection of recipes; it's an appeal to change your perspective on food and a call to action. Accept the power of choice; every component and cooking technique is a deliberate choice that will lead to a more vibrant, healthier version of yourself. Bring Your Inner Chef Out:. ""LOW CHOLESTEROL DIET COOKBOOK ON A BUDGET FOR BEGINNERS"" gives both novice and experienced cooks the tools they need to create meals that uplift the spirit and the heart. It's an investigation of the remarkable tastes that arise from the union of pleasure and wellness. Get a copy of ""LOW CHOLESTEROL DIET COOKBOOK ON A BUDGET FOR BEGINNERS"" by clicking on "" add to cart"" and on a taste-tempting, nourishing, and transformational culinary adventure. The ingredients are ready, the table is set; challenge the commonplace, welcome the exceptional, and practice the art of generous living. Makeover your kitchen. Fill your spirit with nourishment. Explore ""LOW CHOLESTEROL DIET COOKBOOK ON A BUDGET FOR BEGINNERS"" right now. (show less)","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== i've been cooking more and more for my husband since he was hospitalized after a heart attack last july, but it's getting to be too complicated. i'm looking for a cookbook that will have recipes with affordable ingredients that i can use, as well as a meal plan guide for like 4 weeks that will help me plan recipes for him in a smart way. do you have a recommendation? {passage 0} ========== Book Cover of Bobby Parrish, Dessi Parrish - FlavCity's 5 Ingredient Meals: 50 Easy & Tasty Recipes Using the Best Ingredients from the Grocery Store (Heart Healthy Budget Cooking) FlavCity's 5 Ingredient Meals 50 Easy & Tasty Recipes Using the Best Ingredients from the Grocery Store By Bobby Parrish - Passionate home cook & Food Network champion + 1 more 4.72 |2020|208 Pages StraightforwardInformativeEducational FlavCity Five Ingredient Meals For Easy Weeknight Dinners and More! #1 Bestseller in Slow Cooker Recipes, Heart Healthy Cooking, Diets & Weight Loss, Gluten-Free Diets, Budget Cooking, Green Housekeeping, and Allergies, Special Conditions, Cooking Methods, Regional & International, Soul Food, and Quick & Easy. You don’t have to be a chef to create delicious food. In fact, it only takes a handful of ingredients to make mouthwatering and easy weeknight dinners. This cookbook by Bobby and Dessi Parrish is packed full of simple, healthy dinner ideas that even newbie cooks find easy to make. An introduction to easy meals and cooking. ...more Recommended for: Home cooks seeking simple, healthy dinner ideas with minimal ingredients. Beginner to Intermediate readers. You will: Create delicious food with a handful of ingredients Cooking doesn’t have to be complicated Tips for smarter grocery shopping Cooking with a combination of store-bought and fresh items Insight into healthier food choices and product selection Reviews: Simple Recipes Healthy Ingredients Quick Tips Family Passion Grocery Shopping Tips Small Text Missing App #16 Best Seller in Budget Cooking on Amazon Added to Reading List by Nepluz Nepluz Read Amazon reviews | Rate or write a review 2 Book Cover of Ingrid Lamarr - The 15-Minute Air Fryer Cookbook for Beginners: 1800+ Days of Super Easy, Tasty and Budget-Friendly, Low-fat, Air Fryer Recipes for Weight Loss & Eating Healthier. Tips for Perfect Frying and Baking The 15-Minute Air Fryer Cookbook for Beginners 1800+ Days of Super Easy, Tasty and Budget-Friendly, Low-fat, Air Fryer Recipes for Weight Loss & Eating Healthier. Tips for Perfect Frying and Baking By Ingrid Lamarr - Renowned best-selling author and culinary enthusiast 4.66 |2024|111 Pages 🎁 Discover now the 4 EXCLUSIVE BONUSES included: a complete meal prep guide, a conversion chart, Air Fryer maintenance, and a guide to avoiding common mistakes! 🎁. ⭐ ""Transform your kitchen and diet in just 15 minutes with the Air Fryer!"" ⭐. Are you ready to say goodbye to excess oil and effortlessly prepare healthy and delicious meals? Do you want to discover the secret to crispy, flavorful dishes while keeping calorie intake and costs under control? Revolutionize your kitchen with ""The 15-Minute Air Fryer Cookbook for Beginners"" by Ingrid Lamarr, now enriched with an innovative visual experience through QR codes! ...more Recommended for: Culinary enthusiasts seeking healthy, simple, and economical cooking solutions. Beginner to Intermediate readers. Reviews: Tasty Recipes Healthy Meals Budget-Friendly Meal Prep Guide Conversion Chart Light Print Hard to Discern Photos #50 Best Seller in Fryer Recipes on Amazon Read Amazon reviews | Rate or write a review 3 Book Cover of Rosy Luke - Budget-Friendly Diabetic Cookbook for Beginners: Low-Carb, Quick & Tasty Recipes to Master Pre-Diabetes, Type 1 & 2 Diabetes with Ease. Includes 4-Week Smart Meal Plan with Affordable Ingredients Budget-Friendly Diabetic Cookbook for Beginners Low-Carb, Quick & Tasty Recipes to Master Pre-Diabetes, Type 1 & 2 Diabetes with Ease. Includes 4-Week Smart Meal Plan with Affordable Ingredients By Rosy Luke - Passionate advocate for healthy living and delicious food 4.61 |2024|65 Pages EducationalInformativePractical 🎁 Unlock Exclusive EXTRA CONTENTS! 🎁📘 1# Medication Log Books: Stay organized and on track with your diabetes medications effortlessly. 📝 2# Food Journal Log Book: Track your daily meals and snacks to stay mindful of your dietary choices. 📈 3# Blood Sugar Log Book: Monitor and manage your blood sugar levels effectively with my handy log book. 🍽️ 4# Recipe Remix: Transform your favorite dishes into diabetic-friendly delights with my expert tips. 🌟 5# Dine Out Smart Guide: Master the art of dining out while keeping your blood sugar levels in check with my essential tips. Check within your book how to get them! ...more Recommended for: Healthy living enthusiasts seeking delicious and budget-friendly diabetic recipes. Beginner to Intermediate readers. You will: Empower yourself with basic diabetes education and nutritional insights. Save time in the kitchen with quick and easy recipes tailored to busy lifestyles. Use common, affordable ingredients easily found in regular supermarkets. Explore a diverse range of mouthwatering recipes designed to satisfy your taste buds. Prepare recipes suitable for the entire family, reducing the need to cook separate meals. Reviews: Educational Value No-Stress Recipes Cost-Effective Solutions Variety and Taste Family-Friendly Options Too much education High-carb recipes Read Amazon reviews | Rate or write a review Rate or write a review LOW CHOLESTEROL DIET COOKBOOK ON A BUDGET FOR BEGINNERS A Complete guide to Heart Healthy Budget-Friendly recipes with a 30 days meal plan By ALLISON WINSTON 4.16 |2024|90 Pages Have you ever wondered if you could go on a gastronomic journey that satisfied your palate and filled your heart at the same time? Welcome to ""LOW CHOLESTEROL DIET COOKBOOK ON A BUDGET FOR BEGINNERS,"" a cookbook that aims to refute the stereotype that eating a healthy diet is monotonous or constrictive. We want you to challenge the conventional wisdom about what it means to enjoy food that loves you back as we turn the pages of this culinary adventure. Uncover Delicious Health: Indulge in a selection of 30 delectable days, each chock-full of meals that skillfully combine taste and nutrient-denseness. Every meal on the heart-healthy menu, from the refreshing crispness of Cucumber Mint Infused Water to the cozy embrace of Lentil and Vegetable Soup, is a tribute to the variety of flavors that are accessible. Advantages That Go Beyond Taste:. Enhanced Vitality: Fuel your days with meals high in nutrients that promote your general health. Cost-Effective Genius: Acquire the skill of astute supermarket shopping and cost-effective food preparation without sacrificing flavor. Empowered Eating: Take control of your health and rediscover the pleasure of cooking, one delicious meal at a time. Embrace Your Passion for Cooking:. This cookbook is more than simply a collection of recipes; it's an appeal to change your perspective on food and a call to action. Accept the power of choice; every component and cooking technique is a deliberate choice that will lead to a more vibrant, healthier version of yourself. Bring Your Inner Chef Out:. ""LOW CHOLESTEROL DIET COOKBOOK ON A BUDGET FOR BEGINNERS"" gives both novice and experienced cooks the tools they need to create meals that uplift the spirit and the heart. It's an investigation of the remarkable tastes that arise from the union of pleasure and wellness. Get a copy of ""LOW CHOLESTEROL DIET COOKBOOK ON A BUDGET FOR BEGINNERS"" by clicking on "" add to cart"" and on a taste-tempting, nourishing, and transformational culinary adventure. The ingredients are ready, the table is set; challenge the commonplace, welcome the exceptional, and practice the art of generous living. Makeover your kitchen. Fill your spirit with nourishment. Explore ""LOW CHOLESTEROL DIET COOKBOOK ON A BUDGET FOR BEGINNERS"" right now. (show less) https://bookauthority.org/books/beginner-budget-cooking-books","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]
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+Book Cover of Bobby Parrish, Dessi Parrish - FlavCity's 5 Ingredient Meals: 50 Easy & Tasty Recipes Using the Best Ingredients from the Grocery Store (Heart Healthy Budget Cooking) FlavCity's 5 Ingredient Meals 50 Easy & Tasty Recipes Using the Best Ingredients from the Grocery Store By Bobby Parrish - Passionate home cook & Food Network champion + 1 more 4.72 |2020|208 Pages StraightforwardInformativeEducational FlavCity Five Ingredient Meals For Easy Weeknight Dinners and More! #1 Bestseller in Slow Cooker Recipes, Heart Healthy Cooking, Diets & Weight Loss, Gluten-Free Diets, Budget Cooking, Green Housekeeping, and Allergies, Special Conditions, Cooking Methods, Regional & International, Soul Food, and Quick & Easy. You don’t have to be a chef to create delicious food. In fact, it only takes a handful of ingredients to make mouthwatering and easy weeknight dinners. This cookbook by Bobby and Dessi Parrish is packed full of simple, healthy dinner ideas that even newbie cooks find easy to make. An introduction to easy meals and cooking. ...more Recommended for: Home cooks seeking simple, healthy dinner ideas with minimal ingredients. Beginner to Intermediate readers. You will: Create delicious food with a handful of ingredients Cooking doesn’t have to be complicated Tips for smarter grocery shopping Cooking with a combination of store-bought and fresh items Insight into healthier food choices and product selection Reviews: Simple Recipes Healthy Ingredients Quick Tips Family Passion Grocery Shopping Tips Small Text Missing App #16 Best Seller in Budget Cooking on Amazon Added to Reading List by Nepluz Nepluz Read Amazon reviews | Rate or write a review 2 Book Cover of Ingrid Lamarr - The 15-Minute Air Fryer Cookbook for Beginners: 1800+ Days of Super Easy, Tasty and Budget-Friendly, Low-fat, Air Fryer Recipes for Weight Loss & Eating Healthier. Tips for Perfect Frying and Baking The 15-Minute Air Fryer Cookbook for Beginners 1800+ Days of Super Easy, Tasty and Budget-Friendly, Low-fat, Air Fryer Recipes for Weight Loss & Eating Healthier. Tips for Perfect Frying and Baking By Ingrid Lamarr - Renowned best-selling author and culinary enthusiast 4.66 |2024|111 Pages 🎁 Discover now the 4 EXCLUSIVE BONUSES included: a complete meal prep guide, a conversion chart, Air Fryer maintenance, and a guide to avoiding common mistakes! 🎁. ⭐ ""Transform your kitchen and diet in just 15 minutes with the Air Fryer!"" ⭐. Are you ready to say goodbye to excess oil and effortlessly prepare healthy and delicious meals? Do you want to discover the secret to crispy, flavorful dishes while keeping calorie intake and costs under control? Revolutionize your kitchen with ""The 15-Minute Air Fryer Cookbook for Beginners"" by Ingrid Lamarr, now enriched with an innovative visual experience through QR codes! ...more Recommended for: Culinary enthusiasts seeking healthy, simple, and economical cooking solutions. Beginner to Intermediate readers. Reviews: Tasty Recipes Healthy Meals Budget-Friendly Meal Prep Guide Conversion Chart Light Print Hard to Discern Photos #50 Best Seller in Fryer Recipes on Amazon Read Amazon reviews | Rate or write a review 3 Book Cover of Rosy Luke - Budget-Friendly Diabetic Cookbook for Beginners: Low-Carb, Quick & Tasty Recipes to Master Pre-Diabetes, Type 1 & 2 Diabetes with Ease. Includes 4-Week Smart Meal Plan with Affordable Ingredients Budget-Friendly Diabetic Cookbook for Beginners Low-Carb, Quick & Tasty Recipes to Master Pre-Diabetes, Type 1 & 2 Diabetes with Ease. Includes 4-Week Smart Meal Plan with Affordable Ingredients By Rosy Luke - Passionate advocate for healthy living and delicious food 4.61 |2024|65 Pages EducationalInformativePractical 🎁 Unlock Exclusive EXTRA CONTENTS! 🎁📘 1# Medication Log Books: Stay organized and on track with your diabetes medications effortlessly. 📝 2# Food Journal Log Book: Track your daily meals and snacks to stay mindful of your dietary choices. 📈 3# Blood Sugar Log Book: Monitor and manage your blood sugar levels effectively with my handy log book. 🍽️ 4# Recipe Remix: Transform your favorite dishes into diabetic-friendly delights with my expert tips. 🌟 5# Dine Out Smart Guide: Master the art of dining out while keeping your blood sugar levels in check with my essential tips. Check within your book how to get them! ...more Recommended for: Healthy living enthusiasts seeking delicious and budget-friendly diabetic recipes. Beginner to Intermediate readers. You will: Empower yourself with basic diabetes education and nutritional insights. Save time in the kitchen with quick and easy recipes tailored to busy lifestyles. Use common, affordable ingredients easily found in regular supermarkets. Explore a diverse range of mouthwatering recipes designed to satisfy your taste buds. Prepare recipes suitable for the entire family, reducing the need to cook separate meals. Reviews: Educational Value No-Stress Recipes Cost-Effective Solutions Variety and Taste Family-Friendly Options Too much education High-carb recipes Read Amazon reviews | Rate or write a review Rate or write a review LOW CHOLESTEROL DIET COOKBOOK ON A BUDGET FOR BEGINNERS A Complete guide to Heart Healthy Budget-Friendly recipes with a 30 days meal plan By ALLISON WINSTON 4.16 |2024|90 Pages Have you ever wondered if you could go on a gastronomic journey that satisfied your palate and filled your heart at the same time? Welcome to ""LOW CHOLESTEROL DIET COOKBOOK ON A BUDGET FOR BEGINNERS,"" a cookbook that aims to refute the stereotype that eating a healthy diet is monotonous or constrictive. We want you to challenge the conventional wisdom about what it means to enjoy food that loves you back as we turn the pages of this culinary adventure. Uncover Delicious Health: Indulge in a selection of 30 delectable days, each chock-full of meals that skillfully combine taste and nutrient-denseness. Every meal on the heart-healthy menu, from the refreshing crispness of Cucumber Mint Infused Water to the cozy embrace of Lentil and Vegetable Soup, is a tribute to the variety of flavors that are accessible. Advantages That Go Beyond Taste:. Enhanced Vitality: Fuel your days with meals high in nutrients that promote your general health. Cost-Effective Genius: Acquire the skill of astute supermarket shopping and cost-effective food preparation without sacrificing flavor. Empowered Eating: Take control of your health and rediscover the pleasure of cooking, one delicious meal at a time. Embrace Your Passion for Cooking:. This cookbook is more than simply a collection of recipes; it's an appeal to change your perspective on food and a call to action. Accept the power of choice; every component and cooking technique is a deliberate choice that will lead to a more vibrant, healthier version of yourself. Bring Your Inner Chef Out:. ""LOW CHOLESTEROL DIET COOKBOOK ON A BUDGET FOR BEGINNERS"" gives both novice and experienced cooks the tools they need to create meals that uplift the spirit and the heart. It's an investigation of the remarkable tastes that arise from the union of pleasure and wellness. Get a copy of ""LOW CHOLESTEROL DIET COOKBOOK ON A BUDGET FOR BEGINNERS"" by clicking on "" add to cart"" and on a taste-tempting, nourishing, and transformational culinary adventure. The ingredients are ready, the table is set; challenge the commonplace, welcome the exceptional, and practice the art of generous living. Makeover your kitchen. Fill your spirit with nourishment. Explore ""LOW CHOLESTEROL DIET COOKBOOK ON A BUDGET FOR BEGINNERS"" right now. (show less)
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+USER:
+i've been cooking more and more for my husband since he was hospitalized after a heart attack last july, but it's getting to be too complicated. i'm looking for a cookbook that will have recipes with affordable ingredients that i can use, as well as a meal plan guide for like 4 weeks that will help me plan recipes for him in a smart way. do you have a recommendation?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,26,70,1181,,321
+"ONLY USE THE DATA I PROVIDE Limit your response to 250 words If you cannot answer using the contexts alone, say ""I cannot determine the answer to that due to lack of context""",What does it mean when a nail polish is 10-free?,"What is 7 Free Nail Polish? And Why is 10 Free Even Better! September 27, 2021 By Mary Lennon Did you know that the nail polish you are currently using could be affecting your health in ways you may have never even thought? Mainstream nail polishes contain several chemicals and other harsh ingredients that have the ability to cause severe adverse reactions alongside damaging health concerns. As a result of this, you may have come across nail polish brands that claim to be 3-free, 5-free, or even 7-free, and it is likely that you have wondered what exactly is meant by those confusing phrases. In this blog post, we will be covering everything that you need to know about non-toxic nail polish, as well as offer an explanation as to why the nail polish you are using right now could be bad for your health. **The Importance Of Non-Toxic Nail Polish** First off, to truly understand the importance of non-toxic nail polish, it is fundamental that one knows the negative health connotations associated with regular nail polish. A 2015 study found that certain chemicals that are used in most bottles of nail polish, can be absorbed into the body via the nails and cause several damaging health effects to the user. These damaged health effects vary greatly from person to person, but they can cause quite a devastating impact. Regular types of nail polish contain cancer-causing chemicals, can cause hormone imbalances, alongside thyroid issues, and increase the risk of diabetes should you be overexposing yourself to the product. Though you may assume that you are not going to be affected by these chemicals, just think of how much you breathe in the scent of nail lacquer while painting your nails and how often the paint touches your skin, as well as the amount of contact your nails have with your mouth directly, or when preparing food for both you and your loved ones. Fortunately, enough research has been established so that while regular nail polish used at your nail salon is sadly still able to promote itself, innovative and safe nail products have been developed with the health of the customer in mind. Non- toxic nail polish comes in several variants, with each type excluding certain chemicals, ingredients, and products that may have highly damaging effects on the user. These types of non toxic nail polishes are often referred to as 3-free, 5-free, 7-free, or 10-free. Here at Côte Nail Polish, all of our vegan nail polishes are cruelty-free, and most importantly, non-toxic. Our customers can be assured that their health is our optimal concern and that we will always endeavor to use the best and highest quality ingredients for our nail polish and accessories. **What Is 7-Free Nail Polish?** 7-free nail polish is free of 7 toxic chemicals that are common in most regular nail polish formulas. The chemicals this nail lacquer is free from are as follows: dibutyl phthalate, formaldehyde, toluene, formaldehyde resin, camphor, ethyl tosylamide, and xylene. Each of these chemicals can have a negative impact on the user’s health, and therefore, substituting them out of the polish formula will help to lessen the toxic effect of nail varnish. There are also other variants of the free toxin nail polish, each omitting a specific number of chemicals: 3-Free: This formula is void of the “Toxic Trio”: Dibutyl Phthalate (DPB), Formaldehyde, and Toluene. These three chemicals are by far the most harmful, as they are associated with some of the most harmful and debilitating diseases, including cancer and diabetes. 5-Free: The chemicals excluded in 5- free include the above-mentioned “Toxic Trio” as well as formaldehyde resin, and camphor. 10-Free: This type of formula omits dibutyl phthalate, TPHP, toluene, xylene, ethyl tosylamide, camphor, formaldehyde, formaldehyde resin, parabens, and gluten. Therefore, this formula of nail polish is considered to be one of the safest types of nail polish due to its substitution of toxic chemicals. **Chemicals Excluded in 7-Free Polish** Simply providing the names of the seven harmful chemicals left out of these 7- free polishes will not accurately represent the harm that these toxins can cause. In this section, we have outlined the chemicals that are excluded from seven free nail polishes, explaining the health issues that these can cause. Dibutyl Phthalate (DPB): DPB is a harsh chemical that affects the endocrine system, which controls hormone regulation. Too much DPB can cause issues with your thyroid, causing mental health issues as well as physical problems like fatigue. It can also hamper developmental growth and potentially affect reproductive health. Formaldehyde: This commonly used chemical is a known human carcinogen, meaning it has been known to increase the risk of cancer. It can also cause severe dermatitis, skin irritation, and eye irritation. Toluene: Toluene can cause birth defects in the children of pregnant women who are overly exposed to the chemical. It can also affect the nervous system, causing nausea, lightheadedness, and fatigue. Formaldehyde Resin: This chemical is a common allergen causing skin irritation, redness, and itching. It is used in nail lacquers to help solidify the liquid into a thicker texture. Camphor: Camphor can lead to poor nail health, which is the opposite of what you want when caring for and painting your nails. This is because the harsh toxins strip your nails of their essential nutrients, starving them of what they need to maintain their strength. This chemical can also cause disorientation, and more alarmingly, seizures. Ethyl Tosylamide: This chemical is banned in Europe due to potentially causing severe allergic reactions in users. The role of Ethyl Tosylamide is to help the polish to stick to the surface of the nail, though non-toxic nail polish also has great durability without the associated health risks. Xylene: This chemical is what gives your nail polish that distinct smell that often causes headaches or lightheadedness. It is used in nail polish to avoid clumpiness by thinning out the solution, but it is an incredibly toxic chemical that can cause immense reactions and irritation. **Why 10-Free Nail Polish Is Even Better** 10-free nail polish is better than 7-free as it excludes some additional chemicals and products that are not only toxic but also environmentally damaging, and even unethical to be using. Parabens: Parabens are a group of preservatives that are used in polishes to aid longevity. Not only do parabens interfere with the hormonal system, but they're also a factor directly involved with well-researched carcinogens that can cause skin and breast cancer. Triphenyl Phosphate: Triphenyl phosphate is another harmful toxin often included in traditional nail polish to aid the malleability of the varnish. Ongoing or frequent or extended exposure to Triphenyl phosphate can cause changes in hormone regulation, affecting reproductive systems, as well as metabolism. Consequently, it is best to avoid this harmful chemical, especially in your nail polish. Gluten: Gluten may seem surprising, but for those with a gluten allergy or intolerance, the inclusion of gluten in their nail polish can lead to severe adverse reactions. For those with celiac disease, topical exposure to wheat products can cause irritation. **Conclusion** In summary, regular nail polishes can be extremely harmful to not only the health of your nails but to your body as a whole! We believe that educating people on the toxic ingredients in nail polish can help customers to make more informed decisions regarding their health. At Côte, we are dedicated to sharing our belief in beautiful, clean, and safe nontoxic nail polishes, and that is why all our products are 10- free, cruelty free, with a non-toxic formula and amazing vibrant colors. Additionally, all of our products are vegan and free of studies involving lab animals.","[System Instruction] ================== ONLY USE THE DATA I PROVIDE Limit your response to 250 words If you cannot answer using the contexts alone, say ""I cannot determine the answer to that due to lack of context"" ---------------- [Passage] ================== What is 7 Free Nail Polish? And Why is 10 Free Even Better! September 27, 2021 By Mary Lennon Did you know that the nail polish you are currently using could be affecting your health in ways you may have never even thought? Mainstream nail polishes contain several chemicals and other harsh ingredients that have the ability to cause severe adverse reactions alongside damaging health concerns. As a result of this, you may have come across nail polish brands that claim to be 3-free, 5-free, or even 7-free, and it is likely that you have wondered what exactly is meant by those confusing phrases. In this blog post, we will be covering everything that you need to know about non-toxic nail polish, as well as offer an explanation as to why the nail polish you are using right now could be bad for your health. **The Importance Of Non-Toxic Nail Polish** First off, to truly understand the importance of non-toxic nail polish, it is fundamental that one knows the negative health connotations associated with regular nail polish. A 2015 study found that certain chemicals that are used in most bottles of nail polish, can be absorbed into the body via the nails and cause several damaging health effects to the user. These damaged health effects vary greatly from person to person, but they can cause quite a devastating impact. Regular types of nail polish contain cancer-causing chemicals, can cause hormone imbalances, alongside thyroid issues, and increase the risk of diabetes should you be overexposing yourself to the product. Though you may assume that you are not going to be affected by these chemicals, just think of how much you breathe in the scent of nail lacquer while painting your nails and how often the paint touches your skin, as well as the amount of contact your nails have with your mouth directly, or when preparing food for both you and your loved ones. Fortunately, enough research has been established so that while regular nail polish used at your nail salon is sadly still able to promote itself, innovative and safe nail products have been developed with the health of the customer in mind. Non- toxic nail polish comes in several variants, with each type excluding certain chemicals, ingredients, and products that may have highly damaging effects on the user. These types of non toxic nail polishes are often referred to as 3-free, 5-free, 7-free, or 10-free. Here at Côte Nail Polish, all of our vegan nail polishes are cruelty-free, and most importantly, non-toxic. Our customers can be assured that their health is our optimal concern and that we will always endeavor to use the best and highest quality ingredients for our nail polish and accessories. **What Is 7-Free Nail Polish?** 7-free nail polish is free of 7 toxic chemicals that are common in most regular nail polish formulas. The chemicals this nail lacquer is free from are as follows: dibutyl phthalate, formaldehyde, toluene, formaldehyde resin, camphor, ethyl tosylamide, and xylene. Each of these chemicals can have a negative impact on the user’s health, and therefore, substituting them out of the polish formula will help to lessen the toxic effect of nail varnish. There are also other variants of the free toxin nail polish, each omitting a specific number of chemicals: 3-Free: This formula is void of the “Toxic Trio”: Dibutyl Phthalate (DPB), Formaldehyde, and Toluene. These three chemicals are by far the most harmful, as they are associated with some of the most harmful and debilitating diseases, including cancer and diabetes. 5-Free: The chemicals excluded in 5- free include the above-mentioned “Toxic Trio” as well as formaldehyde resin, and camphor. 10-Free: This type of formula omits dibutyl phthalate, TPHP, toluene, xylene, ethyl tosylamide, camphor, formaldehyde, formaldehyde resin, parabens, and gluten. Therefore, this formula of nail polish is considered to be one of the safest types of nail polish due to its substitution of toxic chemicals. **Chemicals Excluded in 7-Free Polish** Simply providing the names of the seven harmful chemicals left out of these 7- free polishes will not accurately represent the harm that these toxins can cause. In this section, we have outlined the chemicals that are excluded from seven free nail polishes, explaining the health issues that these can cause. Dibutyl Phthalate (DPB): DPB is a harsh chemical that affects the endocrine system, which controls hormone regulation. Too much DPB can cause issues with your thyroid, causing mental health issues as well as physical problems like fatigue. It can also hamper developmental growth and potentially affect reproductive health. Formaldehyde: This commonly used chemical is a known human carcinogen, meaning it has been known to increase the risk of cancer. It can also cause severe dermatitis, skin irritation, and eye irritation. Toluene: Toluene can cause birth defects in the children of pregnant women who are overly exposed to the chemical. It can also affect the nervous system, causing nausea, lightheadedness, and fatigue. Formaldehyde Resin: This chemical is a common allergen causing skin irritation, redness, and itching. It is used in nail lacquers to help solidify the liquid into a thicker texture. Camphor: Camphor can lead to poor nail health, which is the opposite of what you want when caring for and painting your nails. This is because the harsh toxins strip your nails of their essential nutrients, starving them of what they need to maintain their strength. This chemical can also cause disorientation, and more alarmingly, seizures. Ethyl Tosylamide: This chemical is banned in Europe due to potentially causing severe allergic reactions in users. The role of Ethyl Tosylamide is to help the polish to stick to the surface of the nail, though non-toxic nail polish also has great durability without the associated health risks. Xylene: This chemical is what gives your nail polish that distinct smell that often causes headaches or lightheadedness. It is used in nail polish to avoid clumpiness by thinning out the solution, but it is an incredibly toxic chemical that can cause immense reactions and irritation. **Why 10-Free Nail Polish Is Even Better** 10-free nail polish is better than 7-free as it excludes some additional chemicals and products that are not only toxic but also environmentally damaging, and even unethical to be using. Parabens: Parabens are a group of preservatives that are used in polishes to aid longevity. Not only do parabens interfere with the hormonal system, but they're also a factor directly involved with well-researched carcinogens that can cause skin and breast cancer. Triphenyl Phosphate: Triphenyl phosphate is another harmful toxin often included in traditional nail polish to aid the malleability of the varnish. Ongoing or frequent or extended exposure to Triphenyl phosphate can cause changes in hormone regulation, affecting reproductive systems, as well as metabolism. Consequently, it is best to avoid this harmful chemical, especially in your nail polish. Gluten: Gluten may seem surprising, but for those with a gluten allergy or intolerance, the inclusion of gluten in their nail polish can lead to severe adverse reactions. For those with celiac disease, topical exposure to wheat products can cause irritation. **Conclusion** In summary, regular nail polishes can be extremely harmful to not only the health of your nails but to your body as a whole! We believe that educating people on the toxic ingredients in nail polish can help customers to make more informed decisions regarding their health. At Côte, we are dedicated to sharing our belief in beautiful, clean, and safe nontoxic nail polishes, and that is why all our products are 10- free, cruelty free, with a non-toxic formula and amazing vibrant colors. Additionally, all of our products are vegan and free of studies involving lab animals. ---------------- [Question] ================== What does it mean when a nail polish is 10-free?","ONLY USE THE DATA I PROVIDE Limit your response to 250 words If you cannot answer using the contexts alone, say ""I cannot determine the answer to that due to lack of context""
+
+EVIDENCE:
+What is 7 Free Nail Polish? And Why is 10 Free Even Better! September 27, 2021 By Mary Lennon Did you know that the nail polish you are currently using could be affecting your health in ways you may have never even thought? Mainstream nail polishes contain several chemicals and other harsh ingredients that have the ability to cause severe adverse reactions alongside damaging health concerns. As a result of this, you may have come across nail polish brands that claim to be 3-free, 5-free, or even 7-free, and it is likely that you have wondered what exactly is meant by those confusing phrases. In this blog post, we will be covering everything that you need to know about non-toxic nail polish, as well as offer an explanation as to why the nail polish you are using right now could be bad for your health. **The Importance Of Non-Toxic Nail Polish** First off, to truly understand the importance of non-toxic nail polish, it is fundamental that one knows the negative health connotations associated with regular nail polish. A 2015 study found that certain chemicals that are used in most bottles of nail polish, can be absorbed into the body via the nails and cause several damaging health effects to the user. These damaged health effects vary greatly from person to person, but they can cause quite a devastating impact. Regular types of nail polish contain cancer-causing chemicals, can cause hormone imbalances, alongside thyroid issues, and increase the risk of diabetes should you be overexposing yourself to the product. Though you may assume that you are not going to be affected by these chemicals, just think of how much you breathe in the scent of nail lacquer while painting your nails and how often the paint touches your skin, as well as the amount of contact your nails have with your mouth directly, or when preparing food for both you and your loved ones. Fortunately, enough research has been established so that while regular nail polish used at your nail salon is sadly still able to promote itself, innovative and safe nail products have been developed with the health of the customer in mind. Non- toxic nail polish comes in several variants, with each type excluding certain chemicals, ingredients, and products that may have highly damaging effects on the user. These types of non toxic nail polishes are often referred to as 3-free, 5-free, 7-free, or 10-free. Here at Côte Nail Polish, all of our vegan nail polishes are cruelty-free, and most importantly, non-toxic. Our customers can be assured that their health is our optimal concern and that we will always endeavor to use the best and highest quality ingredients for our nail polish and accessories. **What Is 7-Free Nail Polish?** 7-free nail polish is free of 7 toxic chemicals that are common in most regular nail polish formulas. The chemicals this nail lacquer is free from are as follows: dibutyl phthalate, formaldehyde, toluene, formaldehyde resin, camphor, ethyl tosylamide, and xylene. Each of these chemicals can have a negative impact on the user’s health, and therefore, substituting them out of the polish formula will help to lessen the toxic effect of nail varnish. There are also other variants of the free toxin nail polish, each omitting a specific number of chemicals: 3-Free: This formula is void of the “Toxic Trio”: Dibutyl Phthalate (DPB), Formaldehyde, and Toluene. These three chemicals are by far the most harmful, as they are associated with some of the most harmful and debilitating diseases, including cancer and diabetes. 5-Free: The chemicals excluded in 5- free include the above-mentioned “Toxic Trio” as well as formaldehyde resin, and camphor. 10-Free: This type of formula omits dibutyl phthalate, TPHP, toluene, xylene, ethyl tosylamide, camphor, formaldehyde, formaldehyde resin, parabens, and gluten. Therefore, this formula of nail polish is considered to be one of the safest types of nail polish due to its substitution of toxic chemicals. **Chemicals Excluded in 7-Free Polish** Simply providing the names of the seven harmful chemicals left out of these 7- free polishes will not accurately represent the harm that these toxins can cause. In this section, we have outlined the chemicals that are excluded from seven free nail polishes, explaining the health issues that these can cause. Dibutyl Phthalate (DPB): DPB is a harsh chemical that affects the endocrine system, which controls hormone regulation. Too much DPB can cause issues with your thyroid, causing mental health issues as well as physical problems like fatigue. It can also hamper developmental growth and potentially affect reproductive health. Formaldehyde: This commonly used chemical is a known human carcinogen, meaning it has been known to increase the risk of cancer. It can also cause severe dermatitis, skin irritation, and eye irritation. Toluene: Toluene can cause birth defects in the children of pregnant women who are overly exposed to the chemical. It can also affect the nervous system, causing nausea, lightheadedness, and fatigue. Formaldehyde Resin: This chemical is a common allergen causing skin irritation, redness, and itching. It is used in nail lacquers to help solidify the liquid into a thicker texture. Camphor: Camphor can lead to poor nail health, which is the opposite of what you want when caring for and painting your nails. This is because the harsh toxins strip your nails of their essential nutrients, starving them of what they need to maintain their strength. This chemical can also cause disorientation, and more alarmingly, seizures. Ethyl Tosylamide: This chemical is banned in Europe due to potentially causing severe allergic reactions in users. The role of Ethyl Tosylamide is to help the polish to stick to the surface of the nail, though non-toxic nail polish also has great durability without the associated health risks. Xylene: This chemical is what gives your nail polish that distinct smell that often causes headaches or lightheadedness. It is used in nail polish to avoid clumpiness by thinning out the solution, but it is an incredibly toxic chemical that can cause immense reactions and irritation. **Why 10-Free Nail Polish Is Even Better** 10-free nail polish is better than 7-free as it excludes some additional chemicals and products that are not only toxic but also environmentally damaging, and even unethical to be using. Parabens: Parabens are a group of preservatives that are used in polishes to aid longevity. Not only do parabens interfere with the hormonal system, but they're also a factor directly involved with well-researched carcinogens that can cause skin and breast cancer. Triphenyl Phosphate: Triphenyl phosphate is another harmful toxin often included in traditional nail polish to aid the malleability of the varnish. Ongoing or frequent or extended exposure to Triphenyl phosphate can cause changes in hormone regulation, affecting reproductive systems, as well as metabolism. Consequently, it is best to avoid this harmful chemical, especially in your nail polish. Gluten: Gluten may seem surprising, but for those with a gluten allergy or intolerance, the inclusion of gluten in their nail polish can lead to severe adverse reactions. For those with celiac disease, topical exposure to wheat products can cause irritation. **Conclusion** In summary, regular nail polishes can be extremely harmful to not only the health of your nails but to your body as a whole! We believe that educating people on the toxic ingredients in nail polish can help customers to make more informed decisions regarding their health. At Côte, we are dedicated to sharing our belief in beautiful, clean, and safe nontoxic nail polishes, and that is why all our products are 10- free, cruelty free, with a non-toxic formula and amazing vibrant colors. Additionally, all of our products are vegan and free of studies involving lab animals.
+
+USER:
+What does it mean when a nail polish is 10-free?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,33,10,1276,,668
+Use only the document provided and nothing else.,"How does Herbalife's ""seed to feed"" strategy influence its product quality and sourcing?","2022 Annual Report To Our Shareholders, We all know coming out of the pandemic has caused many companies to relook at their operations. 2022 was a year of change for Herbalife as well as a year of challenge. With every challenge, there is great opportunity. I came back to Herbalife because I believe passionately about what Herbalife does, and what it provides for health and income. Since returning to Herbalife, I along with our management team and distributor leaders from around the world have embarked on a journey to expand our content, enhance the business opportunity, modernize our brand, and expand our digital platform – with the aim to reach more customers and to provide our distributors a better plat- form to operate their business. Our vision is to be the world’s premier health and wellness company and community. As I write this, more than 3,000 distributor leaders from around the world are traveling to Los Angeles to meet together for the first time in three years to learn, to share, to innovate, and to build a path forward for Herbalife. The time is now for us to reconnect, build on our strategic plan, and provide growth for all of our stakeholders. Our digital transformation “Herbalife One” will enhance the Company’s two main platforms: content and busi- ness opportunity. Our content is our product. With obesity levels hitting record highs around the globe and a greater demand for health and wellness support, we have plans to grow our product portfolio through our daily nutrition products with expanded vegan and protein lines. We plan to explore other health and wellness opportunities that will be based on global as well as regional consumer demands. For example, our unique Ayurvedic product line in India has contributed to the success of our fastest growing market. We are unleashing similar innovative products regionally in Europe, Asia and China, and we will continue to look for synergies and opportunities to globalize our regional product offerings. With enhancements to the business opportunity, our global distributor network will continue to give us a com- petitive advantage to reach more consumers with more offerings than ever before. Our distributors give a personal voice and passion to our products. Spanning across 95 markets, our distributors are amazing entrepreneurs who have unique relationships with their customers, and through an expanded use of data, we will be able to assist our distributors to sell more products and work more closely and efficiently with consumers on their health and wellness journey. To this end, we are modernizing our brand and compensation structure, including new promotions to energize and incentivize our distributors to earn early in their Herbalife business opportunity journey. Together with Herbalife One, our business opportunity will differentiate us and strengthen our leadership in the marketplace. 2023 is a start of a new chapter – one that is both motivating and exciting. In March, I marked my 20th year of devoting my time, passion, and energy to Herbalife. I feel more optimistic about where we are headed today than ever before. Our distributors and employees make Herbalife a community unlike any other. I know our distrib- utors and employees are as incredibly excited about the future as I am. Thank you for your trust and support. Michael O. Johnson Chairman and Chief Executive Officer This letter contains “forward-looking statements” within the meaning of the safe harbor provisions of the Private Securities Litigation Reform Act of 1995. Although we believe that the expectations reflected in any of our forward-looking statements are reasonable, actual results or outcomes could differ materially from those pro- jected or assumed in any of our forward-looking statements. Our future financial condition and results of oper- ations, as well as any forward-looking statements, are subject to change and to inherent risks and uncertainties, many of which are beyond our control. Additionally, many of these risks and uncertainties are, and may continue to be, amplified by the COVID-19 pandemic. Important factors that could cause our actual results, performance and achievements, or industry results to differ materially from estimates or projections contained in or implied by our forward-looking statements include the following: the potential impacts of the COVID-19 pandemic and current global economic conditions, including inflation, on us; our Members, customers, and supply chain; and the world economy; our ability to attract and retain Members; our relationship with, and our ability to influence the actions of, our Members; our noncompliance with, or improper action by our employees or Members in violation of, applicable U.S. and foreign laws, rules, and regulations; adverse publicity associated with our Company or the direct-selling industry, including our ability to comfort the marketplace and regulators regard- ing our compliance with applicable laws; changing consumer preferences and demands and evolving industry standards, including with respect to climate change, sustainability, and other environmental, social, and gover- nance, or ESG, matters; the competitive nature of our business and industry; legal and regulatory matters, including regulatory actions concerning, or legal challenges to, our products or network marketing program and product liability claims; the Consent Order entered into with the FTC, the effects thereof and any failure to comply therewith; risks associated with operating internationally and in China; our ability to execute our growth and other strategic initiatives, including implementation of our Transformation Program and increased pene- tration of our existing markets; any material disruption to our business caused by natural disasters, other cata- strophic events, acts of war or terrorism, including the war in Ukraine, cybersecurity incidents, pandemics, and/ or other acts by third parties; our ability to adequately source ingredients, packaging materials, and other raw materials and manufacture and distribute our products; our reliance on our information technology infra- structure; noncompliance by us or our Members with any privacy laws, rules, or regulations or any security breach involving the misappropriation, loss, or other unauthorized use or disclosure of confidential information; contractual limitations on our ability to expand or change our direct-selling business model; the sufficiency of our trademarks and other intellectual property; product concentration; our reliance upon, or the loss or departure of any member of, our senior management team; restrictions imposed by covenants in the agreements governing our indebtedness; risks related to our convertible notes; changes in, and uncertainties relating to, the application of transfer pricing, income tax, customs duties, value added taxes, and other tax laws, treaties, and regulations, or their interpretation; our incorporation under the laws of the Cayman Islands; and share price volatility related to, among other things, speculative trading and certain traders shorting our common shares. Forward-looking statements in this letter speak only as of March 14, 2023. We do not undertake any obligation to update or release any revisions to any forward-looking statement or to report any events or circumstances after such date or to reflect the occurrence of unanticipated events, except as required by law. UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 Form 10-K (Mark One) ANNUAL REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 For the fiscal year ended December 31, 2022 OR TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 For the transition period from to Commission file number: 1-32381 HERBALIFE NUTRITION LTD. (Exact name of registrant as specified in its charter) Cayman Islands 98-0377871 (State or other jurisdiction of (I.R.S. Employer incorporation or organization) Identification No.) P.O. Box 309GT Ugland House, South Church Street Grand Cayman, Cayman Islands (Address of principal executive offices) (Zip Code) (213) 745-0500 (Registrant’s telephone number, including area code) Securities registered pursuant to Section 12(b) of the Act: Title of each class: Trading Symbol(s): Name of each exchange on which registered: Common Shares, par value $0.0005 per share HLF New York Stock Exchange Securities registered pursuant to Section 12(g) of the Act: None Indicate by check mark if the registrant is a well-known seasoned issuer, as defined in Rule 405 of the Securities Act. Yes ☒ No ☐ Indicate by check mark if the registrant is not required to file reports pursuant to Section 13 or Section 15(d) of the Act. Yes ☐ No ☒ Indicate by check mark whether the registrant: (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days. Yes ☒ No ☐ Indicate by check mark whether the registrant has submitted electronically every Interactive Data File required to be submitted pursuant to Rule 405 of Regulation S-T (§232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to submit such files). Yes ☒ No ☐ Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, a smaller reporting company, or an emerging growth company. See the definitions of “large accelerated filer,” “accelerated filer,” “smaller reporting company,” and “emerging growth company” in Rule 12b-2 of the Exchange Act. Large accelerated filer ☒ Accelerated filer ☐ Non-accelerated filer ☐ Smaller reporting company ☐ Emerging growth company ☐ If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act. ☐ Indicate by check mark whether the registrant has filed a report on and attestation to its management’s assessment of the effectiveness of its internal control over financial reporting under Section 404(b) of the Sarbanes-Oxley Act (15 U.S.C. 7262(b)) by the registered public accounting firm that prepared or issued its audit report. ☒ If securities are registered pursuant to Section 12(b) of the Act, indicate by check mark whether the financial statements of the registrant included in the filing reflect the correction of an error to previously issued financial statements. ☐ Indicate by check mark whether any of those error corrections are restatements that required a recovery analysis of incentive-based compensation received by any of the registrant’s executive officers during the relevant recovery period pursuant to §240.10D-1(b). ☐ Indicate by check mark whether registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act). Yes ☐ No ☒ There were 97,920,728 common shares outstanding as of February 7, 2023. The aggregate market value of the Registrant’s common shares held by non-affiliates was approximately $896 million as of June 30, 2022, based upon the last reported sales price on the New York Stock Exchange on that date of $20.45. For the purposes of this disclosure only, the registrant has assumed that its directors, executive officers, and the beneficial owners of 5% or more of the registrant’s outstanding common stock are the affiliates of the registrant. DOCUMENTS INCORPORATED BY REFERENCE Portions of the registrant’s Definitive Proxy Statement to be filed with the Securities and Exchange Commission no later than 120 days after the end of the Registrant’s fiscal year ended December 31, 2022, are incorporated by reference in Part III of this Annual Report on Form 10-K. 1 TABLE OF CONTENTS Page No. PART I Item 1. Business 5 Item 1A. Risk Factors 19 Item 1B. Unresolved Staff Comments 43 Item 2. Properties 43 Item 3. Legal Proceedings 44 Item 4. Mine Safety Disclosures 44 PART II Item 5. Market for Registrant’s Common Equity, Related Stockholder Matters and Issuer Purchases of Equity 45 Securities Item 6. [Reserved] 46 Item 7. Management’s Discussion and Analysis of Financial Condition and Results of Operations 47 Item 7A. Quantitative and Qualitative Disclosures About Market Risk 67 Item 8. Financial Statements and Supplementary Data 69 Item 9. Changes in and Disagreements With Accountants on Accounting and Financial Disclosure 70 Item 9A. Controls and Procedures 70 Item 9B. Other Information 70 Item 9C. Disclosure Regarding Foreign Jurisdictions that Prevent Inspections 70 PART III Item 10. Directors, Executive Officers and Corporate Governance 71 Item 11. Executive Compensation 71 Item 12. Security Ownership of Certain Beneficial Owners and Management and Related Stockholder Matters 71 Item 13. Certain Relationships and Related Transactions, and Director Independence 71 Item 14. Principal Accounting Fees and Services 71 PART IV Item 15. Exhibits, Financial Statement Schedules 72 Item 16. Form 10-K Summary 125 2 FORWARD-LOOKING STATEMENTS This Annual Report on Form 10-K contains “forward-looking statements” within the meaning of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended. All statements other than statements of historical fact are “forward-looking statements” for purposes of federal and state securities laws, including any projections of earnings, revenue or other financial items; any statements of the plans, strategies and objectives of management, including for future operations, capital expenditures, or share repurchases; any statements concerning proposed new products, services, or developments; any statements regarding future economic conditions or performance; any statements of belief or expectation; and any statements of assumptions underlying any of the foregoing or other future events. Forward-looking statements may include, among other, the words “may,” “will,” “estimate,” “intend,” “continue,” “believe,” “expect,” “anticipate” or any other similar words. Although we believe that the expectations reflected in any of our forward-looking statements are reasonable, actual results or outcomes could differ materially from those projected or assumed in any of our forward-looking statements. Our future financial condition and results of operations, as well as any forward-looking statements, are subject to change and to inherent risks and uncertainties, many of which are beyond our control. Additionally, many of these risks and uncertainties are, and may continue to be, amplified by the COVID-19 pandemic. Important factors that could cause our actual results, performance and achievements, or industry results to differ materially from estimates or projections contained in or implied by our forward-looking statements include the following: • the potential impacts of the COVID-19 pandemic and current global economic conditions, including inflation, on us; our Members, customers, and supply chain; and the world economy; • our ability to attract and retain Members; • our relationship with, and our ability to influence the actions of, our Members; • our noncompliance with, or improper action by our employees or Members in violation of, applicable U.S. and foreign laws, rules, and regulations; • adverse publicity associated with our Company or the direct-selling industry, including our ability to comfort the marketplace and regulators regarding our compliance with applicable laws; • changing consumer preferences and demands and evolving industry standards, including with respect to climate change, sustainability, and other environmental, social, and governance, or ESG, matters; • the competitive nature of our business and industry; • legal and regulatory matters, including regulatory actions concerning, or legal challenges to, our products or network marketing program and product liability claims; • the Consent Order entered into with the FTC, the effects thereof and any failure to comply therewith; • risks associated with operating internationally and in China; • our ability to execute our growth and other strategic initiatives, including implementation of our Transformation Program and increased penetration of our existing markets; • any material disruption to our business caused by natural disasters, other catastrophic events, acts of war or terrorism, including the war in Ukraine, cybersecurity incidents, pandemics, and/or other acts by third parties; • our ability to adequately source ingredients, packaging materials, and other raw materials and manufacture and distribute our products; • our reliance on our information technology infrastructure; • noncompliance by us or our Members with any privacy laws, rules, or regulations or any security breach involving the misappropriation, loss, or other unauthorized use or disclosure of confidential information; • contractual limitations on our ability to expand or change our direct-selling business model; • the sufficiency of our trademarks and other intellectual property; • product concentration; • our reliance upon, or the loss or departure of any member of, our senior management team; • restrictions imposed by covenants in the agreements governing our indebtedness; 3 • risks related to our convertible notes; • changes in, and uncertainties relating to, the application of transfer pricing, income tax, customs duties, value added taxes, and other tax laws, treaties, and regulations, or their interpretation; • our incorporation under the laws of the Cayman Islands; and • share price volatility related to, among other things, speculative trading and certain traders shorting our common shares. Additional factors and uncertainties that could cause actual results or outcomes to differ materially from our forward-looking statements are set forth in this Annual Report on Form 10-K, including in Part I, Item 1A, Risk Factors, and Part II, Item 7, Management’s Discussion and Analysis of Financial Condition and Results of Operations, and in our Consolidated Financial Statements and the related Notes. In addition, historical, current, and forward-looking sustainability-related statements may be based on standards for measuring progress that are still developing, internal controls and processes that continue to evolve, and assumptions that are subject to change in the future. Forward-looking statements in this Annual Report on Form 10-K speak only as of the date hereof. We do not undertake any obligation to update or release any revisions to any forward-looking statement or to report any events or circumstances after the date hereof or to reflect the occurrence of unanticipated events, except as required by law. The Company “We,” “our,” “us,” “Company,” “Herbalife,” and “Herbalife Nutrition” refer to Herbalife Nutrition Ltd., a Cayman Islands exempted company incorporated with limited liability, and its subsidiaries. Herbalife Nutrition Ltd. is a holding company, with substantially all of its assets consisting of the capital stock of its direct and indirectly-owned subsidiaries. 4 PART I Item 1. Business GENERAL Herbalife Nutrition is a global nutrition company that provides health and wellness products to consumers in 95 markets, which consists of countries and territories, through our direct-selling business model. Our products are primarily in the categories of weight management, sports nutrition, and targeted nutrition. We use a direct-selling business model to distribute and market our nutrition products to and through a global network of independent members, or Members. Members include consumers who purchase products for their own personal use and distributors who wish to resell products or build a sales organization. We believe that direct selling is ideally suited for our business because the distribution and sales of our products with personalized support, coaching, and education provide a supportive and understanding community of like-minded people who prioritize health and nutrition. In addition to the effectiveness of personalized selling through a direct-selling business model, we believe the primary drivers for our success throughout our 43-year operating history have been enhanced consumer awareness and demand for our products due to global trends such as the obesity epidemic, increasing interest in a fit and active lifestyle, living healthier, and the rise of entrepreneurship. PRODUCT SALES Our science-backed products help Members and their customers improve their overall health, enhance their wellness, and achieve their fitness and sport goals. As of December 31, 2022, we marketed and sold approximately 131 product types. Our products are often sold as part of a program and therefore our portfolio is comprised of a series of related products designed to simplify weight management, health and wellness, and overall nutrition for our Members and their customers. Our Formula 1 Nutritional Shake Mix, our best-selling product line, approximated 26% of our net sales for the year ended December 31, 2022. The following table summarizes our products by product category: Percentage of Net Sales 2022 2021 2020 Description Representative Products Weight Management 56.8% 58.1% 59.8% Meal replacement, protein Formula 1 Healthy Meal, shakes, drink mixes, weight Herbal Tea Concentrate, loss enhancers and healthy Protein Drink Mix, snacks Personalized Protein Powder, Total Control®, Formula 2 Multivitamin Complex, Prolessa™ Duo, and Protein Bars Targeted Nutrition 29.1% 28.2% 27.6% Functional beverages and Herbal Aloe Concentrate, dietary and nutritional Active Fiber Complex, supplements containing Niteworks®, and quality herbs, vitamins, Herbalifeline® minerals and other natural ingredients Energy, Sports, and 10.6% 9.5% 7.9% Products that support a Herbalife24® product line, Fitness healthy active lifestyle N-R-G Tea, and Liftoff® energy drink Outer Nutrition 1.6% 1.9% 2.0% Facial skin care, body care, Herbalife SKIN line and and hair care Herbal Aloe Bath and Body Care line Literature, Promotional, 1.9% 2.3% 2.7% Start-up kits, sales tools, Herbalife Member Packs and Other and educational materials and BizWorks 5 Product returns and buyback policies We offer a customer satisfaction guarantee in substantially all markets where our products are sold. If for any reason a customer or preferred member is not satisfied with an Herbalife Nutrition product, they may return it or any unused portion of the product within 30 days from the time of receipt for a full refund or credit toward the exchange of another Herbalife Nutrition product. In addition, in substantially all markets, we maintain a buyback program pursuant to which we will purchase back unsold products from a Member who decides to leave the business. Subject to certain terms and conditions that may vary by market, the buyback program generally permits a Member to return unopened products or sales materials in marketable condition purchased within the prior twelve- month period in exchange for a refund of the net price paid for the product and, in most markets, the cost of returning the products and materials to us. Together, product returns and buybacks were approximately 0.1% of net sales for each of the years ended December 31, 2022, 2021, and 2020. Product development Our products are focused on nutrition and seek to help consumers achieve their goals in the areas of weight management; targeted nutrition (including everyday wellness and healthy aging); energy, sports, and fitness; and outer nutrition. We believe our focus on nutrition and botanical science and the combination of our internal efforts with the scientific expertise of outside resources, including our ingredient suppliers, major universities, and our Nutrition Advisory Board, have resulted in product differentiation that has given our Members and consumers increased confidence in our products. We continue to invest in scientific and technical functions, including research and development associated with creating new or enhancing current product formulations and the advancement of personalized nutrition solutions; clinical studies of existing products or products in development; technical operations to improve current product formulations; quality assurance and quality control to establish the appropriate quality systems, controls, and standards; and rigorous ingredient and product testing to ensure compliance with regulatory requirements, as well as in the areas of regulatory and scientific affairs. Our personalized nutrition solutions include tools which aid in the development of optimal product packages specific to our customers’ individual nutritional needs, based on their expected wellness goals. Our product development strategy is twofold: (1) to increase the value of existing customers by investing in products that address customers’ health, wellness and nutrition considerations, fill perceived gaps in our portfolios, add flavors, increase convenience by developing products like snacks and bars, and expand afternoon and evening consumption with products like savory shakes or soups; and (2) to attract new customers by entering into new categories, offering more choices, increasing individualization, and expanding our current sports line. We have a keen focus on product innovation and aim to launch new products and variations on existing products on a regular basis. Once a particular market opportunity has been identified, our scientists, along with our operations, marketing, and sales teams, work closely with Member leadership to introduce new products and variations on existing products. Our Nutrition Advisory Board and Dieticians Advisory Board are comprised of leading experts around the world in the fields of nutrition and health who educate our Members on the principles of nutrition, physical activity, diet, and healthy lifestyle. We rely on the scientific contributions from members of our Nutrition Advisory Board and our in-house scientific team to continually upgrade existing products or introduce new products as new scientific studies become available and are accepted by regulatory authorities around the world. COMPETITION The nutrition industry is highly competitive. Nutrition products are sold through a number of distribution channels, including direct selling, online retailers, specialty retailers, and the discounted channels of food, drug and mass merchandise. Our competitors include companies such as Conagra Brands, Hain Celestial, and Post. Additionally, we compete for the recruitment of Members from other network marketing organizations, including those that market nutrition products and other entrepreneurial opportunities. Our direct-selling competitors include companies such as Nu Skin, Tupperware, and USANA. Our ability to remain competitive depends on many factors, including having relevant products that meet consumer needs, a rewarding compensation plan, enhanced education and tools, innovation in our products and services, competitive pricing, a strong reputation, and a financially viable company. We have differentiated ourselves from our competitors through our Members’ focus on the consultative sales process, which includes ongoing personal contact, coaching, behavior motivation, education, and the creation of supportive communities. For example, many Members have frequent contact with and provide support to their customers through a community-based approach to help them achieve nutrition goals. Some methods include Nutrition Clubs, Weight Loss Challenges, Wellness Evaluations, and Fit Camps. 6 For additional information regarding competition, see Part I, Item 1A, Risk Factors, of this Annual Report on Form 10-K. OUR NETWORK MARKETING PROGRAM General Our products are sold and distributed through a global direct selling business model which individuals may join to become a Member of our network marketing program. We believe that the one-on-one personalized service inherent in the direct-selling business model is ideally suited to marketing and selling our nutrition products. Sales of nutrition products are reinforced by the ongoing personal contact, coaching, behavior motivation, education, and the creation of supportive communities. This frequent, personal contact can enhance consumers’ nutritional and health education as well as motivate healthy behavioral changes in consumers to begin and maintain an active lifestyle through wellness and weight management programs. In addition, our Members consume our products themselves, and, therefore, can provide first-hand testimonials of the use and effectiveness of our products and programs to their customers. The personalized experience of our Members has served as a very powerful sales tool for our products. People become Herbalife Nutrition Members for a number of reasons. Many first start out as consumers of our products who want to lose weight or improve their nutrition, and are customers of our Members. Some later join Herbalife Nutrition and become Members themselves, which makes them eligible to purchase products directly from us, simply to receive a discounted price on products for them and their families. Some Members are interested in the entrepreneurial opportunity to earn compensation based on their own skills and hard work and join Herbalife Nutrition to earn part-time or full-time income. Our objective is sustainable growth in the sales of our products to our Members and their customers by increasing the productivity, retention and recruitment of our Member base through the structure of our network marketing program. Segmentation In many of our markets, including certain of our largest markets such as the United States, Mexico, and India, we have segmented our Member base into two categories: “preferred members” – who are consumers who wish to purchase product for their own household use, and “distributors” – who are Members who also wish to resell products or build a sales organization. This Member segmentation provides a clear differentiation between those interested in retailing our products or building a sales organization, and those simply consuming our products as discount customers. This distinction allows us to more effectively communicate and market to each group, and provides us with better information regarding our Members within the context of their stated intent and goals. As of December 31, 2022, we had approximately 6.2 million Members, including 2.9 million preferred members and 2.0 million distributors in the markets where we have established these two categories and 0.3 million sales representatives and independent service providers in China. The number of preferred members and distributors may change as a result of segmentation and/or conversion, and do not necessarily represent a change in the total number of Members. Any future change in the number of preferred members or distributors is not necessarily indicative of our future expected financial performance. Our Members We believe our Members are the most important differentiator as we go to market with our nutrition products, because of the one- on-one direct contact they have with their customers, along with the education, training and community support services that we believe help improve the nutrition habits of consumers. We work closely with our entrepreneurial Members to improve the sustainability of their businesses and to reach consumers. We require our Members to fairly and honestly market both our products and the Herbalife Nutrition business opportunity. Our relationship with our Members is key to our continued success as they allow us direct access to the voice of consumers. Many of our entrepreneurial Members identify and test new marketing efforts and programs developed by other Members and disseminate successful techniques to their sales organizations. For example, Members in Mexico developed businesses that became known as “Nutrition Clubs,” marketing techniques that improve the productivity and efficiency of our Members as well as the affordability of our weight loss products for their customers. Rather than buying several retail products, these businesses allow consumers to purchase and consume our products each day (a Member marketing technique we refer to as “daily consumption”), while continuing to benefit from the support and interaction with the Member as well as socializing with other customers in a designated location. Other programs to drive daily consumption, whether for weight management or for improved physical fitness, include Member- conducted weight loss contests, or Weight Loss Challenges, Member-led fitness programs, or Fit Camps, and Member-led Wellness Evaluations. We refer to successful Member marketing techniques that we disseminate throughout our Member network, such as Nutrition Clubs, Weight Loss Challenges, and Fit Camps, as Daily Methods of Operations, or DMOs. 7 We believe that personal and professional development is key to our Members’ success and, therefore, we and our sales leader Members – those that achieve certain levels within our Marketing Plan – have meetings and events to support this important objective. We and our Member leadership, which is comprised of sales leaders, conduct in-person and virtual training sessions on local, regional, and global levels attended by thousands of Members to provide updates on product education, sales and marketing training, and instruction on available tools. These events are opportunities to showcase and disseminate our Members’ evolving best marketing practices and DMOs from around the world and to introduce new or upgraded products. A variety of training and development tools are also available through online and mobile platforms. On July 18, 2002, we entered into an agreement with our Members that provides that we will continue to distribute Herbalife Nutrition products exclusively to and through our Members and that, other than changes required by applicable law or necessary in our reasonable business judgment to account for specific local market or currency conditions to achieve a reasonable profit on operations, we will not make any material changes to certain aspects of our Marketing Plan that are adverse to our Members without the support of our Member leadership. Specifically, any such changes would require the approval of at least 51% of our Members then at the level of President’s Team earning at the production bonus level of 6% who vote, provided that at least 50% of those Members entitled to vote do in fact vote. We initiate these types of changes based on the assessment of what will be best for us and our Members and then submit such changes for the requisite vote. We believe that this agreement has strengthened our relationship with our existing Members, improved our ability to recruit new Members and generally increased the long-term stability of our business. Member Compensation and Sales Leader Retention and Requalification In addition to benefiting from discounted prices, Members interested in the entrepreneurial opportunity may earn profit from several sources. First, Members may earn profits by purchasing our products at wholesale prices, discounted depending on the Member’s level within our Marketing Plan, and reselling those products at prices they establish for themselves to generate retail profit. Second, Members who sponsor other Members and establish, maintain, coach, and train their own sales organizations may earn additional income based on the sales of their organization, which may include royalty overrides, production bonuses, and other cash bonuses. Members earning such compensation have generally attained the level of sales leader as described below. There are also many Members, which include distributors, who have not sponsored another Member. Members who have not sponsored another Member are generally considered discount buyers or small retailers. While a number of these Members have also attained the level of sales leader, they do not receive additional income as do Members who have sponsored other Members. We assign point values, known as Volume Points, to each of our products to determine a Member’s level within the Marketing Plan. See Part II, Item 7, Management’s Discussion and Analysis of Financial Condition and Operating Results, of this Annual Report on Form 10-K for a further description of Volume Points. Typically, a Member accumulates Volume Points for a given sale at the time the Member pays for the product. However, since May 2017, a Member does not receive Volume Points for a transaction in the United States until that product is sold to a customer at a profit and it is documented in compliance with the consent order, or Consent Order, we entered into with the Federal Trade Commission, or the FTC, in 2016. The Member’s level within the Marketing Plan is used to determine the discount applied to their purchase of our products and whether they have qualified to become a sales leader. To become a sales leader, or qualify for a higher level within our Marketing Plan, Members must achieve specified Volume Point thresholds of product sales or earn certain amounts of royalty overrides during specified time periods and generally must re-qualify once each year. Qualification criteria vary somewhat by market. We have initial qualification methods of up to 12 months to encourage a more gradual qualification. We believe a gradual qualification approach is important to the success and retention of new sales leaders and benefits the business in the long term as it allows new Members to obtain product and customer experience as well as additional training and education on Herbalife Nutrition products, daily consumption based DMOs, and the business opportunity prior to becoming a sales leader. The basis for calculating Marketing Plan payouts varies depending on product and market: for 2022, we utilized on a weighted- average basis approximately 90% of suggested retail price, to which we applied discounts of up to 50% for distributor allowances and payout rates of up to 15% for royalty overrides, up to 7% for production bonuses, and approximately 1% for a cash bonus known as the Mark Hughes bonus. We believe that the opportunity for Members to earn royalty overrides and production bonuses contributes significantly to our ability to retain our most active and productive Members. Our Marketing Plan generally requires each sales leader to re-qualify for such status each year, prior to February, in order to maintain their 50% discount on products and be eligible to receive additional income. In February of each year, we demote from the rank of sales leader those Members who did not satisfy the re-qualification requirements during the preceding twelve months. The re- qualification requirement does not apply to new sales leaders (i.e. those who became sales leaders subsequent to the January re- qualification of the prior year). 8 As of December 31, 2022, prior to our February re-qualification process, approximately 772,000 of our Members have attained the level of sales leader, of which approximately 734,000 have attained this level in the 94 markets where we use our Marketing Plan and 38,000 independent service providers operating in our China business. See Business in China below for a description of our business in China. The table below reflects sales leader retention rates by year and by region: Sales Leader Retention Rate 2023 2022 2021 North America 69.7% 58.8% 70.8% Latin America (1) 71.6% 69.3% 67.0% EMEA 64.6% 77.1% 72.7% Asia Pacific 66.6% 66.5% 63.5% Total sales leaders 67.6% 68.9% 67.9% (1) The Company combined the Mexico and South and Central America regions into the Latin America region in 2022. Historical information has been reclassified to conform with the current period geographic presentation. For the latest twelve-month re-qualification period ending January 2023, approximately 67.6% of our sales leaders, excluding China, re-qualified, versus 68.9% for the twelve-month period ended January 2022. The Company throughout its history has adjusted the re-qualification criteria from time to time in response to evolving business objectives and market conditions, and the above results include the effects of all such changes. For example, in recent years certain markets have allowed members to utilize a lower re- qualification volume threshold and the Company has continued to expand this lower re-qualification method to additional markets. Separately, with revised business requirements in place following the Consent Order, as described in Network Marketing Program below, we utilize a re-qualification equalization factor for U.S. Members to better align their re-qualification thresholds with Members in other markets, and retention results for each of the years presented include the effect of the equalization factor. We believe this factor preserves retention rate comparability across markets. Also, for each of the years presented, the retention results exclude certain markets for which, due to local operating conditions, sales leaders were not required to requalify. We believe sales leader retention rates are the result of efforts we have made to try and improve the sustainability of sales leaders’ businesses, such as encouraging Members to obtain experience retailing Herbalife Nutrition products before becoming a sales leader and providing them with advanced technology tools, as well as reflecting market conditions. As our business operations evolve, including the segmentation of our Member base in certain markets and changes in sales leader re-qualification thresholds for other markets, management continues to evaluate the importance of sales leader retention rate information. The table below reflects the number of sales leaders as of the end of February of the year indicated (subsequent to the annual re- qualification process) and by region: Number of Sales Leaders 2022 2021 2020 North America 80,278 95,402 71,202 Latin America (1) 125,726 131,359 134,401 EMEA 183,056 158,153 130,438 Asia Pacific 201,137 173,582 158,815 Total sales leaders 590,197 558,496 494,856 China 33,486 68,301 70,701 Worldwide total sales leaders 623,683 626,797 565,557 (1) The Company combined the Mexico and South and Central America regions into the Latin America region in 2022. Historical information has been reclassified to conform with the current period geographic presentation. The number of sales leaders as of December 31 will exceed the number immediately subsequent to the preceding re-qualification period because sales leaders qualify throughout the year but sales leaders who do not re-qualify are removed from the rank of sales leader the following February. 9 Business in China Our business model in China includes unique features as compared to our traditional business model in order to ensure compliance with Chinese regulations. As a result, our business model in China differs from that used in other markets. Members in China are categorized differently than those in other markets. In China, we sell our products to and through independent service providers and sales representatives to customers and preferred customers, as well as through Company-operated retail platforms when necessary. In China, while multi-level marketing is not permitted, direct selling is permitted. Chinese citizens who apply and become Members are referred to as sales representatives. These sales representatives are permitted to sell away from fixed retail locations in the provinces where we have direct selling licenses, including in the provinces of Jiangsu, Guangdong, Shandong, Zhejiang, Guizhou, Beijing, Fujian, Sichuan, Hubei, Shanxi, Shanghai, Jiangxi, Liaoning, Jilin, Henan, Chongqing, Hebei, Shaanxi, Tianjin, Heilongjiang, Hunan, Guangxi, Hainan, Anhui, Yunnan, Gansu, Ningxia, and Inner Mongolia. In Xinjiang province, where we do not have a direct selling license, we have a Company-operated retail store that can directly serve customers and preferred customers. With online orderings throughout China, there has been a declining demand in Company-operated retail stores. Sales representatives receive scaled rebates based on the volume of products they purchase. Sales representatives who reach certain volume thresholds and meet certain performance criteria are eligible to apply to provide marketing, sales and support services. Once their application is accepted, they are referred to as independent service providers. Independent service providers are independent business entities that are eligible to receive compensation from Herbalife Nutrition for the marketing, sales and support services they provide so long as they satisfy certain conditions, including procuring the requisite business licenses, having a physical business location, and complying with all applicable Chinese laws and Herbalife Nutrition rules. In China, our independent service providers are compensated for marketing, sales support, and other services, instead of the Member allowances and royalty overrides utilized in our global Marketing Plan. The service hours and related fees eligible to be earned by the independent service providers are based on a number of factors, including the sales generated through them and through others to whom they may provide marketing, sales support and other services, the quality of their service, and other factors. Total compensation available to our independent service providers in China can generally be comparable to the total compensation available to other sales leaders globally. The Company does this by performing an analysis in our worldwide system to estimate the potential compensation available to the service providers, which can generally be comparable to that of sales leaders in other countries. After adjusting such amounts for other factors and dividing by each service provider’s hourly rate, we then notify each independent service provider the maximum hours of work for which they are eligible to be compensated in the given month. In order for a service provider to be paid, the Company requires each service provider to invoice the Company for their services. RESOURCES We seek to provide the highest quality products to our Members and their customers through our “seed to feed” strategy, which includes significant investments in obtaining quality ingredients from traceable sources, qualified by scientific personnel through product testing, and increasing the amount of self-manufacturing of our top products. Ingredients Our seed to feed strategy is rooted in using quality ingredients from traceable sources. Our procurement process for many of our botanical products now stretches back to the farms and includes self-processing of teas and herbal ingredients into finished raw materials at our own facilities. Our Changsha, China facility exclusively provides high quality tea and herbal raw materials to our manufacturing facilities as well as our third-party contract manufacturers around the world. We also source ingredients that we do not self-process from companies that are well-established, reputable suppliers in their respective field. These suppliers typically utilize similar quality processes, equipment, expertise, and having traceability as we do with our own modern quality processes. As part of our program to ensure the procurement of high-quality ingredients, we also test our incoming raw materials for compliance to potency, identity, and adherence to strict specifications. 10 Manufacturing The next key component of our seed to feed strategy involves the high-quality manufacturing of these ingredients into finished products, which are produced at both third-party manufacturers and our own manufacturing facilities. As part of our long-term strategy, we seek to expand and increase our self-manufacturing capabilities. Our manufacturing facilities, known as Herbalife Innovation and Manufacturing Facilities, or HIMs, include HIM Lake Forest, HIM Winston-Salem, HIM Suzhou, and HIM Nanjing. HIM Winston- Salem is currently our largest manufacturing facility at approximately 800,000 square feet. Together, our HIM manufacturing facilities produce approximately 51% of our inner nutrition products sold worldwide. Self-manufacturing also enables us greater control to reduce negative environmental impacts of our operations and supply chain. As described in the Sustainability section below, we are focused on developing science-based green-house gas emission reduction targets for our manufacturing facilities as part of our sustainability goals. We are also focused on reducing single-use plastics throughout our global distribution network and incorporating more sustainable content, such as post-consumer recycled resin, into our packaging. Our finished products are analyzed for label claims and tested for microbiological purity, thereby verifying that our products comply with food safety standards, meet label claims and have met other quality standards. For self-manufactured products, we conduct all of our testing in-house at our fully-equipped, modern quality control laboratories in the U.S. and China. We have two quality control laboratories in Southern California and Changsha, China (including a Center of Excellence in both locations). In addition, we also have a Center of Excellence laboratory in Bangalore, India, and a quality control laboratory in Winston-Salem, North Carolina, Suzhou, China, and Nanjing, China. All HIM quality control labs contain modern analytical equipment and are backed by the expertise in testing and methods development of our scientists. In our U.S. HIM facilities, which manufacture products for the U.S. and most of our international markets, we operate and adhere to the regulations established by the U.S. Food and Drug Administration, or FDA, and strict Current Good Manufacturing Practice regulations, or CGMPs, for food, acidified foods, and dietary supplements. We also work closely with our third-party manufacturers to ensure high quality products are produced and tested through a vigorous quality control process at approved contract manufacturer labs or third-party labs. For these products manufactured at other facilities, we combine four elements to ensure quality products: (1) the same selectivity and assurance in ingredients as noted above; (2) use of reputable, CGMP-compliant, quality- and sustainability-minded manufacturing partners; (3) supplier qualification through annual audit programs; and (4) significant product quality testing. During 2022, we purchased approximately 15% of our products from our top three third-party manufacturers. Infrastructure and Technology Our direct-selling business model enables us to grow our business with moderate investment in infrastructure and fixed costs. We incur no direct incremental cost to add a new Member in our existing markets, and our Member compensation varies directly with product sales. In addition, our Members also bear a portion of our consumer marketing expenses, and our sales leaders sponsor and coordinate Member recruiting and most meeting and training initiatives. Additionally, our infrastructure features scalable production and distribution of our products as a result of having our own manufacturing facilities and numerous third-party manufacturing relationships, as well as our global footprint of in-house and third-party distribution centers. An important part of our seed to feed strategy is having an efficient infrastructure to deliver products to our Members and their customers. As the shift in consumption patterns continues to reflect an increasing daily consumption focus, one focus of this strategy is to provide more product access points closer to our Members and their customers. We have both Company-operated and outsourced distribution points ranging from our “hub” distribution centers in Los Angeles, Memphis, and Venray, Netherlands, to mid-size distribution centers in major countries, to small pickup locations spread throughout the world. We also expect to continue to improve our distribution channels relating to home delivery as we expect to see continued increased demands for our products being shipped to our Members in certain of our larger markets. In addition to these distribution points, we partner with certain retail locations to provide Member pickup points in areas which are not well serviced by our distribution points. We have also identified a number of methods and approaches that better support Members by providing access points closer to where they do business and by improving product delivery efficiency through our distribution channels. Specific methods vary by markets and consider local Member needs and available resources. In aggregate, we have over 1,500 distribution points and partner retail locations around the world. In addition to our distribution points, we contract third party-run drop-off locations where we can ship to and Members can pick up ordered products. 11 We leverage our technology infrastructure in order to maintain, protect, and enhance existing systems and develop new systems to keep pace with continuing changes in technology, evolving industry and regulatory standards, emerging data security risks, and changing user patterns and preferences. We also continue to invest in our manufacturing and operational infrastructure to accelerate new products to market and accommodate planned business growth. We invest in business intelligence tools to enable better analysis of our business and to identify opportunities for growth. We will continue to build on these platforms to take advantage of the rapid development of technology around the globe to support a more robust Member and customer experience. In addition, we leverage an Oracle business suite platform to support our business operations, improve productivity and support our strategic initiatives. Our investment in technology infrastructure helps support our capacity to grow. In 2021, we also initiated a global transformation program to optimize global processes for future growth, or the Transformation Program. The Transformation Program involves the investment in certain new technologies and the realignment of infrastructure and the locations of certain functions to better support distributors and customers. The Transformation Program is still ongoing and expected to be completed in 2024 as described further in Part II, Item 7, Management’s Discussion and Analysis of Financial Condition and Operating Results, of this Annual Report on Form 10-K and Note 14, Transformation Program, to the Consolidated Financial Statements included in Part IV, Item 15, Exhibits, Financial Statement Schedules, of this Annual Report on Form 10-K. In addition, many Members rely on the use of technology to support their goals and businesses. As part of our continued investment in technology to further support our Members and drive long-term growth, we have enhanced our product access and distribution network to support higher volumes of online or mobile orders, allowing Members and their customers to select home or business delivery options. We have also implemented information technology systems to support Members and their increasing demand to be more connected to Herbalife Nutrition, their business, and their consumers with tools such as HN MyClub, Engage, HNconnect, BizWorks, MyHerbalife, GoHerbalife, and Herbalife.com. Additionally, we continue to support a growing suite of point-of-sale tools to assist our Members with ordering, tracking, and customer relationship management. These tools allow our Members to manage their business and communicate with their customers more efficiently and effectively. During 2022, we also commenced a Digital Technology Program to develop a new enhanced platform to provide enhanced digital capabilities and experiences to our Members. This is a multi-year program and we expect our capital expenditures to increase in 2023 and future years as result of our investments in this Digital Technology Program as described further in Part II, Item 7, Management’s Discussion and Analysis of Financial Condition and Operating Results, of this Annual Report on Form 10-K. Intellectual Property and Branding Marketing foods and supplement products on the basis of sound science means using ingredients in the composition and quantity as demonstrated to be effective in the relevant scientific literature. Use of these ingredients for their well-established purposes is by definition not novel, and for that reason, most food uses of these ingredients are not subject to patent protection. Notwithstanding the absence of patent protection, we do own proprietary formulations for substantially all of our weight management products and dietary and nutritional supplements. We take care in protecting the intellectual property rights of our proprietary formulas by restricting access to our formulas within the Company to those persons or departments that require access to them to perform their functions, and by requiring our finished goods suppliers and consultants to execute supply and non-disclosure agreements that contractually protect our intellectual property rights. Disclosure of these formulas, in redacted form, is also necessary to obtain product registrations in many countries. We also make efforts to protect certain unique formulations under patent law. We strive to protect all new product developments as the confidential trade secrets of the Company. We use the umbrella trademarks Herbalife®, Herbalife Nutrition®, and the Tri-Leaf design worldwide, and protect several other trademarks and trade names related to our products and operations, such as Niteworks® and Liftoff®. Our trademark registrations are issued through the United States Patent and Trademark Office, or USPTO, and comparable agencies in the foreign countries. We believe our trademarks and trade names contribute to our brand awareness. To increase our brand awareness, we and our Members use a variety of tools and marketing channels. These can include anything from traditional media to social media and alliances with partners who can promote our goal of better living through nutrition. Herbalife Nutrition sponsorships of and partnerships with featured athletes, teams, and events promote brand awareness and the use of Herbalife Nutrition products. We continue to build brand awareness with a goal towards becoming the most trusted brand in nutrition. We also work to leverage the power of our Member base as a marketing and brand-building tool. We maintain a brand style guide and brand asset library so that our Members have access to the Herbalife Nutrition brand logo and marketing materials for use in their marketing efforts. 12 Sustainability Our goals and objectives to nourish people and communities and to improve the planet are part of both our day-to-day activities and our long-term growth strategy. As a signatory of the United Nations Global Compact, or UNGC, we have aligned our sustainability initiatives outlined by the United Nations’ Sustainable Development Goals. Our current sustainability initiatives focus on issues including climate and emissions, packaging, and operational waste. For example, we have implemented projects that have reduced overall packaging materials and incorporated usage of recycled materials in the packaging of our flagship product, Formula 1 Healthy Meal Nutritional Shake in North America, Mexico, and in certain markets where permitted by regulations. We are seeking opportunities across operations to reduce waste-prone materials such as single-use plastics. More information on these efforts is provided in the Manufacturing section above. For information relating to our culture, diversity, equity, and inclusion, please see the Human Capital section below. REGULATION General In our United States and foreign markets, we are affected by extensive laws, governmental regulations, administrative determinations and guidance, court decisions and similar constraints that regulate the conduct of our business. Such laws, regulations and other constraints exist at the federal, state or local levels in the United States and at all levels of government in foreign jurisdictions, and include regulations pertaining to: (1) the formulation, manufacturing, packaging, labeling, distribution, importation, sale, and storage of our products; (2) product claims and advertising, including direct claims and advertising by us, as well as claims and advertising by Members, for which we may be held responsible; (3) our network marketing program; (4) transfer pricing and similar regulations that affect the level of U.S. and foreign taxable income and customs duties; (5) taxation of our Members (which in some instances may impose an obligation on us to collect the taxes and maintain appropriate records); (6) our international operations, such as import/export, currency exchange, repatriation and anti-bribery regulations; (7) antitrust issues; and (8) privacy and data protection. See Part I, Item 1A, Risk Factors, of this Annual Report on Form 10-K for additional information. Products In the United States, the formulation, manufacturing, packaging, holding, labeling, promotion, advertising, distribution, and sale of our products are subject to regulation by various federal governmental agencies, including: (1) the FDA; (2) the FTC; (3) the Consumer Product Safety Commission, or CPSC; (4) the United States Department of Agriculture, or USDA; (5) the Environmental Protection Agency, or EPA; (6) the United States Postal Service; (7) United States Customs and Border Protection; and (8) the Drug Enforcement Administration. Our activities also are regulated by various agencies of the states, localities and foreign countries in which our products are manufactured, distributed, or sold. The FDA, in particular, regulates the formulation, manufacture, and labeling of over-the-counter, or OTC, drugs, conventional foods, dietary supplements, and cosmetics such as those distributed by us. The majority of the products marketed by us in the United States are classified as conventional foods or dietary supplements under the Federal Food, Drug and Cosmetic Act, or FFDCA. Internationally, the majority of products marketed by us are classified as foods, health supplements, or food supplements. FDA regulations govern the preparation, packaging, labeling, holding, and distribution of foods, OTC drugs, cosmetics, and dietary supplements. Among other obligations, they require us and our contract manufacturers to meet relevant CGMP regulations for the preparation, packaging, holding, and distribution of OTC drugs and dietary supplements. The FDA also requires identity testing of all incoming dietary ingredients used in dietary supplements, unless a company successfully petitions for an exemption from this testing requirement in accordance with the regulations. The CGMPs are designed to ensure that OTC drugs and dietary supplements are not adulterated with contaminants or impurities, and are labeled to accurately reflect the active ingredients and other ingredients in the products. We have implemented a comprehensive quality assurance program that is designed to maintain compliance with the CGMPs for products manufactured by us or on our behalf for distribution in the United States. As part of this program, we have regularly implemented enhancements, modifications and improvements to our manufacturing and corporate quality processes. We believe that we and our contract manufacturers are compliant with the FDA’s CGMPs and other applicable manufacturing regulations in the United States. The U.S. Dietary Supplement Health and Education Act of 1994, or DSHEA, revised the provisions of FFDCA concerning the composition and labeling of dietary supplements. Under DSHEA, dietary supplement labeling may display structure/function claims that the manufacturer can substantiate, which are claims that the products affect the structure or function of the body, without prior FDA approval, but with notification to the FDA. They may not bear any claim that they can prevent, treat, cure, mitigate or diagnose disease (a drug claim). Apart from DSHEA, the agency permits companies to use FDA-approved full and qualified health claims for food and supplement products containing specific ingredients that meet stated requirements. 13 U.S. law also requires that all serious adverse events occurring within the United States involving dietary supplements or OTC drugs be reported to the FDA. We believe that we are in compliance with this law having implemented a worldwide procedure governing adverse event identification, investigation and reporting. As a result of reported adverse events, we may from time to time elect, or be required, to remove a product from a market, either temporarily or permanently. Some of the products marketed by us are considered conventional foods and are currently labeled as such. Within the United States, this category of products is subject to the federal Nutrition, Labeling and Education Act, or NLEA, and regulations promulgated under the NLEA. The NLEA regulates health claims, ingredient labeling and nutrient content claims characterizing the level of a nutrient in the product. The ingredients in conventional foods must either be generally recognized as safe by experts for the purposes to which they are put in foods, or be approved as food additives under FDA regulations. The federal Food Safety Modernization Act, or FSMA, is also applicable to some of our business. We follow a food safety plan and have implemented preventive measures required by the FSMA. Foreign suppliers of our raw materials are also subject to FSMA requirements, and we have implemented a verification program to comply with the FSMA. Dietary supplements manufactured in accordance with CGMPs and foods manufactured in accordance with the low acid food regulations are exempt. In foreign markets, prior to commencing operations and prior to making or permitting sales of our products in the market, we may be required to obtain an approval, license or certification from the relevant country’s ministry of health or comparable agency. Prior to entering a new market in which a formal approval, license or certificate is required, we work with local authorities in order to obtain the requisite approvals. The approval process generally requires us to present each product and product ingredient to appropriate regulators and, in some instances, arrange for testing of products by local technicians for ingredient analysis. The approvals may be conditioned on reformulation of our products, or may be unavailable with respect to some products or some ingredients. The FTC, which exercises jurisdiction over the advertising of all of our products in the United States, has in the past several years instituted enforcement actions against several dietary supplement and food companies and against manufacturers of weight loss products generally for false and misleading advertising of some of their products. In addition, the FTC has increased its scrutiny of the use of testimonials, which we also utilize, as well as the role of expert endorsers and product clinical studies. We cannot be sure that the FTC, or comparable foreign agencies, will not question our advertising or other operations in the future. In Europe, where an EU Health Claim regulation is in effect, the European Food Safety Authority, or EFSA, issued opinions following its review of a number of proposed claims documents. ESFA’s opinions, which have been accepted by the European Commission, have limited the use of certain nutrition-specific claims made for foods and food supplements. Accordingly, we revised affected product labels to ensure regulatory compliance. We are subject to a permanent injunction issued in October 1986 pursuant to the settlement of an action instituted by the California Attorney General, the State Health Director and the Santa Cruz County District Attorney. We consented to the entry of this injunction without in any way admitting the allegations of the complaint. The injunction prevents us from making specified claims in advertising of our products, but does not prevent us from continuing to make specified claims concerning our products, provided that we have a reasonable basis for making the claims. The injunction also prohibits certain recruiting-related investments from Members and mandates that payments to Members be premised on retail value (as defined); the injunction provides that we may establish a system to verify or document such compliance. Network Marketing Program Our network marketing program is subject to a number of federal and state regulations administered by the FTC and various state regulators as well as regulations in foreign markets administered by foreign regulators. Regulations applicable to network marketing organizations generally are directed at ensuring that product sales ultimately are made to consumers and that advancement within the organization is based on sales of the organization’s products rather than investments in the organization or other non-retail sales related criteria. When required by law, we obtain regulatory approval of our network marketing program or, when this approval is not required, the favorable opinion of local counsel as to regulatory compliance. 14 On July 15, 2016, we reached a settlement with the FTC and entered into a proposed Stipulation to Entry of Order for Permanent Injunction and Monetary Judgment, or the Consent Order, which resolved the FTC’s multi-year investigation of us. The Consent Order became effective on July 25, 2016, or the Effective Date, upon final approval by the U.S. District Court for the Central District of California. Pursuant to the Consent Order, we implemented and continue to enhance certain procedures in the U.S. and agreed to be subject to certain audits by an independent compliance auditor (Affiliated Monitors, Inc.) for a period of seven years. Among other requirements, the Consent Order requires us to categorize all existing and future Members in the U.S. as either “preferred members” – who are simply consumers who only wish to purchase product for their own household use — or “distributors” – who are Members who wish to resell some products or build a sales organization. We also agreed to compensate distributors on U.S. eligible sales within their downline organizations, which include purchases by preferred members, purchases by a distributor for his or her personal consumption within allowable limits and sales of product by a distributor to his or her customers. The Consent Order also requires distributors to meet certain conditions before opening Nutrition Clubs and/or entering into leases for their Herbalife Nutrition business in the United States. The Consent Order also prohibits us from making expressly or by implication, any misrepresentation regarding certain lifestyles or amount or level of income, including full-time or part-time income that a participant can reasonably expect to earn in our network marketing program. The Consent Order also prohibits us and other persons who act in active concert with us from misrepresenting that participation in the network marketing program will result in a lavish lifestyle and from using images or descriptions to represent or imply that participation in the program is likely to result in a lavish lifestyle. In addition, the Consent Order prohibits specified misrepresentations in connection with marketing the program, including misrepresentations regarding any fact material to participation such as the cost to participate or the amount of income likely to be earned. The Consent Order also requires us to clearly and conspicuously disclose information related to our refund and buyback policy on certain company materials and websites. The terms of the Consent Order do not change our going to market through direct selling by independent distributors, and compensating those distributors based upon the product they and their sales organization sell. We have implemented new and enhanced procedures required by the terms of the Consent Order and will continue to do so. We continue to monitor the impact of the Consent Order and our board of directors originally established the Implementation Oversight Committee in connection with monitoring compliance with the Consent Order, and more recently, our Audit Committee assumed oversight of continued compliance with the Consent Order. While we currently do not expect the Consent Order to have a long-term and material adverse impact on our business and our Member base, our business and our Member base, particularly in the U.S., have been in the past, and may in the future, be negatively impacted as we and they adjust to the changes. However, the terms of the Consent Order and the ongoing costs of compliance may adversely affect our business operations, our results of operations, and our financial condition. See Part I, Item 1A, Risk Factors, of this Annual Report on Form 10-K for a discussion of risks related to the settlement with the FTC. On January 4, 2018, the FTC released its nonbinding Business Guidance Concerning Multi-Level Marketing, or MLM Guidance. The MLM Guidance explains, among other things, lawful and unlawful compensation structures, the treatment of personal consumption by participants in determining if an MLM’s compensation structure is unfair or deceptive, and how an MLM should approach representations to current and prospective participants. We believe our current business practices, which include new and enhanced procedures implemented in connection with the Consent Order, are in compliance with the MLM Guidance. Additionally, the FTC has promulgated nonbinding Guides Concerning the Use of Endorsements and Testimonials in Advertising, or Guides, which explain how the FTC interprets Section 5 of the FTC Act’s prohibition on unfair or deceptive acts or practices. Consequently, the FTC could bring a Section 5 enforcement action based on practices that are inconsistent with the Guides. Under the Guides, advertisements that feature a consumer and convey his or her atypical experience with a product or service are required to clearly disclose the typical results that consumers can generally expect. The revised Guides also require advertisers to disclose connections between the advertiser and any endorsers that consumers might not expect, known as “material connections.” We have adapted our practices and rules regarding the practices of our Members to comply with the Guides and to comply with the Consent Order. We also are subject to the risk of private party challenges to the legality of our network marketing program both in the United States and internationally. For example, in Webster v. Omnitrition International, Inc., 79 F.3d 776 (9th Cir. 1996), the network marketing program of Omnitrition International, Inc., or Omnitrition, was challenged in a class action by Omnitrition distributors who alleged that it was operating an illegal “pyramid scheme” in violation of federal and state laws. We believe that our network marketing program satisfies federal and other applicable state statutes and case law. In some countries, regulations applicable to the activities of our Members also may affect our business because in some countries we are, or regulators may assert that we are, responsible for our Members’ conduct. In these countries, regulators may request or require that we take steps to ensure that our Members comply with local regulations. The types of regulated conduct include: (1) representations concerning our products; (2) income representations made by us and/or Members; (3) public media advertisements, which in foreign markets may require prior approval by regulators; (4) sales of products in markets in which the products have not been approved, licensed or certified for sale; and (5) classification by government agencies of our Members as employees of the Company. 15 In some markets, it is possible that improper product claims by Members could result in our products being reviewed by regulatory authorities and, as a result, being classified or placed into another category as to which stricter regulations are applicable. In addition, we might be required to make labeling changes. We also are subject to regulations in various foreign markets pertaining to social security assessments and employment and severance pay requirements. As an example, in some markets, we are substantially restricted in the amount and types of rules and termination criteria that we can impose on Members without having to pay social security assessments on behalf of the Members and without incurring severance obligations to terminated Members. In some countries, we may be subject to these obligations in any event. It is an ongoing part of our business to monitor and respond to regulatory and legal developments, including those that may affect our network marketing program. However, the regulatory requirements concerning network marketing programs do not include bright line rules and are inherently fact-based. An adverse judicial or regulatory determination with respect to our network marketing program could have a material adverse effect on our business, financial condition, and operating results and may also result in negative publicity, requirements to modify our network marketing program, or a negative impact on Member morale. In addition, adverse rulings by courts in any proceedings challenging the legality of network marketing systems, even in those not involving us directly, could have a material adverse effect on our operations. Although questions regarding the legality of our network marketing program have come up in the past and may come up from time to time in the future, we believe, based in part upon guidance to the general public from the FTC, that our network marketing program is compliant with applicable law. Income Tax, Transfer Pricing, and Other Taxes In many countries, including the United States, we are subject to income tax, transfer pricing and other tax regulations designed to ensure that appropriate levels of income are reported as earned by our U.S. and local entities and are taxed accordingly. In addition, our operations are subject to regulations designed to ensure that appropriate levels of customs duties are assessed on the importation of our products. Although we believe that we are in substantial compliance with all applicable tax rules, regulations, and restrictions, we are subject to the risk that governmental authorities could assert that additional taxes are owed based on findings of their audit. For example, we are currently subject to pending or proposed audits that are at various levels of review, assessment or appeal in a number of jurisdictions involving transfer pricing issues, income taxes, duties, value added taxes, withholding taxes and related interest and penalties in material amounts. In some circumstances, additional taxes, interest and penalties have been assessed, and we will be required to appeal or litigate to reverse the assessments. We have taken advice from our tax advisors and believe that there are substantial defenses to the allegations that additional taxes are owed, and we are vigorously defending against the imposition of additional proposed taxes. The ultimate resolution of these matters may take several years, and the outcome is uncertain. In the event that the audits or assessments are concluded adversely, we may or may not be able to offset or mitigate the consolidated effect of foreign income tax assessments through the use of U.S. foreign tax credits. The laws and regulations governing U.S. foreign tax credits are complex and subject to periodic legislative amendment, and there are restrictions on the utilization of U.S. foreign tax credits. Therefore, we cannot be sure that we would in fact be able to take advantage of any foreign tax credits in the future. Compliance Procedures As indicated above, Herbalife Nutrition, our products and our network marketing program are subject, both directly and indirectly through Members’ conduct, to numerous federal, state and local regulations, in the United States and foreign markets. In 1985, we began to institute formal compliance measures by developing a system to identify specific complaints against Members and to remedy any violations of Herbalife Nutrition’s rules by Members through appropriate sanctions, including warnings, fines, suspensions and, when necessary, terminations. We prohibit Members from making therapeutic claims for our products or misrepresentations regarding participating in our network marketing program, including in our manuals, seminars, and other training programs and materials. Our general policy is to reject Member applications from individuals who do not reside in one of our approved markets. 16 In order to comply with regulations that apply to both us and our Members, we research the applicable regulatory framework prior to entering any new market to identify necessary licenses and approvals and applicable limitations relating to our operations in that market and then work to bring our operations into compliance with the applicable limitations and to maintain such licenses. Typically, we conduct this research with the assistance of local legal counsel and other representatives. We also research laws applicable to Member operations and revise or alter our Member applications, rules, and other training materials and programs to provide Members with guidelines for operating their independent business, marketing and distributing our products and similar matters, as required by applicable regulations in each market. While we have rules and guidelines for our Members and monitor their market conduct, we are, however, unable to ensure that our Members will not distribute our products in countries where we have not commenced operations. In addition, regulations in existing and new markets often are ambiguous and subject to considerable interpretive and enforcement discretion by the responsible regulators. Moreover, even when we believe that we and our Members are in compliance with all applicable regulations, new regulations are being added regularly and the interpretation of existing regulations is subject to change. Further, the content and impact of regulations to which we are subject may be influenced by public attention directed at us, our products, or our network marketing program, so that extensive adverse publicity about us, our products, or our network marketing program may increase the likelihood regulatory scrutiny or action. HUMAN CAPITAL At Herbalife Nutrition, our commitment to improving lives and our communities is at the core of everything we do. This commitment also informs how we value and treat our employees. We seek to provide a work environment where employees can grow and thrive while supporting our Members and their customers. We believe attracting, developing, and retaining a talented and diverse workforce are critical factors that contribute to the success and growth of our business. We have operations globally, requiring investment to assess local labor market conditions and recruit and retain the appropriate workforce. Having a business presence in multiple domestic and international markets also requires us to monitor local labor and employment laws for which we often engage third-party advisors. We monitor the talent needs of our departments and functions with particular focus on the areas where human capital resources are important to daily operations to ensure we can timely manufacture, distribute, and sell products to our Members. As of December 31, 2022, we had approximately 10,100 employees, of which approximately 2,800 were located in the United States. Diversity, Equity, and Inclusion We believe diversity is a strength and embrace a core vision that a diverse, equitable, and inclusive culture is imperative to enable us to better serve our Members, stakeholders, and communities. As such, we seek to promote a work environment where all people can thrive, and are committed to diversity, equity, and inclusion, or DEI, at all levels, from our employees, management and executive leadership to our board of directors. Our DEI strategy is currently focused on creating opportunities to further recruit and support diverse talent at all levels, encouraging inclusion and belonging, and embedding equity throughout our culture and operations. Current initiatives include the implementation of a global applicant tracking system to deepen our commitment to fair recruitment processes, offering unconscious bias trainings for all employees, the expansion of existing employee networks which help employees build community and foster a culture of belonging, and further development and involvement of Global and Regional DEI Councils to drive DEI progress. Additionally, we have set diversity goals and targets for women in leadership roles globally and for racial and ethnic minorities in leadership roles in the U.S. Talent Acquisition and Development We seek to attract and retain a talented and diverse workforce. To foster an inclusive hiring process in the U.S., we use a tool that helps ensure that job descriptions do not unintentionally exclude potential applicants. Investment in our employees' professional growth and development is important and helps establish a strong foundation for long- term success. At our Company, we strive to create a learning culture, one in which development is an ongoing focus for all employees and managers. We invest in our employees’ development through a variety of programs. These programs are designed to help our employees grow professionally and strengthen their skills throughout their careers. Examples of these programs include the following: • Training Programs – We provide our employees access to an internal learning management system, Herbalife Nutrition University, which provides professional development courses, technical training, and compliance training to all employees globally. 17 • Mentorship Programs – The principle of servant leadership is a crucial part of our culture. We believe that one way to be a servant leader is to mentor others, and, in 2020, we introduced a new mentorship program to help guide junior employees in their professional journey. Through this program, participating employees can be provided with a one-on-one professional development opportunity, in which they receive dedicated coaching, feedback, and encouragement. • Educational Assistance – Another way we support employees’ continual professional development is by offsetting a portion of the cost of higher education. Program offerings and eligibility vary by region, but may include partial reimbursement of tuition fees incurred for undergraduate and graduate degrees, certificate programs, or skills-based courses. Compensation and Benefits Our Board of Directors and its Compensation Committee establish our general compensation philosophy and oversee and approve the development, adoption, and implementation of compensation policies and programs, which are set at a global level, but also adapted to meet local country requirements as needed. We provide base pay that aligns with employee positions, skill levels, experience, contributions, and geographic location. In addition to base pay, we seek to reward employees with annual incentive awards, recognition programs, and equity awards for employees at certain job grades. Our benefit programs are designed to enhance employee well-being and assist employees in the event of illness, injury, or disability. To this end, we offer benefits that vary worldwide, but may include health insurance, retirement savings programs, and wellness incentives designed to promote a healthy and active lifestyle. We believe we offer our employees wages and benefits packages that are in line with respective local labor markets and laws. Safety, Health, and Well-Being As a nutrition company, we believe the safety, health, and well-being of our employees is of the utmost importance. We endeavor to promote these principles by providing a safe and healthy work environment and encouraging healthy, active lifestyles. Our efforts to provide a safe workplace are guided by various formal policies and programs, which are designed to protect employees, contractors, and visitors from accidents, illnesses, and injuries, while operating in compliance with applicable regulations, including OSHA guidelines in the U.S. We also follow policies and programs regarding material health and safety risks, workplace violence prevention, and incident response and management. In the U.S., our manufacturing facilities in Winston-Salem and Lake Forest are ISO 45001 certified, an international standard for occupational health and safety management. While the COVID-19 pandemic has increased the resources required to keep our employees safe and healthy, we continue to make what we believe are the necessary investments to achieve this goal. In response to, and during various phases of, the pandemic, we have taken several actions, including supporting our employees to work from home when possible, offering mental and emotional wellness resources, and implementing safety measures when necessary at our facilities. Over the course of the pandemic, our senior management team has relied on cross-functional teams to monitor, review, and assess the evolving situation. These cross-functional teams are responsible for recommending risk mitigation actions based on the local risks and in accordance with regulatory requirements and guidelines for the health and safety of our employees and, in the U.S., protocols to align with all federal, state, and local public health guidelines. We believe our proactive efforts have been successful in supporting our business growth despite the obstacles and challenges presented by COVID-19. In addition, we believe in the importance of well-being and provide resources for our employees that support their pursuit of a healthy and active lifestyle. Our flagship wellness program in the U.S., “Wellness for Life,” offers employees a suite of activities to achieve overall wellness through improved fitness, nutrition, intellectual well-being, and financial literacy. The variety of activities offered ensures all employees may participate, no matter where they may be in their wellness journey. While we have many existing regional wellness programs, a new and enhanced global wellness program will launch in January 2023 and feature Herbalife fitness, health and nutrition experts from around the globe. We also have facilities and programs in place that allow employees to incorporate fitness into their daily schedule, such as onsite gyms at several facilities and live virtual classes. Our Members We are dependent on our Members to sell and promote our products to their customers. We frequently interact and work directly with our sales leaders to explore ways to support our and our Members’ businesses, and their customers’ personal goals of living a healthier and more active lifestyle. See the Our Network Marketing Program – Member Compensation and Sales Leader Retention and Requalification section above for sales leader and requalification metrics and further discussion on our sales leaders. 18 Available Information Our Internet website address is www.herbalife.com and our investor relations website is ir.herbalife.com. We make available free of charge on our website our Annual Reports on Form 10-K, Quarterly Reports on Form 10-Q, Current Reports on Form 8-K, proxy statements, and amendments to those reports filed or furnished pursuant to Section 13(a) or 15(d) of the Securities Exchange Act of 1934, as amended, or the Exchange Act, as soon as reasonably practical after we file such material with, or furnish it to, the Securities and Exchange Commission, or SEC. The SEC maintains an Internet website that contains reports, proxy and information statements, and other information regarding issuers that file electronically with the SEC at www.sec.gov. We also make available free of charge on our investor relations website at ir.herbalife.com our Principles of Corporate Governance, our Code of Conduct, and the Charters of our Audit Committee, Nominating and Corporate Governance Committee, Compensation Committee, and ESG Committee of our board of directors. Unless expressly noted, the information on our website, including our investor relations website, or any other website is not incorporated by reference in this Annual Report on Form 10-K and should not be considered part of this Annual Report on Form 10-K or any other filing we make with the SEC. Item 1A. Risk Factors Please carefully consider the following discussion of significant factors, events, and uncertainties that make an investment decision regarding our securities risky. The factors, events, uncertainties, and consequences discussed in these risk factors could, in circumstances we may not be able to accurately predict, recognize, or control, have a material adverse effect on our business, reputation, prospects, financial condition, operating results, cash flows, liquidity, and share price. These risk factors do not identify all risks that we face. We could also be affected by factors, events, or uncertainties that are not presently known to us or that we currently do not consider to present material risks. Additionally, the COVID-19 pandemic has amplified many of the other risks discussed below to which we are subject. We are unable to predict the duration and extent to which the pandemic and its related impacts will adversely impact our business, financial condition, and operating results as well as our share price. In addition, given the unpredictable, unprecedented, and fluid nature of the pandemic, it may also materially and adversely affect our business, financial condition, and operating results in ways that are not currently anticipated by or known to us or that we currently do not consider to present material risks. Risk Factor Summary This risk factor summary contains a high-level summary of certain of the principal factors, events and uncertainties that make an investment in our securities risky, including risks related to our business and industry, risks related to regulatory and legal matters, risks related to our international operations, risks related to our indebtedness and risks related to our common shares. The following summary is not complete and should be read together with the more detailed discussion of these and the other factors, events, and uncertainties set forth below before making an investment decision regarding our securities. The principal factors, events, and uncertainties that make an investment in our securities risky include the following: Risks Related to Our Business and Industry • Our failure to establish and maintain Member and sales leader relationships could negatively impact sales of our products and materially harm our business, financial condition, and operating results. • Because we cannot exert the same level of influence or control over our Members as we could if they were our employees, our Members could fail to comply with applicable law or our rules and procedures, which could result in claims against us that could materially harm our business, financial condition, and operating results. • Adverse publicity associated with our Company or the direct-selling industry could materially harm our business, financial condition, and operating results. • Our failure to compete successfully could materially harm our business, financial condition, and operating results. • Our contractual obligation to sell our products only through our Member network and to refrain from changing certain aspects of our Marketing Plan may limit our growth. • Our failure to appropriately respond to changing consumer trends, preferences, and demand for new products and product enhancements could materially harm our Member relationships, our Members’ customer relationships, and product sales or otherwise materially harm our business, financial condition, and operating results. • If we fail to further penetrate existing markets, the growth in sales of our products, along with our operating results could be negatively impacted. 19 • Since one of our products constitutes a significant portion of our net sales, significant decreases in consumer demand for this product or our failure to produce a suitable replacement, could materially harm our business, financial condition, and operating results. • Our business could be materially and adversely affected by natural disasters, other catastrophic events, acts of war or terrorism, cybersecurity incidents, pandemics, and/or other acts by third parties. • We depend on the integrity and reliability of our information technology infrastructure, and any related interruptions or inadequacies may have a material adverse effect on our business, financial condition, and operating results. • Disruption of supply, shortage, or increases in the cost of ingredients, packaging materials, and other raw materials as well as climate change could materially harm our business, financial condition, and operating results. • If any of our manufacturing facilities or third-party manufacturers fail to reliably supply products to us at required levels of quality or fail to comply with applicable laws, our financial condition and operating results could be materially and adversely impacted. • If we lose the services of members of our senior management team, our business, financial condition, and operating results could be materially harmed. • Our share price may be adversely affected by third parties who raise allegations about our Company. • ESG matters, including those related to climate change and sustainability, may have an adverse effect on our business, financial condition, and operating results and may damage our reputation. Risks Related to Regulatory and Legal Matters • Our products are affected by extensive regulations, and our failure or our Members’ failure to comply with any regulations could lead to significant penalties or claims, which could materially harm our financial condition and operating results. • Our network marketing program is subject to extensive regulation and scrutiny and any failure to comply, or alteration to our compensation practices in order to comply, with these regulations could materially harm our business, financial condition, and operating results. • We are subject to the Consent Order with the FTC, the effects of which, or any failure to comply therewith, could materially harm our business, financial condition, and operating results. • Our actual or perceived failure to comply with privacy and data protection laws, rules, and regulations could materially harm our business, financial condition, and operating results. • We are subject to material product liability risks, which could increase our costs and materially harm our business, financial condition, and operating results. • If we fail to protect our intellectual property, our ability to compete could be negatively affected, which could materially harm our financial condition and operating results. • If we infringe the intellectual property rights of others, our business, financial condition, and operating results could be materially harmed. • We may be held responsible for additional compensation, certain taxes, or assessments relating to the activities of our Members, which could materially harm our financial condition and operating results. Risks Related to Our International Operations • A substantial portion of our business is conducted in foreign jurisdictions, exposing us to the risks associated with international operations. • We are subject to the anti-bribery laws, rules, and regulations of the United States and the other foreign jurisdictions in which we operate. • If we do not comply with transfer pricing, customs duties VAT, and similar regulations, we may be subject to additional taxes, customs duties, interest, and penalties in material amounts, which could materially harm our financial condition and operating results. • Our business in China is subject to general, as well as industry-specific, economic, political, and legal developments and risks and requires that we utilize a modified version of the business model we use elsewhere in the world. • The United Kingdom’s exit from the European Union could adversely impact us. 20 Risks Related to Our Indebtedness • The terms and covenants in our existing indebtedness could limit our discretion with respect to certain business matters, which could harm our business, financial condition, and operating results. • The conversion or maturity of our convertible notes may adversely affect our financial condition and operating results, and their conversion into common shares could have a dilutive effect that could cause our share price to go down. Risks Related to Our Common Shares • Holders of our common shares may difficulties in protecting their interests because we are incorporated under Cayman Islands law. • Provisions of our articles of association and Cayman Islands law may impede a takeover or make it more difficult for shareholders to change the direction or management of the Company, which could reduce shareholders’ opportunity to influence management of the Company. • There is uncertainty as to shareholders’ ability to enforce certain foreign civil liabilities in the Cayman Islands. • U.S. Tax Reform may adversely impact certain U.S. shareholders of the Company. Risks Related to Our Business and Industry Our failure to establish and maintain Member and sales leader relationships could negatively impact sales of our products and materially harm our business, financial condition, and operating results. We distribute our products exclusively to and through our independent Members, and we depend on them directly for substantially all of our sales. To increase our revenue, we must increase the number and productivity of our Members. Accordingly, our success depends in significant part on our relationships with our sales leaders and our ability to recruit, retain, and motivate a large base of Members, including through an attractive compensation plan, the quality of our reputation, the maintenance of an attractive product portfolio, the breadth and quality of our Member services, and other incentives. The loss of a significant number of Members, changes to our network marketing program, our inability to respond to Member demand or generate sufficient interest in our business opportunities, products, or services, decreases in Member engagement, loss of Member or consumer confidence, or any legal or regulatory impact to our Members’ ability to conduct their business could negatively impact sales of our products and our ability to attract and retain Members, each of which could have a material adverse effect on our business, financial condition, and operating results. In our efforts to attract and retain Members, we compete with other direct-selling organizations. In addition, our Member organization has a high turnover rate, which is common in the direct-selling industry, in part because our Members, including our sales leaders, may easily enter and exit our network marketing program without facing a significant investment or loss of capital. For example, the upfront financial cost to become a Member is low, we do not have time or exclusivity requirements, we do not charge for any required training, and, in substantially all jurisdictions, we maintain a buyback program. We believe the COVID-19 pandemic could have an adverse impact on the pipeline of new Members and our Member turnover rate, and may impact our future net sales. See the COVID-19 Pandemic and Sales by Geographic Region sections in Part II, Item 7, Management’s Discussion and Analysis of Financial Condition and Results of Operations, of this Annual Report on Form 10-K for further discussion of the impacts of the COVID-19 pandemic on our business and results of operations. For additional information regarding sales leader retention rates, see Part I, Item 1, Business, of this Annual Report on Form 10-K. Because we cannot exert the same level of influence or control over our Members as we could if they were our employees, our Members could fail to comply with applicable law or our rules and procedures, which could result in claims against us that could materially harm our business, financial condition, and operating results. Our Members are independent contractors and, accordingly, we are not in a position to provide the same direction, motivation, and oversight as we could if Members were our employees. As a result, there can be no assurance that our Members will participate in our marketing strategies or plans, accept our introduction of new products, or comply with applicable legal requirements or our rules and procedures. 21 We are subject to extensive federal, state, local, and foreign laws, rules, and regulations that regulate our business, products, direct sales channel, and network marketing program. See the Regulation section of Part I, Item 1, Business, of this Annual Report on Form 10- K for additional information. While we have implemented policies and procedures designed to govern Member conduct and to protect the goodwill associated with Herbalife Nutrition, it can be difficult to enforce these policies and procedures because of our large number of Members and their status as independent contractors and because our policies and procedures differ by jurisdiction as a result of varying local legal requirements. In addition, although we train our Members and attempt to monitor our Members’ marketing materials, we cannot ensure that our Members will comply with applicable legal requirements or our policies and procedures or that such marketing materials or other Member practices comply with applicable laws, rules, and regulations. It is possible that a court could hold us liable for the actions of our Members, which could materially harm our business, financial condition, and operating results. Adverse publicity associated with our Company or the direct-selling industry could materially harm our business, financial condition, and operating results. Our reputation and the quality of our brand are critical to our business, and the size and success of our Member organization, our operating results, and our share price may be significantly affected by the public’s perception of Herbalife Nutrition and other direct- selling companies. This perception is dependent upon opinions concerning a number of factors, including: • the safety, quality, and efficacy of our products, as well as those of similar companies; • our Members; • our network marketing program or the attractiveness or viability of the financial opportunities it may provide; • the direct-selling business generally; • actual or purported failure by us or our Members to comply with applicable laws, rules, and regulations, including those regarding product claims and advertising, good manufacturing practices, the regulation of our network marketing program, the registration of our products for sale in our target markets, or other aspects of our business; • our commitment to ESG matters and our ESG practices; • the security of our information technology infrastructure; and • actual or alleged impropriety, misconduct, or fraudulent activity by any person formerly or currently associated with our Members or us. Adverse publicity concerning any of the foregoing whether or not accurate or resulting in investigation, enforcement, or other legal or regulatory actions or the imposition of fines, penalties, or other sanctions, could negatively impact our reputation, our ability to attract, motivate, and retain Members, and our ability to generate revenue. In addition, our Members’ and consumers’ perception of Herbalife Nutrition and our direct-selling business as well as similar companies can be significantly influenced by media attention, publicized scientific research or findings, product liability claims, and other publicity, whether or not it is legitimate. For example, as a result of the prevalence and marked increase in the use of blogs, social media platforms, and other forms of Internet-based communications, the opportunity for dissemination of information, both accurate and inaccurate, is seemingly limitless and readily available, and often does not provide any opportunity for correction or other redress. Adverse publicity that associates use of our products or any similar products with adverse effects, questions the quality or benefits of any such products, or claims that any such products are ineffective, inappropriately labeled, or have inaccurate instructions as to their use, could lead to lawsuits or other legal or regulatory challenges and could materially and adversely impact our reputation, the demand for our products, and our business, financial condition, and operating results. Adverse publicity relating to us has had, and could again have, a negative effect on our ability to attract, motivate, and retain Members, on consumer perception of Herbalife Nutrition, and on our share price. For example, the resulting adverse publicity from the 1986 permanent injunction entered in California caused a rapid, substantial loss of Members in the United States and a corresponding reduction in sales beginning in 1985. See also the risk factor titled “Our share price may be adversely affected by third parties who raise allegations about our Company.” We expect that adverse publicity will, from time to time, continue to negatively impact our business in particular markets and may adversely affect our share price. 22 Our failure to compete successfully could materially harm our business, financial condition, and operating results. The business of developing and marketing weight management and other nutrition and personal care products is highly competitive and sensitive to the introduction of new products and weight management plans, including various prescription drugs, which may rapidly capture a significant share of the market. Our competitors include numerous manufacturers; distributors; marketers; online, specialty, mass, and other retailers; and physicians that actively compete for the business of consumers both in the United States and abroad. Some of our competitors have longer operating histories, significantly greater resources, better-developed and more innovative sales and distribution channels and platforms, greater name recognition, and larger established customer bases than we do. Our present and future competitors may be able to offer products at lower prices or better withstand reductions in prices or other adverse economic or market conditions than we can; develop products that are comparable or superior to those we offer; adapt more quickly or effectively to new technologies, changing regulatory requirements, evolving industry trends and standards, and customer requirements than we can; and/or devote greater resources to the development, promotion, and sale of their products than we do. We are also subject to significant competition for the recruitment of Members from other direct-selling organizations, including those that market weight management products, dietary and nutritional supplements, personal care products, and other types of products, as well as those organizations in which former employees or Members are involved. In addition, because the industry in which we operate is not particularly capital intensive or otherwise subject to high barriers to entry, it is relatively easy for new competitors to emerge that will compete with us, including for our Members and their customers. Accordingly, competition may intensify and we may not be able to compete effectively in our markets. If we are not able to retain our Members and their customers or otherwise compete successfully, our business, financial condition, and operating results would be materially adversely affected. Our contractual obligation to sell our products only through our Member network and to refrain from changing certain aspects of our Marketing Plan may limit our growth. We are contractually prohibited from expanding our business by selling Herbalife Nutrition products through other distribution channels that may be available to our competitors, such as over the Internet, through wholesale sales, by establishing retail stores, or through mail order systems. To the extent legally permitted, an agreement we entered into with our Members provides assurances that we will not sell Herbalife Nutrition products worldwide through any distribution channel other than our network of Members. Since this is an open-ended commitment, there can be no assurance that we will be able to take advantage of innovative new distribution channels that are developed in the future or appropriately respond to consumer preferences as they continue to evolve. In addition, this agreement with our Members provides that we will not make any material changes adverse to our Members to certain aspects of our Marketing Plan that may negatively impact our Members without their approval as described in further detail below. For example, our agreement with our Members provides that we may increase, but not decrease, the discount percentages available to our Members for the purchase of products or the applicable royalty override percentages and production and other bonus percentages available to our Members at various qualification levels within our Member hierarchy. We may not modify the eligibility or qualification criteria for these discounts, royalty overrides, and production and other bonuses unless we do so in a manner to make eligibility and/or qualification easier than under the applicable criteria in effect as of the date of the agreement. Our agreement with our Members further provides that we may not vary the criteria for qualification for each Member tier within our Member hierarchy, unless we do so in such a way so as to make qualification easier. We reserved the right to make changes to our Marketing Plan without the consent of our Members in the event that changes are required by applicable law or are necessary in our reasonable business judgment to account for specific local market or currency conditions to achieve a reasonable profit on operations. In addition, we may initiate other changes that are adverse to our Members based on an assessment of what will be best for the Company and its Members. Under the agreement with our Members, these other adverse changes would then be submitted to our Member leadership for a vote. The vote would require the approval of at least 51% of our Members then at the level of President’s Team earning at the production bonus level of 6% who vote, provided that at least 50% of those Members entitled to vote do in fact vote. While we believe this agreement has strengthened our relationship with our existing Members, improved our ability to recruit new Members, and generally increased the long-term stability of our business, there can be no assurance that our agreement with our Members will not restrict our ability to adapt our Marketing Plan or our business to the evolving requirements of the markets in which we operate. As a result, our growth may be limited. 23 Our failure to appropriately respond to changing consumer trends, preferences, and demand for new products and product enhancements could materially harm our Member relationships, Members’ customer relationships, and product sales or otherwise materially harm our business, financial condition, and operating results. Our business is subject to rapidly changing consumer trends and preferences and product introductions, especially with respect to our nutrition products. Our continued success depends in part on our ability to anticipate and respond to these changes and introductions, and we may not respond or develop new products or product enhancements in a cost-effective, timely, or commercially appropriate manner, or at all, particularly while the COVID-19 pandemic persists. Current consumer trends and preferences have evolved and will continue to evolve as a result of, among other things, changes in consumer tastes; health, wellness, and nutrition considerations; competitive product and pricing pressures; changes in consumer preferences for certain sales channels; shifts in demographics; and concerns regarding the environmental and sustainability impact of the product manufacturing process. The success of our response to changing consumer trends and preferences and product introductions, including any new product offerings and enhancements, depends on a number of factors, including our ability to: • accurately anticipate consumer needs; • innovate and develop new products and product enhancements that meet these needs; • successfully commercialize new products and product enhancements; • price our products competitively; • manufacture and deliver our products in sufficient volumes, at our required levels of quality, and in a cost-effective and timely manner; and • differentiate our product offerings from those of our competitors and successfully respond to other competitive pressures, including technological advancements, evolving industry standards, and changing regulatory requirements. Our failure to accurately predict changes in consumer demand and technological advancements could negatively impact consumer opinion of our products or our business, which in turn could harm our Member relationships and the Members’ relationships with their customers, and cause a loss of sales. In addition, if we do not introduce new products or make enhancements to meet the changing needs of our Members and their customers in a cost-effective, timely, and commercially appropriate manner, or if our competitors release new products or product enhancements before we do, some of our product offerings could be rendered obsolete, which could cause our market share to decline and negatively impact our business, financial condition, and operating results. If we fail to further penetrate existing markets, the growth in sales of our products, along with our operating results, could be negatively impacted. The success of our business is to a large extent contingent on our ability to further penetrate existing markets, which is subject to numerous factors, many of which are out of our control. Our ability to increase market penetration may be limited by the finite number of persons in a given country inclined to pursue a direct-selling business opportunity or consumers aware of, or willing to purchase, Herbalife Nutrition products. Moreover, our growth in existing markets will depend upon increased brand awareness and improved training and other activities that enhance Member retention in our markets. While we have recently experienced significant growth in certain of our foreign markets, we cannot assure you that such growth levels will continue in the immediate or long-term future. Furthermore, our efforts to support growth in such foreign markets could be hampered to the extent that our infrastructure in such markets is deficient when compared to our infrastructure in our more developed markets, such as the United States. For example, there can be no assurances that we will be able to successfully manage expansion of manufacturing operations and a growing and dynamic sales force in China. If we are unable to effectively scale our supply chain and manufacturing infrastructure to support future growth in China or other foreign markets, our operations in such markets may be adversely impacted. Therefore, we cannot assure you that our general efforts to increase our market penetration and Member retention in existing markets will be successful. If we are unable to further penetrate existing markets, our business, financial condition, and operating results could materially suffer. Since one of our products constitutes a significant portion of our net sales, significant decreases in consumer demand for this product or our failure to produce a suitable replacement could materially harm our business, financial condition, and operating results. Our Formula 1 Healthy Meal, which is our best-selling product line, approximated 26% of our net sales for the year ended December 31, 2022. If consumer demand for this product decreases significantly or we cease offering this product without a suitable replacement, or if the replacement product fails to gain market acceptance, our business, financial condition, and operating results could be materially harmed. 24 Our business could be materially and adversely affected by natural disasters, other catastrophic events, acts of war or terrorism, cybersecurity incidents, pandemics, and/or other acts by third parties. We depend on the ability of our business to run smoothly, including the ability of Members to engage in their day-to-day selling and business building activities. In coordination with our suppliers, third-party manufacturers, and distributors, our ability to make and move our products reasonably unimpeded around the world is critical to our success. Any material disruption to our collective operations or supply, manufacturing, or distribution capabilities caused by unforeseen or catastrophic events, such as (i) natural disasters or severe weather conditions, including droughts, fires, floods, hurricanes, volcanic eruptions, and earthquakes; (ii) power loss or shortages; (iii) telecommunications or information technology infrastructure failures; (iv) acts or threats of war, terrorism, or other armed hostilities; (v) outbreaks of contagious diseases, epidemics, and pandemics; (vi) cybersecurity incidents, including intentional or inadvertent exposure of content perceived to be sensitive data; (vii) employee misconduct or error; and/or (viii) other actions by third parties and other similar disruptions, could materially adversely affect our ability to conduct business and our Members’ selling activities. For example, our operations in Central America were impacted in November 2020 when Hurricanes Eta and Iota made landfall in the region. The storms disrupted our supply chain transportation network and our ability to import product. In addition, our distribution center in Honduras experienced flooding, which damaged or destroyed product. Furthermore, our headquarters and one of our distribution facilities and manufacturing facilities are located in Southern California, an area susceptible to fires and earthquakes. Although the events in Central America did not have a material negative impact on our operations, we cannot make assurances that any future catastrophic events will not adversely affect our ability to operate our business or our financial condition and operating results. In addition, catastrophic events may result in significant cancellations or cessations of Member orders; contribute to a general decrease in local, regional, or global economic activity; directly impact our marketing, manufacturing, financial, or logistics functions; impair our ability to meet Member demands; harm our reputation; and expose us to significant liability, losses, and legal proceedings, any of which could materially and adversely affect our business, financial condition, and operating results. In March 2020, the World Health Organization declared the COVID-19 outbreak a global pandemic. The COVID-19 pandemic has significantly impacted health and economic conditions globally, disrupted global supply chains, and has adversely affected the Company’s business and that of its Members in certain of the Company’s markets and may continue to impact those markets or others in the future. Government, agency, and other regulatory recommendations, guidelines, mandates, and actions to address public health concerns, including restrictions on movement, public gatherings, and travel and restrictions on, or in certain cases outright prohibitions of, companies’ ability to conduct normal business operations, have and may continue to adversely affect our business. Although we have been classified as an essential business in most jurisdictions where we operate, there is no guarantee that this classification will not change. We may also be forced to or voluntarily elect to limit or cease operations in one or more markets for other reasons, such as the health and safety of our employees or because of disruptions in the operation of our supply chain and sources of supply. For example, it is possible that closures of our manufacturing facilities or those of our third-party contract manufacturers or suppliers could impact our distribution centers and our ability to manufacture and deliver products to our Members. In general, our inventory of products continues to be adequate to meet demand, but we do expect our supply chain and our ability to source and/or manufacture products will be negatively impacted if the negative effects of the pandemic continue for a prolonged period of time or worsen. The pandemic has had an adverse impact on our distribution channels and Members’ product access in some markets, which may, and in some cases will, continue until conditions improve. Our third-party contract manufacturers and suppliers and our Members’ businesses are also subject to many of the same risks and uncertainties related to the COVID-19 pandemic, as well as other pandemic-related risks and uncertainties that may not directly impact our operations, any of which could adversely affect demand for our products. For example, limitations on public gatherings have restricted our Members’ ability to hold meetings with their existing customers and to attract new customers. Significant limitations on cash transactions could also have an adverse effect on sales of products in certain markets. The COVID-19 pandemic has also adversely affected the economies and financial markets of many countries, at times causing a significant deceleration of or interruption to economic activity, which during various stages of the pandemic has reduced production, decreased demand for a broad variety of goods and services, diminished trade levels, and led to widespread corporate downsizing. We have also seen periods of significant disruption of and extreme volatility in the global capital markets, which could increase the cost of, or entirely restrict access to, capital. Further, while some countries have progressed in distributing COVID-19 vaccines to the general population, many countries have limited to no access to vaccines at this time. To the extent the global supply of vaccine remains limited or vaccination rates do not significantly increase, government restrictions in the countries with limited to no access or low vaccination rates may persist or increase and economic activity may remain at depressed levels in those countries or regions. 25 Despite the relaxation of pandemic-related constraints in certain markets, considerable uncertainty still surrounds the COVID-19 pandemic, its potential effects, and the extent and effectiveness of government responses to the pandemic. If the pandemic is not contained, or if new variants emerge or effective vaccines are not made available and utilized quickly enough, the adverse impacts of the COVID-19 pandemic could worsen, impacting all segments of the global economy, and result in a significant recession or worse. However, the unprecedented and sweeping nature of the COVID-19 pandemic makes it extremely difficult to predict how our business and operations will be affected in the long run. Further, the resumption of normal business operations after the disruptions caused by the COVID-19 pandemic may be delayed or constrained by the pandemic’s lingering effects on our Members, consumers, and third- party contract manufacturers and suppliers. Accordingly, our ability to conduct our business in the manner previously done or planned for the future could be materially and adversely affected, and any of the foregoing risks, or other cascading effects of the COVID-19 pandemic, or any other pandemic that may emerge in the future, that are not currently foreseeable, could materially and adversely affect our business, financial condition, and operating results. See the COVID-19 Pandemic and Sales by Geographic Region sections in Part II, Item 7, Management’s Discussion and Analysis of Financial Condition and Results of Operations, of this Annual Report on Form 10- K for further discussion of the impacts of the COVID-19 pandemic on our business and operating results. We depend on the integrity and reliability of our information technology infrastructure, and any related interruptions or inadequacies may have a material adverse effect on our business, financial condition, and operating results. Our business, including our ability to provide products and services to and manage our Members, depends on the performance and availability of our information technology infrastructure, including our core transactional systems. The most important aspect of our information technology infrastructure is the system through which we record and track Member sales, Volume Points, royalty overrides, bonuses, and other incentives. The failure of our information systems to operate effectively, or a breach in security of these systems, could adversely impact the promptness and accuracy of our product distribution and transaction processing. While we continue to invest in our information technology infrastructure, there can be no assurance that there will not be any significant interruptions to such systems, that the systems will be adequate to meet all of our business needs, or that the systems will keep pace with continuing changes in technology, legal and regulatory standards. Further, as discussed in Part II, Item 7, Management’s Discussion and Analysis of Financial Condition and Results of Operations, we recently commenced a Digital Technology Program to develop a new enhanced platform to provide enhanced digital capabilities and experiences to our Members. Our information technology infrastructure, as well as that of our Members and the other third parties with which we interact, may be damaged, disrupted, or breached or otherwise fail for a number of reasons, including power outages, computer and telecommunication failures, internal design, manual or usage errors, workplace violence or wrongdoing, or catastrophic events such as natural disasters, severe weather conditions, or acts of war or terrorism. In addition, numerous and evolving cybersecurity threats, including advanced and persistent cyberattacks, such as unauthorized attempts to access, disable, improperly modify, exfiltrate, or degrade our information technology infrastructure, or the introduction of computer viruses, malware, “phishing” emails, and other destructive software, and social engineering schemes, could compromise the confidentiality, availability, and integrity of our information technology infrastructure as well as those of the third parties with which we interact. These attacks may come from external sources, such as governments or hackers, or may originate internally from an employee or a third party with which we interact. We have been the target of, and may be the target of in the future, malicious cyberattacks, although to date none of these attacks have had a meaningful adverse impact on our business, financial condition, or operating results. The potential risk of cyberattacks may increase as we introduce new technology systems and services. Additionally, in response to the COVID-19 pandemic, many of our employees have been encouraged to work remotely, which may increase our exposure to significant systems interruptions, cybersecurity attacks, and otherwise compromise the integrity and reliability of our information technology infrastructure and our internal controls. Any disruptions to, or failures or inadequacies of, our information technology infrastructure that we may encounter in the future may result in substantial interruptions to our operations, expose us to significant liability, and may damage our reputation and our relationships with, or cause us to lose, our Members, especially if the disruptions, failures, or inadequacies impair our ability to track sales and pay royalty overrides, bonuses, and other incentives, any of which would harm our business, financial condition, and operating results. Any such disruptions, failures, or inadequacies could also create compliance risks under the Consent Order and result in penalties, fines, or sanctions under any applicable laws or regulations. Furthermore, it may be expensive or difficult to correct or replace any aspect of our information technology infrastructure in a timely manner, if at all, and we may have little or no control over whether any malfunctioning information technology services supplied to us by third parties are appropriately corrected, if at all. We have encountered, and may encounter in the future, errors in our software and our enterprise network, and inadequacies in the software and services supplied by certain of our vendors, although to date none of these errors or inadequacies have had a meaningful adverse impact on our business, financial condition or operating results. In addition, developments in technology are continuing to evolve and affecting all aspects of our business, including how we effectively manage our operations, interact with our Members and their customers, and commercialize opportunities that accompany the evolving digital and data driven economy. Therefore, one of our top priorities is to modernize our technology and data infrastructure by, among other things, creating more relevant and more personalized experiences wherever our systems interact with Members and their customers; and developing ways to create more powerful digital tools and capabilities for Members to enable them to grow their 26 businesses. These initiatives to modernize our technology and data infrastructure are expected to be implemented over the course of many years and to require significant investments. If these initiatives are not successful, our ability to attract and retain Members and their customers, increase sales, and reduce costs may be negatively affected. Further, these initiatives may be subject to cost overruns and delays and may cause disruptions in our operations. These cost overruns and delays and disruptions could adversely impact our business, financial condition, and operating results. Disruption of supply, shortage, or increases in the cost of ingredients, packaging materials, and other raw materials as well as climate change could materially harm our business, financial condition, and operating results. We and our third-party contract manufacturers depend on third-party suppliers to supply us with the various ingredients, packaging materials, and other raw materials that we use in the manufacturing and distribution of our products. Our business could be materially harmed if we experience operational difficulties with our third-party suppliers, such as increases in costs, reductions in the availability of materials or production capacity, errors in complying with specifications or applicable law, insufficient quality control, and failures to meet production or shipment deadlines. If we fail to develop or maintain our relationships with our third-party suppliers or if such suppliers cease doing business with us or go out of business, we could face difficulties in finding or transitioning to alternative suppliers that meet our standards. Many of the ingredients, packaging materials, and other raw materials we use are subject to fluctuations in availability and price due to a number of factors beyond our control, including crop size, ingredient, water, and land scarcity, market demand for raw materials, commodity market speculation, energy costs, currency fluctuations, supplier and logistics service capacities, import and export requirements, tariffs, and other government policies, and drought, excessive rain, temperature extremes, and other severe weather events. If we experience supply shortages, price increases, or supplier or regulatory impediments with respect to any of the materials we use in our products or packaging, we may need to seek alternative supplies or suppliers and may experience difficulties in finding replacements that are comparable in quality and price. For a discussion of the impacts of the COVID-19 pandemic on our supply chain see “If any of our manufacturing facilities or third-party manufacturers fail to reliably supply products to us at required levels of quality or fail to comply with applicable laws, our financial condition and operating results could be materially and adversely impacted” below. Further, the risks related to our ability to adequately source the materials required to meet our needs may be exacerbated by the effects of climate change and the legal, regulatory, or market measures that may be implemented to address climate change. There is growing concern that carbon dioxide and other greenhouse gases in the atmosphere may have an adverse impact on global temperatures, weather patterns, and the frequency and severity of extreme weather and natural disasters. If climate change has a negative effect on agricultural productivity, we may be subject to decreased availability or less favorable pricing for certain raw materials that are necessary for our products, such as soybeans, wheat, tea leaves, and nuts. Severe weather conditions and natural disasters can reduce crop size and crop quality, which in turn could reduce our supplies of raw materials, lower recoveries of usable raw materials, increase the prices of our raw materials, increase our cost of storing and transporting our raw materials, or disrupt production schedules. The impacts of climate change may also cause unpredictable water availability or exacerbate water scarcity. In addition, the increasing concern over climate change and related sustainability matters may also result in more federal, state, local, and foreign legal and regulatory requirements relating to climate change, which may significantly increase our costs of operation and delivery. 27","Use only the document provided and nothing else. How does Herbalife's ""seed to feed"" strategy influence its product quality and sourcing? 2022 Annual Report To Our Shareholders, We all know coming out of the pandemic has caused many companies to relook at their operations. 2022 was a year of change for Herbalife as well as a year of challenge. With every challenge, there is great opportunity. I came back to Herbalife because I believe passionately about what Herbalife does, and what it provides for health and income. Since returning to Herbalife, I along with our management team and distributor leaders from around the world have embarked on a journey to expand our content, enhance the business opportunity, modernize our brand, and expand our digital platform – with the aim to reach more customers and to provide our distributors a better plat- form to operate their business. Our vision is to be the world’s premier health and wellness company and community. As I write this, more than 3,000 distributor leaders from around the world are traveling to Los Angeles to meet together for the first time in three years to learn, to share, to innovate, and to build a path forward for Herbalife. The time is now for us to reconnect, build on our strategic plan, and provide growth for all of our stakeholders. Our digital transformation “Herbalife One” will enhance the Company’s two main platforms: content and busi- ness opportunity. Our content is our product. With obesity levels hitting record highs around the globe and a greater demand for health and wellness support, we have plans to grow our product portfolio through our daily nutrition products with expanded vegan and protein lines. We plan to explore other health and wellness opportunities that will be based on global as well as regional consumer demands. For example, our unique Ayurvedic product line in India has contributed to the success of our fastest growing market. We are unleashing similar innovative products regionally in Europe, Asia and China, and we will continue to look for synergies and opportunities to globalize our regional product offerings. With enhancements to the business opportunity, our global distributor network will continue to give us a com- petitive advantage to reach more consumers with more offerings than ever before. Our distributors give a personal voice and passion to our products. Spanning across 95 markets, our distributors are amazing entrepreneurs who have unique relationships with their customers, and through an expanded use of data, we will be able to assist our distributors to sell more products and work more closely and efficiently with consumers on their health and wellness journey. To this end, we are modernizing our brand and compensation structure, including new promotions to energize and incentivize our distributors to earn early in their Herbalife business opportunity journey. Together with Herbalife One, our business opportunity will differentiate us and strengthen our leadership in the marketplace. 2023 is a start of a new chapter – one that is both motivating and exciting. In March, I marked my 20th year of devoting my time, passion, and energy to Herbalife. I feel more optimistic about where we are headed today than ever before. Our distributors and employees make Herbalife a community unlike any other. I know our distrib- utors and employees are as incredibly excited about the future as I am. Thank you for your trust and support. Michael O. Johnson Chairman and Chief Executive Officer This letter contains “forward-looking statements” within the meaning of the safe harbor provisions of the Private Securities Litigation Reform Act of 1995. Although we believe that the expectations reflected in any of our forward-looking statements are reasonable, actual results or outcomes could differ materially from those pro- jected or assumed in any of our forward-looking statements. Our future financial condition and results of oper- ations, as well as any forward-looking statements, are subject to change and to inherent risks and uncertainties, many of which are beyond our control. Additionally, many of these risks and uncertainties are, and may continue to be, amplified by the COVID-19 pandemic. Important factors that could cause our actual results, performance and achievements, or industry results to differ materially from estimates or projections contained in or implied by our forward-looking statements include the following: the potential impacts of the COVID-19 pandemic and current global economic conditions, including inflation, on us; our Members, customers, and supply chain; and the world economy; our ability to attract and retain Members; our relationship with, and our ability to influence the actions of, our Members; our noncompliance with, or improper action by our employees or Members in violation of, applicable U.S. and foreign laws, rules, and regulations; adverse publicity associated with our Company or the direct-selling industry, including our ability to comfort the marketplace and regulators regard- ing our compliance with applicable laws; changing consumer preferences and demands and evolving industry standards, including with respect to climate change, sustainability, and other environmental, social, and gover- nance, or ESG, matters; the competitive nature of our business and industry; legal and regulatory matters, including regulatory actions concerning, or legal challenges to, our products or network marketing program and product liability claims; the Consent Order entered into with the FTC, the effects thereof and any failure to comply therewith; risks associated with operating internationally and in China; our ability to execute our growth and other strategic initiatives, including implementation of our Transformation Program and increased pene- tration of our existing markets; any material disruption to our business caused by natural disasters, other cata- strophic events, acts of war or terrorism, including the war in Ukraine, cybersecurity incidents, pandemics, and/ or other acts by third parties; our ability to adequately source ingredients, packaging materials, and other raw materials and manufacture and distribute our products; our reliance on our information technology infra- structure; noncompliance by us or our Members with any privacy laws, rules, or regulations or any security breach involving the misappropriation, loss, or other unauthorized use or disclosure of confidential information; contractual limitations on our ability to expand or change our direct-selling business model; the sufficiency of our trademarks and other intellectual property; product concentration; our reliance upon, or the loss or departure of any member of, our senior management team; restrictions imposed by covenants in the agreements governing our indebtedness; risks related to our convertible notes; changes in, and uncertainties relating to, the application of transfer pricing, income tax, customs duties, value added taxes, and other tax laws, treaties, and regulations, or their interpretation; our incorporation under the laws of the Cayman Islands; and share price volatility related to, among other things, speculative trading and certain traders shorting our common shares. Forward-looking statements in this letter speak only as of March 14, 2023. We do not undertake any obligation to update or release any revisions to any forward-looking statement or to report any events or circumstances after such date or to reflect the occurrence of unanticipated events, except as required by law. UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 Form 10-K (Mark One) ANNUAL REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 For the fiscal year ended December 31, 2022 OR TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 For the transition period from to Commission file number: 1-32381 HERBALIFE NUTRITION LTD. (Exact name of registrant as specified in its charter) Cayman Islands 98-0377871 (State or other jurisdiction of (I.R.S. Employer incorporation or organization) Identification No.) P.O. Box 309GT Ugland House, South Church Street Grand Cayman, Cayman Islands (Address of principal executive offices) (Zip Code) (213) 745-0500 (Registrant’s telephone number, including area code) Securities registered pursuant to Section 12(b) of the Act: Title of each class: Trading Symbol(s): Name of each exchange on which registered: Common Shares, par value $0.0005 per share HLF New York Stock Exchange Securities registered pursuant to Section 12(g) of the Act: None Indicate by check mark if the registrant is a well-known seasoned issuer, as defined in Rule 405 of the Securities Act. Yes ☒ No ☐ Indicate by check mark if the registrant is not required to file reports pursuant to Section 13 or Section 15(d) of the Act. Yes ☐ No ☒ Indicate by check mark whether the registrant: (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days. Yes ☒ No ☐ Indicate by check mark whether the registrant has submitted electronically every Interactive Data File required to be submitted pursuant to Rule 405 of Regulation S-T (§232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to submit such files). Yes ☒ No ☐ Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, a smaller reporting company, or an emerging growth company. See the definitions of “large accelerated filer,” “accelerated filer,” “smaller reporting company,” and “emerging growth company” in Rule 12b-2 of the Exchange Act. Large accelerated filer ☒ Accelerated filer ☐ Non-accelerated filer ☐ Smaller reporting company ☐ Emerging growth company ☐ If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act. ☐ Indicate by check mark whether the registrant has filed a report on and attestation to its management’s assessment of the effectiveness of its internal control over financial reporting under Section 404(b) of the Sarbanes-Oxley Act (15 U.S.C. 7262(b)) by the registered public accounting firm that prepared or issued its audit report. ☒ If securities are registered pursuant to Section 12(b) of the Act, indicate by check mark whether the financial statements of the registrant included in the filing reflect the correction of an error to previously issued financial statements. ☐ Indicate by check mark whether any of those error corrections are restatements that required a recovery analysis of incentive-based compensation received by any of the registrant’s executive officers during the relevant recovery period pursuant to §240.10D-1(b). ☐ Indicate by check mark whether registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act). Yes ☐ No ☒ There were 97,920,728 common shares outstanding as of February 7, 2023. The aggregate market value of the Registrant’s common shares held by non-affiliates was approximately $896 million as of June 30, 2022, based upon the last reported sales price on the New York Stock Exchange on that date of $20.45. For the purposes of this disclosure only, the registrant has assumed that its directors, executive officers, and the beneficial owners of 5% or more of the registrant’s outstanding common stock are the affiliates of the registrant. DOCUMENTS INCORPORATED BY REFERENCE Portions of the registrant’s Definitive Proxy Statement to be filed with the Securities and Exchange Commission no later than 120 days after the end of the Registrant’s fiscal year ended December 31, 2022, are incorporated by reference in Part III of this Annual Report on Form 10-K. 1 TABLE OF CONTENTS Page No. PART I Item 1. Business 5 Item 1A. Risk Factors 19 Item 1B. Unresolved Staff Comments 43 Item 2. Properties 43 Item 3. Legal Proceedings 44 Item 4. Mine Safety Disclosures 44 PART II Item 5. Market for Registrant’s Common Equity, Related Stockholder Matters and Issuer Purchases of Equity 45 Securities Item 6. [Reserved] 46 Item 7. Management’s Discussion and Analysis of Financial Condition and Results of Operations 47 Item 7A. Quantitative and Qualitative Disclosures About Market Risk 67 Item 8. Financial Statements and Supplementary Data 69 Item 9. Changes in and Disagreements With Accountants on Accounting and Financial Disclosure 70 Item 9A. Controls and Procedures 70 Item 9B. Other Information 70 Item 9C. Disclosure Regarding Foreign Jurisdictions that Prevent Inspections 70 PART III Item 10. Directors, Executive Officers and Corporate Governance 71 Item 11. Executive Compensation 71 Item 12. Security Ownership of Certain Beneficial Owners and Management and Related Stockholder Matters 71 Item 13. Certain Relationships and Related Transactions, and Director Independence 71 Item 14. Principal Accounting Fees and Services 71 PART IV Item 15. Exhibits, Financial Statement Schedules 72 Item 16. Form 10-K Summary 125 2 FORWARD-LOOKING STATEMENTS This Annual Report on Form 10-K contains “forward-looking statements” within the meaning of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended. All statements other than statements of historical fact are “forward-looking statements” for purposes of federal and state securities laws, including any projections of earnings, revenue or other financial items; any statements of the plans, strategies and objectives of management, including for future operations, capital expenditures, or share repurchases; any statements concerning proposed new products, services, or developments; any statements regarding future economic conditions or performance; any statements of belief or expectation; and any statements of assumptions underlying any of the foregoing or other future events. Forward-looking statements may include, among other, the words “may,” “will,” “estimate,” “intend,” “continue,” “believe,” “expect,” “anticipate” or any other similar words. Although we believe that the expectations reflected in any of our forward-looking statements are reasonable, actual results or outcomes could differ materially from those projected or assumed in any of our forward-looking statements. Our future financial condition and results of operations, as well as any forward-looking statements, are subject to change and to inherent risks and uncertainties, many of which are beyond our control. Additionally, many of these risks and uncertainties are, and may continue to be, amplified by the COVID-19 pandemic. Important factors that could cause our actual results, performance and achievements, or industry results to differ materially from estimates or projections contained in or implied by our forward-looking statements include the following: • the potential impacts of the COVID-19 pandemic and current global economic conditions, including inflation, on us; our Members, customers, and supply chain; and the world economy; • our ability to attract and retain Members; • our relationship with, and our ability to influence the actions of, our Members; • our noncompliance with, or improper action by our employees or Members in violation of, applicable U.S. and foreign laws, rules, and regulations; • adverse publicity associated with our Company or the direct-selling industry, including our ability to comfort the marketplace and regulators regarding our compliance with applicable laws; • changing consumer preferences and demands and evolving industry standards, including with respect to climate change, sustainability, and other environmental, social, and governance, or ESG, matters; • the competitive nature of our business and industry; • legal and regulatory matters, including regulatory actions concerning, or legal challenges to, our products or network marketing program and product liability claims; • the Consent Order entered into with the FTC, the effects thereof and any failure to comply therewith; • risks associated with operating internationally and in China; • our ability to execute our growth and other strategic initiatives, including implementation of our Transformation Program and increased penetration of our existing markets; • any material disruption to our business caused by natural disasters, other catastrophic events, acts of war or terrorism, including the war in Ukraine, cybersecurity incidents, pandemics, and/or other acts by third parties; • our ability to adequately source ingredients, packaging materials, and other raw materials and manufacture and distribute our products; • our reliance on our information technology infrastructure; • noncompliance by us or our Members with any privacy laws, rules, or regulations or any security breach involving the misappropriation, loss, or other unauthorized use or disclosure of confidential information; • contractual limitations on our ability to expand or change our direct-selling business model; • the sufficiency of our trademarks and other intellectual property; • product concentration; • our reliance upon, or the loss or departure of any member of, our senior management team; • restrictions imposed by covenants in the agreements governing our indebtedness; 3 • risks related to our convertible notes; • changes in, and uncertainties relating to, the application of transfer pricing, income tax, customs duties, value added taxes, and other tax laws, treaties, and regulations, or their interpretation; • our incorporation under the laws of the Cayman Islands; and • share price volatility related to, among other things, speculative trading and certain traders shorting our common shares. Additional factors and uncertainties that could cause actual results or outcomes to differ materially from our forward-looking statements are set forth in this Annual Report on Form 10-K, including in Part I, Item 1A, Risk Factors, and Part II, Item 7, Management’s Discussion and Analysis of Financial Condition and Results of Operations, and in our Consolidated Financial Statements and the related Notes. In addition, historical, current, and forward-looking sustainability-related statements may be based on standards for measuring progress that are still developing, internal controls and processes that continue to evolve, and assumptions that are subject to change in the future. Forward-looking statements in this Annual Report on Form 10-K speak only as of the date hereof. We do not undertake any obligation to update or release any revisions to any forward-looking statement or to report any events or circumstances after the date hereof or to reflect the occurrence of unanticipated events, except as required by law. The Company “We,” “our,” “us,” “Company,” “Herbalife,” and “Herbalife Nutrition” refer to Herbalife Nutrition Ltd., a Cayman Islands exempted company incorporated with limited liability, and its subsidiaries. Herbalife Nutrition Ltd. is a holding company, with substantially all of its assets consisting of the capital stock of its direct and indirectly-owned subsidiaries. 4 PART I Item 1. Business GENERAL Herbalife Nutrition is a global nutrition company that provides health and wellness products to consumers in 95 markets, which consists of countries and territories, through our direct-selling business model. Our products are primarily in the categories of weight management, sports nutrition, and targeted nutrition. We use a direct-selling business model to distribute and market our nutrition products to and through a global network of independent members, or Members. Members include consumers who purchase products for their own personal use and distributors who wish to resell products or build a sales organization. We believe that direct selling is ideally suited for our business because the distribution and sales of our products with personalized support, coaching, and education provide a supportive and understanding community of like-minded people who prioritize health and nutrition. In addition to the effectiveness of personalized selling through a direct-selling business model, we believe the primary drivers for our success throughout our 43-year operating history have been enhanced consumer awareness and demand for our products due to global trends such as the obesity epidemic, increasing interest in a fit and active lifestyle, living healthier, and the rise of entrepreneurship. PRODUCT SALES Our science-backed products help Members and their customers improve their overall health, enhance their wellness, and achieve their fitness and sport goals. As of December 31, 2022, we marketed and sold approximately 131 product types. Our products are often sold as part of a program and therefore our portfolio is comprised of a series of related products designed to simplify weight management, health and wellness, and overall nutrition for our Members and their customers. Our Formula 1 Nutritional Shake Mix, our best-selling product line, approximated 26% of our net sales for the year ended December 31, 2022. The following table summarizes our products by product category: Percentage of Net Sales 2022 2021 2020 Description Representative Products Weight Management 56.8% 58.1% 59.8% Meal replacement, protein Formula 1 Healthy Meal, shakes, drink mixes, weight Herbal Tea Concentrate, loss enhancers and healthy Protein Drink Mix, snacks Personalized Protein Powder, Total Control®, Formula 2 Multivitamin Complex, Prolessa™ Duo, and Protein Bars Targeted Nutrition 29.1% 28.2% 27.6% Functional beverages and Herbal Aloe Concentrate, dietary and nutritional Active Fiber Complex, supplements containing Niteworks®, and quality herbs, vitamins, Herbalifeline® minerals and other natural ingredients Energy, Sports, and 10.6% 9.5% 7.9% Products that support a Herbalife24® product line, Fitness healthy active lifestyle N-R-G Tea, and Liftoff® energy drink Outer Nutrition 1.6% 1.9% 2.0% Facial skin care, body care, Herbalife SKIN line and and hair care Herbal Aloe Bath and Body Care line Literature, Promotional, 1.9% 2.3% 2.7% Start-up kits, sales tools, Herbalife Member Packs and Other and educational materials and BizWorks 5 Product returns and buyback policies We offer a customer satisfaction guarantee in substantially all markets where our products are sold. If for any reason a customer or preferred member is not satisfied with an Herbalife Nutrition product, they may return it or any unused portion of the product within 30 days from the time of receipt for a full refund or credit toward the exchange of another Herbalife Nutrition product. In addition, in substantially all markets, we maintain a buyback program pursuant to which we will purchase back unsold products from a Member who decides to leave the business. Subject to certain terms and conditions that may vary by market, the buyback program generally permits a Member to return unopened products or sales materials in marketable condition purchased within the prior twelve- month period in exchange for a refund of the net price paid for the product and, in most markets, the cost of returning the products and materials to us. Together, product returns and buybacks were approximately 0.1% of net sales for each of the years ended December 31, 2022, 2021, and 2020. Product development Our products are focused on nutrition and seek to help consumers achieve their goals in the areas of weight management; targeted nutrition (including everyday wellness and healthy aging); energy, sports, and fitness; and outer nutrition. We believe our focus on nutrition and botanical science and the combination of our internal efforts with the scientific expertise of outside resources, including our ingredient suppliers, major universities, and our Nutrition Advisory Board, have resulted in product differentiation that has given our Members and consumers increased confidence in our products. We continue to invest in scientific and technical functions, including research and development associated with creating new or enhancing current product formulations and the advancement of personalized nutrition solutions; clinical studies of existing products or products in development; technical operations to improve current product formulations; quality assurance and quality control to establish the appropriate quality systems, controls, and standards; and rigorous ingredient and product testing to ensure compliance with regulatory requirements, as well as in the areas of regulatory and scientific affairs. Our personalized nutrition solutions include tools which aid in the development of optimal product packages specific to our customers’ individual nutritional needs, based on their expected wellness goals. Our product development strategy is twofold: (1) to increase the value of existing customers by investing in products that address customers’ health, wellness and nutrition considerations, fill perceived gaps in our portfolios, add flavors, increase convenience by developing products like snacks and bars, and expand afternoon and evening consumption with products like savory shakes or soups; and (2) to attract new customers by entering into new categories, offering more choices, increasing individualization, and expanding our current sports line. We have a keen focus on product innovation and aim to launch new products and variations on existing products on a regular basis. Once a particular market opportunity has been identified, our scientists, along with our operations, marketing, and sales teams, work closely with Member leadership to introduce new products and variations on existing products. Our Nutrition Advisory Board and Dieticians Advisory Board are comprised of leading experts around the world in the fields of nutrition and health who educate our Members on the principles of nutrition, physical activity, diet, and healthy lifestyle. We rely on the scientific contributions from members of our Nutrition Advisory Board and our in-house scientific team to continually upgrade existing products or introduce new products as new scientific studies become available and are accepted by regulatory authorities around the world. COMPETITION The nutrition industry is highly competitive. Nutrition products are sold through a number of distribution channels, including direct selling, online retailers, specialty retailers, and the discounted channels of food, drug and mass merchandise. Our competitors include companies such as Conagra Brands, Hain Celestial, and Post. Additionally, we compete for the recruitment of Members from other network marketing organizations, including those that market nutrition products and other entrepreneurial opportunities. Our direct-selling competitors include companies such as Nu Skin, Tupperware, and USANA. Our ability to remain competitive depends on many factors, including having relevant products that meet consumer needs, a rewarding compensation plan, enhanced education and tools, innovation in our products and services, competitive pricing, a strong reputation, and a financially viable company. We have differentiated ourselves from our competitors through our Members’ focus on the consultative sales process, which includes ongoing personal contact, coaching, behavior motivation, education, and the creation of supportive communities. For example, many Members have frequent contact with and provide support to their customers through a community-based approach to help them achieve nutrition goals. Some methods include Nutrition Clubs, Weight Loss Challenges, Wellness Evaluations, and Fit Camps. 6 For additional information regarding competition, see Part I, Item 1A, Risk Factors, of this Annual Report on Form 10-K. OUR NETWORK MARKETING PROGRAM General Our products are sold and distributed through a global direct selling business model which individuals may join to become a Member of our network marketing program. We believe that the one-on-one personalized service inherent in the direct-selling business model is ideally suited to marketing and selling our nutrition products. Sales of nutrition products are reinforced by the ongoing personal contact, coaching, behavior motivation, education, and the creation of supportive communities. This frequent, personal contact can enhance consumers’ nutritional and health education as well as motivate healthy behavioral changes in consumers to begin and maintain an active lifestyle through wellness and weight management programs. In addition, our Members consume our products themselves, and, therefore, can provide first-hand testimonials of the use and effectiveness of our products and programs to their customers. The personalized experience of our Members has served as a very powerful sales tool for our products. People become Herbalife Nutrition Members for a number of reasons. Many first start out as consumers of our products who want to lose weight or improve their nutrition, and are customers of our Members. Some later join Herbalife Nutrition and become Members themselves, which makes them eligible to purchase products directly from us, simply to receive a discounted price on products for them and their families. Some Members are interested in the entrepreneurial opportunity to earn compensation based on their own skills and hard work and join Herbalife Nutrition to earn part-time or full-time income. Our objective is sustainable growth in the sales of our products to our Members and their customers by increasing the productivity, retention and recruitment of our Member base through the structure of our network marketing program. Segmentation In many of our markets, including certain of our largest markets such as the United States, Mexico, and India, we have segmented our Member base into two categories: “preferred members” – who are consumers who wish to purchase product for their own household use, and “distributors” – who are Members who also wish to resell products or build a sales organization. This Member segmentation provides a clear differentiation between those interested in retailing our products or building a sales organization, and those simply consuming our products as discount customers. This distinction allows us to more effectively communicate and market to each group, and provides us with better information regarding our Members within the context of their stated intent and goals. As of December 31, 2022, we had approximately 6.2 million Members, including 2.9 million preferred members and 2.0 million distributors in the markets where we have established these two categories and 0.3 million sales representatives and independent service providers in China. The number of preferred members and distributors may change as a result of segmentation and/or conversion, and do not necessarily represent a change in the total number of Members. Any future change in the number of preferred members or distributors is not necessarily indicative of our future expected financial performance. Our Members We believe our Members are the most important differentiator as we go to market with our nutrition products, because of the one- on-one direct contact they have with their customers, along with the education, training and community support services that we believe help improve the nutrition habits of consumers. We work closely with our entrepreneurial Members to improve the sustainability of their businesses and to reach consumers. We require our Members to fairly and honestly market both our products and the Herbalife Nutrition business opportunity. Our relationship with our Members is key to our continued success as they allow us direct access to the voice of consumers. Many of our entrepreneurial Members identify and test new marketing efforts and programs developed by other Members and disseminate successful techniques to their sales organizations. For example, Members in Mexico developed businesses that became known as “Nutrition Clubs,” marketing techniques that improve the productivity and efficiency of our Members as well as the affordability of our weight loss products for their customers. Rather than buying several retail products, these businesses allow consumers to purchase and consume our products each day (a Member marketing technique we refer to as “daily consumption”), while continuing to benefit from the support and interaction with the Member as well as socializing with other customers in a designated location. Other programs to drive daily consumption, whether for weight management or for improved physical fitness, include Member- conducted weight loss contests, or Weight Loss Challenges, Member-led fitness programs, or Fit Camps, and Member-led Wellness Evaluations. We refer to successful Member marketing techniques that we disseminate throughout our Member network, such as Nutrition Clubs, Weight Loss Challenges, and Fit Camps, as Daily Methods of Operations, or DMOs. 7 We believe that personal and professional development is key to our Members’ success and, therefore, we and our sales leader Members – those that achieve certain levels within our Marketing Plan – have meetings and events to support this important objective. We and our Member leadership, which is comprised of sales leaders, conduct in-person and virtual training sessions on local, regional, and global levels attended by thousands of Members to provide updates on product education, sales and marketing training, and instruction on available tools. These events are opportunities to showcase and disseminate our Members’ evolving best marketing practices and DMOs from around the world and to introduce new or upgraded products. A variety of training and development tools are also available through online and mobile platforms. On July 18, 2002, we entered into an agreement with our Members that provides that we will continue to distribute Herbalife Nutrition products exclusively to and through our Members and that, other than changes required by applicable law or necessary in our reasonable business judgment to account for specific local market or currency conditions to achieve a reasonable profit on operations, we will not make any material changes to certain aspects of our Marketing Plan that are adverse to our Members without the support of our Member leadership. Specifically, any such changes would require the approval of at least 51% of our Members then at the level of President’s Team earning at the production bonus level of 6% who vote, provided that at least 50% of those Members entitled to vote do in fact vote. We initiate these types of changes based on the assessment of what will be best for us and our Members and then submit such changes for the requisite vote. We believe that this agreement has strengthened our relationship with our existing Members, improved our ability to recruit new Members and generally increased the long-term stability of our business. Member Compensation and Sales Leader Retention and Requalification In addition to benefiting from discounted prices, Members interested in the entrepreneurial opportunity may earn profit from several sources. First, Members may earn profits by purchasing our products at wholesale prices, discounted depending on the Member’s level within our Marketing Plan, and reselling those products at prices they establish for themselves to generate retail profit. Second, Members who sponsor other Members and establish, maintain, coach, and train their own sales organizations may earn additional income based on the sales of their organization, which may include royalty overrides, production bonuses, and other cash bonuses. Members earning such compensation have generally attained the level of sales leader as described below. There are also many Members, which include distributors, who have not sponsored another Member. Members who have not sponsored another Member are generally considered discount buyers or small retailers. While a number of these Members have also attained the level of sales leader, they do not receive additional income as do Members who have sponsored other Members. We assign point values, known as Volume Points, to each of our products to determine a Member’s level within the Marketing Plan. See Part II, Item 7, Management’s Discussion and Analysis of Financial Condition and Operating Results, of this Annual Report on Form 10-K for a further description of Volume Points. Typically, a Member accumulates Volume Points for a given sale at the time the Member pays for the product. However, since May 2017, a Member does not receive Volume Points for a transaction in the United States until that product is sold to a customer at a profit and it is documented in compliance with the consent order, or Consent Order, we entered into with the Federal Trade Commission, or the FTC, in 2016. The Member’s level within the Marketing Plan is used to determine the discount applied to their purchase of our products and whether they have qualified to become a sales leader. To become a sales leader, or qualify for a higher level within our Marketing Plan, Members must achieve specified Volume Point thresholds of product sales or earn certain amounts of royalty overrides during specified time periods and generally must re-qualify once each year. Qualification criteria vary somewhat by market. We have initial qualification methods of up to 12 months to encourage a more gradual qualification. We believe a gradual qualification approach is important to the success and retention of new sales leaders and benefits the business in the long term as it allows new Members to obtain product and customer experience as well as additional training and education on Herbalife Nutrition products, daily consumption based DMOs, and the business opportunity prior to becoming a sales leader. The basis for calculating Marketing Plan payouts varies depending on product and market: for 2022, we utilized on a weighted- average basis approximately 90% of suggested retail price, to which we applied discounts of up to 50% for distributor allowances and payout rates of up to 15% for royalty overrides, up to 7% for production bonuses, and approximately 1% for a cash bonus known as the Mark Hughes bonus. We believe that the opportunity for Members to earn royalty overrides and production bonuses contributes significantly to our ability to retain our most active and productive Members. Our Marketing Plan generally requires each sales leader to re-qualify for such status each year, prior to February, in order to maintain their 50% discount on products and be eligible to receive additional income. In February of each year, we demote from the rank of sales leader those Members who did not satisfy the re-qualification requirements during the preceding twelve months. The re- qualification requirement does not apply to new sales leaders (i.e. those who became sales leaders subsequent to the January re- qualification of the prior year). 8 As of December 31, 2022, prior to our February re-qualification process, approximately 772,000 of our Members have attained the level of sales leader, of which approximately 734,000 have attained this level in the 94 markets where we use our Marketing Plan and 38,000 independent service providers operating in our China business. See Business in China below for a description of our business in China. The table below reflects sales leader retention rates by year and by region: Sales Leader Retention Rate 2023 2022 2021 North America 69.7% 58.8% 70.8% Latin America (1) 71.6% 69.3% 67.0% EMEA 64.6% 77.1% 72.7% Asia Pacific 66.6% 66.5% 63.5% Total sales leaders 67.6% 68.9% 67.9% (1) The Company combined the Mexico and South and Central America regions into the Latin America region in 2022. Historical information has been reclassified to conform with the current period geographic presentation. For the latest twelve-month re-qualification period ending January 2023, approximately 67.6% of our sales leaders, excluding China, re-qualified, versus 68.9% for the twelve-month period ended January 2022. The Company throughout its history has adjusted the re-qualification criteria from time to time in response to evolving business objectives and market conditions, and the above results include the effects of all such changes. For example, in recent years certain markets have allowed members to utilize a lower re- qualification volume threshold and the Company has continued to expand this lower re-qualification method to additional markets. Separately, with revised business requirements in place following the Consent Order, as described in Network Marketing Program below, we utilize a re-qualification equalization factor for U.S. Members to better align their re-qualification thresholds with Members in other markets, and retention results for each of the years presented include the effect of the equalization factor. We believe this factor preserves retention rate comparability across markets. Also, for each of the years presented, the retention results exclude certain markets for which, due to local operating conditions, sales leaders were not required to requalify. We believe sales leader retention rates are the result of efforts we have made to try and improve the sustainability of sales leaders’ businesses, such as encouraging Members to obtain experience retailing Herbalife Nutrition products before becoming a sales leader and providing them with advanced technology tools, as well as reflecting market conditions. As our business operations evolve, including the segmentation of our Member base in certain markets and changes in sales leader re-qualification thresholds for other markets, management continues to evaluate the importance of sales leader retention rate information. The table below reflects the number of sales leaders as of the end of February of the year indicated (subsequent to the annual re- qualification process) and by region: Number of Sales Leaders 2022 2021 2020 North America 80,278 95,402 71,202 Latin America (1) 125,726 131,359 134,401 EMEA 183,056 158,153 130,438 Asia Pacific 201,137 173,582 158,815 Total sales leaders 590,197 558,496 494,856 China 33,486 68,301 70,701 Worldwide total sales leaders 623,683 626,797 565,557 (1) The Company combined the Mexico and South and Central America regions into the Latin America region in 2022. Historical information has been reclassified to conform with the current period geographic presentation. The number of sales leaders as of December 31 will exceed the number immediately subsequent to the preceding re-qualification period because sales leaders qualify throughout the year but sales leaders who do not re-qualify are removed from the rank of sales leader the following February. 9 Business in China Our business model in China includes unique features as compared to our traditional business model in order to ensure compliance with Chinese regulations. As a result, our business model in China differs from that used in other markets. Members in China are categorized differently than those in other markets. In China, we sell our products to and through independent service providers and sales representatives to customers and preferred customers, as well as through Company-operated retail platforms when necessary. In China, while multi-level marketing is not permitted, direct selling is permitted. Chinese citizens who apply and become Members are referred to as sales representatives. These sales representatives are permitted to sell away from fixed retail locations in the provinces where we have direct selling licenses, including in the provinces of Jiangsu, Guangdong, Shandong, Zhejiang, Guizhou, Beijing, Fujian, Sichuan, Hubei, Shanxi, Shanghai, Jiangxi, Liaoning, Jilin, Henan, Chongqing, Hebei, Shaanxi, Tianjin, Heilongjiang, Hunan, Guangxi, Hainan, Anhui, Yunnan, Gansu, Ningxia, and Inner Mongolia. In Xinjiang province, where we do not have a direct selling license, we have a Company-operated retail store that can directly serve customers and preferred customers. With online orderings throughout China, there has been a declining demand in Company-operated retail stores. Sales representatives receive scaled rebates based on the volume of products they purchase. Sales representatives who reach certain volume thresholds and meet certain performance criteria are eligible to apply to provide marketing, sales and support services. Once their application is accepted, they are referred to as independent service providers. Independent service providers are independent business entities that are eligible to receive compensation from Herbalife Nutrition for the marketing, sales and support services they provide so long as they satisfy certain conditions, including procuring the requisite business licenses, having a physical business location, and complying with all applicable Chinese laws and Herbalife Nutrition rules. In China, our independent service providers are compensated for marketing, sales support, and other services, instead of the Member allowances and royalty overrides utilized in our global Marketing Plan. The service hours and related fees eligible to be earned by the independent service providers are based on a number of factors, including the sales generated through them and through others to whom they may provide marketing, sales support and other services, the quality of their service, and other factors. Total compensation available to our independent service providers in China can generally be comparable to the total compensation available to other sales leaders globally. The Company does this by performing an analysis in our worldwide system to estimate the potential compensation available to the service providers, which can generally be comparable to that of sales leaders in other countries. After adjusting such amounts for other factors and dividing by each service provider’s hourly rate, we then notify each independent service provider the maximum hours of work for which they are eligible to be compensated in the given month. In order for a service provider to be paid, the Company requires each service provider to invoice the Company for their services. RESOURCES We seek to provide the highest quality products to our Members and their customers through our “seed to feed” strategy, which includes significant investments in obtaining quality ingredients from traceable sources, qualified by scientific personnel through product testing, and increasing the amount of self-manufacturing of our top products. Ingredients Our seed to feed strategy is rooted in using quality ingredients from traceable sources. Our procurement process for many of our botanical products now stretches back to the farms and includes self-processing of teas and herbal ingredients into finished raw materials at our own facilities. Our Changsha, China facility exclusively provides high quality tea and herbal raw materials to our manufacturing facilities as well as our third-party contract manufacturers around the world. We also source ingredients that we do not self-process from companies that are well-established, reputable suppliers in their respective field. These suppliers typically utilize similar quality processes, equipment, expertise, and having traceability as we do with our own modern quality processes. As part of our program to ensure the procurement of high-quality ingredients, we also test our incoming raw materials for compliance to potency, identity, and adherence to strict specifications. 10 Manufacturing The next key component of our seed to feed strategy involves the high-quality manufacturing of these ingredients into finished products, which are produced at both third-party manufacturers and our own manufacturing facilities. As part of our long-term strategy, we seek to expand and increase our self-manufacturing capabilities. Our manufacturing facilities, known as Herbalife Innovation and Manufacturing Facilities, or HIMs, include HIM Lake Forest, HIM Winston-Salem, HIM Suzhou, and HIM Nanjing. HIM Winston- Salem is currently our largest manufacturing facility at approximately 800,000 square feet. Together, our HIM manufacturing facilities produce approximately 51% of our inner nutrition products sold worldwide. Self-manufacturing also enables us greater control to reduce negative environmental impacts of our operations and supply chain. As described in the Sustainability section below, we are focused on developing science-based green-house gas emission reduction targets for our manufacturing facilities as part of our sustainability goals. We are also focused on reducing single-use plastics throughout our global distribution network and incorporating more sustainable content, such as post-consumer recycled resin, into our packaging. Our finished products are analyzed for label claims and tested for microbiological purity, thereby verifying that our products comply with food safety standards, meet label claims and have met other quality standards. For self-manufactured products, we conduct all of our testing in-house at our fully-equipped, modern quality control laboratories in the U.S. and China. We have two quality control laboratories in Southern California and Changsha, China (including a Center of Excellence in both locations). In addition, we also have a Center of Excellence laboratory in Bangalore, India, and a quality control laboratory in Winston-Salem, North Carolina, Suzhou, China, and Nanjing, China. All HIM quality control labs contain modern analytical equipment and are backed by the expertise in testing and methods development of our scientists. In our U.S. HIM facilities, which manufacture products for the U.S. and most of our international markets, we operate and adhere to the regulations established by the U.S. Food and Drug Administration, or FDA, and strict Current Good Manufacturing Practice regulations, or CGMPs, for food, acidified foods, and dietary supplements. We also work closely with our third-party manufacturers to ensure high quality products are produced and tested through a vigorous quality control process at approved contract manufacturer labs or third-party labs. For these products manufactured at other facilities, we combine four elements to ensure quality products: (1) the same selectivity and assurance in ingredients as noted above; (2) use of reputable, CGMP-compliant, quality- and sustainability-minded manufacturing partners; (3) supplier qualification through annual audit programs; and (4) significant product quality testing. During 2022, we purchased approximately 15% of our products from our top three third-party manufacturers. Infrastructure and Technology Our direct-selling business model enables us to grow our business with moderate investment in infrastructure and fixed costs. We incur no direct incremental cost to add a new Member in our existing markets, and our Member compensation varies directly with product sales. In addition, our Members also bear a portion of our consumer marketing expenses, and our sales leaders sponsor and coordinate Member recruiting and most meeting and training initiatives. Additionally, our infrastructure features scalable production and distribution of our products as a result of having our own manufacturing facilities and numerous third-party manufacturing relationships, as well as our global footprint of in-house and third-party distribution centers. An important part of our seed to feed strategy is having an efficient infrastructure to deliver products to our Members and their customers. As the shift in consumption patterns continues to reflect an increasing daily consumption focus, one focus of this strategy is to provide more product access points closer to our Members and their customers. We have both Company-operated and outsourced distribution points ranging from our “hub” distribution centers in Los Angeles, Memphis, and Venray, Netherlands, to mid-size distribution centers in major countries, to small pickup locations spread throughout the world. We also expect to continue to improve our distribution channels relating to home delivery as we expect to see continued increased demands for our products being shipped to our Members in certain of our larger markets. In addition to these distribution points, we partner with certain retail locations to provide Member pickup points in areas which are not well serviced by our distribution points. We have also identified a number of methods and approaches that better support Members by providing access points closer to where they do business and by improving product delivery efficiency through our distribution channels. Specific methods vary by markets and consider local Member needs and available resources. In aggregate, we have over 1,500 distribution points and partner retail locations around the world. In addition to our distribution points, we contract third party-run drop-off locations where we can ship to and Members can pick up ordered products. 11 We leverage our technology infrastructure in order to maintain, protect, and enhance existing systems and develop new systems to keep pace with continuing changes in technology, evolving industry and regulatory standards, emerging data security risks, and changing user patterns and preferences. We also continue to invest in our manufacturing and operational infrastructure to accelerate new products to market and accommodate planned business growth. We invest in business intelligence tools to enable better analysis of our business and to identify opportunities for growth. We will continue to build on these platforms to take advantage of the rapid development of technology around the globe to support a more robust Member and customer experience. In addition, we leverage an Oracle business suite platform to support our business operations, improve productivity and support our strategic initiatives. Our investment in technology infrastructure helps support our capacity to grow. In 2021, we also initiated a global transformation program to optimize global processes for future growth, or the Transformation Program. The Transformation Program involves the investment in certain new technologies and the realignment of infrastructure and the locations of certain functions to better support distributors and customers. The Transformation Program is still ongoing and expected to be completed in 2024 as described further in Part II, Item 7, Management’s Discussion and Analysis of Financial Condition and Operating Results, of this Annual Report on Form 10-K and Note 14, Transformation Program, to the Consolidated Financial Statements included in Part IV, Item 15, Exhibits, Financial Statement Schedules, of this Annual Report on Form 10-K. In addition, many Members rely on the use of technology to support their goals and businesses. As part of our continued investment in technology to further support our Members and drive long-term growth, we have enhanced our product access and distribution network to support higher volumes of online or mobile orders, allowing Members and their customers to select home or business delivery options. We have also implemented information technology systems to support Members and their increasing demand to be more connected to Herbalife Nutrition, their business, and their consumers with tools such as HN MyClub, Engage, HNconnect, BizWorks, MyHerbalife, GoHerbalife, and Herbalife.com. Additionally, we continue to support a growing suite of point-of-sale tools to assist our Members with ordering, tracking, and customer relationship management. These tools allow our Members to manage their business and communicate with their customers more efficiently and effectively. During 2022, we also commenced a Digital Technology Program to develop a new enhanced platform to provide enhanced digital capabilities and experiences to our Members. This is a multi-year program and we expect our capital expenditures to increase in 2023 and future years as result of our investments in this Digital Technology Program as described further in Part II, Item 7, Management’s Discussion and Analysis of Financial Condition and Operating Results, of this Annual Report on Form 10-K. Intellectual Property and Branding Marketing foods and supplement products on the basis of sound science means using ingredients in the composition and quantity as demonstrated to be effective in the relevant scientific literature. Use of these ingredients for their well-established purposes is by definition not novel, and for that reason, most food uses of these ingredients are not subject to patent protection. Notwithstanding the absence of patent protection, we do own proprietary formulations for substantially all of our weight management products and dietary and nutritional supplements. We take care in protecting the intellectual property rights of our proprietary formulas by restricting access to our formulas within the Company to those persons or departments that require access to them to perform their functions, and by requiring our finished goods suppliers and consultants to execute supply and non-disclosure agreements that contractually protect our intellectual property rights. Disclosure of these formulas, in redacted form, is also necessary to obtain product registrations in many countries. We also make efforts to protect certain unique formulations under patent law. We strive to protect all new product developments as the confidential trade secrets of the Company. We use the umbrella trademarks Herbalife®, Herbalife Nutrition®, and the Tri-Leaf design worldwide, and protect several other trademarks and trade names related to our products and operations, such as Niteworks® and Liftoff®. Our trademark registrations are issued through the United States Patent and Trademark Office, or USPTO, and comparable agencies in the foreign countries. We believe our trademarks and trade names contribute to our brand awareness. To increase our brand awareness, we and our Members use a variety of tools and marketing channels. These can include anything from traditional media to social media and alliances with partners who can promote our goal of better living through nutrition. Herbalife Nutrition sponsorships of and partnerships with featured athletes, teams, and events promote brand awareness and the use of Herbalife Nutrition products. We continue to build brand awareness with a goal towards becoming the most trusted brand in nutrition. We also work to leverage the power of our Member base as a marketing and brand-building tool. We maintain a brand style guide and brand asset library so that our Members have access to the Herbalife Nutrition brand logo and marketing materials for use in their marketing efforts. 12 Sustainability Our goals and objectives to nourish people and communities and to improve the planet are part of both our day-to-day activities and our long-term growth strategy. As a signatory of the United Nations Global Compact, or UNGC, we have aligned our sustainability initiatives outlined by the United Nations’ Sustainable Development Goals. Our current sustainability initiatives focus on issues including climate and emissions, packaging, and operational waste. For example, we have implemented projects that have reduced overall packaging materials and incorporated usage of recycled materials in the packaging of our flagship product, Formula 1 Healthy Meal Nutritional Shake in North America, Mexico, and in certain markets where permitted by regulations. We are seeking opportunities across operations to reduce waste-prone materials such as single-use plastics. More information on these efforts is provided in the Manufacturing section above. For information relating to our culture, diversity, equity, and inclusion, please see the Human Capital section below. REGULATION General In our United States and foreign markets, we are affected by extensive laws, governmental regulations, administrative determinations and guidance, court decisions and similar constraints that regulate the conduct of our business. Such laws, regulations and other constraints exist at the federal, state or local levels in the United States and at all levels of government in foreign jurisdictions, and include regulations pertaining to: (1) the formulation, manufacturing, packaging, labeling, distribution, importation, sale, and storage of our products; (2) product claims and advertising, including direct claims and advertising by us, as well as claims and advertising by Members, for which we may be held responsible; (3) our network marketing program; (4) transfer pricing and similar regulations that affect the level of U.S. and foreign taxable income and customs duties; (5) taxation of our Members (which in some instances may impose an obligation on us to collect the taxes and maintain appropriate records); (6) our international operations, such as import/export, currency exchange, repatriation and anti-bribery regulations; (7) antitrust issues; and (8) privacy and data protection. See Part I, Item 1A, Risk Factors, of this Annual Report on Form 10-K for additional information. Products In the United States, the formulation, manufacturing, packaging, holding, labeling, promotion, advertising, distribution, and sale of our products are subject to regulation by various federal governmental agencies, including: (1) the FDA; (2) the FTC; (3) the Consumer Product Safety Commission, or CPSC; (4) the United States Department of Agriculture, or USDA; (5) the Environmental Protection Agency, or EPA; (6) the United States Postal Service; (7) United States Customs and Border Protection; and (8) the Drug Enforcement Administration. Our activities also are regulated by various agencies of the states, localities and foreign countries in which our products are manufactured, distributed, or sold. The FDA, in particular, regulates the formulation, manufacture, and labeling of over-the-counter, or OTC, drugs, conventional foods, dietary supplements, and cosmetics such as those distributed by us. The majority of the products marketed by us in the United States are classified as conventional foods or dietary supplements under the Federal Food, Drug and Cosmetic Act, or FFDCA. Internationally, the majority of products marketed by us are classified as foods, health supplements, or food supplements. FDA regulations govern the preparation, packaging, labeling, holding, and distribution of foods, OTC drugs, cosmetics, and dietary supplements. Among other obligations, they require us and our contract manufacturers to meet relevant CGMP regulations for the preparation, packaging, holding, and distribution of OTC drugs and dietary supplements. The FDA also requires identity testing of all incoming dietary ingredients used in dietary supplements, unless a company successfully petitions for an exemption from this testing requirement in accordance with the regulations. The CGMPs are designed to ensure that OTC drugs and dietary supplements are not adulterated with contaminants or impurities, and are labeled to accurately reflect the active ingredients and other ingredients in the products. We have implemented a comprehensive quality assurance program that is designed to maintain compliance with the CGMPs for products manufactured by us or on our behalf for distribution in the United States. As part of this program, we have regularly implemented enhancements, modifications and improvements to our manufacturing and corporate quality processes. We believe that we and our contract manufacturers are compliant with the FDA’s CGMPs and other applicable manufacturing regulations in the United States. The U.S. Dietary Supplement Health and Education Act of 1994, or DSHEA, revised the provisions of FFDCA concerning the composition and labeling of dietary supplements. Under DSHEA, dietary supplement labeling may display structure/function claims that the manufacturer can substantiate, which are claims that the products affect the structure or function of the body, without prior FDA approval, but with notification to the FDA. They may not bear any claim that they can prevent, treat, cure, mitigate or diagnose disease (a drug claim). Apart from DSHEA, the agency permits companies to use FDA-approved full and qualified health claims for food and supplement products containing specific ingredients that meet stated requirements. 13 U.S. law also requires that all serious adverse events occurring within the United States involving dietary supplements or OTC drugs be reported to the FDA. We believe that we are in compliance with this law having implemented a worldwide procedure governing adverse event identification, investigation and reporting. As a result of reported adverse events, we may from time to time elect, or be required, to remove a product from a market, either temporarily or permanently. Some of the products marketed by us are considered conventional foods and are currently labeled as such. Within the United States, this category of products is subject to the federal Nutrition, Labeling and Education Act, or NLEA, and regulations promulgated under the NLEA. The NLEA regulates health claims, ingredient labeling and nutrient content claims characterizing the level of a nutrient in the product. The ingredients in conventional foods must either be generally recognized as safe by experts for the purposes to which they are put in foods, or be approved as food additives under FDA regulations. The federal Food Safety Modernization Act, or FSMA, is also applicable to some of our business. We follow a food safety plan and have implemented preventive measures required by the FSMA. Foreign suppliers of our raw materials are also subject to FSMA requirements, and we have implemented a verification program to comply with the FSMA. Dietary supplements manufactured in accordance with CGMPs and foods manufactured in accordance with the low acid food regulations are exempt. In foreign markets, prior to commencing operations and prior to making or permitting sales of our products in the market, we may be required to obtain an approval, license or certification from the relevant country’s ministry of health or comparable agency. Prior to entering a new market in which a formal approval, license or certificate is required, we work with local authorities in order to obtain the requisite approvals. The approval process generally requires us to present each product and product ingredient to appropriate regulators and, in some instances, arrange for testing of products by local technicians for ingredient analysis. The approvals may be conditioned on reformulation of our products, or may be unavailable with respect to some products or some ingredients. The FTC, which exercises jurisdiction over the advertising of all of our products in the United States, has in the past several years instituted enforcement actions against several dietary supplement and food companies and against manufacturers of weight loss products generally for false and misleading advertising of some of their products. In addition, the FTC has increased its scrutiny of the use of testimonials, which we also utilize, as well as the role of expert endorsers and product clinical studies. We cannot be sure that the FTC, or comparable foreign agencies, will not question our advertising or other operations in the future. In Europe, where an EU Health Claim regulation is in effect, the European Food Safety Authority, or EFSA, issued opinions following its review of a number of proposed claims documents. ESFA’s opinions, which have been accepted by the European Commission, have limited the use of certain nutrition-specific claims made for foods and food supplements. Accordingly, we revised affected product labels to ensure regulatory compliance. We are subject to a permanent injunction issued in October 1986 pursuant to the settlement of an action instituted by the California Attorney General, the State Health Director and the Santa Cruz County District Attorney. We consented to the entry of this injunction without in any way admitting the allegations of the complaint. The injunction prevents us from making specified claims in advertising of our products, but does not prevent us from continuing to make specified claims concerning our products, provided that we have a reasonable basis for making the claims. The injunction also prohibits certain recruiting-related investments from Members and mandates that payments to Members be premised on retail value (as defined); the injunction provides that we may establish a system to verify or document such compliance. Network Marketing Program Our network marketing program is subject to a number of federal and state regulations administered by the FTC and various state regulators as well as regulations in foreign markets administered by foreign regulators. Regulations applicable to network marketing organizations generally are directed at ensuring that product sales ultimately are made to consumers and that advancement within the organization is based on sales of the organization’s products rather than investments in the organization or other non-retail sales related criteria. When required by law, we obtain regulatory approval of our network marketing program or, when this approval is not required, the favorable opinion of local counsel as to regulatory compliance. 14 On July 15, 2016, we reached a settlement with the FTC and entered into a proposed Stipulation to Entry of Order for Permanent Injunction and Monetary Judgment, or the Consent Order, which resolved the FTC’s multi-year investigation of us. The Consent Order became effective on July 25, 2016, or the Effective Date, upon final approval by the U.S. District Court for the Central District of California. Pursuant to the Consent Order, we implemented and continue to enhance certain procedures in the U.S. and agreed to be subject to certain audits by an independent compliance auditor (Affiliated Monitors, Inc.) for a period of seven years. Among other requirements, the Consent Order requires us to categorize all existing and future Members in the U.S. as either “preferred members” – who are simply consumers who only wish to purchase product for their own household use — or “distributors” – who are Members who wish to resell some products or build a sales organization. We also agreed to compensate distributors on U.S. eligible sales within their downline organizations, which include purchases by preferred members, purchases by a distributor for his or her personal consumption within allowable limits and sales of product by a distributor to his or her customers. The Consent Order also requires distributors to meet certain conditions before opening Nutrition Clubs and/or entering into leases for their Herbalife Nutrition business in the United States. The Consent Order also prohibits us from making expressly or by implication, any misrepresentation regarding certain lifestyles or amount or level of income, including full-time or part-time income that a participant can reasonably expect to earn in our network marketing program. The Consent Order also prohibits us and other persons who act in active concert with us from misrepresenting that participation in the network marketing program will result in a lavish lifestyle and from using images or descriptions to represent or imply that participation in the program is likely to result in a lavish lifestyle. In addition, the Consent Order prohibits specified misrepresentations in connection with marketing the program, including misrepresentations regarding any fact material to participation such as the cost to participate or the amount of income likely to be earned. The Consent Order also requires us to clearly and conspicuously disclose information related to our refund and buyback policy on certain company materials and websites. The terms of the Consent Order do not change our going to market through direct selling by independent distributors, and compensating those distributors based upon the product they and their sales organization sell. We have implemented new and enhanced procedures required by the terms of the Consent Order and will continue to do so. We continue to monitor the impact of the Consent Order and our board of directors originally established the Implementation Oversight Committee in connection with monitoring compliance with the Consent Order, and more recently, our Audit Committee assumed oversight of continued compliance with the Consent Order. While we currently do not expect the Consent Order to have a long-term and material adverse impact on our business and our Member base, our business and our Member base, particularly in the U.S., have been in the past, and may in the future, be negatively impacted as we and they adjust to the changes. However, the terms of the Consent Order and the ongoing costs of compliance may adversely affect our business operations, our results of operations, and our financial condition. See Part I, Item 1A, Risk Factors, of this Annual Report on Form 10-K for a discussion of risks related to the settlement with the FTC. On January 4, 2018, the FTC released its nonbinding Business Guidance Concerning Multi-Level Marketing, or MLM Guidance. The MLM Guidance explains, among other things, lawful and unlawful compensation structures, the treatment of personal consumption by participants in determining if an MLM’s compensation structure is unfair or deceptive, and how an MLM should approach representations to current and prospective participants. We believe our current business practices, which include new and enhanced procedures implemented in connection with the Consent Order, are in compliance with the MLM Guidance. Additionally, the FTC has promulgated nonbinding Guides Concerning the Use of Endorsements and Testimonials in Advertising, or Guides, which explain how the FTC interprets Section 5 of the FTC Act’s prohibition on unfair or deceptive acts or practices. Consequently, the FTC could bring a Section 5 enforcement action based on practices that are inconsistent with the Guides. Under the Guides, advertisements that feature a consumer and convey his or her atypical experience with a product or service are required to clearly disclose the typical results that consumers can generally expect. The revised Guides also require advertisers to disclose connections between the advertiser and any endorsers that consumers might not expect, known as “material connections.” We have adapted our practices and rules regarding the practices of our Members to comply with the Guides and to comply with the Consent Order. We also are subject to the risk of private party challenges to the legality of our network marketing program both in the United States and internationally. For example, in Webster v. Omnitrition International, Inc., 79 F.3d 776 (9th Cir. 1996), the network marketing program of Omnitrition International, Inc., or Omnitrition, was challenged in a class action by Omnitrition distributors who alleged that it was operating an illegal “pyramid scheme” in violation of federal and state laws. We believe that our network marketing program satisfies federal and other applicable state statutes and case law. In some countries, regulations applicable to the activities of our Members also may affect our business because in some countries we are, or regulators may assert that we are, responsible for our Members’ conduct. In these countries, regulators may request or require that we take steps to ensure that our Members comply with local regulations. The types of regulated conduct include: (1) representations concerning our products; (2) income representations made by us and/or Members; (3) public media advertisements, which in foreign markets may require prior approval by regulators; (4) sales of products in markets in which the products have not been approved, licensed or certified for sale; and (5) classification by government agencies of our Members as employees of the Company. 15 In some markets, it is possible that improper product claims by Members could result in our products being reviewed by regulatory authorities and, as a result, being classified or placed into another category as to which stricter regulations are applicable. In addition, we might be required to make labeling changes. We also are subject to regulations in various foreign markets pertaining to social security assessments and employment and severance pay requirements. As an example, in some markets, we are substantially restricted in the amount and types of rules and termination criteria that we can impose on Members without having to pay social security assessments on behalf of the Members and without incurring severance obligations to terminated Members. In some countries, we may be subject to these obligations in any event. It is an ongoing part of our business to monitor and respond to regulatory and legal developments, including those that may affect our network marketing program. However, the regulatory requirements concerning network marketing programs do not include bright line rules and are inherently fact-based. An adverse judicial or regulatory determination with respect to our network marketing program could have a material adverse effect on our business, financial condition, and operating results and may also result in negative publicity, requirements to modify our network marketing program, or a negative impact on Member morale. In addition, adverse rulings by courts in any proceedings challenging the legality of network marketing systems, even in those not involving us directly, could have a material adverse effect on our operations. Although questions regarding the legality of our network marketing program have come up in the past and may come up from time to time in the future, we believe, based in part upon guidance to the general public from the FTC, that our network marketing program is compliant with applicable law. Income Tax, Transfer Pricing, and Other Taxes In many countries, including the United States, we are subject to income tax, transfer pricing and other tax regulations designed to ensure that appropriate levels of income are reported as earned by our U.S. and local entities and are taxed accordingly. In addition, our operations are subject to regulations designed to ensure that appropriate levels of customs duties are assessed on the importation of our products. Although we believe that we are in substantial compliance with all applicable tax rules, regulations, and restrictions, we are subject to the risk that governmental authorities could assert that additional taxes are owed based on findings of their audit. For example, we are currently subject to pending or proposed audits that are at various levels of review, assessment or appeal in a number of jurisdictions involving transfer pricing issues, income taxes, duties, value added taxes, withholding taxes and related interest and penalties in material amounts. In some circumstances, additional taxes, interest and penalties have been assessed, and we will be required to appeal or litigate to reverse the assessments. We have taken advice from our tax advisors and believe that there are substantial defenses to the allegations that additional taxes are owed, and we are vigorously defending against the imposition of additional proposed taxes. The ultimate resolution of these matters may take several years, and the outcome is uncertain. In the event that the audits or assessments are concluded adversely, we may or may not be able to offset or mitigate the consolidated effect of foreign income tax assessments through the use of U.S. foreign tax credits. The laws and regulations governing U.S. foreign tax credits are complex and subject to periodic legislative amendment, and there are restrictions on the utilization of U.S. foreign tax credits. Therefore, we cannot be sure that we would in fact be able to take advantage of any foreign tax credits in the future. Compliance Procedures As indicated above, Herbalife Nutrition, our products and our network marketing program are subject, both directly and indirectly through Members’ conduct, to numerous federal, state and local regulations, in the United States and foreign markets. In 1985, we began to institute formal compliance measures by developing a system to identify specific complaints against Members and to remedy any violations of Herbalife Nutrition’s rules by Members through appropriate sanctions, including warnings, fines, suspensions and, when necessary, terminations. We prohibit Members from making therapeutic claims for our products or misrepresentations regarding participating in our network marketing program, including in our manuals, seminars, and other training programs and materials. Our general policy is to reject Member applications from individuals who do not reside in one of our approved markets. 16 In order to comply with regulations that apply to both us and our Members, we research the applicable regulatory framework prior to entering any new market to identify necessary licenses and approvals and applicable limitations relating to our operations in that market and then work to bring our operations into compliance with the applicable limitations and to maintain such licenses. Typically, we conduct this research with the assistance of local legal counsel and other representatives. We also research laws applicable to Member operations and revise or alter our Member applications, rules, and other training materials and programs to provide Members with guidelines for operating their independent business, marketing and distributing our products and similar matters, as required by applicable regulations in each market. While we have rules and guidelines for our Members and monitor their market conduct, we are, however, unable to ensure that our Members will not distribute our products in countries where we have not commenced operations. In addition, regulations in existing and new markets often are ambiguous and subject to considerable interpretive and enforcement discretion by the responsible regulators. Moreover, even when we believe that we and our Members are in compliance with all applicable regulations, new regulations are being added regularly and the interpretation of existing regulations is subject to change. Further, the content and impact of regulations to which we are subject may be influenced by public attention directed at us, our products, or our network marketing program, so that extensive adverse publicity about us, our products, or our network marketing program may increase the likelihood regulatory scrutiny or action. HUMAN CAPITAL At Herbalife Nutrition, our commitment to improving lives and our communities is at the core of everything we do. This commitment also informs how we value and treat our employees. We seek to provide a work environment where employees can grow and thrive while supporting our Members and their customers. We believe attracting, developing, and retaining a talented and diverse workforce are critical factors that contribute to the success and growth of our business. We have operations globally, requiring investment to assess local labor market conditions and recruit and retain the appropriate workforce. Having a business presence in multiple domestic and international markets also requires us to monitor local labor and employment laws for which we often engage third-party advisors. We monitor the talent needs of our departments and functions with particular focus on the areas where human capital resources are important to daily operations to ensure we can timely manufacture, distribute, and sell products to our Members. As of December 31, 2022, we had approximately 10,100 employees, of which approximately 2,800 were located in the United States. Diversity, Equity, and Inclusion We believe diversity is a strength and embrace a core vision that a diverse, equitable, and inclusive culture is imperative to enable us to better serve our Members, stakeholders, and communities. As such, we seek to promote a work environment where all people can thrive, and are committed to diversity, equity, and inclusion, or DEI, at all levels, from our employees, management and executive leadership to our board of directors. Our DEI strategy is currently focused on creating opportunities to further recruit and support diverse talent at all levels, encouraging inclusion and belonging, and embedding equity throughout our culture and operations. Current initiatives include the implementation of a global applicant tracking system to deepen our commitment to fair recruitment processes, offering unconscious bias trainings for all employees, the expansion of existing employee networks which help employees build community and foster a culture of belonging, and further development and involvement of Global and Regional DEI Councils to drive DEI progress. Additionally, we have set diversity goals and targets for women in leadership roles globally and for racial and ethnic minorities in leadership roles in the U.S. Talent Acquisition and Development We seek to attract and retain a talented and diverse workforce. To foster an inclusive hiring process in the U.S., we use a tool that helps ensure that job descriptions do not unintentionally exclude potential applicants. Investment in our employees' professional growth and development is important and helps establish a strong foundation for long- term success. At our Company, we strive to create a learning culture, one in which development is an ongoing focus for all employees and managers. We invest in our employees’ development through a variety of programs. These programs are designed to help our employees grow professionally and strengthen their skills throughout their careers. Examples of these programs include the following: • Training Programs – We provide our employees access to an internal learning management system, Herbalife Nutrition University, which provides professional development courses, technical training, and compliance training to all employees globally. 17 • Mentorship Programs – The principle of servant leadership is a crucial part of our culture. We believe that one way to be a servant leader is to mentor others, and, in 2020, we introduced a new mentorship program to help guide junior employees in their professional journey. Through this program, participating employees can be provided with a one-on-one professional development opportunity, in which they receive dedicated coaching, feedback, and encouragement. • Educational Assistance – Another way we support employees’ continual professional development is by offsetting a portion of the cost of higher education. Program offerings and eligibility vary by region, but may include partial reimbursement of tuition fees incurred for undergraduate and graduate degrees, certificate programs, or skills-based courses. Compensation and Benefits Our Board of Directors and its Compensation Committee establish our general compensation philosophy and oversee and approve the development, adoption, and implementation of compensation policies and programs, which are set at a global level, but also adapted to meet local country requirements as needed. We provide base pay that aligns with employee positions, skill levels, experience, contributions, and geographic location. In addition to base pay, we seek to reward employees with annual incentive awards, recognition programs, and equity awards for employees at certain job grades. Our benefit programs are designed to enhance employee well-being and assist employees in the event of illness, injury, or disability. To this end, we offer benefits that vary worldwide, but may include health insurance, retirement savings programs, and wellness incentives designed to promote a healthy and active lifestyle. We believe we offer our employees wages and benefits packages that are in line with respective local labor markets and laws. Safety, Health, and Well-Being As a nutrition company, we believe the safety, health, and well-being of our employees is of the utmost importance. We endeavor to promote these principles by providing a safe and healthy work environment and encouraging healthy, active lifestyles. Our efforts to provide a safe workplace are guided by various formal policies and programs, which are designed to protect employees, contractors, and visitors from accidents, illnesses, and injuries, while operating in compliance with applicable regulations, including OSHA guidelines in the U.S. We also follow policies and programs regarding material health and safety risks, workplace violence prevention, and incident response and management. In the U.S., our manufacturing facilities in Winston-Salem and Lake Forest are ISO 45001 certified, an international standard for occupational health and safety management. While the COVID-19 pandemic has increased the resources required to keep our employees safe and healthy, we continue to make what we believe are the necessary investments to achieve this goal. In response to, and during various phases of, the pandemic, we have taken several actions, including supporting our employees to work from home when possible, offering mental and emotional wellness resources, and implementing safety measures when necessary at our facilities. Over the course of the pandemic, our senior management team has relied on cross-functional teams to monitor, review, and assess the evolving situation. These cross-functional teams are responsible for recommending risk mitigation actions based on the local risks and in accordance with regulatory requirements and guidelines for the health and safety of our employees and, in the U.S., protocols to align with all federal, state, and local public health guidelines. We believe our proactive efforts have been successful in supporting our business growth despite the obstacles and challenges presented by COVID-19. In addition, we believe in the importance of well-being and provide resources for our employees that support their pursuit of a healthy and active lifestyle. Our flagship wellness program in the U.S., “Wellness for Life,” offers employees a suite of activities to achieve overall wellness through improved fitness, nutrition, intellectual well-being, and financial literacy. The variety of activities offered ensures all employees may participate, no matter where they may be in their wellness journey. While we have many existing regional wellness programs, a new and enhanced global wellness program will launch in January 2023 and feature Herbalife fitness, health and nutrition experts from around the globe. We also have facilities and programs in place that allow employees to incorporate fitness into their daily schedule, such as onsite gyms at several facilities and live virtual classes. Our Members We are dependent on our Members to sell and promote our products to their customers. We frequently interact and work directly with our sales leaders to explore ways to support our and our Members’ businesses, and their customers’ personal goals of living a healthier and more active lifestyle. See the Our Network Marketing Program – Member Compensation and Sales Leader Retention and Requalification section above for sales leader and requalification metrics and further discussion on our sales leaders. 18 Available Information Our Internet website address is www.herbalife.com and our investor relations website is ir.herbalife.com. We make available free of charge on our website our Annual Reports on Form 10-K, Quarterly Reports on Form 10-Q, Current Reports on Form 8-K, proxy statements, and amendments to those reports filed or furnished pursuant to Section 13(a) or 15(d) of the Securities Exchange Act of 1934, as amended, or the Exchange Act, as soon as reasonably practical after we file such material with, or furnish it to, the Securities and Exchange Commission, or SEC. The SEC maintains an Internet website that contains reports, proxy and information statements, and other information regarding issuers that file electronically with the SEC at www.sec.gov. We also make available free of charge on our investor relations website at ir.herbalife.com our Principles of Corporate Governance, our Code of Conduct, and the Charters of our Audit Committee, Nominating and Corporate Governance Committee, Compensation Committee, and ESG Committee of our board of directors. Unless expressly noted, the information on our website, including our investor relations website, or any other website is not incorporated by reference in this Annual Report on Form 10-K and should not be considered part of this Annual Report on Form 10-K or any other filing we make with the SEC. Item 1A. Risk Factors Please carefully consider the following discussion of significant factors, events, and uncertainties that make an investment decision regarding our securities risky. The factors, events, uncertainties, and consequences discussed in these risk factors could, in circumstances we may not be able to accurately predict, recognize, or control, have a material adverse effect on our business, reputation, prospects, financial condition, operating results, cash flows, liquidity, and share price. These risk factors do not identify all risks that we face. We could also be affected by factors, events, or uncertainties that are not presently known to us or that we currently do not consider to present material risks. Additionally, the COVID-19 pandemic has amplified many of the other risks discussed below to which we are subject. We are unable to predict the duration and extent to which the pandemic and its related impacts will adversely impact our business, financial condition, and operating results as well as our share price. In addition, given the unpredictable, unprecedented, and fluid nature of the pandemic, it may also materially and adversely affect our business, financial condition, and operating results in ways that are not currently anticipated by or known to us or that we currently do not consider to present material risks. Risk Factor Summary This risk factor summary contains a high-level summary of certain of the principal factors, events and uncertainties that make an investment in our securities risky, including risks related to our business and industry, risks related to regulatory and legal matters, risks related to our international operations, risks related to our indebtedness and risks related to our common shares. The following summary is not complete and should be read together with the more detailed discussion of these and the other factors, events, and uncertainties set forth below before making an investment decision regarding our securities. The principal factors, events, and uncertainties that make an investment in our securities risky include the following: Risks Related to Our Business and Industry • Our failure to establish and maintain Member and sales leader relationships could negatively impact sales of our products and materially harm our business, financial condition, and operating results. • Because we cannot exert the same level of influence or control over our Members as we could if they were our employees, our Members could fail to comply with applicable law or our rules and procedures, which could result in claims against us that could materially harm our business, financial condition, and operating results. • Adverse publicity associated with our Company or the direct-selling industry could materially harm our business, financial condition, and operating results. • Our failure to compete successfully could materially harm our business, financial condition, and operating results. • Our contractual obligation to sell our products only through our Member network and to refrain from changing certain aspects of our Marketing Plan may limit our growth. • Our failure to appropriately respond to changing consumer trends, preferences, and demand for new products and product enhancements could materially harm our Member relationships, our Members’ customer relationships, and product sales or otherwise materially harm our business, financial condition, and operating results. • If we fail to further penetrate existing markets, the growth in sales of our products, along with our operating results could be negatively impacted. 19 • Since one of our products constitutes a significant portion of our net sales, significant decreases in consumer demand for this product or our failure to produce a suitable replacement, could materially harm our business, financial condition, and operating results. • Our business could be materially and adversely affected by natural disasters, other catastrophic events, acts of war or terrorism, cybersecurity incidents, pandemics, and/or other acts by third parties. • We depend on the integrity and reliability of our information technology infrastructure, and any related interruptions or inadequacies may have a material adverse effect on our business, financial condition, and operating results. • Disruption of supply, shortage, or increases in the cost of ingredients, packaging materials, and other raw materials as well as climate change could materially harm our business, financial condition, and operating results. • If any of our manufacturing facilities or third-party manufacturers fail to reliably supply products to us at required levels of quality or fail to comply with applicable laws, our financial condition and operating results could be materially and adversely impacted. • If we lose the services of members of our senior management team, our business, financial condition, and operating results could be materially harmed. • Our share price may be adversely affected by third parties who raise allegations about our Company. • ESG matters, including those related to climate change and sustainability, may have an adverse effect on our business, financial condition, and operating results and may damage our reputation. Risks Related to Regulatory and Legal Matters • Our products are affected by extensive regulations, and our failure or our Members’ failure to comply with any regulations could lead to significant penalties or claims, which could materially harm our financial condition and operating results. • Our network marketing program is subject to extensive regulation and scrutiny and any failure to comply, or alteration to our compensation practices in order to comply, with these regulations could materially harm our business, financial condition, and operating results. • We are subject to the Consent Order with the FTC, the effects of which, or any failure to comply therewith, could materially harm our business, financial condition, and operating results. • Our actual or perceived failure to comply with privacy and data protection laws, rules, and regulations could materially harm our business, financial condition, and operating results. • We are subject to material product liability risks, which could increase our costs and materially harm our business, financial condition, and operating results. • If we fail to protect our intellectual property, our ability to compete could be negatively affected, which could materially harm our financial condition and operating results. • If we infringe the intellectual property rights of others, our business, financial condition, and operating results could be materially harmed. • We may be held responsible for additional compensation, certain taxes, or assessments relating to the activities of our Members, which could materially harm our financial condition and operating results. Risks Related to Our International Operations • A substantial portion of our business is conducted in foreign jurisdictions, exposing us to the risks associated with international operations. • We are subject to the anti-bribery laws, rules, and regulations of the United States and the other foreign jurisdictions in which we operate. • If we do not comply with transfer pricing, customs duties VAT, and similar regulations, we may be subject to additional taxes, customs duties, interest, and penalties in material amounts, which could materially harm our financial condition and operating results. • Our business in China is subject to general, as well as industry-specific, economic, political, and legal developments and risks and requires that we utilize a modified version of the business model we use elsewhere in the world. • The United Kingdom’s exit from the European Union could adversely impact us. 20 Risks Related to Our Indebtedness • The terms and covenants in our existing indebtedness could limit our discretion with respect to certain business matters, which could harm our business, financial condition, and operating results. • The conversion or maturity of our convertible notes may adversely affect our financial condition and operating results, and their conversion into common shares could have a dilutive effect that could cause our share price to go down. Risks Related to Our Common Shares • Holders of our common shares may difficulties in protecting their interests because we are incorporated under Cayman Islands law. • Provisions of our articles of association and Cayman Islands law may impede a takeover or make it more difficult for shareholders to change the direction or management of the Company, which could reduce shareholders’ opportunity to influence management of the Company. • There is uncertainty as to shareholders’ ability to enforce certain foreign civil liabilities in the Cayman Islands. • U.S. Tax Reform may adversely impact certain U.S. shareholders of the Company. Risks Related to Our Business and Industry Our failure to establish and maintain Member and sales leader relationships could negatively impact sales of our products and materially harm our business, financial condition, and operating results. We distribute our products exclusively to and through our independent Members, and we depend on them directly for substantially all of our sales. To increase our revenue, we must increase the number and productivity of our Members. Accordingly, our success depends in significant part on our relationships with our sales leaders and our ability to recruit, retain, and motivate a large base of Members, including through an attractive compensation plan, the quality of our reputation, the maintenance of an attractive product portfolio, the breadth and quality of our Member services, and other incentives. The loss of a significant number of Members, changes to our network marketing program, our inability to respond to Member demand or generate sufficient interest in our business opportunities, products, or services, decreases in Member engagement, loss of Member or consumer confidence, or any legal or regulatory impact to our Members’ ability to conduct their business could negatively impact sales of our products and our ability to attract and retain Members, each of which could have a material adverse effect on our business, financial condition, and operating results. In our efforts to attract and retain Members, we compete with other direct-selling organizations. In addition, our Member organization has a high turnover rate, which is common in the direct-selling industry, in part because our Members, including our sales leaders, may easily enter and exit our network marketing program without facing a significant investment or loss of capital. For example, the upfront financial cost to become a Member is low, we do not have time or exclusivity requirements, we do not charge for any required training, and, in substantially all jurisdictions, we maintain a buyback program. We believe the COVID-19 pandemic could have an adverse impact on the pipeline of new Members and our Member turnover rate, and may impact our future net sales. See the COVID-19 Pandemic and Sales by Geographic Region sections in Part II, Item 7, Management’s Discussion and Analysis of Financial Condition and Results of Operations, of this Annual Report on Form 10-K for further discussion of the impacts of the COVID-19 pandemic on our business and results of operations. For additional information regarding sales leader retention rates, see Part I, Item 1, Business, of this Annual Report on Form 10-K. Because we cannot exert the same level of influence or control over our Members as we could if they were our employees, our Members could fail to comply with applicable law or our rules and procedures, which could result in claims against us that could materially harm our business, financial condition, and operating results. Our Members are independent contractors and, accordingly, we are not in a position to provide the same direction, motivation, and oversight as we could if Members were our employees. As a result, there can be no assurance that our Members will participate in our marketing strategies or plans, accept our introduction of new products, or comply with applicable legal requirements or our rules and procedures. 21 We are subject to extensive federal, state, local, and foreign laws, rules, and regulations that regulate our business, products, direct sales channel, and network marketing program. See the Regulation section of Part I, Item 1, Business, of this Annual Report on Form 10- K for additional information. While we have implemented policies and procedures designed to govern Member conduct and to protect the goodwill associated with Herbalife Nutrition, it can be difficult to enforce these policies and procedures because of our large number of Members and their status as independent contractors and because our policies and procedures differ by jurisdiction as a result of varying local legal requirements. In addition, although we train our Members and attempt to monitor our Members’ marketing materials, we cannot ensure that our Members will comply with applicable legal requirements or our policies and procedures or that such marketing materials or other Member practices comply with applicable laws, rules, and regulations. It is possible that a court could hold us liable for the actions of our Members, which could materially harm our business, financial condition, and operating results. Adverse publicity associated with our Company or the direct-selling industry could materially harm our business, financial condition, and operating results. Our reputation and the quality of our brand are critical to our business, and the size and success of our Member organization, our operating results, and our share price may be significantly affected by the public’s perception of Herbalife Nutrition and other direct- selling companies. This perception is dependent upon opinions concerning a number of factors, including: • the safety, quality, and efficacy of our products, as well as those of similar companies; • our Members; • our network marketing program or the attractiveness or viability of the financial opportunities it may provide; • the direct-selling business generally; • actual or purported failure by us or our Members to comply with applicable laws, rules, and regulations, including those regarding product claims and advertising, good manufacturing practices, the regulation of our network marketing program, the registration of our products for sale in our target markets, or other aspects of our business; • our commitment to ESG matters and our ESG practices; • the security of our information technology infrastructure; and • actual or alleged impropriety, misconduct, or fraudulent activity by any person formerly or currently associated with our Members or us. Adverse publicity concerning any of the foregoing whether or not accurate or resulting in investigation, enforcement, or other legal or regulatory actions or the imposition of fines, penalties, or other sanctions, could negatively impact our reputation, our ability to attract, motivate, and retain Members, and our ability to generate revenue. In addition, our Members’ and consumers’ perception of Herbalife Nutrition and our direct-selling business as well as similar companies can be significantly influenced by media attention, publicized scientific research or findings, product liability claims, and other publicity, whether or not it is legitimate. For example, as a result of the prevalence and marked increase in the use of blogs, social media platforms, and other forms of Internet-based communications, the opportunity for dissemination of information, both accurate and inaccurate, is seemingly limitless and readily available, and often does not provide any opportunity for correction or other redress. Adverse publicity that associates use of our products or any similar products with adverse effects, questions the quality or benefits of any such products, or claims that any such products are ineffective, inappropriately labeled, or have inaccurate instructions as to their use, could lead to lawsuits or other legal or regulatory challenges and could materially and adversely impact our reputation, the demand for our products, and our business, financial condition, and operating results. Adverse publicity relating to us has had, and could again have, a negative effect on our ability to attract, motivate, and retain Members, on consumer perception of Herbalife Nutrition, and on our share price. For example, the resulting adverse publicity from the 1986 permanent injunction entered in California caused a rapid, substantial loss of Members in the United States and a corresponding reduction in sales beginning in 1985. See also the risk factor titled “Our share price may be adversely affected by third parties who raise allegations about our Company.” We expect that adverse publicity will, from time to time, continue to negatively impact our business in particular markets and may adversely affect our share price. 22 Our failure to compete successfully could materially harm our business, financial condition, and operating results. The business of developing and marketing weight management and other nutrition and personal care products is highly competitive and sensitive to the introduction of new products and weight management plans, including various prescription drugs, which may rapidly capture a significant share of the market. Our competitors include numerous manufacturers; distributors; marketers; online, specialty, mass, and other retailers; and physicians that actively compete for the business of consumers both in the United States and abroad. Some of our competitors have longer operating histories, significantly greater resources, better-developed and more innovative sales and distribution channels and platforms, greater name recognition, and larger established customer bases than we do. Our present and future competitors may be able to offer products at lower prices or better withstand reductions in prices or other adverse economic or market conditions than we can; develop products that are comparable or superior to those we offer; adapt more quickly or effectively to new technologies, changing regulatory requirements, evolving industry trends and standards, and customer requirements than we can; and/or devote greater resources to the development, promotion, and sale of their products than we do. We are also subject to significant competition for the recruitment of Members from other direct-selling organizations, including those that market weight management products, dietary and nutritional supplements, personal care products, and other types of products, as well as those organizations in which former employees or Members are involved. In addition, because the industry in which we operate is not particularly capital intensive or otherwise subject to high barriers to entry, it is relatively easy for new competitors to emerge that will compete with us, including for our Members and their customers. Accordingly, competition may intensify and we may not be able to compete effectively in our markets. If we are not able to retain our Members and their customers or otherwise compete successfully, our business, financial condition, and operating results would be materially adversely affected. Our contractual obligation to sell our products only through our Member network and to refrain from changing certain aspects of our Marketing Plan may limit our growth. We are contractually prohibited from expanding our business by selling Herbalife Nutrition products through other distribution channels that may be available to our competitors, such as over the Internet, through wholesale sales, by establishing retail stores, or through mail order systems. To the extent legally permitted, an agreement we entered into with our Members provides assurances that we will not sell Herbalife Nutrition products worldwide through any distribution channel other than our network of Members. Since this is an open-ended commitment, there can be no assurance that we will be able to take advantage of innovative new distribution channels that are developed in the future or appropriately respond to consumer preferences as they continue to evolve. In addition, this agreement with our Members provides that we will not make any material changes adverse to our Members to certain aspects of our Marketing Plan that may negatively impact our Members without their approval as described in further detail below. For example, our agreement with our Members provides that we may increase, but not decrease, the discount percentages available to our Members for the purchase of products or the applicable royalty override percentages and production and other bonus percentages available to our Members at various qualification levels within our Member hierarchy. We may not modify the eligibility or qualification criteria for these discounts, royalty overrides, and production and other bonuses unless we do so in a manner to make eligibility and/or qualification easier than under the applicable criteria in effect as of the date of the agreement. Our agreement with our Members further provides that we may not vary the criteria for qualification for each Member tier within our Member hierarchy, unless we do so in such a way so as to make qualification easier. We reserved the right to make changes to our Marketing Plan without the consent of our Members in the event that changes are required by applicable law or are necessary in our reasonable business judgment to account for specific local market or currency conditions to achieve a reasonable profit on operations. In addition, we may initiate other changes that are adverse to our Members based on an assessment of what will be best for the Company and its Members. Under the agreement with our Members, these other adverse changes would then be submitted to our Member leadership for a vote. The vote would require the approval of at least 51% of our Members then at the level of President’s Team earning at the production bonus level of 6% who vote, provided that at least 50% of those Members entitled to vote do in fact vote. While we believe this agreement has strengthened our relationship with our existing Members, improved our ability to recruit new Members, and generally increased the long-term stability of our business, there can be no assurance that our agreement with our Members will not restrict our ability to adapt our Marketing Plan or our business to the evolving requirements of the markets in which we operate. As a result, our growth may be limited. 23 Our failure to appropriately respond to changing consumer trends, preferences, and demand for new products and product enhancements could materially harm our Member relationships, Members’ customer relationships, and product sales or otherwise materially harm our business, financial condition, and operating results. Our business is subject to rapidly changing consumer trends and preferences and product introductions, especially with respect to our nutrition products. Our continued success depends in part on our ability to anticipate and respond to these changes and introductions, and we may not respond or develop new products or product enhancements in a cost-effective, timely, or commercially appropriate manner, or at all, particularly while the COVID-19 pandemic persists. Current consumer trends and preferences have evolved and will continue to evolve as a result of, among other things, changes in consumer tastes; health, wellness, and nutrition considerations; competitive product and pricing pressures; changes in consumer preferences for certain sales channels; shifts in demographics; and concerns regarding the environmental and sustainability impact of the product manufacturing process. The success of our response to changing consumer trends and preferences and product introductions, including any new product offerings and enhancements, depends on a number of factors, including our ability to: • accurately anticipate consumer needs; • innovate and develop new products and product enhancements that meet these needs; • successfully commercialize new products and product enhancements; • price our products competitively; • manufacture and deliver our products in sufficient volumes, at our required levels of quality, and in a cost-effective and timely manner; and • differentiate our product offerings from those of our competitors and successfully respond to other competitive pressures, including technological advancements, evolving industry standards, and changing regulatory requirements. Our failure to accurately predict changes in consumer demand and technological advancements could negatively impact consumer opinion of our products or our business, which in turn could harm our Member relationships and the Members’ relationships with their customers, and cause a loss of sales. In addition, if we do not introduce new products or make enhancements to meet the changing needs of our Members and their customers in a cost-effective, timely, and commercially appropriate manner, or if our competitors release new products or product enhancements before we do, some of our product offerings could be rendered obsolete, which could cause our market share to decline and negatively impact our business, financial condition, and operating results. If we fail to further penetrate existing markets, the growth in sales of our products, along with our operating results, could be negatively impacted. The success of our business is to a large extent contingent on our ability to further penetrate existing markets, which is subject to numerous factors, many of which are out of our control. Our ability to increase market penetration may be limited by the finite number of persons in a given country inclined to pursue a direct-selling business opportunity or consumers aware of, or willing to purchase, Herbalife Nutrition products. Moreover, our growth in existing markets will depend upon increased brand awareness and improved training and other activities that enhance Member retention in our markets. While we have recently experienced significant growth in certain of our foreign markets, we cannot assure you that such growth levels will continue in the immediate or long-term future. Furthermore, our efforts to support growth in such foreign markets could be hampered to the extent that our infrastructure in such markets is deficient when compared to our infrastructure in our more developed markets, such as the United States. For example, there can be no assurances that we will be able to successfully manage expansion of manufacturing operations and a growing and dynamic sales force in China. If we are unable to effectively scale our supply chain and manufacturing infrastructure to support future growth in China or other foreign markets, our operations in such markets may be adversely impacted. Therefore, we cannot assure you that our general efforts to increase our market penetration and Member retention in existing markets will be successful. If we are unable to further penetrate existing markets, our business, financial condition, and operating results could materially suffer. Since one of our products constitutes a significant portion of our net sales, significant decreases in consumer demand for this product or our failure to produce a suitable replacement could materially harm our business, financial condition, and operating results. Our Formula 1 Healthy Meal, which is our best-selling product line, approximated 26% of our net sales for the year ended December 31, 2022. If consumer demand for this product decreases significantly or we cease offering this product without a suitable replacement, or if the replacement product fails to gain market acceptance, our business, financial condition, and operating results could be materially harmed. 24 Our business could be materially and adversely affected by natural disasters, other catastrophic events, acts of war or terrorism, cybersecurity incidents, pandemics, and/or other acts by third parties. We depend on the ability of our business to run smoothly, including the ability of Members to engage in their day-to-day selling and business building activities. In coordination with our suppliers, third-party manufacturers, and distributors, our ability to make and move our products reasonably unimpeded around the world is critical to our success. Any material disruption to our collective operations or supply, manufacturing, or distribution capabilities caused by unforeseen or catastrophic events, such as (i) natural disasters or severe weather conditions, including droughts, fires, floods, hurricanes, volcanic eruptions, and earthquakes; (ii) power loss or shortages; (iii) telecommunications or information technology infrastructure failures; (iv) acts or threats of war, terrorism, or other armed hostilities; (v) outbreaks of contagious diseases, epidemics, and pandemics; (vi) cybersecurity incidents, including intentional or inadvertent exposure of content perceived to be sensitive data; (vii) employee misconduct or error; and/or (viii) other actions by third parties and other similar disruptions, could materially adversely affect our ability to conduct business and our Members’ selling activities. For example, our operations in Central America were impacted in November 2020 when Hurricanes Eta and Iota made landfall in the region. The storms disrupted our supply chain transportation network and our ability to import product. In addition, our distribution center in Honduras experienced flooding, which damaged or destroyed product. Furthermore, our headquarters and one of our distribution facilities and manufacturing facilities are located in Southern California, an area susceptible to fires and earthquakes. Although the events in Central America did not have a material negative impact on our operations, we cannot make assurances that any future catastrophic events will not adversely affect our ability to operate our business or our financial condition and operating results. In addition, catastrophic events may result in significant cancellations or cessations of Member orders; contribute to a general decrease in local, regional, or global economic activity; directly impact our marketing, manufacturing, financial, or logistics functions; impair our ability to meet Member demands; harm our reputation; and expose us to significant liability, losses, and legal proceedings, any of which could materially and adversely affect our business, financial condition, and operating results. In March 2020, the World Health Organization declared the COVID-19 outbreak a global pandemic. The COVID-19 pandemic has significantly impacted health and economic conditions globally, disrupted global supply chains, and has adversely affected the Company’s business and that of its Members in certain of the Company’s markets and may continue to impact those markets or others in the future. Government, agency, and other regulatory recommendations, guidelines, mandates, and actions to address public health concerns, including restrictions on movement, public gatherings, and travel and restrictions on, or in certain cases outright prohibitions of, companies’ ability to conduct normal business operations, have and may continue to adversely affect our business. Although we have been classified as an essential business in most jurisdictions where we operate, there is no guarantee that this classification will not change. We may also be forced to or voluntarily elect to limit or cease operations in one or more markets for other reasons, such as the health and safety of our employees or because of disruptions in the operation of our supply chain and sources of supply. For example, it is possible that closures of our manufacturing facilities or those of our third-party contract manufacturers or suppliers could impact our distribution centers and our ability to manufacture and deliver products to our Members. In general, our inventory of products continues to be adequate to meet demand, but we do expect our supply chain and our ability to source and/or manufacture products will be negatively impacted if the negative effects of the pandemic continue for a prolonged period of time or worsen. The pandemic has had an adverse impact on our distribution channels and Members’ product access in some markets, which may, and in some cases will, continue until conditions improve. Our third-party contract manufacturers and suppliers and our Members’ businesses are also subject to many of the same risks and uncertainties related to the COVID-19 pandemic, as well as other pandemic-related risks and uncertainties that may not directly impact our operations, any of which could adversely affect demand for our products. For example, limitations on public gatherings have restricted our Members’ ability to hold meetings with their existing customers and to attract new customers. Significant limitations on cash transactions could also have an adverse effect on sales of products in certain markets. The COVID-19 pandemic has also adversely affected the economies and financial markets of many countries, at times causing a significant deceleration of or interruption to economic activity, which during various stages of the pandemic has reduced production, decreased demand for a broad variety of goods and services, diminished trade levels, and led to widespread corporate downsizing. We have also seen periods of significant disruption of and extreme volatility in the global capital markets, which could increase the cost of, or entirely restrict access to, capital. Further, while some countries have progressed in distributing COVID-19 vaccines to the general population, many countries have limited to no access to vaccines at this time. To the extent the global supply of vaccine remains limited or vaccination rates do not significantly increase, government restrictions in the countries with limited to no access or low vaccination rates may persist or increase and economic activity may remain at depressed levels in those countries or regions. 25 Despite the relaxation of pandemic-related constraints in certain markets, considerable uncertainty still surrounds the COVID-19 pandemic, its potential effects, and the extent and effectiveness of government responses to the pandemic. If the pandemic is not contained, or if new variants emerge or effective vaccines are not made available and utilized quickly enough, the adverse impacts of the COVID-19 pandemic could worsen, impacting all segments of the global economy, and result in a significant recession or worse. However, the unprecedented and sweeping nature of the COVID-19 pandemic makes it extremely difficult to predict how our business and operations will be affected in the long run. Further, the resumption of normal business operations after the disruptions caused by the COVID-19 pandemic may be delayed or constrained by the pandemic’s lingering effects on our Members, consumers, and third- party contract manufacturers and suppliers. Accordingly, our ability to conduct our business in the manner previously done or planned for the future could be materially and adversely affected, and any of the foregoing risks, or other cascading effects of the COVID-19 pandemic, or any other pandemic that may emerge in the future, that are not currently foreseeable, could materially and adversely affect our business, financial condition, and operating results. See the COVID-19 Pandemic and Sales by Geographic Region sections in Part II, Item 7, Management’s Discussion and Analysis of Financial Condition and Results of Operations, of this Annual Report on Form 10- K for further discussion of the impacts of the COVID-19 pandemic on our business and operating results. We depend on the integrity and reliability of our information technology infrastructure, and any related interruptions or inadequacies may have a material adverse effect on our business, financial condition, and operating results. Our business, including our ability to provide products and services to and manage our Members, depends on the performance and availability of our information technology infrastructure, including our core transactional systems. The most important aspect of our information technology infrastructure is the system through which we record and track Member sales, Volume Points, royalty overrides, bonuses, and other incentives. The failure of our information systems to operate effectively, or a breach in security of these systems, could adversely impact the promptness and accuracy of our product distribution and transaction processing. While we continue to invest in our information technology infrastructure, there can be no assurance that there will not be any significant interruptions to such systems, that the systems will be adequate to meet all of our business needs, or that the systems will keep pace with continuing changes in technology, legal and regulatory standards. Further, as discussed in Part II, Item 7, Management’s Discussion and Analysis of Financial Condition and Results of Operations, we recently commenced a Digital Technology Program to develop a new enhanced platform to provide enhanced digital capabilities and experiences to our Members. Our information technology infrastructure, as well as that of our Members and the other third parties with which we interact, may be damaged, disrupted, or breached or otherwise fail for a number of reasons, including power outages, computer and telecommunication failures, internal design, manual or usage errors, workplace violence or wrongdoing, or catastrophic events such as natural disasters, severe weather conditions, or acts of war or terrorism. In addition, numerous and evolving cybersecurity threats, including advanced and persistent cyberattacks, such as unauthorized attempts to access, disable, improperly modify, exfiltrate, or degrade our information technology infrastructure, or the introduction of computer viruses, malware, “phishing” emails, and other destructive software, and social engineering schemes, could compromise the confidentiality, availability, and integrity of our information technology infrastructure as well as those of the third parties with which we interact. These attacks may come from external sources, such as governments or hackers, or may originate internally from an employee or a third party with which we interact. We have been the target of, and may be the target of in the future, malicious cyberattacks, although to date none of these attacks have had a meaningful adverse impact on our business, financial condition, or operating results. The potential risk of cyberattacks may increase as we introduce new technology systems and services. Additionally, in response to the COVID-19 pandemic, many of our employees have been encouraged to work remotely, which may increase our exposure to significant systems interruptions, cybersecurity attacks, and otherwise compromise the integrity and reliability of our information technology infrastructure and our internal controls. Any disruptions to, or failures or inadequacies of, our information technology infrastructure that we may encounter in the future may result in substantial interruptions to our operations, expose us to significant liability, and may damage our reputation and our relationships with, or cause us to lose, our Members, especially if the disruptions, failures, or inadequacies impair our ability to track sales and pay royalty overrides, bonuses, and other incentives, any of which would harm our business, financial condition, and operating results. Any such disruptions, failures, or inadequacies could also create compliance risks under the Consent Order and result in penalties, fines, or sanctions under any applicable laws or regulations. Furthermore, it may be expensive or difficult to correct or replace any aspect of our information technology infrastructure in a timely manner, if at all, and we may have little or no control over whether any malfunctioning information technology services supplied to us by third parties are appropriately corrected, if at all. We have encountered, and may encounter in the future, errors in our software and our enterprise network, and inadequacies in the software and services supplied by certain of our vendors, although to date none of these errors or inadequacies have had a meaningful adverse impact on our business, financial condition or operating results. In addition, developments in technology are continuing to evolve and affecting all aspects of our business, including how we effectively manage our operations, interact with our Members and their customers, and commercialize opportunities that accompany the evolving digital and data driven economy. Therefore, one of our top priorities is to modernize our technology and data infrastructure by, among other things, creating more relevant and more personalized experiences wherever our systems interact with Members and their customers; and developing ways to create more powerful digital tools and capabilities for Members to enable them to grow their 26 businesses. These initiatives to modernize our technology and data infrastructure are expected to be implemented over the course of many years and to require significant investments. If these initiatives are not successful, our ability to attract and retain Members and their customers, increase sales, and reduce costs may be negatively affected. Further, these initiatives may be subject to cost overruns and delays and may cause disruptions in our operations. These cost overruns and delays and disruptions could adversely impact our business, financial condition, and operating results. Disruption of supply, shortage, or increases in the cost of ingredients, packaging materials, and other raw materials as well as climate change could materially harm our business, financial condition, and operating results. We and our third-party contract manufacturers depend on third-party suppliers to supply us with the various ingredients, packaging materials, and other raw materials that we use in the manufacturing and distribution of our products. Our business could be materially harmed if we experience operational difficulties with our third-party suppliers, such as increases in costs, reductions in the availability of materials or production capacity, errors in complying with specifications or applicable law, insufficient quality control, and failures to meet production or shipment deadlines. If we fail to develop or maintain our relationships with our third-party suppliers or if such suppliers cease doing business with us or go out of business, we could face difficulties in finding or transitioning to alternative suppliers that meet our standards. Many of the ingredients, packaging materials, and other raw materials we use are subject to fluctuations in availability and price due to a number of factors beyond our control, including crop size, ingredient, water, and land scarcity, market demand for raw materials, commodity market speculation, energy costs, currency fluctuations, supplier and logistics service capacities, import and export requirements, tariffs, and other government policies, and drought, excessive rain, temperature extremes, and other severe weather events. If we experience supply shortages, price increases, or supplier or regulatory impediments with respect to any of the materials we use in our products or packaging, we may need to seek alternative supplies or suppliers and may experience difficulties in finding replacements that are comparable in quality and price. For a discussion of the impacts of the COVID-19 pandemic on our supply chain see “If any of our manufacturing facilities or third-party manufacturers fail to reliably supply products to us at required levels of quality or fail to comply with applicable laws, our financial condition and operating results could be materially and adversely impacted” below. Further, the risks related to our ability to adequately source the materials required to meet our needs may be exacerbated by the effects of climate change and the legal, regulatory, or market measures that may be implemented to address climate change. There is growing concern that carbon dioxide and other greenhouse gases in the atmosphere may have an adverse impact on global temperatures, weather patterns, and the frequency and severity of extreme weather and natural disasters. If climate change has a negative effect on agricultural productivity, we may be subject to decreased availability or less favorable pricing for certain raw materials that are necessary for our products, such as soybeans, wheat, tea leaves, and nuts. Severe weather conditions and natural disasters can reduce crop size and crop quality, which in turn could reduce our supplies of raw materials, lower recoveries of usable raw materials, increase the prices of our raw materials, increase our cost of storing and transporting our raw materials, or disrupt production schedules. The impacts of climate change may also cause unpredictable water availability or exacerbate water scarcity. In addition, the increasing concern over climate change and related sustainability matters may also result in more federal, state, local, and foreign legal and regulatory requirements relating to climate change, which may significantly increase our costs of operation and delivery. 27","Use only the document provided and nothing else.
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+EVIDENCE:
+2022 Annual Report To Our Shareholders, We all know coming out of the pandemic has caused many companies to relook at their operations. 2022 was a year of change for Herbalife as well as a year of challenge. With every challenge, there is great opportunity. I came back to Herbalife because I believe passionately about what Herbalife does, and what it provides for health and income. Since returning to Herbalife, I along with our management team and distributor leaders from around the world have embarked on a journey to expand our content, enhance the business opportunity, modernize our brand, and expand our digital platform – with the aim to reach more customers and to provide our distributors a better plat- form to operate their business. Our vision is to be the world’s premier health and wellness company and community. As I write this, more than 3,000 distributor leaders from around the world are traveling to Los Angeles to meet together for the first time in three years to learn, to share, to innovate, and to build a path forward for Herbalife. The time is now for us to reconnect, build on our strategic plan, and provide growth for all of our stakeholders. Our digital transformation “Herbalife One” will enhance the Company’s two main platforms: content and busi- ness opportunity. Our content is our product. With obesity levels hitting record highs around the globe and a greater demand for health and wellness support, we have plans to grow our product portfolio through our daily nutrition products with expanded vegan and protein lines. We plan to explore other health and wellness opportunities that will be based on global as well as regional consumer demands. For example, our unique Ayurvedic product line in India has contributed to the success of our fastest growing market. We are unleashing similar innovative products regionally in Europe, Asia and China, and we will continue to look for synergies and opportunities to globalize our regional product offerings. With enhancements to the business opportunity, our global distributor network will continue to give us a com- petitive advantage to reach more consumers with more offerings than ever before. Our distributors give a personal voice and passion to our products. Spanning across 95 markets, our distributors are amazing entrepreneurs who have unique relationships with their customers, and through an expanded use of data, we will be able to assist our distributors to sell more products and work more closely and efficiently with consumers on their health and wellness journey. To this end, we are modernizing our brand and compensation structure, including new promotions to energize and incentivize our distributors to earn early in their Herbalife business opportunity journey. Together with Herbalife One, our business opportunity will differentiate us and strengthen our leadership in the marketplace. 2023 is a start of a new chapter – one that is both motivating and exciting. In March, I marked my 20th year of devoting my time, passion, and energy to Herbalife. I feel more optimistic about where we are headed today than ever before. Our distributors and employees make Herbalife a community unlike any other. I know our distrib- utors and employees are as incredibly excited about the future as I am. Thank you for your trust and support. Michael O. Johnson Chairman and Chief Executive Officer This letter contains “forward-looking statements” within the meaning of the safe harbor provisions of the Private Securities Litigation Reform Act of 1995. Although we believe that the expectations reflected in any of our forward-looking statements are reasonable, actual results or outcomes could differ materially from those pro- jected or assumed in any of our forward-looking statements. Our future financial condition and results of oper- ations, as well as any forward-looking statements, are subject to change and to inherent risks and uncertainties, many of which are beyond our control. Additionally, many of these risks and uncertainties are, and may continue to be, amplified by the COVID-19 pandemic. Important factors that could cause our actual results, performance and achievements, or industry results to differ materially from estimates or projections contained in or implied by our forward-looking statements include the following: the potential impacts of the COVID-19 pandemic and current global economic conditions, including inflation, on us; our Members, customers, and supply chain; and the world economy; our ability to attract and retain Members; our relationship with, and our ability to influence the actions of, our Members; our noncompliance with, or improper action by our employees or Members in violation of, applicable U.S. and foreign laws, rules, and regulations; adverse publicity associated with our Company or the direct-selling industry, including our ability to comfort the marketplace and regulators regard- ing our compliance with applicable laws; changing consumer preferences and demands and evolving industry standards, including with respect to climate change, sustainability, and other environmental, social, and gover- nance, or ESG, matters; the competitive nature of our business and industry; legal and regulatory matters, including regulatory actions concerning, or legal challenges to, our products or network marketing program and product liability claims; the Consent Order entered into with the FTC, the effects thereof and any failure to comply therewith; risks associated with operating internationally and in China; our ability to execute our growth and other strategic initiatives, including implementation of our Transformation Program and increased pene- tration of our existing markets; any material disruption to our business caused by natural disasters, other cata- strophic events, acts of war or terrorism, including the war in Ukraine, cybersecurity incidents, pandemics, and/ or other acts by third parties; our ability to adequately source ingredients, packaging materials, and other raw materials and manufacture and distribute our products; our reliance on our information technology infra- structure; noncompliance by us or our Members with any privacy laws, rules, or regulations or any security breach involving the misappropriation, loss, or other unauthorized use or disclosure of confidential information; contractual limitations on our ability to expand or change our direct-selling business model; the sufficiency of our trademarks and other intellectual property; product concentration; our reliance upon, or the loss or departure of any member of, our senior management team; restrictions imposed by covenants in the agreements governing our indebtedness; risks related to our convertible notes; changes in, and uncertainties relating to, the application of transfer pricing, income tax, customs duties, value added taxes, and other tax laws, treaties, and regulations, or their interpretation; our incorporation under the laws of the Cayman Islands; and share price volatility related to, among other things, speculative trading and certain traders shorting our common shares. Forward-looking statements in this letter speak only as of March 14, 2023. We do not undertake any obligation to update or release any revisions to any forward-looking statement or to report any events or circumstances after such date or to reflect the occurrence of unanticipated events, except as required by law. UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 Form 10-K (Mark One) ANNUAL REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 For the fiscal year ended December 31, 2022 OR TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 For the transition period from to Commission file number: 1-32381 HERBALIFE NUTRITION LTD. (Exact name of registrant as specified in its charter) Cayman Islands 98-0377871 (State or other jurisdiction of (I.R.S. Employer incorporation or organization) Identification No.) P.O. Box 309GT Ugland House, South Church Street Grand Cayman, Cayman Islands (Address of principal executive offices) (Zip Code) (213) 745-0500 (Registrant’s telephone number, including area code) Securities registered pursuant to Section 12(b) of the Act: Title of each class: Trading Symbol(s): Name of each exchange on which registered: Common Shares, par value $0.0005 per share HLF New York Stock Exchange Securities registered pursuant to Section 12(g) of the Act: None Indicate by check mark if the registrant is a well-known seasoned issuer, as defined in Rule 405 of the Securities Act. Yes ☒ No ☐ Indicate by check mark if the registrant is not required to file reports pursuant to Section 13 or Section 15(d) of the Act. Yes ☐ No ☒ Indicate by check mark whether the registrant: (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days. Yes ☒ No ☐ Indicate by check mark whether the registrant has submitted electronically every Interactive Data File required to be submitted pursuant to Rule 405 of Regulation S-T (§232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to submit such files). Yes ☒ No ☐ Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, a smaller reporting company, or an emerging growth company. See the definitions of “large accelerated filer,” “accelerated filer,” “smaller reporting company,” and “emerging growth company” in Rule 12b-2 of the Exchange Act. Large accelerated filer ☒ Accelerated filer ☐ Non-accelerated filer ☐ Smaller reporting company ☐ Emerging growth company ☐ If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act. ☐ Indicate by check mark whether the registrant has filed a report on and attestation to its management’s assessment of the effectiveness of its internal control over financial reporting under Section 404(b) of the Sarbanes-Oxley Act (15 U.S.C. 7262(b)) by the registered public accounting firm that prepared or issued its audit report. ☒ If securities are registered pursuant to Section 12(b) of the Act, indicate by check mark whether the financial statements of the registrant included in the filing reflect the correction of an error to previously issued financial statements. ☐ Indicate by check mark whether any of those error corrections are restatements that required a recovery analysis of incentive-based compensation received by any of the registrant’s executive officers during the relevant recovery period pursuant to §240.10D-1(b). ☐ Indicate by check mark whether registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act). Yes ☐ No ☒ There were 97,920,728 common shares outstanding as of February 7, 2023. The aggregate market value of the Registrant’s common shares held by non-affiliates was approximately $896 million as of June 30, 2022, based upon the last reported sales price on the New York Stock Exchange on that date of $20.45. For the purposes of this disclosure only, the registrant has assumed that its directors, executive officers, and the beneficial owners of 5% or more of the registrant’s outstanding common stock are the affiliates of the registrant. DOCUMENTS INCORPORATED BY REFERENCE Portions of the registrant’s Definitive Proxy Statement to be filed with the Securities and Exchange Commission no later than 120 days after the end of the Registrant’s fiscal year ended December 31, 2022, are incorporated by reference in Part III of this Annual Report on Form 10-K. 1 TABLE OF CONTENTS Page No. PART I Item 1. Business 5 Item 1A. Risk Factors 19 Item 1B. Unresolved Staff Comments 43 Item 2. Properties 43 Item 3. Legal Proceedings 44 Item 4. Mine Safety Disclosures 44 PART II Item 5. Market for Registrant’s Common Equity, Related Stockholder Matters and Issuer Purchases of Equity 45 Securities Item 6. [Reserved] 46 Item 7. Management’s Discussion and Analysis of Financial Condition and Results of Operations 47 Item 7A. Quantitative and Qualitative Disclosures About Market Risk 67 Item 8. Financial Statements and Supplementary Data 69 Item 9. Changes in and Disagreements With Accountants on Accounting and Financial Disclosure 70 Item 9A. Controls and Procedures 70 Item 9B. Other Information 70 Item 9C. Disclosure Regarding Foreign Jurisdictions that Prevent Inspections 70 PART III Item 10. Directors, Executive Officers and Corporate Governance 71 Item 11. Executive Compensation 71 Item 12. Security Ownership of Certain Beneficial Owners and Management and Related Stockholder Matters 71 Item 13. Certain Relationships and Related Transactions, and Director Independence 71 Item 14. Principal Accounting Fees and Services 71 PART IV Item 15. Exhibits, Financial Statement Schedules 72 Item 16. Form 10-K Summary 125 2 FORWARD-LOOKING STATEMENTS This Annual Report on Form 10-K contains “forward-looking statements” within the meaning of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended. All statements other than statements of historical fact are “forward-looking statements” for purposes of federal and state securities laws, including any projections of earnings, revenue or other financial items; any statements of the plans, strategies and objectives of management, including for future operations, capital expenditures, or share repurchases; any statements concerning proposed new products, services, or developments; any statements regarding future economic conditions or performance; any statements of belief or expectation; and any statements of assumptions underlying any of the foregoing or other future events. Forward-looking statements may include, among other, the words “may,” “will,” “estimate,” “intend,” “continue,” “believe,” “expect,” “anticipate” or any other similar words. Although we believe that the expectations reflected in any of our forward-looking statements are reasonable, actual results or outcomes could differ materially from those projected or assumed in any of our forward-looking statements. Our future financial condition and results of operations, as well as any forward-looking statements, are subject to change and to inherent risks and uncertainties, many of which are beyond our control. Additionally, many of these risks and uncertainties are, and may continue to be, amplified by the COVID-19 pandemic. Important factors that could cause our actual results, performance and achievements, or industry results to differ materially from estimates or projections contained in or implied by our forward-looking statements include the following: • the potential impacts of the COVID-19 pandemic and current global economic conditions, including inflation, on us; our Members, customers, and supply chain; and the world economy; • our ability to attract and retain Members; • our relationship with, and our ability to influence the actions of, our Members; • our noncompliance with, or improper action by our employees or Members in violation of, applicable U.S. and foreign laws, rules, and regulations; • adverse publicity associated with our Company or the direct-selling industry, including our ability to comfort the marketplace and regulators regarding our compliance with applicable laws; • changing consumer preferences and demands and evolving industry standards, including with respect to climate change, sustainability, and other environmental, social, and governance, or ESG, matters; • the competitive nature of our business and industry; • legal and regulatory matters, including regulatory actions concerning, or legal challenges to, our products or network marketing program and product liability claims; • the Consent Order entered into with the FTC, the effects thereof and any failure to comply therewith; • risks associated with operating internationally and in China; • our ability to execute our growth and other strategic initiatives, including implementation of our Transformation Program and increased penetration of our existing markets; • any material disruption to our business caused by natural disasters, other catastrophic events, acts of war or terrorism, including the war in Ukraine, cybersecurity incidents, pandemics, and/or other acts by third parties; • our ability to adequately source ingredients, packaging materials, and other raw materials and manufacture and distribute our products; • our reliance on our information technology infrastructure; • noncompliance by us or our Members with any privacy laws, rules, or regulations or any security breach involving the misappropriation, loss, or other unauthorized use or disclosure of confidential information; • contractual limitations on our ability to expand or change our direct-selling business model; • the sufficiency of our trademarks and other intellectual property; • product concentration; • our reliance upon, or the loss or departure of any member of, our senior management team; • restrictions imposed by covenants in the agreements governing our indebtedness; 3 • risks related to our convertible notes; • changes in, and uncertainties relating to, the application of transfer pricing, income tax, customs duties, value added taxes, and other tax laws, treaties, and regulations, or their interpretation; • our incorporation under the laws of the Cayman Islands; and • share price volatility related to, among other things, speculative trading and certain traders shorting our common shares. Additional factors and uncertainties that could cause actual results or outcomes to differ materially from our forward-looking statements are set forth in this Annual Report on Form 10-K, including in Part I, Item 1A, Risk Factors, and Part II, Item 7, Management’s Discussion and Analysis of Financial Condition and Results of Operations, and in our Consolidated Financial Statements and the related Notes. In addition, historical, current, and forward-looking sustainability-related statements may be based on standards for measuring progress that are still developing, internal controls and processes that continue to evolve, and assumptions that are subject to change in the future. Forward-looking statements in this Annual Report on Form 10-K speak only as of the date hereof. We do not undertake any obligation to update or release any revisions to any forward-looking statement or to report any events or circumstances after the date hereof or to reflect the occurrence of unanticipated events, except as required by law. The Company “We,” “our,” “us,” “Company,” “Herbalife,” and “Herbalife Nutrition” refer to Herbalife Nutrition Ltd., a Cayman Islands exempted company incorporated with limited liability, and its subsidiaries. Herbalife Nutrition Ltd. is a holding company, with substantially all of its assets consisting of the capital stock of its direct and indirectly-owned subsidiaries. 4 PART I Item 1. Business GENERAL Herbalife Nutrition is a global nutrition company that provides health and wellness products to consumers in 95 markets, which consists of countries and territories, through our direct-selling business model. Our products are primarily in the categories of weight management, sports nutrition, and targeted nutrition. We use a direct-selling business model to distribute and market our nutrition products to and through a global network of independent members, or Members. Members include consumers who purchase products for their own personal use and distributors who wish to resell products or build a sales organization. We believe that direct selling is ideally suited for our business because the distribution and sales of our products with personalized support, coaching, and education provide a supportive and understanding community of like-minded people who prioritize health and nutrition. In addition to the effectiveness of personalized selling through a direct-selling business model, we believe the primary drivers for our success throughout our 43-year operating history have been enhanced consumer awareness and demand for our products due to global trends such as the obesity epidemic, increasing interest in a fit and active lifestyle, living healthier, and the rise of entrepreneurship. PRODUCT SALES Our science-backed products help Members and their customers improve their overall health, enhance their wellness, and achieve their fitness and sport goals. As of December 31, 2022, we marketed and sold approximately 131 product types. Our products are often sold as part of a program and therefore our portfolio is comprised of a series of related products designed to simplify weight management, health and wellness, and overall nutrition for our Members and their customers. Our Formula 1 Nutritional Shake Mix, our best-selling product line, approximated 26% of our net sales for the year ended December 31, 2022. The following table summarizes our products by product category: Percentage of Net Sales 2022 2021 2020 Description Representative Products Weight Management 56.8% 58.1% 59.8% Meal replacement, protein Formula 1 Healthy Meal, shakes, drink mixes, weight Herbal Tea Concentrate, loss enhancers and healthy Protein Drink Mix, snacks Personalized Protein Powder, Total Control®, Formula 2 Multivitamin Complex, Prolessa™ Duo, and Protein Bars Targeted Nutrition 29.1% 28.2% 27.6% Functional beverages and Herbal Aloe Concentrate, dietary and nutritional Active Fiber Complex, supplements containing Niteworks®, and quality herbs, vitamins, Herbalifeline® minerals and other natural ingredients Energy, Sports, and 10.6% 9.5% 7.9% Products that support a Herbalife24® product line, Fitness healthy active lifestyle N-R-G Tea, and Liftoff® energy drink Outer Nutrition 1.6% 1.9% 2.0% Facial skin care, body care, Herbalife SKIN line and and hair care Herbal Aloe Bath and Body Care line Literature, Promotional, 1.9% 2.3% 2.7% Start-up kits, sales tools, Herbalife Member Packs and Other and educational materials and BizWorks 5 Product returns and buyback policies We offer a customer satisfaction guarantee in substantially all markets where our products are sold. If for any reason a customer or preferred member is not satisfied with an Herbalife Nutrition product, they may return it or any unused portion of the product within 30 days from the time of receipt for a full refund or credit toward the exchange of another Herbalife Nutrition product. In addition, in substantially all markets, we maintain a buyback program pursuant to which we will purchase back unsold products from a Member who decides to leave the business. Subject to certain terms and conditions that may vary by market, the buyback program generally permits a Member to return unopened products or sales materials in marketable condition purchased within the prior twelve- month period in exchange for a refund of the net price paid for the product and, in most markets, the cost of returning the products and materials to us. Together, product returns and buybacks were approximately 0.1% of net sales for each of the years ended December 31, 2022, 2021, and 2020. Product development Our products are focused on nutrition and seek to help consumers achieve their goals in the areas of weight management; targeted nutrition (including everyday wellness and healthy aging); energy, sports, and fitness; and outer nutrition. We believe our focus on nutrition and botanical science and the combination of our internal efforts with the scientific expertise of outside resources, including our ingredient suppliers, major universities, and our Nutrition Advisory Board, have resulted in product differentiation that has given our Members and consumers increased confidence in our products. We continue to invest in scientific and technical functions, including research and development associated with creating new or enhancing current product formulations and the advancement of personalized nutrition solutions; clinical studies of existing products or products in development; technical operations to improve current product formulations; quality assurance and quality control to establish the appropriate quality systems, controls, and standards; and rigorous ingredient and product testing to ensure compliance with regulatory requirements, as well as in the areas of regulatory and scientific affairs. Our personalized nutrition solutions include tools which aid in the development of optimal product packages specific to our customers’ individual nutritional needs, based on their expected wellness goals. Our product development strategy is twofold: (1) to increase the value of existing customers by investing in products that address customers’ health, wellness and nutrition considerations, fill perceived gaps in our portfolios, add flavors, increase convenience by developing products like snacks and bars, and expand afternoon and evening consumption with products like savory shakes or soups; and (2) to attract new customers by entering into new categories, offering more choices, increasing individualization, and expanding our current sports line. We have a keen focus on product innovation and aim to launch new products and variations on existing products on a regular basis. Once a particular market opportunity has been identified, our scientists, along with our operations, marketing, and sales teams, work closely with Member leadership to introduce new products and variations on existing products. Our Nutrition Advisory Board and Dieticians Advisory Board are comprised of leading experts around the world in the fields of nutrition and health who educate our Members on the principles of nutrition, physical activity, diet, and healthy lifestyle. We rely on the scientific contributions from members of our Nutrition Advisory Board and our in-house scientific team to continually upgrade existing products or introduce new products as new scientific studies become available and are accepted by regulatory authorities around the world. COMPETITION The nutrition industry is highly competitive. Nutrition products are sold through a number of distribution channels, including direct selling, online retailers, specialty retailers, and the discounted channels of food, drug and mass merchandise. Our competitors include companies such as Conagra Brands, Hain Celestial, and Post. Additionally, we compete for the recruitment of Members from other network marketing organizations, including those that market nutrition products and other entrepreneurial opportunities. Our direct-selling competitors include companies such as Nu Skin, Tupperware, and USANA. Our ability to remain competitive depends on many factors, including having relevant products that meet consumer needs, a rewarding compensation plan, enhanced education and tools, innovation in our products and services, competitive pricing, a strong reputation, and a financially viable company. We have differentiated ourselves from our competitors through our Members’ focus on the consultative sales process, which includes ongoing personal contact, coaching, behavior motivation, education, and the creation of supportive communities. For example, many Members have frequent contact with and provide support to their customers through a community-based approach to help them achieve nutrition goals. Some methods include Nutrition Clubs, Weight Loss Challenges, Wellness Evaluations, and Fit Camps. 6 For additional information regarding competition, see Part I, Item 1A, Risk Factors, of this Annual Report on Form 10-K. OUR NETWORK MARKETING PROGRAM General Our products are sold and distributed through a global direct selling business model which individuals may join to become a Member of our network marketing program. We believe that the one-on-one personalized service inherent in the direct-selling business model is ideally suited to marketing and selling our nutrition products. Sales of nutrition products are reinforced by the ongoing personal contact, coaching, behavior motivation, education, and the creation of supportive communities. This frequent, personal contact can enhance consumers’ nutritional and health education as well as motivate healthy behavioral changes in consumers to begin and maintain an active lifestyle through wellness and weight management programs. In addition, our Members consume our products themselves, and, therefore, can provide first-hand testimonials of the use and effectiveness of our products and programs to their customers. The personalized experience of our Members has served as a very powerful sales tool for our products. People become Herbalife Nutrition Members for a number of reasons. Many first start out as consumers of our products who want to lose weight or improve their nutrition, and are customers of our Members. Some later join Herbalife Nutrition and become Members themselves, which makes them eligible to purchase products directly from us, simply to receive a discounted price on products for them and their families. Some Members are interested in the entrepreneurial opportunity to earn compensation based on their own skills and hard work and join Herbalife Nutrition to earn part-time or full-time income. Our objective is sustainable growth in the sales of our products to our Members and their customers by increasing the productivity, retention and recruitment of our Member base through the structure of our network marketing program. Segmentation In many of our markets, including certain of our largest markets such as the United States, Mexico, and India, we have segmented our Member base into two categories: “preferred members” – who are consumers who wish to purchase product for their own household use, and “distributors” – who are Members who also wish to resell products or build a sales organization. This Member segmentation provides a clear differentiation between those interested in retailing our products or building a sales organization, and those simply consuming our products as discount customers. This distinction allows us to more effectively communicate and market to each group, and provides us with better information regarding our Members within the context of their stated intent and goals. As of December 31, 2022, we had approximately 6.2 million Members, including 2.9 million preferred members and 2.0 million distributors in the markets where we have established these two categories and 0.3 million sales representatives and independent service providers in China. The number of preferred members and distributors may change as a result of segmentation and/or conversion, and do not necessarily represent a change in the total number of Members. Any future change in the number of preferred members or distributors is not necessarily indicative of our future expected financial performance. Our Members We believe our Members are the most important differentiator as we go to market with our nutrition products, because of the one- on-one direct contact they have with their customers, along with the education, training and community support services that we believe help improve the nutrition habits of consumers. We work closely with our entrepreneurial Members to improve the sustainability of their businesses and to reach consumers. We require our Members to fairly and honestly market both our products and the Herbalife Nutrition business opportunity. Our relationship with our Members is key to our continued success as they allow us direct access to the voice of consumers. Many of our entrepreneurial Members identify and test new marketing efforts and programs developed by other Members and disseminate successful techniques to their sales organizations. For example, Members in Mexico developed businesses that became known as “Nutrition Clubs,” marketing techniques that improve the productivity and efficiency of our Members as well as the affordability of our weight loss products for their customers. Rather than buying several retail products, these businesses allow consumers to purchase and consume our products each day (a Member marketing technique we refer to as “daily consumption”), while continuing to benefit from the support and interaction with the Member as well as socializing with other customers in a designated location. Other programs to drive daily consumption, whether for weight management or for improved physical fitness, include Member- conducted weight loss contests, or Weight Loss Challenges, Member-led fitness programs, or Fit Camps, and Member-led Wellness Evaluations. We refer to successful Member marketing techniques that we disseminate throughout our Member network, such as Nutrition Clubs, Weight Loss Challenges, and Fit Camps, as Daily Methods of Operations, or DMOs. 7 We believe that personal and professional development is key to our Members’ success and, therefore, we and our sales leader Members – those that achieve certain levels within our Marketing Plan – have meetings and events to support this important objective. We and our Member leadership, which is comprised of sales leaders, conduct in-person and virtual training sessions on local, regional, and global levels attended by thousands of Members to provide updates on product education, sales and marketing training, and instruction on available tools. These events are opportunities to showcase and disseminate our Members’ evolving best marketing practices and DMOs from around the world and to introduce new or upgraded products. A variety of training and development tools are also available through online and mobile platforms. On July 18, 2002, we entered into an agreement with our Members that provides that we will continue to distribute Herbalife Nutrition products exclusively to and through our Members and that, other than changes required by applicable law or necessary in our reasonable business judgment to account for specific local market or currency conditions to achieve a reasonable profit on operations, we will not make any material changes to certain aspects of our Marketing Plan that are adverse to our Members without the support of our Member leadership. Specifically, any such changes would require the approval of at least 51% of our Members then at the level of President’s Team earning at the production bonus level of 6% who vote, provided that at least 50% of those Members entitled to vote do in fact vote. We initiate these types of changes based on the assessment of what will be best for us and our Members and then submit such changes for the requisite vote. We believe that this agreement has strengthened our relationship with our existing Members, improved our ability to recruit new Members and generally increased the long-term stability of our business. Member Compensation and Sales Leader Retention and Requalification In addition to benefiting from discounted prices, Members interested in the entrepreneurial opportunity may earn profit from several sources. First, Members may earn profits by purchasing our products at wholesale prices, discounted depending on the Member’s level within our Marketing Plan, and reselling those products at prices they establish for themselves to generate retail profit. Second, Members who sponsor other Members and establish, maintain, coach, and train their own sales organizations may earn additional income based on the sales of their organization, which may include royalty overrides, production bonuses, and other cash bonuses. Members earning such compensation have generally attained the level of sales leader as described below. There are also many Members, which include distributors, who have not sponsored another Member. Members who have not sponsored another Member are generally considered discount buyers or small retailers. While a number of these Members have also attained the level of sales leader, they do not receive additional income as do Members who have sponsored other Members. We assign point values, known as Volume Points, to each of our products to determine a Member’s level within the Marketing Plan. See Part II, Item 7, Management’s Discussion and Analysis of Financial Condition and Operating Results, of this Annual Report on Form 10-K for a further description of Volume Points. Typically, a Member accumulates Volume Points for a given sale at the time the Member pays for the product. However, since May 2017, a Member does not receive Volume Points for a transaction in the United States until that product is sold to a customer at a profit and it is documented in compliance with the consent order, or Consent Order, we entered into with the Federal Trade Commission, or the FTC, in 2016. The Member’s level within the Marketing Plan is used to determine the discount applied to their purchase of our products and whether they have qualified to become a sales leader. To become a sales leader, or qualify for a higher level within our Marketing Plan, Members must achieve specified Volume Point thresholds of product sales or earn certain amounts of royalty overrides during specified time periods and generally must re-qualify once each year. Qualification criteria vary somewhat by market. We have initial qualification methods of up to 12 months to encourage a more gradual qualification. We believe a gradual qualification approach is important to the success and retention of new sales leaders and benefits the business in the long term as it allows new Members to obtain product and customer experience as well as additional training and education on Herbalife Nutrition products, daily consumption based DMOs, and the business opportunity prior to becoming a sales leader. The basis for calculating Marketing Plan payouts varies depending on product and market: for 2022, we utilized on a weighted- average basis approximately 90% of suggested retail price, to which we applied discounts of up to 50% for distributor allowances and payout rates of up to 15% for royalty overrides, up to 7% for production bonuses, and approximately 1% for a cash bonus known as the Mark Hughes bonus. We believe that the opportunity for Members to earn royalty overrides and production bonuses contributes significantly to our ability to retain our most active and productive Members. Our Marketing Plan generally requires each sales leader to re-qualify for such status each year, prior to February, in order to maintain their 50% discount on products and be eligible to receive additional income. In February of each year, we demote from the rank of sales leader those Members who did not satisfy the re-qualification requirements during the preceding twelve months. The re- qualification requirement does not apply to new sales leaders (i.e. those who became sales leaders subsequent to the January re- qualification of the prior year). 8 As of December 31, 2022, prior to our February re-qualification process, approximately 772,000 of our Members have attained the level of sales leader, of which approximately 734,000 have attained this level in the 94 markets where we use our Marketing Plan and 38,000 independent service providers operating in our China business. See Business in China below for a description of our business in China. The table below reflects sales leader retention rates by year and by region: Sales Leader Retention Rate 2023 2022 2021 North America 69.7% 58.8% 70.8% Latin America (1) 71.6% 69.3% 67.0% EMEA 64.6% 77.1% 72.7% Asia Pacific 66.6% 66.5% 63.5% Total sales leaders 67.6% 68.9% 67.9% (1) The Company combined the Mexico and South and Central America regions into the Latin America region in 2022. Historical information has been reclassified to conform with the current period geographic presentation. For the latest twelve-month re-qualification period ending January 2023, approximately 67.6% of our sales leaders, excluding China, re-qualified, versus 68.9% for the twelve-month period ended January 2022. The Company throughout its history has adjusted the re-qualification criteria from time to time in response to evolving business objectives and market conditions, and the above results include the effects of all such changes. For example, in recent years certain markets have allowed members to utilize a lower re- qualification volume threshold and the Company has continued to expand this lower re-qualification method to additional markets. Separately, with revised business requirements in place following the Consent Order, as described in Network Marketing Program below, we utilize a re-qualification equalization factor for U.S. Members to better align their re-qualification thresholds with Members in other markets, and retention results for each of the years presented include the effect of the equalization factor. We believe this factor preserves retention rate comparability across markets. Also, for each of the years presented, the retention results exclude certain markets for which, due to local operating conditions, sales leaders were not required to requalify. We believe sales leader retention rates are the result of efforts we have made to try and improve the sustainability of sales leaders’ businesses, such as encouraging Members to obtain experience retailing Herbalife Nutrition products before becoming a sales leader and providing them with advanced technology tools, as well as reflecting market conditions. As our business operations evolve, including the segmentation of our Member base in certain markets and changes in sales leader re-qualification thresholds for other markets, management continues to evaluate the importance of sales leader retention rate information. The table below reflects the number of sales leaders as of the end of February of the year indicated (subsequent to the annual re- qualification process) and by region: Number of Sales Leaders 2022 2021 2020 North America 80,278 95,402 71,202 Latin America (1) 125,726 131,359 134,401 EMEA 183,056 158,153 130,438 Asia Pacific 201,137 173,582 158,815 Total sales leaders 590,197 558,496 494,856 China 33,486 68,301 70,701 Worldwide total sales leaders 623,683 626,797 565,557 (1) The Company combined the Mexico and South and Central America regions into the Latin America region in 2022. Historical information has been reclassified to conform with the current period geographic presentation. The number of sales leaders as of December 31 will exceed the number immediately subsequent to the preceding re-qualification period because sales leaders qualify throughout the year but sales leaders who do not re-qualify are removed from the rank of sales leader the following February. 9 Business in China Our business model in China includes unique features as compared to our traditional business model in order to ensure compliance with Chinese regulations. As a result, our business model in China differs from that used in other markets. Members in China are categorized differently than those in other markets. In China, we sell our products to and through independent service providers and sales representatives to customers and preferred customers, as well as through Company-operated retail platforms when necessary. In China, while multi-level marketing is not permitted, direct selling is permitted. Chinese citizens who apply and become Members are referred to as sales representatives. These sales representatives are permitted to sell away from fixed retail locations in the provinces where we have direct selling licenses, including in the provinces of Jiangsu, Guangdong, Shandong, Zhejiang, Guizhou, Beijing, Fujian, Sichuan, Hubei, Shanxi, Shanghai, Jiangxi, Liaoning, Jilin, Henan, Chongqing, Hebei, Shaanxi, Tianjin, Heilongjiang, Hunan, Guangxi, Hainan, Anhui, Yunnan, Gansu, Ningxia, and Inner Mongolia. In Xinjiang province, where we do not have a direct selling license, we have a Company-operated retail store that can directly serve customers and preferred customers. With online orderings throughout China, there has been a declining demand in Company-operated retail stores. Sales representatives receive scaled rebates based on the volume of products they purchase. Sales representatives who reach certain volume thresholds and meet certain performance criteria are eligible to apply to provide marketing, sales and support services. Once their application is accepted, they are referred to as independent service providers. Independent service providers are independent business entities that are eligible to receive compensation from Herbalife Nutrition for the marketing, sales and support services they provide so long as they satisfy certain conditions, including procuring the requisite business licenses, having a physical business location, and complying with all applicable Chinese laws and Herbalife Nutrition rules. In China, our independent service providers are compensated for marketing, sales support, and other services, instead of the Member allowances and royalty overrides utilized in our global Marketing Plan. The service hours and related fees eligible to be earned by the independent service providers are based on a number of factors, including the sales generated through them and through others to whom they may provide marketing, sales support and other services, the quality of their service, and other factors. Total compensation available to our independent service providers in China can generally be comparable to the total compensation available to other sales leaders globally. The Company does this by performing an analysis in our worldwide system to estimate the potential compensation available to the service providers, which can generally be comparable to that of sales leaders in other countries. After adjusting such amounts for other factors and dividing by each service provider’s hourly rate, we then notify each independent service provider the maximum hours of work for which they are eligible to be compensated in the given month. In order for a service provider to be paid, the Company requires each service provider to invoice the Company for their services. RESOURCES We seek to provide the highest quality products to our Members and their customers through our “seed to feed” strategy, which includes significant investments in obtaining quality ingredients from traceable sources, qualified by scientific personnel through product testing, and increasing the amount of self-manufacturing of our top products. Ingredients Our seed to feed strategy is rooted in using quality ingredients from traceable sources. Our procurement process for many of our botanical products now stretches back to the farms and includes self-processing of teas and herbal ingredients into finished raw materials at our own facilities. Our Changsha, China facility exclusively provides high quality tea and herbal raw materials to our manufacturing facilities as well as our third-party contract manufacturers around the world. We also source ingredients that we do not self-process from companies that are well-established, reputable suppliers in their respective field. These suppliers typically utilize similar quality processes, equipment, expertise, and having traceability as we do with our own modern quality processes. As part of our program to ensure the procurement of high-quality ingredients, we also test our incoming raw materials for compliance to potency, identity, and adherence to strict specifications. 10 Manufacturing The next key component of our seed to feed strategy involves the high-quality manufacturing of these ingredients into finished products, which are produced at both third-party manufacturers and our own manufacturing facilities. As part of our long-term strategy, we seek to expand and increase our self-manufacturing capabilities. Our manufacturing facilities, known as Herbalife Innovation and Manufacturing Facilities, or HIMs, include HIM Lake Forest, HIM Winston-Salem, HIM Suzhou, and HIM Nanjing. HIM Winston- Salem is currently our largest manufacturing facility at approximately 800,000 square feet. Together, our HIM manufacturing facilities produce approximately 51% of our inner nutrition products sold worldwide. Self-manufacturing also enables us greater control to reduce negative environmental impacts of our operations and supply chain. As described in the Sustainability section below, we are focused on developing science-based green-house gas emission reduction targets for our manufacturing facilities as part of our sustainability goals. We are also focused on reducing single-use plastics throughout our global distribution network and incorporating more sustainable content, such as post-consumer recycled resin, into our packaging. Our finished products are analyzed for label claims and tested for microbiological purity, thereby verifying that our products comply with food safety standards, meet label claims and have met other quality standards. For self-manufactured products, we conduct all of our testing in-house at our fully-equipped, modern quality control laboratories in the U.S. and China. We have two quality control laboratories in Southern California and Changsha, China (including a Center of Excellence in both locations). In addition, we also have a Center of Excellence laboratory in Bangalore, India, and a quality control laboratory in Winston-Salem, North Carolina, Suzhou, China, and Nanjing, China. All HIM quality control labs contain modern analytical equipment and are backed by the expertise in testing and methods development of our scientists. In our U.S. HIM facilities, which manufacture products for the U.S. and most of our international markets, we operate and adhere to the regulations established by the U.S. Food and Drug Administration, or FDA, and strict Current Good Manufacturing Practice regulations, or CGMPs, for food, acidified foods, and dietary supplements. We also work closely with our third-party manufacturers to ensure high quality products are produced and tested through a vigorous quality control process at approved contract manufacturer labs or third-party labs. For these products manufactured at other facilities, we combine four elements to ensure quality products: (1) the same selectivity and assurance in ingredients as noted above; (2) use of reputable, CGMP-compliant, quality- and sustainability-minded manufacturing partners; (3) supplier qualification through annual audit programs; and (4) significant product quality testing. During 2022, we purchased approximately 15% of our products from our top three third-party manufacturers. Infrastructure and Technology Our direct-selling business model enables us to grow our business with moderate investment in infrastructure and fixed costs. We incur no direct incremental cost to add a new Member in our existing markets, and our Member compensation varies directly with product sales. In addition, our Members also bear a portion of our consumer marketing expenses, and our sales leaders sponsor and coordinate Member recruiting and most meeting and training initiatives. Additionally, our infrastructure features scalable production and distribution of our products as a result of having our own manufacturing facilities and numerous third-party manufacturing relationships, as well as our global footprint of in-house and third-party distribution centers. An important part of our seed to feed strategy is having an efficient infrastructure to deliver products to our Members and their customers. As the shift in consumption patterns continues to reflect an increasing daily consumption focus, one focus of this strategy is to provide more product access points closer to our Members and their customers. We have both Company-operated and outsourced distribution points ranging from our “hub” distribution centers in Los Angeles, Memphis, and Venray, Netherlands, to mid-size distribution centers in major countries, to small pickup locations spread throughout the world. We also expect to continue to improve our distribution channels relating to home delivery as we expect to see continued increased demands for our products being shipped to our Members in certain of our larger markets. In addition to these distribution points, we partner with certain retail locations to provide Member pickup points in areas which are not well serviced by our distribution points. We have also identified a number of methods and approaches that better support Members by providing access points closer to where they do business and by improving product delivery efficiency through our distribution channels. Specific methods vary by markets and consider local Member needs and available resources. In aggregate, we have over 1,500 distribution points and partner retail locations around the world. In addition to our distribution points, we contract third party-run drop-off locations where we can ship to and Members can pick up ordered products. 11 We leverage our technology infrastructure in order to maintain, protect, and enhance existing systems and develop new systems to keep pace with continuing changes in technology, evolving industry and regulatory standards, emerging data security risks, and changing user patterns and preferences. We also continue to invest in our manufacturing and operational infrastructure to accelerate new products to market and accommodate planned business growth. We invest in business intelligence tools to enable better analysis of our business and to identify opportunities for growth. We will continue to build on these platforms to take advantage of the rapid development of technology around the globe to support a more robust Member and customer experience. In addition, we leverage an Oracle business suite platform to support our business operations, improve productivity and support our strategic initiatives. Our investment in technology infrastructure helps support our capacity to grow. In 2021, we also initiated a global transformation program to optimize global processes for future growth, or the Transformation Program. The Transformation Program involves the investment in certain new technologies and the realignment of infrastructure and the locations of certain functions to better support distributors and customers. The Transformation Program is still ongoing and expected to be completed in 2024 as described further in Part II, Item 7, Management’s Discussion and Analysis of Financial Condition and Operating Results, of this Annual Report on Form 10-K and Note 14, Transformation Program, to the Consolidated Financial Statements included in Part IV, Item 15, Exhibits, Financial Statement Schedules, of this Annual Report on Form 10-K. In addition, many Members rely on the use of technology to support their goals and businesses. As part of our continued investment in technology to further support our Members and drive long-term growth, we have enhanced our product access and distribution network to support higher volumes of online or mobile orders, allowing Members and their customers to select home or business delivery options. We have also implemented information technology systems to support Members and their increasing demand to be more connected to Herbalife Nutrition, their business, and their consumers with tools such as HN MyClub, Engage, HNconnect, BizWorks, MyHerbalife, GoHerbalife, and Herbalife.com. Additionally, we continue to support a growing suite of point-of-sale tools to assist our Members with ordering, tracking, and customer relationship management. These tools allow our Members to manage their business and communicate with their customers more efficiently and effectively. During 2022, we also commenced a Digital Technology Program to develop a new enhanced platform to provide enhanced digital capabilities and experiences to our Members. This is a multi-year program and we expect our capital expenditures to increase in 2023 and future years as result of our investments in this Digital Technology Program as described further in Part II, Item 7, Management’s Discussion and Analysis of Financial Condition and Operating Results, of this Annual Report on Form 10-K. Intellectual Property and Branding Marketing foods and supplement products on the basis of sound science means using ingredients in the composition and quantity as demonstrated to be effective in the relevant scientific literature. Use of these ingredients for their well-established purposes is by definition not novel, and for that reason, most food uses of these ingredients are not subject to patent protection. Notwithstanding the absence of patent protection, we do own proprietary formulations for substantially all of our weight management products and dietary and nutritional supplements. We take care in protecting the intellectual property rights of our proprietary formulas by restricting access to our formulas within the Company to those persons or departments that require access to them to perform their functions, and by requiring our finished goods suppliers and consultants to execute supply and non-disclosure agreements that contractually protect our intellectual property rights. Disclosure of these formulas, in redacted form, is also necessary to obtain product registrations in many countries. We also make efforts to protect certain unique formulations under patent law. We strive to protect all new product developments as the confidential trade secrets of the Company. We use the umbrella trademarks Herbalife®, Herbalife Nutrition®, and the Tri-Leaf design worldwide, and protect several other trademarks and trade names related to our products and operations, such as Niteworks® and Liftoff®. Our trademark registrations are issued through the United States Patent and Trademark Office, or USPTO, and comparable agencies in the foreign countries. We believe our trademarks and trade names contribute to our brand awareness. To increase our brand awareness, we and our Members use a variety of tools and marketing channels. These can include anything from traditional media to social media and alliances with partners who can promote our goal of better living through nutrition. Herbalife Nutrition sponsorships of and partnerships with featured athletes, teams, and events promote brand awareness and the use of Herbalife Nutrition products. We continue to build brand awareness with a goal towards becoming the most trusted brand in nutrition. We also work to leverage the power of our Member base as a marketing and brand-building tool. We maintain a brand style guide and brand asset library so that our Members have access to the Herbalife Nutrition brand logo and marketing materials for use in their marketing efforts. 12 Sustainability Our goals and objectives to nourish people and communities and to improve the planet are part of both our day-to-day activities and our long-term growth strategy. As a signatory of the United Nations Global Compact, or UNGC, we have aligned our sustainability initiatives outlined by the United Nations’ Sustainable Development Goals. Our current sustainability initiatives focus on issues including climate and emissions, packaging, and operational waste. For example, we have implemented projects that have reduced overall packaging materials and incorporated usage of recycled materials in the packaging of our flagship product, Formula 1 Healthy Meal Nutritional Shake in North America, Mexico, and in certain markets where permitted by regulations. We are seeking opportunities across operations to reduce waste-prone materials such as single-use plastics. More information on these efforts is provided in the Manufacturing section above. For information relating to our culture, diversity, equity, and inclusion, please see the Human Capital section below. REGULATION General In our United States and foreign markets, we are affected by extensive laws, governmental regulations, administrative determinations and guidance, court decisions and similar constraints that regulate the conduct of our business. Such laws, regulations and other constraints exist at the federal, state or local levels in the United States and at all levels of government in foreign jurisdictions, and include regulations pertaining to: (1) the formulation, manufacturing, packaging, labeling, distribution, importation, sale, and storage of our products; (2) product claims and advertising, including direct claims and advertising by us, as well as claims and advertising by Members, for which we may be held responsible; (3) our network marketing program; (4) transfer pricing and similar regulations that affect the level of U.S. and foreign taxable income and customs duties; (5) taxation of our Members (which in some instances may impose an obligation on us to collect the taxes and maintain appropriate records); (6) our international operations, such as import/export, currency exchange, repatriation and anti-bribery regulations; (7) antitrust issues; and (8) privacy and data protection. See Part I, Item 1A, Risk Factors, of this Annual Report on Form 10-K for additional information. Products In the United States, the formulation, manufacturing, packaging, holding, labeling, promotion, advertising, distribution, and sale of our products are subject to regulation by various federal governmental agencies, including: (1) the FDA; (2) the FTC; (3) the Consumer Product Safety Commission, or CPSC; (4) the United States Department of Agriculture, or USDA; (5) the Environmental Protection Agency, or EPA; (6) the United States Postal Service; (7) United States Customs and Border Protection; and (8) the Drug Enforcement Administration. Our activities also are regulated by various agencies of the states, localities and foreign countries in which our products are manufactured, distributed, or sold. The FDA, in particular, regulates the formulation, manufacture, and labeling of over-the-counter, or OTC, drugs, conventional foods, dietary supplements, and cosmetics such as those distributed by us. The majority of the products marketed by us in the United States are classified as conventional foods or dietary supplements under the Federal Food, Drug and Cosmetic Act, or FFDCA. Internationally, the majority of products marketed by us are classified as foods, health supplements, or food supplements. FDA regulations govern the preparation, packaging, labeling, holding, and distribution of foods, OTC drugs, cosmetics, and dietary supplements. Among other obligations, they require us and our contract manufacturers to meet relevant CGMP regulations for the preparation, packaging, holding, and distribution of OTC drugs and dietary supplements. The FDA also requires identity testing of all incoming dietary ingredients used in dietary supplements, unless a company successfully petitions for an exemption from this testing requirement in accordance with the regulations. The CGMPs are designed to ensure that OTC drugs and dietary supplements are not adulterated with contaminants or impurities, and are labeled to accurately reflect the active ingredients and other ingredients in the products. We have implemented a comprehensive quality assurance program that is designed to maintain compliance with the CGMPs for products manufactured by us or on our behalf for distribution in the United States. As part of this program, we have regularly implemented enhancements, modifications and improvements to our manufacturing and corporate quality processes. We believe that we and our contract manufacturers are compliant with the FDA’s CGMPs and other applicable manufacturing regulations in the United States. The U.S. Dietary Supplement Health and Education Act of 1994, or DSHEA, revised the provisions of FFDCA concerning the composition and labeling of dietary supplements. Under DSHEA, dietary supplement labeling may display structure/function claims that the manufacturer can substantiate, which are claims that the products affect the structure or function of the body, without prior FDA approval, but with notification to the FDA. They may not bear any claim that they can prevent, treat, cure, mitigate or diagnose disease (a drug claim). Apart from DSHEA, the agency permits companies to use FDA-approved full and qualified health claims for food and supplement products containing specific ingredients that meet stated requirements. 13 U.S. law also requires that all serious adverse events occurring within the United States involving dietary supplements or OTC drugs be reported to the FDA. We believe that we are in compliance with this law having implemented a worldwide procedure governing adverse event identification, investigation and reporting. As a result of reported adverse events, we may from time to time elect, or be required, to remove a product from a market, either temporarily or permanently. Some of the products marketed by us are considered conventional foods and are currently labeled as such. Within the United States, this category of products is subject to the federal Nutrition, Labeling and Education Act, or NLEA, and regulations promulgated under the NLEA. The NLEA regulates health claims, ingredient labeling and nutrient content claims characterizing the level of a nutrient in the product. The ingredients in conventional foods must either be generally recognized as safe by experts for the purposes to which they are put in foods, or be approved as food additives under FDA regulations. The federal Food Safety Modernization Act, or FSMA, is also applicable to some of our business. We follow a food safety plan and have implemented preventive measures required by the FSMA. Foreign suppliers of our raw materials are also subject to FSMA requirements, and we have implemented a verification program to comply with the FSMA. Dietary supplements manufactured in accordance with CGMPs and foods manufactured in accordance with the low acid food regulations are exempt. In foreign markets, prior to commencing operations and prior to making or permitting sales of our products in the market, we may be required to obtain an approval, license or certification from the relevant country’s ministry of health or comparable agency. Prior to entering a new market in which a formal approval, license or certificate is required, we work with local authorities in order to obtain the requisite approvals. The approval process generally requires us to present each product and product ingredient to appropriate regulators and, in some instances, arrange for testing of products by local technicians for ingredient analysis. The approvals may be conditioned on reformulation of our products, or may be unavailable with respect to some products or some ingredients. The FTC, which exercises jurisdiction over the advertising of all of our products in the United States, has in the past several years instituted enforcement actions against several dietary supplement and food companies and against manufacturers of weight loss products generally for false and misleading advertising of some of their products. In addition, the FTC has increased its scrutiny of the use of testimonials, which we also utilize, as well as the role of expert endorsers and product clinical studies. We cannot be sure that the FTC, or comparable foreign agencies, will not question our advertising or other operations in the future. In Europe, where an EU Health Claim regulation is in effect, the European Food Safety Authority, or EFSA, issued opinions following its review of a number of proposed claims documents. ESFA’s opinions, which have been accepted by the European Commission, have limited the use of certain nutrition-specific claims made for foods and food supplements. Accordingly, we revised affected product labels to ensure regulatory compliance. We are subject to a permanent injunction issued in October 1986 pursuant to the settlement of an action instituted by the California Attorney General, the State Health Director and the Santa Cruz County District Attorney. We consented to the entry of this injunction without in any way admitting the allegations of the complaint. The injunction prevents us from making specified claims in advertising of our products, but does not prevent us from continuing to make specified claims concerning our products, provided that we have a reasonable basis for making the claims. The injunction also prohibits certain recruiting-related investments from Members and mandates that payments to Members be premised on retail value (as defined); the injunction provides that we may establish a system to verify or document such compliance. Network Marketing Program Our network marketing program is subject to a number of federal and state regulations administered by the FTC and various state regulators as well as regulations in foreign markets administered by foreign regulators. Regulations applicable to network marketing organizations generally are directed at ensuring that product sales ultimately are made to consumers and that advancement within the organization is based on sales of the organization’s products rather than investments in the organization or other non-retail sales related criteria. When required by law, we obtain regulatory approval of our network marketing program or, when this approval is not required, the favorable opinion of local counsel as to regulatory compliance. 14 On July 15, 2016, we reached a settlement with the FTC and entered into a proposed Stipulation to Entry of Order for Permanent Injunction and Monetary Judgment, or the Consent Order, which resolved the FTC’s multi-year investigation of us. The Consent Order became effective on July 25, 2016, or the Effective Date, upon final approval by the U.S. District Court for the Central District of California. Pursuant to the Consent Order, we implemented and continue to enhance certain procedures in the U.S. and agreed to be subject to certain audits by an independent compliance auditor (Affiliated Monitors, Inc.) for a period of seven years. Among other requirements, the Consent Order requires us to categorize all existing and future Members in the U.S. as either “preferred members” – who are simply consumers who only wish to purchase product for their own household use — or “distributors” – who are Members who wish to resell some products or build a sales organization. We also agreed to compensate distributors on U.S. eligible sales within their downline organizations, which include purchases by preferred members, purchases by a distributor for his or her personal consumption within allowable limits and sales of product by a distributor to his or her customers. The Consent Order also requires distributors to meet certain conditions before opening Nutrition Clubs and/or entering into leases for their Herbalife Nutrition business in the United States. The Consent Order also prohibits us from making expressly or by implication, any misrepresentation regarding certain lifestyles or amount or level of income, including full-time or part-time income that a participant can reasonably expect to earn in our network marketing program. The Consent Order also prohibits us and other persons who act in active concert with us from misrepresenting that participation in the network marketing program will result in a lavish lifestyle and from using images or descriptions to represent or imply that participation in the program is likely to result in a lavish lifestyle. In addition, the Consent Order prohibits specified misrepresentations in connection with marketing the program, including misrepresentations regarding any fact material to participation such as the cost to participate or the amount of income likely to be earned. The Consent Order also requires us to clearly and conspicuously disclose information related to our refund and buyback policy on certain company materials and websites. The terms of the Consent Order do not change our going to market through direct selling by independent distributors, and compensating those distributors based upon the product they and their sales organization sell. We have implemented new and enhanced procedures required by the terms of the Consent Order and will continue to do so. We continue to monitor the impact of the Consent Order and our board of directors originally established the Implementation Oversight Committee in connection with monitoring compliance with the Consent Order, and more recently, our Audit Committee assumed oversight of continued compliance with the Consent Order. While we currently do not expect the Consent Order to have a long-term and material adverse impact on our business and our Member base, our business and our Member base, particularly in the U.S., have been in the past, and may in the future, be negatively impacted as we and they adjust to the changes. However, the terms of the Consent Order and the ongoing costs of compliance may adversely affect our business operations, our results of operations, and our financial condition. See Part I, Item 1A, Risk Factors, of this Annual Report on Form 10-K for a discussion of risks related to the settlement with the FTC. On January 4, 2018, the FTC released its nonbinding Business Guidance Concerning Multi-Level Marketing, or MLM Guidance. The MLM Guidance explains, among other things, lawful and unlawful compensation structures, the treatment of personal consumption by participants in determining if an MLM’s compensation structure is unfair or deceptive, and how an MLM should approach representations to current and prospective participants. We believe our current business practices, which include new and enhanced procedures implemented in connection with the Consent Order, are in compliance with the MLM Guidance. Additionally, the FTC has promulgated nonbinding Guides Concerning the Use of Endorsements and Testimonials in Advertising, or Guides, which explain how the FTC interprets Section 5 of the FTC Act’s prohibition on unfair or deceptive acts or practices. Consequently, the FTC could bring a Section 5 enforcement action based on practices that are inconsistent with the Guides. Under the Guides, advertisements that feature a consumer and convey his or her atypical experience with a product or service are required to clearly disclose the typical results that consumers can generally expect. The revised Guides also require advertisers to disclose connections between the advertiser and any endorsers that consumers might not expect, known as “material connections.” We have adapted our practices and rules regarding the practices of our Members to comply with the Guides and to comply with the Consent Order. We also are subject to the risk of private party challenges to the legality of our network marketing program both in the United States and internationally. For example, in Webster v. Omnitrition International, Inc., 79 F.3d 776 (9th Cir. 1996), the network marketing program of Omnitrition International, Inc., or Omnitrition, was challenged in a class action by Omnitrition distributors who alleged that it was operating an illegal “pyramid scheme” in violation of federal and state laws. We believe that our network marketing program satisfies federal and other applicable state statutes and case law. In some countries, regulations applicable to the activities of our Members also may affect our business because in some countries we are, or regulators may assert that we are, responsible for our Members’ conduct. In these countries, regulators may request or require that we take steps to ensure that our Members comply with local regulations. The types of regulated conduct include: (1) representations concerning our products; (2) income representations made by us and/or Members; (3) public media advertisements, which in foreign markets may require prior approval by regulators; (4) sales of products in markets in which the products have not been approved, licensed or certified for sale; and (5) classification by government agencies of our Members as employees of the Company. 15 In some markets, it is possible that improper product claims by Members could result in our products being reviewed by regulatory authorities and, as a result, being classified or placed into another category as to which stricter regulations are applicable. In addition, we might be required to make labeling changes. We also are subject to regulations in various foreign markets pertaining to social security assessments and employment and severance pay requirements. As an example, in some markets, we are substantially restricted in the amount and types of rules and termination criteria that we can impose on Members without having to pay social security assessments on behalf of the Members and without incurring severance obligations to terminated Members. In some countries, we may be subject to these obligations in any event. It is an ongoing part of our business to monitor and respond to regulatory and legal developments, including those that may affect our network marketing program. However, the regulatory requirements concerning network marketing programs do not include bright line rules and are inherently fact-based. An adverse judicial or regulatory determination with respect to our network marketing program could have a material adverse effect on our business, financial condition, and operating results and may also result in negative publicity, requirements to modify our network marketing program, or a negative impact on Member morale. In addition, adverse rulings by courts in any proceedings challenging the legality of network marketing systems, even in those not involving us directly, could have a material adverse effect on our operations. Although questions regarding the legality of our network marketing program have come up in the past and may come up from time to time in the future, we believe, based in part upon guidance to the general public from the FTC, that our network marketing program is compliant with applicable law. Income Tax, Transfer Pricing, and Other Taxes In many countries, including the United States, we are subject to income tax, transfer pricing and other tax regulations designed to ensure that appropriate levels of income are reported as earned by our U.S. and local entities and are taxed accordingly. In addition, our operations are subject to regulations designed to ensure that appropriate levels of customs duties are assessed on the importation of our products. Although we believe that we are in substantial compliance with all applicable tax rules, regulations, and restrictions, we are subject to the risk that governmental authorities could assert that additional taxes are owed based on findings of their audit. For example, we are currently subject to pending or proposed audits that are at various levels of review, assessment or appeal in a number of jurisdictions involving transfer pricing issues, income taxes, duties, value added taxes, withholding taxes and related interest and penalties in material amounts. In some circumstances, additional taxes, interest and penalties have been assessed, and we will be required to appeal or litigate to reverse the assessments. We have taken advice from our tax advisors and believe that there are substantial defenses to the allegations that additional taxes are owed, and we are vigorously defending against the imposition of additional proposed taxes. The ultimate resolution of these matters may take several years, and the outcome is uncertain. In the event that the audits or assessments are concluded adversely, we may or may not be able to offset or mitigate the consolidated effect of foreign income tax assessments through the use of U.S. foreign tax credits. The laws and regulations governing U.S. foreign tax credits are complex and subject to periodic legislative amendment, and there are restrictions on the utilization of U.S. foreign tax credits. Therefore, we cannot be sure that we would in fact be able to take advantage of any foreign tax credits in the future. Compliance Procedures As indicated above, Herbalife Nutrition, our products and our network marketing program are subject, both directly and indirectly through Members’ conduct, to numerous federal, state and local regulations, in the United States and foreign markets. In 1985, we began to institute formal compliance measures by developing a system to identify specific complaints against Members and to remedy any violations of Herbalife Nutrition’s rules by Members through appropriate sanctions, including warnings, fines, suspensions and, when necessary, terminations. We prohibit Members from making therapeutic claims for our products or misrepresentations regarding participating in our network marketing program, including in our manuals, seminars, and other training programs and materials. Our general policy is to reject Member applications from individuals who do not reside in one of our approved markets. 16 In order to comply with regulations that apply to both us and our Members, we research the applicable regulatory framework prior to entering any new market to identify necessary licenses and approvals and applicable limitations relating to our operations in that market and then work to bring our operations into compliance with the applicable limitations and to maintain such licenses. Typically, we conduct this research with the assistance of local legal counsel and other representatives. We also research laws applicable to Member operations and revise or alter our Member applications, rules, and other training materials and programs to provide Members with guidelines for operating their independent business, marketing and distributing our products and similar matters, as required by applicable regulations in each market. While we have rules and guidelines for our Members and monitor their market conduct, we are, however, unable to ensure that our Members will not distribute our products in countries where we have not commenced operations. In addition, regulations in existing and new markets often are ambiguous and subject to considerable interpretive and enforcement discretion by the responsible regulators. Moreover, even when we believe that we and our Members are in compliance with all applicable regulations, new regulations are being added regularly and the interpretation of existing regulations is subject to change. Further, the content and impact of regulations to which we are subject may be influenced by public attention directed at us, our products, or our network marketing program, so that extensive adverse publicity about us, our products, or our network marketing program may increase the likelihood regulatory scrutiny or action. HUMAN CAPITAL At Herbalife Nutrition, our commitment to improving lives and our communities is at the core of everything we do. This commitment also informs how we value and treat our employees. We seek to provide a work environment where employees can grow and thrive while supporting our Members and their customers. We believe attracting, developing, and retaining a talented and diverse workforce are critical factors that contribute to the success and growth of our business. We have operations globally, requiring investment to assess local labor market conditions and recruit and retain the appropriate workforce. Having a business presence in multiple domestic and international markets also requires us to monitor local labor and employment laws for which we often engage third-party advisors. We monitor the talent needs of our departments and functions with particular focus on the areas where human capital resources are important to daily operations to ensure we can timely manufacture, distribute, and sell products to our Members. As of December 31, 2022, we had approximately 10,100 employees, of which approximately 2,800 were located in the United States. Diversity, Equity, and Inclusion We believe diversity is a strength and embrace a core vision that a diverse, equitable, and inclusive culture is imperative to enable us to better serve our Members, stakeholders, and communities. As such, we seek to promote a work environment where all people can thrive, and are committed to diversity, equity, and inclusion, or DEI, at all levels, from our employees, management and executive leadership to our board of directors. Our DEI strategy is currently focused on creating opportunities to further recruit and support diverse talent at all levels, encouraging inclusion and belonging, and embedding equity throughout our culture and operations. Current initiatives include the implementation of a global applicant tracking system to deepen our commitment to fair recruitment processes, offering unconscious bias trainings for all employees, the expansion of existing employee networks which help employees build community and foster a culture of belonging, and further development and involvement of Global and Regional DEI Councils to drive DEI progress. Additionally, we have set diversity goals and targets for women in leadership roles globally and for racial and ethnic minorities in leadership roles in the U.S. Talent Acquisition and Development We seek to attract and retain a talented and diverse workforce. To foster an inclusive hiring process in the U.S., we use a tool that helps ensure that job descriptions do not unintentionally exclude potential applicants. Investment in our employees' professional growth and development is important and helps establish a strong foundation for long- term success. At our Company, we strive to create a learning culture, one in which development is an ongoing focus for all employees and managers. We invest in our employees’ development through a variety of programs. These programs are designed to help our employees grow professionally and strengthen their skills throughout their careers. Examples of these programs include the following: • Training Programs – We provide our employees access to an internal learning management system, Herbalife Nutrition University, which provides professional development courses, technical training, and compliance training to all employees globally. 17 • Mentorship Programs – The principle of servant leadership is a crucial part of our culture. We believe that one way to be a servant leader is to mentor others, and, in 2020, we introduced a new mentorship program to help guide junior employees in their professional journey. Through this program, participating employees can be provided with a one-on-one professional development opportunity, in which they receive dedicated coaching, feedback, and encouragement. • Educational Assistance – Another way we support employees’ continual professional development is by offsetting a portion of the cost of higher education. Program offerings and eligibility vary by region, but may include partial reimbursement of tuition fees incurred for undergraduate and graduate degrees, certificate programs, or skills-based courses. Compensation and Benefits Our Board of Directors and its Compensation Committee establish our general compensation philosophy and oversee and approve the development, adoption, and implementation of compensation policies and programs, which are set at a global level, but also adapted to meet local country requirements as needed. We provide base pay that aligns with employee positions, skill levels, experience, contributions, and geographic location. In addition to base pay, we seek to reward employees with annual incentive awards, recognition programs, and equity awards for employees at certain job grades. Our benefit programs are designed to enhance employee well-being and assist employees in the event of illness, injury, or disability. To this end, we offer benefits that vary worldwide, but may include health insurance, retirement savings programs, and wellness incentives designed to promote a healthy and active lifestyle. We believe we offer our employees wages and benefits packages that are in line with respective local labor markets and laws. Safety, Health, and Well-Being As a nutrition company, we believe the safety, health, and well-being of our employees is of the utmost importance. We endeavor to promote these principles by providing a safe and healthy work environment and encouraging healthy, active lifestyles. Our efforts to provide a safe workplace are guided by various formal policies and programs, which are designed to protect employees, contractors, and visitors from accidents, illnesses, and injuries, while operating in compliance with applicable regulations, including OSHA guidelines in the U.S. We also follow policies and programs regarding material health and safety risks, workplace violence prevention, and incident response and management. In the U.S., our manufacturing facilities in Winston-Salem and Lake Forest are ISO 45001 certified, an international standard for occupational health and safety management. While the COVID-19 pandemic has increased the resources required to keep our employees safe and healthy, we continue to make what we believe are the necessary investments to achieve this goal. In response to, and during various phases of, the pandemic, we have taken several actions, including supporting our employees to work from home when possible, offering mental and emotional wellness resources, and implementing safety measures when necessary at our facilities. Over the course of the pandemic, our senior management team has relied on cross-functional teams to monitor, review, and assess the evolving situation. These cross-functional teams are responsible for recommending risk mitigation actions based on the local risks and in accordance with regulatory requirements and guidelines for the health and safety of our employees and, in the U.S., protocols to align with all federal, state, and local public health guidelines. We believe our proactive efforts have been successful in supporting our business growth despite the obstacles and challenges presented by COVID-19. In addition, we believe in the importance of well-being and provide resources for our employees that support their pursuit of a healthy and active lifestyle. Our flagship wellness program in the U.S., “Wellness for Life,” offers employees a suite of activities to achieve overall wellness through improved fitness, nutrition, intellectual well-being, and financial literacy. The variety of activities offered ensures all employees may participate, no matter where they may be in their wellness journey. While we have many existing regional wellness programs, a new and enhanced global wellness program will launch in January 2023 and feature Herbalife fitness, health and nutrition experts from around the globe. We also have facilities and programs in place that allow employees to incorporate fitness into their daily schedule, such as onsite gyms at several facilities and live virtual classes. Our Members We are dependent on our Members to sell and promote our products to their customers. We frequently interact and work directly with our sales leaders to explore ways to support our and our Members’ businesses, and their customers’ personal goals of living a healthier and more active lifestyle. See the Our Network Marketing Program – Member Compensation and Sales Leader Retention and Requalification section above for sales leader and requalification metrics and further discussion on our sales leaders. 18 Available Information Our Internet website address is www.herbalife.com and our investor relations website is ir.herbalife.com. We make available free of charge on our website our Annual Reports on Form 10-K, Quarterly Reports on Form 10-Q, Current Reports on Form 8-K, proxy statements, and amendments to those reports filed or furnished pursuant to Section 13(a) or 15(d) of the Securities Exchange Act of 1934, as amended, or the Exchange Act, as soon as reasonably practical after we file such material with, or furnish it to, the Securities and Exchange Commission, or SEC. The SEC maintains an Internet website that contains reports, proxy and information statements, and other information regarding issuers that file electronically with the SEC at www.sec.gov. We also make available free of charge on our investor relations website at ir.herbalife.com our Principles of Corporate Governance, our Code of Conduct, and the Charters of our Audit Committee, Nominating and Corporate Governance Committee, Compensation Committee, and ESG Committee of our board of directors. Unless expressly noted, the information on our website, including our investor relations website, or any other website is not incorporated by reference in this Annual Report on Form 10-K and should not be considered part of this Annual Report on Form 10-K or any other filing we make with the SEC. Item 1A. Risk Factors Please carefully consider the following discussion of significant factors, events, and uncertainties that make an investment decision regarding our securities risky. The factors, events, uncertainties, and consequences discussed in these risk factors could, in circumstances we may not be able to accurately predict, recognize, or control, have a material adverse effect on our business, reputation, prospects, financial condition, operating results, cash flows, liquidity, and share price. These risk factors do not identify all risks that we face. We could also be affected by factors, events, or uncertainties that are not presently known to us or that we currently do not consider to present material risks. Additionally, the COVID-19 pandemic has amplified many of the other risks discussed below to which we are subject. We are unable to predict the duration and extent to which the pandemic and its related impacts will adversely impact our business, financial condition, and operating results as well as our share price. In addition, given the unpredictable, unprecedented, and fluid nature of the pandemic, it may also materially and adversely affect our business, financial condition, and operating results in ways that are not currently anticipated by or known to us or that we currently do not consider to present material risks. Risk Factor Summary This risk factor summary contains a high-level summary of certain of the principal factors, events and uncertainties that make an investment in our securities risky, including risks related to our business and industry, risks related to regulatory and legal matters, risks related to our international operations, risks related to our indebtedness and risks related to our common shares. The following summary is not complete and should be read together with the more detailed discussion of these and the other factors, events, and uncertainties set forth below before making an investment decision regarding our securities. The principal factors, events, and uncertainties that make an investment in our securities risky include the following: Risks Related to Our Business and Industry • Our failure to establish and maintain Member and sales leader relationships could negatively impact sales of our products and materially harm our business, financial condition, and operating results. • Because we cannot exert the same level of influence or control over our Members as we could if they were our employees, our Members could fail to comply with applicable law or our rules and procedures, which could result in claims against us that could materially harm our business, financial condition, and operating results. • Adverse publicity associated with our Company or the direct-selling industry could materially harm our business, financial condition, and operating results. • Our failure to compete successfully could materially harm our business, financial condition, and operating results. • Our contractual obligation to sell our products only through our Member network and to refrain from changing certain aspects of our Marketing Plan may limit our growth. • Our failure to appropriately respond to changing consumer trends, preferences, and demand for new products and product enhancements could materially harm our Member relationships, our Members’ customer relationships, and product sales or otherwise materially harm our business, financial condition, and operating results. • If we fail to further penetrate existing markets, the growth in sales of our products, along with our operating results could be negatively impacted. 19 • Since one of our products constitutes a significant portion of our net sales, significant decreases in consumer demand for this product or our failure to produce a suitable replacement, could materially harm our business, financial condition, and operating results. • Our business could be materially and adversely affected by natural disasters, other catastrophic events, acts of war or terrorism, cybersecurity incidents, pandemics, and/or other acts by third parties. • We depend on the integrity and reliability of our information technology infrastructure, and any related interruptions or inadequacies may have a material adverse effect on our business, financial condition, and operating results. • Disruption of supply, shortage, or increases in the cost of ingredients, packaging materials, and other raw materials as well as climate change could materially harm our business, financial condition, and operating results. • If any of our manufacturing facilities or third-party manufacturers fail to reliably supply products to us at required levels of quality or fail to comply with applicable laws, our financial condition and operating results could be materially and adversely impacted. • If we lose the services of members of our senior management team, our business, financial condition, and operating results could be materially harmed. • Our share price may be adversely affected by third parties who raise allegations about our Company. • ESG matters, including those related to climate change and sustainability, may have an adverse effect on our business, financial condition, and operating results and may damage our reputation. Risks Related to Regulatory and Legal Matters • Our products are affected by extensive regulations, and our failure or our Members’ failure to comply with any regulations could lead to significant penalties or claims, which could materially harm our financial condition and operating results. • Our network marketing program is subject to extensive regulation and scrutiny and any failure to comply, or alteration to our compensation practices in order to comply, with these regulations could materially harm our business, financial condition, and operating results. • We are subject to the Consent Order with the FTC, the effects of which, or any failure to comply therewith, could materially harm our business, financial condition, and operating results. • Our actual or perceived failure to comply with privacy and data protection laws, rules, and regulations could materially harm our business, financial condition, and operating results. • We are subject to material product liability risks, which could increase our costs and materially harm our business, financial condition, and operating results. • If we fail to protect our intellectual property, our ability to compete could be negatively affected, which could materially harm our financial condition and operating results. • If we infringe the intellectual property rights of others, our business, financial condition, and operating results could be materially harmed. • We may be held responsible for additional compensation, certain taxes, or assessments relating to the activities of our Members, which could materially harm our financial condition and operating results. Risks Related to Our International Operations • A substantial portion of our business is conducted in foreign jurisdictions, exposing us to the risks associated with international operations. • We are subject to the anti-bribery laws, rules, and regulations of the United States and the other foreign jurisdictions in which we operate. • If we do not comply with transfer pricing, customs duties VAT, and similar regulations, we may be subject to additional taxes, customs duties, interest, and penalties in material amounts, which could materially harm our financial condition and operating results. • Our business in China is subject to general, as well as industry-specific, economic, political, and legal developments and risks and requires that we utilize a modified version of the business model we use elsewhere in the world. • The United Kingdom’s exit from the European Union could adversely impact us. 20 Risks Related to Our Indebtedness • The terms and covenants in our existing indebtedness could limit our discretion with respect to certain business matters, which could harm our business, financial condition, and operating results. • The conversion or maturity of our convertible notes may adversely affect our financial condition and operating results, and their conversion into common shares could have a dilutive effect that could cause our share price to go down. Risks Related to Our Common Shares • Holders of our common shares may difficulties in protecting their interests because we are incorporated under Cayman Islands law. • Provisions of our articles of association and Cayman Islands law may impede a takeover or make it more difficult for shareholders to change the direction or management of the Company, which could reduce shareholders’ opportunity to influence management of the Company. • There is uncertainty as to shareholders’ ability to enforce certain foreign civil liabilities in the Cayman Islands. • U.S. Tax Reform may adversely impact certain U.S. shareholders of the Company. Risks Related to Our Business and Industry Our failure to establish and maintain Member and sales leader relationships could negatively impact sales of our products and materially harm our business, financial condition, and operating results. We distribute our products exclusively to and through our independent Members, and we depend on them directly for substantially all of our sales. To increase our revenue, we must increase the number and productivity of our Members. Accordingly, our success depends in significant part on our relationships with our sales leaders and our ability to recruit, retain, and motivate a large base of Members, including through an attractive compensation plan, the quality of our reputation, the maintenance of an attractive product portfolio, the breadth and quality of our Member services, and other incentives. The loss of a significant number of Members, changes to our network marketing program, our inability to respond to Member demand or generate sufficient interest in our business opportunities, products, or services, decreases in Member engagement, loss of Member or consumer confidence, or any legal or regulatory impact to our Members’ ability to conduct their business could negatively impact sales of our products and our ability to attract and retain Members, each of which could have a material adverse effect on our business, financial condition, and operating results. In our efforts to attract and retain Members, we compete with other direct-selling organizations. In addition, our Member organization has a high turnover rate, which is common in the direct-selling industry, in part because our Members, including our sales leaders, may easily enter and exit our network marketing program without facing a significant investment or loss of capital. For example, the upfront financial cost to become a Member is low, we do not have time or exclusivity requirements, we do not charge for any required training, and, in substantially all jurisdictions, we maintain a buyback program. We believe the COVID-19 pandemic could have an adverse impact on the pipeline of new Members and our Member turnover rate, and may impact our future net sales. See the COVID-19 Pandemic and Sales by Geographic Region sections in Part II, Item 7, Management’s Discussion and Analysis of Financial Condition and Results of Operations, of this Annual Report on Form 10-K for further discussion of the impacts of the COVID-19 pandemic on our business and results of operations. For additional information regarding sales leader retention rates, see Part I, Item 1, Business, of this Annual Report on Form 10-K. Because we cannot exert the same level of influence or control over our Members as we could if they were our employees, our Members could fail to comply with applicable law or our rules and procedures, which could result in claims against us that could materially harm our business, financial condition, and operating results. Our Members are independent contractors and, accordingly, we are not in a position to provide the same direction, motivation, and oversight as we could if Members were our employees. As a result, there can be no assurance that our Members will participate in our marketing strategies or plans, accept our introduction of new products, or comply with applicable legal requirements or our rules and procedures. 21 We are subject to extensive federal, state, local, and foreign laws, rules, and regulations that regulate our business, products, direct sales channel, and network marketing program. See the Regulation section of Part I, Item 1, Business, of this Annual Report on Form 10- K for additional information. While we have implemented policies and procedures designed to govern Member conduct and to protect the goodwill associated with Herbalife Nutrition, it can be difficult to enforce these policies and procedures because of our large number of Members and their status as independent contractors and because our policies and procedures differ by jurisdiction as a result of varying local legal requirements. In addition, although we train our Members and attempt to monitor our Members’ marketing materials, we cannot ensure that our Members will comply with applicable legal requirements or our policies and procedures or that such marketing materials or other Member practices comply with applicable laws, rules, and regulations. It is possible that a court could hold us liable for the actions of our Members, which could materially harm our business, financial condition, and operating results. Adverse publicity associated with our Company or the direct-selling industry could materially harm our business, financial condition, and operating results. Our reputation and the quality of our brand are critical to our business, and the size and success of our Member organization, our operating results, and our share price may be significantly affected by the public’s perception of Herbalife Nutrition and other direct- selling companies. This perception is dependent upon opinions concerning a number of factors, including: • the safety, quality, and efficacy of our products, as well as those of similar companies; • our Members; • our network marketing program or the attractiveness or viability of the financial opportunities it may provide; • the direct-selling business generally; • actual or purported failure by us or our Members to comply with applicable laws, rules, and regulations, including those regarding product claims and advertising, good manufacturing practices, the regulation of our network marketing program, the registration of our products for sale in our target markets, or other aspects of our business; • our commitment to ESG matters and our ESG practices; • the security of our information technology infrastructure; and • actual or alleged impropriety, misconduct, or fraudulent activity by any person formerly or currently associated with our Members or us. Adverse publicity concerning any of the foregoing whether or not accurate or resulting in investigation, enforcement, or other legal or regulatory actions or the imposition of fines, penalties, or other sanctions, could negatively impact our reputation, our ability to attract, motivate, and retain Members, and our ability to generate revenue. In addition, our Members’ and consumers’ perception of Herbalife Nutrition and our direct-selling business as well as similar companies can be significantly influenced by media attention, publicized scientific research or findings, product liability claims, and other publicity, whether or not it is legitimate. For example, as a result of the prevalence and marked increase in the use of blogs, social media platforms, and other forms of Internet-based communications, the opportunity for dissemination of information, both accurate and inaccurate, is seemingly limitless and readily available, and often does not provide any opportunity for correction or other redress. Adverse publicity that associates use of our products or any similar products with adverse effects, questions the quality or benefits of any such products, or claims that any such products are ineffective, inappropriately labeled, or have inaccurate instructions as to their use, could lead to lawsuits or other legal or regulatory challenges and could materially and adversely impact our reputation, the demand for our products, and our business, financial condition, and operating results. Adverse publicity relating to us has had, and could again have, a negative effect on our ability to attract, motivate, and retain Members, on consumer perception of Herbalife Nutrition, and on our share price. For example, the resulting adverse publicity from the 1986 permanent injunction entered in California caused a rapid, substantial loss of Members in the United States and a corresponding reduction in sales beginning in 1985. See also the risk factor titled “Our share price may be adversely affected by third parties who raise allegations about our Company.” We expect that adverse publicity will, from time to time, continue to negatively impact our business in particular markets and may adversely affect our share price. 22 Our failure to compete successfully could materially harm our business, financial condition, and operating results. The business of developing and marketing weight management and other nutrition and personal care products is highly competitive and sensitive to the introduction of new products and weight management plans, including various prescription drugs, which may rapidly capture a significant share of the market. Our competitors include numerous manufacturers; distributors; marketers; online, specialty, mass, and other retailers; and physicians that actively compete for the business of consumers both in the United States and abroad. Some of our competitors have longer operating histories, significantly greater resources, better-developed and more innovative sales and distribution channels and platforms, greater name recognition, and larger established customer bases than we do. Our present and future competitors may be able to offer products at lower prices or better withstand reductions in prices or other adverse economic or market conditions than we can; develop products that are comparable or superior to those we offer; adapt more quickly or effectively to new technologies, changing regulatory requirements, evolving industry trends and standards, and customer requirements than we can; and/or devote greater resources to the development, promotion, and sale of their products than we do. We are also subject to significant competition for the recruitment of Members from other direct-selling organizations, including those that market weight management products, dietary and nutritional supplements, personal care products, and other types of products, as well as those organizations in which former employees or Members are involved. In addition, because the industry in which we operate is not particularly capital intensive or otherwise subject to high barriers to entry, it is relatively easy for new competitors to emerge that will compete with us, including for our Members and their customers. Accordingly, competition may intensify and we may not be able to compete effectively in our markets. If we are not able to retain our Members and their customers or otherwise compete successfully, our business, financial condition, and operating results would be materially adversely affected. Our contractual obligation to sell our products only through our Member network and to refrain from changing certain aspects of our Marketing Plan may limit our growth. We are contractually prohibited from expanding our business by selling Herbalife Nutrition products through other distribution channels that may be available to our competitors, such as over the Internet, through wholesale sales, by establishing retail stores, or through mail order systems. To the extent legally permitted, an agreement we entered into with our Members provides assurances that we will not sell Herbalife Nutrition products worldwide through any distribution channel other than our network of Members. Since this is an open-ended commitment, there can be no assurance that we will be able to take advantage of innovative new distribution channels that are developed in the future or appropriately respond to consumer preferences as they continue to evolve. In addition, this agreement with our Members provides that we will not make any material changes adverse to our Members to certain aspects of our Marketing Plan that may negatively impact our Members without their approval as described in further detail below. For example, our agreement with our Members provides that we may increase, but not decrease, the discount percentages available to our Members for the purchase of products or the applicable royalty override percentages and production and other bonus percentages available to our Members at various qualification levels within our Member hierarchy. We may not modify the eligibility or qualification criteria for these discounts, royalty overrides, and production and other bonuses unless we do so in a manner to make eligibility and/or qualification easier than under the applicable criteria in effect as of the date of the agreement. Our agreement with our Members further provides that we may not vary the criteria for qualification for each Member tier within our Member hierarchy, unless we do so in such a way so as to make qualification easier. We reserved the right to make changes to our Marketing Plan without the consent of our Members in the event that changes are required by applicable law or are necessary in our reasonable business judgment to account for specific local market or currency conditions to achieve a reasonable profit on operations. In addition, we may initiate other changes that are adverse to our Members based on an assessment of what will be best for the Company and its Members. Under the agreement with our Members, these other adverse changes would then be submitted to our Member leadership for a vote. The vote would require the approval of at least 51% of our Members then at the level of President’s Team earning at the production bonus level of 6% who vote, provided that at least 50% of those Members entitled to vote do in fact vote. While we believe this agreement has strengthened our relationship with our existing Members, improved our ability to recruit new Members, and generally increased the long-term stability of our business, there can be no assurance that our agreement with our Members will not restrict our ability to adapt our Marketing Plan or our business to the evolving requirements of the markets in which we operate. As a result, our growth may be limited. 23 Our failure to appropriately respond to changing consumer trends, preferences, and demand for new products and product enhancements could materially harm our Member relationships, Members’ customer relationships, and product sales or otherwise materially harm our business, financial condition, and operating results. Our business is subject to rapidly changing consumer trends and preferences and product introductions, especially with respect to our nutrition products. Our continued success depends in part on our ability to anticipate and respond to these changes and introductions, and we may not respond or develop new products or product enhancements in a cost-effective, timely, or commercially appropriate manner, or at all, particularly while the COVID-19 pandemic persists. Current consumer trends and preferences have evolved and will continue to evolve as a result of, among other things, changes in consumer tastes; health, wellness, and nutrition considerations; competitive product and pricing pressures; changes in consumer preferences for certain sales channels; shifts in demographics; and concerns regarding the environmental and sustainability impact of the product manufacturing process. The success of our response to changing consumer trends and preferences and product introductions, including any new product offerings and enhancements, depends on a number of factors, including our ability to: • accurately anticipate consumer needs; • innovate and develop new products and product enhancements that meet these needs; • successfully commercialize new products and product enhancements; • price our products competitively; • manufacture and deliver our products in sufficient volumes, at our required levels of quality, and in a cost-effective and timely manner; and • differentiate our product offerings from those of our competitors and successfully respond to other competitive pressures, including technological advancements, evolving industry standards, and changing regulatory requirements. Our failure to accurately predict changes in consumer demand and technological advancements could negatively impact consumer opinion of our products or our business, which in turn could harm our Member relationships and the Members’ relationships with their customers, and cause a loss of sales. In addition, if we do not introduce new products or make enhancements to meet the changing needs of our Members and their customers in a cost-effective, timely, and commercially appropriate manner, or if our competitors release new products or product enhancements before we do, some of our product offerings could be rendered obsolete, which could cause our market share to decline and negatively impact our business, financial condition, and operating results. If we fail to further penetrate existing markets, the growth in sales of our products, along with our operating results, could be negatively impacted. The success of our business is to a large extent contingent on our ability to further penetrate existing markets, which is subject to numerous factors, many of which are out of our control. Our ability to increase market penetration may be limited by the finite number of persons in a given country inclined to pursue a direct-selling business opportunity or consumers aware of, or willing to purchase, Herbalife Nutrition products. Moreover, our growth in existing markets will depend upon increased brand awareness and improved training and other activities that enhance Member retention in our markets. While we have recently experienced significant growth in certain of our foreign markets, we cannot assure you that such growth levels will continue in the immediate or long-term future. Furthermore, our efforts to support growth in such foreign markets could be hampered to the extent that our infrastructure in such markets is deficient when compared to our infrastructure in our more developed markets, such as the United States. For example, there can be no assurances that we will be able to successfully manage expansion of manufacturing operations and a growing and dynamic sales force in China. If we are unable to effectively scale our supply chain and manufacturing infrastructure to support future growth in China or other foreign markets, our operations in such markets may be adversely impacted. Therefore, we cannot assure you that our general efforts to increase our market penetration and Member retention in existing markets will be successful. If we are unable to further penetrate existing markets, our business, financial condition, and operating results could materially suffer. Since one of our products constitutes a significant portion of our net sales, significant decreases in consumer demand for this product or our failure to produce a suitable replacement could materially harm our business, financial condition, and operating results. Our Formula 1 Healthy Meal, which is our best-selling product line, approximated 26% of our net sales for the year ended December 31, 2022. If consumer demand for this product decreases significantly or we cease offering this product without a suitable replacement, or if the replacement product fails to gain market acceptance, our business, financial condition, and operating results could be materially harmed. 24 Our business could be materially and adversely affected by natural disasters, other catastrophic events, acts of war or terrorism, cybersecurity incidents, pandemics, and/or other acts by third parties. We depend on the ability of our business to run smoothly, including the ability of Members to engage in their day-to-day selling and business building activities. In coordination with our suppliers, third-party manufacturers, and distributors, our ability to make and move our products reasonably unimpeded around the world is critical to our success. Any material disruption to our collective operations or supply, manufacturing, or distribution capabilities caused by unforeseen or catastrophic events, such as (i) natural disasters or severe weather conditions, including droughts, fires, floods, hurricanes, volcanic eruptions, and earthquakes; (ii) power loss or shortages; (iii) telecommunications or information technology infrastructure failures; (iv) acts or threats of war, terrorism, or other armed hostilities; (v) outbreaks of contagious diseases, epidemics, and pandemics; (vi) cybersecurity incidents, including intentional or inadvertent exposure of content perceived to be sensitive data; (vii) employee misconduct or error; and/or (viii) other actions by third parties and other similar disruptions, could materially adversely affect our ability to conduct business and our Members’ selling activities. For example, our operations in Central America were impacted in November 2020 when Hurricanes Eta and Iota made landfall in the region. The storms disrupted our supply chain transportation network and our ability to import product. In addition, our distribution center in Honduras experienced flooding, which damaged or destroyed product. Furthermore, our headquarters and one of our distribution facilities and manufacturing facilities are located in Southern California, an area susceptible to fires and earthquakes. Although the events in Central America did not have a material negative impact on our operations, we cannot make assurances that any future catastrophic events will not adversely affect our ability to operate our business or our financial condition and operating results. In addition, catastrophic events may result in significant cancellations or cessations of Member orders; contribute to a general decrease in local, regional, or global economic activity; directly impact our marketing, manufacturing, financial, or logistics functions; impair our ability to meet Member demands; harm our reputation; and expose us to significant liability, losses, and legal proceedings, any of which could materially and adversely affect our business, financial condition, and operating results. In March 2020, the World Health Organization declared the COVID-19 outbreak a global pandemic. The COVID-19 pandemic has significantly impacted health and economic conditions globally, disrupted global supply chains, and has adversely affected the Company’s business and that of its Members in certain of the Company’s markets and may continue to impact those markets or others in the future. Government, agency, and other regulatory recommendations, guidelines, mandates, and actions to address public health concerns, including restrictions on movement, public gatherings, and travel and restrictions on, or in certain cases outright prohibitions of, companies’ ability to conduct normal business operations, have and may continue to adversely affect our business. Although we have been classified as an essential business in most jurisdictions where we operate, there is no guarantee that this classification will not change. We may also be forced to or voluntarily elect to limit or cease operations in one or more markets for other reasons, such as the health and safety of our employees or because of disruptions in the operation of our supply chain and sources of supply. For example, it is possible that closures of our manufacturing facilities or those of our third-party contract manufacturers or suppliers could impact our distribution centers and our ability to manufacture and deliver products to our Members. In general, our inventory of products continues to be adequate to meet demand, but we do expect our supply chain and our ability to source and/or manufacture products will be negatively impacted if the negative effects of the pandemic continue for a prolonged period of time or worsen. The pandemic has had an adverse impact on our distribution channels and Members’ product access in some markets, which may, and in some cases will, continue until conditions improve. Our third-party contract manufacturers and suppliers and our Members’ businesses are also subject to many of the same risks and uncertainties related to the COVID-19 pandemic, as well as other pandemic-related risks and uncertainties that may not directly impact our operations, any of which could adversely affect demand for our products. For example, limitations on public gatherings have restricted our Members’ ability to hold meetings with their existing customers and to attract new customers. Significant limitations on cash transactions could also have an adverse effect on sales of products in certain markets. The COVID-19 pandemic has also adversely affected the economies and financial markets of many countries, at times causing a significant deceleration of or interruption to economic activity, which during various stages of the pandemic has reduced production, decreased demand for a broad variety of goods and services, diminished trade levels, and led to widespread corporate downsizing. We have also seen periods of significant disruption of and extreme volatility in the global capital markets, which could increase the cost of, or entirely restrict access to, capital. Further, while some countries have progressed in distributing COVID-19 vaccines to the general population, many countries have limited to no access to vaccines at this time. To the extent the global supply of vaccine remains limited or vaccination rates do not significantly increase, government restrictions in the countries with limited to no access or low vaccination rates may persist or increase and economic activity may remain at depressed levels in those countries or regions. 25 Despite the relaxation of pandemic-related constraints in certain markets, considerable uncertainty still surrounds the COVID-19 pandemic, its potential effects, and the extent and effectiveness of government responses to the pandemic. If the pandemic is not contained, or if new variants emerge or effective vaccines are not made available and utilized quickly enough, the adverse impacts of the COVID-19 pandemic could worsen, impacting all segments of the global economy, and result in a significant recession or worse. However, the unprecedented and sweeping nature of the COVID-19 pandemic makes it extremely difficult to predict how our business and operations will be affected in the long run. Further, the resumption of normal business operations after the disruptions caused by the COVID-19 pandemic may be delayed or constrained by the pandemic’s lingering effects on our Members, consumers, and third- party contract manufacturers and suppliers. Accordingly, our ability to conduct our business in the manner previously done or planned for the future could be materially and adversely affected, and any of the foregoing risks, or other cascading effects of the COVID-19 pandemic, or any other pandemic that may emerge in the future, that are not currently foreseeable, could materially and adversely affect our business, financial condition, and operating results. See the COVID-19 Pandemic and Sales by Geographic Region sections in Part II, Item 7, Management’s Discussion and Analysis of Financial Condition and Results of Operations, of this Annual Report on Form 10- K for further discussion of the impacts of the COVID-19 pandemic on our business and operating results. We depend on the integrity and reliability of our information technology infrastructure, and any related interruptions or inadequacies may have a material adverse effect on our business, financial condition, and operating results. Our business, including our ability to provide products and services to and manage our Members, depends on the performance and availability of our information technology infrastructure, including our core transactional systems. The most important aspect of our information technology infrastructure is the system through which we record and track Member sales, Volume Points, royalty overrides, bonuses, and other incentives. The failure of our information systems to operate effectively, or a breach in security of these systems, could adversely impact the promptness and accuracy of our product distribution and transaction processing. While we continue to invest in our information technology infrastructure, there can be no assurance that there will not be any significant interruptions to such systems, that the systems will be adequate to meet all of our business needs, or that the systems will keep pace with continuing changes in technology, legal and regulatory standards. Further, as discussed in Part II, Item 7, Management’s Discussion and Analysis of Financial Condition and Results of Operations, we recently commenced a Digital Technology Program to develop a new enhanced platform to provide enhanced digital capabilities and experiences to our Members. Our information technology infrastructure, as well as that of our Members and the other third parties with which we interact, may be damaged, disrupted, or breached or otherwise fail for a number of reasons, including power outages, computer and telecommunication failures, internal design, manual or usage errors, workplace violence or wrongdoing, or catastrophic events such as natural disasters, severe weather conditions, or acts of war or terrorism. In addition, numerous and evolving cybersecurity threats, including advanced and persistent cyberattacks, such as unauthorized attempts to access, disable, improperly modify, exfiltrate, or degrade our information technology infrastructure, or the introduction of computer viruses, malware, “phishing” emails, and other destructive software, and social engineering schemes, could compromise the confidentiality, availability, and integrity of our information technology infrastructure as well as those of the third parties with which we interact. These attacks may come from external sources, such as governments or hackers, or may originate internally from an employee or a third party with which we interact. We have been the target of, and may be the target of in the future, malicious cyberattacks, although to date none of these attacks have had a meaningful adverse impact on our business, financial condition, or operating results. The potential risk of cyberattacks may increase as we introduce new technology systems and services. Additionally, in response to the COVID-19 pandemic, many of our employees have been encouraged to work remotely, which may increase our exposure to significant systems interruptions, cybersecurity attacks, and otherwise compromise the integrity and reliability of our information technology infrastructure and our internal controls. Any disruptions to, or failures or inadequacies of, our information technology infrastructure that we may encounter in the future may result in substantial interruptions to our operations, expose us to significant liability, and may damage our reputation and our relationships with, or cause us to lose, our Members, especially if the disruptions, failures, or inadequacies impair our ability to track sales and pay royalty overrides, bonuses, and other incentives, any of which would harm our business, financial condition, and operating results. Any such disruptions, failures, or inadequacies could also create compliance risks under the Consent Order and result in penalties, fines, or sanctions under any applicable laws or regulations. Furthermore, it may be expensive or difficult to correct or replace any aspect of our information technology infrastructure in a timely manner, if at all, and we may have little or no control over whether any malfunctioning information technology services supplied to us by third parties are appropriately corrected, if at all. We have encountered, and may encounter in the future, errors in our software and our enterprise network, and inadequacies in the software and services supplied by certain of our vendors, although to date none of these errors or inadequacies have had a meaningful adverse impact on our business, financial condition or operating results. In addition, developments in technology are continuing to evolve and affecting all aspects of our business, including how we effectively manage our operations, interact with our Members and their customers, and commercialize opportunities that accompany the evolving digital and data driven economy. Therefore, one of our top priorities is to modernize our technology and data infrastructure by, among other things, creating more relevant and more personalized experiences wherever our systems interact with Members and their customers; and developing ways to create more powerful digital tools and capabilities for Members to enable them to grow their 26 businesses. These initiatives to modernize our technology and data infrastructure are expected to be implemented over the course of many years and to require significant investments. If these initiatives are not successful, our ability to attract and retain Members and their customers, increase sales, and reduce costs may be negatively affected. Further, these initiatives may be subject to cost overruns and delays and may cause disruptions in our operations. These cost overruns and delays and disruptions could adversely impact our business, financial condition, and operating results. Disruption of supply, shortage, or increases in the cost of ingredients, packaging materials, and other raw materials as well as climate change could materially harm our business, financial condition, and operating results. We and our third-party contract manufacturers depend on third-party suppliers to supply us with the various ingredients, packaging materials, and other raw materials that we use in the manufacturing and distribution of our products. Our business could be materially harmed if we experience operational difficulties with our third-party suppliers, such as increases in costs, reductions in the availability of materials or production capacity, errors in complying with specifications or applicable law, insufficient quality control, and failures to meet production or shipment deadlines. If we fail to develop or maintain our relationships with our third-party suppliers or if such suppliers cease doing business with us or go out of business, we could face difficulties in finding or transitioning to alternative suppliers that meet our standards. Many of the ingredients, packaging materials, and other raw materials we use are subject to fluctuations in availability and price due to a number of factors beyond our control, including crop size, ingredient, water, and land scarcity, market demand for raw materials, commodity market speculation, energy costs, currency fluctuations, supplier and logistics service capacities, import and export requirements, tariffs, and other government policies, and drought, excessive rain, temperature extremes, and other severe weather events. If we experience supply shortages, price increases, or supplier or regulatory impediments with respect to any of the materials we use in our products or packaging, we may need to seek alternative supplies or suppliers and may experience difficulties in finding replacements that are comparable in quality and price. For a discussion of the impacts of the COVID-19 pandemic on our supply chain see “If any of our manufacturing facilities or third-party manufacturers fail to reliably supply products to us at required levels of quality or fail to comply with applicable laws, our financial condition and operating results could be materially and adversely impacted” below. Further, the risks related to our ability to adequately source the materials required to meet our needs may be exacerbated by the effects of climate change and the legal, regulatory, or market measures that may be implemented to address climate change. There is growing concern that carbon dioxide and other greenhouse gases in the atmosphere may have an adverse impact on global temperatures, weather patterns, and the frequency and severity of extreme weather and natural disasters. If climate change has a negative effect on agricultural productivity, we may be subject to decreased availability or less favorable pricing for certain raw materials that are necessary for our products, such as soybeans, wheat, tea leaves, and nuts. Severe weather conditions and natural disasters can reduce crop size and crop quality, which in turn could reduce our supplies of raw materials, lower recoveries of usable raw materials, increase the prices of our raw materials, increase our cost of storing and transporting our raw materials, or disrupt production schedules. The impacts of climate change may also cause unpredictable water availability or exacerbate water scarcity. In addition, the increasing concern over climate change and related sustainability matters may also result in more federal, state, local, and foreign legal and regulatory requirements relating to climate change, which may significantly increase our costs of operation and delivery. 27
+
+USER:
+How does Herbalife's ""seed to feed"" strategy influence its product quality and sourcing?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,8,13,20903,,480
+"""================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Please summarize this article about new a eczema treatment. I would like bullet points with the important key features of the treatment. Include details about the researched probiotic and what it does for the skin. Keep the answer under 500 words/,"NIAID research has led to the availability of a new over-the-counter topical eczema probiotic. The probiotic is based on the discovery by scientists at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, that bacteria present on healthy skin called Roseomonas mucosa can safely relieve eczema symptoms in adults and children. R. mucosa-based topical interventions could simplify or complement current eczema management, when used in consultation with an individual's healthcare provider. A milestone for eczema sufferers, the availability of an R. mucosa-based probiotic is the result of seven years of scientific discovery and research in NIAID's Laboratory of Clinical Immunology and Microbiology (LCIM). Eczema-;also known as atopic dermatitis-;is a chronic inflammatory skin condition that affects approximately 20% of children and 10% of adults worldwide. The condition is characterized by dry, itchy skin that can compromise the skin's barrier, which functions to retain moisture and keep out allergens. This can make people with eczema more vulnerable to bacterial, viral and fungal skin infections. R. mucosa is a commensal bacterium, meaning it occurs naturally as part of a typical skin microbiome. Individuals with eczema experience imbalances in the microbiome and are deficient in certain skin lipids (oils). NIAID researchers demonstrated that R. mucosa can help restore those lipids. Scientists led by Ian Myles, M.D., M.P.H., chief of the LCIM Epithelial Research Unit, found specific strains of R. mucosa reduced eczema-related skin inflammation and enhanced the skin's natural barrier function in both adults and children. To arrive at this finding, Dr. Myles and colleagues spearheaded a spectrum of translational research on R. mucosa. They isolated and cultured R. mucosa in the laboratory, conducted preclinical (laboratory/animal) and clinical (human) studies, and made the bacteria available for commercial, non-therapeutic development. The R. mucosa-based probiotic released this week is formulated by Skinesa and called Defensin. In Phase 1/2 open-label and Phase 2 blinded, placebo-controlled clinical studies, most people experienced greater than 75% improvement in eczema severity following application of R. mucosa. Improvement was seen on all treated skin sites, including the inner elbows, inner knees, hands, trunk and neck. The researchers also observed improvement in skin barrier function. Additionally, most participants needed fewer corticosteroids to manage their eczema, experienced less itching, and reported a better quality of life following R. mucosa therapy. These benefits persisted after treatment ended: therapeutic R. mucosa strains remained on the skin for up to eight months in study participants who were observed for that duration. eBook: How to Implement Colony Picking Workflows eBook This eBook aims to assist scientists in selecting the most suitable automated colony-picking solution, taking into account the requirements for high throughput, various applications, and key challenges of the process. Download the latest edition To expand the potential use of R. mucosa, NIAID will conduct an additional clinical trial to generate further evidence on its efficacy in reducing eczema symptoms. Those data could form the basis of an application to the Food and Drug Administration to enable the product to be regulated as a nonprescription drug and made accessible to a broader population of people with eczema. Study results are expected in 2024. Source:","""================ <TEXT PASSAGE> ======= NIAID research has led to the availability of a new over-the-counter topical eczema probiotic. The probiotic is based on the discovery by scientists at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, that bacteria present on healthy skin called Roseomonas mucosa can safely relieve eczema symptoms in adults and children. R. mucosa-based topical interventions could simplify or complement current eczema management, when used in consultation with an individual's healthcare provider. A milestone for eczema sufferers, the availability of an R. mucosa-based probiotic is the result of seven years of scientific discovery and research in NIAID's Laboratory of Clinical Immunology and Microbiology (LCIM). Eczema-;also known as atopic dermatitis-;is a chronic inflammatory skin condition that affects approximately 20% of children and 10% of adults worldwide. The condition is characterized by dry, itchy skin that can compromise the skin's barrier, which functions to retain moisture and keep out allergens. This can make people with eczema more vulnerable to bacterial, viral and fungal skin infections. R. mucosa is a commensal bacterium, meaning it occurs naturally as part of a typical skin microbiome. Individuals with eczema experience imbalances in the microbiome and are deficient in certain skin lipids (oils). NIAID researchers demonstrated that R. mucosa can help restore those lipids. Scientists led by Ian Myles, M.D., M.P.H., chief of the LCIM Epithelial Research Unit, found specific strains of R. mucosa reduced eczema-related skin inflammation and enhanced the skin's natural barrier function in both adults and children. To arrive at this finding, Dr. Myles and colleagues spearheaded a spectrum of translational research on R. mucosa. They isolated and cultured R. mucosa in the laboratory, conducted preclinical (laboratory/animal) and clinical (human) studies, and made the bacteria available for commercial, non-therapeutic development. The R. mucosa-based probiotic released this week is formulated by Skinesa and called Defensin. In Phase 1/2 open-label and Phase 2 blinded, placebo-controlled clinical studies, most people experienced greater than 75% improvement in eczema severity following application of R. mucosa. Improvement was seen on all treated skin sites, including the inner elbows, inner knees, hands, trunk and neck. The researchers also observed improvement in skin barrier function. Additionally, most participants needed fewer corticosteroids to manage their eczema, experienced less itching, and reported a better quality of life following R. mucosa therapy. These benefits persisted after treatment ended: therapeutic R. mucosa strains remained on the skin for up to eight months in study participants who were observed for that duration. eBook: How to Implement Colony Picking Workflows eBook This eBook aims to assist scientists in selecting the most suitable automated colony-picking solution, taking into account the requirements for high throughput, various applications, and key challenges of the process. Download the latest edition To expand the potential use of R. mucosa, NIAID will conduct an additional clinical trial to generate further evidence on its efficacy in reducing eczema symptoms. Those data could form the basis of an application to the Food and Drug Administration to enable the product to be regulated as a nonprescription drug and made accessible to a broader population of people with eczema. Study results are expected in 2024. Source: https://www.news-medical.net/news/20240626/NIAID-scientists-discover-probiotic-treatment-for-eczema.aspx ================ <QUESTION> ======= Please summarize this article about new a eczema treatment. I would like bullet points with the important key features of the treatment. Include details about the researched probiotic and what it does for the skin. Keep the answer under 500 words/ ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""","""================ <TEXT PASSAGE> ======= [context document] ================ <QUESTION> ======= [user request] ================ <TASK> ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""
+
+EVIDENCE:
+NIAID research has led to the availability of a new over-the-counter topical eczema probiotic. The probiotic is based on the discovery by scientists at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, that bacteria present on healthy skin called Roseomonas mucosa can safely relieve eczema symptoms in adults and children. R. mucosa-based topical interventions could simplify or complement current eczema management, when used in consultation with an individual's healthcare provider. A milestone for eczema sufferers, the availability of an R. mucosa-based probiotic is the result of seven years of scientific discovery and research in NIAID's Laboratory of Clinical Immunology and Microbiology (LCIM). Eczema-;also known as atopic dermatitis-;is a chronic inflammatory skin condition that affects approximately 20% of children and 10% of adults worldwide. The condition is characterized by dry, itchy skin that can compromise the skin's barrier, which functions to retain moisture and keep out allergens. This can make people with eczema more vulnerable to bacterial, viral and fungal skin infections. R. mucosa is a commensal bacterium, meaning it occurs naturally as part of a typical skin microbiome. Individuals with eczema experience imbalances in the microbiome and are deficient in certain skin lipids (oils). NIAID researchers demonstrated that R. mucosa can help restore those lipids. Scientists led by Ian Myles, M.D., M.P.H., chief of the LCIM Epithelial Research Unit, found specific strains of R. mucosa reduced eczema-related skin inflammation and enhanced the skin's natural barrier function in both adults and children. To arrive at this finding, Dr. Myles and colleagues spearheaded a spectrum of translational research on R. mucosa. They isolated and cultured R. mucosa in the laboratory, conducted preclinical (laboratory/animal) and clinical (human) studies, and made the bacteria available for commercial, non-therapeutic development. The R. mucosa-based probiotic released this week is formulated by Skinesa and called Defensin. In Phase 1/2 open-label and Phase 2 blinded, placebo-controlled clinical studies, most people experienced greater than 75% improvement in eczema severity following application of R. mucosa. Improvement was seen on all treated skin sites, including the inner elbows, inner knees, hands, trunk and neck. The researchers also observed improvement in skin barrier function. Additionally, most participants needed fewer corticosteroids to manage their eczema, experienced less itching, and reported a better quality of life following R. mucosa therapy. These benefits persisted after treatment ended: therapeutic R. mucosa strains remained on the skin for up to eight months in study participants who were observed for that duration. eBook: How to Implement Colony Picking Workflows eBook This eBook aims to assist scientists in selecting the most suitable automated colony-picking solution, taking into account the requirements for high throughput, various applications, and key challenges of the process. Download the latest edition To expand the potential use of R. mucosa, NIAID will conduct an additional clinical trial to generate further evidence on its efficacy in reducing eczema symptoms. Those data could form the basis of an application to the Food and Drug Administration to enable the product to be regulated as a nonprescription drug and made accessible to a broader population of people with eczema. Study results are expected in 2024. Source:
+
+USER:
+Please summarize this article about new a eczema treatment. I would like bullet points with the important key features of the treatment. Include details about the researched probiotic and what it does for the skin. Keep the answer under 500 words/
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,49,41,523,,595
+Use information from the article only to explain your answer. Do not rely on outside knowledge.,What happened in the Obergefell v. Hodges case?,"Obergefell v. Hodges: Same-Sex Marriage Legalized Rodney M. Perry Legislative Attorney August 7, 2015 Congressional Research Service 7-5700 www.crs.gov R44143 Obergefell v. Hodges: Same-Sex Marriage Legalized Summary On June 26, 2015, the Supreme Court issued its decision in Obergefell v. Hodges requiring states to issue marriage licenses to same-sex couples and to recognize same-sex marriages that were legally formed in other states. In doing so, the Court resolved a circuit split regarding the constitutionality of state same-sex marriage bans and legalized same-sex marriage throughout the country. The Court’s decision relied on the Fourteenth Amendment’s equal protection and due process guarantees. Under the Fourteenth Amendment’s Equal Protection Clause, state action that classifies groups of individuals may be subject to heightened levels of judicial scrutiny, depending on the type of classification involved or whether the classification interferes with a fundamental right. Additionally, under the Fourteenth Amendment’s substantive due process guarantees, state action that infringes upon a fundamental right—such as the right to marry—is subject to a high level of judicial scrutiny. In striking down state same-sex marriage bans as unconstitutional in Obergefell, the Court rested its decision upon the fundamental right to marry. The Court acknowledged that its precedents have described the fundamental right to marry in terms of opposite-sex relationships. Even so, the Court determined that the reasons why the right to marry is considered fundamental apply equally to same-sex marriages. The Court thus held that the fundamental right to marry extends to samesex couples, and that state same-sex marriage bans unconstitutionally interfere with this right. Though the Supreme Court’s decision in Obergefell resolved the question of whether or not state same-sex marriage bans are unconstitutional, it raised a number of other questions. These include questions regarding, among other things, Obergefell’s broader impact on the rights of gay individuals; the proper level of judicial scrutiny applicable to classifications based on sexual orientation; what the decision might mean for laws prohibiting plural marriages; the Court’s approach to recognizing fundamental rights moving forward; and the proper level of judicial scrutiny applicable to governmental action interfering with fundamental rights. This report explores these questions. Congressional Research Service Obergefell v. Hodges: Same-Sex Marriage Legalized Contents General Constitutional Principles .................................................................................................... 1 Equal Protection ........................................................................................................................ 1 Substantive Due Process............................................................................................................ 3 The Supreme Court Invalidates State Same-Sex Marriage Bans in Obergefell ............................... 4 Implications of the Supreme Court’s Decision in Obergefell .......................................................... 6 Contacts Author Contact Information............................................................................................................. 8 Congressional Research Service Obergefell v. Hodges: Same-Sex Marriage Legalized O n June 26, 2015, the Supreme Court issued its decision in Obergefell v. Hodges legalizing same-sex marriage throughout the country by requiring states to issue marriage licenses to same-sex couples and to recognize same-sex marriages that were legally formed in other states. In doing so, the Court resolved a circuit split1 regarding the constitutionality of state same-sex marriage bans. This report provides background on, and analysis of, significant legal issues raised by the Supreme Court’s decision in Obergefell. It first offers background on the constitutional principles on which the Court relied in Obergefell to invalidate state same-sex marriage bans as unconstitutional. Then, it walks through the Court’s opinion and rationale. Finally, it discusses potential implications of the Court’s decision. General Constitutional Principles Equal Protection Under the Fourteenth Amendment’s Equal Protection Clause, “[n]o State shall … deny to any person within its jurisdiction the equal protection of the laws.”2 Though there is no parallel constitutional provision expressly prohibiting the federal government from denying equal protection of the law, the Supreme Court has held that equal protection principles similarly apply to the federal government.3 Under the Constitution’s equal protection guarantees, when courts review governmental action that distinguishes between classes of people, they apply different levels of scrutiny depending on the classification involved. The more suspect the government’s classification, or the more likely that the government’s classification was motivated by discrimination, the higher the level of scrutiny that courts will utilize in evaluating the government’s action.4 Increased scrutiny raises the likelihood that a court will find the action unconstitutional. Generally speaking, there are three such levels of scrutiny: (1) strict scrutiny; (2) intermediate scrutiny; and (3) rational basis review. Strict scrutiny is the most demanding form of judicial review. The Supreme Court has observed that strict scrutiny applies to governmental classifications that are constitutionally “suspect,” or that interfere with fundamental rights.5 In determining whether a classification is suspect, courts consider whether the classified group (1) has historically been subject to discrimination; (2) is a 11 Previously, the Fourth, Seventh, Ninth, and Tenth Circuits had struck down state same-sex marriage bans under equal protection or due process grounds after generally, though not uniformly, subjecting them to heightened levels of judicial scrutiny. Bostic v. Schaeffer, 760 F.3d 352 (4th Cir. 2014); Baskin v. Bogan, 766 F.3d 648 (7th Cir. 2014); Latta v. Otter, 771 F.3d 456 (9th Cir. 2014); Bishop v. Smith, 760 F.3d 1070 (10th Cir. 2014); Kitchen v. Herbert, 755 F.3d 1193 (10th Cir. 2014). Conversely, the Sixth Circuit had upheld state same-sex marriage bans and observed that such bans warrant the lowest level of judicial review. DeBoer v. Snyder, 772 F.3d 388 (6th Cir. 2014). 2 U.S. Const. amend. XIV, §1. 3 See Bolling v. Sharpe, 347 U.S. 497 (1954). More specifically, the Court has held that the Fifth Amendment’s guarantee of “due process of the law,” applicable to the federal government, incorporates equal protection guarantees. See id. at 500. 4 Compare City of Cleburne v. Cleburne Living Center, 473 U.S. 432 (1985) (holding that mental disability is not a “quasi-suspect” classification, and thus is entitled to rational basis review), with Graham v. Richardson, 403 U.S. 365 (1971) (holding that classifications based on alienage are “inherently suspect,” and are subject to strict scrutiny). 5 See Mass. Bd. of Retirement v. Murgia, 427 U.S. 307, 312 (1976); see also Heller v. Doe, 509 U.S. 312, 319 (1993). Congressional Research Service 1 Obergefell v. Hodges: Same-Sex Marriage Legalized minority group exhibiting an unchangeable characteristic that establishes the group as distinct; or (3) is inadequately protected by the political process.6 There are generally three governmental classifications that are suspect—those based on race, national origin, and alienage.7 When applying strict scrutiny to governmental action, reviewing courts consider whether the governmental action is narrowly tailored to a compelling government interest.8 The government bears the burden of proving the constitutional validity of its action under strict scrutiny, and, in doing so, must generally show that it cannot meet its goals via less discriminatory means.9 Intermediate scrutiny is less searching than strict scrutiny, though it subjects governmental action to more stringent inspection than rational basis review. Intermediate scrutiny applies to “quasisuspect” classifications such as classifications based on gender10 or illegitimacy.11 When reviewing courts apply intermediate scrutiny to governmental action, they determine whether the action is substantially related to achieving an important government interest.12 As with strict scrutiny, the government bears the burden of establishing the constitutional validity of its actions under intermediate scrutiny.13 Rational basis review is the least searching form of judicial scrutiny, and generally applies to all classifications that are not subject to heightened levels of scrutiny.14 For governmental action to survive rational basis review, it must be rationally related to a legitimate government interest.15 When evaluating governmental action under rational basis review, courts consider the legitimacy of any possible governmental purpose behind the action.16 That is, courts are not limited to considering the actual purposes behind the government’s action.17 Additionally, the governmental action needs only be a reasonable way of achieving a legitimate government purpose to survive rational basis review; it does not need to be the most reasonable way of doing so, or even more reasonable than alternatives.18 Accordingly, rational basis review is deferential to the government, and courts generally presume that governmental action that is subject to such review is 6 See Lyng v. Castillo, 477 U.S. 635, 638 (1986); see also United States v. Carolene Prods. Co., 304 U.S. 144, 152 n. 4 (1938). 7 Graham, 403 U.S. at 371-72 (“… the Court’s decisions have established that classifications based on alienage, like those based on nationality or race, are inherently suspect and subject to close judicial scrutiny.”). 8 Parents Involved in Cmty. Schs. v. Seattle Sch. Dist. No. 1, 551 U.S. 701, 720 (2007). 9 See Fisher v. University of Tex. at Austin, 133 S. Ct. 2411, 2420 (2014). 10 United States v. Virginia, 518 U.S. 515, 533 (1996); see Miss. Univ. for Women v. Hogan, 458 U.S. 718, 724 (1982). 11 Clark v. Jeter, 486 U.S. 456, 461 (1988) (“Between these extremes of rational basis review and strict scrutiny lies a level of intermediate scrutiny, which generally has been applied to discriminatory classifications based on sex or illegitimacy.”). 12 See Craig v. Boren, 429 U.S. 190, 198 (1976); see also Clark, 486 U.S. at 461. 13 Virginia, 518 U.S. at 533; see Miss. Univ. for Women, 458 U.S. at 724. 14 See Cleburne Living Center, 473 U.S at 440-42; see also Schweiker v. Wilson, 450 U.S. 221, 230 (1981). 15 See City of Cleburne, 473 U.S. at 440. 16 See Nordlinger v. Hahn, 505 U.S. 1, 15 (1992); see also Heller, 509 U.S. at 320. 17 See Nordlinger, 505 U.S. at 15; see also Heller, 509 U.S. at 320. 18 See Schweiker, 450 U.S. 221, 235 (1981) (observing that, under rational basis review, “[a]s long as the classificatory scheme chosen by Congress rationally advances a reasonable and identifiable governmental objective, we must disregard the existence of other methods of allocation that we, as individuals, perhaps would have preferred.”); see also Heller, 509 U.S. at 320 (observing that under rational basis review, “a classification ‘must be upheld against equal protection challenge if there is any reasonably conceivable state of facts that could provide a rational basis for the classification.’”) (quoting F.C.C. v. Beach Commc’ns, Inc., 508 U.S. 307, 312 (1993)). Congressional Research Service 2 Obergefell v. Hodges: Same-Sex Marriage Legalized constitutionally valid.19 Parties challenging governmental actions bear the burden of establishing their invalidity under rational basis review.20 Substantive Due Process The U.S. Constitution’s due process guarantees are contained within two separate clauses; one can be found in the Fifth Amendment, and the other resides in the Fourteenth Amendment. Each clause provides that the government shall not deprive a person of “life, liberty, or property, without due process of law.”21 However, the Fifth Amendment applies to action by the federal government, whereas the Fourteenth Amendment applies to state action.22 The Constitution’s due process language makes clear that the government cannot deprive individuals of life, liberty, or property without observing certain procedural requirements. The Supreme Court has interpreted this language to also include substantive guarantees that prohibit the government from taking action that unduly burdens certain liberty interests.23 More specifically, substantive due process protects against undue governmental infringement upon fundamental rights.24 In determining whether a right is fundamental, Supreme Court precedent looks to whether the right was historically and traditionally recognized, and whether failing to recognize the right would contravene liberty and justice.25 The Supreme Court has held that governmental action infringing upon fundamental rights is subject to strict scrutiny,26 and thus must be narrowly tailored to a compelling government interest.27 Under strict scrutiny, the government must generally show that it has a “substantial” and “legitimate” need for its action to be in furtherance of a compelling government interest.28 If the government successfully establishes a compelling interest, its action cannot encumber fundamental rights any more than is necessary to achieve the government’s need.29 Additionally, the government could not have possibly taken alternative action that would similarly further its interest while being less burdensome on fundamental rights.30 Otherwise, the government’s action is not narrowly tailored to the government’s interest.31 The Supreme Court has recognized a 19 See Beach Commc’ns, Inc., 508 U.S. at 315; see also Murgia, 427 U.S. at 315. Heller, 509 U.S. at 320 (noting that, when reviewing a governmental classification under rational basis review, a governmental action is “presumed constitutional,” and the burden lies on the party attacking the governmental action to establish the action’s unconstitutionality.). 21 U.S. Const. amend. XIV, §1; U.S. Const. amend. V. 22 See U.S. Const. amend. XIV, §1; U.S. Const. amend. V. 23 See Washington v. Glucksberg, 521 U.S. 702, 719-720 (1997). 24 See id. 25 See id. at 720. 26 See Reno v. Flores, 507 U.S. 292, 301-02 (1993). 27 Id. (observing that a line of Supreme Court cases interprets the Fifth Amendment’s and Fourteenth Amendment’s due process principles to “forbid[] the government to infringe certain ‘fundamental’ liberty interests at all … unless the infringement is narrowly tailored to serve a compelling state interest.”). 28 San Antonio Indep. School Dist. v. Rodriguez, 411 U.S. 1, 98 (1973). 29 See Dunn v. Blumstein, 405 U.S. 330, 343 (1972). 30 Id. (“if there are other, reasonable ways to achieve [government interests] with a lesser burden on constitutionally protected activity, a State may not choose the way of greater interference. If it acts at all, it must choose ‘less drastic means.’”) (quoting Shelton v. Tucker, 364 U.S. 479, 488 (1960)). 31 See id. 20 Congressional Research Service 3 Obergefell v. Hodges: Same-Sex Marriage Legalized number of rights as fundamental, including the right to have children,32 use contraception,33 and marry.34 In Obergefell, the Court considered whether the Fourteenth Amendment’s substantive due process guarantees require states to issue marriage licenses to same-sex couples and require states to recognize same-sex marriages that were legally formed in other states. The Supreme Court Invalidates State Same-Sex Marriage Bans in Obergefell The Supreme Court resolved a circuit split on the constitutionality of state same-sex marriage bans, finding them unconstitutional in Obergefell v. Hodges. In doing so, the Court relied on the Constitution’s due process and equal protection principles to hold that states must issue marriage licenses to same-sex couples and recognize same-sex marriages that were legally formed in other states. The majority in Obergefell rested its decision upon the fundamental right to marry. The Court observed that it has long found the right to marry to be constitutionally protected, though it acknowledged that its precedent describing the right presumed an opposite-sex relationship.35 Even so, according to the Court, these cases have identified reasons why the right to marry is fundamental,36 which apply equally to same-sex couples. 37 These reasons included (1) personal choice in whom to marry is inherent in the concept of individual autonomy; (2) marriage’s unique support and recognition of a two-person, committed union; (3) the safeguarding of children within a marriage, as both same-sex couples and opposite-sex couples have children; and (4) marriage as a keystone of the nation’s social order, with no distinction between same-sex couples and opposite-sex couples in states conferring benefits and responsibilities upon marriages.38 Accordingly, the Court extended the fundamental right to marry to same-sex couples. In holding that the fundamental right to marry includes same-sex couples’ right to marry, the Court appeared to acknowledge its departure from precedent for determining whether a right is fundamental—mentioned earlier in this report—which considers whether it is “deeply rooted in this Nation’s history and tradition and implicit in the concept of ordered liberty.”39 The Court observed that if rights were defined by who could historically use them, old practices could continuously prevent new groups from exercising fundamental rights.40 As such, the Court found that “rights come not from ancient sources alone. They rise, too, from a better informed 32 Skinner v. Okla., 316 U.S. 535 (1942). Griswold v. Connecticut, 381 U.S. 479 (1965). 34 Loving v. Virginia, 388 U.S. 1 (1967). 35 Obergefell, 135 S.Ct. at 2598. 36 Id. 37 Id. at 2599. 38 Id. at 2599-2601. 39 Glucksberg, 512 U.S. at 720. 40 Obergefell, 135 S. Ct. at 2602 (“If rights were defined by who exercised them in the past, then received practices could serve as their own continued justification and new groups could not invoke rights once denied.”). 33 Congressional Research Service 4 Obergefell v. Hodges: Same-Sex Marriage Legalized understanding of how constitutional imperatives define a liberty that remains urgent in our own era.”41 After determining that the fundamental right to marry includes the right of same-sex couples to marry, the Court also seemed to depart from precedent—and the approaches of courts of appeals that relied on the fundamental right to marry to strike down state same-sex marriage bans—by not applying strict scrutiny to such bans. As previously noted, courts generally subject governmental action that infringes upon a fundamental right to strict scrutiny, requiring that the action be narrowly tailored to a compelling government interest to be constitutional.42 The states had argued two primary interests for their bans on same-marriage: (1) the desire to wait and see how the same-sex marriage debate progresses before changing long-existing marriage norms; and (2) incentivizing procreating couples to stay together during child rearing. However, the Court made no mention of whether the state same-sex marriage bans at issue were narrowly tailored to these justifications. Rather, the Court noted why these justifications were invalid without appearing to apply any of the typical levels of judicial review (i.e., rational basis review, intermediate scrutiny, or strict scrutiny).43 The Court held that both equal protection and due process guarantees protect the fundamental right to marry, and that states can no longer deny this right to same-sex couples.44 Importantly, in doing so, the Court did not hold that classifications based on sexual orientation warrant any form of heightened scrutiny. In fact, the Court made no mention of the proper level of scrutiny applicable to such classifications. Some of the dissenting Justices in Obergefell thought that the majority exceeded the Court’s proper role by removing the question of whether same-sex couples have the right to marry from the democratic process, where, they stated, it is properly resolved.45 According to these Justices, the five-person majority should not have resolved the hotly contested issue of same-sex marriage for the entire country; such resolution should have come from the people.46 The dissenting Justices also voiced concern with the majority looking beyond history and tradition to establish a fundamental right contrary to Supreme Court precedent.47 According to the dissenting Justices, the requirement that fundamental rights be rooted in tradition and history exists to prevent the Court from imparting its policy decisions regarding which rights have constitutional protection.48 41 Id. See Flores, 507 U.S. at 301-02. 43 See Obergefell, 135 S. Ct. at 2605-07. 44 Id. at 2604. 45 Id. at 2612, 2615 (Roberts, J., dissenting). 46 See id. 47 See id. at 2617. 48 See id. 42 Congressional Research Service 5 Obergefell v. Hodges: Same-Sex Marriage Legalized Implications of the Supreme Court’s Decision in Obergefell Although the Supreme Court answered questions surrounding the constitutionality of state samesex marriage bans in Obergefell, its decision raised a number of other questions. These include questions regarding, among other things, Obergefell’s broader impact on the rights of gay individuals; the proper level of judicial scrutiny applicable to classifications based on sexual orientation; what the decision might mean for laws prohibiting plural marriages; the Court’s approach to recognizing fundamental rights moving forward; and the proper level of judicial scrutiny applicable to governmental action interfering with fundamental rights. This section briefly explores these questions. Obergefell raised questions about the decision’s broader impact on the rights of gay individuals— that is, whether its rationale extends rights to gay individuals outside of the marriage context. However, the decision appears limited to the marriage context. Although the majority opinion did make reference to same-sex marriage bans implicating equal protection guarantees, its holding rested entirely on such bans infringing upon the fundamental right to marry in violation of both equal protection and due process guarantees. The Court did not mention whether classifications based on sexual orientation are suspect or quasi-suspect, and thus warrant any form of heightened scrutiny. If the Court had rendered such a holding, its decision would have arguably had broader implications for the rights of gay individuals, as it would have potentially subjected all governmental action that classifies based on sexual orientation to a heightened form of judicial scrutiny. Prior to Obergefell, federal appeals courts were split regarding the proper level of judicial scrutiny applicable to governmental action that classifies based on sexual orientation. The U.S. Court of Appeals for the Ninth Circuit (Ninth Circuit) has held that classifications based on sexual orientation warrant heightened scrutiny, though it did not clarify whether this heightened scrutiny was intermediate or strict scrutiny.49 The U.S. Court of Appeals for the Second Circuit (Second Circuit) has similarly found that classifications based on sexual orientation are quasisuspect, and thus any governmental action that classifies based on sexual orientation is subject to intermediate scrutiny.50 Conversely, however, the U.S. Court of Appeals for the Sixth Circuit (Sixth Circuit) has held that governmental action that classifies based on sexual orientation is neither suspect nor quasi-suspect, and thus subject only to rational basis review.51 Because the Court’s decision in Obergefell rested on the fundamental right to marry—and therefore seems limited to the marriage context—nothing in the opinion appears to resolve the circuit split between the Second, Sixth, and Ninth Circuits regarding the correct level of scrutiny applicable to classifications based on sexual orientation. Other lower courts will be left to grapple with this issue in the future. This ambiguity leaves open the possibility that, moving forward, circuit courts could either, like the Second and Ninth Circuits, apply heightened scrutiny to laws that classify based on sexual orientation (e.g., laws that provide exemptions from antidiscrimination legislation for religious entities based on their objections to certain sexual 49 See Latta, 771 F.3d at 468. Windsor v. United States, 699 F.3d 169, 185 (2nd Cir. 2012). 51 Davis v. Prison Health Servs., 679 F.3d 433, 438 (6th Cir. 2012). 50 Congressional Research Service 6 Obergefell v. Hodges: Same-Sex Marriage Legalized orientations), or could apply rational basis review to such laws like the Sixth Circuit. The fact that some lower courts may apply heightened scrutiny to government action that classifies based on sexual orientation where other courts may not is significant because, as discussed earlier in this report, laws subject to higher levels of scrutiny are more likely to be found unconstitutional. As such, this could create a situation wherein similar laws that classify based on sexual orientation receive dissimilar outcomes when facing constitutional challenge, depending on the evaluating court. The Supreme Court’s decision in Obergefell also raised questions regarding whether the Court’s rationale could potentially extend the fundamental right to marry to polygamy. In fact, Chief Justice John Roberts, in his dissent in Obergefell, seems to suggest that the majority’s opinion could lead to the legalization of plural marriages.52 However, the majority’s opinion seems crafted so as to try to limit its reach to the same-sex marriage context, in a possible attempt to prevent its rationale from extending the fundamental right to marry to plural marriages. As previously discussed, the majority in Obergefell found that the four reasons why the right to marry is fundamental apply equally to same-sex couples, and thus extended the fundamental right to marry to same-sex couples. Some commentators have observed that there are distinctions between plural marriages and same-sex marriages sufficient to prevent Obergefell’s rationale from being extended to legalize plural marriage.53 Conversely, other commentators have observed that parts of the Court’s opinion discussing why the fundamental right to marry includes same-sex marriage (e.g., the majority’s consideration of individual autonomy and family) could potentially provide basis for extending constitutional protections to plural marriages.54 Additionally, the majority in Obergefell seemingly departed from precedent for determining whether a right is fundamental by looking beyond historical and traditional recognition. This deviation from prior cases raises the possibility that, when determining whether a right is fundamental in the future, the Court will consider how the right is viewed at the time, in addition to its historical and traditional recognition. This could have the effect of expanding the number of rights that are deemed fundamental for purposes of substantive due process protections. Finally, the Court did not clarify which, if any, of the typical levels of judicial review (i.e., rational basis review, intermediate scrutiny, or strict scrutiny) it applied to state same-sex marriage bans after finding that such bans interfere with same-sex couples’ fundamental right to marry. Moving forward, this raises questions regarding the proper level of judicial scrutiny 52 See Obergefell, 135 S. Ct. at 2621 (“It is striking how much of the majority’s reasoning would apply with equal force to the claim of a fundamental right to plural marriage.”). 53 See, e.g., Joanna L. Grossman and Lawrence M. Friedman, Is Three Still a Crowd? Polygamy and the Law After Obergefell v. Hodges, JUSTIA, July 7, 2015, https://verdict.justia.com/2015/07/07/is-three-still-a-crowd-polygamy-andthe-law-after-obergefell-v-hodges (observing that, to win in court, polygamists must “convince a court that the justification for allowing same-sex couples to marry applies with equal force to a person who wants multiple spouses,” and questioning whether the four “main reasons for recognizing the right of same-sex couples to marry” apply to polygamists); see also Richard A. Posner, The Chief Justice’s Dissent is Heartless, Slate, June 27, 2015, http://www.slate.com/articles/news_and_politics/the_breakfast_table/features/2015/scotus_roundup/ supreme_court_gay_marriage_john_roberts_dissent_in_obergefell_is_heartless.html. 54 See, e.g., William Baude, Is Polygamy Next?, N. Y. TIMES, July 21, 2015, http://www.nytimes.com/2015/07/21/ opinion/is-polygamy-next.html?mabReward=CTM&action=click&pgtype=Homepage&region=CColumn&module= Recommendation&src=rechp&WT.nav=RecEngine; see also Jonathan Turley, The Trouble with the ‘Dignity’ of SameSex Marriage, Wash. Post, July 2, 2015, https://www.washingtonpost.com/opinions/the-trouble-with-the-dignity-ofsame-sex-marriage/2015/07/02/43bd8f70-1f4e-11e5-aeb9-a411a84c9d55_story.html. Congressional Research Service 7 Obergefell v. Hodges: Same-Sex Marriage Legalized applicable to governmental action that infringes upon fundamental rights. Given that increased scrutiny decreases the likelihood that a court will find government action constitutional, this could create ambiguity regarding the degree to which the government can permissibly take action that interferes with fundamental rights. Author Contact Information Rodney M. Perry Legislative Attorney rperry@crs.loc.gov, 7-5203 Congressional Research Service 8","Use information from the article only to explain your answer. Do not rely on outside knowledge. What happened in the Obergefell v. Hodges case? Obergefell v. Hodges: Same-Sex Marriage Legalized Rodney M. Perry Legislative Attorney August 7, 2015 Congressional Research Service 7-5700 www.crs.gov R44143 Obergefell v. Hodges: Same-Sex Marriage Legalized Summary On June 26, 2015, the Supreme Court issued its decision in Obergefell v. Hodges requiring states to issue marriage licenses to same-sex couples and to recognize same-sex marriages that were legally formed in other states. In doing so, the Court resolved a circuit split regarding the constitutionality of state same-sex marriage bans and legalized same-sex marriage throughout the country. The Court’s decision relied on the Fourteenth Amendment’s equal protection and due process guarantees. Under the Fourteenth Amendment’s Equal Protection Clause, state action that classifies groups of individuals may be subject to heightened levels of judicial scrutiny, depending on the type of classification involved or whether the classification interferes with a fundamental right. Additionally, under the Fourteenth Amendment’s substantive due process guarantees, state action that infringes upon a fundamental right—such as the right to marry—is subject to a high level of judicial scrutiny. In striking down state same-sex marriage bans as unconstitutional in Obergefell, the Court rested its decision upon the fundamental right to marry. The Court acknowledged that its precedents have described the fundamental right to marry in terms of opposite-sex relationships. Even so, the Court determined that the reasons why the right to marry is considered fundamental apply equally to same-sex marriages. The Court thus held that the fundamental right to marry extends to samesex couples, and that state same-sex marriage bans unconstitutionally interfere with this right. Though the Supreme Court’s decision in Obergefell resolved the question of whether or not state same-sex marriage bans are unconstitutional, it raised a number of other questions. These include questions regarding, among other things, Obergefell’s broader impact on the rights of gay individuals; the proper level of judicial scrutiny applicable to classifications based on sexual orientation; what the decision might mean for laws prohibiting plural marriages; the Court’s approach to recognizing fundamental rights moving forward; and the proper level of judicial scrutiny applicable to governmental action interfering with fundamental rights. This report explores these questions. Congressional Research Service Obergefell v. Hodges: Same-Sex Marriage Legalized Contents General Constitutional Principles .................................................................................................... 1 Equal Protection ........................................................................................................................ 1 Substantive Due Process............................................................................................................ 3 The Supreme Court Invalidates State Same-Sex Marriage Bans in Obergefell ............................... 4 Implications of the Supreme Court’s Decision in Obergefell .......................................................... 6 Contacts Author Contact Information............................................................................................................. 8 Congressional Research Service Obergefell v. Hodges: Same-Sex Marriage Legalized O n June 26, 2015, the Supreme Court issued its decision in Obergefell v. Hodges legalizing same-sex marriage throughout the country by requiring states to issue marriage licenses to same-sex couples and to recognize same-sex marriages that were legally formed in other states. In doing so, the Court resolved a circuit split1 regarding the constitutionality of state same-sex marriage bans. This report provides background on, and analysis of, significant legal issues raised by the Supreme Court’s decision in Obergefell. It first offers background on the constitutional principles on which the Court relied in Obergefell to invalidate state same-sex marriage bans as unconstitutional. Then, it walks through the Court’s opinion and rationale. Finally, it discusses potential implications of the Court’s decision. General Constitutional Principles Equal Protection Under the Fourteenth Amendment’s Equal Protection Clause, “[n]o State shall … deny to any person within its jurisdiction the equal protection of the laws.”2 Though there is no parallel constitutional provision expressly prohibiting the federal government from denying equal protection of the law, the Supreme Court has held that equal protection principles similarly apply to the federal government.3 Under the Constitution’s equal protection guarantees, when courts review governmental action that distinguishes between classes of people, they apply different levels of scrutiny depending on the classification involved. The more suspect the government’s classification, or the more likely that the government’s classification was motivated by discrimination, the higher the level of scrutiny that courts will utilize in evaluating the government’s action.4 Increased scrutiny raises the likelihood that a court will find the action unconstitutional. Generally speaking, there are three such levels of scrutiny: (1) strict scrutiny; (2) intermediate scrutiny; and (3) rational basis review. Strict scrutiny is the most demanding form of judicial review. The Supreme Court has observed that strict scrutiny applies to governmental classifications that are constitutionally “suspect,” or that interfere with fundamental rights.5 In determining whether a classification is suspect, courts consider whether the classified group (1) has historically been subject to discrimination; (2) is a 11 Previously, the Fourth, Seventh, Ninth, and Tenth Circuits had struck down state same-sex marriage bans under equal protection or due process grounds after generally, though not uniformly, subjecting them to heightened levels of judicial scrutiny. Bostic v. Schaeffer, 760 F.3d 352 (4th Cir. 2014); Baskin v. Bogan, 766 F.3d 648 (7th Cir. 2014); Latta v. Otter, 771 F.3d 456 (9th Cir. 2014); Bishop v. Smith, 760 F.3d 1070 (10th Cir. 2014); Kitchen v. Herbert, 755 F.3d 1193 (10th Cir. 2014). Conversely, the Sixth Circuit had upheld state same-sex marriage bans and observed that such bans warrant the lowest level of judicial review. DeBoer v. Snyder, 772 F.3d 388 (6th Cir. 2014). 2 U.S. Const. amend. XIV, §1. 3 See Bolling v. Sharpe, 347 U.S. 497 (1954). More specifically, the Court has held that the Fifth Amendment’s guarantee of “due process of the law,” applicable to the federal government, incorporates equal protection guarantees. See id. at 500. 4 Compare City of Cleburne v. Cleburne Living Center, 473 U.S. 432 (1985) (holding that mental disability is not a “quasi-suspect” classification, and thus is entitled to rational basis review), with Graham v. Richardson, 403 U.S. 365 (1971) (holding that classifications based on alienage are “inherently suspect,” and are subject to strict scrutiny). 5 See Mass. Bd. of Retirement v. Murgia, 427 U.S. 307, 312 (1976); see also Heller v. Doe, 509 U.S. 312, 319 (1993). Congressional Research Service 1 Obergefell v. Hodges: Same-Sex Marriage Legalized minority group exhibiting an unchangeable characteristic that establishes the group as distinct; or (3) is inadequately protected by the political process.6 There are generally three governmental classifications that are suspect—those based on race, national origin, and alienage.7 When applying strict scrutiny to governmental action, reviewing courts consider whether the governmental action is narrowly tailored to a compelling government interest.8 The government bears the burden of proving the constitutional validity of its action under strict scrutiny, and, in doing so, must generally show that it cannot meet its goals via less discriminatory means.9 Intermediate scrutiny is less searching than strict scrutiny, though it subjects governmental action to more stringent inspection than rational basis review. Intermediate scrutiny applies to “quasisuspect” classifications such as classifications based on gender10 or illegitimacy.11 When reviewing courts apply intermediate scrutiny to governmental action, they determine whether the action is substantially related to achieving an important government interest.12 As with strict scrutiny, the government bears the burden of establishing the constitutional validity of its actions under intermediate scrutiny.13 Rational basis review is the least searching form of judicial scrutiny, and generally applies to all classifications that are not subject to heightened levels of scrutiny.14 For governmental action to survive rational basis review, it must be rationally related to a legitimate government interest.15 When evaluating governmental action under rational basis review, courts consider the legitimacy of any possible governmental purpose behind the action.16 That is, courts are not limited to considering the actual purposes behind the government’s action.17 Additionally, the governmental action needs only be a reasonable way of achieving a legitimate government purpose to survive rational basis review; it does not need to be the most reasonable way of doing so, or even more reasonable than alternatives.18 Accordingly, rational basis review is deferential to the government, and courts generally presume that governmental action that is subject to such review is 6 See Lyng v. Castillo, 477 U.S. 635, 638 (1986); see also United States v. Carolene Prods. Co., 304 U.S. 144, 152 n. 4 (1938). 7 Graham, 403 U.S. at 371-72 (“… the Court’s decisions have established that classifications based on alienage, like those based on nationality or race, are inherently suspect and subject to close judicial scrutiny.”). 8 Parents Involved in Cmty. Schs. v. Seattle Sch. Dist. No. 1, 551 U.S. 701, 720 (2007). 9 See Fisher v. University of Tex. at Austin, 133 S. Ct. 2411, 2420 (2014). 10 United States v. Virginia, 518 U.S. 515, 533 (1996); see Miss. Univ. for Women v. Hogan, 458 U.S. 718, 724 (1982). 11 Clark v. Jeter, 486 U.S. 456, 461 (1988) (“Between these extremes of rational basis review and strict scrutiny lies a level of intermediate scrutiny, which generally has been applied to discriminatory classifications based on sex or illegitimacy.”). 12 See Craig v. Boren, 429 U.S. 190, 198 (1976); see also Clark, 486 U.S. at 461. 13 Virginia, 518 U.S. at 533; see Miss. Univ. for Women, 458 U.S. at 724. 14 See Cleburne Living Center, 473 U.S at 440-42; see also Schweiker v. Wilson, 450 U.S. 221, 230 (1981). 15 See City of Cleburne, 473 U.S. at 440. 16 See Nordlinger v. Hahn, 505 U.S. 1, 15 (1992); see also Heller, 509 U.S. at 320. 17 See Nordlinger, 505 U.S. at 15; see also Heller, 509 U.S. at 320. 18 See Schweiker, 450 U.S. 221, 235 (1981) (observing that, under rational basis review, “[a]s long as the classificatory scheme chosen by Congress rationally advances a reasonable and identifiable governmental objective, we must disregard the existence of other methods of allocation that we, as individuals, perhaps would have preferred.”); see also Heller, 509 U.S. at 320 (observing that under rational basis review, “a classification ‘must be upheld against equal protection challenge if there is any reasonably conceivable state of facts that could provide a rational basis for the classification.’”) (quoting F.C.C. v. Beach Commc’ns, Inc., 508 U.S. 307, 312 (1993)). Congressional Research Service 2 Obergefell v. Hodges: Same-Sex Marriage Legalized constitutionally valid.19 Parties challenging governmental actions bear the burden of establishing their invalidity under rational basis review.20 Substantive Due Process The U.S. Constitution’s due process guarantees are contained within two separate clauses; one can be found in the Fifth Amendment, and the other resides in the Fourteenth Amendment. Each clause provides that the government shall not deprive a person of “life, liberty, or property, without due process of law.”21 However, the Fifth Amendment applies to action by the federal government, whereas the Fourteenth Amendment applies to state action.22 The Constitution’s due process language makes clear that the government cannot deprive individuals of life, liberty, or property without observing certain procedural requirements. The Supreme Court has interpreted this language to also include substantive guarantees that prohibit the government from taking action that unduly burdens certain liberty interests.23 More specifically, substantive due process protects against undue governmental infringement upon fundamental rights.24 In determining whether a right is fundamental, Supreme Court precedent looks to whether the right was historically and traditionally recognized, and whether failing to recognize the right would contravene liberty and justice.25 The Supreme Court has held that governmental action infringing upon fundamental rights is subject to strict scrutiny,26 and thus must be narrowly tailored to a compelling government interest.27 Under strict scrutiny, the government must generally show that it has a “substantial” and “legitimate” need for its action to be in furtherance of a compelling government interest.28 If the government successfully establishes a compelling interest, its action cannot encumber fundamental rights any more than is necessary to achieve the government’s need.29 Additionally, the government could not have possibly taken alternative action that would similarly further its interest while being less burdensome on fundamental rights.30 Otherwise, the government’s action is not narrowly tailored to the government’s interest.31 The Supreme Court has recognized a 19 See Beach Commc’ns, Inc., 508 U.S. at 315; see also Murgia, 427 U.S. at 315. Heller, 509 U.S. at 320 (noting that, when reviewing a governmental classification under rational basis review, a governmental action is “presumed constitutional,” and the burden lies on the party attacking the governmental action to establish the action’s unconstitutionality.). 21 U.S. Const. amend. XIV, §1; U.S. Const. amend. V. 22 See U.S. Const. amend. XIV, §1; U.S. Const. amend. V. 23 See Washington v. Glucksberg, 521 U.S. 702, 719-720 (1997). 24 See id. 25 See id. at 720. 26 See Reno v. Flores, 507 U.S. 292, 301-02 (1993). 27 Id. (observing that a line of Supreme Court cases interprets the Fifth Amendment’s and Fourteenth Amendment’s due process principles to “forbid[] the government to infringe certain ‘fundamental’ liberty interests at all … unless the infringement is narrowly tailored to serve a compelling state interest.”). 28 San Antonio Indep. School Dist. v. Rodriguez, 411 U.S. 1, 98 (1973). 29 See Dunn v. Blumstein, 405 U.S. 330, 343 (1972). 30 Id. (“if there are other, reasonable ways to achieve [government interests] with a lesser burden on constitutionally protected activity, a State may not choose the way of greater interference. If it acts at all, it must choose ‘less drastic means.’”) (quoting Shelton v. Tucker, 364 U.S. 479, 488 (1960)). 31 See id. 20 Congressional Research Service 3 Obergefell v. Hodges: Same-Sex Marriage Legalized number of rights as fundamental, including the right to have children,32 use contraception,33 and marry.34 In Obergefell, the Court considered whether the Fourteenth Amendment’s substantive due process guarantees require states to issue marriage licenses to same-sex couples and require states to recognize same-sex marriages that were legally formed in other states. The Supreme Court Invalidates State Same-Sex Marriage Bans in Obergefell The Supreme Court resolved a circuit split on the constitutionality of state same-sex marriage bans, finding them unconstitutional in Obergefell v. Hodges. In doing so, the Court relied on the Constitution’s due process and equal protection principles to hold that states must issue marriage licenses to same-sex couples and recognize same-sex marriages that were legally formed in other states. The majority in Obergefell rested its decision upon the fundamental right to marry. The Court observed that it has long found the right to marry to be constitutionally protected, though it acknowledged that its precedent describing the right presumed an opposite-sex relationship.35 Even so, according to the Court, these cases have identified reasons why the right to marry is fundamental,36 which apply equally to same-sex couples. 37 These reasons included (1) personal choice in whom to marry is inherent in the concept of individual autonomy; (2) marriage’s unique support and recognition of a two-person, committed union; (3) the safeguarding of children within a marriage, as both same-sex couples and opposite-sex couples have children; and (4) marriage as a keystone of the nation’s social order, with no distinction between same-sex couples and opposite-sex couples in states conferring benefits and responsibilities upon marriages.38 Accordingly, the Court extended the fundamental right to marry to same-sex couples. In holding that the fundamental right to marry includes same-sex couples’ right to marry, the Court appeared to acknowledge its departure from precedent for determining whether a right is fundamental—mentioned earlier in this report—which considers whether it is “deeply rooted in this Nation’s history and tradition and implicit in the concept of ordered liberty.”39 The Court observed that if rights were defined by who could historically use them, old practices could continuously prevent new groups from exercising fundamental rights.40 As such, the Court found that “rights come not from ancient sources alone. They rise, too, from a better informed 32 Skinner v. Okla., 316 U.S. 535 (1942). Griswold v. Connecticut, 381 U.S. 479 (1965). 34 Loving v. Virginia, 388 U.S. 1 (1967). 35 Obergefell, 135 S.Ct. at 2598. 36 Id. 37 Id. at 2599. 38 Id. at 2599-2601. 39 Glucksberg, 512 U.S. at 720. 40 Obergefell, 135 S. Ct. at 2602 (“If rights were defined by who exercised them in the past, then received practices could serve as their own continued justification and new groups could not invoke rights once denied.”). 33 Congressional Research Service 4 Obergefell v. Hodges: Same-Sex Marriage Legalized understanding of how constitutional imperatives define a liberty that remains urgent in our own era.”41 After determining that the fundamental right to marry includes the right of same-sex couples to marry, the Court also seemed to depart from precedent—and the approaches of courts of appeals that relied on the fundamental right to marry to strike down state same-sex marriage bans—by not applying strict scrutiny to such bans. As previously noted, courts generally subject governmental action that infringes upon a fundamental right to strict scrutiny, requiring that the action be narrowly tailored to a compelling government interest to be constitutional.42 The states had argued two primary interests for their bans on same-marriage: (1) the desire to wait and see how the same-sex marriage debate progresses before changing long-existing marriage norms; and (2) incentivizing procreating couples to stay together during child rearing. However, the Court made no mention of whether the state same-sex marriage bans at issue were narrowly tailored to these justifications. Rather, the Court noted why these justifications were invalid without appearing to apply any of the typical levels of judicial review (i.e., rational basis review, intermediate scrutiny, or strict scrutiny).43 The Court held that both equal protection and due process guarantees protect the fundamental right to marry, and that states can no longer deny this right to same-sex couples.44 Importantly, in doing so, the Court did not hold that classifications based on sexual orientation warrant any form of heightened scrutiny. In fact, the Court made no mention of the proper level of scrutiny applicable to such classifications. Some of the dissenting Justices in Obergefell thought that the majority exceeded the Court’s proper role by removing the question of whether same-sex couples have the right to marry from the democratic process, where, they stated, it is properly resolved.45 According to these Justices, the five-person majority should not have resolved the hotly contested issue of same-sex marriage for the entire country; such resolution should have come from the people.46 The dissenting Justices also voiced concern with the majority looking beyond history and tradition to establish a fundamental right contrary to Supreme Court precedent.47 According to the dissenting Justices, the requirement that fundamental rights be rooted in tradition and history exists to prevent the Court from imparting its policy decisions regarding which rights have constitutional protection.48 41 Id. See Flores, 507 U.S. at 301-02. 43 See Obergefell, 135 S. Ct. at 2605-07. 44 Id. at 2604. 45 Id. at 2612, 2615 (Roberts, J., dissenting). 46 See id. 47 See id. at 2617. 48 See id. 42 Congressional Research Service 5 Obergefell v. Hodges: Same-Sex Marriage Legalized Implications of the Supreme Court’s Decision in Obergefell Although the Supreme Court answered questions surrounding the constitutionality of state samesex marriage bans in Obergefell, its decision raised a number of other questions. These include questions regarding, among other things, Obergefell’s broader impact on the rights of gay individuals; the proper level of judicial scrutiny applicable to classifications based on sexual orientation; what the decision might mean for laws prohibiting plural marriages; the Court’s approach to recognizing fundamental rights moving forward; and the proper level of judicial scrutiny applicable to governmental action interfering with fundamental rights. This section briefly explores these questions. Obergefell raised questions about the decision’s broader impact on the rights of gay individuals— that is, whether its rationale extends rights to gay individuals outside of the marriage context. However, the decision appears limited to the marriage context. Although the majority opinion did make reference to same-sex marriage bans implicating equal protection guarantees, its holding rested entirely on such bans infringing upon the fundamental right to marry in violation of both equal protection and due process guarantees. The Court did not mention whether classifications based on sexual orientation are suspect or quasi-suspect, and thus warrant any form of heightened scrutiny. If the Court had rendered such a holding, its decision would have arguably had broader implications for the rights of gay individuals, as it would have potentially subjected all governmental action that classifies based on sexual orientation to a heightened form of judicial scrutiny. Prior to Obergefell, federal appeals courts were split regarding the proper level of judicial scrutiny applicable to governmental action that classifies based on sexual orientation. The U.S. Court of Appeals for the Ninth Circuit (Ninth Circuit) has held that classifications based on sexual orientation warrant heightened scrutiny, though it did not clarify whether this heightened scrutiny was intermediate or strict scrutiny.49 The U.S. Court of Appeals for the Second Circuit (Second Circuit) has similarly found that classifications based on sexual orientation are quasisuspect, and thus any governmental action that classifies based on sexual orientation is subject to intermediate scrutiny.50 Conversely, however, the U.S. Court of Appeals for the Sixth Circuit (Sixth Circuit) has held that governmental action that classifies based on sexual orientation is neither suspect nor quasi-suspect, and thus subject only to rational basis review.51 Because the Court’s decision in Obergefell rested on the fundamental right to marry—and therefore seems limited to the marriage context—nothing in the opinion appears to resolve the circuit split between the Second, Sixth, and Ninth Circuits regarding the correct level of scrutiny applicable to classifications based on sexual orientation. Other lower courts will be left to grapple with this issue in the future. This ambiguity leaves open the possibility that, moving forward, circuit courts could either, like the Second and Ninth Circuits, apply heightened scrutiny to laws that classify based on sexual orientation (e.g., laws that provide exemptions from antidiscrimination legislation for religious entities based on their objections to certain sexual 49 See Latta, 771 F.3d at 468. Windsor v. United States, 699 F.3d 169, 185 (2nd Cir. 2012). 51 Davis v. Prison Health Servs., 679 F.3d 433, 438 (6th Cir. 2012). 50 Congressional Research Service 6 Obergefell v. Hodges: Same-Sex Marriage Legalized orientations), or could apply rational basis review to such laws like the Sixth Circuit. The fact that some lower courts may apply heightened scrutiny to government action that classifies based on sexual orientation where other courts may not is significant because, as discussed earlier in this report, laws subject to higher levels of scrutiny are more likely to be found unconstitutional. As such, this could create a situation wherein similar laws that classify based on sexual orientation receive dissimilar outcomes when facing constitutional challenge, depending on the evaluating court. The Supreme Court’s decision in Obergefell also raised questions regarding whether the Court’s rationale could potentially extend the fundamental right to marry to polygamy. In fact, Chief Justice John Roberts, in his dissent in Obergefell, seems to suggest that the majority’s opinion could lead to the legalization of plural marriages.52 However, the majority’s opinion seems crafted so as to try to limit its reach to the same-sex marriage context, in a possible attempt to prevent its rationale from extending the fundamental right to marry to plural marriages. As previously discussed, the majority in Obergefell found that the four reasons why the right to marry is fundamental apply equally to same-sex couples, and thus extended the fundamental right to marry to same-sex couples. Some commentators have observed that there are distinctions between plural marriages and same-sex marriages sufficient to prevent Obergefell’s rationale from being extended to legalize plural marriage.53 Conversely, other commentators have observed that parts of the Court’s opinion discussing why the fundamental right to marry includes same-sex marriage (e.g., the majority’s consideration of individual autonomy and family) could potentially provide basis for extending constitutional protections to plural marriages.54 Additionally, the majority in Obergefell seemingly departed from precedent for determining whether a right is fundamental by looking beyond historical and traditional recognition. This deviation from prior cases raises the possibility that, when determining whether a right is fundamental in the future, the Court will consider how the right is viewed at the time, in addition to its historical and traditional recognition. This could have the effect of expanding the number of rights that are deemed fundamental for purposes of substantive due process protections. Finally, the Court did not clarify which, if any, of the typical levels of judicial review (i.e., rational basis review, intermediate scrutiny, or strict scrutiny) it applied to state same-sex marriage bans after finding that such bans interfere with same-sex couples’ fundamental right to marry. Moving forward, this raises questions regarding the proper level of judicial scrutiny 52 See Obergefell, 135 S. Ct. at 2621 (“It is striking how much of the majority’s reasoning would apply with equal force to the claim of a fundamental right to plural marriage.”). 53 See, e.g., Joanna L. Grossman and Lawrence M. Friedman, Is Three Still a Crowd? Polygamy and the Law After Obergefell v. Hodges, JUSTIA, July 7, 2015, https://verdict.justia.com/2015/07/07/is-three-still-a-crowd-polygamy-andthe-law-after-obergefell-v-hodges (observing that, to win in court, polygamists must ��convince a court that the justification for allowing same-sex couples to marry applies with equal force to a person who wants multiple spouses,” and questioning whether the four “main reasons for recognizing the right of same-sex couples to marry” apply to polygamists); see also Richard A. Posner, The Chief Justice’s Dissent is Heartless, Slate, June 27, 2015, http://www.slate.com/articles/news_and_politics/the_breakfast_table/features/2015/scotus_roundup/ supreme_court_gay_marriage_john_roberts_dissent_in_obergefell_is_heartless.html. 54 See, e.g., William Baude, Is Polygamy Next?, N. Y. TIMES, July 21, 2015, http://www.nytimes.com/2015/07/21/ opinion/is-polygamy-next.html?mabReward=CTM&action=click&pgtype=Homepage&region=CColumn&module= Recommendation&src=rechp&WT.nav=RecEngine; see also Jonathan Turley, The Trouble with the ‘Dignity’ of SameSex Marriage, Wash. Post, July 2, 2015, https://www.washingtonpost.com/opinions/the-trouble-with-the-dignity-ofsame-sex-marriage/2015/07/02/43bd8f70-1f4e-11e5-aeb9-a411a84c9d55_story.html. Congressional Research Service 7 Obergefell v. Hodges: Same-Sex Marriage Legalized applicable to governmental action that infringes upon fundamental rights. Given that increased scrutiny decreases the likelihood that a court will find government action constitutional, this could create ambiguity regarding the degree to which the government can permissibly take action that interferes with fundamental rights. Author Contact Information Rodney M. Perry Legislative Attorney rperry@crs.loc.gov, 7-5203 Congressional Research Service 8","Use information from the article only to explain your answer. Do not rely on outside knowledge.
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+Obergefell v. Hodges: Same-Sex Marriage Legalized Rodney M. Perry Legislative Attorney August 7, 2015 Congressional Research Service 7-5700 www.crs.gov R44143 Obergefell v. Hodges: Same-Sex Marriage Legalized Summary On June 26, 2015, the Supreme Court issued its decision in Obergefell v. Hodges requiring states to issue marriage licenses to same-sex couples and to recognize same-sex marriages that were legally formed in other states. In doing so, the Court resolved a circuit split regarding the constitutionality of state same-sex marriage bans and legalized same-sex marriage throughout the country. The Court’s decision relied on the Fourteenth Amendment’s equal protection and due process guarantees. Under the Fourteenth Amendment’s Equal Protection Clause, state action that classifies groups of individuals may be subject to heightened levels of judicial scrutiny, depending on the type of classification involved or whether the classification interferes with a fundamental right. Additionally, under the Fourteenth Amendment’s substantive due process guarantees, state action that infringes upon a fundamental right—such as the right to marry—is subject to a high level of judicial scrutiny. In striking down state same-sex marriage bans as unconstitutional in Obergefell, the Court rested its decision upon the fundamental right to marry. The Court acknowledged that its precedents have described the fundamental right to marry in terms of opposite-sex relationships. Even so, the Court determined that the reasons why the right to marry is considered fundamental apply equally to same-sex marriages. The Court thus held that the fundamental right to marry extends to samesex couples, and that state same-sex marriage bans unconstitutionally interfere with this right. Though the Supreme Court’s decision in Obergefell resolved the question of whether or not state same-sex marriage bans are unconstitutional, it raised a number of other questions. These include questions regarding, among other things, Obergefell’s broader impact on the rights of gay individuals; the proper level of judicial scrutiny applicable to classifications based on sexual orientation; what the decision might mean for laws prohibiting plural marriages; the Court’s approach to recognizing fundamental rights moving forward; and the proper level of judicial scrutiny applicable to governmental action interfering with fundamental rights. This report explores these questions. Congressional Research Service Obergefell v. Hodges: Same-Sex Marriage Legalized Contents General Constitutional Principles .................................................................................................... 1 Equal Protection ........................................................................................................................ 1 Substantive Due Process............................................................................................................ 3 The Supreme Court Invalidates State Same-Sex Marriage Bans in Obergefell ............................... 4 Implications of the Supreme Court’s Decision in Obergefell .......................................................... 6 Contacts Author Contact Information............................................................................................................. 8 Congressional Research Service Obergefell v. Hodges: Same-Sex Marriage Legalized O n June 26, 2015, the Supreme Court issued its decision in Obergefell v. Hodges legalizing same-sex marriage throughout the country by requiring states to issue marriage licenses to same-sex couples and to recognize same-sex marriages that were legally formed in other states. In doing so, the Court resolved a circuit split1 regarding the constitutionality of state same-sex marriage bans. This report provides background on, and analysis of, significant legal issues raised by the Supreme Court’s decision in Obergefell. It first offers background on the constitutional principles on which the Court relied in Obergefell to invalidate state same-sex marriage bans as unconstitutional. Then, it walks through the Court’s opinion and rationale. Finally, it discusses potential implications of the Court’s decision. General Constitutional Principles Equal Protection Under the Fourteenth Amendment’s Equal Protection Clause, “[n]o State shall … deny to any person within its jurisdiction the equal protection of the laws.”2 Though there is no parallel constitutional provision expressly prohibiting the federal government from denying equal protection of the law, the Supreme Court has held that equal protection principles similarly apply to the federal government.3 Under the Constitution’s equal protection guarantees, when courts review governmental action that distinguishes between classes of people, they apply different levels of scrutiny depending on the classification involved. The more suspect the government’s classification, or the more likely that the government’s classification was motivated by discrimination, the higher the level of scrutiny that courts will utilize in evaluating the government’s action.4 Increased scrutiny raises the likelihood that a court will find the action unconstitutional. Generally speaking, there are three such levels of scrutiny: (1) strict scrutiny; (2) intermediate scrutiny; and (3) rational basis review. Strict scrutiny is the most demanding form of judicial review. The Supreme Court has observed that strict scrutiny applies to governmental classifications that are constitutionally “suspect,” or that interfere with fundamental rights.5 In determining whether a classification is suspect, courts consider whether the classified group (1) has historically been subject to discrimination; (2) is a 11 Previously, the Fourth, Seventh, Ninth, and Tenth Circuits had struck down state same-sex marriage bans under equal protection or due process grounds after generally, though not uniformly, subjecting them to heightened levels of judicial scrutiny. Bostic v. Schaeffer, 760 F.3d 352 (4th Cir. 2014); Baskin v. Bogan, 766 F.3d 648 (7th Cir. 2014); Latta v. Otter, 771 F.3d 456 (9th Cir. 2014); Bishop v. Smith, 760 F.3d 1070 (10th Cir. 2014); Kitchen v. Herbert, 755 F.3d 1193 (10th Cir. 2014). Conversely, the Sixth Circuit had upheld state same-sex marriage bans and observed that such bans warrant the lowest level of judicial review. DeBoer v. Snyder, 772 F.3d 388 (6th Cir. 2014). 2 U.S. Const. amend. XIV, §1. 3 See Bolling v. Sharpe, 347 U.S. 497 (1954). More specifically, the Court has held that the Fifth Amendment’s guarantee of “due process of the law,” applicable to the federal government, incorporates equal protection guarantees. See id. at 500. 4 Compare City of Cleburne v. Cleburne Living Center, 473 U.S. 432 (1985) (holding that mental disability is not a “quasi-suspect” classification, and thus is entitled to rational basis review), with Graham v. Richardson, 403 U.S. 365 (1971) (holding that classifications based on alienage are “inherently suspect,” and are subject to strict scrutiny). 5 See Mass. Bd. of Retirement v. Murgia, 427 U.S. 307, 312 (1976); see also Heller v. Doe, 509 U.S. 312, 319 (1993). Congressional Research Service 1 Obergefell v. Hodges: Same-Sex Marriage Legalized minority group exhibiting an unchangeable characteristic that establishes the group as distinct; or (3) is inadequately protected by the political process.6 There are generally three governmental classifications that are suspect—those based on race, national origin, and alienage.7 When applying strict scrutiny to governmental action, reviewing courts consider whether the governmental action is narrowly tailored to a compelling government interest.8 The government bears the burden of proving the constitutional validity of its action under strict scrutiny, and, in doing so, must generally show that it cannot meet its goals via less discriminatory means.9 Intermediate scrutiny is less searching than strict scrutiny, though it subjects governmental action to more stringent inspection than rational basis review. Intermediate scrutiny applies to “quasisuspect” classifications such as classifications based on gender10 or illegitimacy.11 When reviewing courts apply intermediate scrutiny to governmental action, they determine whether the action is substantially related to achieving an important government interest.12 As with strict scrutiny, the government bears the burden of establishing the constitutional validity of its actions under intermediate scrutiny.13 Rational basis review is the least searching form of judicial scrutiny, and generally applies to all classifications that are not subject to heightened levels of scrutiny.14 For governmental action to survive rational basis review, it must be rationally related to a legitimate government interest.15 When evaluating governmental action under rational basis review, courts consider the legitimacy of any possible governmental purpose behind the action.16 That is, courts are not limited to considering the actual purposes behind the government’s action.17 Additionally, the governmental action needs only be a reasonable way of achieving a legitimate government purpose to survive rational basis review; it does not need to be the most reasonable way of doing so, or even more reasonable than alternatives.18 Accordingly, rational basis review is deferential to the government, and courts generally presume that governmental action that is subject to such review is 6 See Lyng v. Castillo, 477 U.S. 635, 638 (1986); see also United States v. Carolene Prods. Co., 304 U.S. 144, 152 n. 4 (1938). 7 Graham, 403 U.S. at 371-72 (“… the Court’s decisions have established that classifications based on alienage, like those based on nationality or race, are inherently suspect and subject to close judicial scrutiny.”). 8 Parents Involved in Cmty. Schs. v. Seattle Sch. Dist. No. 1, 551 U.S. 701, 720 (2007). 9 See Fisher v. University of Tex. at Austin, 133 S. Ct. 2411, 2420 (2014). 10 United States v. Virginia, 518 U.S. 515, 533 (1996); see Miss. Univ. for Women v. Hogan, 458 U.S. 718, 724 (1982). 11 Clark v. Jeter, 486 U.S. 456, 461 (1988) (“Between these extremes of rational basis review and strict scrutiny lies a level of intermediate scrutiny, which generally has been applied to discriminatory classifications based on sex or illegitimacy.”). 12 See Craig v. Boren, 429 U.S. 190, 198 (1976); see also Clark, 486 U.S. at 461. 13 Virginia, 518 U.S. at 533; see Miss. Univ. for Women, 458 U.S. at 724. 14 See Cleburne Living Center, 473 U.S at 440-42; see also Schweiker v. Wilson, 450 U.S. 221, 230 (1981). 15 See City of Cleburne, 473 U.S. at 440. 16 See Nordlinger v. Hahn, 505 U.S. 1, 15 (1992); see also Heller, 509 U.S. at 320. 17 See Nordlinger, 505 U.S. at 15; see also Heller, 509 U.S. at 320. 18 See Schweiker, 450 U.S. 221, 235 (1981) (observing that, under rational basis review, “[a]s long as the classificatory scheme chosen by Congress rationally advances a reasonable and identifiable governmental objective, we must disregard the existence of other methods of allocation that we, as individuals, perhaps would have preferred.”); see also Heller, 509 U.S. at 320 (observing that under rational basis review, “a classification ‘must be upheld against equal protection challenge if there is any reasonably conceivable state of facts that could provide a rational basis for the classification.’”) (quoting F.C.C. v. Beach Commc’ns, Inc., 508 U.S. 307, 312 (1993)). Congressional Research Service 2 Obergefell v. Hodges: Same-Sex Marriage Legalized constitutionally valid.19 Parties challenging governmental actions bear the burden of establishing their invalidity under rational basis review.20 Substantive Due Process The U.S. Constitution’s due process guarantees are contained within two separate clauses; one can be found in the Fifth Amendment, and the other resides in the Fourteenth Amendment. Each clause provides that the government shall not deprive a person of “life, liberty, or property, without due process of law.”21 However, the Fifth Amendment applies to action by the federal government, whereas the Fourteenth Amendment applies to state action.22 The Constitution’s due process language makes clear that the government cannot deprive individuals of life, liberty, or property without observing certain procedural requirements. The Supreme Court has interpreted this language to also include substantive guarantees that prohibit the government from taking action that unduly burdens certain liberty interests.23 More specifically, substantive due process protects against undue governmental infringement upon fundamental rights.24 In determining whether a right is fundamental, Supreme Court precedent looks to whether the right was historically and traditionally recognized, and whether failing to recognize the right would contravene liberty and justice.25 The Supreme Court has held that governmental action infringing upon fundamental rights is subject to strict scrutiny,26 and thus must be narrowly tailored to a compelling government interest.27 Under strict scrutiny, the government must generally show that it has a “substantial” and “legitimate” need for its action to be in furtherance of a compelling government interest.28 If the government successfully establishes a compelling interest, its action cannot encumber fundamental rights any more than is necessary to achieve the government’s need.29 Additionally, the government could not have possibly taken alternative action that would similarly further its interest while being less burdensome on fundamental rights.30 Otherwise, the government’s action is not narrowly tailored to the government’s interest.31 The Supreme Court has recognized a 19 See Beach Commc’ns, Inc., 508 U.S. at 315; see also Murgia, 427 U.S. at 315. Heller, 509 U.S. at 320 (noting that, when reviewing a governmental classification under rational basis review, a governmental action is “presumed constitutional,” and the burden lies on the party attacking the governmental action to establish the action’s unconstitutionality.). 21 U.S. Const. amend. XIV, §1; U.S. Const. amend. V. 22 See U.S. Const. amend. XIV, §1; U.S. Const. amend. V. 23 See Washington v. Glucksberg, 521 U.S. 702, 719-720 (1997). 24 See id. 25 See id. at 720. 26 See Reno v. Flores, 507 U.S. 292, 301-02 (1993). 27 Id. (observing that a line of Supreme Court cases interprets the Fifth Amendment’s and Fourteenth Amendment’s due process principles to “forbid[] the government to infringe certain ‘fundamental’ liberty interests at all … unless the infringement is narrowly tailored to serve a compelling state interest.”). 28 San Antonio Indep. School Dist. v. Rodriguez, 411 U.S. 1, 98 (1973). 29 See Dunn v. Blumstein, 405 U.S. 330, 343 (1972). 30 Id. (“if there are other, reasonable ways to achieve [government interests] with a lesser burden on constitutionally protected activity, a State may not choose the way of greater interference. If it acts at all, it must choose ‘less drastic means.’”) (quoting Shelton v. Tucker, 364 U.S. 479, 488 (1960)). 31 See id. 20 Congressional Research Service 3 Obergefell v. Hodges: Same-Sex Marriage Legalized number of rights as fundamental, including the right to have children,32 use contraception,33 and marry.34 In Obergefell, the Court considered whether the Fourteenth Amendment’s substantive due process guarantees require states to issue marriage licenses to same-sex couples and require states to recognize same-sex marriages that were legally formed in other states. The Supreme Court Invalidates State Same-Sex Marriage Bans in Obergefell The Supreme Court resolved a circuit split on the constitutionality of state same-sex marriage bans, finding them unconstitutional in Obergefell v. Hodges. In doing so, the Court relied on the Constitution’s due process and equal protection principles to hold that states must issue marriage licenses to same-sex couples and recognize same-sex marriages that were legally formed in other states. The majority in Obergefell rested its decision upon the fundamental right to marry. The Court observed that it has long found the right to marry to be constitutionally protected, though it acknowledged that its precedent describing the right presumed an opposite-sex relationship.35 Even so, according to the Court, these cases have identified reasons why the right to marry is fundamental,36 which apply equally to same-sex couples. 37 These reasons included (1) personal choice in whom to marry is inherent in the concept of individual autonomy; (2) marriage’s unique support and recognition of a two-person, committed union; (3) the safeguarding of children within a marriage, as both same-sex couples and opposite-sex couples have children; and (4) marriage as a keystone of the nation’s social order, with no distinction between same-sex couples and opposite-sex couples in states conferring benefits and responsibilities upon marriages.38 Accordingly, the Court extended the fundamental right to marry to same-sex couples. In holding that the fundamental right to marry includes same-sex couples’ right to marry, the Court appeared to acknowledge its departure from precedent for determining whether a right is fundamental—mentioned earlier in this report—which considers whether it is “deeply rooted in this Nation’s history and tradition and implicit in the concept of ordered liberty.”39 The Court observed that if rights were defined by who could historically use them, old practices could continuously prevent new groups from exercising fundamental rights.40 As such, the Court found that “rights come not from ancient sources alone. They rise, too, from a better informed 32 Skinner v. Okla., 316 U.S. 535 (1942). Griswold v. Connecticut, 381 U.S. 479 (1965). 34 Loving v. Virginia, 388 U.S. 1 (1967). 35 Obergefell, 135 S.Ct. at 2598. 36 Id. 37 Id. at 2599. 38 Id. at 2599-2601. 39 Glucksberg, 512 U.S. at 720. 40 Obergefell, 135 S. Ct. at 2602 (“If rights were defined by who exercised them in the past, then received practices could serve as their own continued justification and new groups could not invoke rights once denied.”). 33 Congressional Research Service 4 Obergefell v. Hodges: Same-Sex Marriage Legalized understanding of how constitutional imperatives define a liberty that remains urgent in our own era.”41 After determining that the fundamental right to marry includes the right of same-sex couples to marry, the Court also seemed to depart from precedent—and the approaches of courts of appeals that relied on the fundamental right to marry to strike down state same-sex marriage bans—by not applying strict scrutiny to such bans. As previously noted, courts generally subject governmental action that infringes upon a fundamental right to strict scrutiny, requiring that the action be narrowly tailored to a compelling government interest to be constitutional.42 The states had argued two primary interests for their bans on same-marriage: (1) the desire to wait and see how the same-sex marriage debate progresses before changing long-existing marriage norms; and (2) incentivizing procreating couples to stay together during child rearing. However, the Court made no mention of whether the state same-sex marriage bans at issue were narrowly tailored to these justifications. Rather, the Court noted why these justifications were invalid without appearing to apply any of the typical levels of judicial review (i.e., rational basis review, intermediate scrutiny, or strict scrutiny).43 The Court held that both equal protection and due process guarantees protect the fundamental right to marry, and that states can no longer deny this right to same-sex couples.44 Importantly, in doing so, the Court did not hold that classifications based on sexual orientation warrant any form of heightened scrutiny. In fact, the Court made no mention of the proper level of scrutiny applicable to such classifications. Some of the dissenting Justices in Obergefell thought that the majority exceeded the Court’s proper role by removing the question of whether same-sex couples have the right to marry from the democratic process, where, they stated, it is properly resolved.45 According to these Justices, the five-person majority should not have resolved the hotly contested issue of same-sex marriage for the entire country; such resolution should have come from the people.46 The dissenting Justices also voiced concern with the majority looking beyond history and tradition to establish a fundamental right contrary to Supreme Court precedent.47 According to the dissenting Justices, the requirement that fundamental rights be rooted in tradition and history exists to prevent the Court from imparting its policy decisions regarding which rights have constitutional protection.48 41 Id. See Flores, 507 U.S. at 301-02. 43 See Obergefell, 135 S. Ct. at 2605-07. 44 Id. at 2604. 45 Id. at 2612, 2615 (Roberts, J., dissenting). 46 See id. 47 See id. at 2617. 48 See id. 42 Congressional Research Service 5 Obergefell v. Hodges: Same-Sex Marriage Legalized Implications of the Supreme Court’s Decision in Obergefell Although the Supreme Court answered questions surrounding the constitutionality of state samesex marriage bans in Obergefell, its decision raised a number of other questions. These include questions regarding, among other things, Obergefell’s broader impact on the rights of gay individuals; the proper level of judicial scrutiny applicable to classifications based on sexual orientation; what the decision might mean for laws prohibiting plural marriages; the Court’s approach to recognizing fundamental rights moving forward; and the proper level of judicial scrutiny applicable to governmental action interfering with fundamental rights. This section briefly explores these questions. Obergefell raised questions about the decision’s broader impact on the rights of gay individuals— that is, whether its rationale extends rights to gay individuals outside of the marriage context. However, the decision appears limited to the marriage context. Although the majority opinion did make reference to same-sex marriage bans implicating equal protection guarantees, its holding rested entirely on such bans infringing upon the fundamental right to marry in violation of both equal protection and due process guarantees. The Court did not mention whether classifications based on sexual orientation are suspect or quasi-suspect, and thus warrant any form of heightened scrutiny. If the Court had rendered such a holding, its decision would have arguably had broader implications for the rights of gay individuals, as it would have potentially subjected all governmental action that classifies based on sexual orientation to a heightened form of judicial scrutiny. Prior to Obergefell, federal appeals courts were split regarding the proper level of judicial scrutiny applicable to governmental action that classifies based on sexual orientation. The U.S. Court of Appeals for the Ninth Circuit (Ninth Circuit) has held that classifications based on sexual orientation warrant heightened scrutiny, though it did not clarify whether this heightened scrutiny was intermediate or strict scrutiny.49 The U.S. Court of Appeals for the Second Circuit (Second Circuit) has similarly found that classifications based on sexual orientation are quasisuspect, and thus any governmental action that classifies based on sexual orientation is subject to intermediate scrutiny.50 Conversely, however, the U.S. Court of Appeals for the Sixth Circuit (Sixth Circuit) has held that governmental action that classifies based on sexual orientation is neither suspect nor quasi-suspect, and thus subject only to rational basis review.51 Because the Court’s decision in Obergefell rested on the fundamental right to marry—and therefore seems limited to the marriage context—nothing in the opinion appears to resolve the circuit split between the Second, Sixth, and Ninth Circuits regarding the correct level of scrutiny applicable to classifications based on sexual orientation. Other lower courts will be left to grapple with this issue in the future. This ambiguity leaves open the possibility that, moving forward, circuit courts could either, like the Second and Ninth Circuits, apply heightened scrutiny to laws that classify based on sexual orientation (e.g., laws that provide exemptions from antidiscrimination legislation for religious entities based on their objections to certain sexual 49 See Latta, 771 F.3d at 468. Windsor v. United States, 699 F.3d 169, 185 (2nd Cir. 2012). 51 Davis v. Prison Health Servs., 679 F.3d 433, 438 (6th Cir. 2012). 50 Congressional Research Service 6 Obergefell v. Hodges: Same-Sex Marriage Legalized orientations), or could apply rational basis review to such laws like the Sixth Circuit. The fact that some lower courts may apply heightened scrutiny to government action that classifies based on sexual orientation where other courts may not is significant because, as discussed earlier in this report, laws subject to higher levels of scrutiny are more likely to be found unconstitutional. As such, this could create a situation wherein similar laws that classify based on sexual orientation receive dissimilar outcomes when facing constitutional challenge, depending on the evaluating court. The Supreme Court’s decision in Obergefell also raised questions regarding whether the Court’s rationale could potentially extend the fundamental right to marry to polygamy. In fact, Chief Justice John Roberts, in his dissent in Obergefell, seems to suggest that the majority’s opinion could lead to the legalization of plural marriages.52 However, the majority’s opinion seems crafted so as to try to limit its reach to the same-sex marriage context, in a possible attempt to prevent its rationale from extending the fundamental right to marry to plural marriages. As previously discussed, the majority in Obergefell found that the four reasons why the right to marry is fundamental apply equally to same-sex couples, and thus extended the fundamental right to marry to same-sex couples. Some commentators have observed that there are distinctions between plural marriages and same-sex marriages sufficient to prevent Obergefell’s rationale from being extended to legalize plural marriage.53 Conversely, other commentators have observed that parts of the Court’s opinion discussing why the fundamental right to marry includes same-sex marriage (e.g., the majority’s consideration of individual autonomy and family) could potentially provide basis for extending constitutional protections to plural marriages.54 Additionally, the majority in Obergefell seemingly departed from precedent for determining whether a right is fundamental by looking beyond historical and traditional recognition. This deviation from prior cases raises the possibility that, when determining whether a right is fundamental in the future, the Court will consider how the right is viewed at the time, in addition to its historical and traditional recognition. This could have the effect of expanding the number of rights that are deemed fundamental for purposes of substantive due process protections. Finally, the Court did not clarify which, if any, of the typical levels of judicial review (i.e., rational basis review, intermediate scrutiny, or strict scrutiny) it applied to state same-sex marriage bans after finding that such bans interfere with same-sex couples’ fundamental right to marry. Moving forward, this raises questions regarding the proper level of judicial scrutiny 52 See Obergefell, 135 S. Ct. at 2621 (“It is striking how much of the majority’s reasoning would apply with equal force to the claim of a fundamental right to plural marriage.”). 53 See, e.g., Joanna L. Grossman and Lawrence M. Friedman, Is Three Still a Crowd? Polygamy and the Law After Obergefell v. Hodges, JUSTIA, July 7, 2015, https://verdict.justia.com/2015/07/07/is-three-still-a-crowd-polygamy-andthe-law-after-obergefell-v-hodges (observing that, to win in court, polygamists must “convince a court that the justification for allowing same-sex couples to marry applies with equal force to a person who wants multiple spouses,” and questioning whether the four “main reasons for recognizing the right of same-sex couples to marry” apply to polygamists); see also Richard A. Posner, The Chief Justice’s Dissent is Heartless, Slate, June 27, 2015, http://www.slate.com/articles/news_and_politics/the_breakfast_table/features/2015/scotus_roundup/ supreme_court_gay_marriage_john_roberts_dissent_in_obergefell_is_heartless.html. 54 See, e.g., William Baude, Is Polygamy Next?, N. Y. TIMES, July 21, 2015, http://www.nytimes.com/2015/07/21/ opinion/is-polygamy-next.html?mabReward=CTM&action=click&pgtype=Homepage&region=CColumn&module= Recommendation&src=rechp&WT.nav=RecEngine; see also Jonathan Turley, The Trouble with the ‘Dignity’ of SameSex Marriage, Wash. Post, July 2, 2015, https://www.washingtonpost.com/opinions/the-trouble-with-the-dignity-ofsame-sex-marriage/2015/07/02/43bd8f70-1f4e-11e5-aeb9-a411a84c9d55_story.html. Congressional Research Service 7 Obergefell v. Hodges: Same-Sex Marriage Legalized applicable to governmental action that infringes upon fundamental rights. Given that increased scrutiny decreases the likelihood that a court will find government action constitutional, this could create ambiguity regarding the degree to which the government can permissibly take action that interferes with fundamental rights. Author Contact Information Rodney M. Perry Legislative Attorney rperry@crs.loc.gov, 7-5203 Congressional Research Service 8
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+"<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> [user request] <TEXT> [context document]","I'm tired of wearing eye-sight glasses now and planning laser surgery for my eyes. The issue is I have a very thin cornea, so will I be considered an unsuitable candidate for laser eye surgery, and what other factors could disqualify a person from undergoing the procedure?","The eye has an outer layer called the cornea. Some people’s corneas can undergo changes in their shape, leading to vision issues, such as astigmatism and myopia. Laser eye surgery is a medical procedure that reshapes this layer. Precisely how laser eye surgery reshapes the cornea depends on the vision condition that the treatment aims to correct. Laser eye surgery can fix vision issues, such as nearsightedness and farsightedness. The surgery is quick, and people remain awake throughout the procedure. It is also usually painless — if a person experiences pain, it usually indicates there have been complications. This article discusses what laser eye surgery is, who it can help, costs, duration of the surgery, recovery time, and any associated short- and long-term risks. What is laser eye surgery (LASIK or PRK) SCIENCE PHOTO LIBRARY/Getty Images LASIK stands for laser-assisted in situ keratomileusis and is the most common type of refractive eye surgery. LASIK was first patented in 1989 and has become the most commonTrusted Source treatment for refractive eye errors. The procedure involves lasers to reshape the cornea. Who may it help? According to the American Academy of Ophthalmology, over 150 million Americans use corrective eyewear, such as glasses or contact lenses, to compensate for refractive errors. Refractive errors occur when the eye does not bend — or refract — the light to properly focus on the retina in the back of the eye. This is usually due to the shape of the cornea. Farsightedness The clinical name for farsightedness is hyperopia. People with this condition can see objects in the distance clearly, but other things can appear blurry at close distance. Farsightedness is due to the curvature of the cornea being too flat. Laser eye surgery can correct this by reshaping the cornea to have a steeper curve. Nearsightedness Nearsightedness, known as myopia or short-sightedness, is where a person can see objects close to them clearly. However, distant objects can appear blurred. This is due to the curvature of the cornea being too steep. Healthcare professionals can correct this through laser eye surgery by reshaping the cornea. Astigmatism People with astigmatism have a differently-shaped eye that characterizes this condition. The eye of someone without the condition is round, like a soccer ball, while with astigmatism, the eye may have more of a football-like shape. It is possible to correct this irregular curvature of the cornea with laser eye surgery in some cases. Get our Eye Health Newsletter Receive expert advice, tips to manage your symptoms, and the latest on condition breakthroughs delivered straight to your inbox. Enter your email Also sign up for our popular Heart Health newsletter Your privacy is important to us People who are not suitableTrusted Source candidates for laser eye surgery include those who: have had a change in their eye prescription in the last 12 months take medications that may cause changes in vision are in their 20s or younger, although some experts recommend not being under 18 years have thin corneas, which may not be stable following laser surgery are pregnant or nursing Benefits The main benefit of laser eye surgery is that mostTrusted Source people no longer have to wear corrective eyewear to see clearly. Individuals may choose to undergo the procedure for several reasons, including: being unable to wear contact lenses but preferring not to wear glasses, perhaps for cosmetic reasons wishing to undertake activities, such as sports, that require a person not to wear glasses or contact lenses having the convenience of not having to wear corrective eyewear A person is more at riskTrusted Source of developing complications if they have the followingTrusted Source eye conditions: eye infections, such as keratitis or ocular herpes significant cataracts — people with this condition will not have corrected vision after laser surgery glaucoma large pupils keratoconus, a disease that makes the cornea thinner and unstable over time As with all surgeries, a person may experience complications, including: Dry eyes: Up to 95%Trusted Source of people who have laser eye surgery may experience dry eyes after the procedure, where the eyes produce fewer tears. Lubricating eye drops can help with this symptom. Glare or halo: 20% of people undergoing laser eye surgery may experience visual changes such as glare, halo, or sensitivity to light. Double or blurry vision: As many as 1 in 50 people may report blurriness and feel there is something in their eyes. Diffuse lamellar keratitis — also called “sands of Sahara” syndrome — may be the cause. Other complications a person may experience include: eye infection corneal flap complications red or bloodshot whites of the eye Most symptoms should resolve after the first few days, so an individual experiencing any symptoms after this time should consult with a medical professional. The Food & Drug Administration (FDA) suggests laser eye surgery usually takes less than 30 minutesTrusted Source. Others estimate the procedure will take around 5 minutes per eye. People undergoing laser eye surgery should expect the following: They will sit in a chair and recline, so they are flat on their back underneath a laser device and computer screen. The surgical team will clean the area around the eye and place numbing drops in the eye. Surgeons will use a lid speculum, a medical instrument, to hold the eyelids open. A laser will cut a flap in the cornea, and the surgeon will then lift this open. People will need to stare at a light to keep their eyes still while the laser works. The laser will then reshape the surface of the cornea. The surgeon will then place the flap back into position and apply a shield to protect the eye. Recovery time The FDATrusted Source notes that after surgery, a person may feel as though their eye is burning, itchy, or that there is a foreign object present. The surgeon may recommend a mild pain reliever, such as acetaminophen, to help with these sensations. Surgeons will provide people with an eye shield to protect their eyes, as there will be no stitches holding the flap in place. The guard helps prevent rubbing the eye or accidentally applying pressure, such as during sleep. Individuals will usually take a few days off from work so they can recover. They should schedule an appointment to see their eye doctor within the first 24–48 hours after surgery to undergo an eye examination. The doctor will make sure the eyes are healing as they should. After this, a person will need several additional appointments over the first 6 months. Results It may take up to 6 monthsTrusted Source for a person’s vision to stabilize after laser eye surgery. They may notice their vision fluctuates for a while after the procedure, but this should not be a cause for concern. However, it is common for vision to vary for the initial few months following surgery. Additionally, sometimes laser eye surgery may accidentally over- or under-correct a person’s sight. This might require further surgery to rectify, which healthcare professionals usually called enhancement. It is also important to remember that corrected vision can regress years after the procedure. The cost of LASIK surgery will be different depending on where the person lives. Other surgeons may use various equipment or techniques, which the price may reflect. Health insurance companies usually categorize LASIK as an elective or cosmetic procedure and do not typically cover these treatments. In 2020, the American Refractive Surgery Council estimated that LASIK surgery might cost around $4,200 per eye, on average. Although laser eye surgery can be expensive, it is crucial that people thoroughly do their research before undergoing treatment at reduced prices. There may be a reason the price is so low, which may increase the risk of complications.","<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> I'm tired of wearing eye-sight glasses now and planning laser surgery for my eyes. The issue is I have a very thin cornea, so will I be considered an unsuitable candidate for laser eye surgery, and what other factors could disqualify a person from undergoing the procedure? <TEXT> The eye has an outer layer called the cornea. Some people’s corneas can undergo changes in their shape, leading to vision issues, such as astigmatism and myopia. Laser eye surgery is a medical procedure that reshapes this layer. Precisely how laser eye surgery reshapes the cornea depends on the vision condition that the treatment aims to correct. Laser eye surgery can fix vision issues, such as nearsightedness and farsightedness. The surgery is quick, and people remain awake throughout the procedure. It is also usually painless — if a person experiences pain, it usually indicates there have been complications. This article discusses what laser eye surgery is, who it can help, costs, duration of the surgery, recovery time, and any associated short- and long-term risks. What is laser eye surgery (LASIK or PRK) SCIENCE PHOTO LIBRARY/Getty Images LASIK stands for laser-assisted in situ keratomileusis and is the most common type of refractive eye surgery. LASIK was first patented in 1989 and has become the most commonTrusted Source treatment for refractive eye errors. The procedure involves lasers to reshape the cornea. Who may it help? According to the American Academy of Ophthalmology, over 150 million Americans use corrective eyewear, such as glasses or contact lenses, to compensate for refractive errors. Refractive errors occur when the eye does not bend — or refract — the light to properly focus on the retina in the back of the eye. This is usually due to the shape of the cornea. Farsightedness The clinical name for farsightedness is hyperopia. People with this condition can see objects in the distance clearly, but other things can appear blurry at close distance. Farsightedness is due to the curvature of the cornea being too flat. Laser eye surgery can correct this by reshaping the cornea to have a steeper curve. Nearsightedness Nearsightedness, known as myopia or short-sightedness, is where a person can see objects close to them clearly. However, distant objects can appear blurred. This is due to the curvature of the cornea being too steep. Healthcare professionals can correct this through laser eye surgery by reshaping the cornea. Astigmatism People with astigmatism have a differently-shaped eye that characterizes this condition. The eye of someone without the condition is round, like a soccer ball, while with astigmatism, the eye may have more of a football-like shape. It is possible to correct this irregular curvature of the cornea with laser eye surgery in some cases. Get our Eye Health Newsletter Receive expert advice, tips to manage your symptoms, and the latest on condition breakthroughs delivered straight to your inbox. Enter your email Also sign up for our popular Heart Health newsletter Your privacy is important to us People who are not suitableTrusted Source candidates for laser eye surgery include those who: have had a change in their eye prescription in the last 12 months take medications that may cause changes in vision are in their 20s or younger, although some experts recommend not being under 18 years have thin corneas, which may not be stable following laser surgery are pregnant or nursing Benefits The main benefit of laser eye surgery is that mostTrusted Source people no longer have to wear corrective eyewear to see clearly. Individuals may choose to undergo the procedure for several reasons, including: being unable to wear contact lenses but preferring not to wear glasses, perhaps for cosmetic reasons wishing to undertake activities, such as sports, that require a person not to wear glasses or contact lenses having the convenience of not having to wear corrective eyewear A person is more at riskTrusted Source of developing complications if they have the followingTrusted Source eye conditions: eye infections, such as keratitis or ocular herpes significant cataracts — people with this condition will not have corrected vision after laser surgery glaucoma large pupils keratoconus, a disease that makes the cornea thinner and unstable over time As with all surgeries, a person may experience complications, including: Dry eyes: Up to 95%Trusted Source of people who have laser eye surgery may experience dry eyes after the procedure, where the eyes produce fewer tears. Lubricating eye drops can help with this symptom. Glare or halo: 20% of people undergoing laser eye surgery may experience visual changes such as glare, halo, or sensitivity to light. Double or blurry vision: As many as 1 in 50 people may report blurriness and feel there is something in their eyes. Diffuse lamellar keratitis — also called “sands of Sahara” syndrome — may be the cause. Other complications a person may experience include: eye infection corneal flap complications red or bloodshot whites of the eye Most symptoms should resolve after the first few days, so an individual experiencing any symptoms after this time should consult with a medical professional. The Food & Drug Administration (FDA) suggests laser eye surgery usually takes less than 30 minutesTrusted Source. Others estimate the procedure will take around 5 minutes per eye. People undergoing laser eye surgery should expect the following: They will sit in a chair and recline, so they are flat on their back underneath a laser device and computer screen. The surgical team will clean the area around the eye and place numbing drops in the eye. Surgeons will use a lid speculum, a medical instrument, to hold the eyelids open. A laser will cut a flap in the cornea, and the surgeon will then lift this open. People will need to stare at a light to keep their eyes still while the laser works. The laser will then reshape the surface of the cornea. The surgeon will then place the flap back into position and apply a shield to protect the eye. Recovery time The FDATrusted Source notes that after surgery, a person may feel as though their eye is burning, itchy, or that there is a foreign object present. The surgeon may recommend a mild pain reliever, such as acetaminophen, to help with these sensations. Surgeons will provide people with an eye shield to protect their eyes, as there will be no stitches holding the flap in place. The guard helps prevent rubbing the eye or accidentally applying pressure, such as during sleep. Individuals will usually take a few days off from work so they can recover. They should schedule an appointment to see their eye doctor within the first 24–48 hours after surgery to undergo an eye examination. The doctor will make sure the eyes are healing as they should. After this, a person will need several additional appointments over the first 6 months. Results It may take up to 6 monthsTrusted Source for a person’s vision to stabilize after laser eye surgery. They may notice their vision fluctuates for a while after the procedure, but this should not be a cause for concern. However, it is common for vision to vary for the initial few months following surgery. Additionally, sometimes laser eye surgery may accidentally over- or under-correct a person’s sight. This might require further surgery to rectify, which healthcare professionals usually called enhancement. It is also important to remember that corrected vision can regress years after the procedure. The cost of LASIK surgery will be different depending on where the person lives. Other surgeons may use various equipment or techniques, which the price may reflect. Health insurance companies usually categorize LASIK as an elective or cosmetic procedure and do not typically cover these treatments. In 2020, the American Refractive Surgery Council estimated that LASIK surgery might cost around $4,200 per eye, on average. Although laser eye surgery can be expensive, it is crucial that people thoroughly do their research before undergoing treatment at reduced prices. There may be a reason the price is so low, which may increase the risk of complications. https://www.medicalnewstoday.com/articles/laser-eye-surgery#summary","<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> [user request] <TEXT> [context document]
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+EVIDENCE:
+The eye has an outer layer called the cornea. Some people’s corneas can undergo changes in their shape, leading to vision issues, such as astigmatism and myopia. Laser eye surgery is a medical procedure that reshapes this layer. Precisely how laser eye surgery reshapes the cornea depends on the vision condition that the treatment aims to correct. Laser eye surgery can fix vision issues, such as nearsightedness and farsightedness. The surgery is quick, and people remain awake throughout the procedure. It is also usually painless — if a person experiences pain, it usually indicates there have been complications. This article discusses what laser eye surgery is, who it can help, costs, duration of the surgery, recovery time, and any associated short- and long-term risks. What is laser eye surgery (LASIK or PRK) SCIENCE PHOTO LIBRARY/Getty Images LASIK stands for laser-assisted in situ keratomileusis and is the most common type of refractive eye surgery. LASIK was first patented in 1989 and has become the most commonTrusted Source treatment for refractive eye errors. The procedure involves lasers to reshape the cornea. Who may it help? According to the American Academy of Ophthalmology, over 150 million Americans use corrective eyewear, such as glasses or contact lenses, to compensate for refractive errors. Refractive errors occur when the eye does not bend — or refract — the light to properly focus on the retina in the back of the eye. This is usually due to the shape of the cornea. Farsightedness The clinical name for farsightedness is hyperopia. People with this condition can see objects in the distance clearly, but other things can appear blurry at close distance. Farsightedness is due to the curvature of the cornea being too flat. Laser eye surgery can correct this by reshaping the cornea to have a steeper curve. Nearsightedness Nearsightedness, known as myopia or short-sightedness, is where a person can see objects close to them clearly. However, distant objects can appear blurred. This is due to the curvature of the cornea being too steep. Healthcare professionals can correct this through laser eye surgery by reshaping the cornea. Astigmatism People with astigmatism have a differently-shaped eye that characterizes this condition. The eye of someone without the condition is round, like a soccer ball, while with astigmatism, the eye may have more of a football-like shape. It is possible to correct this irregular curvature of the cornea with laser eye surgery in some cases. Get our Eye Health Newsletter Receive expert advice, tips to manage your symptoms, and the latest on condition breakthroughs delivered straight to your inbox. Enter your email Also sign up for our popular Heart Health newsletter Your privacy is important to us People who are not suitableTrusted Source candidates for laser eye surgery include those who: have had a change in their eye prescription in the last 12 months take medications that may cause changes in vision are in their 20s or younger, although some experts recommend not being under 18 years have thin corneas, which may not be stable following laser surgery are pregnant or nursing Benefits The main benefit of laser eye surgery is that mostTrusted Source people no longer have to wear corrective eyewear to see clearly. Individuals may choose to undergo the procedure for several reasons, including: being unable to wear contact lenses but preferring not to wear glasses, perhaps for cosmetic reasons wishing to undertake activities, such as sports, that require a person not to wear glasses or contact lenses having the convenience of not having to wear corrective eyewear A person is more at riskTrusted Source of developing complications if they have the followingTrusted Source eye conditions: eye infections, such as keratitis or ocular herpes significant cataracts — people with this condition will not have corrected vision after laser surgery glaucoma large pupils keratoconus, a disease that makes the cornea thinner and unstable over time As with all surgeries, a person may experience complications, including: Dry eyes: Up to 95%Trusted Source of people who have laser eye surgery may experience dry eyes after the procedure, where the eyes produce fewer tears. Lubricating eye drops can help with this symptom. Glare or halo: 20% of people undergoing laser eye surgery may experience visual changes such as glare, halo, or sensitivity to light. Double or blurry vision: As many as 1 in 50 people may report blurriness and feel there is something in their eyes. Diffuse lamellar keratitis — also called “sands of Sahara” syndrome — may be the cause. Other complications a person may experience include: eye infection corneal flap complications red or bloodshot whites of the eye Most symptoms should resolve after the first few days, so an individual experiencing any symptoms after this time should consult with a medical professional. The Food & Drug Administration (FDA) suggests laser eye surgery usually takes less than 30 minutesTrusted Source. Others estimate the procedure will take around 5 minutes per eye. People undergoing laser eye surgery should expect the following: They will sit in a chair and recline, so they are flat on their back underneath a laser device and computer screen. The surgical team will clean the area around the eye and place numbing drops in the eye. Surgeons will use a lid speculum, a medical instrument, to hold the eyelids open. A laser will cut a flap in the cornea, and the surgeon will then lift this open. People will need to stare at a light to keep their eyes still while the laser works. The laser will then reshape the surface of the cornea. The surgeon will then place the flap back into position and apply a shield to protect the eye. Recovery time The FDATrusted Source notes that after surgery, a person may feel as though their eye is burning, itchy, or that there is a foreign object present. The surgeon may recommend a mild pain reliever, such as acetaminophen, to help with these sensations. Surgeons will provide people with an eye shield to protect their eyes, as there will be no stitches holding the flap in place. The guard helps prevent rubbing the eye or accidentally applying pressure, such as during sleep. Individuals will usually take a few days off from work so they can recover. They should schedule an appointment to see their eye doctor within the first 24–48 hours after surgery to undergo an eye examination. The doctor will make sure the eyes are healing as they should. After this, a person will need several additional appointments over the first 6 months. Results It may take up to 6 monthsTrusted Source for a person’s vision to stabilize after laser eye surgery. They may notice their vision fluctuates for a while after the procedure, but this should not be a cause for concern. However, it is common for vision to vary for the initial few months following surgery. Additionally, sometimes laser eye surgery may accidentally over- or under-correct a person’s sight. This might require further surgery to rectify, which healthcare professionals usually called enhancement. It is also important to remember that corrected vision can regress years after the procedure. The cost of LASIK surgery will be different depending on where the person lives. Other surgeons may use various equipment or techniques, which the price may reflect. Health insurance companies usually categorize LASIK as an elective or cosmetic procedure and do not typically cover these treatments. In 2020, the American Refractive Surgery Council estimated that LASIK surgery might cost around $4,200 per eye, on average. Although laser eye surgery can be expensive, it is crucial that people thoroughly do their research before undergoing treatment at reduced prices. There may be a reason the price is so low, which may increase the risk of complications.
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+I'm tired of wearing eye-sight glasses now and planning laser surgery for my eyes. The issue is I have a very thin cornea, so will I be considered an unsuitable candidate for laser eye surgery, and what other factors could disqualify a person from undergoing the procedure?
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+Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document],"Describe the different types of hydrogen, how the hydrogen is produced and how each type of hydrogen is relevant in the context of climate change.","Grey hydrogen and blue hydrogen The grey hydrogen considered in this study is produced by SMR technology, and the production starts with hydrogen purging with natural gas feedstock to break long hydrocarbon chains. This step is followed by sulphur removal by chemical absorption on a ZnO bed because even a small amount of sulphur present in natural gas poisons the catalyst. Then, methane is fed to the steam reformer together with steam. The subsequent reaction is a strongly endothermic reaction and produces a mixture containing hydrogen and carbon monoxide. The required steam is assumed to be produced from natural gas. Next, the produced syngas and steam go to a water gas shift reactor to produce more hydrogen and some carbon dioxide from the carbon monoxide. Subsequently, the pressure swing adsorbent (PSA) process is used to separate hydrogen and CO2 and the hydrogen is stored with a compression to 60 bar.19 Unrecovered hydrogen, methane, CO and other compounds go to the furnace to produce heat for the reformer.20 A study by Alhamdani et al. (2017) showed that the fugitive emission from the SMR process is equal to 0.004 kg CO2 eq. per kg H2 and does not have a major impact.21 In view of the low level of fugitive emissions, their effects are neglected in this study. An overview of a typical SMR process is given in Fig. 3. The production process for blue hydrogen is the same as that for grey hydrogen, except that carbon dioxide is captured from the plant, stored and sequestered as shown in Fig. 3. Fig. 3 Grey hydrogen (SMR) and blue hydrogen (SMR-CCS) production (modified from Petrescu et al., 2014).19 2.3.2. Turquoise hydrogen TDM consumes less natural gas than SMR for hydrogen production and has lower total environmental impact.22 This superior environmental performance is because the TDM process does not release carbon dioxide to air. Moreover, since carbon dioxide is in a solid form, carbon gas cannot escape from the process, and a large amount of carbon dioxide can be captured with little impact on the environment. Typically, TDM is a form of pyrolysis of methane at a high temperature of 1500 K. There are two alternate routes in this process: one involving the use of a catalyst, which requires a lower temperature of around 1000 K, and the other without a catalyst, which requires a higher temperature of 1500 K.23 One of the advantages of pyrolysis of methane is that the only reaction products are hydrogen and solid carbon, thereby preventing the formation of CO2 during the reaction.24 Consequently, TDM is considered a promising alternative method for hydrogen production and can be seen in Fig. 4. The produced solid carbon can be utilised in many applications, such as chemical and industrial use.5 The benefit of using TDM is that it does not depend on CCS development and the infrastructure since the output carbon is in the solid form.25 Fig. 4 Turquoise hydrogen (TDM) production (modified from Keipi et al., 2018).25 2.3.3. Green hydrogen Electrolysis of water to split water into oxygen and hydrogen using renewable energy as an electricity source is currently considered the most promising method for carbon-free hydrogen production. Electrolyzers range in size from small apparatus-sized devices suitable for small-scale decentralized production of hydrogen to large centralized production facilities that could be directly connected to renewable or other zero-emission forms of electricity generation. A number of different electrolyzer types exist that operate on different principles: polymer electrolyte membrane (PEM) electrolyzers, alkaline electrolyzers and solid electrolyzers.26 An overview of the general process of water electrolysis for hydrogen production is given in Fig. 5. By-product oxygen from water hydrolysis can be used in combustion processes in the form of oxygen-enriched air to overcome mass transfer limitations and increase the flame speed and temperature.","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. Describe the different types of hydrogen, how the hydrogen is produced and how each type of hydrogen is relevant in the context of climate change. Grey hydrogen and blue hydrogen The grey hydrogen considered in this study is produced by SMR technology, and the production starts with hydrogen purging with natural gas feedstock to break long hydrocarbon chains. This step is followed by sulphur removal by chemical absorption on a ZnO bed because even a small amount of sulphur present in natural gas poisons the catalyst. Then, methane is fed to the steam reformer together with steam. The subsequent reaction is a strongly endothermic reaction and produces a mixture containing hydrogen and carbon monoxide. The required steam is assumed to be produced from natural gas. Next, the produced syngas and steam go to a water gas shift reactor to produce more hydrogen and some carbon dioxide from the carbon monoxide. Subsequently, the pressure swing adsorbent (PSA) process is used to separate hydrogen and CO2 and the hydrogen is stored with a compression to 60 bar.19 Unrecovered hydrogen, methane, CO and other compounds go to the furnace to produce heat for the reformer.20 A study by Alhamdani et al. (2017) showed that the fugitive emission from the SMR process is equal to 0.004 kg CO2 eq. per kg H2 and does not have a major impact.21 In view of the low level of fugitive emissions, their effects are neglected in this study. An overview of a typical SMR process is given in Fig. 3. The production process for blue hydrogen is the same as that for grey hydrogen, except that carbon dioxide is captured from the plant, stored and sequestered as shown in Fig. 3. Fig. 3 Grey hydrogen (SMR) and blue hydrogen (SMR-CCS) production (modified from Petrescu et al., 2014).19 2.3.2. Turquoise hydrogen TDM consumes less natural gas than SMR for hydrogen production and has lower total environmental impact.22 This superior environmental performance is because the TDM process does not release carbon dioxide to air. Moreover, since carbon dioxide is in a solid form, carbon gas cannot escape from the process, and a large amount of carbon dioxide can be captured with little impact on the environment. Typically, TDM is a form of pyrolysis of methane at a high temperature of 1500 K. There are two alternate routes in this process: one involving the use of a catalyst, which requires a lower temperature of around 1000 K, and the other without a catalyst, which requires a higher temperature of 1500 K.23 One of the advantages of pyrolysis of methane is that the only reaction products are hydrogen and solid carbon, thereby preventing the formation of CO2 during the reaction.24 Consequently, TDM is considered a promising alternative method for hydrogen production and can be seen in Fig. 4. The produced solid carbon can be utilised in many applications, such as chemical and industrial use.5 The benefit of using TDM is that it does not depend on CCS development and the infrastructure since the output carbon is in the solid form.25 Fig. 4 Turquoise hydrogen (TDM) production (modified from Keipi et al., 2018).25 2.3.3. Green hydrogen Electrolysis of water to split water into oxygen and hydrogen using renewable energy as an electricity source is currently considered the most promising method for carbon-free hydrogen production. Electrolyzers range in size from small apparatus-sized devices suitable for small-scale decentralized production of hydrogen to large centralized production facilities that could be directly connected to renewable or other zero-emission forms of electricity generation. A number of different electrolyzer types exist that operate on different principles: polymer electrolyte membrane (PEM) electrolyzers, alkaline electrolyzers and solid electrolyzers.26 An overview of the general process of water electrolysis for hydrogen production is given in Fig. 5. By-product oxygen from water hydrolysis can be used in combustion processes in the form of oxygen-enriched air to overcome mass transfer limitations and increase the flame speed and temperature. https://pubs.rsc.org/en/content/articlelanding/2024/gc/d3gc02410e","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]
+
+EVIDENCE:
+Grey hydrogen and blue hydrogen The grey hydrogen considered in this study is produced by SMR technology, and the production starts with hydrogen purging with natural gas feedstock to break long hydrocarbon chains. This step is followed by sulphur removal by chemical absorption on a ZnO bed because even a small amount of sulphur present in natural gas poisons the catalyst. Then, methane is fed to the steam reformer together with steam. The subsequent reaction is a strongly endothermic reaction and produces a mixture containing hydrogen and carbon monoxide. The required steam is assumed to be produced from natural gas. Next, the produced syngas and steam go to a water gas shift reactor to produce more hydrogen and some carbon dioxide from the carbon monoxide. Subsequently, the pressure swing adsorbent (PSA) process is used to separate hydrogen and CO2 and the hydrogen is stored with a compression to 60 bar.19 Unrecovered hydrogen, methane, CO and other compounds go to the furnace to produce heat for the reformer.20 A study by Alhamdani et al. (2017) showed that the fugitive emission from the SMR process is equal to 0.004 kg CO2 eq. per kg H2 and does not have a major impact.21 In view of the low level of fugitive emissions, their effects are neglected in this study. An overview of a typical SMR process is given in Fig. 3. The production process for blue hydrogen is the same as that for grey hydrogen, except that carbon dioxide is captured from the plant, stored and sequestered as shown in Fig. 3. Fig. 3 Grey hydrogen (SMR) and blue hydrogen (SMR-CCS) production (modified from Petrescu et al., 2014).19 2.3.2. Turquoise hydrogen TDM consumes less natural gas than SMR for hydrogen production and has lower total environmental impact.22 This superior environmental performance is because the TDM process does not release carbon dioxide to air. Moreover, since carbon dioxide is in a solid form, carbon gas cannot escape from the process, and a large amount of carbon dioxide can be captured with little impact on the environment. Typically, TDM is a form of pyrolysis of methane at a high temperature of 1500 K. There are two alternate routes in this process: one involving the use of a catalyst, which requires a lower temperature of around 1000 K, and the other without a catalyst, which requires a higher temperature of 1500 K.23 One of the advantages of pyrolysis of methane is that the only reaction products are hydrogen and solid carbon, thereby preventing the formation of CO2 during the reaction.24 Consequently, TDM is considered a promising alternative method for hydrogen production and can be seen in Fig. 4. The produced solid carbon can be utilised in many applications, such as chemical and industrial use.5 The benefit of using TDM is that it does not depend on CCS development and the infrastructure since the output carbon is in the solid form.25 Fig. 4 Turquoise hydrogen (TDM) production (modified from Keipi et al., 2018).25 2.3.3. Green hydrogen Electrolysis of water to split water into oxygen and hydrogen using renewable energy as an electricity source is currently considered the most promising method for carbon-free hydrogen production. Electrolyzers range in size from small apparatus-sized devices suitable for small-scale decentralized production of hydrogen to large centralized production facilities that could be directly connected to renewable or other zero-emission forms of electricity generation. A number of different electrolyzer types exist that operate on different principles: polymer electrolyte membrane (PEM) electrolyzers, alkaline electrolyzers and solid electrolyzers.26 An overview of the general process of water electrolysis for hydrogen production is given in Fig. 5. By-product oxygen from water hydrolysis can be used in combustion processes in the form of oxygen-enriched air to overcome mass transfer limitations and increase the flame speed and temperature.
+
+USER:
+Describe the different types of hydrogen, how the hydrogen is produced and how each type of hydrogen is relevant in the context of climate change.
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,24,25,629,,101
+Only respond to the prompt using the information in the prompt. Format the response as a numbered list.,What are three failures of the WHO regarding fighting diseases and other health threats?,"WHO achievements: A mixed track record Fighting infectious diseases One of the WHO's biggest achievements was in eradicating smallpox: in 1980, 21 years after launching an international vaccination campaign, it was finally able to declare the world free of the disease. In 1988, the WHO declared a target of similarly eliminating polio by the end of the millennium. That target was missed, and the stubborn persistence of infections prompted the WHO to declare a PHEIC in 2014. Nevertheless, considerable progress has been made, with the number of cases falling by 99 % over the past three decades. Unfortunately, tuberculosis is very far from disappearing; however, the WHO's Global Drug Facility has enabled millions of patients in developing countries to access high-quality anti-TB medicines, both through collective purchasing mechanisms that bring the cost of drugs down, and through grants that help the poorest countries to buy such medicines. The WHO has also been praised for its leadership during the 2003 SARS epidemic; within just four months, the disease had been contained. In 2009, fears that the swine flu virus could mutate into a more lethal form prompted the WHO to declare its first ever Public Health Emergency of International Concern (PHEIC – see Box). Governments rushed to stockpile vaccines, most of which were never used, as the epidemic turned out to be milder than expected. This 'disproportionate' response, as it was described in a 2011 European Parliament resolution, was blamed for wasting millions of euros of public money on unnecessary vaccines. Some critics even alleged that WHO decisions had been swayed by the interests of the pharmaceutical sector. An internal enquiry exonerated the WHO from most of these accusations, arguing that, in view of the evidence available at the time, it would not have been possible to predict the course of the epidemic, while also acknowledging that the situation could have been handled more transparently. Whereas the WHO was accused of over-reacting to swine flu, its response to the 2014 West African Ebola outbreak came too late to prevent tens of thousands of deaths. In what international health experts described as an 'egregious failure', the WHO waited months before declaring a PHEIC, despite warnings, including from its own staff, that the epidemic was out of control. The organisation's lumbering bureaucratic response contrasted unfavourably with more agile interventions by non-governmental bodies such as Médecins Sans Frontières. On the other hand, in 2018 efforts to contain a second outbreak of Ebola in the Democratic Republic of the Congo were more successful, with just 33 deaths in total; for some observers, the organisation's quick response, which included the release of emergency funding just hours after the start of the outbreak and a personal visit to Kinshasa by Director-General Tedros a few days later, suggested that it had learned lessons from its 2014 failures. Ebola remains a serious threat in West Africa; a subsequent outbreak triggered another PHEIC, and killed over 2 000. Non-communicable diseases and other health threats While media attention tends to focus on emergencies caused by infectious diseases, noncommunicable diseases such as cancer cost far more lives. However, the WHO's track record in this respect is, again, a mixed one. For example, many recommendations issued by the International Agency for Research on Cancer, a semi-autonomous branch of the WHO, are scientifically sound; however, critics allege that the body does not do enough to prevent conflicts of interest that might influence expert assessments on which its recommendations are based, nor is it very successful at communicating its conclusions with the public. On smoking, described by the WHO as a 'global epidemic', the main instrument is the 2003 Framework Convention on Tobacco Control, the first ever international treaty adopted within the WHO framework. The measures it envisages have played a key role in shaping national tobacco control policies, including in developing countries. Implementation is still patchy, but gradually improving: as of 2018, 12 % of the 181 countries which are parties to the Convention were failing to ensure protection from passive smoking (e.g. bans on smoking in public places), 23 % were not applying packaging and labelling requirements (such as health warnings on cigarette packets), 29 % did not have awareness-raising and educational measures in place, while 30 % were not restricting tobacco sales to and by minors. Tobacco still kills over 8 million people every year, most of them in developing countries, and consumption is only declining slowly. Obesity is another global health scourge that the WHO has taken on. For example, in 2016 it endorsed taxes on soft drinks as an effective means of reducing sugar consumption. However, it has run into resistance from the beverages industry, and the US government, which in 2018 blocked a WHO panel from issuing a global recommendation on sugar taxes. In developing countries, the high cost of medicines is often a barrier to effective treatment. Improving access to medicines has long been a priority for the WHO. The interests of producers, which are protected by patents, have to be balanced against patients' need for affordable treatment. However, WHO work in this area has been blocked by disagreements between countries which argue that intellectual property is not part of the organisation's remit – typically pharmaceutical exporters, such as the United States (US) – and others, including developing countries, which feel that it should be.","What are three failures of the WHO regarding fighting diseases and other health threats? Only respond to the prompt using the information in the prompt. Format the response as a numbered list. WHO achievements: A mixed track record Fighting infectious diseases One of the WHO's biggest achievements was in eradicating smallpox: in 1980, 21 years after launching an international vaccination campaign, it was finally able to declare the world free of the disease. In 1988, the WHO declared a target of similarly eliminating polio by the end of the millennium. That target was missed, and the stubborn persistence of infections prompted the WHO to declare a PHEIC in 2014. Nevertheless, considerable progress has been made, with the number of cases falling by 99 % over the past three decades. Unfortunately, tuberculosis is very far from disappearing; however, the WHO's Global Drug Facility has enabled millions of patients in developing countries to access high-quality anti-TB medicines, both through collective purchasing mechanisms that bring the cost of drugs down, and through grants that help the poorest countries to buy such medicines. The WHO has also been praised for its leadership during the 2003 SARS epidemic; within just four months, the disease had been contained. In 2009, fears that the swine flu virus could mutate into a more lethal form prompted the WHO to declare its first ever Public Health Emergency of International Concern (PHEIC – see Box). Governments rushed to stockpile vaccines, most of which were never used, as the epidemic turned out to be milder than expected. This 'disproportionate' response, as it was described in a 2011 European Parliament resolution, was blamed for wasting millions of euros of public money on unnecessary vaccines. Some critics even alleged that WHO decisions had been swayed by the interests of the pharmaceutical sector. An internal enquiry exonerated the WHO from most of these accusations, arguing that, in view of the evidence available at the time, it would not have been possible to predict the course of the epidemic, while also acknowledging that the situation could have been handled more transparently. Whereas the WHO was accused of over-reacting to swine flu, its response to the 2014 West African Ebola outbreak came too late to prevent tens of thousands of deaths. In what international health experts described as an 'egregious failure', the WHO waited months before declaring a PHEIC, despite warnings, including from its own staff, that the epidemic was out of control. The organisation's lumbering bureaucratic response contrasted unfavourably with more agile interventions by non-governmental bodies such as Médecins Sans Frontières. On the other hand, in 2018 efforts to contain a second outbreak of Ebola in the Democratic Republic of the Congo were more successful, with just 33 deaths in total; for some observers, the organisation's quick response, which included the release of emergency funding just hours after the start of the outbreak and a personal visit to Kinshasa by Director-General Tedros a few days later, suggested that it had learned lessons from its 2014 failures. Ebola remains a serious threat in West Africa; a subsequent outbreak triggered another PHEIC, and killed over 2 000. Non-communicable diseases and other health threats While media attention tends to focus on emergencies caused by infectious diseases, noncommunicable diseases such as cancer cost far more lives. However, the WHO's track record in this respect is, again, a mixed one. For example, many recommendations issued by the International Agency for Research on Cancer, a semi-autonomous branch of the WHO, are scientifically sound; however, critics allege that the body does not do enough to prevent conflicts of interest that might influence expert assessments on which its recommendations are based, nor is it very successful at communicating its conclusions with the public. On smoking, described by the WHO as a 'global epidemic', the main instrument is the 2003 Framework Convention on Tobacco Control, the first ever international treaty adopted within the WHO framework. The measures it envisages have played a key role in shaping national tobacco control policies, including in developing countries. Implementation is still patchy, but gradually improving: as of 2018, 12 % of the 181 countries which are parties to the Convention were failing to ensure protection from passive smoking (e.g. bans on smoking in public places), 23 % were not applying packaging and labelling requirements (such as health warnings on cigarette packets), 29 % did not have awareness-raising and educational measures in place, while 30 % were not restricting tobacco sales to and by minors. Tobacco still kills over 8 million people every year, most of them in developing countries, and consumption is only declining slowly. Obesity is another global health scourge that the WHO has taken on. For example, in 2016 it endorsed taxes on soft drinks as an effective means of reducing sugar consumption. However, it has run into resistance from the beverages industry, and the US government, which in 2018 blocked a WHO panel from issuing a global recommendation on sugar taxes. In developing countries, the high cost of medicines is often a barrier to effective treatment. Improving access to medicines has long been a priority for the WHO. The interests of producers, which are protected by patents, have to be balanced against patients' need for affordable treatment. However, WHO work in this area has been blocked by disagreements between countries which argue that intellectual property is not part of the organisation's remit – typically pharmaceutical exporters, such as the United States (US) – and others, including developing countries, which feel that it should be.","Only respond to the prompt using the information in the prompt. Format the response as a numbered list.
+
+EVIDENCE:
+WHO achievements: A mixed track record Fighting infectious diseases One of the WHO's biggest achievements was in eradicating smallpox: in 1980, 21 years after launching an international vaccination campaign, it was finally able to declare the world free of the disease. In 1988, the WHO declared a target of similarly eliminating polio by the end of the millennium. That target was missed, and the stubborn persistence of infections prompted the WHO to declare a PHEIC in 2014. Nevertheless, considerable progress has been made, with the number of cases falling by 99 % over the past three decades. Unfortunately, tuberculosis is very far from disappearing; however, the WHO's Global Drug Facility has enabled millions of patients in developing countries to access high-quality anti-TB medicines, both through collective purchasing mechanisms that bring the cost of drugs down, and through grants that help the poorest countries to buy such medicines. The WHO has also been praised for its leadership during the 2003 SARS epidemic; within just four months, the disease had been contained. In 2009, fears that the swine flu virus could mutate into a more lethal form prompted the WHO to declare its first ever Public Health Emergency of International Concern (PHEIC – see Box). Governments rushed to stockpile vaccines, most of which were never used, as the epidemic turned out to be milder than expected. This 'disproportionate' response, as it was described in a 2011 European Parliament resolution, was blamed for wasting millions of euros of public money on unnecessary vaccines. Some critics even alleged that WHO decisions had been swayed by the interests of the pharmaceutical sector. An internal enquiry exonerated the WHO from most of these accusations, arguing that, in view of the evidence available at the time, it would not have been possible to predict the course of the epidemic, while also acknowledging that the situation could have been handled more transparently. Whereas the WHO was accused of over-reacting to swine flu, its response to the 2014 West African Ebola outbreak came too late to prevent tens of thousands of deaths. In what international health experts described as an 'egregious failure', the WHO waited months before declaring a PHEIC, despite warnings, including from its own staff, that the epidemic was out of control. The organisation's lumbering bureaucratic response contrasted unfavourably with more agile interventions by non-governmental bodies such as Médecins Sans Frontières. On the other hand, in 2018 efforts to contain a second outbreak of Ebola in the Democratic Republic of the Congo were more successful, with just 33 deaths in total; for some observers, the organisation's quick response, which included the release of emergency funding just hours after the start of the outbreak and a personal visit to Kinshasa by Director-General Tedros a few days later, suggested that it had learned lessons from its 2014 failures. Ebola remains a serious threat in West Africa; a subsequent outbreak triggered another PHEIC, and killed over 2 000. Non-communicable diseases and other health threats While media attention tends to focus on emergencies caused by infectious diseases, noncommunicable diseases such as cancer cost far more lives. However, the WHO's track record in this respect is, again, a mixed one. For example, many recommendations issued by the International Agency for Research on Cancer, a semi-autonomous branch of the WHO, are scientifically sound; however, critics allege that the body does not do enough to prevent conflicts of interest that might influence expert assessments on which its recommendations are based, nor is it very successful at communicating its conclusions with the public. On smoking, described by the WHO as a 'global epidemic', the main instrument is the 2003 Framework Convention on Tobacco Control, the first ever international treaty adopted within the WHO framework. The measures it envisages have played a key role in shaping national tobacco control policies, including in developing countries. Implementation is still patchy, but gradually improving: as of 2018, 12 % of the 181 countries which are parties to the Convention were failing to ensure protection from passive smoking (e.g. bans on smoking in public places), 23 % were not applying packaging and labelling requirements (such as health warnings on cigarette packets), 29 % did not have awareness-raising and educational measures in place, while 30 % were not restricting tobacco sales to and by minors. Tobacco still kills over 8 million people every year, most of them in developing countries, and consumption is only declining slowly. Obesity is another global health scourge that the WHO has taken on. For example, in 2016 it endorsed taxes on soft drinks as an effective means of reducing sugar consumption. However, it has run into resistance from the beverages industry, and the US government, which in 2018 blocked a WHO panel from issuing a global recommendation on sugar taxes. In developing countries, the high cost of medicines is often a barrier to effective treatment. Improving access to medicines has long been a priority for the WHO. The interests of producers, which are protected by patents, have to be balanced against patients' need for affordable treatment. However, WHO work in this area has been blocked by disagreements between countries which argue that intellectual property is not part of the organisation's remit – typically pharmaceutical exporters, such as the United States (US) – and others, including developing countries, which feel that it should be.
+
+USER:
+What are three failures of the WHO regarding fighting diseases and other health threats?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,18,14,887,,146
+Model must only respond using information contained in the context block. Model should not rely on its own knowledge or outside sources of information when responding.,In which situations will the Accidental Death Policy not pay out?,"LIFE INSURANCE AND CRITICAL ILLNESS COVER POLICY SUMMARY. This policy is provided by Legal & General Assurance Society Limited. OVERVIEW. These policies are designed for people who want to help protect against the impact of death or terminal illness or critical illness. The policy could be used to help pay your outstanding mortgage or to help protect your family’s lifestyle and everyday living expenses. This Policy Summary is only a brief guide to the cover and exclusions. You will find full details in the Policy Booklet which will form the basis of our contract with you. WHAT IS COVERED? Life insurance You will be covered if before the end of the policy: • you die. • you are diagnosed as being terminally ill, and in the opinion of your hospital consultant and our medical officer, the illness is expected to lead to death within 12 months. We’ll pay out your amount of cover once. After this happens, the policy will end and you’ll no longer have any cover. Critical illness cover If you choose to add critical illness cover alongside your life insurance as a separate policy, (also referred to as additional or independent critical illness cover) you will be covered if before the end of the policy: • You are diagnosed with or undergo a medical procedure for one of the critical illnesses we cover and you survive for 14 days from diagnosis. We’ll pay out your amount of cover in full once. After this happens, the policy will end and you’ll no longer have any cover. T 2 LIFE INSURANCE AND CRITICAL ILLNESS COVER XWHAT IS NOT COVERED? You are not covered if you don’t give us full and honest answers to the questions we ask you before the policy starts. Please don’t assume that we’ll contact your doctor to find out your full medical details. Life insurance We won’t pay out: • If within the first year of the policy, your death is caused by suicide or, intentional and serious self-injury or an event where, in our reasonable opinion, you took your own life. • If some elements of cover are restricted based on the information you give us. If we do this we’ll tell you what we’ve excluded in your policy booklet under ‘What you are not covered for’. • The amount of cover more than once if a joint life policy is chosen. This may be when the first person dies or has a valid claim. We have a replacement cover option which could allow the other person covered to take out a new single life policy, ensuring they still have some protection in place. • If you are diagnosed with a terminal illness which doesn’t meet our definition. Terminal Illness cover can’t be claimed: • after your death • or if the length of the policy is less than two years. Critical illness cover We won’t pay out: • If you are diagnosed with or undergo a medical procedure for one of the critical illnesses we cover which doesn’t meet our definition. • If death occurs within 14 days of diagnosis of one of the critical illnesses we cover. • If you die. • If some elements of cover are restricted based on the information you give us. If we do this we’ll tell you what we’ve excluded in your policy booklet under ‘What you are not covered for’. • The amount of cover more than once if a joint life policy is chosen. This will be when the first person has a valid claim. We have a replacement cover option which could allow the other person covered to take out a new single life policy, ensuring they still have some protection in place. For all policies • Life cover policies have no cash value and we will not pay out if you reach the end of the policy without making a valid claim. • If you stop paying your premiums your cover will end 60 days after the first missed premium. 3 LIFE INSURANCE AND CRITICAL ILLNESS COVER ABOUT THE POLICY. YOUR PREMIUMS Your premiums will remain the same during the length of the policy unless you make any changes. AGE LIMITS Product Maximum age for buying a policy Minimum length of the policy Maximum length of the policy Your policy must end before age Life Insurance* 77 1 year 50 years 90 Decreasing Life Insurance* 74 5 years 50 years 90 Critical Illness Cover* 67 2 years 50 years 75 The minimum age to take out a policy is 18. The policy must not end before your 29th birthday. *Guaranteed premiums 4 LIFE INSURANCE AND CRITICAL ILLNESS COVER YOUR COVER Level cover If you choose level cover, your amount of cover will stay the same unless you change it. If the policy is to help repay a mortgage, you need to ensure that your amount of cover matches your outstanding mortgage. The policy may not completely pay off your outstanding mortgage, if you change the mortgage you have in any way and you don’t adjust your cover to match your new arrangements. Decreasing cover If you choose decreasing cover it is often used to help protect a repayment mortgage. Therefore the amount of cover reduces roughly in line with the way a repayment mortgage decreases. You need to ensure that your amount of cover matches your outstanding mortgage. The policy may not completely pay off your outstanding mortgage, if: • you change the mortgage you have in any way and you don’t adjust your cover to match your new arrangements. • the interest rate on your mortgage becomes higher than the rate applied to the policy. The rate will be shown in your Personal Quote or the Policy Booklet. 5 LIFE INSURANCE AND CRITICAL ILLNESS COVER BENEFITS FOR LIFE INSURANCE. The following benefit(s) may have eligibility criteria and restrictions that apply. ACCIDENTAL DEATH BENEFIT Included at no extra cost. WHAT IS COVERED? We’ll cover you from when we receive your application, for up to 90 days or until we accept, postpone or decline your application. This means that if you die due to an accident during this time, we’ll pay out the amount you’ve asked to be insured for, up to a maximum of £300,000 for all applications. The benefit will be paid out if the person covered, or one of the persons covered, sustains a bodily injury caused by accidental, violent, external and visible means, which solely and independently of any other cause results in death within 90 days of the accident. WHAT IS NOT COVERED? We won’t pay out if death occurs from: • Suicide, intentional and serious self-injury or an event where, in our reasonable opinion, you took your own life. • Taking part or attempting to take part in a dangerous sport or pastime. • Taking part or attempting to take part in any aerial flight other than as a fare paying passenger on a licensed airline. • Committing, attempting or provoking an assault or criminal offence. • War (whether declared or not), riot or civil commotion. • Taking alcohol or drugs (unless these drugs were prescribed by a registered doctor in the United Kingdom). • Accidents that happened before you applied. We don’t provide this benefit: • If we have been told that the application is to replace an existing policy with us while cover is still provided under the existing policy. • From the date you tell us that you no longer want the application to proceed. Your lump sum will be paid only once either under the Accidental Death Benefit, Free Life Cover or the policy itself. T X 6 LIFE INSURANCE AND CRITICAL ILLNESS COVER FREE LIFE COVER Included at no extra cost if you are moving home. WHAT IS COVERED? We’ll cover you if you die between exchange of contracts and completion of your property purchase up to a maximum of 90 days, provided you are accepted on standard terms and we have everything we need to start your policy. Your Free Life Cover will end as soon as the policy starts. You’ll be covered for the lower of your proposed amount of cover or the amount of your mortgage, up to a maximum of £300,000. If you live in Scotland, you’ll be covered between completion of missives and your date of entry. WHAT IS NOT COVERED? You won’t be accepted for Free Life Cover if you are 55 years old or over. For joint life policies you both need to be under this age for Free Life Cover to apply. We won’t provide cover if you have another policy with any provider covering the same mortgage. Your amount of cover will be paid only once either under Free Life Cover, Accidental Death Benefit or the policy itself. T X 7 LIFE INSURANCE AND CRITICAL ILLNESS COVER CRITICAL ILLNESSES COVERED. If you choose Critical Illness Cover, you will be covered for the illnesses shown below. For a claim to pay out, your illness must meet Legal & General’s definition. It must also be verified by a consultant at a hospital in the UK, who is a specialist in an area of medicine appropriate to the cause of your claim as in some instances cover may be limited. For example: • some types of cancer are not covered • to make a claim for some illnesses, you need to have permanent symptoms. Please check the full definitions found in the Guide to Critical Illness Cover and Policy Booklet to make sure that you understand exactly what is covered. • Aorta graft surgery - requiring surgical replacement. • Aplastic anaemia - with permanent bone marrow failure. • Bacterial meningitis - resulting in permanent symptoms • Benign brain tumour - resulting in either surgical removal or permanent symptoms. • Blindness - permanent and irreversible. • Cancer - excluding less advanced cases. • Cardiac arrest - with insertion of a defibrillator. • Cardiomyopathy - of specified severity. • Coma - with associated permanent symptoms. • Coronary artery by-pass grafts – with surgery to divide the breastbone or thoracotomy. • Creutzfeldt-Jakob disease (CJD) – resulting in permanent symptoms. • Deafness - permanent and irreversible. • Dementia including Alzheimer’s disease - of specified severity. • Encephalitis - resulting in permanent symptoms. • Heart attack - of specified severity. • Heart valve replacement or repair - with surgery. • Kidney failure - requiring permanent dialysis. • Liver failure - of advanced stage. • Loss of hand or foot – permanent physical severance. • Loss of speech - total permanent and irreversible. • Major organ transplant – from another donor. • Motor neurone disease - resulting in permanent symptoms. • Multiple sclerosis - where there have been symptoms. • Multiple system atrophy – resulting in permanent symptoms. 8 LIFE INSURANCE AND CRITICAL ILLNESS COVER • Open heart surgery – with median sternotomy. • Paralysis of limb – total and irreversible. • Parkinson’s disease - resulting in permanent symptoms. • Primary pulmonary hypertension - of specified severity. • Progressive supranuclear palsy – resulting in permanent symptoms. • Removal of an eyeball – due to injury or disease. • Respiratory failure - of advanced stage. • Spinal stroke - resulting in symptoms lasting at least 24 hours. • Stroke - resulting in symptoms lasting at least 24 hours. • Systemic lupus erythematosus - with severe complications. • Third degree burns - covering 20% of the surface area of the body or 20% of the face or head. • Traumatic brain injury – resulting in permanent symptoms. • Total and Permanent Disability – of specified severity. We’ll cover you for the loss of physical or mental ability, due to an illness or injury, to do either your own occupation or at least three of the six Specified Work Tasks (see section headed Specified Work Tasks). The definition that applies to you will be shown in the Policy Booklet and will depend on your occupation, employment status and whether you are paid for your work. Total and Permanent Disability will end when the oldest person covered reaches the policy end date, or 70th birthday, whichever is earlier. SPECIFIED WORK TASKS Walking – The ability to walk more than 200 metres on a level surface. Climbing – The ability to climb up a flight of 12 stairs and down again, using the handrail if needed. Lifting – The ability to pick up an object weighing 2kg at table height and hold for 60 seconds before replacing the object on the table. Bending – The ability to bend or kneel to touch the floor and straighten up again. Getting in and out of a car – The ability to get into a standard saloon car, and out again. Writing – The manual dexterity to write legibly using a pen or pencil, or type using a desktop personal computer keyboard. 9 LIFE INSURANCE AND CRITICAL ILLNESS COVER ADDITIONAL COVER IF CRITICAL ILLNESS COVER IS CHOSEN. • Carcinoma in situ of the breast - treated by surgery. • Low grade prostate cancer - requiring treatment. WHAT IS COVERED? Unless specifically excluded in the Policy Booklet under the heading ‘What you are not covered for’: We’ll pay out 25% of your amount of cover up to a maximum of £25,000. Your amount of cover and premiums will not be affected if we make an additional payment to you and we’ll still pay out the amount you are covered for under the main policy in case of a terminal illness or critical illness or death. We’ll only pay out once for each definition shown above. If joint life cover is chosen both lives insured will be able to claim. WHAT IS NOT COVERED? Please check the full definitions found in the Guide to Critical Illness Cover and Policy Booklet to make sure you understand exactly what is not covered. T X 10 LIFE INSURANCE AND CRITICAL ILLNESS COVER EXTRA BENEFITS INCLUDED IF CRITICAL ILLNESS COVER IS CHOSEN. ACCIDENT HOSPITALISATION BENEFIT WHAT IS COVERED? We’ll pay £5,000 if you are in hospital with physical injuries for a minimum of 28 consecutive days, immediately following an accident. WHAT IS NOT COVERED? This benefit will not be payable if a valid claim has been made for Critical Illness Cover. We’ll only pay one claim for each person covered T X 11 LIFE INSURANCE AND CRITICAL ILLNESS COVER CHILDREN'S CRITICAL ILLNESS COVER WHAT IS COVERED? We’ll cover a relevant child* or any children you have in the future if, before the end of your policy, they’re diagnosed with one of the critical illnesses we cover, including Additional Cover (except for Total and Permanent Disability). They are covered from when they’re 30 days old to their 18th birthday (or 21st birthday if they’re in full time education). We’ll pay out 50% of your original amount of cover up to a maximum of £25,000 for a valid claim. Your amount of cover and premiums will not be affected if we make an additional payment to you. We’ll pay out one claim per relevant child* under the policy. Once two claims in total have been made, children’s cover will end. If the same relevant child* is covered by more than one policy issued by us, we’ll pay out a maximum of £50,000 for that relevant child*. WHAT IS NOT COVERED? Your children will not be covered: • For Total and Permanent Disability. • For Terminal Illness Cover. • For any condition that was present at birth. • Where the symptoms arose before the relevant child* was covered. • If death occurs within 14 days of diagnosis of one of the critical illnesses we cover. T X 12 LIFE INSURANCE AND CRITICAL ILLNESS COVER ADDITIONAL BENEFITS INCLUDED FOR CHILDREN'S CRITICAL ILLNESS COVER Your amount of cover and premiums will not be affected if we make an additional benefit payment to you. For further details, please read your Policy Booklet. Child Accident Hospitalisation Benefit - pays £5,000 if a relevant child* is admitted to hospital with physical injuries for a minimum of 28 consecutive days immediately following an accident. Child Funeral Benefit - contributes £4,000 towards the funeral of a relevant child*. Childcare Benefit - if we have paid a claim for a critical illness under this policy, and you have a natural child, legally adopted child or stepchild under 5 years old, we’ll pay up to £1,000 towards childcare with a registered childminder. Family Accommodation Benefit - pays £100 for every night a relevant child* spends in hospital, in the three months immediately following diagnosis of one of the critical illnesses covered (up to a maximum of £1,000). *Relevant child - a natural child, legally adopted child or stepchild of the person covered, who is at least 30 days old and younger than 18 (21 years old if in full-time education). 13 LIFE INSURANCE AND CRITICAL ILLNESS COVER FURTHER INFORMATION. CAN I INCREASE MY COVER? You can apply to increase your cover at anytime. Usually, changes to your amount of cover will be assessed at the time. However, if the ‘Changing your policy’ section is shown in your Policy Booklet then you can increase your cover, for certain life events, without the need to provide us with further medical information. Please see your Policy Booklet for further information. Eligibility criteria apply. CAN I MAKE CHANGES? You can make changes to the policy. Please talk to us and we’ll consider your request and let you know if what you’re asking for is possible and what your new premium will be. If you make any changes to the policy then a new policy may be set up and different terms and conditions could apply. WHAT HAPPENS IF I MOVE ABROAD? If you move abroad during the length of the policy, please check the Policy Booklet, as your policy may be affected. ARE PAY OUTS TAXED? For life insurance Any pay outs we make should be free from UK Income Tax and Capital Gains Tax. The Government may change this tax position at any time. If the policy is written under a suitable trust, the amount of cover payable on death should not form part of the estate for Inheritance Tax purposes. If the policy is not written in trust, the amount of cover payable will normally go into the estate and Inheritance Tax may apply. For critical illness cover Any pay outs that we make should be free from UK Income Tax and Capital Gains Tax. The Government may change this tax position at any time. If you are diagnosed with or undergo a medical procedure for one of the specified critical illnesses we cover and you survive 10 days from diagnosis then the policy may pay out after you die in which case the amount of cover will be payable to your estate and may be subject to Inheritance Tax. If the policy is absolutely assigned, the amount of cover payable should not form part of the estate for Inheritance Tax purposes. The policy cannot be issued or assigned into a trust. 14 LIFE INSURANCE AND CRITICAL ILLNESS COVER WHAT IF I WANT TO CANCEL OR CLAIM? You can cancel the policy at any time. When you first take out the policy you will have the opportunity to cancel. If you cancel within 30 days, we’ll refund any premiums you’ve paid. If you cancel the policy at a later stage, you will not get any money back if you pay your premiums monthly. If you pay annually you will receive a proportionate refund of your annual premium. To cancel or claim you can write to us at: Claims or Cancellations Department, Legal & General Assurance Society Limited, City Park, The Droveway, Hove, East Sussex BN3 7PY. Or call or email us: • For Life claims: 0800 137 101* life.claims@landg.com • For critical illness claims: 0800 068 0789* health.claims@landg.com • For Cancellations: 0370 010 4080* HOW DO I COMPLAIN? If you have a complaint about our service or would like a copy of our internal complaint handling procedure, please contact us at: Legal & General Assurance Society Limited, Four Central Square, Cardiff CF10 1FS 0370 010 4080* Making a complaint doesn’t affect your legal rights. If you’re not happy with the way we handle your complaint, you can talk to the Financial Ombudsman Service at: Exchange Tower, London E14 9SR 0800 023 4567 0300 123 9123 complaint.info@financial-ombudsman.org.uk www.financial-ombudsman.org.uk * Calls may be recorded and monitored. Call charges may vary. 15 LIFE INSURANCE AND CRITICAL ILLNESS COVER M www.legalandgeneral.com Legal & General Assurance Society Limited Registered in England and Wales No. 00166055 Registered office: One Coleman Street, London EC2R5AA We are authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. 02/2024 QGI16569 THE FINANCIAL SERVICES COMPENSATION SCHEME (FSCS) We are covered by the Financial Services Compensation Scheme (FSCS). You may be entitled to compensation from the scheme if we cannot meet our obligations. Whether or not you are able to claim and how much you may be entitled to will depend on the specific circumstances at the time. For further information about the scheme please contact the FSCS at: www.fscs.org.uk or call them on: 0800 678 1100. Alternative formats If you would like a copy of this in large print, braille, PDF or in an audio format, call us on 0370 010 4080. We may record and monitor calls. Call charges will vary.","Model must only respond using information contained in the context block. Model should not rely on its own knowledge or outside sources of information when responding. In which situations will the Accidental Death Policy not pay out? LIFE INSURANCE AND CRITICAL ILLNESS COVER POLICY SUMMARY. This policy is provided by Legal & General Assurance Society Limited. OVERVIEW. These policies are designed for people who want to help protect against the impact of death or terminal illness or critical illness. The policy could be used to help pay your outstanding mortgage or to help protect your family’s lifestyle and everyday living expenses. This Policy Summary is only a brief guide to the cover and exclusions. You will find full details in the Policy Booklet which will form the basis of our contract with you. WHAT IS COVERED? Life insurance You will be covered if before the end of the policy: • you die. • you are diagnosed as being terminally ill, and in the opinion of your hospital consultant and our medical officer, the illness is expected to lead to death within 12 months. We’ll pay out your amount of cover once. After this happens, the policy will end and you’ll no longer have any cover. Critical illness cover If you choose to add critical illness cover alongside your life insurance as a separate policy, (also referred to as additional or independent critical illness cover) you will be covered if before the end of the policy: • You are diagnosed with or undergo a medical procedure for one of the critical illnesses we cover and you survive for 14 days from diagnosis. We’ll pay out your amount of cover in full once. After this happens, the policy will end and you’ll no longer have any cover. T 2 LIFE INSURANCE AND CRITICAL ILLNESS COVER XWHAT IS NOT COVERED? You are not covered if you don’t give us full and honest answers to the questions we ask you before the policy starts. Please don’t assume that we’ll contact your doctor to find out your full medical details. Life insurance We won’t pay out: • If within the first year of the policy, your death is caused by suicide or, intentional and serious self-injury or an event where, in our reasonable opinion, you took your own life. • If some elements of cover are restricted based on the information you give us. If we do this we’ll tell you what we’ve excluded in your policy booklet under ‘What you are not covered for’. • The amount of cover more than once if a joint life policy is chosen. This may be when the first person dies or has a valid claim. We have a replacement cover option which could allow the other person covered to take out a new single life policy, ensuring they still have some protection in place. • If you are diagnosed with a terminal illness which doesn’t meet our definition. Terminal Illness cover can’t be claimed: • after your death • or if the length of the policy is less than two years. Critical illness cover We won’t pay out: • If you are diagnosed with or undergo a medical procedure for one of the critical illnesses we cover which doesn’t meet our definition. • If death occurs within 14 days of diagnosis of one of the critical illnesses we cover. • If you die. • If some elements of cover are restricted based on the information you give us. If we do this we’ll tell you what we’ve excluded in your policy booklet under ‘What you are not covered for’. • The amount of cover more than once if a joint life policy is chosen. This will be when the first person has a valid claim. We have a replacement cover option which could allow the other person covered to take out a new single life policy, ensuring they still have some protection in place. For all policies • Life cover policies have no cash value and we will not pay out if you reach the end of the policy without making a valid claim. • If you stop paying your premiums your cover will end 60 days after the first missed premium. 3 LIFE INSURANCE AND CRITICAL ILLNESS COVER ABOUT THE POLICY. YOUR PREMIUMS Your premiums will remain the same during the length of the policy unless you make any changes. AGE LIMITS Product Maximum age for buying a policy Minimum length of the policy Maximum length of the policy Your policy must end before age Life Insurance* 77 1 year 50 years 90 Decreasing Life Insurance* 74 5 years 50 years 90 Critical Illness Cover* 67 2 years 50 years 75 The minimum age to take out a policy is 18. The policy must not end before your 29th birthday. *Guaranteed premiums 4 LIFE INSURANCE AND CRITICAL ILLNESS COVER YOUR COVER Level cover If you choose level cover, your amount of cover will stay the same unless you change it. If the policy is to help repay a mortgage, you need to ensure that your amount of cover matches your outstanding mortgage. The policy may not completely pay off your outstanding mortgage, if you change the mortgage you have in any way and you don’t adjust your cover to match your new arrangements. Decreasing cover If you choose decreasing cover it is often used to help protect a repayment mortgage. Therefore the amount of cover reduces roughly in line with the way a repayment mortgage decreases. You need to ensure that your amount of cover matches your outstanding mortgage. The policy may not completely pay off your outstanding mortgage, if: • you change the mortgage you have in any way and you don’t adjust your cover to match your new arrangements. • the interest rate on your mortgage becomes higher than the rate applied to the policy. The rate will be shown in your Personal Quote or the Policy Booklet. 5 LIFE INSURANCE AND CRITICAL ILLNESS COVER BENEFITS FOR LIFE INSURANCE. The following benefit(s) may have eligibility criteria and restrictions that apply. ACCIDENTAL DEATH BENEFIT Included at no extra cost. WHAT IS COVERED? We’ll cover you from when we receive your application, for up to 90 days or until we accept, postpone or decline your application. This means that if you die due to an accident during this time, we’ll pay out the amount you’ve asked to be insured for, up to a maximum of £300,000 for all applications. The benefit will be paid out if the person covered, or one of the persons covered, sustains a bodily injury caused by accidental, violent, external and visible means, which solely and independently of any other cause results in death within 90 days of the accident. WHAT IS NOT COVERED? We won’t pay out if death occurs from: • Suicide, intentional and serious self-injury or an event where, in our reasonable opinion, you took your own life. • Taking part or attempting to take part in a dangerous sport or pastime. • Taking part or attempting to take part in any aerial flight other than as a fare paying passenger on a licensed airline. • Committing, attempting or provoking an assault or criminal offence. • War (whether declared or not), riot or civil commotion. • Taking alcohol or drugs (unless these drugs were prescribed by a registered doctor in the United Kingdom). • Accidents that happened before you applied. We don’t provide this benefit: • If we have been told that the application is to replace an existing policy with us while cover is still provided under the existing policy. • From the date you tell us that you no longer want the application to proceed. Your lump sum will be paid only once either under the Accidental Death Benefit, Free Life Cover or the policy itself. T X 6 LIFE INSURANCE AND CRITICAL ILLNESS COVER FREE LIFE COVER Included at no extra cost if you are moving home. WHAT IS COVERED? We’ll cover you if you die between exchange of contracts and completion of your property purchase up to a maximum of 90 days, provided you are accepted on standard terms and we have everything we need to start your policy. Your Free Life Cover will end as soon as the policy starts. You’ll be covered for the lower of your proposed amount of cover or the amount of your mortgage, up to a maximum of £300,000. If you live in Scotland, you’ll be covered between completion of missives and your date of entry. WHAT IS NOT COVERED? You won’t be accepted for Free Life Cover if you are 55 years old or over. For joint life policies you both need to be under this age for Free Life Cover to apply. We won’t provide cover if you have another policy with any provider covering the same mortgage. Your amount of cover will be paid only once either under Free Life Cover, Accidental Death Benefit or the policy itself. T X 7 LIFE INSURANCE AND CRITICAL ILLNESS COVER CRITICAL ILLNESSES COVERED. If you choose Critical Illness Cover, you will be covered for the illnesses shown below. For a claim to pay out, your illness must meet Legal & General’s definition. It must also be verified by a consultant at a hospital in the UK, who is a specialist in an area of medicine appropriate to the cause of your claim as in some instances cover may be limited. For example: • some types of cancer are not covered • to make a claim for some illnesses, you need to have permanent symptoms. Please check the full definitions found in the Guide to Critical Illness Cover and Policy Booklet to make sure that you understand exactly what is covered. • Aorta graft surgery - requiring surgical replacement. • Aplastic anaemia - with permanent bone marrow failure. • Bacterial meningitis - resulting in permanent symptoms • Benign brain tumour - resulting in either surgical removal or permanent symptoms. • Blindness - permanent and irreversible. • Cancer - excluding less advanced cases. • Cardiac arrest - with insertion of a defibrillator. • Cardiomyopathy - of specified severity. • Coma - with associated permanent symptoms. • Coronary artery by-pass grafts – with surgery to divide the breastbone or thoracotomy. • Creutzfeldt-Jakob disease (CJD) – resulting in permanent symptoms. • Deafness - permanent and irreversible. • Dementia including Alzheimer’s disease - of specified severity. • Encephalitis - resulting in permanent symptoms. • Heart attack - of specified severity. • Heart valve replacement or repair - with surgery. • Kidney failure - requiring permanent dialysis. • Liver failure - of advanced stage. • Loss of hand or foot – permanent physical severance. • Loss of speech - total permanent and irreversible. • Major organ transplant – from another donor. • Motor neurone disease - resulting in permanent symptoms. • Multiple sclerosis - where there have been symptoms. • Multiple system atrophy – resulting in permanent symptoms. 8 LIFE INSURANCE AND CRITICAL ILLNESS COVER • Open heart surgery – with median sternotomy. • Paralysis of limb – total and irreversible. • Parkinson’s disease - resulting in permanent symptoms. • Primary pulmonary hypertension - of specified severity. • Progressive supranuclear palsy – resulting in permanent symptoms. • Removal of an eyeball – due to injury or disease. • Respiratory failure - of advanced stage. • Spinal stroke - resulting in symptoms lasting at least 24 hours. • Stroke - resulting in symptoms lasting at least 24 hours. • Systemic lupus erythematosus - with severe complications. • Third degree burns - covering 20% of the surface area of the body or 20% of the face or head. • Traumatic brain injury – resulting in permanent symptoms. • Total and Permanent Disability – of specified severity. We’ll cover you for the loss of physical or mental ability, due to an illness or injury, to do either your own occupation or at least three of the six Specified Work Tasks (see section headed Specified Work Tasks). The definition that applies to you will be shown in the Policy Booklet and will depend on your occupation, employment status and whether you are paid for your work. Total and Permanent Disability will end when the oldest person covered reaches the policy end date, or 70th birthday, whichever is earlier. SPECIFIED WORK TASKS Walking – The ability to walk more than 200 metres on a level surface. Climbing – The ability to climb up a flight of 12 stairs and down again, using the handrail if needed. Lifting – The ability to pick up an object weighing 2kg at table height and hold for 60 seconds before replacing the object on the table. Bending – The ability to bend or kneel to touch the floor and straighten up again. Getting in and out of a car – The ability to get into a standard saloon car, and out again. Writing – The manual dexterity to write legibly using a pen or pencil, or type using a desktop personal computer keyboard. 9 LIFE INSURANCE AND CRITICAL ILLNESS COVER ADDITIONAL COVER IF CRITICAL ILLNESS COVER IS CHOSEN. • Carcinoma in situ of the breast - treated by surgery. • Low grade prostate cancer - requiring treatment. WHAT IS COVERED? Unless specifically excluded in the Policy Booklet under the heading ‘What you are not covered for’: We’ll pay out 25% of your amount of cover up to a maximum of £25,000. Your amount of cover and premiums will not be affected if we make an additional payment to you and we’ll still pay out the amount you are covered for under the main policy in case of a terminal illness or critical illness or death. We’ll only pay out once for each definition shown above. If joint life cover is chosen both lives insured will be able to claim. WHAT IS NOT COVERED? Please check the full definitions found in the Guide to Critical Illness Cover and Policy Booklet to make sure you understand exactly what is not covered. T X 10 LIFE INSURANCE AND CRITICAL ILLNESS COVER EXTRA BENEFITS INCLUDED IF CRITICAL ILLNESS COVER IS CHOSEN. ACCIDENT HOSPITALISATION BENEFIT WHAT IS COVERED? We’ll pay £5,000 if you are in hospital with physical injuries for a minimum of 28 consecutive days, immediately following an accident. WHAT IS NOT COVERED? This benefit will not be payable if a valid claim has been made for Critical Illness Cover. We’ll only pay one claim for each person covered T X 11 LIFE INSURANCE AND CRITICAL ILLNESS COVER CHILDREN'S CRITICAL ILLNESS COVER WHAT IS COVERED? We’ll cover a relevant child* or any children you have in the future if, before the end of your policy, they’re diagnosed with one of the critical illnesses we cover, including Additional Cover (except for Total and Permanent Disability). They are covered from when they’re 30 days old to their 18th birthday (or 21st birthday if they’re in full time education). We’ll pay out 50% of your original amount of cover up to a maximum of £25,000 for a valid claim. Your amount of cover and premiums will not be affected if we make an additional payment to you. We’ll pay out one claim per relevant child* under the policy. Once two claims in total have been made, children’s cover will end. If the same relevant child* is covered by more than one policy issued by us, we’ll pay out a maximum of £50,000 for that relevant child*. WHAT IS NOT COVERED? Your children will not be covered: • For Total and Permanent Disability. • For Terminal Illness Cover. • For any condition that was present at birth. • Where the symptoms arose before the relevant child* was covered. • If death occurs within 14 days of diagnosis of one of the critical illnesses we cover. T X 12 LIFE INSURANCE AND CRITICAL ILLNESS COVER ADDITIONAL BENEFITS INCLUDED FOR CHILDREN'S CRITICAL ILLNESS COVER Your amount of cover and premiums will not be affected if we make an additional benefit payment to you. For further details, please read your Policy Booklet. Child Accident Hospitalisation Benefit - pays £5,000 if a relevant child* is admitted to hospital with physical injuries for a minimum of 28 consecutive days immediately following an accident. Child Funeral Benefit - contributes £4,000 towards the funeral of a relevant child*. Childcare Benefit - if we have paid a claim for a critical illness under this policy, and you have a natural child, legally adopted child or stepchild under 5 years old, we’ll pay up to £1,000 towards childcare with a registered childminder. Family Accommodation Benefit - pays £100 for every night a relevant child* spends in hospital, in the three months immediately following diagnosis of one of the critical illnesses covered (up to a maximum of £1,000). *Relevant child - a natural child, legally adopted child or stepchild of the person covered, who is at least 30 days old and younger than 18 (21 years old if in full-time education). 13 LIFE INSURANCE AND CRITICAL ILLNESS COVER FURTHER INFORMATION. CAN I INCREASE MY COVER? You can apply to increase your cover at anytime. Usually, changes to your amount of cover will be assessed at the time. However, if the ‘Changing your policy’ section is shown in your Policy Booklet then you can increase your cover, for certain life events, without the need to provide us with further medical information. Please see your Policy Booklet for further information. Eligibility criteria apply. CAN I MAKE CHANGES? You can make changes to the policy. Please talk to us and we’ll consider your request and let you know if what you’re asking for is possible and what your new premium will be. If you make any changes to the policy then a new policy may be set up and different terms and conditions could apply. WHAT HAPPENS IF I MOVE ABROAD? If you move abroad during the length of the policy, please check the Policy Booklet, as your policy may be affected. ARE PAY OUTS TAXED? For life insurance Any pay outs we make should be free from UK Income Tax and Capital Gains Tax. The Government may change this tax position at any time. If the policy is written under a suitable trust, the amount of cover payable on death should not form part of the estate for Inheritance Tax purposes. If the policy is not written in trust, the amount of cover payable will normally go into the estate and Inheritance Tax may apply. For critical illness cover Any pay outs that we make should be free from UK Income Tax and Capital Gains Tax. The Government may change this tax position at any time. If you are diagnosed with or undergo a medical procedure for one of the specified critical illnesses we cover and you survive 10 days from diagnosis then the policy may pay out after you die in which case the amount of cover will be payable to your estate and may be subject to Inheritance Tax. If the policy is absolutely assigned, the amount of cover payable should not form part of the estate for Inheritance Tax purposes. The policy cannot be issued or assigned into a trust. 14 LIFE INSURANCE AND CRITICAL ILLNESS COVER WHAT IF I WANT TO CANCEL OR CLAIM? You can cancel the policy at any time. When you first take out the policy you will have the opportunity to cancel. If you cancel within 30 days, we’ll refund any premiums you’ve paid. If you cancel the policy at a later stage, you will not get any money back if you pay your premiums monthly. If you pay annually you will receive a proportionate refund of your annual premium. To cancel or claim you can write to us at: Claims or Cancellations Department, Legal & General Assurance Society Limited, City Park, The Droveway, Hove, East Sussex BN3 7PY. Or call or email us: • For Life claims: 0800 137 101* life.claims@landg.com • For critical illness claims: 0800 068 0789* health.claims@landg.com • For Cancellations: 0370 010 4080* HOW DO I COMPLAIN? If you have a complaint about our service or would like a copy of our internal complaint handling procedure, please contact us at: Legal & General Assurance Society Limited, Four Central Square, Cardiff CF10 1FS 0370 010 4080* Making a complaint doesn’t affect your legal rights. If you’re not happy with the way we handle your complaint, you can talk to the Financial Ombudsman Service at: Exchange Tower, London E14 9SR 0800 023 4567 0300 123 9123 complaint.info@financial-ombudsman.org.uk www.financial-ombudsman.org.uk * Calls may be recorded and monitored. Call charges may vary. 15 LIFE INSURANCE AND CRITICAL ILLNESS COVER M www.legalandgeneral.com Legal & General Assurance Society Limited Registered in England and Wales No. 00166055 Registered office: One Coleman Street, London EC2R5AA We are authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. 02/2024 QGI16569 THE FINANCIAL SERVICES COMPENSATION SCHEME (FSCS) We are covered by the Financial Services Compensation Scheme (FSCS). You may be entitled to compensation from the scheme if we cannot meet our obligations. Whether or not you are able to claim and how much you may be entitled to will depend on the specific circumstances at the time. For further information about the scheme please contact the FSCS at: www.fscs.org.uk or call them on: 0800 678 1100. Alternative formats If you would like a copy of this in large print, braille, PDF or in an audio format, call us on 0370 010 4080. We may record and monitor calls. Call charges will vary.","Model must only respond using information contained in the context block. Model should not rely on its own knowledge or outside sources of information when responding.
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+EVIDENCE:
+LIFE INSURANCE AND CRITICAL ILLNESS COVER POLICY SUMMARY. This policy is provided by Legal & General Assurance Society Limited. OVERVIEW. These policies are designed for people who want to help protect against the impact of death or terminal illness or critical illness. The policy could be used to help pay your outstanding mortgage or to help protect your family’s lifestyle and everyday living expenses. This Policy Summary is only a brief guide to the cover and exclusions. You will find full details in the Policy Booklet which will form the basis of our contract with you. WHAT IS COVERED? Life insurance You will be covered if before the end of the policy: • you die. • you are diagnosed as being terminally ill, and in the opinion of your hospital consultant and our medical officer, the illness is expected to lead to death within 12 months. We’ll pay out your amount of cover once. After this happens, the policy will end and you’ll no longer have any cover. Critical illness cover If you choose to add critical illness cover alongside your life insurance as a separate policy, (also referred to as additional or independent critical illness cover) you will be covered if before the end of the policy: • You are diagnosed with or undergo a medical procedure for one of the critical illnesses we cover and you survive for 14 days from diagnosis. We’ll pay out your amount of cover in full once. After this happens, the policy will end and you’ll no longer have any cover. T 2 LIFE INSURANCE AND CRITICAL ILLNESS COVER XWHAT IS NOT COVERED? You are not covered if you don’t give us full and honest answers to the questions we ask you before the policy starts. Please don’t assume that we’ll contact your doctor to find out your full medical details. Life insurance We won’t pay out: • If within the first year of the policy, your death is caused by suicide or, intentional and serious self-injury or an event where, in our reasonable opinion, you took your own life. • If some elements of cover are restricted based on the information you give us. If we do this we’ll tell you what we’ve excluded in your policy booklet under ‘What you are not covered for’. • The amount of cover more than once if a joint life policy is chosen. This may be when the first person dies or has a valid claim. We have a replacement cover option which could allow the other person covered to take out a new single life policy, ensuring they still have some protection in place. • If you are diagnosed with a terminal illness which doesn’t meet our definition. Terminal Illness cover can’t be claimed: • after your death • or if the length of the policy is less than two years. Critical illness cover We won’t pay out: • If you are diagnosed with or undergo a medical procedure for one of the critical illnesses we cover which doesn’t meet our definition. • If death occurs within 14 days of diagnosis of one of the critical illnesses we cover. • If you die. • If some elements of cover are restricted based on the information you give us. If we do this we’ll tell you what we’ve excluded in your policy booklet under ‘What you are not covered for’. • The amount of cover more than once if a joint life policy is chosen. This will be when the first person has a valid claim. We have a replacement cover option which could allow the other person covered to take out a new single life policy, ensuring they still have some protection in place. For all policies • Life cover policies have no cash value and we will not pay out if you reach the end of the policy without making a valid claim. • If you stop paying your premiums your cover will end 60 days after the first missed premium. 3 LIFE INSURANCE AND CRITICAL ILLNESS COVER ABOUT THE POLICY. YOUR PREMIUMS Your premiums will remain the same during the length of the policy unless you make any changes. AGE LIMITS Product Maximum age for buying a policy Minimum length of the policy Maximum length of the policy Your policy must end before age Life Insurance* 77 1 year 50 years 90 Decreasing Life Insurance* 74 5 years 50 years 90 Critical Illness Cover* 67 2 years 50 years 75 The minimum age to take out a policy is 18. The policy must not end before your 29th birthday. *Guaranteed premiums 4 LIFE INSURANCE AND CRITICAL ILLNESS COVER YOUR COVER Level cover If you choose level cover, your amount of cover will stay the same unless you change it. If the policy is to help repay a mortgage, you need to ensure that your amount of cover matches your outstanding mortgage. The policy may not completely pay off your outstanding mortgage, if you change the mortgage you have in any way and you don’t adjust your cover to match your new arrangements. Decreasing cover If you choose decreasing cover it is often used to help protect a repayment mortgage. Therefore the amount of cover reduces roughly in line with the way a repayment mortgage decreases. You need to ensure that your amount of cover matches your outstanding mortgage. The policy may not completely pay off your outstanding mortgage, if: • you change the mortgage you have in any way and you don’t adjust your cover to match your new arrangements. • the interest rate on your mortgage becomes higher than the rate applied to the policy. The rate will be shown in your Personal Quote or the Policy Booklet. 5 LIFE INSURANCE AND CRITICAL ILLNESS COVER BENEFITS FOR LIFE INSURANCE. The following benefit(s) may have eligibility criteria and restrictions that apply. ACCIDENTAL DEATH BENEFIT Included at no extra cost. WHAT IS COVERED? We’ll cover you from when we receive your application, for up to 90 days or until we accept, postpone or decline your application. This means that if you die due to an accident during this time, we’ll pay out the amount you’ve asked to be insured for, up to a maximum of £300,000 for all applications. The benefit will be paid out if the person covered, or one of the persons covered, sustains a bodily injury caused by accidental, violent, external and visible means, which solely and independently of any other cause results in death within 90 days of the accident. WHAT IS NOT COVERED? We won’t pay out if death occurs from: • Suicide, intentional and serious self-injury or an event where, in our reasonable opinion, you took your own life. • Taking part or attempting to take part in a dangerous sport or pastime. • Taking part or attempting to take part in any aerial flight other than as a fare paying passenger on a licensed airline. • Committing, attempting or provoking an assault or criminal offence. • War (whether declared or not), riot or civil commotion. • Taking alcohol or drugs (unless these drugs were prescribed by a registered doctor in the United Kingdom). • Accidents that happened before you applied. We don’t provide this benefit: • If we have been told that the application is to replace an existing policy with us while cover is still provided under the existing policy. • From the date you tell us that you no longer want the application to proceed. Your lump sum will be paid only once either under the Accidental Death Benefit, Free Life Cover or the policy itself. T X 6 LIFE INSURANCE AND CRITICAL ILLNESS COVER FREE LIFE COVER Included at no extra cost if you are moving home. WHAT IS COVERED? We’ll cover you if you die between exchange of contracts and completion of your property purchase up to a maximum of 90 days, provided you are accepted on standard terms and we have everything we need to start your policy. Your Free Life Cover will end as soon as the policy starts. You’ll be covered for the lower of your proposed amount of cover or the amount of your mortgage, up to a maximum of £300,000. If you live in Scotland, you’ll be covered between completion of missives and your date of entry. WHAT IS NOT COVERED? You won’t be accepted for Free Life Cover if you are 55 years old or over. For joint life policies you both need to be under this age for Free Life Cover to apply. We won’t provide cover if you have another policy with any provider covering the same mortgage. Your amount of cover will be paid only once either under Free Life Cover, Accidental Death Benefit or the policy itself. T X 7 LIFE INSURANCE AND CRITICAL ILLNESS COVER CRITICAL ILLNESSES COVERED. If you choose Critical Illness Cover, you will be covered for the illnesses shown below. For a claim to pay out, your illness must meet Legal & General’s definition. It must also be verified by a consultant at a hospital in the UK, who is a specialist in an area of medicine appropriate to the cause of your claim as in some instances cover may be limited. For example: • some types of cancer are not covered • to make a claim for some illnesses, you need to have permanent symptoms. Please check the full definitions found in the Guide to Critical Illness Cover and Policy Booklet to make sure that you understand exactly what is covered. • Aorta graft surgery - requiring surgical replacement. • Aplastic anaemia - with permanent bone marrow failure. • Bacterial meningitis - resulting in permanent symptoms • Benign brain tumour - resulting in either surgical removal or permanent symptoms. • Blindness - permanent and irreversible. • Cancer - excluding less advanced cases. • Cardiac arrest - with insertion of a defibrillator. • Cardiomyopathy - of specified severity. • Coma - with associated permanent symptoms. • Coronary artery by-pass grafts – with surgery to divide the breastbone or thoracotomy. • Creutzfeldt-Jakob disease (CJD) – resulting in permanent symptoms. • Deafness - permanent and irreversible. • Dementia including Alzheimer’s disease - of specified severity. • Encephalitis - resulting in permanent symptoms. • Heart attack - of specified severity. • Heart valve replacement or repair - with surgery. • Kidney failure - requiring permanent dialysis. • Liver failure - of advanced stage. • Loss of hand or foot – permanent physical severance. • Loss of speech - total permanent and irreversible. • Major organ transplant – from another donor. • Motor neurone disease - resulting in permanent symptoms. • Multiple sclerosis - where there have been symptoms. • Multiple system atrophy – resulting in permanent symptoms. 8 LIFE INSURANCE AND CRITICAL ILLNESS COVER • Open heart surgery – with median sternotomy. • Paralysis of limb – total and irreversible. • Parkinson’s disease - resulting in permanent symptoms. • Primary pulmonary hypertension - of specified severity. • Progressive supranuclear palsy – resulting in permanent symptoms. • Removal of an eyeball – due to injury or disease. • Respiratory failure - of advanced stage. • Spinal stroke - resulting in symptoms lasting at least 24 hours. • Stroke - resulting in symptoms lasting at least 24 hours. • Systemic lupus erythematosus - with severe complications. • Third degree burns - covering 20% of the surface area of the body or 20% of the face or head. • Traumatic brain injury – resulting in permanent symptoms. • Total and Permanent Disability – of specified severity. We’ll cover you for the loss of physical or mental ability, due to an illness or injury, to do either your own occupation or at least three of the six Specified Work Tasks (see section headed Specified Work Tasks). The definition that applies to you will be shown in the Policy Booklet and will depend on your occupation, employment status and whether you are paid for your work. Total and Permanent Disability will end when the oldest person covered reaches the policy end date, or 70th birthday, whichever is earlier. SPECIFIED WORK TASKS Walking – The ability to walk more than 200 metres on a level surface. Climbing – The ability to climb up a flight of 12 stairs and down again, using the handrail if needed. Lifting – The ability to pick up an object weighing 2kg at table height and hold for 60 seconds before replacing the object on the table. Bending – The ability to bend or kneel to touch the floor and straighten up again. Getting in and out of a car – The ability to get into a standard saloon car, and out again. Writing – The manual dexterity to write legibly using a pen or pencil, or type using a desktop personal computer keyboard. 9 LIFE INSURANCE AND CRITICAL ILLNESS COVER ADDITIONAL COVER IF CRITICAL ILLNESS COVER IS CHOSEN. • Carcinoma in situ of the breast - treated by surgery. • Low grade prostate cancer - requiring treatment. WHAT IS COVERED? Unless specifically excluded in the Policy Booklet under the heading ‘What you are not covered for’: We’ll pay out 25% of your amount of cover up to a maximum of £25,000. Your amount of cover and premiums will not be affected if we make an additional payment to you and we’ll still pay out the amount you are covered for under the main policy in case of a terminal illness or critical illness or death. We’ll only pay out once for each definition shown above. If joint life cover is chosen both lives insured will be able to claim. WHAT IS NOT COVERED? Please check the full definitions found in the Guide to Critical Illness Cover and Policy Booklet to make sure you understand exactly what is not covered. T X 10 LIFE INSURANCE AND CRITICAL ILLNESS COVER EXTRA BENEFITS INCLUDED IF CRITICAL ILLNESS COVER IS CHOSEN. ACCIDENT HOSPITALISATION BENEFIT WHAT IS COVERED? We’ll pay £5,000 if you are in hospital with physical injuries for a minimum of 28 consecutive days, immediately following an accident. WHAT IS NOT COVERED? This benefit will not be payable if a valid claim has been made for Critical Illness Cover. We’ll only pay one claim for each person covered T X 11 LIFE INSURANCE AND CRITICAL ILLNESS COVER CHILDREN'S CRITICAL ILLNESS COVER WHAT IS COVERED? We’ll cover a relevant child* or any children you have in the future if, before the end of your policy, they’re diagnosed with one of the critical illnesses we cover, including Additional Cover (except for Total and Permanent Disability). They are covered from when they’re 30 days old to their 18th birthday (or 21st birthday if they’re in full time education). We’ll pay out 50% of your original amount of cover up to a maximum of £25,000 for a valid claim. Your amount of cover and premiums will not be affected if we make an additional payment to you. We’ll pay out one claim per relevant child* under the policy. Once two claims in total have been made, children’s cover will end. If the same relevant child* is covered by more than one policy issued by us, we’ll pay out a maximum of £50,000 for that relevant child*. WHAT IS NOT COVERED? Your children will not be covered: • For Total and Permanent Disability. • For Terminal Illness Cover. • For any condition that was present at birth. • Where the symptoms arose before the relevant child* was covered. • If death occurs within 14 days of diagnosis of one of the critical illnesses we cover. T X 12 LIFE INSURANCE AND CRITICAL ILLNESS COVER ADDITIONAL BENEFITS INCLUDED FOR CHILDREN'S CRITICAL ILLNESS COVER Your amount of cover and premiums will not be affected if we make an additional benefit payment to you. For further details, please read your Policy Booklet. Child Accident Hospitalisation Benefit - pays £5,000 if a relevant child* is admitted to hospital with physical injuries for a minimum of 28 consecutive days immediately following an accident. Child Funeral Benefit - contributes £4,000 towards the funeral of a relevant child*. Childcare Benefit - if we have paid a claim for a critical illness under this policy, and you have a natural child, legally adopted child or stepchild under 5 years old, we’ll pay up to £1,000 towards childcare with a registered childminder. Family Accommodation Benefit - pays £100 for every night a relevant child* spends in hospital, in the three months immediately following diagnosis of one of the critical illnesses covered (up to a maximum of £1,000). *Relevant child - a natural child, legally adopted child or stepchild of the person covered, who is at least 30 days old and younger than 18 (21 years old if in full-time education). 13 LIFE INSURANCE AND CRITICAL ILLNESS COVER FURTHER INFORMATION. CAN I INCREASE MY COVER? You can apply to increase your cover at anytime. Usually, changes to your amount of cover will be assessed at the time. However, if the ‘Changing your policy’ section is shown in your Policy Booklet then you can increase your cover, for certain life events, without the need to provide us with further medical information. Please see your Policy Booklet for further information. Eligibility criteria apply. CAN I MAKE CHANGES? You can make changes to the policy. Please talk to us and we’ll consider your request and let you know if what you’re asking for is possible and what your new premium will be. If you make any changes to the policy then a new policy may be set up and different terms and conditions could apply. WHAT HAPPENS IF I MOVE ABROAD? If you move abroad during the length of the policy, please check the Policy Booklet, as your policy may be affected. ARE PAY OUTS TAXED? For life insurance Any pay outs we make should be free from UK Income Tax and Capital Gains Tax. The Government may change this tax position at any time. If the policy is written under a suitable trust, the amount of cover payable on death should not form part of the estate for Inheritance Tax purposes. If the policy is not written in trust, the amount of cover payable will normally go into the estate and Inheritance Tax may apply. For critical illness cover Any pay outs that we make should be free from UK Income Tax and Capital Gains Tax. The Government may change this tax position at any time. If you are diagnosed with or undergo a medical procedure for one of the specified critical illnesses we cover and you survive 10 days from diagnosis then the policy may pay out after you die in which case the amount of cover will be payable to your estate and may be subject to Inheritance Tax. If the policy is absolutely assigned, the amount of cover payable should not form part of the estate for Inheritance Tax purposes. The policy cannot be issued or assigned into a trust. 14 LIFE INSURANCE AND CRITICAL ILLNESS COVER WHAT IF I WANT TO CANCEL OR CLAIM? You can cancel the policy at any time. When you first take out the policy you will have the opportunity to cancel. If you cancel within 30 days, we’ll refund any premiums you’ve paid. If you cancel the policy at a later stage, you will not get any money back if you pay your premiums monthly. If you pay annually you will receive a proportionate refund of your annual premium. To cancel or claim you can write to us at: Claims or Cancellations Department, Legal & General Assurance Society Limited, City Park, The Droveway, Hove, East Sussex BN3 7PY. Or call or email us: • For Life claims: 0800 137 101* life.claims@landg.com • For critical illness claims: 0800 068 0789* health.claims@landg.com • For Cancellations: 0370 010 4080* HOW DO I COMPLAIN? If you have a complaint about our service or would like a copy of our internal complaint handling procedure, please contact us at: Legal & General Assurance Society Limited, Four Central Square, Cardiff CF10 1FS 0370 010 4080* Making a complaint doesn’t affect your legal rights. If you’re not happy with the way we handle your complaint, you can talk to the Financial Ombudsman Service at: Exchange Tower, London E14 9SR 0800 023 4567 0300 123 9123 complaint.info@financial-ombudsman.org.uk www.financial-ombudsman.org.uk * Calls may be recorded and monitored. Call charges may vary. 15 LIFE INSURANCE AND CRITICAL ILLNESS COVER M www.legalandgeneral.com Legal & General Assurance Society Limited Registered in England and Wales No. 00166055 Registered office: One Coleman Street, London EC2R5AA We are authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. 02/2024 QGI16569 THE FINANCIAL SERVICES COMPENSATION SCHEME (FSCS) We are covered by the Financial Services Compensation Scheme (FSCS). You may be entitled to compensation from the scheme if we cannot meet our obligations. Whether or not you are able to claim and how much you may be entitled to will depend on the specific circumstances at the time. For further information about the scheme please contact the FSCS at: www.fscs.org.uk or call them on: 0800 678 1100. Alternative formats If you would like a copy of this in large print, braille, PDF or in an audio format, call us on 0370 010 4080. We may record and monitor calls. Call charges will vary.
+
+USER:
+In which situations will the Accidental Death Policy not pay out?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,26,11,3570,,71
+Respond using only information contained in the context block.,"According to the shareholder letter, what are the differences between all US and Japanese companies?","This year, I would like to describe two other investments that we expect to maintain indefinitely. Like Coke and AMEX, these commitments are not huge relative to our resources. They are worthwhile, however, and we were able to increase both positions during 2023. At yearend, Berkshire owned 27.8% of Occidental Petroleum’s common shares and also owned warrants that, for more than five years, give us the option to materially increase our ownership at a fixed price. Though we very much like our ownership, as well as the option, Berkshire has no interest in purchasing or managing Occidental. We particularly like its vast oil and gas holdings in the United States, as well as its leadership in carbon-capture initiatives, though the economic feasibility of this technique has yet to be proven. Both of these activities are very much in our country’s interest. Not so long ago, the U.S. was woefully dependent on foreign oil, and carbon capture had no meaningful constituency. Indeed, in 1975, U.S. production was eight million barrels of oil-equivalent per day (“BOEPD”), a level far short of the country’s needs. From the favorable energy position that facilitated the U.S. mobilization in World War II, the country had retreated to become heavily dependent on foreign – potentially unstable – suppliers. Further declines in oil production were predicted along with future increases in usage. 9 For a long time, the pessimism appeared to be correct, with production falling to five million BOEPD by 2007. Meanwhile, the U.S. government created a Strategic Petroleum Reserve (“SPR”) in 1975 to alleviate – though not come close to eliminating – this erosion of American self-sufficiency. And then – Hallelujah! – shale economics became feasible in 2011, and our energy dependency ended. Now, U.S. production is more than 13 million BOEPD, and OPEC no longer has the upper hand. Occidental itself has annual U.S. oil production that each year comes close to matching the entire inventory of the SPR. Our country would be very – very – nervous today if domestic production had remained at five million BOEPD, and it found itself hugely dependent on non-U.S. sources. At that level, the SPR would have been emptied within months if foreign oil became unavailable. Under Vicki Hollub’s leadership, Occidental is doing the right things for both its country and its owners. No one knows what oil prices will do over the next month, year, or decade. But Vicki does know how to separate oil from rock, and that’s an uncommon talent, valuable to her shareholders and to her country. * * * * * * * * * * * * Additionally, Berkshire continues to hold its passive and long-term interest in five very large Japanese companies, each of which operates in a highly-diversified manner somewhat similar to the way Berkshire itself is run. We increased our holdings in all five last year after Greg Abel and I made a trip to Tokyo to talk with their managements. Berkshire now owns about 9% of each of the five. (A minor point: Japanese companies calculate outstanding shares in a manner different from the practice in the U.S.) Berkshire has also pledged to each company that it will not purchase shares that will take our holdings beyond 9.9%. Our cost for the five totals ¥1.6 trillion, and the yearend market value of the five was ¥2.9 trillion. However, the yen has weakened in recent years and our yearend unrealized gain in dollars was 61% or $8 billion. Neither Greg nor I believe we can forecast market prices of major currencies. We also don’t believe we can hire anyone with this ability. Therefore, Berkshire has financed most of its Japanese position with the proceeds from ¥1.3 trillion of bonds. This debt has been very well-received in Japan, and I believe Berkshire has more yen-denominated debt outstanding than any other American company. The weakened yen has produced a yearend gain for Berkshire of $1.9 billion, a sum that, pursuant to GAAP rules, has periodically been recognized in income over the 2020-23 period. In certain important ways, all five companies – Itochu, Marubeni, Mitsubishi, Mitsui and Sumitomo – follow shareholder-friendly policies that are much superior to those customarily practiced in the U.S. Since we began our Japanese purchases, each of the five has reduced the number of its outstanding shares at attractive prices. 10 Meanwhile, the managements of all five companies have been far less aggressive about their own compensation than is typical in the United States. Note as well that each of the five is applying only about 1⁄3 of its earnings to dividends. The large sums the five retain are used both to build their many businesses and, to a lesser degree, to repurchase shares. Like Berkshire, the five companies are reluctant to issue shares. An additional benefit for Berkshire is the possibility that our investment may lead to opportunities for us to partner around the world with five large, well-managed and well-respected companies. Their interests are far more broad than ours. And, on their side, the Japanese CEOs have the comfort of knowing that Berkshire will always possess huge liquid resources that can be instantly available for such partnerships, whatever their size may be. Our Japanese purchases began on July 4, 2019. Given Berkshire’s present size, building positions through open-market purchases takes a lot of patience and an extended period of “friendly” prices. The process is like turning a battleship. That is an important disadvantage which we did not face in our early days at Berkshire.","system instruction: Respond using only information contained in the context block. question: According to the shareholder letter, what are the differences between all US and Japanese companies? context block: This year, I would like to describe two other investments that we expect to maintain indefinitely. Like Coke and AMEX, these commitments are not huge relative to our resources. They are worthwhile, however, and we were able to increase both positions during 2023. At yearend, Berkshire owned 27.8% of Occidental Petroleum’s common shares and also owned warrants that, for more than five years, give us the option to materially increase our ownership at a fixed price. Though we very much like our ownership, as well as the option, Berkshire has no interest in purchasing or managing Occidental. We particularly like its vast oil and gas holdings in the United States, as well as its leadership in carbon-capture initiatives, though the economic feasibility of this technique has yet to be proven. Both of these activities are very much in our country’s interest. Not so long ago, the U.S. was woefully dependent on foreign oil, and carbon capture had no meaningful constituency. Indeed, in 1975, U.S. production was eight million barrels of oil-equivalent per day (“BOEPD”), a level far short of the country’s needs. From the favorable energy position that facilitated the U.S. mobilization in World War II, the country had retreated to become heavily dependent on foreign – potentially unstable – suppliers. Further declines in oil production were predicted along with future increases in usage. 9 For a long time, the pessimism appeared to be correct, with production falling to five million BOEPD by 2007. Meanwhile, the U.S. government created a Strategic Petroleum Reserve (“SPR”) in 1975 to alleviate – though not come close to eliminating – this erosion of American self-sufficiency. And then – Hallelujah! – shale economics became feasible in 2011, and our energy dependency ended. Now, U.S. production is more than 13 million BOEPD, and OPEC no longer has the upper hand. Occidental itself has annual U.S. oil production that each year comes close to matching the entire inventory of the SPR. Our country would be very – very – nervous today if domestic production had remained at five million BOEPD, and it found itself hugely dependent on non-U.S. sources. At that level, the SPR would have been emptied within months if foreign oil became unavailable. Under Vicki Hollub’s leadership, Occidental is doing the right things for both its country and its owners. No one knows what oil prices will do over the next month, year, or decade. But Vicki does know how to separate oil from rock, and that’s an uncommon talent, valuable to her shareholders and to her country. * * * * * * * * * * * * Additionally, Berkshire continues to hold its passive and long-term interest in five very large Japanese companies, each of which operates in a highly-diversified manner somewhat similar to the way Berkshire itself is run. We increased our holdings in all five last year after Greg Abel and I made a trip to Tokyo to talk with their managements. Berkshire now owns about 9% of each of the five. (A minor point: Japanese companies calculate outstanding shares in a manner different from the practice in the U.S.) Berkshire has also pledged to each company that it will not purchase shares that will take our holdings beyond 9.9%. Our cost for the five totals ¥1.6 trillion, and the yearend market value of the five was ¥2.9 trillion. However, the yen has weakened in recent years and our yearend unrealized gain in dollars was 61% or $8 billion. Neither Greg nor I believe we can forecast market prices of major currencies. We also don’t believe we can hire anyone with this ability. Therefore, Berkshire has financed most of its Japanese position with the proceeds from ¥1.3 trillion of bonds. This debt has been very well-received in Japan, and I believe Berkshire has more yen-denominated debt outstanding than any other American company. The weakened yen has produced a yearend gain for Berkshire of $1.9 billion, a sum that, pursuant to GAAP rules, has periodically been recognized in income over the 2020-23 period. In certain important ways, all five companies – Itochu, Marubeni, Mitsubishi, Mitsui and Sumitomo – follow shareholder-friendly policies that are much superior to those customarily practiced in the U.S. Since we began our Japanese purchases, each of the five has reduced the number of its outstanding shares at attractive prices. 10 Meanwhile, the managements of all five companies have been far less aggressive about their own compensation than is typical in the United States. Note as well that each of the five is applying only about 1⁄3 of its earnings to dividends. The large sums the five retain are used both to build their many businesses and, to a lesser degree, to repurchase shares. Like Berkshire, the five companies are reluctant to issue shares. An additional benefit for Berkshire is the possibility that our investment may lead to opportunities for us to partner around the world with five large, well-managed and well-respected companies. Their interests are far more broad than ours. And, on their side, the Japanese CEOs have the comfort of knowing that Berkshire will always possess huge liquid resources that can be instantly available for such partnerships, whatever their size may be. Our Japanese purchases began on July 4, 2019. Given Berkshire’s present size, building positions through open-market purchases takes a lot of patience and an extended period of “friendly” prices. The process is like turning a battleship. That is an important disadvantage which we did not face in our early days at Berkshire.","Respond using only information contained in the context block.
+
+EVIDENCE:
+This year, I would like to describe two other investments that we expect to maintain indefinitely. Like Coke and AMEX, these commitments are not huge relative to our resources. They are worthwhile, however, and we were able to increase both positions during 2023. At yearend, Berkshire owned 27.8% of Occidental Petroleum’s common shares and also owned warrants that, for more than five years, give us the option to materially increase our ownership at a fixed price. Though we very much like our ownership, as well as the option, Berkshire has no interest in purchasing or managing Occidental. We particularly like its vast oil and gas holdings in the United States, as well as its leadership in carbon-capture initiatives, though the economic feasibility of this technique has yet to be proven. Both of these activities are very much in our country’s interest. Not so long ago, the U.S. was woefully dependent on foreign oil, and carbon capture had no meaningful constituency. Indeed, in 1975, U.S. production was eight million barrels of oil-equivalent per day (“BOEPD”), a level far short of the country’s needs. From the favorable energy position that facilitated the U.S. mobilization in World War II, the country had retreated to become heavily dependent on foreign – potentially unstable – suppliers. Further declines in oil production were predicted along with future increases in usage. 9 For a long time, the pessimism appeared to be correct, with production falling to five million BOEPD by 2007. Meanwhile, the U.S. government created a Strategic Petroleum Reserve (“SPR”) in 1975 to alleviate – though not come close to eliminating – this erosion of American self-sufficiency. And then – Hallelujah! – shale economics became feasible in 2011, and our energy dependency ended. Now, U.S. production is more than 13 million BOEPD, and OPEC no longer has the upper hand. Occidental itself has annual U.S. oil production that each year comes close to matching the entire inventory of the SPR. Our country would be very – very – nervous today if domestic production had remained at five million BOEPD, and it found itself hugely dependent on non-U.S. sources. At that level, the SPR would have been emptied within months if foreign oil became unavailable. Under Vicki Hollub’s leadership, Occidental is doing the right things for both its country and its owners. No one knows what oil prices will do over the next month, year, or decade. But Vicki does know how to separate oil from rock, and that’s an uncommon talent, valuable to her shareholders and to her country. * * * * * * * * * * * * Additionally, Berkshire continues to hold its passive and long-term interest in five very large Japanese companies, each of which operates in a highly-diversified manner somewhat similar to the way Berkshire itself is run. We increased our holdings in all five last year after Greg Abel and I made a trip to Tokyo to talk with their managements. Berkshire now owns about 9% of each of the five. (A minor point: Japanese companies calculate outstanding shares in a manner different from the practice in the U.S.) Berkshire has also pledged to each company that it will not purchase shares that will take our holdings beyond 9.9%. Our cost for the five totals ¥1.6 trillion, and the yearend market value of the five was ¥2.9 trillion. However, the yen has weakened in recent years and our yearend unrealized gain in dollars was 61% or $8 billion. Neither Greg nor I believe we can forecast market prices of major currencies. We also don’t believe we can hire anyone with this ability. Therefore, Berkshire has financed most of its Japanese position with the proceeds from ¥1.3 trillion of bonds. This debt has been very well-received in Japan, and I believe Berkshire has more yen-denominated debt outstanding than any other American company. The weakened yen has produced a yearend gain for Berkshire of $1.9 billion, a sum that, pursuant to GAAP rules, has periodically been recognized in income over the 2020-23 period. In certain important ways, all five companies – Itochu, Marubeni, Mitsubishi, Mitsui and Sumitomo – follow shareholder-friendly policies that are much superior to those customarily practiced in the U.S. Since we began our Japanese purchases, each of the five has reduced the number of its outstanding shares at attractive prices. 10 Meanwhile, the managements of all five companies have been far less aggressive about their own compensation than is typical in the United States. Note as well that each of the five is applying only about 1⁄3 of its earnings to dividends. The large sums the five retain are used both to build their many businesses and, to a lesser degree, to repurchase shares. Like Berkshire, the five companies are reluctant to issue shares. An additional benefit for Berkshire is the possibility that our investment may lead to opportunities for us to partner around the world with five large, well-managed and well-respected companies. Their interests are far more broad than ours. And, on their side, the Japanese CEOs have the comfort of knowing that Berkshire will always possess huge liquid resources that can be instantly available for such partnerships, whatever their size may be. Our Japanese purchases began on July 4, 2019. Given Berkshire’s present size, building positions through open-market purchases takes a lot of patience and an extended period of “friendly” prices. The process is like turning a battleship. That is an important disadvantage which we did not face in our early days at Berkshire.
+
+USER:
+According to the shareholder letter, what are the differences between all US and Japanese companies?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",False,9,15,918,,835
+You must not use any prior knowledge or external resources to answer this prompt. You must use only the information included in this prompt in your answer. You must use no more than 3 sentences in your answer.,What is the difference between hard information and soft information?,"Challenges and Considerations Promulgating the Final Rule The CFPB took more than a decade before promulgating the final Section 1071 rule. Evaluating the extent of lending gaps—and specifically fair lending risks—in small business credit markets has complications. Dodd-Frank directed the definition of small business, discussed in the section of this report entitled “Summary of the Section 1071 Final Rule.” Nevertheless, the CFPB’s challenge was to design a dataset with the ability to conduct meaningful comparisons across loan products and over time given the various differences in small business types and models. 7 See CFPB, “CFPB Explores Ways to Assess the Availability of Credit for Small Business,” press release, May 10, 2017, https://www.consumerfinance.gov/about-us/newsroom/cfpb-explores-ways-assess-availability-credit-small- business/. 8 For more information, see Federal Financial Institutions Examination Council, Interagency Fair Lending Examination Procedures, August 2009, https://www.ffiec.gov/pdf/fairlend.pdf. 9 See CFPB, “Small Business Lending under the Equal Credit Opportunity Act (Regulation B),” March 30, 2023, https://www.consumerfinance.gov/rules-policy/final-rules/small-business-lending-under-the-equal-credit-opportunity- act-regulation-b/. Congressional Research Service 2 Section 1071: Small Business Lending Data Collection and Reporting Multiple Small Business Definitions No consensus definition of small business exists among the federal government and industry participants. Consequently, establishing a universal dataset to evaluate the performance of small business lending markets is challenging. Definitions of small business include the following: • The SBA defines small business primarily by using a size standards table it compiles and updates periodically. The table lists size thresholds for various industries by either average annual receipts or number of employees.10 The SBA also defines small business differently for different SBA programs. For example, the SBA’s 7(a), Certified Development Company/504, and Small Business Investment Company (SBIC) programs have alternative size standards based on tangible net worth and average net income.11 • Academic research frequently uses a firm that has 500 employees or fewer (but does not monopolize an industry) as a proxy measure for a small business. Various federal agencies—such as the U.S. Census Bureau, the Bureau of Labor Statistics, and the Federal Reserve—have relied upon this definition.12 In addition, some researchers view microbusinesses as a subset of small businesses. A common academic definition of microbusiness is a firm with only one owner, five employees or fewer, and annual sales and assets under $250,000.13 • Definitions of small business also vary in statute. For example, eligibility thresholds for “small business” tax incentives vary under tax law. Certain firms with average annual gross receipts of $25 million or less are able to use cash-based accounting for tax purposes. The tax credit for employee health insurance costs is available to employers with 25 or fewer employees whose average annual compensation is below a certain wage threshold.14 • According to a Federal Deposit Insurance Corporation survey, small and large banks have their own definitions of small business.15 Small banks (defined as banks with $10 billion or less in assets) often view a small business as one in which the owner “wears many hats,” referring to an owner who performs multiple tasks, perhaps because the firm is starting up or still in its early growth stage. Large banks define small business more formally in terms of annual revenues and sales. • Likewise, the definition of small farm varies. For example, the Farm Credit System and parts of the U.S. Department of Agriculture (USDA) each define small farm or ranch as one with gross annual sales of less than $250,000. The USDA Economic Research Service, for statistical purposes, defines small farm as one having less than $350,000 of gross cash farm income. SBA defines small farms as those having less than $5 million in annual sales. The CRA definition of small farm loan is $500,000 or less. The Small Business Regulatory Enforcement Fairness Act of 1996 (P.L. 104-121) also requires the CFPB to address issues that could potentially have significant economic impacts on small entities subject to the Section 1071 rule.16 The CFPB had to consider, for example, key 10 For the current size standards, see SBA, “Table of Size Standards,” https://www.sba.gov/document/support-table- size-standards. For a historical analysis of the size standards, see CRS Report R40860, Small Business Size Standards: A Historical Analysis of Contemporary Issues, by Robert Jay Dilger, R. Corinne Blackford, and Anthony A. Cilluffo. 11 See SBA, “Lender and Development Company Loan Programs,” SOP 50 10 6, October 1, 2020, pp. 118-119. 12 See Karen Gordon Mills and Brayden McCarthy, The State of Small Business Lending: Innovation and Technology and the Implications for Regulation, Harvard Business School Entrepreneurial Management Working Paper no. 17-042, November 29, 2016. 13 See Tammie Hoy, Jessie Romero, and Kimberly Zeuli, Microenterprise and the Small-Dollar Loan Market, Federal Reserve Bank of Richmond, May 2012, https://www.richmondfed.org/-/media/richmondfedorg/publications/research/ economic_brief/2012/pdf/eb_12-05.pdf. 14 See CRS Report RL32254, Small Business Tax Benefits: Current Law, by Gary Guenther. 15 See Federal Deposit Insurance Corporation (FDIC), 2018 FDIC Small Business Lending Survey, revised December 20, 2018, https://www.fdic.gov/bank/historical/sbls/full-survey.pdf. 16 See CFPB, Final Report of the Small Business Review Panel on the CFPB’s Proposals Under Consideration for the Small Business Lending Data Collection Rulemaking, December 14, 2020, https://files.consumerfinance.gov/f/ documents/cfpb_1071-sbrefa-report.pdf. Congressional Research Service 3 Section 1071: Small Business Lending Data Collection and Reporting differences in the lending models of large and small lenders, which affect the type and cost of data that would be collected.17 First, large and small lenders often collect different types of data. Large lenders typically engage in lending to borrowers who possess more conventional financial metrics and documentation (e.g., sales fluctuations, costs of inputs, specific industry factors), which is considered hard information that can be used in automated and statistical underwriting methodologies to price loans.18 By contrast, small lenders typically engage in relationship lending, meaning that they must develop close familiarity with their customers to gather soft information, which contains circumstantial details about factors such as non-standardized business risks, insufficient collateral, or weak or thin (business) credit histories. Because of soft information, the loan underwriting process to determine more customized loan products and loan pricing is generally less algorithmic and more labor intensive.19 Second, the type of information collected, which varies among lenders, would also be expected to influence their reporting costs. For example, because hard information is already quite uniform, large lenders may already have adopted automated technological systems that can handle large volumes of standardized and digitized financial data. In these cases, reporting is likely to be less expensive per applicant. By contrast, soft information is more unique to applicant circumstances, infrequent, and localized such that standardization of the data for electronic collection and reporting purposes is challenging. The reporting cost per applicant is also likely to be more expensive for small lenders that lack the volume of applications to justify the costs to convert soft information to digital and secure formats. Therefore, data likely to be informative about lending gaps in the small business and farm credit markets may be more difficult to standardize and more costly to collect, especially if small lenders predominantly serve these markets. The CFPB also had to consider how Section 1071 implementation requirements might affect the supply of small business loans. For example, some institutions might decide to offer more standardized, less tailored financial products to reduce their reporting costs. Some lenders might require minimum principal loan amounts (e.g., $100,000) to ensure that the loans generate enough revenue to cover the costs to fund and report data, thereby leaving gaps in credit markets for many businesses that are starting up or small. In short, Section 1071 implementation, which is designed to identify any lending gaps, could potentially exacerbate lending gaps in various credit market segments without careful consideration of the potential impact of its requirements.","Challenges and Considerations Promulgating the Final Rule The CFPB took more than a decade before promulgating the final Section 1071 rule. Evaluating the extent of lending gaps—and specifically fair lending risks—in small business credit markets has complications. Dodd-Frank directed the definition of small business, discussed in the section of this report entitled “Summary of the Section 1071 Final Rule.” Nevertheless, the CFPB’s challenge was to design a dataset with the ability to conduct meaningful comparisons across loan products and over time given the various differences in small business types and models. 7 See CFPB, “CFPB Explores Ways to Assess the Availability of Credit for Small Business,” press release, May 10, 2017, https://www.consumerfinance.gov/about-us/newsroom/cfpb-explores-ways-assess-availability-credit-small- business/. 8 For more information, see Federal Financial Institutions Examination Council, Interagency Fair Lending Examination Procedures, August 2009, https://www.ffiec.gov/pdf/fairlend.pdf. 9 See CFPB, “Small Business Lending under the Equal Credit Opportunity Act (Regulation B),” March 30, 2023, https://www.consumerfinance.gov/rules-policy/final-rules/small-business-lending-under-the-equal-credit-opportunity- act-regulation-b/. Congressional Research Service 2 Section 1071: Small Business Lending Data Collection and Reporting Multiple Small Business Definitions No consensus definition of small business exists among the federal government and industry participants. Consequently, establishing a universal dataset to evaluate the performance of small business lending markets is challenging. Definitions of small business include the following: • The SBA defines small business primarily by using a size standards table it compiles and updates periodically. The table lists size thresholds for various industries by either average annual receipts or number of employees.10 The SBA also defines small business differently for different SBA programs. For example, the SBA’s 7(a), Certified Development Company/504, and Small Business Investment Company (SBIC) programs have alternative size standards based on tangible net worth and average net income.11 • Academic research frequently uses a firm that has 500 employees or fewer (but does not monopolize an industry) as a proxy measure for a small business. Various federal agencies—such as the U.S. Census Bureau, the Bureau of Labor Statistics, and the Federal Reserve—have relied upon this definition.12 In addition, some researchers view microbusinesses as a subset of small businesses. A common academic definition of microbusiness is a firm with only one owner, five employees or fewer, and annual sales and assets under $250,000.13 • Definitions of small business also vary in statute. For example, eligibility thresholds for “small business” tax incentives vary under tax law. Certain firms with average annual gross receipts of $25 million or less are able to use cash-based accounting for tax purposes. The tax credit for employee health insurance costs is available to employers with 25 or fewer employees whose average annual compensation is below a certain wage threshold.14 • According to a Federal Deposit Insurance Corporation survey, small and large banks have their own definitions of small business.15 Small banks (defined as banks with $10 billion or less in assets) often view a small business as one in which the owner “wears many hats,” referring to an owner who performs multiple tasks, perhaps because the firm is starting up or still in its early growth stage. Large banks define small business more formally in terms of annual revenues and sales. • Likewise, the definition of small farm varies. For example, the Farm Credit System and parts of the U.S. Department of Agriculture (USDA) each define small farm or ranch as one with gross annual sales of less than $250,000. The USDA Economic Research Service, for statistical purposes, defines small farm as one having less than $350,000 of gross cash farm income. SBA defines small farms as those having less than $5 million in annual sales. The CRA definition of small farm loan is $500,000 or less. The Small Business Regulatory Enforcement Fairness Act of 1996 (P.L. 104-121) also requires the CFPB to address issues that could potentially have significant economic impacts on small entities subject to the Section 1071 rule.16 The CFPB had to consider, for example, key 10 For the current size standards, see SBA, “Table of Size Standards,” https://www.sba.gov/document/support-table- size-standards. For a historical analysis of the size standards, see CRS Report R40860, Small Business Size Standards: A Historical Analysis of Contemporary Issues, by Robert Jay Dilger, R. Corinne Blackford, and Anthony A. Cilluffo. 11 See SBA, “Lender and Development Company Loan Programs,” SOP 50 10 6, October 1, 2020, pp. 118-119. 12 See Karen Gordon Mills and Brayden McCarthy, The State of Small Business Lending: Innovation and Technology and the Implications for Regulation, Harvard Business School Entrepreneurial Management Working Paper no. 17-042, November 29, 2016. 13 See Tammie Hoy, Jessie Romero, and Kimberly Zeuli, Microenterprise and the Small-Dollar Loan Market, Federal Reserve Bank of Richmond, May 2012, https://www.richmondfed.org/-/media/richmondfedorg/publications/research/ economic_brief/2012/pdf/eb_12-05.pdf. 14 See CRS Report RL32254, Small Business Tax Benefits: Current Law, by Gary Guenther. 15 See Federal Deposit Insurance Corporation (FDIC), 2018 FDIC Small Business Lending Survey, revised December 20, 2018, https://www.fdic.gov/bank/historical/sbls/full-survey.pdf. 16 See CFPB, Final Report of the Small Business Review Panel on the CFPB’s Proposals Under Consideration for the Small Business Lending Data Collection Rulemaking, December 14, 2020, https://files.consumerfinance.gov/f/ documents/cfpb_1071-sbrefa-report.pdf. Congressional Research Service 3 Section 1071: Small Business Lending Data Collection and Reporting differences in the lending models of large and small lenders, which affect the type and cost of data that would be collected.17 First, large and small lenders often collect different types of data. Large lenders typically engage in lending to borrowers who possess more conventional financial metrics and documentation (e.g., sales fluctuations, costs of inputs, specific industry factors), which is considered hard information that can be used in automated and statistical underwriting methodologies to price loans.18 By contrast, small lenders typically engage in relationship lending, meaning that they must develop close familiarity with their customers to gather soft information, which contains circumstantial details about factors such as non-standardized business risks, insufficient collateral, or weak or thin (business) credit histories. Because of soft information, the loan underwriting process to determine more customized loan products and loan pricing is generally less algorithmic and more labor intensive.19 Second, the type of information collected, which varies among lenders, would also be expected to influence their reporting costs. For example, because hard information is already quite uniform, large lenders may already have adopted automated technological systems that can handle large volumes of standardized and digitized financial data. In these cases, reporting is likely to be less expensive per applicant. By contrast, soft information is more unique to applicant circumstances, infrequent, and localized such that standardization of the data for electronic collection and reporting purposes is challenging. The reporting cost per applicant is also likely to be more expensive for small lenders that lack the volume of applications to justify the costs to convert soft information to digital and secure formats. Therefore, data likely to be informative about lending gaps in the small business and farm credit markets may be more difficult to standardize and more costly to collect, especially if small lenders predominantly serve these markets. The CFPB also had to consider how Section 1071 implementation requirements might affect the supply of small business loans. For example, some institutions might decide to offer more standardized, less tailored financial products to reduce their reporting costs. Some lenders might require minimum principal loan amounts (e.g., $100,000) to ensure that the loans generate enough revenue to cover the costs to fund and report data, thereby leaving gaps in credit markets for many businesses that are starting up or small. In short, Section 1071 implementation, which is designed to identify any lending gaps, could potentially exacerbate lending gaps in various credit market segments without careful consideration of the potential impact of its requirements. What is the difference between hard information and soft information? You must not use any prior knowledge or external resources to answer this prompt. You must use only the information included in this prompt in your answer. You must use no more than 3 sentences in your answer.","You must not use any prior knowledge or external resources to answer this prompt. You must use only the information included in this prompt in your answer. You must use no more than 3 sentences in your answer.
+
+EVIDENCE:
+Challenges and Considerations Promulgating the Final Rule The CFPB took more than a decade before promulgating the final Section 1071 rule. Evaluating the extent of lending gaps—and specifically fair lending risks—in small business credit markets has complications. Dodd-Frank directed the definition of small business, discussed in the section of this report entitled “Summary of the Section 1071 Final Rule.” Nevertheless, the CFPB’s challenge was to design a dataset with the ability to conduct meaningful comparisons across loan products and over time given the various differences in small business types and models. 7 See CFPB, “CFPB Explores Ways to Assess the Availability of Credit for Small Business,” press release, May 10, 2017, https://www.consumerfinance.gov/about-us/newsroom/cfpb-explores-ways-assess-availability-credit-small- business/. 8 For more information, see Federal Financial Institutions Examination Council, Interagency Fair Lending Examination Procedures, August 2009, https://www.ffiec.gov/pdf/fairlend.pdf. 9 See CFPB, “Small Business Lending under the Equal Credit Opportunity Act (Regulation B),” March 30, 2023, https://www.consumerfinance.gov/rules-policy/final-rules/small-business-lending-under-the-equal-credit-opportunity- act-regulation-b/. Congressional Research Service 2 Section 1071: Small Business Lending Data Collection and Reporting Multiple Small Business Definitions No consensus definition of small business exists among the federal government and industry participants. Consequently, establishing a universal dataset to evaluate the performance of small business lending markets is challenging. Definitions of small business include the following: • The SBA defines small business primarily by using a size standards table it compiles and updates periodically. The table lists size thresholds for various industries by either average annual receipts or number of employees.10 The SBA also defines small business differently for different SBA programs. For example, the SBA’s 7(a), Certified Development Company/504, and Small Business Investment Company (SBIC) programs have alternative size standards based on tangible net worth and average net income.11 • Academic research frequently uses a firm that has 500 employees or fewer (but does not monopolize an industry) as a proxy measure for a small business. Various federal agencies—such as the U.S. Census Bureau, the Bureau of Labor Statistics, and the Federal Reserve—have relied upon this definition.12 In addition, some researchers view microbusinesses as a subset of small businesses. A common academic definition of microbusiness is a firm with only one owner, five employees or fewer, and annual sales and assets under $250,000.13 • Definitions of small business also vary in statute. For example, eligibility thresholds for “small business” tax incentives vary under tax law. Certain firms with average annual gross receipts of $25 million or less are able to use cash-based accounting for tax purposes. The tax credit for employee health insurance costs is available to employers with 25 or fewer employees whose average annual compensation is below a certain wage threshold.14 • According to a Federal Deposit Insurance Corporation survey, small and large banks have their own definitions of small business.15 Small banks (defined as banks with $10 billion or less in assets) often view a small business as one in which the owner “wears many hats,” referring to an owner who performs multiple tasks, perhaps because the firm is starting up or still in its early growth stage. Large banks define small business more formally in terms of annual revenues and sales. • Likewise, the definition of small farm varies. For example, the Farm Credit System and parts of the U.S. Department of Agriculture (USDA) each define small farm or ranch as one with gross annual sales of less than $250,000. The USDA Economic Research Service, for statistical purposes, defines small farm as one having less than $350,000 of gross cash farm income. SBA defines small farms as those having less than $5 million in annual sales. The CRA definition of small farm loan is $500,000 or less. The Small Business Regulatory Enforcement Fairness Act of 1996 (P.L. 104-121) also requires the CFPB to address issues that could potentially have significant economic impacts on small entities subject to the Section 1071 rule.16 The CFPB had to consider, for example, key 10 For the current size standards, see SBA, “Table of Size Standards,” https://www.sba.gov/document/support-table- size-standards. For a historical analysis of the size standards, see CRS Report R40860, Small Business Size Standards: A Historical Analysis of Contemporary Issues, by Robert Jay Dilger, R. Corinne Blackford, and Anthony A. Cilluffo. 11 See SBA, “Lender and Development Company Loan Programs,” SOP 50 10 6, October 1, 2020, pp. 118-119. 12 See Karen Gordon Mills and Brayden McCarthy, The State of Small Business Lending: Innovation and Technology and the Implications for Regulation, Harvard Business School Entrepreneurial Management Working Paper no. 17-042, November 29, 2016. 13 See Tammie Hoy, Jessie Romero, and Kimberly Zeuli, Microenterprise and the Small-Dollar Loan Market, Federal Reserve Bank of Richmond, May 2012, https://www.richmondfed.org/-/media/richmondfedorg/publications/research/ economic_brief/2012/pdf/eb_12-05.pdf. 14 See CRS Report RL32254, Small Business Tax Benefits: Current Law, by Gary Guenther. 15 See Federal Deposit Insurance Corporation (FDIC), 2018 FDIC Small Business Lending Survey, revised December 20, 2018, https://www.fdic.gov/bank/historical/sbls/full-survey.pdf. 16 See CFPB, Final Report of the Small Business Review Panel on the CFPB’s Proposals Under Consideration for the Small Business Lending Data Collection Rulemaking, December 14, 2020, https://files.consumerfinance.gov/f/ documents/cfpb_1071-sbrefa-report.pdf. Congressional Research Service 3 Section 1071: Small Business Lending Data Collection and Reporting differences in the lending models of large and small lenders, which affect the type and cost of data that would be collected.17 First, large and small lenders often collect different types of data. Large lenders typically engage in lending to borrowers who possess more conventional financial metrics and documentation (e.g., sales fluctuations, costs of inputs, specific industry factors), which is considered hard information that can be used in automated and statistical underwriting methodologies to price loans.18 By contrast, small lenders typically engage in relationship lending, meaning that they must develop close familiarity with their customers to gather soft information, which contains circumstantial details about factors such as non-standardized business risks, insufficient collateral, or weak or thin (business) credit histories. Because of soft information, the loan underwriting process to determine more customized loan products and loan pricing is generally less algorithmic and more labor intensive.19 Second, the type of information collected, which varies among lenders, would also be expected to influence their reporting costs. For example, because hard information is already quite uniform, large lenders may already have adopted automated technological systems that can handle large volumes of standardized and digitized financial data. In these cases, reporting is likely to be less expensive per applicant. By contrast, soft information is more unique to applicant circumstances, infrequent, and localized such that standardization of the data for electronic collection and reporting purposes is challenging. The reporting cost per applicant is also likely to be more expensive for small lenders that lack the volume of applications to justify the costs to convert soft information to digital and secure formats. Therefore, data likely to be informative about lending gaps in the small business and farm credit markets may be more difficult to standardize and more costly to collect, especially if small lenders predominantly serve these markets. The CFPB also had to consider how Section 1071 implementation requirements might affect the supply of small business loans. For example, some institutions might decide to offer more standardized, less tailored financial products to reduce their reporting costs. Some lenders might require minimum principal loan amounts (e.g., $100,000) to ensure that the loans generate enough revenue to cover the costs to fund and report data, thereby leaving gaps in credit markets for many businesses that are starting up or small. In short, Section 1071 implementation, which is designed to identify any lending gaps, could potentially exacerbate lending gaps in various credit market segments without careful consideration of the potential impact of its requirements.
+
+USER:
+What is the difference between hard information and soft information?
+
+Assistant: Answer *only* using the evidence. If unknown, say you cannot answer. Cite sources.",True,38,10,1254,,77